Effect of post-exercise lactate administration on glycogen repletion and signaling activation in different types of mouse skeletal muscle

Lactate is not merely a metabolic intermediate that serves as an oxidizable and glyconeogenic substrate, but it is also a potential signaling molecule. The objectives of this study were to investigate whether lactate administration enhances post-exercise glycogen repletion in association with cellular signaling activation in different types of skeletal muscle. Eight-week-old male ICR mice performed treadmill running (20 m/min for 60 min) following overnight fasting (16 h). Immediately after the exercise, animals received an intraperitoneal injection of phosphate-buffered saline or sodium lactate (equivalent to 1 g/kg body weight), followed by oral ingestion of water or glucose (2 g/kg body weight). At 60 min of recovery, glucose ingestion enhanced glycogen content in the soleus, plantaris, and gastrocnemius muscles. In addition, lactate injection additively increased glycogen content in the plantaris and gastrocnemius muscles, but not in the soleus muscle. Nevertheless, lactate administration did not significantly alter protein levels related to glucose uptake and oxidation in the plantaris muscle, but enhanced phosphorylation of TBC1D1, a distal protein regulating GLUT4 translocation, was observed in the soleus muscle. Muscle FBP2 protein content was significantly higher in the plantaris and gastrocnemius muscles than in the soleus muscle, whereas MCT1 protein content was significantly higher in the soleus muscle than in the plantaris and gastrocnemius muscles. The current findings suggest that an elevated blood lactate concentration and post-exercise glucose ingestion additively enhance glycogen recovery in glycolytic phenotype muscles. This appears to be associated with glyconeogenic protein content, but not with enhanced glucose uptake, attenuated glucose oxidation, or lactate transport protein.

Competitive evaluation in male elite junior soccer players: entire match, replaced, and substitute players

The purpose of this study was to analyze the mood states, recovery, displacement patterns, and rating of perceived exertion of elite junior soccer players during a national competition, considering substitutions in the matches. Before the games, the mood states and total quality recovery (TQR) were evaluated. During the games, the total distance (TD), low-speed distance (LSD), and high-speed distance were monitored. At the end of the matches, the rating of perceived exertion scale was used. The average and standard deviation were used to compare the match stages, soccer positions and influence of the substitutions. The significance level adopted was 5%. In relation to the mood states, fatigue presented higher values (P<0.05) for entire match and substitute players, and in the TQR, substitute players presented better recovery (P<0.05) than entire match and replaced players. In the TD, shorter distances covered were observed (P<0.05) in the first half, and the average of the midfielders was longer (P<0.05) than that of the defenders. In the LSD, the midfielders covered longer distances (P<0.05) than the strikers and defenders. It is possible to conclude that the substitutions have an impact on the player positions, match stages and maintenance of the intensity of the players.

Unintended consequences of institutionalizing peer support work in mental healthcare

The widespread shift towards recovery-oriented mental healthcare has led to the extensive growth of peer-delivered services. Peer support workers draw on lived experience of mental health challenges and service use to provide non-clinical support services. As peer support services have grown, they have also formalized. This mixed-methods study of peer support work in Pennsylvania (USA) explores how peer support has been institutionalized, and identifies the intended impacts and unintended consequences associated with that process. In Pennsylvania, the inclusion of peer support services as a Medicaid reimbursable service, in addition to county level mandates regarding peer support service availability, have served to institutionalize the field. Data include 49 semi-structured interviews conducted with peer support workers (n = 35) and stakeholders (n = 14) in 2016. Qualitative analyses reveal changes to the scope and nature of peer support work, the peer workforce, peer client relationships, and to stigma in the workplace. Despite these changes, peer workers frequently remain underpaid and unable to advance professionally. The institutionalization of peer support serves as a barrier to worker entry and retention and highlights tensions between the consumer-driven origin of the recovery field and the current mental healthcare system. The institutionalization of roles defined by experiential expertise, such as peer support, has the potential to reduce the very centrality of experiential expertise, reproduce social inequalities, and paradoxically impact stigma.

Recovery from physical limitations among older Mexican adults

OBJECTIVES

This paper examines the key determinants of the likelihood of recovery from a physical disability among older adults.

