Effect of exercise based interventions on sleep and circadian rhythm in cancer survivors-a systematic review and meta-analysis

BACKGROUND: Disrupted circadian rhythm commonly reported in cancer survivors is closely associated with cancer related fatigue, sleep disturbances and compromised quality of life. As more cancer survivors request non-pharmacological treatment strategies for the management of their chronic sleep-related symptoms, there is a need for meta-analyses of various interventions such as exercise on sleep and circadian rhythm disturbances.METHODS: A search for RCT's was conducted in April 2020 and updated in July 2023 using relevant keywords for cancer, sleep, circadian rhythm and exercise interventions on PubMed, Scopus, Web of Science, PEDro and CINAHL.RESULTS: Thirty-six studies were included for qualitative analysis and 26, for meta-analysis. Thirty-five studies analyzed sleep outcomes, while five analyzed circadian rhythm. RCT's studying the effect of aerobic exercise, resistance exercise, combined aerobic and resistance exercise, physical activity, yoga, or tai chi were included. Meta-analysis results showed significant exercise-related improvements on sleep quality assessed by Pittsburgh Sleep Quality index (PSQI) (SMD = -0.50 [-0.87, -0.13], p = 0.008), wake after sleep onset (WASO) (SMD = -0.29 [-0.53, -0.05], p = 0.02) and circadian rhythm, assessed by salivary cortisol levels (MD = -0.09 (95% CI [-0.13 to -0.06]) mg/dL, p &lt; 0.001). Results of the meta-analysis indicated that exercise had no significant effect on sleep efficiency, sleep onset latency, total sleep time and circadian rhythm assessed by accelerometry values. CONCLUSION: While some sleep and circadian rhythm outcomes (PSQI, WASO and salivary cortisol) exhibited significant improvements, it is still somewhat unclear what exercise prescriptions would optimize different sleep and circadian rhythm outcomes across a variety of groups of cancer survivors.IMPLICATION: As exercise does not exacerbate cancer-related circadian rhythm and sleep disturbances, and may actually produce some significant benefits, this meta-analysis provides further evidence for cancer survivors to perform regular exercise.</p

Residential energy expenditures and the relevance of financial inclusion across location, wealth quintiles and household structures

This paper examines the relative role of financial inclusion in enhancing households’ ability to spend on energy consumption across rural and urban locations. It uses comprehensive household data from Ghana and employs the ordinary least square (OLS) as well as an instrumental variable estimation technique. Endogeneity of financial inclusion is instrumented using distance to the nearest bank. Our findings suggest that a standard deviation increase in financial inclusion contributes to an improvement in residential energy expenditure by 1.2835 standard deviations. This finding is robust to different methods for resolving endogeneity and alternative weighting schemes in the financial inclusion construct. Among the different sources of energy for lighting and cooking, financial inclusion increases expenditure on LPG and electricity more than the others. Financial inclusion increases the ability to spend more on residential energy in urban, poorest, and female-headed dual-parent households. Household net income is a key pathway through which financial inclusion affects residential energy expenditure

A profile of two different applicant test batteries with regards to sex and age in successful law enforcement applicants

BACKGROUND: Law enforcement (LE) applicant assessments and initial academy training vary greatly across the United States of America (USA), with 820+ academies operating across 50 different states. Rising obesity and declining physical fitness underscore the need for benchmarks of applicant physical performance.OBJECTIVE: Create a “point-in-time” descriptive profile of the performance of LE applicants and determine any differences between males, females, and age using two applicant test batteries (ATBs).METHODS: Archival data from one large USA LE academy were analysed. Applicants completed one of two ATBs; ATB1 (n = 1674): 68.8-meter agility run (AR), 60-s push-ups, 60-s sit-ups, 60-s arm ergometer revolutions, and 2.4 km run; ATB2 (n = 355): AR, 60-s push-ups, 60-s sit-ups, and a multistage fitness test. Data were coded for sex and age. Independent samples t-tests compared the sexes. A one-way ANOVA with Bonferroni post hoc analysis compared age groups (18–24, 25–29, 30–34, 35–39, 40 + years).RESULTS: Males outperformed females in all fitness assessments across both ATBs (p ≤ 0.02). The 18–24 age group demonstrated faster run times in the AR and 2.4 km for ATB1 compared to all groups. (p ≤ 0.03). In ATB2, the 18–24 age group was faster in the AR compared to all other groups except the 25–29 age group (p ≤ 0.026).CONCLUSIONS: Regardless of ATB used, females and older applicants generally would benefit from specific fitness training to better prepare for academy. Older applicants may experience greater challenges in running tasks, especially those involving sprinting, which could also be impacted by qualities important for running/sprinting (i.e., maximal strength and power)

Comparing dietary strategies to manage cardiovascular risk in primary care: a narrative review of systematic reviews

