901 resultados para Exercise functional capacity
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PROGNOSTIC FACTORS PREDICTING FUNCTIONAL OUTCOME AT FOUR MONTHS FOLLOWING ACUTE ANKLE SPRAINBleakley C.M.1, O'Connor S.R.1, Tully M.A.2, Rocke L.G.3, MacAuley D.C.1, Bradbury I.4, Keegan S.4, McDonough S.M.11University of Ulster, Health & Rehabilitation Sciences Research Institute, Newtownabbey, United Kingdom, 2Queen's University, UKCRC Centre of Excellence for Public Health (NI), Belfast, United Kingdom, 3Royal Victoria Hospital, Department of Emergency Medicine, Belfast, United Kingdom, 4Frontier Science (Scotland), Kincraig, Inverness-shire, United KingdomPurpose: To identify clinically relevant factors assessed following acute ankle sprain that predict functional recovery at four months post-injury.Relevance: Ankle sprains are one of the most common musculoskeletal injuries with an estimated 5000 new cases occurring each day in the United Kingdom. In the acute phase, ankle sprains may be associated with pain and loss of function. In the longer-term there is a risk of residual problems including chronic pain or reinjury. Few studies have sought to examine factors associated with a poor long-term prognosis.Participants: 101 patients (Age: Mean (SD) 25.9 (7.9) years; Body Mass Index (BMI): 25.3 (3.5) kg/m2) with an acute grade 1 or 2 ankle sprain attending an accident and emergency department or sports injury clinic. Exclusion criteria included complete (grade 3) rupture of the ankle ligament complex, bony ankle injury or multiple injuries.Methods: Participants were allocated as part of a randomised controlled trial to an accelerated intervention incorporating intermittent ice and early therapeutic exercise or a standard protection, rest, ice, compression, and elevation intervention for one week. Treatment was then standardised in both groups and consisted of ankle rehabilitation exercises focusing on muscle strengthening, neuromuscular training, and sports specific functional exercises for a period of approximately four to six weeks. On initial assessment age, gender, mechanism of injury, presence of an audible pop or snap and the presence of contact during the injury were recorded. The following factors were also recorded at baseline and at one and four weeks post-injury: weight-bearing dorsi-flexion test, lateral hop test, presence of medial pain on palpation and a positive impingement sign. Functional status was assessed using the Karlsson score at baseline, at week four and at four months. Reinjury rates were recorded throughout the intervention phase and at four months.Analysis: A mixed between-within subjects analysis of variance (ANOVA) was used to determine the effect of each factor on functional status at week four and at four months. Significance was set at a Bonferroni adjusted level of 0.0125 (0.05/4).Results: Eighty-five participants (84%) were available at final follow-up assessment. Pain on weight-bearing dorsi-flexion and lateral hop tests at week four were both associated with a lower functional score at four months post-injury (P = 0.011 and P = 0.001). No other significant interactions were observed at any other timepoint (baseline or week one). There were only two reinjuries within the four month follow-up period with a further two reported at approximately six months post-injury. We were therefore unable to determine whether any factors were associated with an increased risk of reinjury.Conclusions: Potential prognostic factors on initial or early examination after acute ankle sprain did not help predict functional recovery at four months post-injury. However, pain on weight-bearing dorsi-flexion and lateral hop tests observed at four weeks were associated with a slower rate of recovery.Implications: Some clinical tests may help identify patients at risk of poor functional recovery after acute ankle sprain. However, further work is required to examine factors which may be predictive on initial assessment.Key-words: 1. Prognostic factors 2. Recovery 3. Ankle sprainFunding acknowledgements: Physiotherapy Research Foundation, Chartered Society of Physiotherapy, Strategic Priority Fund; Department of Employment and Learning, Northern Ireland.Ethics approval: Office for Research Ethics Committee (UK).
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BACKGROUND:
Acute ankle sprains are usually managed functionally, with advice to undertake progressive weight-bearing and walking. Mechanical loading is an important modular of tissue repair; therefore, the clinical effectiveness of walking after ankle sprain may be dose dependent. The intensity, magnitude and duration of load associated with current functional treatments for ankle sprain are unclear.
AIM:
To describe physical activity (PA) in the first week after ankle sprain and to compare results with a healthy control group.
