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Discussion in 'General Issues and Discussion Forum' started by NewsBot, Jul 14, 2007.
Supervised exercise therapy for intermittent claudication in a community-based setting is as effective as clinic-based.
J Vasc Surg. 2007 Jun;45(6):1192-6.
Bendermacher BL, Willigendael EM, Nicolaï SP, Kruidenier LM, Welten RJ, Hendriks E, Prins MH, Teijink JA, de Bie RA.
OBJECTIVE: This cohort study was conducted to determine the effect on walking distances of supervised exercise therapy provided in a community-based setting.
METHODS: The study included all consecutive patients presenting at the vascular outpatient clinic with intermittent claudication, diagnosed by a resting ankle brachial index<0.9, who had no previous peripheral vascular intervention for peripheral arterial disease, no major amputation, and sufficient command of the Dutch language. The exclusion criterion was the inability to walk the baseline treadmill test for a minimum of 10 m. The intervention was a supervised exercise therapy in a community-based setting. A progressive treadmill test at baseline and at 1, 3, and 6 months of follow-up measured initial claudication distance and absolute claudication distance. Changes were calculated using the mean percentages of change.
RESULTS: From January through October 2005, 93 consecutive patients with claudication were eligible. Overall, 37 patients discontinued the supervised exercise therapy program. Eleven stopped because of intercurrent diseases, whereas for 10, supervised exercise therapy did not lead to adequate improvement and they underwent a vascular intervention. Three patients quit the program, stating that they were satisfied with the regained walking distance and did not require further supervised exercise therapy. Ten patients were not motivated sufficiently to continue the program, and in three patients, a lack of adequate insurance coverage was the reason for dropping out. Data for 56 patients were used and showed a mean percentage increase in initial claudication distance of 187% after 3 months and 240% after 6 months. The mean percentage of the absolute claudication distance increased 142% after 3 months and 191% after 6 months.
CONCLUSION: Supervised exercise therapy in a community-based setting is a promising approach to providing conservative treatment for patients with intermittent claudication.
An exercise regimen can help with this because collateral circulation is formed.
Exercise performance in patients with peripheral arterial disease who have different types of exertional leg pain.
Gardner AW, Montgomery PS, Afaq A.
J Vasc Surg. 2007 Jul;46(1):79-86.
OBJECTIVE: This study compared the exercise performance of patients with peripheral arterial disease (PAD) who have different types of exertional leg pain.
METHODS: Patients with PAD were classified into one of four groups according to the San Diego Claudication Questionnaire: intermittent claudication (n = 406), atypical exertional leg pain causing patients to stop (n = 125), atypical exertional leg pain in which patients were able to continue walking (n = 81), and leg pain on exertion and rest (n = 103). Patients were assessed on the primary outcome measures of ankle-brachial index (ABI), treadmill exercise measures, and ischemic window.
RESULTS: All patients experienced leg pain consistent with intermittent claudication during a standardized treadmill test. The mean (+/- SD) initial claudication distance (ICD) was similar (P = .642) among patients with intermittent claudication (168 +/- 160 meters), atypical exertional leg pain causing patients to stop (157 +/- 130 meters), atypical exertional leg pain in which patients were able to continue walking (180 +/- 149 meters), and leg pain on exertion and rest (151 +/- 136 meters). The absolute claudication distance (ACD) was similar (P = .648) in the four respective groups (382 +/- 232, 378 +/- 237, 400 +/- 245, and 369 +/- 236 meters). Similarly, the ischemic window, expressed as the area under the curve (AUC) after treadmill exercise, was similar (P = .863) in these groups (189 +/- 137, 208 +/- 183, 193 +/- 143, and 199 +/- 119 AUC).
CONCLUSION: PAD patients with different types of exertional leg pain, all limited by intermittent claudication during a standardized treadmill test, were remarkably similar in ICD, ACD, and ischemic window. Thus, the presence of ambulatory symptoms should be of primary clinical concern in evaluating PAD patients regardless of whether they are consistent with classic intermittent claudication.
Supervised exercise training for intermittent claudication: lasting benefit at three years.
Ratliff DA, Puttick M, Libertiny G, Hicks RC, Earby LE, Richards T.
Eur J Vasc Endovasc Surg. 2007 Sep;34(3):322-6.
OBJECTIVES: To assess the long-term outcome of supervised exercise training for intermittent claudication.
METHODS: A prospective study was undertaken of all patients referred to a single centre with intermittent claudication (>46 m). Patients underwent supervised exercise training twice weekly for 10 weeks, with regular follow-up to 3 years. Actual Claudication Distance (ACD), Maximum Walking Distance (MWD) and ankle-brachial pressure indices (ABPI) were measured.
RESULTS: In 202 patients the initial median ACD and MWD were 112 m and 197 m. Following exercise therapy both the median ACD and MWD increased to 266 m and 477 m at three months, increases of 237% and 242% respectively (p<0.001). At three years the median ACD and MWD were 250 m and 372 m, increases of 223% and 188% respectively (p<0.001). There was no significant change in ACD or MWD at 3 months compared to 1, 2 or 3 years. ABPI remained unchanged throughout.
CONCLUSIONS: Supervised exercise training has long term benefit in patients with intermittent claudication. Results seen at 12 weeks are sustained at three years.
Effects of a long-term exercise program on lower limb mobility, physiological responses, walking performance, and physical activity levels in patients with peripheral arterial disease.
Crowther RG, Spinks WL, Leicht AS, Sangla K, Quigley F, Golledge J.
OBJECTIVE: The purpose of the study was to examine the effects of a 12-month exercise program on lower limb mobility (temporal-spatial gait parameters and gait kinematics), walking performance, peak physiological responses, and physical activity levels in individuals with symptoms of intermittent claudication due to peripheral arterial disease (PAD-IC).
METHODS: Participants (n = 21) with an appropriate history of PAD-IC, ankle-brachial pressure index (ABI) <0.9 in at least one leg and a positive Edinburgh claudication questionnaire response were prospectively recruited. Participants were randomly allocated to either a control PAD-IC group (CPAD-IC) (n = 11) that received standard medical therapy and a treatment PAD-IC group (TPAD-IC) (n = 10), which also took part in a 12-month supervised exercise program. A further group of participants (n = 11) free of PAD (ABI >0.9) and who were non-regular exercisers were recruited from the community to act as age and mass matched controls (CON). Lower limb mobility was determined via two-dimensional video motion analysis. A graded treadmill test was used to assess walking performance and peak physiological responses to exercise. Physical activity levels were measured via a 7-day pedometer recording. Differences between groups were analyzed via repeated measures analysis of variance (ANOVA).
RESULTS: The 12-month supervised exercise program had no significant effect on lower limb mobility, peak physiological responses, or physical activity levels in TPAD-IC compared with CPAD-IC participants. However, the TPAD-IC participants demonstrated significantly greater walking performance (171% improvement in pain free walking time and 120% improvement in maximal walking time compared with baseline).
CONCLUSION: The results of this study confirm that a 12-month supervised exercise program will result in improved walking performance, but does not have an impact on lower limb mobility, peak physiological responses, or physical activity levels of PAD-IC patients.
Claudication secondary to peripheral arterial disease leads to reduced mobility, limited physical functioning, and poor health outcomes. Disease severity can be assessed with quantitative clinical methods and qualitative self-perceived measures of quality of life. Limited data exist to document the degree to which quantitative and qualitative measures correlate. The current study provides data on the relationship between quantitative and qualitative measures of symptomatic peripheral arterial disease.
This descriptive case series was set in an academic vascular surgery unit and biomechanics laboratory. The subjects were symptomatic patients with peripheral arterial disease patients presenting with claudication. The quantitative evaluation outcome measures included measurement of ankle-brachial index, initial claudication distance, absolute claudication distance, and self-selected treadmill pace. Qualitative measurements included the Walking Impairment Questionnaire (WIQ) and the Medical Outcomes Study Short Form-36 (SF-36) Health Survey. Spearman rank correlations were performed to determine the relationship between each quantitative and qualitative measure and also between the WIQ and SF-36.
Included were 48 patients (age, 62 ± 9.6 years; weight, 83.0 ± 15.4 kg) with claudication (ABI, 0.50 ± 0.20). Of the four WIQ subscales, the ankle-brachial index correlated with distance (r = 0.29) and speed (r = 0.32); and initial claudication distance and absolute claudication distance correlated with pain (r = 0.40 and 0.43, respectively), distance (r = 0.35 and 0.41, respectively), and speed (r = 0.39 and 0.39 respectively). Of the eight SF-36 subscales, no correlation was found for the ankle-brachial index, initial claudication distance correlated with Bodily Pain (r = 0.46) and Social Functioning (r = 0.30), and absolute claudication time correlated with Physical Function (r = 0.31) and Energy (r = 0.30). The results of both questionnaires showed reduced functional status in claudicating patients.
Initial and absolute claudication distances and WIQ pain, speed, and distance subscales are the measures that correlated the best with the ambulatory limitation of patients with symptomatic peripheral arterial disease. These results suggest the WIQ is the most specific questionnaire for documenting the qualitative deficits of the patient with claudication while providing strong relationships with the quantitative measures of arterial disease. Future studies of claudication patients should include both quantitative and qualitative assessments to adequately assess disease severity and functional status in peripheral arterial disease patients.
Watson L, Ellis B, Leng GC.
Cochrane Database Syst Rev. 2008 Oct 8;(4):CD000990.
BACKGROUND: Exercise programmes are a relatively inexpensive, low-risk option compared with other more invasive therapies for leg pain on walking (intermittent claudication (IC)).
OBJECTIVES: To determine the effects of exercise programmes on IC, particularly in respect of reduction of symptoms on walking and improvement in quality of life.
SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last search February 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2008, Issue 1.
SELECTION CRITERIA: Randomised controlled trials of exercise regimens in people with IC due to peripheral arterial disease.
DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed trial quality.
