Exercise and Mood: Exploring the Role of Exercise in Regulating Stress Reactivity in Bipolar Disorder

Bipolar Disorder (BD) is a recurrent and debilitating psychological disorder characterized by a chronic dysregulation of mood with fluctuations between extremely low (e.g., depression) and extremely elevated mood states (e.g., mania), and ranks as the 6th leading cause of disability in the world. Although research has consistently shown that exercise may have antidepressant and stress-attenuating benefits in other psychiatric illnesses (e.g., depression, anxiety), these benefits have not been directly investigated for BD. The current study represents the first known investigation to examine this relationship. Single-participant designs, with crossover and interaction treatment components (i.e., A/B/A/B/A, A/C/A/C/A, A/B/A/C/A, or A/C/A/B/A) were utilized to investigate the impact of participation in a prescribed regimen of exercise (EP) versus standard behavioral activation (SBA; i.e., non-exercise activity) has on stress perception and reactivity, and mood stability in a sample of individuals with BD. Individuals completed four total weeks of treatment, and psychophysiological measures of reactivity were recorded during a laboratory stress task (i.e., backward counting task) prior to and following each two-week intervention phase. No appreciable differences were found between levels of exercise participation between treatment groups. Interestingly, symptoms of depressed mood (BDI-II scores) decreased at similar rates following 4 weeks of treatment for all participants. BDI-II decreases were found to be most correlated with elective exercise participation, although this relationship was not significant. Regarding stress reactivity, elective participation in mild to moderate intensity exercise was found to reduce an individual’s perception of stress reactivity to an acute stressor, while participation in a prescribed program of exercise was more effective in reducing physiological response to the same task. Utilizing multiple forms of behavioral activation simultaneously was found to be most effective in decreasing perception of stress reactivity, and may also result in a positive change in the use of adaptive versus maladaptive coping strategies. Participation in a 4-week program of exercise appeared to provide the most benefit, consistent with exercise habituation theories. Overall, current findings provide preliminary support for the prophylactic benefits of including a prescribed and monitored program of exercise as an adjunct treatment for individuals with BD. Larger scale research is needed to more clearly determine the impact of exercise on stress reactivity and mood episode relapse in individuals with BD.

A model of factors determining levels of public support for health care policy in the United States

Public preferences for policy are formed in a little-understood process that is not adequately described by traditional economic theory of choice. In this paper I suggest that U.S. aggregate support for health reform can be modeled as tradeoffs among a small number of behavioral values and the stage of policy development. The theory underlying the model is based on Samuelson, et al.'s (1986) work and Wilke's (1991) elaboration of it as the Greed/Efficiency/Fairness (GEF) hypothesis of motivation in the management of resource dilemmas, and behavioral economics informed by Kahneman and Thaler's prospect theory. ^ The model developed in this paper employs ordered probit econometric techniques applied to data derived from U.S. polls taken from 1990 to mid-2003 that measured support for health reform proposals. Outcome data are four-tiered Likert counts; independent variables are dummies representing the presence or absence of operationalizations of each behavioral variable, along with an integer representing policy process stage. Marginal effects of each independent variable predict how support levels change on triggering that variable. Model estimation results indicate a vanishingly small likelihood that all coefficients are zero and all variables have signs expected from model theory. ^ Three hypotheses were tested: support will drain from health reform policy as it becomes increasingly well-articulated and approaches enactment; reforms appealing to fairness through universal health coverage will enjoy a higher degree of support than those targeted more narrowly; health reforms calling for government operation of the health finance system will achieve lower support than those that do not. Model results support the first and last hypotheses. Contrary to expectations, universal health care proposals did not provide incremental support beyond those targeted to “deserving” populations—children, elderly, working families. In addition, loss of autonomy (e.g. restrictions on choice of care giver) is found to be the “third rail” of health reform with significantly-reduced support. When applied to a hypothetical health reform in which an employer-mandated Medical Savings Account policy is the centerpiece, the model predicts support that may be insufficient to enactment. These results indicate that the method developed in the paper may prove valuable to health policy designers. ^

