Safety of exercise training in multiple sclerosis: a protocol for an updated systematic review and meta-analysis.

BACKGROUND: There has been an exponential growth in the number of clinical research studies regarding exercise training in multiple sclerosis, and literature reviews and meta-analyses have documented the many benefits of exercise training. This research further requires careful review for documenting the safety of exercise training in multiple sclerosis, as clarity on safety represents a major hurdle in the clinical prescription of exercise behaviour. OBJECTIVES: To enhance understanding of the feasibility of exercise in multiple sclerosis, we (1) provide a protocol of a systematic review and meta-analysis that summarises rates and risks of clinical relapse, adverse events (i.e., an unfavourable outcome that occurs during the intervention delivery time period), and serious adverse events (i.e., an untoward occurrence that results in death or is life threatening, requires hospitalisation, or results in disability during the intervention delivery time period), as well as retention, adherence, and compliance, from randomised controlled trials of exercise training in persons with multiple sclerosis; and (2) identify moderators of relapse, adverse events, and serious adverse event rates. METHODS: Eight field-relevant databases will be searched electronically. Studies that involve a randomised controlled trial of exercise training (with non-exercise, non-pharmacological, comparator), report on safety outcomes, and include adults with multiple sclerosis will be included. Rates and relative risks of the three primary outcomes (relapse, adverse event, and serious adverse event) will be calculated and reported each with standard error and 95% confidence interval. Random-effects meta-analysis will estimate mean population relative risk for outcomes. Potential sources of variability, including participant characteristics, features of the exercise stimulus, and comparison condition, will be examined with random-effects meta-regression with maximum likelihood estimation. DISCUSSION: The results from this systematic review and meta-analysis will inform and guide healthcare practitioners, researchers, and policymakers on the safety of exercise training in persons with multiple sclerosis. Where possible, we will identify the impact of exercise type, exercise delivery style, participant disability level, and the prescription of exercise guidelines, on the safety of exercise training. The result will identify critical information on the safety of exercise in persons with multiple sclerosis, while also identifying gaps in research and setting priorities for future enquiries. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2020 CRD42020190544.

Physical activity correlates among older adults with probable generalized anxiety disorder: Results from The Irish Longitudinal Study on Ageing.

OBJECTIVES: This study assessed physical activity (PA) correlates among 1237 (69.0% female; age ≥ 50 years) community-dwelling adults with probable-generalized anxiety disorder (GAD). METHODS: Wave 1 data from The Irish Longitudinal Study on Ageing were analysed. PA was measured using the short-form International PA Questionnaire. Probable-GAD caseness was indicated by a score of ≥23 on the abbreviated Penn State Worry Questionnaire. Potential correlates were analysed using binomial logistic regression. Hierarchical logistic regression consisting of three blocks (sociodemographic variables; quality of life (QoL) variables; physical health and performance variables) examined the proportion of the variance for PA that was explained at each step of the regression model. RESULTS: Five hundred thirty-five participants (43.2%) met PA guidelines. After adjustment for age and sex, younger age and being male were associated with increased likelihood of meeting PA guidelines. Significant correlates of PA were in employment, higher QoL (CASP-19), social connectedness, and grip-strength. Additionally, polypharmacy (i.e., taking ≥five medications), antidepressant use, at-risk waist circumference (i.e., Males: >94 cm; Females >80 cm), up-and-go time, and number of self-reported physical limitations were significantly negatively associated with meeting PA guidelines. Physical health and performance variables explained significant variation (8.4%) in meeting physical activity guidelines beyond that of sociodemographics, and QoL variables. CONCLUSIONS: This study identified a range of sociodemographic, physical, and psychological variables that were associated with meeting or not meeting PA guidelines among older adults with probable-GAD.

Associations of physical activity with anxiety symptoms and status: results from The Irish longitudinal study on ageing.

