Effectiveness of aerobic exercise for adults living with HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol

Background: People with HIV are living longer with the health-related consequences of HIV, multi-morbidity, and aging. Exercise is a key strategy that may improve or sustain health for people living with HIV. Our aim was to examine the safety and effectiveness of aerobic exercise interventions on immunological, virological, cardiorespiratory, strength, weight, body composition, and psychological outcomes in adults living with HIV. Methods: We conducted a systematic review using the Cochrane Collaboration protocol. We searched databases up to April 2013. We included randomized controlled trials comparing aerobic exercise with no exercise or another intervention performed at least three times per week for at least four weeks among adults living with HIV. Two reviewers independently determined study eligibility. Data were extracted from studies that met inclusion criteria using standardized forms. We assessed risk of bias using the Cochrane Collaboration’s tool for assessing risk of bias. Outcomes were analyzed as continuous and meta-analyses conducted using random effects models with Review Manager (RevMan) computer software. Results: Twenty-four studies met inclusion criteria (n = 936 participants at study completion); the majority of participants were men (73 %) and the majority were taking antiretroviral therapy (19/24 included studies). The exercise intervention included aerobic exercise alone (11 studies) or a combination of aerobic and resistive exercise (13 studies) ranging from 5 to 52 weeks. Fifty-eight meta-analyses were performed. Main results indicated statistically significant improvements in selected outcomes of cardiorespiratory status (maximum oxygen consumption, exercise time), strength (chest press, knee flexion), body composition (lean body mass, percent body fat, leg muscle area), depression symptoms, and quality of life (SF-36 questionnaire) among exercisers compared with non-exercisers. No significant differences in change in CD4 count and viral load were found. Conclusions: Performing aerobic exercise or a combination of aerobic and resistive exercise at least three times per week for at least five weeks is safe and can lead to improvements in cardiorespiratory fitness, strength, body composition and quality of life for adults with HIV. Aerobic exercise is safe and beneficial for adults living with HIV who are medically stable

All-Wales licensed premises intervention (AWLPI): a randomised controlled trial to reduce alcohol-related violence

Background: Alcohol-related violence in and in the vicinity of licensed premises continues to place a considerable burden on the United Kingdom’s (UK) health services. Robust interventions targeted at licensed premises are therefore required to reduce the costs of alcohol-related harm. Previous evaluations of interventions in licensed premises have a number of methodological limitations and none have been conducted in the UK. The aim of the trial was to determine the effectiveness of the Safety Management in Licensed Environments intervention designed to reduce alcohol-related violence in licensed premises, delivered by Environmental Health Officers, under their statutory authority to intervene in cases of violence in the workplace.<p></p> Methods/Design: A national randomised controlled trial, with licensed premises as the unit of allocation. Premises were identified from all 22 Local Authorities in Wales. Eligible premises were those with identifiable violent incidents on premises, using police recorded violence data. Premises were allocated to intervention or control by optimally balancing by Environmental Health Officer capacity in each Local Authority, number of violent incidents in the 12 months leading up to the start of the project and opening hours. The primary outcome measure is the difference in frequency of violence between intervention and control premises over a 12 month follow-up period, based on a recurrent event model. The trial incorporates an embedded process evaluation to assess intervention implementation, fidelity, reach and reception, and to interpret outcome effects, as well as investigate its economic impact.<p></p> Discussion: The results of the trial will be applicable to all statutory authorities directly involved with managing violence in the night time economy and will provide the first formal test of Health and Safety policy in this environment. If successful, opportunities for replication and generalisation will be considered.<p></p&gt

Lessons Learned in Conducting School Health Research in Massachusetts: A Massachusetts School Nurse Research Network (MASNRN) Project

The Institute of Medicine (2007) and the Robert Wood Johnson Foundation (RWJF) (2010) recognized that the school environment plays a role in shaping children’s health and health behaviors, and school health services are positioned to model these approaches. The majority of school health services are school nurse (SN) managed (RWJF, 2012; Schainker, 2005), but a research gap exists linking school health services with improved student outcomes (Hootman, 2002; Lear, 2007). In Massachusetts, the student health research question ideally has roots in the expertise of the SN. The researcher conducting a school-based student health study interacts with SNs and administrators in school districts that vary by the type and number of health staff , as well as district location and size. These variables confound the research design in terms of structure and process. IRB issues and permission for research conduction in the school district are particularly vexing. Consent of parents and assent of children are required, and SNs participating in the research must complete human subjects training. Massachusetts School Nurse Research Network (MASNRN) was founded in 2004 by a group of SN experts to conduct school based research. The 100 members of MASNRN have conducted studies across the state and within school districts on asthma, availability of epinephrine for anaphylaxis, bullying, immunizations, training modules and mental health. Particular lessons learned from the unique experience of conducting research in schools are presented