BACKGROUND: Nutrition care in general practice is crucial for cardiovascular disease (CVD) prevention and management, although comparison between dietary strategies is lacking.AIM: To compare the best available (most recent, relevant, and high-quality) evidence for six dietary strategies that are effective for primary prevention/absolute risk reduction of CVD.DESIGN AND SETTING: A pragmatic narrative review of systematic reviews of randomised trials focused on primary prevention of cardiovascular events.METHOD: Studies about: 1) adults without a history of cardiovascular events; 2) target dietary strategies postulated to reduce CVD risk; and 3) direct cardiovascular or all-cause mortality outcomes were included. Six dietary strategies were examined: energy deficit, Mediterranean-like diet, sodium reduction (salt reduction and substitution), the Dietary Approaches to Stop Hypertension (DASH) diet, alcohol reduction, and fish/fish oil consumption. Reviews were selected based on quality, recency, and relevance. Quality and certainty of evidence was assessed using GRADE.RESULTS: Twenty-five reviews met inclusion criteria; eight were selected as the highest quality, recent, and relevant. Three dietary strategies showed modest, significant reductions in cardiovascular events: energy deficit (relative risk reduction [RRR] 30%, 95% confidence interval [CI] = 13 to 43), Mediterranean-like diet (RRR 40%, 95% CI = 20 to 55), and salt substitution (RRR 30%, 95% CI = 7 to 48). Still, some caveats remain on the effectiveness of these dietary strategies. Salt reduction, DASH diet, and alcohol reduction showed small, significant reductions in blood pressure, but no reduction in cardiovascular events. Fish/fish oil consumption showed little or no effect; supplementation of fish oil alone showed small reductions in CVD events.CONCLUSION: For primary prevention, energy deficit, Mediterranean-like diets, and sodium substitution have modest evidence for risk reduction of CVD events. Strategies incorporated into clinical nutrition care should ensure guidance is person centred and tailored to clinical circumstances.</p

Using Machine Learning Techniques to Assess the Financial Impact of the COVID-19 Pandemic on the Global Aviation Industry

Prediction of financial distress is a crucial concern for decision-makers, especially in industries prone to external shocks, such as the aviation sector. This study employs machine learning techniques on a comprehensive global dataset of aviation companies to develop highly accurate financial distress prediction models. These models empower stakeholders with informed decision-making capabilities to navigate the aviation industry's challenges, most notably exemplified by the COVID-19 pandemic. The aviation industry holds substantial economic importance, contributing significantly to revenue, employment, and economic activity worldwide. However, its susceptibility to external factors underscores the need for robust predictive tools. Leveraging advances in machine learning, this study pioneers the application of data-driven, non-parametric solutions to the aviation sector, both before and after the pandemic. Importantly, this study addresses a gap in the field by conducting comparative evaluations of prediction models, which have been lacking in previous research efforts, often leading to inconclusive outcomes. Key findings of the study highlight the Random Forest and Stochastic Gradient Boosting models as the most accurate in forecasting financial distress within the aviation industry. Notably, the study identifies debt-to-equity, return on invested capital, and debt ratio as the most important predictors of financial distress in this context.<br/

The political economy of energy transition: The role of globalization and governance in the adoption of clean cooking fuels and technologies

The need for substantial economic, political, and social integration among economies and an effective domestic governance system to create a more inclusive and clean energy economy cannot be underestimated. Overreliance on biomass and other dirty fuels for cooking in developing countries has contributed to the global climate change challenge. In this study, we examine the impact of globalization and governance on adopting clean fuels and cooking technologies in sub-Saharan Africa (SSA). Regarding analytical approaches, we deploy econometric techniques such as Driscoll-Kraay and instrumental variable generalized method of moment techniques to control econometric issues such as autocorrelation, heteroskedasticity, cross-sectional dependence, and endogeneity. The findings indicate that globalization (economic, social, and political) and governance (government effectiveness, control of corruption, political stability, and the rule of law) drive the adoption of clean fuels and technologies for cooking. The results further reveal that right-wing political leaders contribute significantly to adopting clean cooking fuels and technologies in SSA, while left-wing and center-wing political leaders do not. These findings differ among the sub-regions in SSA. Furthermore, interaction and marginal effect analysis suggest that improving the governance system enhances the effect of globalization on access to clean cooking fuels and technologies. Hence, improving the efficacy of the domestic governance system would enable globalization to speed up the adoption of clean fuels and technologies for cooking in SSA

Common barriers and enablers to the use of non-drug interventions for managing common chronic conditions in primary care: an overview of reviews

