| Prediction of Planetary Mission Task Performance for Long-Duration Spaceflight Introduction This study aimed to determine values and ranges for key aerobic fitness variables that can individually map the level of success for planetary mission tasks performance for long-duration spaceflight. With the goal to develop a predictor-testing model that can be performed with in-flight equipment. Methods We studied a group of 45 men and women who completed a series of mission critical tasks; a surface traverse task and a hill climb task. Participants performed each mission task at a low and moderate intensity designed to elicit specific metabolic responses similar to what is expected for ambulation in Lunar and Martian gravities, respectively. Aerobic fitness was characterized via cycling and rowing V[Combining Dot Above]O2peak, ventilatory threshold (VT), and critical power. Logistic regression and receiver operating characteristic (ROC) curve analysis were used to determine the cutoff thresholds for each aerobic fitness parameter that accurately predicted task performance. Results The participants of this study were characterized by a range of cycling V[Combining Dot Above]O2peaks from 15.5 to 54.1 ml kg−1 min−1. A V[Combining Dot Above]O2peak optimal cutoff values of X and Y ml kg−1 min−1 were identified for the low and moderate intensity surface traverse task respectively. For the low and moderate intensity hill climb test the optimal V[Combining Dot Above]O2peak cutoff values were X and Y ml kg−1 min−1, respectively. VT and critical power also showed high sensitivity and specificity for identifying individuals who could not complete the mission tasks. Conclusion In summary, we identified aerobic fitness thresholds below which task performance was impaired for both low and moderate intensity mission critical tasks. Specifically, cycling V[Combining Dot Above]O2peak, VT, and rowing CP could each be used to predict task failure. Address for correspondence Carl J. Ade, Ph.D. Kansas State University Manhattan, KS 66506 E-mail: cade@ksu.edu The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and statement that results of the present study do not constitute endorsement by ACSM. This study was supported by a National Aeronautics and Space Administration (NASA) research grant awarded to C.J Ade and T. J. Barstow. CONFLICT OF INTERESTS. None Submitted for publication August 2018. Accepted for publication February 2019. © 2019 American College of Sports Medicine |
| Independent Influence of Spinal Cord Injury Level on Thermoregulation during Exercise Purpose Establish the true influence of spinal cord injury (SCI) level on core temperature and sweating during exercise in the heat independently of biophysical factors. Methods 31 trained males (8 tetraplegic (TP; C5-C8), 7 high paraplegic (HP; T1-T5), 8 low paraplegic (LP; T6-L1) and 8 able-bodied (AB)) performed 3×10-min of arm ergometry with 3-min rest at a metabolic heat production of: a) 4.0 W/kg (AB vs. TP), or b) 6.0 W/kg (AB vs. HP vs. LP), in 35°C, 50% relative humidity (RH). Esophageal (Tes) and local skin temperatures, and local sweat rate (LSR) on the forehead and upper-back were measured throughout. Results Change in Tes was greatest in TP (1.86±0.32°C vs. 0.29±0.07°C, p<0.001), and greater in HP compared to LP and AB, reaching 1.20±0.50°C, 0.66±0.23°C and 0.53±0.12°C, respectively (p<0.001). Approximately half of the variability in end-trial ΔTes was described by SCI level in paraplegics (adjusted R2=0.490; p=0.005). Esophageal temperature onset thresholds of sweating at the forehead and upper-back were similar among HP, LP and AB, while no sweating was observed in TP. Thermosensitivity (ΔTes vs. ΔLSR) was also similar, except for LP demonstrating lower thermosensitivity than AB at the upper-back (0.78±0.26 mg·cm-2·min-1 vs. 1.59±0.89 mg·cm-2·min-1, p=0.039). Change in skin temperature was greatest in denervated regions, most notably at the calf in all SCI groups (TP: 2.07±0.93°C, HP: 2.73±0.68°C, LP: 2.92±1.48°C). Conclusion This study is the first to show the relationship between ΔTes and SCI level in athletes with paraplegia after removing variability arising from differences in metabolic heat production and mass. Individual variability in ΔTes is further reduced among athletes with tetraplegia due to minimal evaporative heat loss secondary to an absence of sweating. Address for correspondence: Dr. Ollie Jay PhD Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, NSW 2141. Australia e-mail: ollie.jay@sydney.edu.au This study was supported by a Collaborative Research Network for Advancing Exercise and Sport Science grant from Bond University, and a High Performance Sport Research Fund grant from Australian Institute of Sport. The authors would like to thank the athletes who volunteered their time, and the National Sporting Organisations that supported their involvement. In addition, to Nikola Srnic for his assistance with the data collection, Dr Yorgi Mavros for performing the DXA scans, and the University of Sydney Thermal Ergonomics Laboratory staff and students for technical support during data collection. The results of the present study do not constitute endorsement by ACSM and the authors declare no conflict of interest. The results of the study are presented honestly, and without fabrication, falsification, or inappropriate data manipulation. Submitted for publication November 2018. Accepted for publication February 2019. © 2019 American College of Sports Medicine |
| Testosterone and Resistance Training Improve Muscle Quality in Spinal Cord Injury Purpose Spinal cord injury (SCI) negatively impacts muscle quality and testosterone levels. Resistance training (RT) has been shown to increase muscle cross-sectional area (CSA) following SCI, while testosterone replacement therapy (TRT) has been shown to improve muscle quality in other populations. The purpose of this pilot study was to examine if the combined effects of these interventions, TRT+RT, may maximize the beneficial effects on muscle quality after SCI. Methods Twenty-two SCI subjects randomized into either a TRT+RT (n = 11) or TRT (n = 11) intervention for 16 weeks. Muscle quality measured by peak torque at speeds of 0, 60, 90, and 180°·sec-1 (PT-0°, PT-60°, PT-90°, PT-180°), knee extensor CSA (KE-CSA), specific tension (ST), and contractile speed (rise time [RTi], and half-time to relaxation [½TiR]) was assessed for each limb at baseline and post-intervention using 2x2 mixed models. Results Following 16-weeks subjects in the TRT+RT group increased PT-0° (48.4%, P = 0.017), KE-CSA (30.8%, P < 0.0001), and RTi (17.7%, P = 0.012); with no significant changes observed in the TRT group. Regardless of the intervention, changes to PT-60° (28.4% P = 0.020), PT-90° (26.1%, P = 0.055), and PT-180° (20.6% P = 0.09) for each group were similar. Conclusion The addition of mechanical stress via RT to TRT maximizes improvements to muscle quality following complete SCI when compared to TRT administered alone. Our evidence shows that this intervention increases muscle size and strength, while also improving muscle contractile properties. CORRESPONDING AUTHOR: Ashraf S. Gorgey, MPT, PhD, FACSM, FACRM, Hunter Holmes McGuire VA Medical Center, Spinal Cord Injury & Disorders Service, 1201 Broad Rock Blvd, Richmond, VA 23249, USA, Phone: (804) 675-5000 ext. 3386, Email: ashraf.gorgey@va.gov This work was supported by funding from the United States Department of Veteran Affairs: VA-RRD CDA2 (B7867-W). We, the authors, affirm that we have no financial interests or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript. Our study design, collection, analysis, and reporting of results were not influenced by our funding source. The results of the present study do not constitute endorsement by the ACSM. The results of the present study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 1 March 2019 © 2019 American College of Sports Medicine |
| Fat Oxidation Rates in Professional Soccer Players Purpose Large inter-individual variation exists in maximal fat oxidation rates (MFO) and the exercise intensity at which it occurs (FATMAX). However, there is no data describing the shape of the fat oxidation curve or, if individual differences exist when tested on separate occasions. Furthermore, there is limited data on fat metabolism in professional team sport athletes. Therefore, the aim of this study was to test-retest the concavity (shape) and intercept (height) of fat oxidation curves within a group of professional soccer players. Method On two occasions 16 professional male soccer players completed a graded exercise test in a fasted state (≥5 h). Rates of fat oxidation were determined using indirect calorimetry. Maximal oxygen uptake (VO2max) was measured to calculate FATMAX (%VO2max). The shape of the fat oxidation curves were modelled on an individual basis using third degree polynomial. Test-by-test differences, in the shape and vertical shift of the fat oxidation curves, were established to assess within-individual variability. Results Average absolute MFO was 0.69 ± 0.15 g[BULLET OPERATOR]min-1 (range 0.45 – 0.99g[BULLET OPERATOR]min-1). On a group level, no significant differences were found in MFO between the two tests. No differences were found (p>0.05) in the shape of the fat oxidation curves in 13/16 players (Test1 vs. Test2). There were also no differences (p>0.05) in the vertical shift of the fat oxidation curves in 10 players. Conclusion In general, the shape of the fat oxidation curve does not change within an individual however the vertical shift is more susceptible to change, which may be due to training status and body composition. Understanding a player's metabolism may be of value to practitioners working within sport, with regards to personalising nutrition strategies. Address for Correspondence: Rebecca K. Randell, Gatorade Sports Science Institute, PepsiCo Global R&D, Beaumont Park, 4 Leycroft Road, LEICESTER, LE4 1ET, United Kingdom. Email: rebecca.randell@pepsico.com The results of this study are presented clearly, honestly and without fabrication or inappropriate data manipulation and statement that results of the present study do not constitute endorsement by ACSM. R.R, J.C, I.R are employees of The Gatorade Sports Science Institute (GSSI), a division of PepsiCo, Inc. MA.L and J.Y are employees of FC Barcelona. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of PepsiCo, Inc. Financial support for this study was provided by the Gatorade Sports Science Institute, a division of PepsiCo, Inc. Accepted for publication: 26 February 2019. © 2019 American College of Sports Medicine |
