Relaxation versus exercise for improved quality of life in lymphoma survivors-a randomised controlled trial.

PURPOSE: Lymphoma survivors experience persisting needs as a consequence of disease and treatment, which have an impact on quality of life (QoL). There is evidence supporting the use of relaxation and exercise to improve QoL, but there is no agreement on which is more beneficial. This study aims to compare a relaxation intervention versus an exercise intervention to determine which has a greater impact on QoL post-chemotherapy. METHODS: Eligible participants (n = 46) were randomised to a relaxation or exercise intervention for 12 weeks. QoL was assessed at baseline, 6 weeks and post-intervention using the European Organisation for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC QLQ-C30) questionnaire, which is a valid and reliable tool. The summary score and all EORTC domains were assessed. RESULTS: There was a significant difference in QoL post-intervention between groups (p = 0.029) while adjusting for baseline QoL, with the exercise group demonstrating a larger improvement. Within-group QoL significantly improved pre- to post-intervention in both the relaxation (p = 0.036) and exercise (p = 0.004) groups. CONCLUSIONS: A self-management intervention of either exercise or relaxation can help significantly improve QoL in lymphoma survivors following chemotherapy. While exercise is preferred, a relaxation intervention would also have a beneficial impact on QoL. IMPLICATIONS FOR CANCER SURVIVORS: Lymphoma survivors should be routinely screened and those with decreased QoL referred for an exercise programme, or relaxation for survivors who are unable to exercise or choose not to. A home-based programme can have a significant positive impact on QoL and is a feasible and effective method in the current climate. TRIAL REGISTRATION NUMBER: Clinical Trials ID NCT02272751.

Let the river erode! Enabling lateral migration increases geomorphic unit diversity.

River restoration practice frequently employs conservative designs that create and maintain prescribed, static morphology. Such approaches ignore an emerging understanding of resilient river systems that typically adjust their morphology in response to hydrologic, vegetative and sediment supply changes. As such, using increased dynamism as a restoration design objective will arguably yield more diverse and productive habitats, better managed expectations, and more self-sustaining outcomes. Here, we answer the following question: does restoring lateral migration in a channelised river that was once a wandering gravel-bed river, result in more diverse in-channel geomorphology? We acquired pre- and post-restoration topographic surveys on a segment of the Allt Lorgy, Scotland to quantify morphodynamics and systematically map geomorphic units, using Geomorphic Unit Tool (GUT) software. GUT implements topographic definitions to discriminate between a taxonomy of fluvial landforms that have been developed from an extension of the River Styles framework, using 3-tiered hierarchy: (1) differentiation based on stage or elevation relative to channel; (2) classification of form based on shape (mound, bowl, trough, saddle, plane, wall); and (3) mapping geomorphic units based on attributes (e.g., position and orientation). Results showed restoration increased geomorphic unit diversity, with the Shannon Diversity Index increasing from 1.40 pre-restoration (2012) to 2.04 (2014) and 2.05 (2016) after restoration. Channel widening, due to bank erosion, caused aerial coverage of in-channel geomorphic units to increase 23% after restoration and 6% further in the two-years following restoration. Once bank protection was removed, allowing bank erosion yieled a local supply of sediment to enable the formation and maintenance of lateral and point bars, riffles and diagonal bar complexes, and instream wood created structurally-forced pools and riffles. The methodology used systematically quantifies how geomorphic unit diversity increases when a river is given back its freedom space. The framework allows for testing restoration design hypotheses in post-project appraisal.

Lymphoma survivors' experience of participation in a home-based intervention post-chemotherapy.

PURPOSE: Further research on patient experience and involvement is recommended in order to develop evidence-based and meaningful care pathways for lymphoma survivors. This study aims to explore the experience of a sample of lymphoma survivors participating in a home-based intervention following chemotherapy. METHODS: Eligible participants who completed a 12-week home-based intervention were invited to complete the End of Study Questionnaire designed to explore perceptions, preferences and barriers to participation. Content analysis was used to generate codes, describe frequencies and identify themes. RESULTS: Participating in a home-based intervention post-treatment was a positive experience overall, and aided recovery in this sample of lymphoma survivors (n = 35). Participants felt the programme provided structure, motivation and liked contact with the researcher. Participants highlighted their need for advice on healthy lifestyle, diet in particular. CONCLUSIONS: Lymphoma survivors in this study reported participation in a home-based intervention following treatment beneficial and aided recovery. IMPLICATIONS FOR CANCER SURVIVORS: A large proportion of lymphoma survivors would benefit from a rehabilitation intervention post-chemotherapy. Intervention programmes should include follow-ups to monitor progress and provide support and motivation. Health professionals should recommend healthy lifestyle guidelines to survivors on completion of treatment or refer patients to appropriate services for rehabilitation and advice.

The contributions of oxidative stress, oxidised lipoproteins and AMPK towards exercise-associated PPARγ signalling within human monocytic cells.