MAIN RESULTS: Twenty-two trials met the inclusion criteria involving a total of 1200 participants with stable leg pain. Follow-up period was from two weeks to two years. There was some variation in the exercise regimens used, all recommended at least two sessions weekly of mostly supervised exercise. All trials used a treadmill walking test for one of the outcome measures. Quality of the included trials was good, though the majority of trials were small with 20 to 49 participants. Fourteen trials compared exercise with usual care or placebo; patients with various medical conditions or other pre-existing limitations to their exercise capacity were generally excluded.Compared with usual care or placebo, exercise significantly improved maximal walking time: mean difference (MD) 5.12 minutes (95% confidence interval (CI) 4.51 to 5.72 with an overall improvement in walking ability of approximately 50% to 200%; exercise did not affect the ankle brachial pressure index (ABPI) (MD -0.01, 95% CI -0.05 to 0.04). Walking distances were also significantly improved: pain-free walking distance MD 82.19 metres (95% CI 71.73 to 92.65) and maximum walking distance MD 113.20 metres (95% CI 94.96 to 131.43). Improvements were seen for up to two years. The effect of exercise compared with placebo or usual care was inconclusive on mortality, amputation and peak exercise calf blood flow due to limited data.Evidence was generally limited for exercise compared with surgical intervention, angioplasty, antiplatelet therapy, pentoxifylline, iloprost and pneumatic foot and calf compression due to small numbers of trials and participants. Angioplasty may produce greater improvements than exercise in the short term but this effect may not be sustained.
AUTHORS' CONCLUSIONS: Exercise programmes were of significant benefit compared with placebo or usual care in improving walking time and distance in selected patients with leg pain from IC.
I have to ask " is it worth the effort"? statistically significant but is it realy clinically significant?
All the cited studies show improvement in walking distance post supervised exercise for a period of time. statistical percentages of 120% - 190% improvement are quoted, which didn't include those who dropped out fo various reasons. These figures appear significant but are they?
If the the average distance of painfree walking or distance to point where the subject had to stop and rest was say 500 metres then 20% improvement only = 600mtrs. a 90% improvement = 950mtrs. However most of these studies seem to indicate a much lower baseline than 500mtrs and overal improvement appear to be around the 100mtr mark ie 100mtrs further then 12 months ago.
Would thid be a significant improvement to the patient after 12 months of painful therapy?
J Physiol 2008 586: 5983-5998.
This study evaluated whether -adrenergic activation contributes to collateral circuit vascular resistance in the hindlimb following acute unilateral occlusion of the femoral artery in rats. Blood pressures (BPs) were measured above (caudal artery) and below (distal femoral artery) the collateral circuit. Arterial BPs were reduced (15–35 mmHg) with individual (prazosin, rauwolscine) or combined (phentolamine) -receptor inhibition. Blood flows (BFs) were measured using microspheres before and after inhibition during the same treadmill speed. 1 inhibition increased blood flow by 40% to active muscles that were not affected by femoral occlusion, whereas collateral-dependent BFs to the calf muscles were reduced by 29 ± 8.4% (P < 0.05), due to a decrease in muscle conductance with no change in collateral circuit conductance. 2 inhibition decreased both collateral circuit (39 ± 6.0%; P < 0.05) and calf muscle conductance (36 ± 7.3%; P < 0.05), probably due to residual 1 activation, since renal BF was markedly reduced with rauwolscine. Most importantly, inhibiting 2 receptors in the presence of 1 inhibition increased (43 ± 12%; P < 0.05) collateral circuit conductance. Similarly, non-selective inhibition with phentolamine increased collateral conductance (242 ± 59%; P < 0.05). We interpret these findings to indicate that both 1- and 2-receptor activation can influence collateral circuit resistance in vivo during the high flow demands caused by exercise. Furthermore, we observed a reduced maximal conductances of active muscles that were ischaemic. Our findings imply that in the presence of excessive sympathetic activation, which can occur in the condition of intermittent claudication during exertion, an exaggerated vasoconstriction of the existing collateral circuit and active muscle will occur.
You probably know that poor diet and lack of exercise can lead to dangerous deposits of fatty plaques in arteries. But it is not just the heart that is affected – blood flow can be blocked to the legs too, leading to pain when walking, immobility and even in extreme cases, amputation.
Approximately 20% of us will suffer from this peripheral artery disease (PAD) once we are 65 or over, and with risk factors including smoking, diabetes, obesity and high blood pressure it is on the rise. Surgical intervention can sometimes help, but the prognosis is not good.
Encouragingly, new research by Ronald Terjung et al. published in The Journal of Physiology shows that regular, moderate exercise can go a long way to relieving the symptoms of PAD, and by some unexpected mechanisms.
When a major artery in the leg becomes blocked, the body naturally seeks another route for the blood to pass through by expanding and multiplying the surrounding smaller blood vessels in the area, called collateral blood flow.
The researchers studied rats with a blocked femoral artery and found that collateral blood flow was much more effective in restoring normal muscle function in rats that were put on regular exercise training.
The collateral vessels themselves were larger and less prone to constriction – a problem exacerbated with PAD – than in sedentary animals. Surprisingly, the function of blood vessels ‘downstream’ of the blockage also changed, making them more efficient.
The authors predict that a suitable exercise programme would delay the onset of pain and increase mobility for people suffering with PAD.
“Our findings raise the potential that new collateral vessels, that can develop in patients with PAD who are physically active, will function effectively to help minimize the consequences of the original vascular obstruction.” commented Dr Terjung.
Plantar flexion: an effective training for peripheral arterial disease.
Wang E, Hoff J, Loe H, Kaehler N, Helgerud J.
Eur J Appl Physiol. 2008 Nov;104(4):749-56.
This study examined whether a training intervention likely to elicit adaptations in the leg could result in reduced leg pain and increased whole body physical capacity. Twenty-seven peripheral arterial disease (PAD) patients were randomized to either an individual leg plantar flexion training group (TG) training 4 x 4 min intervals at 80% of maximal work rate three times per week for 8 weeks or a control group. The TG significantly increased plantar flexion peak oxygen uptake and power output by 23.5 and 43.9%, respectively. Treadmill peak oxygen uptake (VO(2peak)) significantly increased 12.3% in the TG and was associated with a significant increased time to exhaustion of 20.0% when treadmill walking. Eleven of 14 patients no longer reported leg pain limitations at VO(2peak). No differences in cardiac output measured at VO(2peak), or walking economy were observed. Plantar flexion training was effective in increasing VO(2peak) and walking performance, and may be a useful strategy in treatment of PAD.
Effects of exercise training on calf tissue oxygenation in men with intermittent claudication.
Figoni SF, Kunkel CF, Scremin AM, Asher A, Banks NL, Rivera A, Tin JK, Cohen B.
OBJECTIVE: To determine the effects of exercise training on calf tissue oxygenation in men with peripheral arterial disease and intermittent calf claudication.
DESIGN: This pilot study was prospective and longitudinal and used a one-group, pretest-posttest design. SETTING: Tertiary care medical center for veterans. PARTICIPANTS: Fifteen male veterans (mean age 69 years) with Fontaine stage IIa peripheral arterial disease and classic intermittent claudication. MAIN OUTCOME MEASUREMENTS: Before and after intervention, participants performed graded treadmill exercise tests while medial calf tissue oxygenation (StO(2), % oxyhemoglobin saturation) was monitored continuously with near-infrared spectroscopy. INTERVENTION: The intervention consisted of a 3-month exercise training program involving 3 sessions per week at the clinic (treadmill walking, calf ergometry) and 2 sessions per week at home (free walking, standing heel raises).
RESULTS: After completion of the intervention, participants significantly increased their maximal treadmill exercise time from 7.19 to 11.27 minutes. Mean exercise StO(2) decreased from 29% to 19% saturation, StO(2) x time area increased from 421%.min to 730%.min StO(2) nadir, and StO(2) recovery time did not change significantly.
Strength training increases walking tolerance in intermittent claudication patients: randomized trial.
Ritti-Dias RM, Wolosker N, de Moraes Forjaz CL, Carvalho CR, Cucato GG, Leão PP, de Fátima Nunes Marucci M.
J Vasc Surg. 2010 Jan;51(1):89-95.
OBJECTIVE: To analyze the effects of strength training (ST) in walking capacity in patients with intermittent claudication (IC) compared with walking training (WT) effects.
METHODS: Thirty patients with IC were randomized into ST and WT. Both groups trained twice a week for 12 weeks at the same rate of perceived exertion. ST consisted of three sets of 10 repetitions of whole body exercises. WT consisted of 15 bouts of 2-minute walking. Before and after the training program walking capacity, peak VO(2), VO(2) at the first stage of treadmill test, ankle brachial index, ischemic window, and knee extension strength were measured.
RESULTS: ST improved initial claudication distance (358 +/- 224 vs 504 +/- 276 meters; P < .01), total walking distance (618 +/- 282 to 775 +/- 334 meters; P < .01), VO(2) at the first stage of treadmill test (9.7 +/- 2.6 vs 8.1 +/- 1.7 mL.kg(-1).minute; P < .01), ischemic window (0.81 +/- 1.16 vs 0.43 +/- 0.47 mm Hg minute meters(-1); P = .04), and knee extension strength (19 +/- 9 vs 21 +/- 8 kg and 21 +/- 9 vs 23 +/- 9; P < .01). Strength increases correlated with the increase in initial claudication distance (r = 0.64; P = .01) and with the decrease in VO(2) measured at the first stage of the treadmill test (r = -0.52; P = .04 and r = -0.55; P = .03). Adaptations following ST were similar to the ones observed after WT; however, patients reported lower pain during ST than WT (P < .01).
A systematic review of randomized controlled trials: Walking versus alternative exercise prescription as treatment for intermittent claudication.
Parmenter BJ, Raymond J, Dinnen P, Singh MA.
There is a subset of older adults with peripheral arterial disease (PAD) who are unable to complete current walking exercise therapy guidelines due to the severity of claudication, presence of foot pathology, arthritis and/or other co-morbidities. Our aim was to therefore systematically review the evidence for the effectiveness of all forms of exercise on claudication in PAD, and subsequently compare walking to alternative modes.
An electronic search of the literature was performed from earliest record until March 2011 using a variety of electronic databases. To be included trials must have been a randomized controlled trial of an exercise intervention for adults with intermittent claudication and have reported at least one claudication parameter such as initial (ICT/D) and/or absolute claudication time or distance (ACT/D) measured via a treadmill protocol. Assessment of study quality was performed using a modified version of the Physiotherapy Evidence Database Scale (PEDro). Mean difference and relative effect sizes (ESs) were calculated and adjusted via Hedges' bias-corrected for small sample sizes.
