A 12-week lifestyle intervention: effects on fatigue, fear, and nutritional status in children with a Fontan circulation

IntroductionChildren and adolescents with a Fontan circulation are less physically active compared to healthy peers. In the current study, effects of a 12-week lifestyle intervention on fatigue, fears regarding exercise, caloric intake, rest energy expenditure (REE), and body composition were measured in children with a Fontan circulation.MethodsThis study was a semi-cross-over randomized controlled trial. The lifestyle intervention consisted of a 12-week high-weight resistance training (three supervised training sessions a week) supported by high-protein diet (>2 g/kg) and tailored recommended caloric intake. Fatigue (measured by the validated PedsQol Multidimensional Fatigue Scale), fears regarding exercise (measured on a fear thermometer), REE (measured using indirect calorimetry), caloric intake and body composition using air displacement plethysmography, and four-skinfold method were measured before and after the intervention and control period.ResultsTwenty-seven pediatric Fontan patients, median age 12.9 years (IQR: 10.5–16.2), of the included 28 patients successfully completed the program. Before training, both child- and parent-reported levels of fatigue were significantly worse on all domains (general, sleep/rest, and cognitive fatigue) compared to healthy peers. After training, parent-reported fatigue significantly improved on the general and cognitive fatigue domains [effect size +16 points (7–25), p < 0.001, and +10 points (2–17), p = 0.015, compared to the control period]. Before training, fear regarding exercise scored on the fear thermometer was low for both children and parents (median score 1 and 2, respectively, on a scale of 0–8). After training, child-reported fear decreased further compared to the control period [effect size −1.4 points (−2.3 to −0.6), p = 0.001]. At baseline, children had increased REE +12% compared to reference values, which did not change after exercise. Children ate an average of 637 calories below recommended intake based on REE, caloric deficit became smaller after the intervention, and protein intake increased compared to the control period [−388 calories (−674 to −102), p = 0.008, and +15 g (0.4–30), p = 0.044]. Body fat percentage did not change significantly.ConclusionA 12-week lifestyle intervention improved parent-reported fatigue symptoms in the children, further decreased child-reported fears, and increased caloric and protein intake

Leg-focused high-weight resistance training improves ventricular stroke volume, exercise capacity and strength in young patients with a Fontan circulation

INTRODUCTION: Effective therapy to improve exercise capacity in Fontan patients is lacking. Leg-focused high-weight resistance training might augment the peripheral muscle pump and thereby improve exercise capacity.METHODS: This randomized semi-cross-over controlled trial investigated effects of a 12-week leg-focused high-weight resistance training plus high-protein diet, on (sub)maximal exercise capacity, cardiac function (assessed with cardiovascular magnetic resonance), muscle strength and quality of life in pediatric Fontan patients.RESULTS: Twenty-eight pediatric Fontan patients were included, 27 patients, (median age 12.9 [10.5-15.7]), successfully completed the program. Peak oxygen uptake (PeakVO2) at baseline was reduced (33.3 ml/kg/min [27.1-37.4],73% [62-79] of predicted). After training PeakVO2/kg and Peak workload improved significantly with +6.2 ml/kg/min [95%CI: 3.4-9.0](+18%) p&lt;0.001 and +22 Watts [95%CI: 12-32](+18%) p&lt;0.001 respectively, compared to the control period. Indexed single ventricle stroke volume increased significantly (43 ml/beat/m2 [40-49] versus 46 [41-53], p=0.014), as did inferior vena cava flow (21 ml/beat/m2 [18-24] versus 23 [20-28], p=0.015), while superior vena cava flow remained unchanged. Strength of all measured leg muscles increased significantly compared to the control period. Self-reported quality of life improved on the physical functioning and change in health domains of the child health questionnaire, parent-reported quality of life improved on the bodily pain, general health perception, and change in health domains compared to the control period.CONCLUSION:In a relatively large group of 27 older Fontan children, 12-weeks of leg-focused high-weight resistance training improved exercise capacity, stroke volume, (sub)maximal exercise capacity, muscle strength, and domains of quality of life.</p

Psychomotor therapy targeting anger and aggressive behaviour in individuals with mild or borderline intellectual disabilities:A systematic review

Background: Poor anger regulation is considered a risk factor of aggression in individuals with mild or borderline intellectual disabilities. Psychomotor therapy (PMT) targets anger regulation through body- and movement-oriented interventions. This study aims to inform practitioners on efficacy and research-base of PMT in this population. Method: This systematic review evaluated nine studies which met inclusion criteria in terms of participants, intervention procedures, outcomes and certainty of evidence. Results: Seven studies revealed a substantial reduction of aggressive behaviour or anger. Certainty of evidence was rated inconclusive in most cases due to absence of experimental control. Conclusions: We can conclude that body-oriented PMT, involving progressive relaxation and meditation procedure "Soles of the Feet", is a promising approach. However, the paucity of studies and methodological limitations preclude classifying it as an evidence-based practice. This suggests stronger methodological research and research aimed at PMT's mechanisms of action (e.g., improved interoceptive awareness) is warranted.</p