Peroxisome proliferator-activated receptor gamma (PPARγ) is known to be activated via exercise-associated transient increases in oxidative stress. However, the precise mechanism(s) triggering PPARγ activation in monocytes during/following exercise remain to be confirmed. Here, two cohorts of five healthy male individuals undertook exercise bouts (cycling; 70% VO2max; 45 min) in the presence/absence of dietary antioxidant supplementation (vitamins C (1000 mg/day) and E (400IU/day) for four weeks before exercise); monocytic 5' adenosine monophosphate-activated protein kinase (AMPK)/PPARγ co-activator-1alpha (PGC-1α)/PPARγ signalling was investigated in samples obtained before exercise and up to 24 h after exercise, while THP-1 cells were cultured as an in vitro monocyte model. In THP-1 cells, AMPKα1 was phosphorylated within 1h of menadione (15 µM)-triggered increases in [reactive oxygen species (ROS)]cyto, an effect which was followed by upregulation of PPARγ and several of its target genes (PGC-1α, liver X receptor alpha [LXRα] and ATP-binding cassette subfamily A, member 1 [ABCA1]; 24-72 h), with these effects being blunted by co-administration of vitamin C (62.5 µM). Conversely, treatment with oxidised low-density lipoprotein (oxLDL) (1 µg/mL; 24-72 h), but not non-oxidised LDL, upregulated the above PPARγ-regulated genes without affecting AMPKα1 phosphorylation. In vivo, dietary antioxidant supplementation (which is known to prevent exercise-triggered increases in oxLDL levels) blunted exercise-associated upregulation of the above PPARγ-regulated genes, but had no effect on exercise-associated transient [ROS]cyto increases, or on AMPK phosphorylation. These data suggest that exercise-associated PPARγ signalling effects appear, at least in monocytes, to be mediated by increased generation of PPARγ ligands via oxidation of lipoproteins (following exercise-associated transient increases in oxidative stress), rather than via [ROS]cyto-mediated AMPK activation. These findings may be of clinical relevance, as PPARγ activation in monocytes is associated with beneficial effects related to type-2 diabetes and its cardiovascular complications.

Interleukin-6 in combination with the interleukin-6 receptor stimulates glucose uptake in resting human skeletal muscle independently of insulin action.

AIM: To examine if the physiological concentrations of both interleukin-6 (IL-6), in combination with IL-6 receptor (IL-6R), are able to stimulate glucose uptake in human skeletal muscle and to identify the associated signalling pathways. METHODS: Skeletal muscle tissue (~60 mg) obtained from healthy female volunteers via muscle biopsy was subjected to incubation in the absence or presence of insulin (60 µU/ml), recombinant human IL-6 (rhIL-6) (4 ng/ml) or a combination of rhIL-6 (4 ng/ml) and rhIL-6R (100 ng/ml) for 30 min, with glucose transport measured for each incubation. Western blot analysis was conducted on key signalling proteins, protein kinase B (PKB/Akt), adenosine monophosphate kinase (AMPK) and mammalian target of rapamycin (mTOR) to gain an early insight into any differing transport mechanisms. RESULTS: Human skeletal muscle exhibited increased glucose uptake with insulin (1.85-fold; p < 0.05) and stimulated phosphorylation of PKB/Akt and AMPK (0.98 ± 0.23 and 1.49 ± 0.13, respectively, phosphorylated: total; p < 0.05). IL-6/IL-6R increased phosphorylation of mTOR (fourfold, p < 0.05) compared to insulin, IL-6 alone and basal control. IL-6 did not stimulate glucose uptake but combined with IL-6R, induced 1.5-fold increase in glucose uptake (p < 0.05) and phosphorylation of AMPK (0.95 ± 0.19; phosphorylated: total, p < 0.05). CONCLUSIONS: IL-6 in combination with IL-6R and not IL-6 alone increased glucose uptake in human skeletal muscle. IL-6/IL-6R-mediated glucose uptake occurred independently of PKB/Akt phosphorylation, showing that IL-6/IL-6R-induced glucose uptake is dependent on a divergent pathway.

Exercise-associated generation of PPARγ ligands activates PPARγ signaling events and upregulates genes related to lipid metabolism.