| Shared Neuromuscular Performance Traits in Military Personnel with Prior Concussion Concussions are common in military personnel and may result in increased risk of musculoskeletal injury. One plausible explanation for this risk could be that neuromotor deficiencies enhance injury risk following concussion through altered muscular activation/contraction timing. Purpose To compare military personnel with at least one concussion during the past 1 month to 2 years (CONCUSSED) to military branch-, age- and Special Operations Forces group- matched controls (CONTROL) on physiological, musculoskeletal and biomechanical performance. Methods A total of 48 (24 CONCUSSED, 24 CONTROL) male Air Force and Naval Special Warfare Operators aged 19-34 years participated in the study. Participants self-reported demographics/injury history and completed the following assessments: 1) physiological- body composition, anaerobic power and capacity, aerobic capacity and lactate threshold; 2) musculoskeletal- lower extremity isokinetic strength testing, including time to peak torque; and 3) biomechanical- single-leg jump and landing task, including landing kinematics of the hip, knee and ankle. A machine learning decision tree algorithm (C5.0) and one-way ANOVA were used to compare the two groups on these outcomes. Results Despite non-significant differences using ANOVA, the C5.0 algorithm revealed CONCUSSED demonstrated quicker time to peak knee flexion angle during the single-leg landing task (<=0.170 secs; CONCUSSED: n=22 vs. CONTROL: n=14), longer time to peak torque in knee extension isokinetic strength testing (>500 msecs; CONCUSSED: n=18 vs. CONTROL: n=4) and larger knee flexion angle at initial contact (>7.7°; CONCUSSED: n=18 vs. CONTROL: n=2). Conclusion The findings supported the hypothesis that CONCUSSED military personnel would demonstrate altered neuromuscular control in landing strategies and muscular activation. Future research should assess prospectively neuromuscular changes following concussion and determine if these changes increase risk of subsequent musculoskeletal injuries. Corresponding Author: Shawn R. Eagle, 3860 S. Water St, Pittsburgh, PA 15203. (p): 412-246-0460. (e): seagle@pitt.edu The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of this study do not constitute endorsement by ACSM. The authors have no conflicts of interest to report. This study was funded by Air Force Special Operations Command (#FA8650-12-2-6271) and Office of Naval Research (#N00014-11-1-0929). Opinions, interpretations, conclusions, and recommendations are those of the authors and not necessarily endorsed by the Department of Defense, US Navy, US Air Force or Naval Special Warfare. Accepted for publication: 28 February 2019. © 2019 American College of Sports Medicine |
| Compositional Influence of Movement Behaviours on Bone Health during Ageing Introduction and Purpose Physical activity (PA) is considered the best non-pharmacological treatment for the decrease in bone mass (BM) produced during ageing. Therefore, it is essential to assess how the time spent in PA is distributed in order to control further changes. This work examines the relationship between movement behaviours and BM during ageing, using compositional data analysis. Methods We studied 227 older people aged 65 to 94 (102 men and 125 women) divided by sex and bone status, over a period of 4 years. Time spent in sedentary behaviour (SB), light PA (LPA) and moderate-to-vigorous PA (MVPA), was assessed using accelerometry. BM was determined by dual-energy X-ray absorptiometry. Results The changes in MVPA was positively associated with the rate of BM decay at spine and leg in the whole sample and men's subgroup (p≤0.05). In women, the rate of BM decay at spine and Ward's triangle were negatively associated with SB changes and BM decay at femoral neck and Ward's was positively associated with LPA (p≤0.05). Conclusion Increasing MVPA related to other movement behaviours produces improvements in the rate of bone change in older men; while to increase LPA and maintain MVPA would be the best approach to enhance bone mass in older women. Corresponding Author: Ignacio Ara, PhD, GENUD Toledo Research Group; University of Castilla-La Mancha, Avda Carlos III s/n; 45071 Toledo, Spain. Phone: +34 925 268 800 Ext 5543. Email: ignacio.ara@uclm.es Equal contribution (Francisco J. García-García and Ignacio Ara) This work was supported by the Biomedical Research Networking Centre on Frailty and Healthy Ageing (CIBERFES) and FEDER funds from the European Union (CB16/10/00477) and (CB16/10/00456). It was further funded by grants from the Government of Castilla-La Mancha (PI2010/020; Institute of Health Sciences, Ministry of Health of Castilla-La Mancha, 03031-00), Spanish Government (Spanish Ministry of Economy, "Ministry of Economy and Competitiveness," The Carlos III Institute of Health, PI10/ 01532, PI031558, PI11/01068), and by European Grants (Seventh Framework Programme: FRAILOMIC). IRG and AM received a PhD grant from the University of Castilla-La Mancha "Pre-doctoral contracts for the training of research staff in the framework of its own programme of I+D+I, cofinanced by the European Social Fund" (2014/10340 and 2015/4062, respectively). The authors report no conflict of interest and they affirm that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by the American College of Sports Medicine. Accepted for publication: 14 February 2019. © 2019 American College of Sports Medicine |
| Persistent Impairment in Cardiopulmonary Fitness following Breast Cancer Chemotherapy Purpose Anthracycline chemotherapy (AC) is associated with acute reductions in cardiopulmonary fitness (VO2peak). We sought to determine whether changes in VO2peak and cardiac function persisted at 12-months post-AC completion, and whether changes in cardiac function explain the heightened long-term heart failure risk. Methods Women with breast cancer scheduled for AC (n=28) who participated in a non-randomized trial of exercise training (ET; n=14) or usual care (UC; n=14) during AC completed a follow-up evaluation 12-months post-AC completion (16-months from baseline). At baseline, 4-months, and 16-months, participants underwent a resting echocardiogram (left ventricular ejection fraction, LVEF; global longitudinal strain, GLS), a blood sample (troponin; b-type natriuretic peptide), a cardiopulmonary exercise test, and cardiac MRI measures of stroke volume (SV), heart rate (HR) and cardiac output (Qc) at rest, and during intense exercise. Results Seventeen women (UC: n=8; ET: n=9) completed evaluation at baseline, 4-months and 16-months. At 4-months, AC was associated with 18% and 6% reductions in VO2peak in the UC and ET groups respectively, that persisted at 16-months (UC: -16%; ET: -7%), and was not attenuated by ET (interaction, P=0.10). Exercise Qc was lower at 16-months compared to baseline and 4-months (P<0.001), which was due to a blunted augmentation of SV during exercise (P=0.032; a 14% reduction in peak SV), with no changes in HR response. There was a small reduction in resting LVEF (baseline to 4-months) and GLS (between 4-months and 16-months), and an increase in troponin (baseline to 4-months), but only exercise Qc was associated with VO2peak (R2=0.47, P<0.01). Conclusion Marked reductions in VO2peak persisted 12-months following anthracycline-based chemotherapy, which was associated with impaired exercise cardiac function. Clinical Trial Registration: ACTRN12616001602415 Address for correspondence: Associate Professor André La Gerche, Head, Clinical Research Domain, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne 3004, VIC, Australia. Phone: +61 38532 1143. Fax: +61 38532 1899. E-mail: Andre.LaGerche@baker.edu.au This project was supported by a project grant from the Jack Brockhoff Foundation, Australia (JBF 4039). Andre La Gerche is supported by a Career Development Fellowship from the National Health and Medical Research Council (NHMRC 1089039) and a Future Leaders Fellowship from the National Heart Foundation (NHF 100409) of Australia. Stephen Foulkes is supported by an Australian Government Research Training Program Scholarship (RTP 4635089552). Professor Haykowsky is funded, in part, by the Moritz Chair in Geriatrics in the College of Nursing and Health Innovation at the University of Texas at Arlington. The authors have no conflict of interest. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for publication: 16 February 2019. © 2019 American College of Sports Medicine |
| High-Intensity Aerobic Exercise Acutely Increases Brain-derived Neurotrophic Factor Aerobic exercise (AEx) exerts antidepressant effects, although the neurobiological mechanisms underlying such effects are not well understood. Reduced brain-derived neurotrophic factor (BDNF) and elevated cortisol have been implicated in the pathophysiology of depression and appear to normalize with antidepressant treatment. Thus BDNF and cortisol may serve as biological targets for developing AEx as an antidepressant treatment. Purpose This study examined the effects of AEx, of different intensities, on serum BDNF and cortisol in individuals with and without depression. Methods Thirteen participants with depression (10 female; age = 27.2 ± 6.9; Montgomery-Äsberg Depression Rating Scale (MADRS) = 21.7 ± 4.7) and thirteen control participants (10 female; age 27.2 ± 7.2; MADRS = 0.5 ± 0.9) participated. Experimental visits consisted of 15 minutes of low intensity cycling (LO) at 35% heart rate reserve (HRR), high intensity cycling (HI) at 70% HRR, or sitting (CON). During each visit, blood samples were obtained at baseline, immediately post-exercise (IP), and then every fifteen minutes post-exercise for one hour (15P, 30P, 45P, 60P). Group, condition, and time differences in BDNF and cortisol were assessed. Results There were no group differences in cortisol and BDNF. Secondary analysis revealed that BDNF increased in an intensity-dependent nature at IP and cortisol was significantly elevated at 15P following HI. Changes in BDNF and cortisol showed significant linear relationships with changes in HR. Conclusion HI AEx can elicit acute, transient increases in BDNF and cortisol in young, healthy, and physically active, non-depressed and mild-moderately depressed individuals. This work suggests AEx has potential to significantly impact central nervous system function and the magnitude of such impact may be directly driven by exercise intensity. Corresponding author: Ryan E. Ross, 77 President St., MSC 700, Charleston, SC 29425. (p) 843-792-3477. (e) rossre@musc.edu This project was supported by funding from the National Institute of General Medical Sciences under grant number P20-GM109040 and by MUSC's Clinical and Translational Science Award grant UL1 TR001450 from the National Center for Advancing Translational Sciences (NCATS). Conflict of Interest. The authors have no conflicts to report. The results of this study do not constitute endorsement by the American College of Sports Medicine. The results are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for publication: 24 February 2019. © 2019 American College of Sports Medicine |