METHODS:
Participants (16-65 years) with an acute ankle sprain were randomised into two groups (standard or exercise). Both groups were advised to apply ice and compression, and walk within the limits of pain. The exercise group undertook additional therapeutic exercises. PA was measured using an activPAL accelerometer, worn for 7 days after injury. Comparisons were made with a non-injured control group.
RESULTS:
The standard group were significantly less active (1.2 ± 0.4 h activity/day; 5621 ± 2294 steps/day) than the exercise (1.7 ± 0 .7 h/day, p=0.04; 7886 ± 3075 steps/day, p=0.03) and non-injured control groups (1.7 ± 0.4 h/day, p=0.02; 8844 ± 2185 steps/day, p=0.002). Also, compared with the non-injured control group, the standard and exercise groups spent less time in moderate (38.3 ± 12.7 min/day vs 14.5 ± 11.4 min/day, p=0.001 and 22.5 ± 15.9 min/day, p=0.003) and high-intensity activity (4.1 ± 6.9 min/day vs 0.1 ± 0.1 min/day, p=0.001 and 0.62 ± 1.0 min/day p=0.005).
CONCLUSION:
PA patterns are reduced in the first week after ankle sprain, which is partly ameliorated with addition of therapeutic exercises. This study represents the first step towards developing evidence-based walking prescription after acute ankle sprain.
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Biodiversity loss is one of the most significant drivers of ecosystem change and is projected to continue at a rapid rate. While protected areas, such as national parks, are seen as important refuges for biodiversity, their effectiveness in stemming biodiversity decline has been questioned. Public agencies have a critical role in the governance of many such areas, but there are tensions between the need for these agencies to be more “adaptive” and their current operating environment. Our aim is to analyze how institutions enable or constrain capacity to conserve biodiversity in a globally significant cross-border network of protected areas, the Australian Alps. Using a novel conceptual framework for diagnosing biodiversity institutions, our research examined institutional adaptive capacity and more general capacity for conserving biodiversity. Several intertwined issues limit public agencies’ capacity to fulfill their conservation responsibilities. Narrowly defined accountability measures constrain adaptive capacity and divert attention away from addressing key biodiversity outcomes. Implications for learning were also evident, with protected area agencies demonstrating successful learning for on-ground issues but less success in applying this learning to deeper policy change. Poor capacity to buffer political and community influences in managing significant cross-border drivers of biodiversity decline signals poor fit with the institutional context and has implications for functional fit. While cooperative federalism provides potential benefits for buffering through diversity, it also means protected area agencies have restricted authority to address cross-border threats. Restrictions on staff authority and discretion, as public servants, have further implications for deploying capacity. This analysis, particularly the possibility of fostering “ambidexterity”—creatively responding to political pressures in a way that also achieves a desirable outcome for biodiversity conservation—is one promising way of building capacity to buffer both political influences and ecological pressures. The findings and the supporting analysis provide insight into how institutional capacity to conserve biodiversity can be enhanced in protected areas in Australia and elsewhere, especially those governed by public agencies and/or multiple organizations and across jurisdictions.
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Mestrado em Fisioterapia
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Pulmonary hypertension (PH) is a rare but serious condition that causes progressive right ventricular (RV) failure and death. PH may be idiopathic, associated with underlying connective-tissue disease or hypoxic lung disease, and is also increasingly being observed in the setting of heart failure with preserved ejection fraction (HFpEF). The management of PH has been revolutionised by the recent development of new disease-targeted therapies which are beneficial in pulmonary arterial hypertension (PAH), but can be potentially harmful in PH due to left heart disease, so accurate diagnosis and classification of patients is essential. These PAH therapies improve exercise capacity and pulmonary haemodynamics, but their overall effect on the right ventricle remains unclear. Current practice in the UK is to assess treatment response with 6-minute walk test and NYHA functional class, neither of which truly reflects RV function. Cardiac magnetic resonance (CMR) imaging has been established as the gold standard for the evaluation of right ventricular structure and function, but it also allows a non-invasive and accurate study of the left heart. The aims of this thesis were to investigate the use of CMR in the diagnosis of PH, in the assessment of treatment response, and in predicting survival in idiopathic and connective-tissue disease associated PAH. In Chapter 3, a left atrial volume (LAV) threshold of 43 ml/m2 measured with CMR was able to distinguish idiopathic PAH from PH due to HFpEF (sensitivity 97%, specificity 100%). In Chapter 4, disease-targeted PAH therapy resulted in significant improvements in RV and left ventricular ejection fraction (p<0.001 and p=0.0007, respectively), RV stroke volume index (p<0.0001), and left ventricular end-diastolic volume index (p=0.0015). These corresponded to observed improvements in functional class and exercise capacity, although correlation coefficients between Δ 6MWD and Δ RVEF or Δ LVEDV were low. Finally, in Chapter 5, one-year and three-year survival was worse in CTD-PAH (75% and 53%) than in IPAH (83% and 74%), despite similar baseline clinical characteristics, lung function, pulmonary haemodynamics and treatment. Baseline right ventricular stroke volume index was an independent predictor of survival in both conditions. The presence of LV systolic dysfunction was of prognostic significance in CTD-PAH but not IPAH, and a higher LAV was observed in CTD-PAH suggesting a potential contribution from LV diastolic dysfunction in this group.