Impact of flow pulsatility on arterial drug distribution in stent-based therapy

Drug-eluting stents reside in a dynamic fluid environment where the extent to which drugs are distributed within the arterial wall is critically modulated by the blood flowing through the arterial lumen. Yet several factors associated with the pulsatile nature of blood flow and their impact on arterial drug deposition have not been fully investigated. We employed an integrated framework comprising bench-top and computational models to explore the factors governing the time-varying fluid dynamic environment within the vasculature and their effects on arterial drug distribution patterns. A custom-designed bench-top framework comprising a model of a single drug-eluting stent strut and a poly-vinyl alcohol-based hydrogel as a model tissue bed simulated fluid flow and drug transport under fully apposed strut settings. Bench-top experiments revealed a relative independence between drug distribution and the factors governing pulsatile flow and these findings were validated with the in silico model. Interestingly, computational models simulating suboptimal deployment settings revealed a complex interplay between arterial drug distribution, Womersley number and the extent of malapposition. In particular, for a stent strut offset from the wall, total drug deposition was sensitive to changes in the pulsatile flow environment, with this dependence increasing with greater wall displacement. Our results indicate that factors governing pulsatile luminal flow on arterial drug deposition should be carefully considered in conjunction with device deployment settings for better utilization of drug-eluting stent therapy.National Institutes of Health (U.S.) (grant NIH R01 GM-49039

REVIEWS REVIEWS REVIEWS Disturbance and the rising tide: the

low-island ecosystem

Facilitation mediates species presence beyond their environmental optimum

Species distributions are driven by abiotic conditions that filter species with specific traits and physiological tolerances and match them with their suitable environment. Plant–plant interactions can constrict (through competition) or loosen (through facilitation) the strength of these environmental filters, which in turn inhibit or enhance establishment and recruitment of plant species at a finer spatial scale. Although competition is often the focus of community assembly processes that further impede the entry of plant species into a site, facilitation is also important for potentially loosening environmental filters (especially climatic filters such as temperature and precipitation), ultimately enhancing species occurrence beyond their physiological optimum. We used multiple data sets from the arid site of Rambla del Saltador Valley to test the hypothesis that facilitation by a nurse-plant promotes the presence of herbaceous, beneficiary species beyond their environmental optimum relative to open sites. Furthermore, we propose that the median elevation and community composition of herbaceous species expands with the age of the nurse-plant, and we tested this hypothesis by examining 105 beneficiary species under 50 nurse-plant shrubs varying in age from 6 to 48 years old. We found nurse-plants both facilitate herbaceous species occurrence beyond their median elevation and support more diverse and a distinctly different composition of species in contrast to open sites. Specifically, herbaceous species that originate from a median elevation more than 600 to 700 m above the site only existed beneath nurse-plants, and below this median elevation, half the species only occurred below the nurse-plant. Moreover, the richness and elevation provenance of the herbaceous species increased with increasing nurse-plant age. Our results highlight the importance of facilitation for alleviating physiological strain (in support of the strain hypothesis) and mediating regional species distributions, which has implications for understanding species movements and community assembly at larger-scales under hotter and drier climates

Evaluation of the RumiWatchSystem for measuring grazing behaviour of cows

peer-reviewedFeeding behaviour is an important parameter of animal performance, health and welfare, as well as reflecting levels and quality of feed available. Previously, sensors were only used for measuring animal feeding behaviour in indoor housing systems. However, sensors such as the RumiWatchSystem can also monitor such behaviour continuously in pasture-based environments. Therefore, the aim of this study was to validate the RumiWatchSystem to record cow activity and feeding behaviour in a pasture-based system. The RumiWatchSystem was evaluated against visual observation across two different experiments. The time duration per hour at grazing, rumination, walking, standing and lying recorded by the RumiWatchSystem was compared to the visual observation data in Experiment 1. Concordance Correlation Coefficient (CCC) values of CCC = 0.96 for grazing, CCC = 0.99 for rumination, CCC = 1.00 for standing and lying and CCC = 0.92 for walking were obtained. The number of grazing and rumination bouts within one hour were also analysed resulting in Cohen‘s Kappa (κ) = 0.62 and κ = 0.86 for grazing and rumination bouts, respectively. Experiment 2 focused on the validation of grazing bites and rumination chews. The accordance between visual observation and automated measurement by the RumiWatchSystem was high with CCC = 0.78 and CCC = 0.94 for grazing bites and rumination chews, respectively. These results indicate that the RumiWatchSystem is a reliable sensor technology for observing cow activity and feeding behaviour in a pasture based milk production system, and may be used for research purposes in a grazing environment