| Effects of Exercise on Stress-induced Attenuation of Vaccination Responses in Mice Studies suggest that exercise can improve vaccination responses in humans. Chronic stress can lead to immunosuppression, and there may be a role for exercise in augmenting immune responses. Purpose To investigate the effects of acute eccentric exercise (ECC) and voluntary wheel exercise training (VWR) on antibody and cell-mediated immune responses to vaccination in chronically stressed mice. We hypothesized that both ECC and VWR would attenuate chronic stress-induced reductions in vaccination responses. Methods Mice were randomized into four groups: Control (CON), Stress (S)-ECC, S-VWR, and S-Sedentary (SED). Stressed groups received chronic restraint stress for 6 h/day, 5 days/wk for three weeks. After the first week of stress, S-ECC were exercised at 17m/min speed at -20% grade for 45 minutes on a treadmill and then intramuscularly injected with 100μg of ovalbumin and 200μg of alum adjuvant. All other groups were also vaccinated at this time. Stress-VWR mice voluntarily ran on a wheel for the entire experiment. Plasma was collected prior to, and at one, two and four weeks post-vaccination. ELISA was performed to analyze anti-OVA IgG and IgM antibodies. After three weeks of chronic stress, all mice were injected with OVA into the ear to determine the delayed-type hypersensitivity (DTH). Results We found that chronic restraint stress significantly reduced body weight and caused adrenal hypertrophy. We also found both S-ECC and S-VWR groups had significantly elevated anti-OVA IgG (p < 0.05) while no significant differences between the two exercise groups. Neither S-ECC nor S-VWR altered anti-OVA IgM or DTH responses compared to S-SED group. Conclusion Acute eccentric exercise and voluntary exercise training alleviated the chronic stress-induced anti-OVA IgG reductions in vaccination responses. Corresponding Author: Jeffrey A. Woods, 1008B Khan Annex/Huff Hall, 1204 S. 6th Street, Champaign, IL 61820. woods1@illinois.edu. (217) 244-8815 The authors state that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The authors report no conflict of interest. The results of the present study do not constitute endorsement by ACSM. Accepted for publication: 25 February 2019. © 2019 American College of Sports Medicine |
| High-Intensity Interval Training Improves Left Ventricular Contractile Function Introduction Improved myocardial contractility is a critical circulatory adaptation to exercise training. However, the types of exercise that enhance left ventricular (LV) contractile and diastolic functions have not yet been established. This study investigated how high-intensity interval (HIIT) and moderate-intensity continuous training (MICT) influence LV mechanics during exercise. Methods Fifty-four healthy sedentary males were randomized to engage in either HIIT (3-minute intervals at 40% and 80% of VO2max, n=18) or MICT (sustained 60% of VO2max, n=18) for 30 minutes/day, 5 days/week for 6 weeks or to a control group (CTL, n=18) that did not engage in exercise intervention. LV mechanics during semi-upright bicycle exercise tests were measured by two-dimensional speckle-tracking echocardiography. Results Before the interventions, acute bicycle exercise increased (i) peak basal/apical radial and circumferential and peak longitudinal strains and strain rates (SRs), (ii) peak basal/apical rotations and torsion, and (iii) peak systolic twisting and early diastolic untwisting velocities in the LV. After the interventions, the HIIT group exhibited greater LV mass and diastolic internal diameter as well as higher E/A ratio and early diastolic propagation velocity than the MICT group. Despite decreased peak apical rotation and torsion, HIIT enhanced peak apical radial strain and SR as well as shortened the time to reach peak untwisting velocity in the LV during exercise. However, the LV mechanics during exercise were unchanged in the CTL group. Conclusion HIIT but not MICT induces eccentric myocardial hypertrophy. Moreover, HIIT effectively improves the LV mechanics during exercise by increasing contractile and diastolic functions. Correspondence to: Professor, Jong-Shyan Wang Graduate Institute of Rehabilitation Science Chang Gung University 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, 333, Taiwan. E-mail: s5492@mail.cgu.edu.tw This work was supported by the National Science Council of Taiwan (grant number NSC 100-2314-B-182-004-MY3), Chang Gung Medical Research Program (grant number CMRPD1A0131), and Healthy Aging Research Center, Chang Gung University (grant number EMRPD1A0841). The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. No conflicts of interest, financial or otherwise, are declared by the authors. Submitted for publication January 2018. Accepted for publication February 2019. © 2019 American College of Sports Medicine |
Κυριακή 17 Μαρτίου 2019
Medicine & Science in Sports & Exercise
Σάββατο 16 Μαρτίου 2019
Palaeogeography, Palaeoclimatology, Palaeoecology
| Aberrations in the infrabasal circlet of the cladid crinoid genus Cupulocrinus (Echinodermata) and implications for the origin of flexible crinoids Publication date: 15 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 522 Author(s): M.E. Peter AbstractFlexible crinoids (subclass Flexibilia) likely originated from the cladid crinoid genus Cupulocrinus or one of its immediate ancestors in the Middle to Late Ordovician. A remarkably constant and clade-defining character of flexible crinoids is the possession of three plates in the infrabasal circlet of the calyx. This character was a significant morphological modification for the origin of the flexible clade, resulting from the reduction of the number of infrabasal plates from five plates in the ancestral cupulocrinid. Of 615 museum specimens of Cupulocrinus sp. for which the number of infrabasal plates could be determined, 21 specimens, or 3.4%, displayed a deviation from the normal five infrabasals. Of the aberrant specimens, fifteen have four infrabasal plates, and six have six infrabasal plates. An additional aberrant specimen has five infrabasals, with one significantly reduced in size. Although the number of infrabasals is typically thought to be constant within a species, this trait appears to have been variable in the immediate ancestor of flexible crinoids, in the time period just before the number of infrabasals became fixed at three for the Flexibilia. This paper documents the range of aberrations within the infrabasal circlet of Cupulocrinus and considers the implications for the origin of the flexible crinoids. Graphical abstract |
| Sedimentary pyrite framboid size-frequency distributions: A meta-analysis Publication date: 15 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 522 Author(s): David Rickard AbstractFramboids, microscopic sub-spheroidal aggregates of pyrite microcrystals, are found in sediments of all ages and framboid size-frequency distributions are widely used to determine the oxygenation states of paleo-waters. Sedimentary framboid populations display unimodal log-normal size distributions as a consequence of the multiplicative central limit theorem in probability theory. The application of additive statistics to framboid populations and their consequent characterization in terms of arithmetic means and standard deviations is wrong because it predicts a subset of framboids with negative diameters. A meta–analysis of 377 sets of measurements of the diameters of 48,063 pyrite framboids from 104 sediment and sedimentary rock locations shows that the geometric mean diameter of sedimentary framboids is 6.2 μm and the geometric standard deviation is 1.5. Ninety-five percent of all sedimentary framboids have geometric mean diameters between 2.9 and 13.9 μm. The geometric mean diameter of modern syngenetic framboids formed within euxinic water columns is 4.7 μm and that of diagenetic framboids formed within sediments is 6.7 μm. The estimated measurement error is ±10%. Framboid mean diameters can be used to help discriminate the oxygenation state of paleo-waters. A minimum number of 30 measurements is required and ideally ≥100 measurements are recommended. The conflicting evidence reported in the literature for the application of framboid size-frequency measurements results mainly from the intrinsic nature of statistical analyses: there is always a finite chance that a particular framboid size-frequency distribution is a result of either syngenetic or diagenetic processes. Including the systematic stereological error in framboid size measurements, the geometric mean size range for syngenetic framboids is 2.9–10.9 μm and that for diagenetic framboids 3.1–20.9 μm. This suggests a significant overlap in geometric mean diameters of framboids from euxinic and non-euxinic environments between ~3 and ~11 μm. Geometric mean framboid diameters within this size range are not robust proxies for paleo-water oxygenation conditions. The origin of the smaller sizes of syngenetic compared with diagenetic framboids appears to be related to the limited time available for framboid crystal growth within the water column. The statistical uncertainty in assigning particular framboid size-frequency distributions to defined oxygenation conditions results mainly from (a) some diagenetic framboids forming over a limited time, thereby also producing smaller framboids and (b) mixtures of syngenetic and diagenetic framboid populations through unavoidable time-averaging of samples. The absence of any significant differences in the sizes of modern and ancient framboids indicates that framboids do not continue to grow over extended time periods: once formed they remain the same over geologic time periods and only change through infilling, overgrowth and recrystallization. The result is that ancient framboids may sample the contemporary paleoenvironment in the sedimentary system in which they are found. |