AIMS: Anxiety is debilitating and associated with numerous mental and physical comorbidities. There is a need to identify and investigate low-risk prevention and treatment strategies. Therefore, the purpose of this study was to investigate cross-sectional and longitudinal associations between different volumes of moderate-to-vigorous physical activity (PA) and anxiety symptoms and status among older adults in Ireland. METHODS: Participants (n = 4175; 56.8% female) aged ⩾50 years completed the International PA Questionnaire (IPAQ) at baseline, and the anxiety subscale of the Hospital Anxiety and Depression Scale at baseline and follow-up (2009-2013). Participants were classified according to meeting World Health Organisation PA guidelines, and divided into IPAQ categories. Respondents without anxiety at baseline (n = 3165) were included in prospective analyses. Data were analysed in 2017. RESULTS: Anxiety symptoms were significantly higher among females than males (p < 0.001). Models were adjusted for age, sex, waist circumference, social class, smoking status and pain. In cross-sectional analyses, meeting PA guidelines was associated with 9.3% (OR = 0.91, 95% confidence interval 0.78-1.06) lower odds of anxiety. Compared with the inactive group, the minimally- and very-active groups were associated with 8.4% (OR = 0.92, 0.76-1.10) and 18.8% (OR = 0.81, 0.67-0.98) lower odds of anxiety, respectively. In prospective analyses, meeting guidelines was associated with 6.3% (OR = 0.94, 0.63-1.40) reduced odds of anxiety. Compared with the inactive group, the minimally and very-active groups were associated with 43.5% (OR = 1.44, 0.89-2.32) increased, and 4.3% (OR = 0.96, 0.56-1.63) reduced odds of anxiety. The presence of pain, included in models as a covariate, was associated with a 108.7% (OR = 2.09, 1.80-2.42) increase in odds of prevalent anxiety, and a 109.7% (OR = 2.10, 1.41-3.11) increase in odds of incident anxiety. CONCLUSION: High volumes of PA are cross-sectionally associated with lower anxiety symptoms and status, with a potential dose-response apparent. However, significant associations were not observed in prospective analyses. The low absolute number of incident anxiety cases (n = 109) potentially influenced these findings. Further, as older adults may tend to experience and/or report more somatic anxiety symptoms, and the HADS focuses primarily on cognitive symptoms, it is plausible that the HADS was not an optimal measure of anxiety symptoms in the current population.

Associations of physical activity and depression: Results from the Irish Longitudinal Study on Ageing.

Physical activity (PA) can protect against depression, but few studies have assessed whether meeting PA guidelines is sufficient, or if benefits can be derived from greater volumes of PA. The present study examines cross-sectional and prospective associations between different volumes of moderate-to-vigorous PA (MVPA) and walking, and depressive symptoms and status. Participants (n = 4556; 56.7% female) aged ≥ 50 years completed the International PA Questionnaire (IPAQ) at baseline and the Center for Epidemiological Studies Depression Scale at baseline and two years later. Prevalence and incidence of depression were 9.0% (n = 410) and 5.0% (n = 207), respectively. After full adjustment, odds of prevalent depression were: 40% (OR = 0.60, 95%CI: 0.48-0.76) lower among those meeting PA guidelines; 23% (OR = 0.77, 0.49-1.21) and 43% (OR = 0.57, 0.45-0.73) lower among those in moderate and high categories, respectively; and, 22% (OR = 0.78, 0.61-1.01) and 44.0% (OR = 0.56, 0.42-0.74) lower among those in moderate and high walking tertiles, respectively. Odds of incident depression were: 23% (OR = 0.77, 0.58-1.04) lower among those meeting PA guidelines; 37% (OR = 0.63, 0.32-1.22) and 20.0% (OR = 0.80, 0.59-1.09) lower among those in moderate and high categories, respectively; and, 21% (OR = 0.79, 0.56-1.12) and 25% (OR = 0.75, 0.52-1.07) lower among those in moderate and high walking tertiles, respectively. Moderate and high volumes of MVPA were significantly associated with lower odds of concurrent depression, and significantly and non-significantly associated with reduced odds of incident depression, respectively. Meeting recommended levels of MVPA and walking were associated with significantly lower odds of concurrent depression, and non-significantly reduced odds of the development of depression over two years.

Incidence and outcomes of sepsis after cardiac surgery as defined by the Sepsis-3 guidelines.