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Objective: To evaluate the functional status of elderly residents in long-term institutions. Methods: Exploratory-descriptive study, developed in two long-term care institutions for the elderly (LTC), in city of Fortaleza, Ceará. The instruments utilized were: 1) Sociodemographic form, 2) Functional Independence Measure (FIM), and 3) International Classification of Functioning (ICF). Data was descriptively analyzed through the calculation of frequency, mean and standard deviation. Results: There was a predominance of males (n=47; 59.49%), with mean age of 74.58 (± 8.89) years, 68.35% (n=54) have been or are married, and 49.37% (n=39) are illiterate. In reference to the FIM, it was observed that the elderly perform the activities in a complete or modified mode and 18.99% (n=15) have difficulty climbing stairs. As to the association between the FIM and the ICF, in relation to self-care, it was seen that 96.20% (n=76) have no difficulty in performing tasks; 92.40% (n=73) move around without difficulty; and 98.73% (n=78) have preserved the cognition. In relation to the capacity of maintaining and controlling social interactions, all exhibit this domain preserved. Conclusion: The surveyed elderly presented good cognitive status and little dependence in activities regarding personal care, mobility and communication. The use of the ICF allows the visualization of the functionality scenario among the elderly, what can facilitate more effective health promotion strategies for this population.
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The main purpose of this pilot study was to investigate the possible influence of genetic polymorphisms of the hOGG1 (Ser326Cys) gene in DNA damage and repair activity by 8-oxoguanine DNA glycosylase 1 (OGG1 enzyme) in response to 16 weeks of combined physical exercise training. Thirty-two healthy Caucasian men (40-74 years old) were enrolled in this study. All the subjects were submitted to a training of 16 weeks of combined physical exercise. The subjects with Ser/Ser genotype were considered as wild-type group (WTG), and Ser/Cys and Cys/Cys genotype were analysed together as mutant group (MG). We used comet assay in conjunction with formamidopyrimidine DNA glycoslyase (FPG) to analyse both strand breaks and FPG-sensitive sites. DNA repair activity were also analysed with the comet assay technique. Our results showed no differences between DNA damage (both strand breaks and FPG-sensitive sites) and repair activity (OGG1) between genotype groups (in the pre-training condition). Regarding the possible influence of genotype in the response to 16 weeks of physical exercise training, the results revealed a decrease in DNA strand breaks in both groups, a decrease in FPG-sensitive sites and an increase in total antioxidant capacity in the WTG, but no changes were found in MG. No significant changes in DNA repair activity was observed in both genotype groups with physical exercise training. This preliminary study suggests the possibility of different responses in DNA damage to the physical exercise training, considering the hOGG1 Ser326Cys polymorphism.