| Combining machine learning algorithms and geometric morphometrics: A study of carnivore tooth marks Publication date: 15 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 522 Author(s): Lloyd A. Courtenay, José Yravedra, Rosa Huguet, Julia Aramendi, Miguel Ángel Maté-González, Diego González-Aguilera, Mari Carmen Arriaza AbstractSince the 1980s an intense scientific debate has revolved around the hunting capacities of early hominin populations and the behavioral patterns of carnivores sharing the same ecosystem, and thus competing for the same resources. This debate, commonly known as the hunter-scavenger debate, fostered the emergence of a new research line into the Bone Surface Modifications (BSMs) produced by both taphonomic agents. Throughout the following 20 years, multiple studies concerning the action of carnivores have been developed, with a particular focus on the oldest archaeological sites in East Africa. Recent technological advances applied to taphonomy have provided new insight into carnivore BSMs. A newly developed part of this work relies on Geometric Morphometrics (GMM) studies aimed at discerning carnivore agency through the morphologic characterization of tooth scores and pits. GMM studies have produced promising results, however methodological limitations are still present. This paper presents the first combined application of Machine Learning (ML) algorithms and GMM to the analysis of carnivore tooth marks, generating classification rates of 100% between carnivore species in some cases. |
| A robust vegetation-based elevation transfer method for reconstructing Arctic polygon mire palaeo-microtopography Publication date: 15 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 522 Author(s): Annette Teltewskoi, Dierk Michaelis, Lutz Schirrmeister, Hans Joosten, Ulf Schiefelbein, Michael Manthey AbstractThe reconstruction of past environments by means of macrofossil and pollen analysis is commonly based on the modern ecological preferences of the taxa that may have produced these fossils. Here we present a modelling approach, in which we use modern vegetation–surface height relationships to quantify past surface heights in an Arctic ice-wedge polygon mire. Vegetation composition and ground surface height (GSH) were assessed in a polygon mire near Kytalyk (Northeastern Siberia). Cluster analysis revealed five plant communities, which are clearly separated with respect to ground surface height, frost surface height and coverages of open water and vegetation. Based on the composition of modern vegetation we constructed two sets of potential fossil types (plant macrofossils and pollen), an extensive one and a more restricted one to reflect different conditions of preservation and recognisability. We applied Canonical Correspondence Analysis to model the relationships between potential fossil types and measured GSH. Both models show a strong relationship between modelled and measured GSH values and a high accuracy in prediction. Finally, we used the models to predict GSH values for Holocene peat samples and found a fair correspondence with expert-based multi-proxy reconstruction of wetness conditions, even though only a minor part of the encountered fossils were represented in the GSH models, illustrating the robustness of the approach. Our approach can be used to reconstruct palaeoenvironmental conditions in a more objective way and can serve as a template for further palaeoecological studies. Graphical abstract |
| The evolution and control of detrital sediment provenance in the middle and northern Okinawa Trough since the last deglaciation: Evidence from Sr and Nd isotopes Publication date: 15 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 522 Author(s): Fuqing Jiang, Zhifang Xiong, Martin Frank, Xuebo Yin, Anchun Li AbstractThe Okinawa Trough (OT) is a large sink of sediments supplied by the East Asian continent. Identifying the provenance of the OT sediments is key to reconstructing the temporal and spatial variations of the terrigenous supply to this area and is important for understanding the impact of paleoclimatic and paleoceanographic variability on the sediment supply to this marginal sea over the late Quaternary. In this contribution, we show that radiogenic strontium (Sr) and neodymium (Nd) isotopes allow to efficiently distinguish Yellow and Yangtze/Taiwan River detrital sediments, and can be used to reconstruct distinct changes in the provenance of the detrital fraction of marine sediments from the middle and northern OT since the last deglaciation. The Sr and Nd isotope signatures are compared to those of the potential sediment sources, namely the Yellow and Yangtze Rivers, the Taiwan orogen, and volcanic material from the OT and nearby islands, and the relative contributions of these sources are reconstructed. The Sr and Nd isotope compositions of the detrital fraction in the two sediment cores recovered from the middle and northern OT show that the sediments mainly originated from the Yangtze River between 18 and 10.5 ka, which was caused by low sea level and a widely developed channel system on the continental shelf. During the period between 10.5 and 7.0 ka, the rising sea level resulted in elevated Yangtze and Yellow Rivers sediment input into the OT. Simultaneously, large-scale volcanic activity also contributed significant amounts of material to the OT. During the last 7.0 ka, besides important contributions from the Yellow River, the intensification of the Kuroshio Current resulted in increased delivery of sediment from Taiwan to the OT. |
| The Permian-Triassic transition in ocean island setting: Environmental disturbances and new high-resolution carbon-isotope record from the Qiangtang Basin, NW China Publication date: 15 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 522 Author(s): Xiugen Fu, Jian Wang, Chunyan Song, Zhongwei Wang, Shengqiang Zeng, Dong Wang AbstractThe Permian-Triassic boundary (PTB) events such as carbon-isotope excursion, volcanism, and environmental disturbances are not well understood in an ocean island setting. Here, we develop a new case study for the Permian-Triassic transition in the Qiangtang Basin, Tibet, by combining existing biostratigraphy, new carbon-isotope data, sedimentological data, U |
| Phylogenetic community paleoecology of one of the earliest complex crinoid faunas (Brechin Lagerstätte, Ordovician) Publication date: 1 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 521 Author(s): Selina R. Cole, David F. Wright, William I. Ausich AbstractIntegrating phylogenetic biology with paleoecology can provide a valuable context for understanding patterns of community structure and niche partitioning in ancient ecosystems. However, the lack of robust phylogenies for many fossil taxa precludes studies of this nature, particularly among marine invertebrates. Fossil Crinoidea (Echinodermata) comprise an ideal model system for phylogenetic community paleoecology for three reasons: (1) they preserve anatomical features that directly relate to feeding ecology, (2) assemblages of well-preserved specimens represent "ecological snapshots" in time, and (3) recent advances in resolving the crinoid tree of life have produced high-resolution phylogenies for Ordovician lineages. Here, we apply multivariate and phylogenetic comparative methods to investigate patterns of paleocommunity structure, niche partitioning, and ecomorphospace occupation in one of the earliest known complex crinoid paleocommunities, the Brechin Lagerstätte (Upper Ordovician, Katian). Results indicate niche differences among species were determined primarily by characters related to filtration fan morphology. Filtration fan density and body size distributions support phylogenetic niche conservatism, but traits related to the size of the feeding area are more labile and exhibit greater divergence than expected among closely related species. Finally, we compare changes in the shape and phylogenetic structure of niche distributions between the Brechin Lagerstätte and the Edwardsville crinoid fauna, a well-studied Mississippian (Viséan) paleocommunity, to examine patterns of community change across the Early to Middle Paleozoic Crinoid Macroevolutionary Faunas. |
| Paleoenvironmental changes during the late Albian oceanic anoxic event 1d: An example from the Capacho Formation, southwestern Venezuela Publication date: 1 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 521 Author(s): María-Emilia Rodríguez-Cuicas, Jean-Carlos Montero-Serrano, Grony Garbán AbstractThe late Albian–early Cenomanian oceanic anoxic event 1d (OAE-1d; ~103 to 99.5 Ma) represents a global interval of enhanced organic carbon burial due to widespread oxygen deficiency in the water column and/or increased primary productivity. The biostratigraphy and geochemistry of organic-rich sediments in the La Grita Member (Capacho Formation) in southwestern Venezuela were studied to document the paleoenvironmental conditions that governed the deposition of this succession during OAE-1d. Carbon-isotope (δ13Ccarb and δ13CCorg) chemostratigraphy and biostratigraphic constraints show that the La Grita Member spans the late Aptian period (Rotalipora appenninica Zone), and that OAE-1d is well recorded in this succession. A prominent increase in total organic carbon (TOC) values (up to 10%) is clearly recorded through the onset of OAE-1d, coinciding with a prominent change in overall redox-sensitive proxies suggesting that the La Grita Member sediments accumulated under anoxic (and possibly euxinic) bottom-water conditions in a partially restricted basin. The detrital proxies suggest that the greenhouse climate prevailing during OAE-1d induced significant acceleration of the hydrologic cycle and an increase in continental chemical weathering rates. Overall, the carbon and oxygen isotope records, TOC contents, as well as the detrital proxies show cyclic variation during the late Albian stage. These variations support the hypothesis that orbital forcing likely also modulated the equatorial monsoonal activity during the OAE-1d. |