The effects of obesity in critical illness

Obesity continues to cripple the United States in terms of increasing health care expenditures and its rising rate of prevalence in epidemic proportions. The comorbidities associated with obesity have continued to represent some of the most deadly chronic health diseases. The most vulnerable subpopulation, the critically ill, suffers from not only the comorbid conditions but also the complications encountered within their specialized care. Taking into account the rising prevalence rates of obesity and critical care patients, it has come to the attention of many researchers to measure the trends associated with these two health conditions. Hospital mortality was found to be lower in higher BMI groups whereas there was no difference between BMI groups for ICU mortality. Length of stay and mechanical ventilation were both higher for obese rather than non-obese patients. The most prevalent disease states among the obese critically injured was cardiovascular and pulmonary disease. In conclusion, obesity is not independently associated with increased ICU mortality, but the comorbidities linked to obesity prove a greater threat to vitality.^

The performance of interferon-gamma release assays in tuberculosis patients with type II diabetes

The sensitivity of Interferon-γ release assays for detection of Mycobacterium tuberculosis (MTB) infection or disease is affected by conditions that depress host immunity (such as HIV). It is critical to determine whether these assays are affected by diabetes and related conditions (i.e. hyperglycemia, chronic hyperglycemia, or being overweight/obese) given that immune impairment is thought to underline susceptibility to tuberculosis (TB) in people with diabetes. This is important for tuberculosis control due to the millions of type 2 diabetes patients at risk for tuberculosis worldwide.^ The objective of this study was to identify host characteristics, including diabetes, that may affect the sensitivity of two commercially available Interferon-γ (IFN-γ) release assays (IGRA), the QuantiFERON®-TB Gold (QFT-G) and the T-SPOT®.TB in active TB patients. We further explored whether IFN-γ secretion in response to MTB antigens (ESAT-6 and CFP-10) is associated with diabetes and its defining characteristics (high blood glucose, high HbA1c, high BMI). To achieve these objectives, the sensitivity of QFT-G and T-SPOT. TB assays were evaluated in newly diagnosed, tuberculosis confirmed (by positive smear for acid fast bacilli and/or positive culture for MTB) adults enrolled at Texas and Mexico study sites between March 2006 and April 2009. Univariate and multivariate models were constructed to identify host characteristics associated with IGRA result and level of IFN-γ secretion.^ QFT-G was positive in 68% of tuberculosis patients. Those with diabetes, chronic hyperglycemia or obesity were more likely to have a positive QFT-G result, and to secrete higher levels of IFN-γ in response to the mycobacterial antigens (p<0.05). Previous history of BCG vaccination was the only other host characteristic associated with QFT-G result, whereby a higher proportion of non-BCG vaccinated persons were QFT-G positive, in comparison to vaccinated persons. In a separate group of patients, the T-SPOT.TB was 94% sensitive, with similar performance in all tuberculosis patients, regardless of host characteristics.^ In summary, we have demonstrated the validity of QFT-G and T-SPOT. TB to support the diagnosis of TB in patients with a range of host characteristics, but most notably in patients with diabetes. We also confirmed that TB patients with diabetes and associated characteristics (chronic hyperglycemia or BMI) secreted higher titers of IFN-γ when stimulated with MTB specific antigens, in comparison to patients without these characteristics. Together, these findings suggest that the mechanism by which diabetes increases risk to TB may not be explained by the inability to secrete IFN-γ, a key cytokine for TB control.^

Understanding mental illness in Nigeria: Bringing culture and traditional medicine into mental health policy