Thirty-six trials reported on walking distance in PAD: 32 aerobic (including 20 walking); 4 progressive resistance training (PRT) or graduated weight lifting exercise. In total 1644 subjects (73% male) were studied (1183 underwent exercise training); with few over 75. Most modes and intensities of exercise, irrespective of pain level, significantly improved walking capability (ACD/T Relative ES range 0.5-3.53). However, overall quality of the trials was only modest with on average 6 of the 11 PEDro quality criteria being present (mean 5.8±1.3), and on average sample sizes were small (mean 44±51).
Modes of aerobic exercise other than walking appear equally beneficial for claudication and the benefits of PRT and upper body exercise appear promising, but little data are published on these modalities. Additional studies of high quality are required to validate these alternative prescriptions and their efficacy relative to walking.
iT HAS BEEN ESTABLISHED FOR A NUMBER OF YEARS THAT EXERCISE BENEFITS THOSE WITH iNTERMITTENT CLAUDICATION. THE REAL QUESTION IS HOW TO MOTIVATE PEOPLE WITH im TO DO MORE EXERCISE????
Though being physically active has associated with a healthier ankle-brachial index (ABI) in observational studies, ABI usually does not change with exercise training in patients with peripheral artery disease (PAD). Less is known about the effect of exercise training on ABI in patients without PAD but at high risk due to the presence of type 2 diabetes (T2DM).
Participants (n=140) with uncomplicated T2DM, and without known cardiovascular disease or PAD, aged 40-65 years, were randomized to supervised aerobic and resistance training 3 times per week for 6 months or to a usual care control group. ABI was measured before and after the intervention.
Baseline ABI was 1.02±0.02 in exercisers and 1.03±0.01 in controls (p=0.57). At 6 months, exercisers vs. controls improved ABI by 0.04±0.02 vs. -0.03±0.02 (p=0.001). This change was driven by an increase in ankle pressures (p<0.01) with no change in brachial pressures (p=0.747). In subgroup analysis, ABI increased in exercisers vs. controls among those with baseline ABI<1.0 (0.14±0.03 vs. 0.02±0.02, p=0.004), but not in those with a baseline ABI≥1.0 (p=0.085). The prevalence of ABI between 1.0-1.3 increased from 63% to 78% in exercisers and decreased from 62% to 53% in controls. Increased ABI correlated with decreased HbA1c, systolic and diastolic blood pressure, but the effect of exercise on ABI change remained significant after adjustment for these changes (β=0.061, p=0.004).
These data suggest a possible role for exercise training in the prevention or delay of PAD in T2DM, particularly among those starting with an ABI <1.0.
For millions of Americans, simply walking to the mailbox can cause unbearable leg pain as muscles scream for more blood and oxygen.
It's called peripheral arterial disease and, ironically, one of the best ways to alleviate it is by regularly walking to that point of pain. However, researchers hope a noninvasive measure of oxygen levels in leg muscles will put patients on the road to improvement without the severe discomfort.
The idea is to push to the point of often intolerable pain then rest so the blood requirements of the muscles decrease, said Dr. Jonathan Murrow, cardiologist and faculty member at the Georgia Regents University/University of Georgia Medical Partnership in Athens.
"It's been shown that if you do this over and over again three times a week for an hour per session, that by the end of 12 weeks you will be able to walk twice as far as you did when you started," said Murrow, who also is a partner in the Athens Cardiology Group. "However, if you just tell somebody to do that, many simply won't."
He's principal investigator on a new American Heart Association-funded study to determine if a sophisticated light sensor that distinguishes which red blood cells are carrying oxygen and which aren't, can also signal when patients have pushed far enough before pain hits.
"We want to find a better way to use exercise as medicine for these patients," said Murrow, who is working with colleagues at UGA and Emory University to directly compare results from the old and new approaches in about 100 patients. "We want to help them to continue to enjoy what they like to do. If that's going grocery shopping without a motorized cart, that is what we want them to do."
They also want to understand more about why their approach does – or doesn't – help, so over the 12-week course will measure blood levels of progenitor cells as well as vascular endothelial growth factor that can aid growth of new blood vessels with exercise. New vessels don't cure the disease but typically give patients greater pain-free exercise tolerance.
They also are looking at the function and number of mitochondria, a sort of cell powerhouse that converts oxygen into cell fuel. "Mitochondrial function is not normal in people who have arterial disease, and we want to know if it gets better with a training program," Murrow said.
"We know arterial disease is a problem with the supply, and we are trying to see whether increasing the number of working mitochondria in the muscle helps improve the supply-demand mismatch," he said.
If the new light measure method works, the scientists want to determine if it can be used easily in a physician's office without all the research support. They'd also like to develop an app that could work anywhere.
Methods using the light sensor were developed by Dr. Kevin K. McCully, a physiologist in UGA's Department of Kinesiology, to measure oxygen levels in the exercising muscles as well as the number of working mitochondria. It's similar to the red glowing pulse oximeter placed on hospital patients' fingertips to measure oxygen saturation but McCully's system uses more powerful spectroscopy light that can permeate denser tissue like a leg muscle.
About 8 million Americans have peripheral arterial disease, according to the American Heart Association. It shares risk factors with other major cardiovascular problems such as heart disease and stroke, including diabetes, smoking, age, inactivity, high blood pressure and high cholesterol. Surgical and pharmacological treatments produce mixed results and have side effects, Murrow said.
Lane R, Ellis B, Watson L, Leng GC.
Exercise programmes are a relatively inexpensive, low-risk option compared with other more invasive therapies for leg pain on walking (intermittent claudication (IC)). This is an update of a review first published in 1998.
The prime objective of this review was to determine whether an exercise programme in people with intermittent claudication was effective in alleviating symptoms and increasing walking treadmill distances and walking times. Secondary objectives were to determine whether exercise was effective in preventing deterioration of underlying disease, reducing cardiovascular events and improving quality of life.
For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched September 2013) and CENTRAL (2013, Issue 8).
Randomised controlled trials of an exercise regimen versus control or versus medical therapy in people with IC due to peripheral arterial disease. Any exercise programme or regimen used in the treatment of intermittent claudication was included, such as walking, skipping and running. Inclusion of trials was not affected by the duration, frequency or intensity of the exercise programme. Outcome measures collected included treadmill walking distance (time to onset of pain or pain-free walking distance and maximum walking time or maximal walking distance), ankle brachial index (ABI), quality of life, morbidity or amputation; if none of these were reported the trial was not included in this review.
Two review authors independently extracted data and assessed trial quality.
Eleven additional studies were included in this update making a total of 30 trials which met the inclusion criteria, involving a total of 1816 participants with stable leg pain. The follow-up period ranged from two weeks to two years. The types of exercise varied from strength training to polestriding and upper or lower limb exercises; generally supervised sessions were at least twice a week. Most trials used a treadmill walking test for one of the outcome measures. Quality of the included trials was moderate, mainly due to an absence of relevant information. The majority of trials were small with 20 to 49 participants. Twenty trials compared exercise with usual care or placebo, the remainder of the trials compared exercise to medication (pentoxifylline, iloprost, antiplatelet agents and vitamin E) or pneumatic calf compression; people with various medical conditions or other pre-existing limitations to their exercise capacity were generally excluded.Overall, when taking the first time point reported in each of the studies, exercise significantly improved maximal walking time when compared with usual care or placebo: mean difference (MD) 4.51 minutes (95% confidence interval (CI) 3.11 to 5.92) with an overall improvement in walking ability of approximately 50% to 200%. Walking distances were also significantly improved: pain-free walking distance MD 82.29 metres (95% CI 71.86 to 92.72) and maximum walking distance MD 108.99 metres (95% CI 38.20 to 179.78). Improvements were seen for up to two years, and subgroup analyses were performed at three, six and 12 months where possible. Exercise did not improve the ABI (MD 0.05, 95% CI 0.00 to 0.09). The effect of exercise, when compared with placebo or usual care, was inconclusive on mortality, amputation and peak exercise calf blood flow due to limited data. No data were given on non-fatal cardiovascular events.Quality of life measured using the Short Form (SF)-36 was reported at three and six months. At three months, physical function, vitality and role physical all significantly improved with exercise, however this was a limited finding as this measure was only reported in two trials. At six months five trials reported outcomes of a significantly improved physical summary score and mental summary score secondary to exercise. Only two trials reported improvements in other domains, physical function and general health.Evidence was generally limited for exercise compared with antiplatelet therapy, pentoxifylline, iloprost, vitamin E and pneumatic foot and calf compression due to small numbers of trials and participants.
Exercise programmes are of significant benefit compared with placebo or usual care in improving walking time and distance in people with leg pain from IC who were considered to be fit for exercise intervention.
Background: Research has highlighted that sedentary behaviour is independently related to indicators of chronic disease. It has been suggested that breaking up sedentary time can be beneficial in offsetting the damage caused by prolonged sitting. Patients with Stage II Peripheral Arterial Disease (PAD) experience leg pain when walking. This can be alleviated by rest and so they are more likely to engage in long sitting periods.
Methods: Observational analysis of a case and control group was performed using 19 PAD patients (84% male, aged 62.9±8.8 years) from a vascular outpatient clinic and 22 controls with no history of vascular disease (77% male, aged 62.3±9.3 years) from the surrounding area. Data were collected for 7 days using a motion sensor (ActivPAL), daily activity diary, and a questionnaire. Functional ability was assessed using a 6-minute walk test and 30 second chair stand test. Vascular health was measured using Ankle Brachial Index and health status was recorded using a Peripheral Artery Questionnaire.