METHODS

Data come from the Mexican Health and Aging Study (MHAS), a national sample of adults born in 1951 or earlier, including a baseline survey in 2001 and follow-ups in 2003, 2012 and 2015. At baseline, we divided our sample of older adults aged 60+ by dimensions of physical limitations (ADLs, IADLs, mobility) and classified respondents as having physical limitations in zero, one, two or three dimensions. Each respondent was then categorized as "same", "worse", "improved" or "died" depending on the number of physical dimensions with a limitation in a 2-year span (2001-2003) and again, separately, in a 3-year span (2012-2015). We then used a multinomial logistic regression to analyze the relative risk of transitioning from one category to another.

FINDINGS

Around 21 % of our sample exhibited some recovery in 2003 and around 20 % recovered in 2015. Age, gender, poor self-rated health, depression and some chronic conditions were significant for shifting the relative risk from staying the same to getting worse, dying or even improving.

CONCLUSIONS

Disability from a physical limitation is a reversible and dynamic process. Our results reflect the importance of considering the dimensions of physical ability while analyzing recovery, and illustrate that the presence of a chronic condition or depressive symptoms does not necessarily imply permanent disability.

Survival and functional outcome at hospital discharge following in-hospital cardiac arrest (IHCA): A prospective multicentre observational study

AIM

To evaluate the functional outcome of patients after in-hospital cardiac arrest (IHCA) and to identify associations with good functional outcome at hospital discharge.

METHOD

Emergency calls were prospectively screened and data collected for IHCAs in seven Australian hospitals. Patients were included if aged > 18 years, admitted as an acute care hospital in-patient and experienced IHCA; defined by a period of unresponsiveness with no observed respiratory effort and commencement of external cardiac compressions. Data collected included patient demographics, clinical and cardiac arrest characteristics, survival and functional outcome at hospital discharge using the modified Rankin Scale (mRS) and Katz Index of Independence in ADLs (Katz-ADL).

RESULTS

152 patients suffered 159 IHCAs (male 66.4%; mean age 70.2 (± 13.9) years). Sixty patients (39.5%) survived, of whom 43 (71.7%) had a good functional outcome (mRS ≤ 3) and 38 (63.3%) were independent with activities of daily living (ADLs) at hospital discharge (Katz-ADL = 6). Younger age (OR 0.95; 95% CI 0.91-0.98; p = 0.003), shorter duration of CPR (OR 0.84; 95% CI 0.77-0.91; p < 0.0001) and shorter duration of hospital admission prior to IHCA (OR 0.96; 95% CI 0.93-0.998; p = 0.04) were independently associated with a good functional outcome at hospital discharge.

CONCLUSION

The majority of survivors had a good functional outcome and were independent with their ADLs at hospital discharge. Factors associated with good functional outcome at hospital discharge were identified.

Back squat velocity to assess neuromuscular status of rugby league players following a match

OBJECTIVES

Back squat mean concentric velocity (MV) and countermovement jump (CMJ) performance were examined in sub-elite rugby league players post-match to monitor changes in neuromuscular status (NMS) from baseline. Relationships between changes in back squat MV and CMJ performance variables were used to compare back squat MV to an established method to monitor NMS.

DESIGN

Longitudinal observational design.

METHODS

18 male sub-elite rugby league players (mean±SD, 20.5±2.4 yr; 180.0±6.7cm; 93.3±11.2kg) performed 3 repetitions of CMJ and back squat with an individualised, pre-determined load at -2h (baseline), +30min, +24h, and +48h in relation to a match. Back squat MV, CMJ height, CMJ peak power, and CMJ peak velocity were measured with a linear position transducer.

RESULTS

Significant (p<0.05), small to large decreases (ES=0.52-1.24) were observed in back squat MV up to +48h post-match. Significant (p<0.05), small to moderate decreases (ES=0.52-0.70) in CMJ height were also observed up to +24h post-match, returning to baseline at +48h. CMJ peak power and peak velocity post-match changes were not significant compared to baseline (p>0.05). Significant positive correlations were found between changes in back squat MV and CMJ height at +30min (r=0.59; p=0.009) and +48h (r=0.51; p=0.03).

CONCLUSIONS

These findings suggest back squat MV may be a suitable alternative or addition to CMJ testing for monitoring NMS in rugby league players.

A trauma medical home, evaluating collaborative care for the older injured patient: study protocol for a randomized controlled trial

Background

It is estimated that 55 million adults will be 65 years and older in the USA by 2020. These older adults are at increased risk for injury and their recovery is multi-faceted. A collaborative care model may improve psychological and functional outcomes of the non-neurologically impaired older trauma patient and reduce health care costs.