BACKGROUND: The Sepsis-3 guidelines diagnose sepsis based on organ dysfunction in patients with either proven or suspected infection. The objective of this study was to assess the incidence and outcomes of sepsis diagnosed using these guidelines in patients in a cardiac intensive care unit (CICU) after cardiac surgery. METHODS: Daily sequential organ failure assessment (SOFA) scores were calculated for 2230 consecutive adult cardiac surgery patients between January 2013 and May 2015. Patients with an increase in SOFA score of ≥2 and suspected or proven infection were identified. The length of CICU stay, 30-day mortality and 2-yr survival were compared between groups. Multivariable linear regression, multivariable logistic regression, and Cox proportional hazards regression were used to adjust for possible confounders. RESULTS: Sepsis with suspected or proven infection was diagnosed in 104 (4.7%) and 107 (4.8%) patients, respectively. After adjustment for confounding variables, sepsis with suspected infection was associated with an increased length of CICU stay of 134.1h (95% confidence interval (CI) 99.0-168.2, P<0.01) and increased 30-day mortality risk (odds ratio 3.7, 95% CI 1.1-10.2, P=0.02). Sepsis with proven infection was associated with an increased length of CICU stay of 266.1h (95% CI 231.6-300.7, P<0.01) and increased 30-day mortality risk (odds ratio 6.6, 95% CI 2.6-15.7, P<0.01). CONCLUSIONS: Approximately half of sepsis diagnoses were based on proven infection and half on suspected infection. Patients diagnosed with sepsis using the Sepsis-3 guidelines have significantly worse outcomes after cardiac surgery. The Sepsis-3 guidelines are a potentially useful tool in the management of sepsis following cardiac surgery.

The cross-sectional associations between objectively measured sedentary time and cardiometabolic health markers in adults - a systematic review with meta-analysis component.

Sedentary time is viewed as an independent risk factor for adverse cardiometabolic health (CMH). No systematic review and meta-analysis on the cross-sectional associations between objectively measured sedentary time and CMH markers has been conducted. PubMed, Scopus and Web of Science Core Collection were searched for papers that examined the cross-sectional association between objectively measured sedentary time and CMH markers in adults. Forty-six papers met the inclusion criteria. The included papers had a combined sample size of 70,576 and an age range of 18-87 years. To examine the effect of increased levels of sedentary time on CMH markers, data on effect sizes and moderators were extracted, where possible. By pooling the unadjusted data from the included papers, increased sedentary time was shown to have a significant detrimental association with fasting glucose (Δ = 0.12, 95% confidence interval [CI]: 0.02, 0.23), fasting insulin (Δ = 0.19, 95% CI: 0.06, 0.32), triglycerides (Δ = 0.25, 95% CI: 0.14, 0.37), high-density lipoprotein cholesterol (Δ = -0.20, 95% CI: -0.28, -0.13) and waist circumference (Δ = 0.25, 95% CI: 0.15, 0.35). How sedentary time was quantified and the device used to measure sedentary time significantly influence the size of the effect reported. Future interventions focused on both decreasing sedentary time and increasing physical activity may be the most effective strategy to improve CMH.

Sedentary behavior and anxiety: Association and influential factors among 42,469 community-dwelling adults in six low- and middle-income countries.

OBJECTIVE: This study investigated the association between sedentary behavior (SB) and anxiety, and explored factors that influence this relationship in six low- and middle-income countries. METHOD: Cross-sectional data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. Multivariable linear and logistic regression analyses were conducted to assess the association between anxiety and self-reported SB. Potentially influential factors were examined with mediation analysis. RESULTS: The sample consisted of 42,469 adults aged≥18years (50.1% female; mean age 43.8years). After adjusting for sociodemographics and country, people with anxiety engaged in 24 (95%CI=7-41) more minutes per day of SB than non-anxious individuals; the corresponding figure for the elderly (≥65years) was much higher (55min; 95% CI=29-81). Anxiety was associated with a 2.0 (95%CI=1.5-2.7) times higher odds for high SB (i.e., ≥8h/day). Overall, the largest proportion of the high SB-anxiety relationship was explained by mobility limitations (46.8%), followed by impairments in sleep/energy (44.9%), pain/discomfort (31.7%), disability (27.0%), cognition (13.3%), and physical activity levels (6.3%). CONCLUSIONS: Anxiety was significantly associated with high SB, particularly among older adults. Future longitudinal studies are warranted to disentangle the potentially complex interplay of factors that may influence the anxiety-SB relationship.