The aim of the present study was to test the hypotheses that exercise is associated with generation of peroxisome proliferator-activated receptor-γ (PPARγ) ligands in the plasma and that this may activate PPARγ signaling within circulating monocytes, thus providing a mechanism to underpin the exercise-induced antiatherogenic benefits observed in previous studies. A cohort of healthy individuals undertook an 8-wk exercise-training program; samples were obtained before (Pre) and after (Post) standardized submaximal exercise bouts (45 min of cycling at 70% of maximal O(2) uptake, determined at baseline) at weeks 0, 4, and 8. Addition of plasma samples to PPARγ response element (PPRE)-luciferase reporter gene assays showed increased PPARγ activity following standardized exercise bouts (Post/Pre = 1.23 ± 0.10 at week 0, P < 0.05), suggesting that PPARγ ligands were generated during exercise. However, increases in PPARγ/PPRE-luciferase activity in response to the same standardized exercise bout were blunted during the training program (Post/Pre = 1.18 ± 0.14 and 1.10 ± 0.10 at weeks 4 and 8, respectively, P > 0.05 for both), suggesting that the relative intensity of the exercise may affect PPARγ ligand generation. In untrained individuals, specific transient increases in monocyte expression of PPARγ-regulated genes were observed within 1.5-3 h of exercise (1.7 ± 0.4, 2.6 ± 0.4, and 1.4 ± 0.1 fold for CD36, liver X receptor-α, and ATP-binding cassette subfamily A member 1, respectively, P < 0.05), with expression returning to basal levels within 24 h. In contrast, by the end of the exercise program, expression at the protein level of PPARγ target genes had undergone sustained increases that were not associated with an individual exercise bout (e.g., week 8 Pre/week 0 Pre = 2.79 ± 0.61 for CD36, P < 0.05). Exercise is known to upregulate PPARγ-controlled genes to induce beneficial effects in skeletal muscle (e.g., mitochondrial biogenesis and aerobic respiration). We suggest that parallel exercise-induced benefits may occur in monocytes, as monocyte PPARγ activation has been linked to beneficial antidiabetic effects (e.g., exercise-induced upregulation of monocytic PPARγ-controlled genes is associated with reverse cholesterol transport and anti-inflammatory effects). Thus, exercise-triggered monocyte PPARγ activation may constitute an additional rationale for prescribing exercise to type 2 diabetes patients.

Fine sediment influence on salmonid spawning habitat in a lowland agricultural stream: a preliminary assessment.

Spawning habitat utilized by Atlantic Salmon (Salmo salar) and Sea Trout (Salmo trutta) was characterized in a 1.6-km reach of the Newmills Burn, a small, highly canalized tributary of the River Don in Aberdeenshire. The Newmills Burn is typical of the intensively farmed lower sub-catchments of the major salmon rivers on the east coast of Scotland. Such streams have substantial potential in providing spawning and juvenile habitat for salmonids, with high redd densities resulting in egg deposition rates of > 5 m2. However, in comparison with upland spawning tributaries draining less intensively managed catchments, canalization and intensive cultivation has seriously degraded the physical characteristics of aquatic habitats in many streams. In the Newmills Burn, spawning gravels have a relatively high (> 20% by mass) fine sediment (< 2 mm in size) content. The burn is characterized by hydraulic conditions that are suitable for salmonid spawning, with modal velocities of 0.50-0.65 m s(-1) and depths of 0.20-0.25 m. However, infiltration of fine sediments into gravels is rapid during hydrological events in the winter months. Thus, complete siltation of open gravel matrices (simulated redds) can occur within a week, and probably within a single moderate to large storm event. Appreciable, but small, deposition of organic and silt/clay particles can also affect spawning gravels. Egg mortalities in redds following spawning are variable, but can be as high as 86% in the Newmills Burn. This may be related to fine sediment infiltration, reduced permeability of spawning gravels and reduced oxygen supply to ova. It appears that the main cause of high influx is sediment loads mobilized from intensively managed land. It is suggested that fundamental changes to the management of agricultural land is required if fish habitats are to be improved and degraded streams are allowed to re-naturalize. The need for closely focused investigations of the causal relationships between fine sediment infiltration and egg survival is stressed.

Female access to non-primary occupations: the Indonesian case.

PIP: Focus in this discussion is on the range of nonprimary occupations open to women in Indonesia compared to those open to men. Particular attention is directed to the question of whether given occupations (particularly those that are important sources of employment) are more or less open to women in urban compared to rural areas. Whether an occupation is open to women or not is defined on the basis of the proportion female in that occupation. Where the proportion female is high, it is evident that women have a substantial degree of access to that occupation. In contrast, where the proportion female is very low, it is obviously unusual for women to enter that occupation and female access to such occupations is relatively restricted. The data presented refer to the employed population, i.e., the economically active population excluding the unemployed. The 1971 Population Census is used to maintain seasonal comparability with other analyses of the Indonesian workforce and to allow for seasonal comparability with the data from the 1980 Population Census. Out of 75 nonprimary occupation groups, 39 are excluded from the analysis because in most provinces they employ less than 0.1% of the labor force. The percentage of the male workforce in rural areas that is engaged in the remaining 36 occupations is less than the percentage of the female rural workforce engaged in these same occupations (95.0 compared to 98.2% in Java-Bali and 94.1 compared to 97.4% in the Outer Islands). In urban areas, male-female differences in the percentage concentrated in these 36 occupations are slightly larger (4.4 percentage points in urban compared to 3.2 percentage points in rural Java-Bali and 5.6 and 3.3 percentage points for urban and rural areas in the Outer Islands). A negative association was found between the degree of occupational segregation by sex and the relative modernness of an area, i.e., occupational segregation by sex is greatest in the least modern area of the country, the rural areas of the other islands, and is lowest in the metropolitan area of Jakarta. Although occupational segregation is lower in Jakarta than elsewhere in Indonesia, it is still quite high with an Index value of 51.2. Women were found to be underrepresented in the upper level occupations in all areas of Indonesia. The degree of underrepresentation was considerably greater in rural than in urban areas. Women are over-represented in sales and service occupations, and within these broad categories are most dominant in the more traditional sector of the economy than is the male labor force.^ieng