Methods

This is a randomized controlled trial of 430 patients aged 50 and older who have suffered a non-neurologic injury and are admitted to a level one trauma center in Indianapolis, IN, or Madison, WI. Participants will be assigned to either the Trauma Medical Home (TMH) intervention or usual care. The TMH intervention is a collaborative care model that includes validated protocols addressing the multi-faceted needs of this population, with the help of care coordination software and a mobile office concept. The primary outcome is self-reported physical recovery at 6- and 12-month follow-up. Secondary outcomes include self-reported psychological recovery, acute health care utilization, and cost-effectiveness of the intervention at 6 and 12 months. The TMH collaborative care model will be delivered by a registered nurse care coordinator. The assessments will be completed by trained blinded research assistants.

Discussion

The proposed study will evaluate a collaborative care model to help maximize psychological and functional recovery for non-neurologically injured older patients at four level one trauma centers in the Midwest.

Trial registration

Clinical Trials. NCT03108820. Registered on 11 April 2017.

Protocol Version 6: Study # 1612690852. April 12, 2019.

Sponsor: Indiana University. Human subjects and IRB contact information: irb@iu.edu

Prospectively registered in the WHO ICTRP on 4 June 2017.

A critical updated review of the hydrometallurgical routes for recycling zinc and manganese from spent zinc-based batteries

This review paper aims to present and analyse data from the most recent literature (between 2007 and 2019) published on the topic of manganese (Mn) and zinc (Zn) recovery from zinc-based spent batteries through hydrometallurgical methods. In a first attempt, a detailed comparative assessment of the metals leaching performance (as well as the experimental variables that influence its performance) reported in the various studies with strong acid or bases, potentially supplemented by complexing or reducing agents, as well as the reactions involved, are reviewed and discussed. All data point out that the use of a reductant is needed to fully solubilize Mn from spent batteries during the leaching process. Comparison of the data seem to indicate that most reductants have similar performance and, therefore, the choice of a reductant should be focused on low cost or even waste materials. In a second attempt, the separative processes mostly described in the literature to recover Mn and Zn from leachates are reviewed emphasizing the strengths and weaknesses of each technique. Solvent extraction is the most widely tested process for this aim. A thorough comparison of existing data indicates that, in general, neutral extractants have higher potential for selective separation of Zn and Mn. Furthermore, although chemical precipitation is a simple process, low pure final metal hydroxide products are expected to be achieved when alkaline precipitation is implemented comparatively to the Mn oxidative precipitation where Mn can be recovered selectively as a solid of manganese (IV) oxide.

Effects of Supervised Early Resistance Training versus standard care on cognitive recovery following cardiac surgery via median sternotomy (the SEcReT study): protocol for a randomised controlled pilot study

Introduction

Mild cognitive impairment is considered a precursor to dementia and significantly impacts upon quality of life. The prevalence of mild cognitive impairment is higher in the post-surgical cardiac population than in the general population, with older age and comorbidities further increasing the risk of cognitive decline. Exercise improves neurogenesis, synaptic plasticity and inflammatory and neurotrophic factor pathways, which may help to augment the effects of cognitive decline. However, the effects of resistance training on cognitive, functional and overall patient-reported recovery have not been investigated in the surgical cardiac population. This study aims to determine the effect of early moderate-intensity resistance training, compared to standard care, on cognitive recovery following cardiac surgery via a median sternotomy. The safety, feasibility and effect on functional recovery will also be examined.

Methods

This study will be a prospective, pragmatic, pilot randomised controlled trial comparing a standard care group (low-intensity aerobic exercise) and a moderate-intensity resistance training group. Participants aged 18 years and older with coronary artery and/or valve disease requiring surgical intervention will be recruited pre-operatively and randomised 1:1 to either the resistance training or standard care group post-operatively. The primary outcome, cognitive function, will be assessed using the Alzheimer’s Disease Assessment Scale and cognitive subscale. Secondary measures include safety, feasibility, muscular strength, physical function, multiple-domain quality of recovery, dynamic balance and patient satisfaction. Assessments will be conducted at baseline (pre-operatively) and post-operatively at 2 weeks, 8 weeks, 14 weeks and 6 months.

Discussion

The results of this pilot study will be used to determine the feasibility of a future large-scale randomised controlled trial that promotes the integration of early resistance training into existing aerobic-based cardiac rehabilitation programs in Australia.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001430325p. Registered on 9 October 2017. Universal Trial Number (UTN): U1111-1203-2131.