Eating and arterial endothelial function: a meta-analysis of the acute effects of meal consumption on flow-mediated dilation.

Given that endothelial dysfunction precedes atherosclerotic cardiovascular disease, exploring the parameters that modify postprandial flow-mediated dilation (FMD) is important for public health. The objectives of the study are to estimate the population effect of meal ingestion on FMD and to determine how the effect varied based on patient characteristics and modifiable methodological features. Articles published before June 2015 were located using MEDLINE, PubMed and Web of Science. One hundred fifty-four effects were derived from 78 articles involving 2,548 subjects were selected. Included articles required measurement of FMD in adults before and after meal ingestion. Effects were analysed using an unstandardized mean gain random effects model, and significant moderators were analysed using meta-regression. Meal consumption significantly reduced FMD by a heterogeneous mean effect size delta (Δ) of -2.03 (95% CI: [-2.28, -1.77]), an ~2% reduction in FMD. FMD reductions were larger among normal weight individuals, males, those with a cardio-metabolic disorder, those with elevated baseline FMD, and individuals with impaired glucose tolerance at baseline. Macronutrient meal ingestion significantly reduced FMD, an effect that was moderated by body mass index, sex and two-way interactions between disease status and both baseline FMD and baseline blood glucose levels.

Early life exposure to allergen and ozone results in altered development in adolescent rhesus macaque lungs.

In rhesus macaques, previous studies have shown that episodic exposure to allergen alone or combined with ozone inhalation during the first 6 months of life results in a condition with many of the hallmarks of asthma. This exposure regimen results in altered development of the distal airways and parenchyma (Avdalovic et al., 2012). We hypothesized that the observed alterations in the lung parenchyma would be permanent following a long-term recovery in filtered air (FA) housing. Forty-eight infant rhesus macaques (30 days old) sensitized to house dust mite (HDM) were treated with two week cycles of FA, house dust mite allergen (HDMA), ozone (O3) or HDMA/ozone (HDMA+O3) for five months. At the end of the five months, six animals from each group were necropsied. The other six animals in each group were allowed to recover in FA for 30 more months at which time they were necropsied. Design-based stereology was used to estimate volumes of lung components, number of alveoli, size of alveoli, distribution of alveolar volumes, interalveolar capillary density. After 30 months of recovery, monkeys exposed to HDMA, in either group, had significantly more alveoli than filtered air. These alveoli also had higher capillary densities as compared with FA controls. These results indicate that early life exposure to HDMA alone or HDMA+O3 alters the development process in the lung alveoli.

Genetic factors in exercise adoption, adherence and obesity.

Physical activity and exercise play critical roles in energy balance. While many interventions targeted at increasing physical activity have demonstrated efficacy in promoting weight loss or maintenance in the short term, long term adherence to such programmes is not frequently observed. Numerous factors have been examined for their ability to predict and/or influence physical activity and exercise adherence. Although physical activity has been demonstrated to have a strong genetic component in both animals and humans, few studies have examined the association between genetic variation and exercise adherence. In this review, we provide a detailed overview of the non-genetic and genetic predictors of physical activity and adherence to exercise. In addition, we report the results of analysis of 26 single nucleotide polymorphisms in six candidate genes examined for association to exercise adherence, duration, intensity and total exercise dose in young adults from the Training Interventions and Genetics of Exercise Response (TIGER) Study. Based on both animal and human research, neural signalling and pleasure/reward systems in the brain may drive in large part the propensity to be physically active and to adhere to an exercise programme. Adherence/compliance research in other fields may inform future investigation of the genetics of exercise adherence.

Fe2O3 nanoparticle mediated molecular growth and soot inception from the oxidative pyrolysis of 1-methylnaphthalene.