One of the major challenges in treating mental illness in Nigeria is that the health care facilities and mental health care professionals are not enough in number or well equipped to handle the burden of mental illness. There are several barriers to treatment for individual Nigerians which include the following: such as the lack of understanding of the root causes of mental illness, lack of financial support to get mental treatment, lack of social support (family, friends, neighbors), the fear of stigmatization concerning being labeled as mentally ill or being in association with the mentally ill, and the consultation of traditional native healers who may be unknowingly prolonging illness, rather than addressing and treating them due to lack of formal education and standardization of their treatments. Another barrier is the non-health nature of the mental health services in Nigeria. Traditional healers are essentially the mental health system. The elderly, women, and children are the most vulnerable groups in times of strife and hardships. Their mental well-being must be taken into account as well as their special needs in times of personal or societal crisis. ^ Nigerian mental health policy is geared toward forming a mental health system, but in actuality only a mental illness care system is the observed result of the policy. The government of Nigeria has drafted a mental health policy, yet its actual implementation into the Nigerian health infrastructure and society waits to be materialized. The limited health legislation or policy implementations tend to favor those who have access to these urban areas and the facilities' health services. Nigerians living in rural areas are at a disadvantage; many of them may not even be aware of services available to help them understand and treat mental illness. Perhaps, government driven health interventions geared toward mental illness in rural areas would reach an underserved Nigerians and Africans in general. Issues with political instability and limited infrastructure often hinder crucial financial resources and legislation from reaching the people that are truly in need of governmental leadership in regards to mental health policy.^ Traditional healers are a severely untapped resource in the treatment of mental illness within the Nigerian population. They are abundant within Nigerian communities and are meeting a real need for the mentally ill. However, much can be done to remove the barriers that prevent the integration of traditional healers within the mental health system and improve the quality of care they administer within the population. Mental illness is almost exclusively coped with through traditional medicine practices. Mobilization and education from each strata of Nigerian society and government as well as input from the medical community can improve how traditional medicine is utilized as a treatment for clinical illness and help alleviate the heavy burden of mental illness in Nigeria. Currently, there is no existing policy making structure for a working mental health system in Nigeria, and traditional healers are not taken into account in any formulation of mental health policy. Advocacy for mental illness is severely inadequate due to fear of stigmatization, with no formally recognized national of regional mental health association.^

The Children’s Bureau’s Role in Promoting Parent Engagement and Family Support: A Brief History and Current Efforts

Over the years, federal child welfare policy has supported parent engagement and family support strategies through various Children’s Bureau funded state formula grant programs, research and demonstration discretionary grants, and technical assistance. This article highlights programs funded by two federal laws, Promoting Safe and Stable Families and the Child Abuse Prevention and Treatment Act, and Children’s Bureau’s efforts to test innovations and disseminate knowledge about promising and evidence-based practices regarding parent engagement and family support. The article begins with a brief legislative history and then describes several grant programs that are supported by the legislation. The article concludes with lessons learned and a discussion of the new opportunities for system changes through the Title IV-E Waiver Demonstration projects.

The CoastColour Round Robin datasets: a database to evaluate the performance of algorithms for the retrieval of water quality parameters in coastal waters

The CoastColour project Round Robin (CCRR) project (http://www.coastcolour.org) funded by the European Space Agency (ESA) was designed to bring together a variety of reference datasets and to use these to test algorithms and assess their accuracy for retrieving water quality parameters. This information was then developed to help end-users of remote sensing products to select the most accurate algorithms for their coastal region. To facilitate this, an inter-comparison of the performance of algorithms for the retrieval of in-water properties over coastal waters was carried out. The comparison used three types of datasets on which ocean colour algorithms were tested. The description and comparison of the three datasets are the focus of this paper, and include the Medium Resolution Imaging Spectrometer (MERIS) Level 2 match-ups, in situ reflectance measurements and data generated by a radiative transfer model (HydroLight). The datasets mainly consisted of 6,484 marine reflectance associated with various geometrical (sensor viewing and solar angles) and sky conditions and water constituents: Total Suspended Matter (TSM) and Chlorophyll-a (CHL) concentrations, and the absorption of Coloured Dissolved Organic Matter (CDOM). Inherent optical properties were also provided in the simulated datasets (5,000 simulations) and from 3,054 match-up locations. The distributions of reflectance at selected MERIS bands and band ratios, CHL and TSM as a function of reflectance, from the three datasets are compared. Match-up and in situ sites where deviations occur are identified. The distribution of the three reflectance datasets are also compared to the simulated and in situ reflectances used previously by the International Ocean Colour Coordinating Group (IOCCG, 2006) for algorithm testing, showing a clear extension of the CCRR data which covers more turbid waters.