Predictors of premature treatment termination in a large residential addiction medicine program

BACKGROUND

While inpatient programs are a common setting for addiction treatment, patients' premature termination is a major concern. Predicting premature treatment termination has the potential to substantially improve patient outcomes by identifying high-risk profiles and suggesting care paths that might reduce dropout. The current study examined the predictors of premature termination from an inpatient addiction medicine service.

METHODS

In 1082 patients admitted to a large inpatient addiction medicine service, we used intake assessments of severity of alcohol use disorder, illicit drug use disorder, post-traumatic stress disorder (PTSD), anxiety disorders, and major depressive disorder to predict planned termination (n = 922) or premature termination (n = 160). We used two complementary analytic approaches-traditional binary logistic regression and a data-driven latent profile analysis (LPA).

RESULTS

Binary logistic regression revealed that alcohol use severity, illicit drug use severity, and PTSD severity significantly predicted termination status, although alcohol use severity notably exhibited an inverse relationship. The LPA revealed four distinct profiles, with one profile exhibiting a significantly higher rate of premature termination and another exhibiting a significantly lower rate of premature termination. The high-risk profile was characterized by high drug severity, high comorbid psychopathology (PTSD, depression, and anxiety symptoms), but low alcohol severity. The low-risk profile was characterized by high alcohol severity, but low drug use and low comorbid psychopathology.

CONCLUSIONS

These results provide converging evidence that illicit drug severity and psychiatric severity, and particularly PTSD, were associated with premature termination. Moreover, the LPA revealed distinct latent subgroups of patients with meaningfully higher and lower risk of premature termination, suggesting that addiction services should develop strategies for identifying high-risk individuals or develop care paths for high-risk symptom clusters. Approaches that are trauma-informed or otherwise focus on the management of comorbid psychiatric conditions may be particularly appropriate for reducing premature termination.

The Characteristic Recovery Time as a Novel, Noninvasive Metric for Assessing In Vivo Cartilage Mechanical Function

Osteoarthritis (OA) is a disease characterized by the degeneration of cartilage tissue, and is a leading cause of disability in the United States. The clinical diagnosis of OA includes the presence of pain and radiographic imaging findings, which typically do not present until advanced stages of the disease when treatment is difficult. Therefore, identifying new methods of OA detection that are sensitive to earlier pathological changes in cartilage, which may be addressed prior to the development of irreversible OA, is critical for improving OA treatment. A potentially promising avenue for developing early detection methods involves measuring the tissue’s in vivo mechanical response to loading, as changes in mechanical function are commonly observed in ex vivo studies of early OA. However, thus far the mechanical function of cartilage has not been widely assessed in vivo. Therefore, the purpose of this study was to develop a novel methodology that can be used to measure an in vivo mechanical property of cartilage: the characteristic recovery time. Specifically, in this study we quantified the characteristic recovery time of cartilage thickness after exercise in relatively young subjects with asymptomatic cartilage. Additionally, we measured baseline cartilage thickness and T1rho and T2 relaxation times (quantitative MRI) prior to exercise in these subjects to assess whether baseline MRI measures are predictive of the characteristic recovery time, to understand whether or not the characteristic recovery time provides independent information about cartilage’s mechanical state. Our results show that the mean recovery strain response across subjects was well-characterized by an exponential approach with a characteristic time of 25.2 min, similar to literature values of human characteristic times measured ex vivo. Further, we were unable to detect a statistically significant linear relationship between the characteristic recovery time and the baseline metrics measured here (T1rho relaxation time, T2 relaxation time, and cartilage thickness). This might suggest that the characteristic recovery time has the potential to provide additional information about the mechanical state of cartilage not captured by these baseline MRI metrics. Importantly, this study presents a noninvasive methodology for quantifying the characteristic recovery time, an in vivo mechanical property of cartilage. As mechanical response may be indicative of cartilage health, this study underscores the need for future studies investigating the characteristic recovery time and in vivo cartilage mechanical response at various stages of OA.

Nutritional interventions for reducing the signs and symptoms of exercise-induced muscle damage and accelerate recovery in athletes: current knowledge, practical application and future perspectives

PURPOSE

This review provides an overview of the current knowledge of the nutritional strategies to treat the signs and symptoms related to EIMD. These strategies have been organized into the following sections based upon the quality and quantity of the scientific support available: (1) interventions with a good level of evidence; (2) interventions with some evidence and require more research; and (3) potential nutritional interventions with little to-no-evidence to support efficacy.

