A review of the potential local mechanisms by which exercise improves functional outcomes in intermittent claudication

© 2016 Elsevier Inc. All rights reserved. Background Intermittent claudication (IC) is a common condition which is associated with significant quality of life limitation. National Institute for Health and Care Excellence guidelines recommend a group-based supervised exercise program as the primary treatment option for claudication, based on clinical and cost effectiveness. This review aims to assess the mechanisms by which exercise improves outcomes in patients with IC. Methods MEDLINE, EMBASE, and PubMed were searched using the search strategy "claudication" [AND] "exercise" [AND] "mechanisms." Searches were limited from 1947 to October 2014. Only full-text articles published in the English language in adults (over 18 years of age) were eligible for the review. Any trial involving a nonsupervised exercise program was excluded. Abstracts identified by the database search were interrogated for relevance and citations from the shortlisted papers were hand searched for relevant references. Results The search yielded a total of 112 studies, of which 42 were duplicates. Forty-seven of the remaining 70 were deemed appropriate for inclusion in the review. Exercise is the first-line treatment for IC. Supervised exercise programs improve walking distances, endothelial and mitochondrial function, muscle strength, and endurance. Furthermore, it leads to a generalized improvement in cardiovascular fitness and overall quality of life. Conclusions The mechanism by which exercise improves outcome in claudicants is complicated and multifactorial. Further research is required in this area to fully elucidate the precise and predominant mechanisms and to assess whether targeted exercise program modification maximizes mechanism efficacy and patient outcome

Attachment, Personality, and Conflict Behaviors in Romantic Couples: Examining Vulnerability to Depression

Major Depressive Disorder has been conceptualized from a number of theoretical perspectives. The present study aims to provide a theoretically integrated understanding of depression vulnerability. Cognitive and interpersonal theories of depressive vulnerability were considered simultaneously in a sample of undergraduate research participants. Study procedures included an attachment elicitation exercise, which was preceded by completion of a self-report measure of depressive and anxious affect. The attachment elicitation exercise was followed by self-report measures of relationship behavior, adult attachment style, cognitive vulnerability, depressive symptomatology, and additional self-report measures of affect. Results of hierarchical multiple regression analyses indicated that the effects of insecure attachment and cognitive personal style on relational behavior are complex. Anxiously attached, sociotropic individuals appear to utilize more passive-aggressive behaviors (i.e., negativity) to negotiate conflict and avoidantly attached, autonomous individuals reported engagement in more overt, distancing behaviors (i.e., negative escalation and withdrawal). Moreover, significant interactions between avoidant attachment and autonomy suggested that the greatest impact on behavior occurred when autonomy was high and avoidant attachment was low. It appears that avoidant attachment may suppress some of the negative emotional expressions or behaviors of highly autonomous individuals. Contrary to expectations, insecure attachment and cognitive personal style did not predict pre- to post-changes in depressive affect, although these relationships were significant for both pre-stress induction affect and post-stress induction affect. Limitations and directions for future research are discussed

Observation of coherent delocalized phonon-like modes in DNA under physiological conditions

Underdamped terahertz-frequency delocalized phonon-like modes have long been suggested to play a role in the biological function of DNA. Such phonon modes involve the collective motion of many atoms and are prerequisite to understanding the molecular nature of macroscopic conformational changes and related biochemical phenomena. Initial predictions were based on simple theoretical models of DNA. However, such models do not take into account strong interactions with the surrounding water, which is likely to cause phonon modes to be heavily damped and localized. Here we apply state-of-the-art femtosecond optical Kerr effect spectroscopy, which is currently the only technique capable of taking low-frequency (GHz to THz) vibrational spectra in solution. We are able to demonstrate that phonon modes involving the hydrogen bond network between the strands exist in DNA at physiologically relevant conditions. In addition, the dynamics of the solvating water molecules is slowed down by about a factor of 20 compared with the bulk

Precarious education and the university: navigating the silenced borders of participation