Results: ActivPAL mean daily activity time (1.46±.43 vs. 1.92±1.59 h; p=0.007) and mean number of steps/day (6801±2518 vs. 9357±3452; p=0.009) were significantly lower among cases than controls. ActivPAL mean daily sedentary time (9.59±1.74 vs. 9.51±1.77 h) was similar across cases and controls. Self-reported sedentary time via questionnaire was significantly lower among cases than controls (5.01±2.62 vs. 8.78±4.28 h; p=0.029). Sedentary patterns were similar, with the exception of morning time patterns which were longer in duration among cases. Mean number of breaks in sedentary time per day were lower (51.7±12.6 vs. 54.6±15) and the average duration of breaks were shorter (7.83±2.86 vs. 8.32±4.35 min) among cases than controls, but differences between the groups were not statistically significant. Mean scores from both functional ability tests (chair repetitions and walking test) were significantly lower among PAD patients (cases) than controls (p=0.003 and p=0.000, respectively).
Conclusion: Lower activity time among cases may be due to reduced functional ability as a result of their condition. Objectively measured sedentary time was not different between groups but subjective data suggested higher sedentary time in the control group.
Establish a govt funded thingy that they have to sign in to a gym to get $ for going a certain amount of times per week, to the gym.
The govt could save $ by motivating ppl to go to the gym.
•True cadence and step accumulation outcomes are not the same.
•Stepping was spread across the same number of mins/d for those with IC as controls.
•People with intermittent claudication (IC) take fewer high cadences steps than matched controls.
•To avoid ambiguity, ‘cadence’ must be reserved for ‘true cadence’: stepping rate during stepping.
•‘Step accumulation’ should be used to describe discontinuous stepping within set time periods.
‘True cadence’ is the rate of stepping during the period of stepping. ‘Step accumulation’ is the steps within an epoch of time (e.g. 1 min). These terms have been used interchangeably in the literature. These outcomes are compared within a population with intermittent claudication (IC). Multiday, 24hr stepping activity of those with IC (30) and controls (30) was measured objectively using the activPAL physical activity monitor. ‘True cadence’ and ‘step accumulation’ outcomes were calculated. Those with IC took fewer steps/d 6,531 ± 2,712 than controls 8692 ± 2945 (P = 0.003). However, these steps were taken within approximately the same number of minute epochs (IC 301 ± 100mins/d; controls 300 ± 70mins/d, P = 0.894) with only slightly lower true cadence (IC 69(IQ 66,72)steps/min; controls 72(IQ 68,76)steps/min, P = 0.026), giving substantially lower step accumulation (IC 22(IQ 19,24)steps/min; controls 30(IQ 23,34)steps/min) (P < 0.001). However, the true cadence of stepping within the blocks of the 1, 5, 20, 30 and 60 minutes with the maximum number of steps accumulated was lower for those with IC than controls (P < 0.05). Those with IC took 1300 steps fewer per day above a true cadence of 90steps/min. True cadence and step accumulation outcomes were radically different for the outcomes examined. ‘True cadence’ and ‘step accumulation’ were not equivalent in those with IC or controls. The measurement of true cadence in the population of people with IC provides information about their stepping rate during the time they are stepping. True cadence should be used to correctly describe the rate of stepping as performed.
Improved Walking Claudication Distance with Transcutaneous Electrical Nerve Stimulation: An Old Treatment with a New Indication in Patients with Peripheral Artery Disease.
Objective: The aim of this study was to determine whether 45 mins of transcutaneous electrical nerve stimulation before exercise could delay pain onset and increase walking distance in peripheral artery disease patients.
Design: After a baseline assessment of the walking velocity that led to pain after 300 m, 15 peripheral artery disease patients underwent four exercise sessions in a random order. The patients had a 45-min transcutaneous electrical nerve stimulation session with different experimental conditions: 80 Hz, 10 Hz, sham (presence of electrodes without stimulation), or control with no electrodes, immediately followed by five walking bouts on a treadmill until pain occurred. The patients were allowed to rest for 10 mins between each bout and had no feedback concerning the walking distance achieved.
Results: Total walking distance was significantly different between T10, T80, sham, and control (P < 0.0003). No difference was observed between T10 and T80, but T10 was different from sham and control. Sham, T10, and T80 were all different from control (P < 0.001). There was no difference between each condition for heart rate and blood pressure.
Conclusions: Transcutaneous electrical nerve stimulation immediately before walking can delay pain onset and increase walking distance in patients with class II peripheral artery disease, with transcutaneous electrical nerve stimulation of 10 Hz being the most effective.
Intensive Walking Exercise for Lower Extremity Peripheral Arterial Disease: a Systematic Review and Meta-analysis.
Lyu X, Li S, Peng S, Cai H, Liu G, Ran X.
Supervised treadmill exercise is the recommended therapy for peripheral arterial disease (PAD) patients with intermittent claudication (IC). However, most PAD patients do not exhibit the typical symptom of IC. The objective of the current study was to explore the efficacy and safety of intensive walking exercise in PAD patients with and without IC.
Databases of Pubmed, Embase and Cochrane Library were systematically searched. Randomized controlled trials comparing the effect ofintensive walking exercise with usual care control in patients with PAD were included for systematic review and meta-analysis.
Eighteen trials with 1200 patients were eligible for this analysis. Compared with usual care control, intensive walking exercise couldsignificantly improve the maximal walking distance ( MWD ), pain-free walking distance (PFWD) and 6-minute walking distance (6-MWD) in patients with PAD (P < 0.00001 for all). Subgroup analyses indicated that lesserimprovement of MWD was observed in subgroup with more diabetes patients, and subgroup with better baseline walking ability was associated with greater improvement in walking performance. In addition, similar improvement in walking performance was observed between different exercise length and modality. No significant difference was found in adverse events between the two groups (RR = 0.84, 95%CI = [0.51, 1.39], P = 0.50).
Regardless of exercise length and modality, regularly intensive walking exercise improves walking ability in PAD patients more than usual care control. Presence of diabetes may attenuate the improvement of walking performance in patients with PAD following exercise.
Prevalence of peripheral arterial disease is equal in men and women. However, women seem to suffer more from the burden of disease. Current studies on gender-related outcomes following supervised exercise therapy (SET) for intermittent claudication (IC) yield conflicting results.
A follow-up analysis was performed on data from the 2010 Exercise Therapy in Peripheral Arterial Disease (EXITPAD) study, a multicenter randomized controlled trial including IC patients receiving SET or a walking advice. The SET program was supervised by physiotherapists and included interval-based treadmill walking approximating maximal pain combined with activities such as cycling and rowing. Patients usually started with three 30-minute sessions a week. Training frequency was adapted during the following year on the basis of individual needs. The primary outcome was gender differences regarding the change in absolute claudication distance (ACD) after SET. ACD was defined as the number of meters that a patient had covered just before he or she was forced to stop walking because of intolerable pain. Secondary outcomes were gender differences in change of functional walking distance, quality of life, and walking (dis)ability after SET. Walking distances were obtained by standardized treadmill testing according to the Gardner-Skinner protocol. Quality of life was measured by the 36-Item Short Form Health Survey, and walking (dis)ability was determined by the Walking Impairment Questionnaire (WIQ). Measurements were performed at baseline and after 3, 6, 9, and 12 months. Only patients who met the 12-month follow-up measure were included in the analysis.
A total of 113 men and 56 women were available for analysis. At baseline, groups were similar in terms of clinical characteristics and ACD walking distances (men, 250 meters; women, 270 meters; P = .45). ACD improved for both sexes. However, ACD increase was significantly lower for women than for men during the first 3 months of SET (Δ 280 meters for men vs Δ 220 meters for women; P = .04). Moreover, absolute walking distance was significantly shorter for women compared with men after 1 year (565 meters vs 660 meters; P = .032). Women also reported less on several WIQ subdomains, although total WIQ score was similar (0.69 for men vs 0.61 for women; P = .592). No differences in quality of life after SET were observed.
Women with IC benefit less during the first 3 months of SET and have lower absolute walking distances after 12 months of follow-up compared with men. More research is needed to determine whether gender-based IC treatment strategies are required.
Objectives: The extent to which gastrocnemius muscle and Achilles tendon properties contribute to the impaired walking endurance of claudicants is not known.
Methods: Ultrasound images quantified muscle architecture of the lateral and medial gastrocnemius (GL and GM) and were combined with dynamometry during plantarflexor contractions to calculate tendon stress, strain, stiffness, the Young modulus, and hysteresis. Key parameters were entered into multiple regression models to explain walking endurance.
Results: Worse disease severity was significantly associated with longer fascicle: tendon length ratios (GL R = -0.789 and GM R = -0.828) and increased tendon hysteresis (R = -0.740). Walking endurance could be explained by GL and GM pennation angle, maximum tendon force, tendon hysteresis, and disease severity (R2 = ∼0.6).
Conclusions: Peripheral arterial disease was associated with functionally important changes in muscle and tendon properties, including the utilization of stored elastic energy. Interventions known to target these characteristics should be adopted as a means to improve walking endurance.
A PhD student from our School of Health Sciences is looking for volunteers to take part in a new research study that aims to help people who suffer from poor blood circulation to walk without pain.
The walking distance for people with poor blood circulation, termed peripheral arterial disease, in their legs can be limited because of aching pains felt around the calf muscles, and occasionally thighs. This is caused by a low supply of blood and oxygen to certain muscles, intermitted claudication.
This study aims to better understand why an act as simple as walking can become so painful for those affected. The results of this study will be incorporated in the design of a new rocker sole shoe that specifically reduces this pain. A rocker sole shoe is a type of footwear used to take on part of the work normally carried out by a person’s calf muscles, making this an appropriate style of shoe to use.