METHOD

Pubmed, EMBASE, Scopus and Web of Science were used. The search terms 'EIMD' and 'exercise-induced muscle damage' were individually concatenated with 'supplementation', 'athletes', 'recovery', 'adaptation', 'nutritional strategies', hormesis'.

RESULT

Supplementation with tart cherries, beetroot, pomegranate, creatine monohydrate and vitamin D appear to provide a prophylactic effect in reducing EIMD. β-hydroxy β-methylbutyrate, and the ingestion of protein, BCAA and milk could represent promising strategies to manage EIMD. Other nutritional interventions were identified but offered limited effect in the treatment of EIMD; however, inconsistencies in the dose and frequency of interventions might account for the lack of consensus regarding their efficacy.

CONCLUSION

There are clearly varying levels of evidence and practitioners should be mindful to refer to this evidence-base when prescribing to clients and athletes. One concern is the potential for these interventions to interfere with the exercise-recovery-adaptation continuum. Whilst there is no evidence that these interventions will blunt adaptation, it seems pragmatic to use a periodised approach to administering these strategies until data are in place to provide and evidence base on any interference effect on adaptation.

Ageing as a risk factor for cerebral ischemia: Underlying mechanisms and therapy in animal models and in the clinic

Age is the only one non-modifiable risk of cerebral ischemia. Advances in stroke medicine and behavioral adaptation to stroke risk factors and comorbidities was successful in decreasing stroke incidence and increasing the number of stroke survivors in western societies. Comorbidities aggravates the outcome after cerebral ischemia. However, due to the increased in number of elderly, the incidence of stroke has increased again paralleled by an increase in the number of stroke survivors, many with severe disabilities, that has led to an increased economic and social burden in society. Animal models of stroke often ignore age and comorbidities frequently associated with senescence. This might explain why drugs working nicely in animal models fail to show efficacy in stroke survivors. Since stroke afflicts mostly the elderly comorbid patients, it is highly desirable to test the efficacy of stroke therapies in an appropriate animal stroke model. Therefore, in this review, we make parallels between animal models of stroke und clinical data and summarize the impact of ageing and age-related comorbidities on stroke outcome.

[Radical prostatectomy for prostate cancer, perioperative management by French urologists in 2018]

INTRODUCTION

Prostatectomy (PT) is a common procedure performed by many urologists. In 2018, 20,207 prostatectomies were performed in France, and few studies evaluated the perioperative habits of urologists. As part of writing guidelines for enhanced recovery after surgery (ERAS) we wished to evaluate practice of urologists in their hospital management of a prostatectomy.

MATERIEL AND METHODS

A questionnaire was sent by Survey Monkey in June and July 2018 to all urologists who are members of the French Association of Urology.

RESULTS

One hundred and sixty seven urologists (14%) answered the questionnaire, 62% have private practice. The average number of operators per center performing PT was 4, with a median number of 70 interventions (0 to 486) per center in 2018. Open surgery is still gold standard (39.13%), followed by the robot-assisted transperitoneal laparoscopic (34.78%) and standard laparoscopic (24.22%). Alimentation, like first stand-up, was re-established on the first post-operative day, and the average hospital stay was 4±2 nights. The removal of the bladder catheter was most often performed at home by nurse (49.06%), one week after surgery. Only 10.06% of urologists systematically perform a cystography before removal urinary catheter.

CONCLUSION

The perioperative management of prostatectomy in France is relatively homogeneous, between urologists. The length of hospital stay remains important and could be reduced by proposing an ERAS protocol as has been obtained for cystectomy.

LEVEL OF EVIDENCE

III.

Methadone maintenance treatment is swapping one drug for another, and that's why it works: Towards a treatment-based critique of the war on drugs

The claim that methadone maintenance treatment (MMT) is 'just swapping one drug for another' has typically been used to de-legitimize the treatment and attack those who use it. However, this commentary re-positions that argument as a way of bringing analytic focus to the role of structural forces, like criminalization and the war on drugs, in the treatment decisions of people who use illegal drugs. Specifically, I use my experience as a qualitative sociologist who studies MMT as well as my own experience on MMT to demonstrate how criminalization functions as source of harm in the lives of people who use illegal drugs, that drives them towards the legal, and thus comparatively safer, style of substance use made available by MMT. Moreover, I argue that the dominance of individually-focused theories based on addiction and recovery to understand MMT is related to its punitive organizational structure and lack of popularity among people who use illegal opioids. Ultimately, I argue for a paradigm shift, both in policy and scholarship, that acknowledges the pragmatic value of MMT within the structural context of criminalization.