Predicting temporary wetland plant community responses to changes in the hydroperiod

The expected changes on rainfall in the next decades may cause significant changes of the hydroperiod of temporary wetlands and, consequently, shifts on plant community distributions. Predicting plant community responses to changes in the hydroperiod is a key issue for conservation and management of temporary wetlands. We present a predictive distribution model for Arthrocnemum macrostachyum communities in the Doñana wetland (Southern Spain). Logistic regression was used to fit the model using the number of days of inundation and the mean water height as predictors. The internal validation of the model yielded good performance measures. The model was applied to a set of expected scenarios of changes in the hydroperiod to anticipate the most likely shifts in the distribution of Arthrocnemum macrostachyum communities.

Lesson from the habitat suitability models to evaluate the environmental of Pinus nigra Arnold and Pinus sylvesris L. in the Iberian Peninsula

PREDICT POTENTIAL DISTRIBUTION. Spatial and temporal evolution of the species under different climate scenarios. Generation of habitat suitability models (HSM)  high degree of uncertainty and limitations. The importance of their validation has been stressed. In this work we discuss the present potential distribution of P. sylvestris and P. nigra in the Iberian Peninsula by using MaxEnt, and evaluate the influence of the different environmental variables. Our intention is to select a set of environmental variables that explains better their current distribution, to achieve the most accurate and reliable models. Then we project them to the past climatic conditions (21 to 0 kyrs BP), to evaluate the outputs with existing palaeo-ecological data.

Introducing Nuclear Energy to High-School Students: The Spanish Young Generation in Nuclear (Jóvenes Nucleares) Lectures

One of the main goals of Spanish Young Generation (JJNN) is to spread knowledge about nuclear energy, not only pointing out its advantages and its role in our society, but also trying to correct some of the ideas that are due to the biased information and to the lack of knowledge. With this goal in mind, lectures were given in several high schools, aimed at students ranging from 14 to 18 years old. This paper explains the experience accumulated during those talks and the conclusions that can be drawn, so as to better focus the communication about nuclear energy, especially the one aimed at a young public. In order to evaluate the degree of knowledge and information on a specific topic of a given group of individuals, statistical methods must be used. At the beginning of each lecture (and sometimes at the end, in order to evaluate the impact of the talk) the students were submitted to a short survey conducted by Spanish Young Generation. It consisted in eight questions, dealing with the relation between the main environmental issues (global warming, acid rain, radioactive waste…) and nuclear energy. The answers can be surprising, especially for professionals of the nuclear field who, since they are so familiar with this topic, often forget that this is just the case of a minority of people. A better knowledge of the degree of information of a given group enables to focus and personalize the communication. Another communication tool is the direct contact with students: it starts with their questions, which can then lead to a small debate. If the surveys inform about the topics they are unaware of, the direct exchange with them enables to find the most effective way to provide them the information. Of course, it depends a lot on the public attending the talk (age, background…) and on the debate following the talk: a good communication, adapted to the public, is necessary. Therefore, the outcome of the performed exercise is that Spanish teenagers have still a lack of knowledge about nuclear energy. We can learn that items that are evident for nuclear young professionals are unknown for high school teenagers

Migration to an a on-line laboatory in mechanical engineering. The case of a cam-follower design practice.

The European Higher Education Area (EHEA) has leaded to a change in the way the subjects are taught. One of the more important aspects of the EHEA is to support the autonomous study of the students. Taking into account this new approach, the virtual laboratory of the subject Mechanisms of the Aeronautical studies at the Technical University of Madrid is being migrated to an on-line scheme. This virtual laboratory consist on two practices: the design of cam-follower mechanisms and the design of trains of gears. Both practices are software applications that, in the current situation, need to be installed on each computer and the students carry out the practice at the computer classroom of the school under the supervision of a teacher. During this year the design of cam-follower mechanisms practice has been moved to a web application using Java and the Google Development Toolkit. In this practice the students has to design and study the running of a cam to perform a specific displacement diagram with a selected follower taking into account that the mechanism must be able to work properly at high speed regime. The practice has maintained its objectives in the new platform but to take advantage of the new methodology and try to avoid the inconveniences that the previous version had shown. Once the new practice has been ready, a pilot study has been carried out to compare both approaches: on-line and in-lab. This paper shows the adaptation of the cam and follower practice to an on-line methodology. Both practices are described and the changes that has been done to the initial one are shown. They are compared and the weak and strong points of each one are analyzed. Finally we explain the pilot study carried out, the students impression and the results obtained.