The study itself will include examining the differences between those who experience pain whilst walking and those who don’t and investigating how modified shoes could help ease the pain. It is hoped the new shoe will help people with poor blood circulation to walk further distances, improve blood supply to the legs and feet, and help to reduce the risk of future pain.
PHD student Effy Evangelopoulou, who will be leading the study, says: “This research study hopes to improve the uncomfortable experience many people, suffering from poor blood circulation, currently endure when walking short or long distances.
Lane R, Harwood A, Watson L, Leng GC.
Exercise programmes are a relatively inexpensive, low-risk option compared with other, more invasive therapies for treatment of leg pain on walking (intermittent claudication (IC)). This is the fourth update of a review first published in 1998.
Our goal was to determine whether an exercise programme was effective in alleviating symptoms and increasing walking treadmill distances and walking times in people with intermittent claudication. Secondary objectives were to determine whether exercise was effective in preventing deterioration of underlying disease, reducing cardiovascular events, and improving quality of life.
For this update, the Cochrane Vascular Information Specialist searched the Specialised Register (last searched 15 November 2016) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 10) via the Cochrane Register of Studies Online, along with trials registries.
Randomised controlled trials of an exercise regimen versus control or versus medical therapy for people with IC due to peripheral arterial disease (PAD). We included any exercise programme or regimen used for treatment of IC, such as walking, skipping, and running. Inclusion of trials was not affected by duration, frequency, or intensity of the exercise programme. Outcome measures collected included treadmill walking distance (time to onset of pain or pain-free walking distance and maximum walking time or maximum walking distance), ankle brachial index (ABI), quality of life, morbidity, or amputation; if none of these was reported, we did not include the trial in this review.
For this update (2017), RAL and AH selected trials and extracted data independently. We assessed study quality by using the Cochrane 'Risk of bias' tool. We analysed continuous data by determining mean differences (MDs) and 95% confidence intervals (CIs), and dichotomous data by determining risk ratios (RRs) and 95% CIs. We pooled data using a fixed-effect model unless we identified significant heterogeneity, in which case we used a random-effects model. We used the GRADE approach to assess the overall quality of evidence supporting the outcomes assessed in this review.
We included two new studies in this update and identified additional publications for previously included studies, bringing the total number of studies meeting the inclusion criteria to 32, and involving a total of 1835 participants with stable leg pain. The follow-up period ranged from two weeks to two years. Types of exercise varied from strength training to polestriding and upper or lower limb exercises; supervised sessions were generally held at least twice a week. Most trials used a treadmill walking test for one of the primary outcome measures. The methodological quality of included trials was moderate, mainly owing to absence of relevant information. Most trials were small and included 20 to 49 participants. Twenty-seven trials compared exercise versus usual care or placebo, and the five remaining trials compared exercise versus medication (pentoxifylline, iloprost, antiplatelet agents, and vitamin E) or pneumatic calf compression; we generally excluded people with various medical conditions or other pre-existing limitations to their exercise capacity.Meta-analysis from nine studies with 391 participants showed overall improvement in pain-free walking distance in the exercise group compared with the no exercise group (MD 82.11 m, 95% CI 71.73 to 92.48, P < 0.00001, high-quality evidence). Data also showed benefit from exercise in improved maximum walking distance (MD 120.36 m, 95% CI 50.79 to 189.92, P < 0.0007, high-quality evidence), as revealed by pooling data from 10 studies with 500 participants. Improvements were seen for up to two years.Exercise did not improve the ABI (MD 0.04, 95% CI 0.00 to 0.08, 13 trials, 570 participants, moderate-quality evidence). Limited data were available for the outcomes of mortality and amputation; trials provided no evidence of an effect of exercise, when compared with placebo or usual care, on mortality (RR 0.92, 95% CI 0.39 to 2.17, 5 trials, 540 participants, moderate-quality evidence) or amputation (RR 0.20, 95% CI 0.01 to 4.15, 1 trial, 177 participants, low-quality evidence).Researchers measured quality of life using Short Form (SF)-36 at three and six months. At three months, the domains 'physical function', 'vitality', and 'role physical' improved with exercise; however this was a limited finding, as it was reported by only two trials. At six months, meta-analysis showed improvement in 'physical summary score' (MD 2.15, 95% CI 1.26 to 3.04, P = 0.02, 5 trials, 429 participants, moderate-quality evidence) and in 'mental summary score' (MD 3.76, 95% CI 2.70 to 4.82, P < 0.01, 4 trials, 343 participants, moderate-quality evidence) secondary to exercise. Two trials reported the remaining domains of the SF-36. Data showed improvements secondary to exercise in 'physical function' and 'general health'. The other domains - 'role physical', 'bodily pain', 'vitality', 'social', 'role emotional', and 'mental health' - did not show improvement at six months.Evidence was generally limited in trials comparing exercise versus antiplatelet therapy, pentoxifylline, iloprost, vitamin E, and pneumatic foot and calf compression owing to small numbers of trials and participants.Review authors used GRADE to assess the evidence presented in this review and determined that quality was moderate to high. Although results showed significant heterogeneity between trials, populations and outcomes were comparable overall, with findings relevant to the claudicant population. Results were pooled for large sample sizes - over 300 participants for most outcomes - using reproducible methods.
High-quality evidence shows that exercise programmes provided important benefit compared with placebo or usual care in improving both pain-free and maximum walking distance in people with leg pain from IC who were considered to be fit for exercise intervention. Exercise did not improve ABI, and we found no evidence of an effect of exercise on amputation or mortality. Exercise may improve quality of life when compared with placebo or usual care. As time has progressed, the trials undertaken have begun to include exercise versus exercise or other modalities; therefore we can include fewer of the new trials in this update.
The role of psychopathology in perceiving, reporting and treating intermittent claudication. A systematic review.
To review the association between mental health and intermittent claudication (IC) perception, reporting and treatment in subjects with peripheral artery disease (PAD).Literature searches of experimental and observational studies published up until 1.02.2016 were conducted using the following electronic databases: Medline/PubMed and Embase. The selection criteria for the studies included a population of patients diagnosed with peripheral artery disease who reported symptoms of intermittent claudication and were assessed for any psychopathological states (depression, anxiety, mood and personality disorders), which in turn were analysed with regard to the following: IC severity, symptom perception and reporting, patients' quality of life, treatment compliance and its effectiveness. The risk of bias was assessed using Cochrane Collaboration's tool and the Newcastle Ottawa Scales. The strength of recommendations was graded according to GRADE system.The literature search identified 1598 citations, of which 13 studies with varying risk of bias were included in the review. Depression, anxiety, and personality types were described in more than 800 patients with peripheral arterial disease who suffered from intermittent claudication. With regard to IC perception and reporting, individuals with higher levels of depression had lower levels of pain acceptance, were more dissatisfied with their function and control over function and had a poorer quality of life. In the case of the type D personality, the results were not consistent. Studies assessing the influence of psychopathology on IC severity and treatment also showed discrepant results. Some studies indicated no differences between type D and non-type D patients with regard to the ankle brachial index (ABI) as well as pain free (PFWD) and maximal walking distances (MWD). On the other hand, others revealed that type D and depressed patients terminated 6MWT prematurely due to the onset of symptoms and experienced a greater annual decline in 6-minute walk distance, fast walking velocity and short physical performance battery. With regard to treatment adherence, patients with no mental problems made the best recoveries. Hostility, aggressiveness and affect-liability were the greatest obstacles to compliance.Mental disorders might influence the way in which the symptoms of the disease are reported, coped with, and treated. However, the results of the review preclude recommending a routine psychological examination as one of basic diagnostic procedures in patients with peripheral artery disease suffering from IC.
Objective Resistance training (RT) improves walking ability in persons with peripheral artery disease. We conducted a meta-analysis of randomised controlled trials (RCTs) investigating the effect of RT on peripheral artery disease (as measured by walking ability).
Design We included RCTs that investigated the effect of RT on treadmill and/or 6 min walk (6-MWT) distances. RT intensity was assessed according to the American College of Sports Medicine guidelines by 1 repetition maximum or rating of perceived exertion. Standardised mean (SMD) and mean differences (MD) were calculated using a random-effects inverse variance model. Heterogeneity and bias were assessed using RevMan V.5.3. Meta-regression and meta-analysis of variance were performed as moderator analyses.
Data sources Databases (Medline, Embase, Web of Science, Cinahl and Google Scholar) were searched until July 2018.
Results Fifteen trials isolated RT; 7 trials compared RT with aerobic exercise. We analysed 826 patients (n=363 completing RT), with a mean age of 67.1±3.8 years. Training ranged from low-high intensity, 2–7 times per week for 17±7 weeks, with a mix of upper, lower or whole body training. Overall RT significantly improved constant load treadmill claudication onset (COD) (SMD 0.66 [0.40, 0.93], p<0.00001) and total walking distance (WD) (SMD 0.51 [0.23, 0.79], p=0.0003), progressive treadmill COD (SMD 0.56 [0.00, 1.13], p=0.05) and total WD (SMD 0.45 [0.08, 0.83], p=0.02), and 6-MWT COD (MD 82.23 m [40.91, 123.54], p<0.0001). Intensity played a role in improvement, with high-intensity training yielding the greatest improvement (p=0.02).
Conclusions RT clinically improved treadmill and flat ground walking ability in persons with peripheral artery disease. Higher intensity training was associated with better outcomes. Our study makes a case for clinicians to include high-intensity lower body RT in the treatment of peripheral artery disease.