Killing Two Birds with One Stone? Green Dead Ends and Ways Out of the COVID-19 Crisis

The coronavirus crisis has opened up a window of opportunity for transformation. This should be used without getting off the regulatory track. Green recovery programs must not be reduced to a mere competition for green subsidies. Abandoning barriers to green investments and imposing a carbon price are equally important. Where economically sensible, green subsidies should contribute both to stabilizing the economy and mitigating climate change. Moreover, smart green recovery programs may contribute to raising revenues for the additionally necessary public expenditures.

The valorisation of residual waste bales by urban mining

In the last decade, the approach to waste management has undergone severe changes. The urgent need to face the sustainable demand for energy and materials while limiting the burdens associated to traditional waste handling practices have figured out the concept of waste as a resource. New strategies boosting the extensive recovery and diverting waste from disposal activities have been promoted and framed in the wider context of the urban mining, promoting the full exploitation of waste as resource for either new materials or energy production. Such approach has been recently proposed to handle over 5 million tons of pretreated municipal solid waste produced and stored in the form of bales in Campania Region, in southern Italy, between 2000 and 2009. However, since the feasibility of this approach is related to the waste composition as well as to the selection process, an experimental study was performed at an industrial mechanical treatment plant to assess the potential for valorisation of this waste. Results showed that the overall sustainability of the urban mining strategies for the management of Campania waste bales is tightly linked to the flexibility of the selection process scheme to be adopted, which should make the waste recovery fit the market demand of either material or energy.

Case Report: Buccal administration of hydrogen-producing blend after a mild traumatic brain injury in a professional athlete

Background: Sport-related mild traumatic brain injury (TBI) is a serious trauma that could impair brain function of an injured athlete. Treatment solutions for mild TBI typically concentrate on complete rest, while non-traditional therapeutic options remain largely ineffective. Molecular hydrogen (H _² ) is an innovative neuroprotective agent that can easily reach the brain, yet no data are available concerning its value as a first-aid intervention after a mild TBI. Case report: This case report demonstrates the efficacy and safety of a hydrogen-producing dissolving tablet administered buccally during the first 24 hours post-injury in a professional soccer player who suffered a mild TBI. The patient received a formulated dosage of hydrogen every 2 hours, with the first intervention given immediately after an initial examination (~ 15 min after the injury). The overall score for Sport Concussion Assessment Tool 2 (SCAT2), a standardized method of evaluating injured athletes for concussion, increased from 68 points (severe disruption) at baseline to 84 points (mild disruption) at 24-h follow-up. The patient reported no side effects of hydrogen intervention. Conclusions: This case has demonstrated that intensive consecutive therapy with oral transmucosal hydrogen formulation is a beneficial strategy with regard to the reduction of presence and severity of symptoms of sport-related mild TBI.

Building Resilience during Recovery: Lessons from Colorado's Watershed Resilience Pilot Program

As the potential for and scope of some types of disasters increases, so too does the need to build greater disaster resilience across the globe. Communities ideally begin building resilience prior to experiencing a disaster in order to reduce negative impacts and ease recovery processes; however, numerous environmental and sociopolitical factors can impede such efforts until a disaster occurs. While the disaster recovery period offers opportunities for communities to build resilience as they replace infrastructure and restore services, a host of new issues arise during this time that can further complicate or delay resilience building. In this study, we highlight the opportunities and challenges inherent at the intersection of disaster recovery and resilience building, which we term the "recovery-resilience nexus." To study this nexus, we analyze a first-of-its-kind disaster recovery program in Colorado, United States, that promotes resilience-building activities in disaster-affected communities by supporting the efforts of place-based watershed coalitions. Although the program faced numerous and interrelated technical, political, and fiscal hurdles, we argue that it provides an opportunity for drawing important lessons about how communities can navigate the recovery-resilience nexus via cross-boundary collaboration and creatively leveraging traditional disaster recovery funding sources to achieve resilience goals.