| Monsoon-influenced variations in plankton community structure and upper-water column stratification in the western Bay of Bengal during the past 80 ky Publication date: 1 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 521 Author(s): Yuki Ota, Junichiro Kuroda, Asuka Yamaguchi, Atsushi Suzuki, Daisuke Araoka, Toyoho Ishimura, NGHP Expedition 02 JAMSTEC Science Team, Hodaka Kawahata AbstractTo enhance our understanding of the forcing factors of marine biological community structure in the Bay of Bengal, we studied proxies for biogenic carbonate and silicate production in the western Bay of Bengal and compared them with proxies for upper-ocean stratification and strength of the Indian summer monsoon (ISM). Specifically, we investigated the record in a sediment core from the western Bay of Bengal that extended to approximately 80 ky before the present (BP). The records of Globigerinoides ruber sensu stricto δ18O minus Neogloboquadrina dutertrei δ18O (Δδ18Or–d) were used to investigate changes in upper-ocean stratification. We reconstructed variations in mass accumulation rates (MARs) of CaCO3 and biogenic silica (BSi) to discuss plankton community structure. Greater difference between Globigerinoides ruber sensu stricto δ18O and Neogloboquadrina dutertrei δ18O during the marine isotope stage (MIS) 1 and 5a indicate intervals with less saline and more stratified conditions. In contrast, the relatively small difference between both planktic foraminiferal δ18O during MIS 2 and 4 indicates diminished stratification during these periods. Elevated carbonate production during MIS 2 and 4, demonstrated by the increase in CaCO3 MAR, could have been driven by lower freshwater influx to the western Bay of Bengal resulting from lower ISM precipitation, and thus the increased mixing and upwelling of deep nitrate into the photic zone. The relative increase in BSi MAR during periods of high ISM precipitation and decreased salinity of surface waters suggests a limited recovery in biological siliceous production under interglacial conditions, possibly due to enhanced fluvial SiO4 delivery to the ocean. Fluctuations of Δδ18Or–d during MIS 3 indicate that freshwater stratification was moderate and insufficient to restrict upwelling. This might have induced moderate biogenic silica and carbonate productions during this period. |
| Recovery of benthic communities following the Toarcian oceanic anoxic event in the Cleveland Basin, UK Publication date: 1 May 2019 Source: Palaeogeography, Palaeoclimatology, Palaeoecology, Volume 521 Author(s): Bryony A. Caswell, Stephanie J. Dawn AbstractDuring the Toarcian oceanic anoxic event (OAE) considerable environmental changes occurred that were associated with global warming, perturbations to the C-cycle and ocean deoxygenation which resulted in a mass extinction of marine fauna. Recovery of the biota after the event was protracted and has to date undergone limited study. However, understanding the patterns and processes of recovery are critical to anticipating ecosystem responses to the environmental changes predicted for the near future. Results showed that increases in benthic diversity, and the re-establishment of the Toarcian infauna was gradual and followed the changing redox conditions. Pioneering infauna, such as Dacryomya ovum that dominated the seafloor after the event in the Cleveland Basin, Yorkshire, UK, can modify the physico-chemical environment and thus facilitate ecological succession after disturbance. The length of D. ovum increased >8 mm throughout the bifrons Zone and these body-size changes were linked with total organic carbon (TOC) content suggesting a link to primary productivity, although only at intermediate levels of deoxygenation. Major changes in the phytoplankton, and so food supply, seem to have driven changes in bivalve body size, across trophic guilds, both during and after the event in Yorkshire, and on the mid to lower shelf in Spain and France, respectively. Primary productivity collapse seems then to have been a major driver of biotic change throughout the Toarcian event, as it was during the Permian–Triassic, Triassic/Jurassic and Cretaceous/Tertiary mass extinctions. Further investigation of both the palaeontological and geochemical changes that occurred within early successional Toarcian infaunal communities are required to more fully understand the pattern of recovery after the OAE. |
Agriculture and Human Values
Gendered agrobiodiversity management and adaptation to climate change: differentiated strategies in two marginal rural areas of IndiaAbstractSocial and cultural contexts influence power dynamics and shape gender perceptions, roles, and decisions regarding the management of agrobiodiversity for dealing with and adapting to climate change. Based on a feminist political ecology framework and a mixed method approach, this research performs an empirical analysis of two case studies in the northern of India, one in the Himalayan Mountains and another in the Indian-Gangetic plains. It explores context-specific (i) influence of gender roles and responsibilities on on-farm agrobiodiversity management (ii) gendered expertise and knowledge related to agrobiodiversity and (iii) gendered preferences for practices and institutional arrangements for agrobiodiversity conservation linked to adaptation to climate change. In the Himalayan mountains women actively participate in crop and seed management decisions and tasks, and maintain informal institutions for seed and services exchanges in the case of crisis, which simultaneously favours high levels of agrobiodiversity and enhances women's social status. By contrast, in the Indio-Gangetic plains, where women from better-off households are socially secluded and women from poorer households work mainly as labourer to respond to high out-migration of men, they exercise less public control over agrobiodiversity, with their role being mainly invisible at the homestead and related to post-production tasks. We finally discuss as improved understanding of the links between gendered spaces, crops, tasks, social status, and agrobiodiversity management can facilitate the design of gender-sensitive policy interventions for conservation and adaptation to climate change. |
| Symposium introduction—ethics and sustainable agri-food governance: appraisal and new directions |
| Book review: Steve Ventura and Martin Bailkey (eds): Good food, strong communities: promoting social justice through local and regional food systems |
| Jennifer Meta Robinson and James Robert Farmer: Selling local: why local food movements matter |
| Collen Murphy, Paolo Gardoni and Robert McKim (eds): Climate change and its impacts: risks and inequalities |
| Stephanie Paladino and Shirley J. Fiske (Eds): The carbon fix: forest carbon, social justice, and environmental governance |
| Brandi Janssen: Making local food work: the challenges and opportunities of today's small farmers |
| Books received |
The importance of food retailers: applying network analysis techniques to the study of local food systemsAbstractAs local food activities expand and grow, an important question to answer is how various participants contribute to a local food system's overall vitality and strength. This paper does so by focusing on the relationships between locally-oriented farm and retail actors and assessing what the configuration of these relationships tells us about the workings of the broader local food system. Such an analysis reveals two things. Empirically, it shows the important role food retailers play in the overall vibrancy of local food exchanges: food retailers form crucial links holding the broader system together and significantly expanding consumer access to local foods. Further, different retailer types have distinct impacts on network configurations, each serving particular roles in the development and maintenance of local food systems. Methodologically, this paper shows the value of applying social network analysis techniques to the study of local food systems: such an approach yields insights that may not be as readily assessable from other strategies. In this paper, I overview common network analysis techniques and apply them to a case study of local food activities in New England, suggesting how such an approach might be applied to local food systems in other places. |
Challenging the urban–rural dichotomy in agri-food systemsAbstractThe idea of a profound urban–rural divide has shaped analysis of the 2016 U.S. presidential election results. Here, through examples from agri-food systems, we consider the limitations of the urban–rural divide framework in light of the assumptions and intentions that underpin it. We explore the ideas and imaginaries that shape urban and rural categories, consider how material realities are and are not translated into U.S. rural development, farm, and nutrition policies, and examine the blending of rural and urban identities through processes of rural deagrarianization and urban reagrarianization. We do not argue that an urban–rural divide does not exist, as studies and public opinion polls illustrate both measured and perceived differences in many aspects of the lived experiences that shape our individual and collective actions. Ultimately, we suggest that the urban–rural divide concept obscures the diversity and dynamism of experiences each category encompasses. Additionally, it ignores the connections and commonalities that demand integrative solutions to challenges in agri-food systems, and draw attention to the power relations that shape resource access and use within and across urban and rural spaces. |
Dermatology
| Update on management of polycystic ovarian syndrome for dermatologists Shalini Gainder, Bharti Sharma Indian Dermatology Online Journal 2019 10(2):97-105 Polycystic ovarian syndrome (PCOS) is the commonest endocrine disorder in women having wide range of clinical manifestation. These women may present with reproductive, dermatological, metabolic, psychological, or neoplastic implications from adolescence to menopause. The common dermatological manifestations include hirsutism, acne, alopecia, or acanthosis nigricans. Women presenting with these dermatological manifestations must be evaluated for PCOS. A multidisciplinary team approach involving a reproductive endocrinologist, dermatologist, psychologist/psychiatrist, dietician, and sometimes a bariatric surgeon should be undertaken for long-term management of these patients. Unless metabolic and underlying endocrinal disturbances arecorrected and simultaneous life-style modification is adopted, cosmetic treatment would give only temporary relief. |
| Recent laboratory advances in diagnostics and monitoring response to treatment in leprosy Utpal Sengupta Indian Dermatology Online Journal 2019 10(2):106-114 The present review briefly summarizes the highlights of the recent advances in Mycobacterium leprae-specific tests for early diagnosis of leprosy. In addition to establishing the diagnosis of clinical cases of leprosy, these tests have also been used to detect subclinical infections in endemic population. Several attempts have been made from 1980 onward for standardization of specific diagnostic assays for early detection of leprosy. Brief account about the development and use of these assays has been described in this review article. |