industry_corpus2: Health & Medicine


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Every November, banks and money experts talk about the importance of financial literacy as part of Financial Literacy Month. Experts recognize the importance of understanding money matters; what often gets overlooked is the lack of financial education available to young people, the effect this has on their money-management skills and the subsequent impact on their financial freedom.
According to the latest census, more than a third of young Canadians aged 20-34 are still living with their parents. While this can be partly attributed to rising housing costs, it also reflects the fact that our young people may lack the essential budgeting skills to live independently.
Money may be a finite resource, but ways to spend it aren’t — a reality that plays out for most young people before their real financial education begins.
According to a study from Cambridge University, children start forming financial habits from age seven. Most children at seven understand the concept of money — that it can be exchanged for goods (or candy) — but not always that it’ll do better for them in the long run if it stays in the piggy bank.
Financial education should start from a young age — both at home and in school. Some educators suggest implementing mandatory personal-finance courses in undergraduate curricula, but in reality, financial education needs to start years before university.
After all, by 17 or 18, young people are expected to make significant financial decisions — should I borrow thousands of dollars to go to university? How can I finance buying a car? How can I save enough to spend my summer exploring the world? — and are forced to consider the prospect of debt long before they even start to make a salary.
I remember stumbling upon a compound-interest calculator app that breaks down the math. I realized that if someone starts with $10,000 in savings and adds $5,000 per year to those savings for 40 years, instead of ending up with $210,000 as the simple math would show, at a 10-per-cent rate of compounding, that rate of savings produces an end result of $2.9 million. When I saw the math in action it blew my mind.
Figuring out how compound interest worked was a defining moment in my understanding of money. It made me question why something so fundamental and important in managing finances isn’t a part of the mandatory curriculum in school, like basic math or science. Money is a common thread that permeates every aspect of our daily lives. We all have to deal with it, regardless of how old we are or where we stand in the socio-economic order. Yet, we are failing to teach fundamental money-management skills to the next generation.
While young Canadians fare well in global rankings of financial literacy, and the thirst to remain a global leader in financial literacy is evident in the government’s ‘Count me in, Canada’ financial-literacy strategy, it’s important that specific programs are developed for children and young adults.
Understanding how money works makes long-term financial goals real, and ultimately motivates you to work toward them. Being able to leave the parental nest and find a place of your own is a rite of passage for most twenty-somethings. But with rising house prices and a lack of financial know-how, millennials have effectively had their wings clipped.
Money education from an early age isn’t just a more realistic approach to financial literacy, but crucial if young people are to experience financial freedom and security.
Parents, educators, government and organizations mandated to promote financial literacy can all help improve the money skills of our young people. This knowledge can be imparted at home, in school or via resources shared online. Children learn differently and we need to offer different options for learning such fundamental skills.
The next generation leaving school will be our brightest and most-educated yet. We don’t want a lack of financial literacy to hold them back from achieving their full potential.
David Gens is the founder and CEO of Vancouver-based Merchant Advance Capital, which provides financing to small-business owners. David is embarking on a series of financial literacy engagements with secondary schools across Vancouver to teach the fundamentals of money management.

industry_corpus2: Finance & Economics


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Edifier 5.1 Surround Sound Speakers S760D is a ground-shaking 5.1 surround sound system that maximises your listening experience. The S760D is a 5.1 home theatre system with Dolby Digital, Pro Logic II and DTS with 3 optical, 1 coaxial, analog 5.1 and dual stereo inputs. The S760D also comes with a multi-functional controller and wireless remote control. Looking adding surround sound to you Virtual relaity experience then why not treat youself to this 5.1 speaker system. These speaking will allow you to get the full audio experience without using a headset over your current VR headest allowing you a compfortable gaming experience.
Boasting 540 watts RMS, S760D demands its share of attention. A massive 10" subwoofer driver and twin bass radiators deliver superb bass performance. Complemented by two-way satellite speakers with 3½” midrange drivers and 1” solk-domed tweeters. But S760's superior sound doesn't stop there. With the power booster function to enhance system volume, S760D is designed to instantly fill a large room with exhilarating sound. The two-way satellite speakers, with professionally calibrated crossovers, is equipped with 3.5-inch mid-range drivers and 1-inch silk dome tweeters.
Featuring 3 optical inputs, 1 coaxial input, analog 5.1 and dual stereo inputs, S760D is a versatile speaker system for home entertainment, gaming and music, you name it.
More links for "S760D 5.1 Surround Sound Speakers"
So we had excellent service from Overclockers of course, buying this Edifier speaker set 2 weeks ago and enjoying it since.
This was a replacement for our trusty Logitech Z5500s. I'd had those since 2006 and was blessed at the time to find them new for just £195, though typical price was/is £300-350. They had been used for both PC gaming, and then moved to living room set up for XBox360 and streaming box / DVD / Blu-ray playback.
As you're probably aware, the Z5500s are fairly legendary by reputation, with great sound and powerful 10" sub woofer to rattle your bones. Being THX certified, you'd expect that level of sound quality.
Our old Logitechs however finally died after I'd been trying various solutions to clean the electrical signal going in to them (we use Powerline networking and this caused the amp to make the subwoofer continuously rumble and pop 'quietly' but enough to disturb relaxing time and cloud soundtracks).
So, I was forced to find a suitable replacement. There isn't a huge choice any more in this price range it seems. Naturally I had looked at the newer Logitech z906s, but, I was reading mixed reviews if they were not being used just for gaming.
Never having heard of Edifier before, I conducted research on these S960D bad boys. The main reviews out there were foreign, so I got a 85% idea of what they could do with Google Translate, and various Youtube videos of people expecting you to hear the speaker quality from their cheap mics on camera, compressed by Youtube further.
So.... it was a bit of a gamble, with slight confidence. General reviews of the Edifier S960Ds seemed decent and suggested the 10" sub woofer had some punch (I am a sucker for bass....).
As I said, we've had the in our lounge now for 2 weeks, using them for DVDs, Blu-rays, streaming services (Netflix, Amazon Prime), and for music playback.
You spend the first day or two tweaking settings to find the 'recipe' of sound that you like, compared to what you had before. Then you sit back and enjoy.
It's subtle, but it nips at you, trying to impress you with the sound quality the more you use it.
Unlike the old Logitech Z5500s, these Edifier S960Ds are not THX certified, but, at the price they are going for, you would hope they are better.
For movies, we've found new clarity in the sound effects, and the voices. Somehow, the left / right staging seems more prominent so you feel more immersed. Explosions and bass-hits shake the furniture and your backside if you allow it - causing even my wife to crack impressed smiles (sometimes accompanied with colourful language) and causing me to panic that the neighbours will start knocking angrily on the front door. Interestingly, even older movies from the 1980s seem to have more life, as suddenly you can hear much more subtle detail in the audio, we noticed last night.
For music, they are great. Rather than the sub woofer try to make its presence known all the time, it kicks in just when it needs to. It's clear, defined and can pack a punch. Lyrics are far more detailed and audible than before, and even when I am upstairs and the Mrs decides to whack on some heavy rock (if the mood takes) there's clarity and clean vocal even between floors! She says she loves our new speakers!
All in all, a great 5.1 speaker system. Lovely clarity and detail, great volume, tight and clear bass which is less muffled and more defined than the older Logitechs'. Music and movies have gone up a level in enjoyment factor.
Thank you Edifier S960D engineers!

industry_corpus2: Computing & Telecommunications


text:
Parent Orientation: Saturday, Sept. 10th 9:00-10:00am in the church.
Communion program is now a two year program.
If your child will be in the 2nd grade this year but has not been registered in our program last year, then he/she must be catechized for another year before receiving the sacrament of Holy Eucharist.