Adaptation, self-motivation and support services are key to physical activity participation three to five years after major trauma: a qualitative study

QUESTIONS

What are the perceived long-term impacts of major trauma on physical activity participation over time? What factors influence physical activity participation in people recovering from major trauma?

DESIGN

Longitudinal qualitative study.

PARTICIPANTS

Sixty-six people aged ≥ 16 years with non-neurological major trauma.

METHODS

Participants were interviewed 3 years (n = 66), 4 years (n = 63) and 5 years (n = 57) after their injury. A thematic analysis was performed.

RESULTS

Despite wanting to be physically active, many participants experienced significant, long-term physical activity restriction after their injury, which persisted over time. Restrictions were often related to a fear of re-injury or of exacerbating pain and fatigue levels. These restrictions were a source of distress and frustration for many participants, given the perceived impacts on their social life, family roles and enjoyment of life. Participants were also concerned about weight gain, health decline and reduced physical fitness. Participants valued the support of insurers and specialised services in facilitating access to modified activities, such as clinical Pilates and hydrotherapy. Many participants also recognised the importance of adaptation, goal-setting, self-motivation and determination to be physically active despite limitations.

CONCLUSION

People recovering from major trauma experienced significant and persistent physical activity restriction after their injury. Given the high prevalence of activity restrictions, distress and health concerns that were reported, there is an urgent need to develop and evaluate support strategies to improve physical activity participation in this group.

Prevalence of and recovery from common mental disorder including psychotic experiences in the UK Primary Care Improving Access to Psychological Therapies (IAPT) Programme

BACKGROUND

Psychotic experiences (PE) may co-occur with common mental disorders (CMD), such as depression and anxiety. However, we know very little about the prevalence of and recovery from PE in primary mental health care settings, such as the Improving Access to Psychological Therapies (IAPT) services in the UK National Health Service (NHS), where most CMD are treated.

METHODS

We used the Community Assessment of Psychic Experiences - Positive 15-item Scale (CAPE-P15) to determine the prevalence of PE in patients receiving treatment from IAPT services. Patient-reported measures of depression (PHQ-9) and anxiety (GAD-7) are routinely collected and establish recovery in IAPT services. We studied recovery rates according to the absence and presence of PE. Multi-group growth models estimated improvement trajectories for each group.

RESULTS

A total of 2,042 patients with CMD completed the CAPE-P15. The mean age was 39.8. The overall prevalence of PE was 29.68%. The recovery rate was 27.43% compared to 62.08% for those without PE. Although patients with or without PE shared similar improvement trajectories, the initial severity of patients with PE impeded their likelihood of recovery.

LIMITATIONS

We mirrored routine data collection in IAPT services, including self-report questionnaires that may affect valid reporting of symptoms. Missing data in the calculation of improvement trajectories may reduce generalisability.

CONCLUSIONS

At least one in four patients receiving treatment from IAPT services in primary care experience CMD and PE. This significant group of people experience a lower recovery rate, with adverse implications not only for them but also for efficiency of services.

Resilience of the seagrass Posidonia oceanica following pulse-type disturbance

Understanding the response of species to disturbance and the ability to recover is crucial for preventing their potential collapse and ecosystem phase shifts. Explosive submarine activity, occurring in shallow volcanic vents, can be considered as a natural pulse disturbance, due to its suddenness and high intensity, potentially affecting nearby species and ecosystems. Here, we present the response of Posidonia oceanica, a long-lived seagrass, to an exceptional submarine volcanic explosion, which occurred in the Aeolian Archipelago (Italy, Mediterranean Sea) in 2002, and evaluate its resilience in terms of time required to recover after such a pulse event. The study was carried out in 2011 in the sea area off Panarea Island, in the vicinity of Bottaro Island by adopting a back-dating methodological approach, which allowed a retrospective analysis of the growth performance and stable carbon isotopes (δ¹³C) in sheaths and rhizomes of P. oceanica, during a 10-year period (2001-2010). After the 2002 explosion, a trajectory shift towards decreasing values for both growth performance and δ¹³C in sheaths and rhizomes was observed. The decreasing trend reversed in 2004 when recovery took place progressively for all the analysed variables. Full recovery of P. oceanica occurred 8 years after the explosive event with complete restoration of all the variables (rhizome growth performance and δ¹³C) by 2010. Given the ecological importance of this seagrass in marine coastal ecosystems and its documented large-scale decline, the understanding of its potential recovery in response to environmental changes is imperative.