| Dietary protein deficit and deregulated autophagy: A new Clinico-diagnostic perspective in pathogenesis of early aging, skin, and hair disorders Suruchi Garg, Ankita Sangwan Indian Dermatology Online Journal 2019 10(2):115-124 Background: Diet has an important role to play in the well-being of human body. Aims: The study intends to establish the “hypothesis of conscious, selective, and self-destruction i.e., deregulated autophagy of skin and hair in low dietary protein scenario” by determining the facial profile, clinical presentation, and histopathological correlation of deficient protein intake and missing of meals in a tertiary care aesthetic skin institute. Methods: A total of 98 patients of skin- and hair-related complaints were enrolled in the study and a histopathological correlation was established by skin and scalp biopsies in high and low protein groups. Results: A significant number of subjects (68.4%) were taking less than half of the recommended daily allowance of proteins and faced problems like hair fall, acne, pigmentation, vitiligo, hirsutism, melasma, and premature aging. Subjects missing breakfast were found to have hypothyroidism, diffuse hairfall, autoimmune disorders like vitiligo, lichen planus, and alopecia areata. Histopathological images from submental area showed loose and fragmented collagen in high carbohydrate group in comparison to high protein group where thick, uniformly stained collagen bundles were found in dermis. Histopathology of scalp tissue showed chronic perifollicular inflammatory infiltrate and fibrosis in high carbohydrate group which was absent in histopathology specimen of high protein group. Patients taking early and nutrient-rich breakfast had higher mean protein intakes and less severe skin and hair problems suggesting a role of circadian rhythm as well. Conclusion: Dietary protein adequacy and early breakfast have significant role in preventing self-destruction or deregulated autophagy in trichology and cosmetic dermatology and may prevent various autoimmune, inflammatory, and metabolic diseases. |
| Oral antifungal therapy: Emerging culprits of cutaneous adverse drug reactions Raju G Chaudhary, Santoshdev P Rathod, Ashish Jagati, Dhara Zankat, Arwinder K Brar, Bansri Mahadevia Indian Dermatology Online Journal 2019 10(2):125-130 Introduction: Antifungals are one of the most widely used drugs in dermatology practice for dermatophytosis. Oral antifungal therapy against superficial dermatophytosis is generally associated with a low incidence of adverse events in an immunocompetent population. However, lately, cutaneous adverse drugs reactions (CADRs) have been reported with varying incidence rates in the patients on oral antifungal therapy with many uncommon morphological patterns. The present, observational study was conducted over a period of 4 months to report the cases which presented with antifungal therapy-associated CADRs. Materials and Methods: It was an observational, prospective study carried out at a tertiary care center in Western India over a period of 4 months. All patients diagnosed with superficial dermatophytic infections (clinically and fungal hyphae seen on 10% potassium hydroxide mount) started on oral antifungal therapy, presenting with cutaneous manifestation other than the primary dermatophytosis were included. The incidence of CADRs due to oral antifungal agents and the percentage of each clinical type of the CADR observed was calculated. Results: The incidence of CADRs due to antifungal drugs was 8.3 per 10,000 patients. In total, 35 cases were reported out of 4,208 cases of dermatophytosis. Terbinafine was the most common causative drug, accounting for nearly 83% of cases, followed by itraconazole for 14% cases, and griseofulvin for 2.8% of cases. Conclusion: The role of systemic antifungals must not be overlooked in any patient with a CADR and should be reported as a trend indicator. |
| Association of Vitamin D receptor gene polymorphisms and serum 25-Hydroxy Vitamin D levels in vitiligo – A case-control study Iffat Hassan, Yasmeen J bhat, Sabhiya Majid, Peerzada Sajad, Farhan Rasool, Rawoof A Malik, Inam Ul Haq Indian Dermatology Online Journal 2019 10(2):131-138 Background: Vitamin D has stimulatory and protective effects on melanocytes and acts through its nuclear vitamin D receptor (VDR) on target cells. Various single-nucleotide polymorphisms (SNPs) in VDR genes have been described. Aims: The aim was to study and compare the association of SNP of BsmI/Apa-I/TaqI/FokI/Cdx2 in VDR gene as well as the plasma vitamin D levels in vitiligo patients and healthy controls. Methods: This was a case-control study, in which 100 patients of vitiligo and an equal number of healthy individuals were studied. The VDR polymorphisms of Bsm I, Apa-I, TaqI, fok I, and cdx2 were investigated, after extraction of genomic DNA by rapid capillary polymerase chain reaction with melting curve analysis, and 25 hydroxy vitamin D levels were measured in cases and controls. Results: The frequency of genotypes (SNP FokI and cdx2) was higher in the patient group versus controls (P = 0.002). The genotype frequency (TaqI and Apa-I) was higher in the patients than the controls for the Tt genotype, but not significantly higher (48% vs. 39%, P= 0.1431). The difference between the groups in frequency of the genotype Aa(TaqI and Apa-I) was statistically significant (P = 0.0001 and P= 0.033). Statistically significant difference was also observed in Apa-I-evaluated alleles in cases when compared to controls (P = 0.0001). There was no significant difference in serum vitamin D levels between various genotypes among cases and controls. Out of 100 cases, 10 were found to have vitamin D levels of >30 ng/ml, 15 had levels between 20 and 30 ng/ml, 52 had ≤20 ng/ml, and 23 ≤ 10 ng/ml, respectively. Limitations: Since the skin biopsies were not taken from the lesions of vitiligo, the correlation of serum levels with tissue levels of VDR gene was not possible and the role of vitamin D supplementation was not evaluated. Conclusion: The single nucleotide gene polymorphisms of various VDR genes as found in the cases might lead to vitamin D deficiency, due to VDR dysfunction, which in turn could increase the susceptibility to develop vitiligo. |
| Awareness of cosmetic dermatology procedures among health workers in a Tertiary Care Hospital Deeptara P Thapa Indian Dermatology Online Journal 2019 10(2):139-143 Introduction: Cosmetic dermatology is a branch of dermatology which deals with the enhancement of beauty. There is a rise in cosmetic dermatological procedures throughout the world, but its awareness is limited not only in the general population but also among the health workers. Materials and Methods: We conducted a cross-sectional questionnaire-based study to know the knowledge and awareness of cosmetic dermatological procedures among health workers in a hospital setting. Results: There were a total of 155 respondents. The maximum number of respondents belonged to age group of 20–30 years (65.2%). Female respondents were 66% and males were 34%. Of the total respondents, 39% were medical students, 31% doctors, 23% nurses, 6% OPD assistants, and 1% ward maids. Hinduism was practiced by 91% of the respondents. About 84.5% of subjects were aware of cosmetic dermatological procedures. Regarding the source of information, 34.2% implicated textbooks. According to 53.5% participants, cosmetic dermatological procedures are done by a dermatologist. Around 59.4% responded that they were aware of many procedures such as botox injections, laser hair removal, hair transplant, and chemical peeling; 51% were aware of risks associated with procedures, such as allergy, burns, and pigmentation; 44.5% rated the facility as good; 31% believed that outcome of the procedures is different in Nepal as compared to a foreign countries. About 23.9% thought public disposition will change if they underwent the procedures. Around 11.6% thought this shall negatively affect them; however, 53.5% believed it would be socially acceptable. About 78.1% thought that these procedures are done only in cities with 62.6% believing it is commonly done by high-class economic status people. About 73.5% respondents believed that this was adopted by literate people; 7.1% were concerned about taboos against cosmetic dermatosurgical procedures; 84.5% agreed that there should be awareness program on these procedures. Conclusion: We found lack of awareness, knowledge, attitudes, and disposition about cosmetic dermatosurgical procedures among health workers. Further community-based population studies and awareness programmes should be carried out regarding this aspect. |
| An observational study to describe the clinical pattern of dermatological emergencies from emergency department and intensive care unit: Our experience from a tertiary care hospital in Northern India Debdeep Mitra, Ajay Chopra, Neerja Saraswat, Reetu Agarwal, Sushil Kumar Indian Dermatology Online Journal 2019 10(2):144-148 Background: A large number of skin diseases have the potential to culminate into potentially fatal “acute skin failure.” The concept of dermatological intensive care unit (ICU) has largely evolved as a result of increased number of emergencies encountered by dermatologists these days. Dermatological emergencies comprise 8–20% of cases presenting to the emergency department. A wide variety of these conditions require a collective effort by intensivists, surgeons, physicians, and nursing staff in association with the treating dermatologist to reduce the associated mortality and morbidity. Dermatology ICU along with state-of-the-art nursing care is required to manage these cases, which result in acute skin failure. Materials and Methods: A prospective study conducted in a tertiary care center with a round the clock emergency department and a state-of-the-art dermatology ICU over a period of 12 months. Patients requiring primary dermatological consultation in the emergency department and patients admitted in the dermatology intensive care unit were evaluated, and their clinical variables were statistically analyzed. Results: In total, 327 cases were seen in the emergency department, out of which 54 (16.5%) cases were admitted in dermatology ICU, 239 (73.1%) were treated as outpatient cases, and 34 (10.4%) were managed as inpatients in other wards of the hospital. The most common condition in out-patient cases was acute urticaria and angioedema in 71 (29.7%), while vesiculobullous disorders in 16 (29.6%) patients was the most common condition requiring admission in dermatology ICU. Conclusions: At present, only few studies are available in the literature on the spectrum of dermatological disorders reporting to emergency department, and further requiring intensive care under ICU setting. This prospective study highlights the varied patterns of dermatosis reporting to emergency outpatient department and those managed in the ICU. |