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In this thesis, we study the causal relationship between functional distribution of income and economic growth. In particular, we focus on some of the aspects that might alter the effect of the profit share on growth. After a brief introduction and literature review, the empirical contributions will be presented in Chapters 3,4 and 5. Chapter 3 analyses the effect of a contemporaneous decrease in the wage share among countries that are major trade partners. Falling wage share and wage moderation are a global phenomenon which are hardly opposed by governments. This is because lower wages are associated with lower export prices and, therefore, have a positive effect on net-exports. There is, however, a fallacy of composition problem: not all countries can improve their balance of payments contemporaneously. Studying the country members of the North America Free Trade Agreement, we find that the effect on export of a contemporaneous decrease in the wage share in Mexico, Canada and the United States, is negative in all countries. In other words, the competitive advantage that each country gains because of a reduction in its wage share (to which is associated a decrease in export prices), is offset by a contemporaneous increase in competitiveness in the other two countries. Moreover, we find that NAFTA is overall wage-led: the profit share has a negative effect on aggregate demand. Chapter 4 tests whether it is possible that the effect of the profit share on growth is different in the long run and in the short run. Following Blecker (2014) our hypothesis is that in the short run the growth regime is less wage-led than it is in the long run. The results of our empirical investigation support this hypothesis, at least for the United States over the period 1950-2014. The effect of wages on consumption increases more than proportionally compared to the effect of profits on consumption from the short to the long run. Moreover, consumer debt seem to have only a short-run effect on consumption indicating that in the long run, when debt has to be repaid, consumption depends more on the level of income and on how it is distributed. Regarding investment, the effect of capacity utilization is always larger than the effect of the profit share and that the difference between the two effects is higher in the long run than in the short run. This confirms the hypothesis that in the long run, unless there is an increase in demand, it is likely that firms are not going to increase investments even in the presence of high profits. In addition, the rentier share of profits – that comprises dividends and interest payments – has a long-run negative effect on investment. In the long run rentiers divert firms’ profits from investment and, therefore, it weakens the effect of profits on investment. Finally, Chapter 5 studies the possibility of structural breaks in the relationship between functional distribution of income and growth. We argue that, from the 1980s, financialization and the European exchange rate agreements weakened the positive effect of the profit share on growth in Italy. The growth regime is therefore becoming less profit-led and more wage-led. Our results confirm this hypothesis and also shed light on the concept of cooperative and conflictual regimes as defined by Bhaduri and Marglin (1990).
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abuticaba (Myrciaria cauliflora. Mart) is a highly perishable fruit native to Brazil, which is consumed both fresh and industrially processed in the form of juices, jams, wines and distilled liqueurs. This processing generates a large amount of waste by-products, which represent approximately 50% of the fruit weight. The by-products are of interest for obtaining valuable bioactive compounds that could be used as nutraceuticals or functional ingredients. In this study, fermented and non-fermented jabuticaba pomaces were studied regarding their hydrophilic and lipophilic compounds, as well as their antioxidant properties, including: soluble sugars, organic acids and tocopherols (using high performance liquid chromatography coupled to refraction index, diode array and fluorescence detector, respectively); phenolics and anthocyanins, (using liquid chromatography coupled to diode array detection, and mass spectrometry with electrospray ionization); and fatty acids (using gas-liquid chromatography with flame ionization detection). The analytical data demonstrated that jabuticaba pomaces are a rich source of bioactive compounds such as tocopherols, polyunsaturated fatty acids and phenolic compounds (namely hydrolyzable tannins and anthocyanins) with antioxidant potential. Therefore, jabuticaba pomace may have good potential as a functional ingredient in the fabrication of human foods and animal feed.
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Introduction Cerebral misery perfusion represents a failure of cerebral autoregulation. It is animportant differential diagnosis in post-stroke patients presenting with collapses in the presence of haemodynamically significant cerebrovascular stenosis. This is particularly the case when cortical or internal watershed infarcts are present. When this condition occurs, further investigation should be done immediately. Case presentation A 50-year-old Caucasian man presented with a stroke secondary to complete occlusion of his left internal carotid artery. He went on to suffer recurrent seizures. Neuroimaging demonstrated numerous new watershed-territory cerebral infarcts. No source of arterial thromboembolism was demonstrable. Hypercapnic blood-oxygenation-level-dependent-contrast functional magnetic resonance imaging was used to measure his cerebrovascular reserve capacity. The findings were suggestive of cerebral misery perfusion. Conclusions Blood-oxygenation-level-dependent-contrast functional magnetic resonance imaging allows the inference of cerebral misery perfusion. This procedure is cheaper and more readily available than positron emission tomography imaging, which is the current gold standard diagnostic test. The most evaluated treatment for cerebral misery perfusion is extracranial-intracranial bypass. Although previous trials of this have been unfavourable, the results of new studies involving extracranial-intracranial bypass in high-risk patients identified during cerebral perfusion imaging are awaited. Cerebral misery perfusion is an important and under-recognized condition in which emerging imaging and treatment modalities present the possibility of practical and evidence-based management in the near future. Physicians should thus be aware of this disorder and of recent developments in diagnostic tests that allow its detection.