Migration to an a on.line laboratory in mechanical engineering. The case of a cam follower design practice.

The European Higher Education Area (EHEA) has leaded to a change in the way the subjects are taught. One of the more important aspects of the EHEA is to support the autonomous study of the students. Taking into account this new approach, the virtual laboratory of the subject Mechanisms of the Aeronautical studies at the Technical University of Madrid is being migrated to an on-line scheme. This virtual laboratory consist on two practices: the design of cam-follower mechanisms and the design of trains of gears. Both practices are software applications that, in the current situation, need to be installed on each computer and the students carry out the practice at the computer classroom of the school under the supervision of a teacher. During this year the design of cam-follower mechanisms practice has been moved to a web application using Java and the Google Development Toolkit. In this practice the students has to design and study the running of a cam to perform a specific displacement diagram with a selected follower taking into account that the mechanism must be able to work properly at high speed regime. The practice has maintained its objectives in the new platform but to take advantage of the new methodology and try to avoid the inconveniences that the previous version had shown. Once the new practice has been ready, a pilot study has been carried out to compare both approaches: on-line and in-lab. This paper shows the adaptation of the cam and follower practice to an on-line methodology. Both practices are described and the changes that has been done to the initial one are shown. They are compared and the weak and strong points of each one are analyzed. Finally we explain the pilot study carried out, the students impression and the results obtained.

Integration of Virtual Map Rooms as a support tool in historical and social research

At the present time almost all map libraries on the Internet are image collections generated by the digitization of early maps. This type of graphics files provides researchers with the possibility of accessing and visualizing historical cartographic information keeping in mind that this information has a degree of quality that depends upon elements such as the accuracy of the digitization process and proprietary constraints (e.g. visualization, resolution downloading options, copyright, use constraints). In most cases, access to these map libraries is useful only as a first approach and it is not possible to use those maps for scientific work due to the sparse tools available to measure, match, analyze and/or combine those resources with different kinds of cartography. This paper presents a method to enrich virtual map rooms and provide historians and other professional with a tool that let them to make the most of libraries in the digital era.

Configuration management and product lines to enhance the replication process in software engineering

This research is concerned with the experimental software engineering area, specifically experiment replication. Replication has traditionally been viewed as a complex task in software engineering. This is possibly due to the present immaturity of the experimental paradigm applied to software development. Researchers usually use replication packages to replicate an experiment. However, replication packages are not the solution to all the information management problems that crop up when successive replications of an experiment accumulate. This research borrows ideas from the software configuration management and software product line paradigms to support the replication process. We believe that configuration management can help to manage and administer information from one replication to another: hypotheses, designs, data analysis, etc. The software product line paradigm can help to organize and manage any changes introduced into the experiment by each replication. We expect the union of the two paradigms in replication to improve the planning, design and execution of further replications and their alignment with existing replications. Additionally, this research work will contribute a web support environment for archiving information related to different experiment replications. Additionally, it will provide flexible enough information management support for running replications with different numbers and types of changes. Finally, it will afford massive storage of data from different replications. Experimenters working collaboratively on the same experiment must all have access to the different experiments.

El fitness como factor determinante en el riesgo de discapacidad, su relación con la composición corporal y el estado cognitivo en población mayor institucionalizada y de vida independiente = Fitness as a determinant factor in the risk of disability, and its relationship to body composition and cognitive status in institutionalized elderly population and independent living