| Idiopathic localized involutional lipoatrophy: A retrospective study of 12 cases Reena K Sharma, Mudita Gupta, Lalita Negi Indian Dermatology Online Journal 2019 10(2):149-152 Background: Idiopathic localized involutional lipoatrophy (ILIL) is focal loss of subcutaneous tissue without any clinical or histopathological inflammation with spontaneous regression. Objective: To retrospectively study clinical features and evolution of lesions in patients diagnosed with idiopathic localized lipoatrophy presenting to the department of dermatology of two district hospitals of Himachal Pradesh. Materials and Methods: A retrospective study of clinical patterns and evolution of ILIL was done in patients presenting with this condition in two district hospitals in the past 4 years (October 2013–September 2017). All clinically suspected and histopathologically confirmed cases of idiopathic localized lipoatrophy were included in the study. All cases with history of antecedent injections, vaccination, or medications before the development of lesion and inflammatory lipoatrophy on histopathology were excluded. Results: We found a total of 12 patients with ILIL. About 66% were children (8/12), 3 (25%) young females, and 1 (8%) young adult male. The most common site involved was buttock in 9 (75%) cases followed by a single case each (8%) with lesion on arm, face, and lower back. Two children and one adult were having bilateral involvement (25%), whereas the remaining had unilateral lesions. Lipoatrophy in 8 (66%) patients decreased spontaneously (with placebo) within 4–12 weeks duration whereas 4 required treatment. None required surgical or cosmetic interventions. Limitations: Small sample size and nonavailability of immunohistochemistry reports in all patients. Conclusion: ILIL is a rare form of lipoatrophy with specific loss of adipose tissue without any inflammatory changes. We concluded that ILIL is an underreported entity, probably due to its spontaneous resolution. |
| Study on assessment of quality of life and depression in patients of vitiligo RahulKrishna S Kota, Rita V Vora, Jagdish R Varma, Suresh K Kota, Trusha M Patel, Jaishree Ganjiwale Indian Dermatology Online Journal 2019 10(2):153-157 Context: Vitiligo is an autoimmune pigmentary disorder characterized by localized or generalized depigmentation of the skin. It is associated with significant stigma and has impact on patient's quality of life (QoL) and psychological wellbeing. Aims: To see the variance in QoL and level of depression in vitiligo patients with extent of vitiligo. Materials and Methods: Vitiligo patients aged ≥18 years attending OPD were included in the study. Impairment in QoL was assessed by administering DLQI (Dermatology Life Quality Index) and VIS22 (Vitiligo Impact Scale22). Depression was assessed by administering QIDSSR16 (Quick Inventory of Depressive Symptomatology). The Vitiligo Area Scoring Index (VASI) was calculated based on clinical examination. Results: One hundred and fifty patients enrolled. Most common age group was 18–30 years. Mean DLQI, VIS22, QIDSSR16 scores were 7.02, 16.37, 5.87, respectively. QoL was affected to some extent in 85.3% and 86.7% according to the DLQI and VIS22, respectively. Depression was seen in 44%. Coclusion: Young patients showed higher impairment in QoL and also higher levels of depression. It would be useful to offer psychiatric consult and counseling in addition to specific treatment.Context: Vitiligo is an autoimmune pigmentary disorder characterized by localized or generalized depigmentation of the skin. It is associated with significant stigma and has impact on patient's quality of life (QoL) and psychological wellbeing. Aims: To see the variance in QoL and level of depression in vitiligo patients with extent of vitiligo. Materials and Methods: Vitiligo patients aged ≥18 years attending OPD were included in the study. Impairment in QoL was assessed by administering DLQI (Dermatology Life Quality Index) and VIS22 (Vitiligo Impact Scale22). Depression was assessed by administering QIDSSR16 (Quick Inventory of Depressive Symptomatology). The Vitiligo Area Scoring Index (VASI) was calculated based on clinical examination. Results: One hundred and fifty patients enrolled. Most common age group was 18–30 years. Mean DLQI, VIS22, QIDSSR16 scores were 7.02, 16.37, 5.87, respectively. QoL was affected to some extent in 85.3% and 86.7% according to the DLQI and VIS22, respectively. Depression was seen in 44%. Conclusion: Young patients showed higher impairment in QoL and also higher levels of depression. It would be useful to offer psychiatric consult and counseling in addition to specific treatment. |
| Barber Say Syndrome (A new case report) Mehrdad Rezaei, Susan Zamani, Hourvash Haghighinejad Indian Dermatology Online Journal 2019 10(2):158-161 Barber Say syndrome (BSS) is a rare ectodermal dysplasia with neonatal onset characterized by congenital generalized hypertrichosis, atrophic skin, ectropion and macrostomia. A literature review showed less than 20 previously reported cases of Barber Say syndrome. This presentation reports a one day old female with syndrome face, low hairline, coarse face, macrostomia, thin upper lip, bilateral ectropion and hypertelorism, hypertrichosis, senile skin appearance, hypoplastic nipples and one area of mild skin atrophy. These findings are consistent with BSS. |
Community Health
| Correction to: No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015–2016 The article No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015–2016, written by Mohsin Ali and Marsha D. Williams, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 02 January 2019 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 13 January 2019 to © The Author(s) 2019 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. |
| Building Community Partnerships: The Role of Schools of Public Health |
A Workplace-Based Intervention to Improve Awareness, Knowledge, and Utilization of Breast, Cervical, and Colorectal Cancer Screenings Among Latino Service and Manual Labor Employees in UtahAbstractIn the United States, Latinos are more likely to be uninsured and diagnosed with later stage cancer than non-Hispanic whites. Promotoras (lay health educators) help improve cancer knowledge and facilitate access to cancer screenings. We tested a promotora led workplace-based intervention to improve knowledge of and adherence to breast, cervical, and colorectal cancer screening among Latino employees in service or manual labor jobs. Latinos 18 and older from Salt Lake County, Utah were enrolled from January 2015 to February 2016. N = 265 completed pre- and post-intervention surveys that measured knowledge of and adherence to breast, cervical, and colorectal cancer screenings. Demographic, economic, and cancer factors of participants who completed the intervention were compared to those who were incomplete. Changes in knowledge and adherence were calculated using McNemar's tests. Logistic regression compared outcomes by select demographic, economic and cancer factors. More participants were older, spoke Non-English languages, were single/widow(er)s, worked part-time, and had an immediate family member with cancer compared to those who did not complete the study (all p < 0.05). Knowledge of the age to begin cancer screenings increased significantly from baseline to follow-up for cervical (65.1–77.7%), breast (67.2–81.7%), and colorectal cancer (49.8–80.7%), all p ≤ 0.001. Knowledge of the frequency of cervical (34.0–46.5%) and colorectal (72.1–84.5%) screening increased from baseline to follow-up, both p < 0.001. Adherence to fecal immunochemical tests (FIT) for colorectal cancer increased from baseline to follow-up (13.8–56.9%, p < 0.001). Promotora led workplace-based interventions can strengthen community capacity for educating and supporting Latino employees in preventing breast, cervical, and colorectal cancer. |
Sugary Drink Consumption Among NYC Children, Youth, and Adults: Disparities Persist Over Time, 2007–2015AbstractSugary drink consumption is associated with many adverse health outcomes, including weight gain, diabetes, and other chronic conditions. These beverages are widely marketed and ubiquitously available. This analysis explores sugary drink consumption across all age groups among New York City (NYC) residents using representative survey data. Three population-based representative surveys of NYC residents of different age groups were analyzed. Adult participants, youth participants, and caregivers of child participants self-reported the number of sugary drinks they consumed per day. Mean sugary drink intake per day was estimated overall and by demographic characteristics, for the 2015 cycle of each survey and the 2007–2015 cycles of the adult survey. T tests were used to determine whether means differed by demographics. Long-term trends in mean sugary drink consumption among adult participants were conducted to examine changes over time overall and by demographic characteristics. In 2015, the mean daily number of sugary drinks consumed was 0.53 (95% CI 0.45, 0.61) among children 0–5 years old, 1.05 (95% CI 0.90, 1.21) among children 6–12 years old, and 1.16 (95% CI 1.09, 1.29) among NYC high school students. Among all NYC adults, sugary drink intake decreased 36% from 1.03 (95% CI 0.99, 1.08) in 2007 to 0.66 (95% CI 0.62, 0.70) drinks per day in 2015, p < 0.01. However, at each age level, there were persistent disparities in sugary drink consumption by sex, race/ethnicity, educational attainment, and poverty level. Decreasing overall rates of sugary drink consumption are promising; however, disparities by socio-demographics are a concern. Reducing sugary drink consumption across all ages is recommended as is minimizing the introduction at an early age. Reduction of sugary drink consumption will require a collaborative, multi-sectoral approach. |
A Mixed-Methods Assessment of a Peer-Enforced Tobacco- and Smoke-Free Policy at a Large Urban UniversityAbstractThe study aims to evaluate the enforcement, opinions, and effectiveness of the University of South Florida's tobacco free policy one year following implementation. By assessing readiness to change and using geographic information system (GIS) mapping this study sought to introduce a unique and effective way of evaluating college tobacco free policies. A cross-sectional survey was administered to students, faculty, and staff to assess knowledge of policy and resources, tobacco use observations, stage change regarding policy enforcement, self-efficacy to enforce, and policy impact on perceived campus tobacco use (n = 5242). Additionally, using ArcGIS Collector (in: ESRI, ArcGIS desktop: release 10, Environmental Systems Research Institute, Redlands, 2011) volunteers collected geospatial data on tobacco use continuing to occur on campus following policy implementation. Overall there was moderate knowledge of the current policy and low beliefs for policy enforcement. Majority of respondents were not approaching violators to remind them of the policy and did not plan to do so in the future. There were statistically significant differences between smokers and non-smokers as well as between students and faculty and staff. The mapping of observed violations revealed continued tobacco use on campus with 158 data points. From both the geospatial results as well as the survey findings, the current policy is ineffective in reducing tobacco use across campus. With rapidly increasing numbers of smoke and tobacco free universities, new and innovative evaluation tools are needed so institution leaders can efficiently evaluate their implementation. |