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Single-cell functional proteomics assays can connect genomic information to biological function through quantitative and multiplex protein measurements. Tools for single-cell proteomics have developed rapidly over the past 5 years and are providing unique opportunities. This thesis describes an emerging microfluidics-based toolkit for single cell functional proteomics, focusing on the development of the single cell barcode chips (SCBCs) with applications in fundamental and translational cancer research.
The microchip designed to simultaneously quantify a panel of secreted, cytoplasmic and membrane proteins from single cells will be discussed at the beginning, which is the prototype for subsequent proteomic microchips with more sophisticated design in preclinical cancer research or clinical applications. The SCBCs are a highly versatile and information rich tool for single-cell functional proteomics. They are based upon isolating individual cells, or defined number of cells, within microchambers, each of which is equipped with a large antibody microarray (the barcode), with between a few hundred to ten thousand microchambers included within a single microchip. Functional proteomics assays at single-cell resolution yield unique pieces of information that significantly shape the way of thinking on cancer research. An in-depth discussion about analysis and interpretation of the unique information such as functional protein fluctuations and protein-protein correlative interactions will follow.
The SCBC is a powerful tool to resolve the functional heterogeneity of cancer cells. It has the capacity to extract a comprehensive picture of the signal transduction network from single tumor cells and thus provides insight into the effect of targeted therapies on protein signaling networks. We will demonstrate this point through applying the SCBCs to investigate three isogenic cell lines of glioblastoma multiforme (GBM).
The cancer cell population is highly heterogeneous with high-amplitude fluctuation at the single cell level, which in turn grants the robustness of the entire population. The concept that a stable population existing in the presence of random fluctuations is reminiscent of many physical systems that are successfully understood using statistical physics. Thus, tools derived from that field can probably be applied to using fluctuations to determine the nature of signaling networks. In the second part of the thesis, we will focus on such a case to use thermodynamics-motivated principles to understand cancer cell hypoxia, where single cell proteomics assays coupled with a quantitative version of Le Chatelier's principle derived from statistical mechanics yield detailed and surprising predictions, which were found to be correct in both cell line and primary tumor model.
The third part of the thesis demonstrates the application of this technology in the preclinical cancer research to study the GBM cancer cell resistance to molecular targeted therapy. Physical approaches to anticipate therapy resistance and to identify effective therapy combinations will be discussed in detail. Our approach is based upon elucidating the signaling coordination within the phosphoprotein signaling pathways that are hyperactivated in human GBMs, and interrogating how that coordination responds to the perturbation of targeted inhibitor. Strongly coupled protein-protein interactions constitute most signaling cascades. A physical analogy of such a system is the strongly coupled atom-atom interactions in a crystal lattice. Similar to decomposing the atomic interactions into a series of independent normal vibrational modes, a simplified picture of signaling network coordination can also be achieved by diagonalizing protein-protein correlation or covariance matrices to decompose the pairwise correlative interactions into a set of distinct linear combinations of signaling proteins (i.e. independent signaling modes). By doing so, two independent signaling modes – one associated with mTOR signaling and a second associated with ERK/Src signaling have been resolved, which in turn allow us to anticipate resistance, and to design combination therapies that are effective, as well as identify those therapies and therapy combinations that will be ineffective. We validated our predictions in mouse tumor models and all predictions were borne out.
In the last part, some preliminary results about the clinical translation of single-cell proteomics chips will be presented. The successful demonstration of our work on human-derived xenografts provides the rationale to extend our current work into the clinic. It will enable us to interrogate GBM tumor samples in a way that could potentially yield a straightforward, rapid interpretation so that we can give therapeutic guidance to the attending physicians within a clinical relevant time scale. The technical challenges of the clinical translation will be presented and our solutions to address the challenges will be discussed as well. A clinical case study will then follow, where some preliminary data collected from a pediatric GBM patient bearing an EGFR amplified tumor will be presented to demonstrate the general protocol and the workflow of the proposed clinical studies.