While it is well documented iron oxide can reduce soot through burnout in the oxidative regions of flames, it may also impact molecular growth and particle inception. The role of Fe2O3 nanoparticles in mass growth of soot from 1-methylnapthalene (1-MN) was studied in a dual-zone, high-temperature flow reactor. An iron substituted, dendrimer template was oxidized in the first zone to generate ~5 nm Fe2O3 nanoparticles, which were seeded into the second zone of the flow reactor containing 1-MN at 1100°C and ϕ = 1.4-5.0. Enhanced molecular growth in the presence of Fe2O3 nanoparticles resulted in increased yields of polycyclic aromatic hydrocarbons (PAH) and soot compared to purely gas-phase reactions of 1-MN at identical fuel-air equivalence ratios. This also resulted in an increase in soot-number concentration and a slight shift to smaller particles with increasing addition (from no addition to 3 mM) of Fe2O3. Introduction of Fe2O3 nanoparticles resulted in the formation of stabilization of environmentally persistent free radicals (EPFRs), including benzyl, phenoxyl, or semiquinone-type radicals as well as carbon-centered radicals, such as cyclopentadienyl or a delocalized electron in a carbon matrix. At the high concentrations in the flow reactor, these resonance-stabilized free radicals can undergo surface-mediated, radical-radical, molecular growth reactions which may contribute to molecular growth and soot particle inception.

Coregulation of balance between children's prosocial approaches and acts of compliance: a pathway to mother-child cooperation?

Examined the free-field interaction of 32 mother-child dyads who volunteered to participate in a 1-hr home observation. Observers coded mother instructions, child compliance, and child prosocial approaches plus mothers' social attention as potential reinforcers for the children's compliance and social approaches. Herrnstein's matching law was used to analyze covariations between mothers' attention and the children's 2 responses. This analysis was followed by correlational and sequential probability analyses to determine linkages between these 2 child responses and the children's willingness to obey their mothers' instructions. Results showed consistent matching between mothers' social attention and the children's production of prosocial approaches and acts of compliance. An index of the proportions of these 2 responses also covaried with the children's compliance probabilities, and the prosocial approach component was the direct covariate. These findings are discussed within an interactional synchrony framework in which children's willingness to obey their mothers is influenced by opportunities for the dyad to engage each other in specific forms of social interaction.

In-home continuing care services for substance-affected families: the bridges program.

Addressing substance abuse in families is an important concern for the social work field. This article presents a preliminary view of a continuing care substance abuse recovery services program designed to assist the substance-affected family. The intervention approach is a blended model of substance abuse recovery work and family preservation. Services are directed at helping substance-abusing parents with "recovering" their role with their families, developing support for their recovery work, and helping them gain the education and skills they need for effective parenting, supportive family involvement, and avoidance of drugs and alcohol. The program focuses on helping substance abusers and their families achieve relapse prevention by addressing functioning in four domains: individual actions and cognitions, individual recovery actions, family actions and cognitions, and family recovery actions. The article presents two case examples to highlight the efficacy of the intervention model and the general positive effect continuing care services are having on substance-affected families.

The impact of behavior-specific and behavior-nonspecific reinforcement on child compliance to mother directives.

Theories of child socialization differ with regard to the influence they attribute to behavior-specific reinforcement contingencies versus behavior-nonspecific reinforcement contingencies (i.e. social responsiveness). The present research investigated, at a within-individual level, the relationship between both types of reinforcement and child compliance with maternal directives. Behavior-specific reinforcement was defined as the history of reinforcement obtained by children for prior episodes of compliance and noncompliance to mother directives. Behavior-nonspecific reinforcement was defined as the history of reinforcement obtained by children for prosocial and aversive behaviors unrelated to mother directives. It was hypothesized that both reinforcement processes would be related to child responses to subsequent mother directives. The findings support these hypotheses. The discussion addresses caretaker social responsiveness as an intervention target of behavioral family therapy.

Comparison of pelvic organ prolapse in the dorsal lithotomy compared with the standing position.

