A randomized cross-over trial to detect differences in arm volume after low- and heavy-load resistance exercise among patients receiving adjuvant chemotherapy for breast cancer at risk for arm lymphedema:study protocol

BACKGROUND: In an effort to reduce the risk of breast cancer-related arm lymphedema, patients are commonly advised to avoid heavy lifting, impacting activities of daily living and resistance exercise prescription. This advice lacks evidence, with no prospective studies investigating arm volume changes after resistance exercise with heavy loads in this population. The purpose of this study is to determine acute changes in arm volume after a session of low- and heavy-load resistance exercise among women undergoing adjuvant chemotherapy for breast cancer at risk for arm lymphedema. METHODS/DESIGN: This is a randomized cross-over trial. Participants: Women receiving adjuvant chemotherapy for breast cancer who have undergone axillary lymph node dissection will be recruited from rehabilitation centers in the Copenhagen area. Intervention: Participants will be randomly assigned to engage in a low- (two sets of 15–20 repetition maximum) and heavy-load (three sets of 5–8 repetition maximum) upper-extremity resistance exercise session with a one week wash-out period between sessions. Outcome: Changes in extracellular fluid (L-Dex score) and arm volume (ml) will be assessed using bioimpedance spectroscopy and dual-energy x-ray absorptiometry, respectively. Symptom severity related to arm lymphedema will be determined using a visual analogue scale (heaviness, swelling, pain, tightness). Measurements will be taken immediately pre- and post-exercise, and 24- and 72-hours post-exercise. Sample size: A sample size of 20 participants was calculated based on changes in L-Dex scores between baseline and 72-hours post exercise sessions. DISCUSSION: Findings from this study are relevant for exercise prescription guidelines, as well as recommendations regarding participating in activities of daily living for women following surgery for breast cancer and who may be at risk of developing arm lymphedema. TRIAL REGISTRATION: Current Controlled Trials ISRCTN97332727. Registered 12 February 2015. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12885-016-2548-y) contains supplementary material, which is available to authorized users

The CHOICE (Choice of Health Options In prevention of Cardiovascular Events) replication trial: study protocol

Background: although morbidity and mortality from coronary heart disease (CHD) are high, only a minority of acute coronary syndrome (ACS) survivors accesses an effective secondary prevention program. We aim to determine whether the previously proven CHOICE program can be replicated at multiple sites and whether ongoing reinforcement further improves risk factor modification.Methods/design: participants eligible for but not accessing standard cardiac rehabilitation will be randomly allocated to either a previously tested 3-month CHOICE program or a 30-month CHOICE program (CHOICE-plus). Both groups will participate in individualised risk factor modules of differing duration that involve choice, goal setting and telephone follow-up for three months. CHOICE-plus will also receive additional face-to-face and telephone reinforcement between three and 30 months. At one site we will recruit a randomised control group, receiving conventional care. Primary outcomes are lipid levels, blood pressure, physical activity levels and smoking rates. Secondary outcomes include readmission rates, death, the number of risk factors, other modifiable risk factors, quality of life and process evaluation measures over three years.Discussion: we present the rationale and design of a multi-centre, replication study testing a modular approach for the secondary prevention of CHD following an ACS

Glacial history of the Åsgardfonna Ice Cap, NE Spitsbergen, since the last glaciation

The response of glaciers and ice caps to past climate change provides important insight into how they will react to ongoing and future global warming. In Svalbard, the Holocene glacial history has been studied for many cirque and valley glaciers. However, little is known about how the larger ice caps in Svalbard responded to Late Glacial and Holocene climate changes. Here we use lake sediment cores and geophysical data from Femmilsjøen, one of Svalbard’s largest lakes, to reconstruct the glacial history of the Åsgardfonna Ice Cap since the last deglaciation. We find that Femmilsjøen potentially deglaciated prior to 16.1 ± 0.3 cal ka BP and became isolated from the marine environment between 11.7 ± 0.3 to 11.3 ± 0.2 cal ka BP. Glacial meltwater runoff was absent between 10.1 ± 0.4 and 3.2 ± 0.2 cal ka BP, indicating that Åsgardfonna was greatly reduced or disappeared in the Early and Middle Holocene. Deposition of glacial-meltwater sediments re-commenced in Femmilsjøen at c. 3.2 ± 0.2 cal ka BP, indicating glacier re-growth in the Femmilsjøen catchment and the onset of the Neoglacial. The glacier(s) in the Femmilsjøen catchment area reached sizes no smaller than their modern extents already at c. 2.1 ± 0.7 cal ka BP. Our results suggest that larger Svalbard ice caps such as Åsgardfonna are very sensitive to climate changes and probably melted completely during the Holocene Thermal Maximum. Such information can be used as important constraints in future ice-cap simulations

Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial

Objective To assess the effect of a multimodal group exercise intervention, as an adjunct to conventional care, on fatigue, physical capacity, general wellbeing, physical activity, and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment for advanced disease

Benthos

Currently, > 4,000 Arctic macro- and megabenthic species are known, representing the majority of Arctic marine faunal diversity. This estimate is expected to increase. • Benthic invertebrates are food to shes, marine mammals, seabirds and humans, and are commercially harvested. • Traditional Knowledge (TK) emphasizes the link between the benthic species and their predators, such as walrus, and their signi cance to culture. • Decadal changes in benthos biodiversity are observed in some well-studied regions, such as the Barents Sea and Chukchi Sea. • Drivers related to climate-change such as warming, ice decline and acidification are affecting the benthic community on a pan-Arctic scale, while drivers such as trawling, river/glacier discharge and invasive species have signficant impact on regional or local scales. • Increasing numbers of species are moving into, or shifting, their distributions in Arctic waters. These species will outcompete, prey on or offer less nutritious value as prey for Arctic species. • Current monitoring efforts have focused on macro- and megabenthic species, but have been confined to the Chukchi Sea and the Barents Sea. Efforts are increasing in waters of Greenland, Iceland, the Canadian Arctic, and in the Norwegian Sea. All other Arctic Marine Areas are lacking long-term benthic monitoring. • As a first step towards an international collaborative monitoring framework, we recommend to develop a time- and cost-effective, long-term and standardized monitoring of megabenthic communities in all Arctic regions with regular annual groundfish assessment surveys. Expanding monitoring on micro-, meio- and macrobenthic groups is encouraged