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In this Clinical Practice Guideline we discuss the diagnostic and therapeutic approach of adult patients with constipation and abdominal complaints at the confluence of the irritable bowel syndrome spectrum and functional constipation. Both conditions are included among the functional bowel disorders, and have a significant personal, healthcare, and social impact, affecting the quality of life of the patients who suffer from them. The first one is the irritable bowel syndrome subtype, where constipation represents the predominant complaint, in association with recurrent abdominal pain, bloating, and abdominal distension. Constipation is characterized by difficulties with or low frequency of bowel movements, often accompanied by straining during defecation or a feeling of incomplete evacuation. Most cases have no underlying medical cause, and are therefore considered as a functional bowel disorder. There are many clinical and pathophysiological similarities between both disorders, and both respond similarly to commonly used drugs, their primary difference being the presence or absence of pain, albeit not in an "all or nothing" manner. Severity depends not only upon bowel symptom intensity but also upon other biopsychosocial factors (association of gastrointestinal and extraintestinal symptoms, grade of involvement, and perception and behavior variants). Functional bowel disorders are diagnosed using the Rome criteria. This Clinical Practice Guideline has been made consistent with the Rome IV criteria, which were published late in May 2016, and discuss alarm criteria, diagnostic tests, and referral criteria between Primary Care and gastroenterology settings. Furthermore, all the available treatment options (exercise, fluid ingestion, diet with soluble fiber-rich foods, fiber supplementation, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antidepressants, psychological therapy, acupuncture, enemas, sacral root neurostimulation, surgery) are discussed, and practical recommendations are made regarding each of them.
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This study determined roller massager (RM) effectiveness on ankle plantar flexors’ recovery after exercise-induced muscle damage (EIMD) stimulus. Two experiments were conducted. The first experiment (n=10) examined functional [i.e., ankle plantar flexion maximal voluntary isometric contraction (MVIC) and submaximal (30% of MVIC) sustained force; ankle dorsiflexion maximal range of motion and resistance to stretch; and pain pressure threshold] and morphological [medial gastrocnemius (MG) cross sectional area, thickness, fascicle length, and fascicle angle] variables, before and immediately, 1h, 24h, 48h, and 72 after EIMD. In the second experiment (n=10), changes in MG deoxyhemoglobin concentration kinetics (velocity and amplitude) during a submaximal sustained force test were observed before and 48h after EIMD. Participants performed both experiments twice, with and without (NRM) the application of a RM (6 × 45 seconds with 20 seconds rest between sets). RM intervention did not alter plantar flexors’ strength and flexibility impairment after EIMD, as well the MG morphology and oxygenation kinetics (p>0.05). On the other hand, a strong tendency for an acute (within 1 hour) change of ipsilateral (post-effects: RM=+19%, NRM=-5%, p=0.032) and contralateral (p=0.095) MG pain pressure threshold was observed. In conclusion, the present results suggest that a roller massager has no effect on muscular performance, morphology, and oxygenation recovery after EIMD, except for muscle pain pressure threshold (i.e., a soreness). Thus, RM may have potential application in recovery for people with increased muscle soreness, if performed immediately before a physical task.
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Communities can be defined as assemblages of species coexisting under particular environments. The relationship between environment and species are regulated by both environmental requirements –which ultimately determine the species capacity to establish and survive in a particular environment– and the ecological interactions occurring during assembly processes –which also determine community composition by conditioning species coexistence. In this context, plant functional traits are attributes that represent ecological strategies and determine how plants respond to environmental factors and interact with other species. Therefore, the analysis of how traits vary through the dynamics of communities, such as along successions, can give insights about how environmental requirements and species interactions may determine the composition and functional structure of these communities. The xerophytic shrub communities inhabiting inland sand dunes in SW Portugal are characterized by successional processes that are mainly driven by local (edaphic gradients and human disturbance) and regional (climate) processes. Therefore, they constitute an appropriate system for studying species interactions and environmentcommunity co-variations based on functional terms. Using these communities as a model, we evaluate the hypothesis that successional community changes in species composition of xerophytic shrub communities can result in concurrent changes in functional diversity