The questionable efficacy of manualized psychological treatments for distressed breast cancer patients: An individual patient data meta-analysis

Previous meta-analyses conclude that psychological treatments are efficacious for emotional distress in breast cancer (BCa). However, the practical relevance of these meta-analyses is questionable; none focused specifically on clinically distressed patients or whether treatment effects were clinically significant. In a two-stage individual patient data (IPD) meta-analysis of 17 randomized controlled trials of manualized psychological treatments in BCa, we evaluated treatment efficacy in distressed BCa patients (n = 1591) using clinical significance and effect size analyses. Outcomes were anxiety, depression, and general distress, evaluated at post-treatment and follow-up. Moderators examined were treatment type, treatment format, therapists' profession, control condition, age, outcome measure, and trial quality. Treated patients were more likely than controls to recover from anxiety and general distress at post-treatment (14-15% more treated patients recovered), but not at mean 8-months follow-up. Overall recovery rates were low: across outcomes, at post-treatment, only 30-32% of treated patients and 15-25% of controls recovered; at follow-up, only 21-30% of treated patients and 18-35% of controls recovered. Small between-group effect sizes in favour of treatment were found across outcomes at post-treatment (g = 0.32-0.34) but not at follow-up. Across the different analysis methods, few moderator effects were found. More efficacious psychological treatments are needed for distressed BCa patients.

Measuring capital in active addiction and recovery: the development of the strengths and barriers recovery scale (SABRS)

BACKGROUND

The international Life In Recovery (LiR) surveys have provided an important message to the public and policy makers about the reality of change from addiction to recovery, consistently demonstrating both that there are marked gains across a range of life domains and that the longer the person is in recovery the better their recovery strengths and achievements. However, to date, no attempt has been made to quantify the Life In Recovery scales and to assess what levels of change in removing barriers and building strengths is achieved at which point in the recovery journey.

METHODS

The current study undertakes a preliminary analysis of strengths and barriers from the Life in Recovery measure, using data from a European survey on drug users in recovery (n = 480), and suggests that the instrument can be edited into a Strengths And Barriers Recovery Scale (SABRS). The new scale provides a single score for both current recovery strengths and barriers to recovery.

RESULTS

The resulting data analysis shows that there are stepwise incremental changes in recovery strengths at different recovery stages, but these occur with only very limited reductions in barriers to recovery, with even those in stable recovery typically having at least two barriers to their quality of life and wellbeing. Greater strengths in active addiction are associated with greater strengths and resources in recovery.

CONCLUSION

As well as demonstrating population changes in each of the domains assessed, the current study has shown the potential of the Life In Recovery Scale as a measure of recovery capital that can be used to support recovery interventions and pathways.

Upper limb kinematics during the first year after stroke: the stroke arm longitudinal study at the University of Gothenburg (SALGOT)

Background

Reduction of compensation and improved movement quality indicate recovery after stroke. Since clinical measures alone are often inadequate to distinguish between behavioral recovery and compensation, kinematic analysis of functional tasks has been recommended.

Objective

To quantify longitudinal changes and residual deficits in movement performance and quality during the first year after stroke using kinematic analysis of drinking task.

Methods

A total of 56 participants with first ever stroke causing upper extremity impairment were extracted from a non-selected stroke unit cohort (Stroke Arm Longitudinal Study at the University of Gothenburg-SALGOT). Participants needed to able to perform the drinking task with the more-affected arm at least on 2 occasions out of 6 (3 days, 10 days, 4 weeks, and 3, 6, and 12 months) during the first year to be included. A cohort of 60 healthy individuals was used as reference. Longitudinal changes were analyzed using linear mixed models.

Results

Movement time, number of movement units, peak angular velocity of the elbow, peak hand velocity, and trunk displacement improved significantly over the first 3 months with a peak at 6 months. Movement time and peak hand velocity reached levels comparable to healthy at 3 months, but number of movement units, peak elbow angular velocity, trunk displacement, and arm abduction remained different from healthy over the first year after stroke.

Conclusions

Even when the recovery patterns of kinematics follow the known nonlinear pattern, not all kinematic measures reach the levels in par with healthy controls at one year post stroke. Since the number of movement units, peak angular velocity, trunk displacement, and arm abduction remained impaired over the first year, they might be the most suited measures to distinguish behavioral recovery from compensation strategies.

Trial registration

ClinicalTrials: NCT01115348. 4 May 2010. Retrospectively registered.