La condición física, o como mejor se la conoce hoy en día el “fitness”, es una variable que está cobrando gran protagonismo, especialmente desde la perspectiva de la salud. La mejora de la calidad de vida que se ha experimentado en los últimos años en las sociedades desarrolladas, conlleva un aumento de la esperanza de vida, lo que hace que cada vez más personas vivan más años. Este rápido crecimiento de la población mayor de 60 años hace que, un grupo poblacional prácticamente olvidado desde el punto de vista de la investigación científica en el campo de la actividad física y del deporte, cobre gran relevancia, con el fin de poder ayudar a alcanzar el dicho “no se trata de aportar años a la vida sino vida a lo años”. La presente memoria de Tesis Doctoral tiene como principal objetivo valorar los niveles de fitness en población mayor española, además de analizar la relación existente entre el fitness, sus condicionantes y otros aspectos de la salud, tales como la composición corporal y el estado cognitivo. Entendemos que para poder establecer futuras políticas de salud pública en relación a la actividad física y el envejecimiento activo es necesario conocer cuáles son los niveles de partida de la población mayor en España y sus condicionantes. El trabajo está basado en los datos del estudio multicéntrico EXERNET (Estudio Multi-céntrico para la Evaluación de los Niveles de Condición Física y su relación con Estilos de Vida Saludables en población mayor española no institucionalizada), así como en los datos de dos estudios, llevados a cabo en población mayor institucionalizada. Se han analizado un total de 3136 mayores de vida independiente, procedentes de 6 comunidades autónomas, y 153 mayores institucionalizados en residencias de la Comunidad de Madrid. Los principales resultados de esta tesis son los siguientes: a) Fueron establecidos los valores de referencia, así como las curvas de percentiles, para cada uno de los test de fitness, de acuerdo a la edad y al sexo, en población mayor española de vida independiente y no institucionalizada. b) Los varones obtuvieron mejores niveles de fitness que las mujeres, excepto en los test de flexibilidad; existe una tendencia a disminuir la condición física en ambos sexos a medida que la edad aumenta. c) Niveles bajos de fitness funcional fueron asociados con un aumento en la percepción de problemas. d) El nivel mínimo de fitness funcional a partir del cual los mayores perciben problemas en sus actividades de la vida diaria (AVD) es similar en ambos sexos. e) Niveles elevados de fitness fueron asociados con un menor riesgo de sufrir obesidad sarcopénica y con una mejor salud percibida en los mayores. f) Las personas mayores con obesidad sarcopénica tienen menor capacidad funcional que las personas mayores sanas. g) Niveles elevados de fuerza fueron asociados con un mejor estado cognitivo siendo el estado cognitivo la variable que más influye en el deterioro de la fuerza, incluso más que el sexo y la edad. ABSTRACT Fitness is a variable that is gaining in prominence, especially from the health perspective. Improvement of life quality that has been experienced in the last few years in developed countries, leads to an expanded life expectancy, increasing the numbers of people living longer. This population consisting of people of over 60 years, an almost forgotten population group from the point of view of scientific research in the field of physical activity and sport, is becoming increasingly important, with the main aim of helping to achieve the saying “do not only add years to life, but also add life to years”. The principal aim of the current thesis was to assess physical fitness levels in Spanish elderly people, of over 65 years, analyzing relationship between physical fitness, its determinants, and other aspects of health such as body composition and cognitive status. In order to establish further public health policies in relation to physical activity and active ageing it is necessary to identify the starting physical fitness levels of the Spanish population and their determinants. The work is based on data from the EXERNET multi-center study ("Multi-center Study for the Evaluation of Fitness levels and their relationship to Healthy Lifestyles in noninstitutionalized Spanish elderly"), and on data from two studies conducted in institutionalized elderly people: a total of 3136 non-institutionalized elderly, from 6 Regions of Spain, and 153 institutionalized elderly in nursing homes of Madrid. The main outcomes of this thesis are: a) sex- and age-specific physical fitness normative values and percentile curves for independent and non-institutionalized Spanish elderly were established. b) Greater physical fitness was present in the elderly men than in women, except for the flexibility test, and a trend toward decreased physical fitness in both sexes as their age increased. c) Lower levels of functional fitness were associated with increased perceived problems. d) The minimum functional fitness level at which older adults perceive problems in their ADLs, is similar for both sexes e) Higher levels of physical fitness were associated with a reduced risk of suffering sarcopenic obesity and better perceived health among the elderly. f) The elderly with sarcopenic obesity have lower physical functioning than healthy counterparts. g) Higher strength values were associated with better cognitive status with cognitive status being the most influencing variable in strength deterioration even more than sex and age.