industry_corpus2: Subject Education


text:
Going by a health service coverage index, some countries are making clear strides toward universal health coverage. There’s just one problem: The index neglected to include services for neglected tropical diseases.
To tackle that oversight, researchers led by the WHO’s Christopher Fitzpatrick developed a comparable index focused on NTD service coverage. They focused on preventive chemotherapy and 5 NTDs: lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiases, and trachoma—then held it up against the UHC service coverage index.
81 of 113 countries measured performed lower in NTD than UHC services in the index, suggesting that countries with large gaps might need to shift focus to more interventions for their poorest populations.


text:
Newman International Academy excels to produce champions both on the field and off the field, teaching students teamwork, the value of hard work and effort, discipline, and dedication. We offer sports year round including football, volleyball, cheerleading, cross country, basketball, soccer, track and field, softball, and baseball.
~ Student athletes will be champions, doing their best in their field of sport and in their studies.
~ Student athletes will be Citius, Altius, Fortius - “FASTER, HIGHER STRONGER” in line with the Olympic motto and train to that end.
~ Student Athletes will be individuals of character and good conduct; salt and light - salt by changing the world through good deeds and behavior, and light by being people of sound mind, love, power and self control at all times and places.
Newman International Academy focuses on producing champions with the knowledge that not every athlete can be “the champion” in the eyes of the world, but that there is a CHAMPION in every child and in every student athlete. Our expectation will be that every student athlete will be a CHAMPION with the help, support, encouragement, opportunity and training that Newman International Academy and its families provide.
Please use the links provided on the left to scroll through our individual campus athletic programs so that you can better understand the campus specific athletic options available to your student.


text:
Epstein SK. Corticosteroids to prevent postextubation upper airway obstruction: the evidence mounts. Crit Care. 2007;11(4):156. PMC2206510.
François B, Bellissant E, Gissot V, Desachy A, Normand S, Boulain T, Brenet O, Preux PM, Vignon P; Association des Réanimateurs du Centre-Ouest (ARCO). 12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: a randomised double-blind trial. Lancet. 2007 Mar 31;369(9567):1083-9. PubMed PMID: 17398307.
Lee CH, Peng MJ, Wu CL. Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study. Crit Care. 2007;11(4):R72. PMC2206529.
Wittekamp BH, van Mook WN, Tjan DH, Zwaveling JH, Bergmans DC. Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care. 2009;13(6):233. PMC2811912.


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Dr.T.KALPA LATHA REDDY ME, Ph.D, LMIETE, LMISTE.
Dr.T.KALPA LATHA REDDY completed her B.Tech from S.V University-Tirupathi in the branch of Electronics and Communication Engineering. She completed her M.Tech from Anna University,Chennai in Applied Electronics. She was awarded Ph.D from Anna University,Chennai for presenting Thesis on ‘Texture Analysis of Jaw Bone CT Images for characterization of Bone Quality’. Her Areas of Interest are Medical Imaging, Signal Processing, Artificial Neural Networks, VLSI.
She has around 23 years of Experience as Academician in Teaching profession as well as Administration & the major contribution of several years goes to Research & Development [ R&D ]. She also has three years of Industry Experience as Software Engineer. She worked in various institutes and handeled different positions starting with Lecturer to Vice Principal & Dean.
She has organized many Technical Events, Symposiums, Seminars, Workshops, FDPs, Conferences etc., during her academic experience.She has presented and published more than 50 papers in various International and National journals & conferences.
Beyond her scholarly academic works, she has been part of the various professional bodies serving responsible positions.
* She is a Life member of MIET, LMIETE, LMISTE.
* Presiding officer for Gate Exam Conducted by IIT-CHENNAI.
* Merit scholarship for securing highest marks in SSC.
* University III rd rank in UG, SV University, Tirupathi.
*IE (INDIA) award of Appreciation from C-Tides for proactive effort in learning initiatives, placements, campus Research & Development efforts.
* Best LabVIEW Academy award from NI(India), 2014.
* Best Student Chapter Award from IET for organizing more student centric programs in Chennai Network.
* Panel Judge for VI-Mantra Technical paper contest (Research Category) organized by National Instruments (India) during 2012, 2013& 2014.
* Invited Speaker for ICEBB2011, Shanghai, China.
* Session Chair for ICEBB2011, Shanghai, China.
* Sub Editor-International Journal of Engineering Research in Electronics and Communications.
* Question Paper Setter-Anna University,SathyabamaUniversity, S.K.R College of Engineering,Tiruchengode, Dr.M.G.R.Educational and Research Institute,Chennai.
* Design Consultant, MSME Design Clinic Scheme.

industry_corpus2: Technology & Research


text:
About the Book An interesting sequence of letters, written by L.M. Montgomery early in the century, was found in 1956 among the papers of Ephraim Weber who was living in the West. Now lodged in the National Archives in Ottawa, the letters reproduced here exactly as they were written, form a fascinating footnote to the history of Canadian letters. These letters are of interest and importance not only because they were written during the years of gestation and birth and outstanding success of the book Anne of Green Gables, but also because they reveal a lively extrovert in an eminently healthy balance. This is an absorbing book, for adults who have nostalgic memories of "Anne," and for writers who need encouragement in their struggle for literary recognition.
Wilfrid Eggleston (1902-1986), the founding director of Carleton University's School of Journalism, came to Canada from Lincoln, England. Raised in Alberta, he obtained a Bachelor of Arts degree at Queen's University before becoming Ottawa correspondent for "The Toronto Star" and Reuters. He was also chief press censor during the Second World War. His works include novels, literary criticism, histories of Ottawa, nuclear energy in Canada, the National Research Council, and two memoirs.

industry_corpus2: Literature & Emotions


text:
More than 120 enthusiastic participants gathered at the Ericsson Studio in Kista for Drive Sweden’s Annual Conference. The number of members has more than doubled over the first year of operation and a lot of resources have been put into project activities within the program.
The day started with a short Annual General Meeting, where Catharina Elmsäter-Svärd was re-elected chairwoman of the Program Board for the coming year.
Jane Lappin, Director at the Toyota Research Institute, talked about their massive investment in automated vehicles, and the challenges involved.
Kalle Runnberg, from Volvo Cars, gave an interesting update on the Drive Me project, the research platform involving the world’s first field test involving normal customers driving highly automated cars on public roads.
Presentations were held by several Drive Sweden supported projects, all in all describing a wide scale of activities. The Drive Sweden Open Innovation Cloud being the largest one of those projects, was presented in more detail and it was highlighted how this platform will enable various projects to share data, connect fleets of vehicles etc.
Also during the day, three of Drive Sweden’s more recent members, Uber, Uniti and RideCell, presented their ”Partner pitches”, describing their respective visions for the future mobility. Lewis Horne from Uniti has a clear aim for their electric city car.
“We see three major trends for the future; shared, electric, self-driving, and shared self-driving vehicles could reduce the number of vehicles by 90%”. Martin also gave examples of co-operations Uber has with cities and companies, providing different flavors of mobility services.
”Birthdays are always fun, but celebrating Drive Sweden’s progress after our first year of operation was particularly satisfying. The breadth of the participants and their energy level, the results that were showcased, and inspiring speeches from our external guests; everything added to this event being a great first year wrap-up, but also a terrific launch pad for our continued activities”.

industry_corpus2: Automobiles


text:
I’ve been at this blogging thing for more than five-and-a-half years. In that time, I’ve had some awesome opportunities come my way as a result.
My first book, which I co-authored with some friends—Think Before You Click: Strategies for Managing Social Media in the Workplace—remains available for download from Thompson.
I’ve appeared too many times to count on Stephanie Thomas’s fabulous Proactive Employer Podcast, including my upcoming appearance next Thursday at 3 pm to promote The Employer Bill of Rights.
I’ve done other radio appearances, including DriveThruHR and NPR.
And, I’ve been syndicated. In addition to reading my posts right here at the Ohio Employer’s Law Blog, you can also read many republished on Crain’s Workforce, under the byline, The Practical Employer.
This week, I’m adding another opportunity. For the past four years, I’ve edited Business Management Daily’s Ohio Employment Law Newsletter. Next month will be its last print edition. The publisher offered to continue our relationship online, and will publish my content in blog form. My newest blog, Business Management Daily’s The Legal Workplace, debuted yesterday. It will feature original content every other Thursday.
If I could just figure out how to clone myself, this would all become a whole lot easier.
AmLaw 2012 survey shows strong iPhone, iPad support at the most profitable law firms — from iPhone J.D.

industry_corpus2: Law & Justice


text:
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Unless you tell us not to, we might contact you via email down the road to tell you about specials, new products or services, or changes to our policy. You always can opt out of any future contacts from us at any time.
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This policy may change from time to time and all updates will be shown on this page.


text:
To celebrate Linda’s new business, she will be giving a free, entertaining & informative powerpoint presentation for parents. Enjoy the food, fun, friendship, and door prizes too!
RSVP: (310) 422-2397 or Lmartenspeaks@yahoo.com or leave a comment!