BACKGROUND: Non-drug interventions are recommended for chronic condition prevention and management yet are underused in clinical practice. Understanding barriers and enablers to using non-drug interventions may help implement non-drug interventions in primary care. We aimed to conduct an overview of reviews to identify and summarise common barriers and enablers for using non-drug interventions for common chronic conditions in primary care.METHODS: We included qualitative and quantitative reviews that used systematic process or methods to examine barriers and enablers to using non-drug interventions for chronic condition prevention and management in primary care settings. We searched 5 electronic databases (PubMed, Cochrane Database of Systematic Reviews, EMBASE, PsycInfo and CINAHL) from inception to September 2022. Two authors independently screened reviews. One author extracted and deductively coded data to Consolidated Framework of Implementation Research (CFIR) (and where relevant, Theoretical Domains Framework [TDF]). A second author validated 10% of extracted data and coding. Data was synthesised thematically using CFIR and TDF. One author assessed the methodological quality of included reviews using a modified AMSTAR 2 tool, with 10% validated by a second author. We assessed overlap between primary studies in included reviews.RESULTS: From 5324 records, we included 25 reviews, with data predominately from patients. Overall, 130 subthemes (71 barrier and 59 enabler) were identified across 4 CFIR domains (Innovation, Outer Setting, Inner Setting, and Individuals), and all TDF domains. Common barrier and enabler subthemes were identified for CFIR constructs of Innovation Adaptability, Innovation Cost, Innovation Relative Advantage, Local Attitudes, External Pressure, Local Conditions, Relational Connections, Available Resources, and Access to Knowledge and Information. For TDF domains, important barrier and enabler subthemes were identified for Knowledge, Skills, Environmental Context and Resources, Beliefs about Consequences, Reinforcement, and Emotion.CONCLUSIONS: We synthesised reviews to provide new insight into common barriers and enablers for using non-drug interventions to prevent and manage chronic conditions in primary care. The factors identified can inform the development of generalisable implementation interventions to enhance uptake of multiple non-drug interventions simultaneously.TRIAL REGISTRATION: This study was registered in PROSPERO (CRD42022357583).</p

Is exercise therapy the right treatment for rotator cuff-related shoulder pain: Uncertainties, theory, and practice

BACKGROUND: Exercise therapy is a popular non-surgical treatment to help manage individuals with rotator cuff-related shoulder pain (RCRSP) and is recommended in all clinical practice guidelines. Due to modest effect sizes, low quality evidence, uncertainty relating to efficacy, and mechanism(s) of benefit, exercise as a therapeutic intervention has been the subject of increasing scrutiny.AIMS: The aim of this critical review is to lay out where the purported uncertainties of exercise for RCRSP exist by exploring the relevant quantitative and qualitative literature. We conclude by offering theoretical and practical considerations to help reduce the uncertainty of delivering exercise therapy in a clinical environment.RESULTS AND DISCUSSION: Uncertainty underpins much of the theory and practice of delivering exercise therapy for individuals with RCRSP. Nonetheless, exercise is an often-valued treatment by individuals with RCRSP, when provided within an appropriate clinical context. We encourage clinicians to use a shared decision-making paradigm and embrace a pluralistic model when prescribing therapeutic exercise. This may take the form of using exercise experiments to trial different exercise approaches, adjusting, and adapting the exercise type, load, and context based on the individual's symptom irritability, preferences, and goals.CONCLUSION: We contend that providing exercise therapy should remain a principal treatment option for helping individuals with RCRSP. Limitations notwithstanding, exercise therapy is relatively low cost, accessible, and often valued by individuals with RCRSP. The uncertainty surrounding exercise therapy requires ongoing research and emphasis could be directed towards investigating causal mechanisms to better understand how exercise may benefit an individual with RCRSP.</p

Finding the Evidence

This book will help you learn how to decide what clinical questions to ask, search for research evidence to answer them, and analyse the evidence to decide if the results are believable, important, and applicable. You will learn how to talk with patients about evidence and make collaborative decisions and how to approach evidence implementation at an individual and organisational level

Impact of passengers' perceptions of social responsibility activities on the efficacy of PPP urban rail transit projects

Although public perceptions of social responsibility (SR) activities are considered to provide a useful guide to improving the efficacy of underground infrastructure projects in general to meet the needs of users, little research has been conducted to date in the context of public-private partnership (PPP) urban rail transit (URT) projects. In this paper, a theoretical framework is developed based on the literature review, from which six hypotheses are proposed and tested by structural equation modeling based on data drawn from a questionnaire survey of 708 residents concerning three typical PPP URT projects in Beijing, Dalian, and Hangzhou, China. The results show that, firstly passenger-perceived SR activities have a direct and indirect positive impact on satisfaction, and perceived efficacy, as well as only have a direct influence on perceived quality; secondly passenger-perceived efficacy was influenced by passengers' satisfaction directly and perceived quality indirectly; and thirdly perceived quality has a direct positive influence on satisfaction. The findings contribute to the body of knowledge, provide guidance for project operation management and the sustainable development in the URT domain, by exploring the determinants of the perceived efficacy of PPP URT projects