Quantum-classical transition in Scale Relativity

The theory of scale relativity provides a new insight into the origin of fundamental laws in physics. Its application to microphysics allows us to recover quantum mechanics as mechanics on a non-differentiable (fractal) spacetime. The Schrodinger and Klein-Gordon equations are demonstrated as geodesic equations in this framework. A development of the intrinsic properties of this theory, using the mathematical tool of Hamilton's bi-quaternions, leads us to a derivation of the Dirac equation within the scale-relativity paradigm. The complex form of the wavefunction in the Schrodinger and Klein-Gordon equations follows from the non-differentiability of the geometry, since it involves a breaking of the invariance under the reflection symmetry on the (proper) time differential element (ds - ds). This mechanism is generalized for obtaining the bi-quaternionic nature of the Dirac spinor by adding a further symmetry breaking due to non-differentiability, namely the differential coordinate reflection symmetry (dx^mu - dx^mu) and by requiring invariance under parity and time inversion. The Pauli equation is recovered as a non-relativistic-motion approximation of the Dirac equation.Comment: 28 pages, no figur

Conservation planning in an uncertain climate: Identifying projects that remain valuable and feasible across future scenarios

Conservation actors face the challenge of allocating limited resources despite uncertainty about future climate conditions. In many cases, the potential value and feasibility of proposed projects vary across climate scenarios. A key goal is to identify areas where conservation outcomes can balance both environmental and human needs. We developed a conservation prioritization framework that jointly considers the value and feasibility of candidate projects across future climate scenarios. We then applied this framework to the challenge of meeting environmental flow targets across the Red River basin of the south‐central United States. To estimate the conservation feasibility of meeting environmental flow goals in a river reach in each climate scenario, we used a basin‐wide hydrologic planning tool to quantify the reduction in societal water usage needed to meet environmental flow targets. To estimate the biodiversity value of each river reach in each climate scenario, we used climate‐driven species distribution models and species’ conservation status. We found that river reaches in the east‐central portion of the basin may be good candidates for conservation investments, because they had high biodiversity value and high sociopolitical feasibility in all future climate scenarios. In contrast, sites in the arid western reaches of the basin had high biodiversity value, but low feasibility of achieving environmental flow goals. Our framework should have broad applicability given that the value and feasibility of conservation projects vary across climate scenarios in ecosystems around the world. It may serve as a coarse filter to identify sites for more detailed analyses and could be integrated with complementarity‐based approaches to conservation planning to balance species’ representation across projects.This research was supported by S.M.W.'s Science to Action Fellowship through the National Climate Adaptation Science Center at the US Geological Survey. U.S. Geological Survey. Grant Number: G17AP00120 Open Access fees paid for in whole or in part by the University of Oklahoma Libraries.Ye

Interaction and Modulation of Two Antagonistic Cell Wall Enzymes of Mycobacteria

Bacterial cell growth and division require coordinated cell wall hydrolysis and synthesis, allowing for the removal and expansion of cell wall material. Without proper coordination, unchecked hydrolysis can result in cell lysis. How these opposing activities are simultaneously regulated is poorly understood. In Mycobacterium tuberculosis, the resuscitation-promoting factor B (RpfB), a lytic transglycosylase, interacts and synergizes with Rpf-interacting protein A (RipA), an endopeptidase, to hydrolyze peptidoglycan. However, it remains unclear what governs this synergy and how it is coordinated with cell wall synthesis. Here we identify the bifunctional peptidoglycan-synthesizing enzyme, penicillin binding protein 1 (PBP1), as a RipA-interacting protein. PBP1, like RipA, localizes both at the poles and septa of dividing cells. Depletion of the ponA1 gene, encoding PBP1 in M. smegmatis, results in a severe growth defect and abnormally shaped cells, indicating that PBP1 is necessary for viability and cell wall stability. Finally, PBP1 inhibits the synergistic hydrolysis of peptidoglycan by the RipA-RpfB complex in vitro. These data reveal a post-translational mechanism for regulating cell wall hydrolysis and synthesis through protein–protein interactions between enzymes with antagonistic functions

The association of pure fruit juice, sugar-sweetened beverages and fruit consumption with asthma prevalence in adolescents growing up from 11 to 20 years: The PIAMA birth cohort study

Pure fruit juice is comparable to sugar-sweetened beverages (SSBs) with respect to its sugar and fructose content. However, it also contains favorable components like polyphenols. From this perspective, pure fruit juice is more comparable with whole fruit. SSBs have been associated with higher asthma risk, while whole fruit consumption has been associated with lower prevalence of asthma (symptoms). Associations with pure fruit juice have been rarely studied. Therefore, we studied the associations of consumption of pure fruit juice, SSBs and whole fruit with asthma prevalence in 3046 children of the Dutch Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort growing up from 11 to 20 years. Consumption of pure fruit juice, SSBs and fruit was self-reported at the ages of 11, 14, 17 and 20 years. Presence of asthma was defined based on parental reports of asthma diagnosis ever, and wheezing and asthma medication in the last 12 months. Odds ratios (OR) were estimated using generalized linear mixed models accounting for correlation between repeated measurements within subjects. No associations were found between pure fruit juice, SSBs and fruit consumption and the overall prevalence of asthma from 11 to 20 years. An earlier reported association of low pure fruit juice consumption with higher asthma prevalence at the age of 11 years in the PIAMA population was confirmed, but no associations were found at the ages of 14, 17 and 20 years