Access to and participation in university education is a key equity issue, with increased efforts to widen the participation of secondary school-aged students from low socio-economic status (LSES) backgrounds in many countries worldwide. In Australia, programmes aimed at widening university participation generally target LSES children and young people engaged in schooling. Access to such programmes thus demands a connection to schooling, yet not all school-age young people have such connections: they may experience what we term \u27precarious\u27 relationships to education. Without school connections, young people with precarious relationships to education have extremely limited opportunities to engage (or to imagine engaging) in higher education. This paper considers this issue from the perspectives of young people who have precarious relationships with school education. Drawing on qualitative research investigating disadvantage and university education, the paper reports on how the imagination of university education, which might be argued to be a \u27silenced\u27 border of social inclusion, is described by young people with precarious relationships to education. Drawing on Judith Butler\u27s book Precarious Life (2004), the paper puts forward the argument that the precariousness of education is relational and that universities thus have a moral responsibility to recognize and respond to the educational precariousness of the Other

Neocuproine-functionalized silica-coated magnetic nanoparticles for extraction of copper(II) from aqueous solution

Neocuproine has been covalently bound to silica-coated maghemite(c-Fe2O3) magnetic nanoparticles (MNPs) by a phenyl ether linkage. The resulting MNPs are able to remove Cu(II) from 12 ppm aqueous solution with an extraction efficiency of up to 99% at pH 2

Presurgery conditioning interventions (prehabilitation) in adults undergoing lower limb surgery for peripheral arterial disease

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To assess the effectiveness of prehabilitation (preoperative exercise, either alone or in combination with nutritional or psychological interventions or both) on postoperative outcomes in adults with PAD undergoing open lower limb surgery

Safety and Tolerability of Antiretrovirals during Pregnancy

Combination antiretroviral therapy (CART) dramatically decreases mother-to-child HIV-1 transmission (MTCT), but maternal adverse events are not infrequent. A review of 117 locally followed pregnancies revealed 7 grade ≥3 AEs possibly related to antiretrovirals, including 2 hematologic, 3 hepatic, and 2 obstetric cholestasis cases. A fetal demise was attributed to obstetric cholestasis, but no maternal deaths occurred. The drugs possibly associated with these AE were zidovudine, nelfinavir, lopinavir/ritonavir, and indinavir. AE or intolerability required discontinuation/substitution of nevirapine in 16% of the users, zidovudine in 10%, nelfinavir in 9%, lopinavir/ritonavir in 1%, but epivir and stavudine in none. In conclusion, nevirapine, zidovudine, and nelfinavir had the highest frequency of AE and/or the lowest tolerability during pregnancy. Although nevirapine and nelfinavir are infrequently used in pregnancy at present, zidovudine is included in most MTCT preventative regimens. Our data emphasize the need to revise the treatment recommendations for pregnant women to include safer and better-tolerated drugs

Kinetics and Determining Factors of the Virologic Response to Antiretrovirals during Pregnancy

HIV-infected pregnant women with undetectable plasma HIV RNA concentrations at delivery pose a minimal risk of vertical transmission. We studied the kinetics and the determinants of the virologic response to antiretroviral therapy in 117 consecutive pregnancies. Patients who initiated therapy during pregnancy had a VL decrease of 2 and 2.5 log10 after 4 and 24 weeks, respectively. Therapeutic drug monitoring (TDM) of the protease inhibitors administered in doses recommended for nonpregnant adults resulted in below-target concentrations in 29%, 35%, and 44% of 1st, 2nd, and 3rd trimester measurements, respectively, but low drug concentrations did not correlate with virologic failure. Demographic characteristics, antiretroviral experience prior to pregnancy, baseline VL, or use of specific antiretrovirals did not affect the virologic response. Adherence to ≥95% of prescribed doses and utilization of psychosocial services were associated with undetectable plasma HIV RNA at delivery. In conclusion, the virologic responses of pregnant and nonpregnant adults share similar charactersitics