A Systematic Review of Interventions to Minimize Transportation Barriers Among People with Chronic DiseasesAbstractTransportation is an important social determinant of health. Transportation barriers disproportionately affect the most vulnerable groups of society who carry the highest burden of chronic diseases; therefore, it is critical to identify interventions that improve access to transportation. We synthesized evidence concerning the types and impact of interventions that address transportation to chronic care management. A systematic literature search of peer-reviewed studies that include an intervention with a transportation component was performed using three electronic databases—PubMed, EMBASE, and CINAHL—along with a hand-search. We screened 478 unique titles and abstracts. Two reviewers independently evaluated 41 full-text articles and 10 studies met eligibility criteria for inclusion. The transportation interventions included one or more of the following: providing bus passes (n = 5), taxi/transport vouchers or reimbursement (n = 3), arranging or connecting participants to transportation (n = 2), and a free shuttle service (n = 1). Transportation support was offered within multi-component interventions including counseling, care coordination, education, financial incentives, motivational interviewing, and navigation assistance. Community health/outreach workers (n = 3), nurses (n = 3), and research or clinic staff (n = 3) were the most common interventionists. Studies reported improvements in cancer screening rates, chronic disease management, hospital utilization, linkage and follow up to care, and maternal empathy. Overall, transportation is a well-documented barrier to engaging in chronic care among vulnerable populations. We found evidence suggesting transportation services offered in combination with other tailored services improves patient health outcomes; however, future research is warranted to examine the separate impact of transportation interventions that are tested within multi-component studies. |
Awareness and Knowledge of Human Papilloma Virus and Cervical Cancer in Women with High Pap UptakeAbstractThis cross-sectional study explored knowledge, awareness, and health practices surrounding cervical cancer prevention and screening. Patients (n = 129) were recruited from three community clinics of underserved populations in Dallas, Texas. Women between ages 18–65 were surveyed using a self-administered questionnaire to evaluate their knowledge, awareness, and attitudes related to pap tests, human papilloma virus (HPV), HPV vaccines, and cervical cancer. Most women reported having a pap test in the past 3–5 years (86.6%). Over half knew that there was an increased risk of cervical cancer with an HPV infection, abnormal pap test, or both (52%). However, less than half of women knew the purpose of a pap test (40%), the purpose of the HPV vaccine (48%), or the transmission mode of HPV (25%). Over half of participants first heard about a pap test from a doctor (60%), about one quarter from their mother (24%), and less than a quarter from others (16%). More than half of women were aware of HPV (55%), while less than half were aware of the HPV vaccine (48%). Overall, we found that while most women had a high uptake of pap tests, they had low knowledge of the purpose of a pap test, the HPV vaccine, and transmission mode of HPV. They also had low awareness of HPV and the HPV vaccine. Given that almost all cases of cervical cancer are due to HPV infection, future studies should aim to further explore the gap between knowledge and awareness of HPV and pap uptake. |
Birth Certificate Validity and the Impact on Primary Cesarean Section Quality Measure in New York StateAbstractIn New York (NY), birth certificate data are routinely used for assessing quality of care and health outcomes such as primary cesarean section (PCS) rates. However rare events are often underreported. This study compared birth certificates to medical records, and examined the impact of underreporting on risk adjustment variables for PCS. We conducted an internal validation study using a random sample of 702 NY births in 2009. Sensitivity and positive predictive value (PPV) of rare events reported on birth certificates were determined using abstracted and matched medical records as the gold standard. To assess the impact, we calculated PCS odds ratios for variables in the risk-adjustment model before and after correcting for measurement error. The sensitivity and PPV of birth certificate data elements including those in the PCS risk model varied from 0 to 100. After correction for measurement error, PCS odds ratios increased for most variables. For example, the PCS odds ratio for those with no prior live births was 3.03 (95% CI 2.94, 3.13), but after correction of measurement error increased to 3.46 (95% CI 3.22, 3.67). A composite negative event variable including abruptio placenta, eclampsia, or infection was the only variable that decreased after correction and was no longer significant (uncorrected OR 3.06, 95% CI 2.86, 3.29; corrected OR 1.42, 95% CI 0.79, 2.59). Underreporting on birth certificates remains concerning and impacts the risk adjustment for quality measures. Without improved data validity, health plans' quality metrics do not fully account for patient case-mix. |
Knowledge and Practice of Health Workers about Healthcare Waste Management in Public Health Facilities in Eastern EthiopiaAbstractHealthcare waste management (HWM) problems are growing with an ever-increasing number of hospitals, clinics, diagnostic laboratories, etc in Ethiopia. Health workers are one of the key personnel who are responsible for the proper management of healthcare wastes at any health facilities. However, this performance will depend the level of knowledge and practice regarding waste management. A facility based cross-sectional study design was applied on 400 health workers. All public health institutions inside Jigjiga town were included and the study participants were randomly selected from each health facility. Data were collected using pre-tested and self administered questionnaire. The collected data was analyzed using SPSS version 20. Multivariable logistic regression model was used to identify factors associated with knowledge and practice of health workers. Out of those involved in this study, 47.7% and 42.3% of respondents had good knowledge and good practice on healthcare waste management, respectively. Health workers in the age group of 35–44 years, nurses, midwifes, medical laboratory, were significantly associated with knowledge of health workers. On the other hand, only educational status was significantly associated with practice. In this study, both knowledge and practice of health workers about healthcare waste management was poor. To enhance both the knowledge and practice of health workers, on job training is recommended. |
No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015–2016AbstractMystery patient drills using simulated patients have been used in hospitals to assess emergency preparedness for infectious diseases, but these drills have seldom been reported in primary care settings. We conducted three rounds of mystery patient drills designed to simulate either influenza-like illness (ILI) or measles at 41 community health centers in New York City from April 2015 through December 2016. Among 50 drills conducted, 49 successfully screened the patient–actor (defined as provision of a mask or referral to the medical team given concern of infection requiring potential isolation), with 35 (70%) drills completing screening without any challenges. In 47 drills, the patient was subsequently isolated (defined as placement in a closed room to limit transmission), with 29 (58%) drills completing isolation without any challenges. Patient–actors simulating ILI were more likely to be masked than those simulating measles (93% vs. 59%, p = 0.007). Median time to screening was 2 min (interquartile range [IQR] 2–6 min) and subsequently to isolation was 1 min (IQR 0–2 min). Approximately 95% of participants reported the drill was realistic and prepared them to deal with the hazards addressed. Qualitative analysis revealed recurring themes for strengths (e.g., established protocols, effective communication) and areas for improvement (e.g., hand hygiene, explaining isolation rationale). We conclude that mystery patient drills are an effective and feasible longitudinal collaboration between health departments and primary care clinics to assess and inform emergency preparedness for infectious diseases. |
Εγγραφή σε:
Αναρτήσεις (Atom)
Δημοφιλείς αναρτήσεις
-
Wordle is a toy for generating “word clouds” from text that you provide. The clouds give greater prominence to words that appear more freque...
-
Your source for quotations from famous people and literature. Search or browse over 27,000 quotations from thousands of authors. Includes th...
-
The population of American Indians and Alaska Natives (AIAN) in the USA, which comprise about 5 million individuals, have worse health outco...
-
SMARTCOCKPIT; Our #1 goal, since 2000, is to offer the most extensive online aviation resource to worldwide professional pilots. We desire t...
-
Abstract Purpose C-reactive protein and procalcitonin are reliable early predictors of infection after colorectal surgery. However, the ...
-
Famous Quotes: Hand Picked Funny, Inspirational and Love Quotes. Looking for the best famous quotes? from #AlexandrosSfakianakis via Alexa...
-
Economics articles & eBooks. Essays on topical issues, latest developments in UK and global economies, and answers to readers questions ...
-
Inspirational Quotations offers nature quotes celebrating the beauty of nature, flowers, rainbows, oceans, streams, and meadows. A free insp...
-
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Despite many advances in the study ...