OBJECTIVE: To determine if there is a significant difference in the degree of pelvic organ prolapse assigned during examination in the standing position compared with the dorsal lithotomy position with the patient performing maximal Valsalva maneuver. METHODS: Fifty-one women with symptoms of pelvic organ prolapse were examined in both the dorsal lithotomy position, while performing maximal Valsalva, and in the standing position at the same visit by one of two examiners. Nine site-specific measures and summary stages were recorded, as outlined by the International Continence Society's classification system for pelvic organ prolapse. The data were analyzed by Wilcoxon signed-rank test and correlation coefficients. RESULTS: The mean age was 52 +/- 15 years. Excellent correlation was noted between all six points representing the vaginal prolapse. The R values for point Aa were 0.97, Ba 0.96, C 0.98, Ap 0.97, Bp 0.96, and D 0.97. The total vaginal length, perineal body, and genital hiatus measurements were performed in the dorsal lithotomy position with the patient at rest and were not repeated. The stages were identical in 48 of 51 patients. The average stage in the dorsal lithotomy position was 2.3 and in the standing position, 2.3. There was no statistically significant difference between the stage or any of the measured points in the dorsal lithotomy and standing examinations. CONCLUSION: The degree of pelvic organ prolapse can be assessed adequately in the dorsal lithotomy position with the patient performing maximal Valsalva. It is not necessary to routinely repeat the examination in the standing position.

The Mars oxidant experiment (MOx) for Mars '96.

The MOx instrument was developed to characterize the reactive nature of the martian soil. The objectives of MOx were: (1) to measure the rate of degradation of organics in the martian environment; (2) to determine if the reactions seen by the Viking biology experiments were caused by a soil oxidant and measure the reactivity of the soil and atmosphere: (3) to monitor the degradation, when exposed to the martian environment, of materials of potential use in future missions; and, finally, (4) to develop technologies and approaches that can be part of future soil analysis instrumentation. The basic approach taken in the MOx instrument was to place a variety of materials composed as thin films in contact with the soil and monitor the physical and chemical changes that result. The optical reflectance of the thin films was the primary sensing-mode. Thin films of organic materials, metals, and semiconductors were prepared. Laboratory simulations demonstrated the response of thin films to active oxidants.

ERISA preemption of surety bond claims: the state's choice of weapon: plain old common sense.

One avenue that may be available to multiemployer funds in the collection of delinquent contributions from insolvent employers is to file suit on the state surety bond. However, such action may raise the issue of ERISA preemption. This article analyzes recent state and federal cases addressing the preemption of state surety bond claims and argues against a finding of ERISA preemption based on the underlying purpose of ERISA and appropriate deference to traditional areas of state regulation.

A preliminary analysis of interactive effects between common classroom contingencies and methylphenidate.

To assess the drug-behavior interaction effects with an 8-year-old boy wih attention deficit hyperactivity disorder, common classroom antecedent (e.g., seating arrangement) and consequent (e.g., peer prompts) stimuli were alternated within a school day while drug conditions (methylphenidate vs. placebo) were alternated across days. The results suggested that peer attention maintained disruptive behavior when methylphenidate was absent but not when it was present.

The differential effects of teacher and peer attention on the disruptive classroom behavior of three children with a diagnosis of attention deficit hyperactivity disorder.

We conducted functional analyses of classroom disruption during contingent teacher and peer attention conditions for 3 children with attention deficit hyperactivity disorder. Attention provided by peer confederates appeared to function as a distinct form of positive reinforcement for all 3 children.

Endothelial seeding of polytetrafluoroethylene femoral popliteal bypasses: the failure of low-density seeding to improve patency.

PURPOSE: We compared 66 seeded polytetrafluoroethylene and 53 autologous vein grafts to determine whether endothelial seeding could improve the patency of polytetrafluoroethylene femoral popliteal bypass grafts and to determine whether endothelial seeding could be performed consistently in multiple institutions. METHODS: Nine surgeons at four hospitals randomized patients to receive either a seeded polytetrafluoroethylene or a vein graft, but if no satisfactory vein (n = 26) existed, an "obligatory" seeded polytetrafluoroethylene graft was used. RESULTS: Scanning electron microscopy confirmed satisfactory initial attachment of endothelium on the discarded ends of the grafts. Patency was compared with the use of log rank analysis and revealed better patency in vein grafts at 30 months (vein = 91.6% +/- 4.1%; seeded polytetrafluoroethylene = 37.8% +/- 9.4%; p = 0.006). Failed grafts revealed anastomotic hyperplasia. CONCLUSIONS: (1) Vein graft patency was better than seeded polytetrafluoroethylene grafts; (2) seeding did not improve patency in below-the-knee bypasses as suggested by pilot studies; (3) the failure of seeded grafts was associated with anastomotic hyperplasia but not with the failure of initial endothelial attachment; and (4) each institution reported similar results.