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Broomfield residents know that the hot dry summer is right around the corner. If you are looking for swamp cooler in Broomfield, you’ve come to the right place. Brothers Plumbing, Heating, and Electric is a reliable provider of portable swamp coolers in Broomfield. For many years, we have been providing quality portable swamp coolers in Broomfield and the surrounding areas. We have established a great reputation in this area and have a large number of customers who are completely satisfied with the products and services they have received from our company.
Our team of professional Broomfield swamp cooler experts is always standing by to help keep cool. Give us a call or click here to learn more about our affordable and reliable cooling services today!
At Brothers Plumbing, Heating, and Electric, we have an amazing selection of Broomfield evaporative coolers at affordable prices. Not only is our portable swamp cooler in Broomfield designed to effectively lower the temperature of indoor air, it also makes the atmosphere more pleasant. With Broomfield evaporative coolers, the cooled air is slightly damper and gets recirculated which leaves your home cool, but not overly dry.
With air conditioners old air is recirculated, which reduces the humidity, proves unhealthy and uncomfortable in a dry climate. A moderate amount of humidity keeps the body’s mucous membranes moist, which increases those membranes’ effectiveness at boosting the body’s immunity. In addition, experts believe that swamp coolers, such as Broomfield swamp coolers, use significantly less energy than air conditioners. Many people enjoy the sensation of fresh breeze created with evaporative cooling.
A portable evaporative cooler is an alternative to an air conditioner, and it uses evaporation to lower the temperature. People who live in hot and dry climates have long accepted swamp coolers as being very effective at cooling homes. They’re affordable, efficient, moisten and cool the air and good for the environment. When you are ready to get a swamp cooler in Broomfield or nearby area, it is imperative that you find Broomfield swamp coolers from our company. Although there are many companies that offer evaporative cooler in Broomfield and the surrounding areas, not all companies that sell swamp coolers and evaporative cooler in Broomfield are created equal. You need to contact a company with a team of professionals who have a good understanding of portable evaporative coolers and swamp coolers so you can get top quality service.
Brothers Plumbing, Heating And Electric is your trusted Broomfield evaporative coolers and swamp coolers in Broomfield. Our company comes highly recommended in Broomfield and surrounding areas. We can help you select the right size swamp cooler or evaporative cooler for your home. Contact us at (303) 468-2294 or visit us at 12249 Pennsylvania Street, Thornton, CO 80241 for assistance with getting your Broomfield swamp coolers up and running. To learn more about the energy savings that can be obtained with a new cooling system, just lick HERE.
Reliable and affordable Broomfield swamp cooler service is always just a quick phone call away.

industry_corpus2: Power & Energy


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Hotel/Casinos are now making more money on food, shows, spas and shopping than gaming. So now there are a couple new Hotels in this center strip area (Vdara is the other) that choose to be in the Hotel business and let the others compete with the gaming.
As the name would suggest Mandarin Oriental has Asian roots and if you have ever stayed in a luxury Hotel in Asia you know it is far superior to one in America (sorry, but its a fact). The level of service is beyond belief. This Hotel will provide that same kind of service that it's Asian Hotels properties do.
The lobby offers amazing views of the strip both north and south, it is located on the 23rd floor. Next time you are in Vegas take a look, they welcome visitors even if you are not staying there.
Dining and Lounging are different here. Its all first class and all in a subdued atmosphere. Without the sounds of a Casino outside the doors, it lets You get away from the fast pace for a little while. All in 5 star comfort.

industry_corpus2: Hospitality & Catering


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Kayer (Sublevel Epidemic/LA2theBay) releases "Permanent Knock" a 10 song album of True School lyricism and beats made to live forever.
Guest appearances by Project Blowed/Heavyweights Myka 9 (Freestyle Fellowship), Spoon of Iodine, 2Mex (The Visionaries) and Maleko. Productions and scratches by ITF Champion Vinroc, DJ Icewater, Deeskee, 8:35, Ian Mckee and DJ Fossil. Art by Skill One UTI. Vinyl release scheduled for August 2017.
Kayer Rewind a Decade: Archives from 2003-2007 recorded at the Corner Store Studios in Oakland Ca. Album features Project Blowed/Heavyweights Spoon (of Iodine) & P.E.A.C.E. of Freestyle Fellowship, DJ Icewater, Jungle Boogie Brown, DJ Vinroc of Triple Threat DJs, Luna Angel, and Eddie K. 88 of Gurp City. Productions by Cosiner, Vinroc, Stressnotic, Ian McKee and Jaz Jetson. Published by Bay Area label Hit Status Recordings. Cover art by Blaine Fontana.
Available on itunes/Apple Music, Google Play, Spotify, Bandcamp, Amazon and all other digital/streaming sites. Vinyl & CD Also available at Amoeba, Access Hip-Hop, Future Shock etc.

industry_corpus2: Film & Entertainment


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Mr. and Mrs. Chester Bunkelman of Milan (Marathon Co., Wis.) are the parents of a son born Friday, February 13, 1970, at St. Joseph's Hospital, Marshfield. He weighed ten pounds, eight ounces and is their fourteenth child. Chris John has eight brothers and five sisters.
Grandparents of the children are Mr. and Mrs. Bernard Gall of Dorchester (Clark Co., Wis.) and Mrs. Tillie Bunkelman of Milan.

industry_corpus2: Others


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How can I backup a remote Stash instance with the Stash Backup Client?
I downloaded stash-backup-distribution-1.6.0.zip and unziped it.
2014-11-28 20:38:10,433 ERROR        A backup could not be created. Reason: The configured STASH_HOME, /var/atlassian/application-data/stash, does not appear to be a valid home directory. Creating a backup requires direct access to the home directory for the running instance to allow it to interact with the repositories.
com.atlassian.stash.internal.backup.client.BackupException: The configured STASH_HOME, /var/atlassian/application-data/stash, does not appear to be a valid home directory. Creating a backup requires direct access to the home directory for the running instance to allow it to interact with the repositories.
When I execute the backup client on the Stash instance is works.
"The Backup Client must be run from somewhere with access to the Stash home directory. Usually, you will run the Backup Client directly on the Stash server."
In that case, the answer would be yes only if your remote server can also access your "Stash home" via network (i.e. you've got it mounted in the remote host because your Stash Home is in a NFS).
I don't think the backup client supports this directly.
You could use the operating systems remote execution capabilities, e.g. sysinternals on Windows and rsh on linux, or a generic ssh.


text:
Lex (pre-flashpoint) once dated Matrix Supergirl when he was posing as his son in a younger body. Mostly to get at Superman it seems in the long run. When that went sour it seemed he had a passionate hate for any female who decided to wear the S shield. Once Linda had retired as Supergirl and Cir-El was out of the picture, Kara landed on earth and became Supergirl.
So we left off with Matrix being captured by Dichon to host her plasmic body.
A 1995 story featuring Matrix from Showcase '95. Before her merge with Linda Danvers, being an artificial life form, there was a time when she was wanted not only by Luthor but also by an robot alien to have her body shaped for his own due to her abilities and shape shifting.
In light of her successful TV show, continuing a look at Supergirl's Rogues' Gallery, such as it is.
When Supergirl got her own comic, with Paul Kupperberg and Carmine Infantino as creators, Linda had moved to Chicago to go to her third college, Lake Shore University. (Some people keep on returning to higher education: Linda Danvers was one of those.) Kupperberg and Infantino tried to give her some memorable villains. Psi appeared in the first three issues of the DARING NEW ADVENTURES OF SUPERGIRL. One could consider it three separate appearances or one three-part story--I am inclined to the latter...but she oddly continued in some other DC comics, and made enough of a presence at DC as a whole to deserve an entry.
She died, but has resurfaced in the new 52. Of course, you could say the same for Supergirl.
Psi had the potential to be a GREAT Supergirl villain. In many ways she was as powerful as Jean Grey as Pheonix. She had a vast array of powers that did not duplicate Supergirl's...but she came across as more of a confused victim, rather than a formidable foe.
flint_marko's recent entry about Superboy's Robot Teacher that "made him a man" reminded me that I've been meaning to post this. You'll understand why once you've read it.
This time we look at Re-ign of the Supermen and the re-turn of...well, you'll see.
7 & 1/3 pages of 22.
Up next: Aquaman breaks his silence on Roe v. Wade!


text:
Caroline Dionne is Assistant Professor in the History & Theory of Design Practice and Curatorial Studies at Parsons School of Design. At the intersection of architecture, literature and language theories, her current research is concerned with the concept of usage—of words and spaces—as a semantically productive component of spatial design in modern and contemporary practices.
She was a Research and Teaching Postdoctoral Fellow at the Swiss Federal Institute of Technology Lausanne (EPFL) from 2011 to 2016, and a Visiting Scholar at the Canadian Centre for Architecture, Montreal, in 2014. She holds a PhD in the History and Theory of Architecture from McGill University, Montreal.


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I just returned from a 2 week rotation in the Southern Lau Islands of Fiji on the sailing vessel Dragonfly. I can honestly say it is one of the best experiences of my life. I felt like I was in a National Geographic special. I loved almost everything about the trip, the people, the sailing, the food and all the experiences I encountered. We were a group of 7: Al and Jill Wiggington: Sail Captain and Co-Captain, Myself, Suzanne Benloucif , from the USA, a nurse of 38 years, with the past 16 years as a Nurse Practitioner; Marina, a PA from the USA; Jacquie, a RN from Australia: Miri, a RN from Fiji; Timoce, the Royco (govenor) of the Southern Lau Islands in Fiji.
In 2 weeks we traveled to 8 different Islands. The Islands we visited were very remote villages. They have received few or no outside visitors aside from their own government supply boats. Each day we were greeted by a member of the island who would come out in a “fiber” power boat to bring us, and our supplies, to shore. We then would go to the Nurses Station and meet the Island RN. This is a government provided building that each island had. They were small and stocked (sometimes fairly and sometimes poorly) with basic medical supplies. The RN’s , after graduating from nursing school, must do a 3 year rotation on one of these remote islands. We immediately set about evaluating what we had and what we could do.
We set up “stations”. The first was the weight, BP, and glucose station. At this juncture we would also assess for any other issues the person may have. We would then triage them to the eye exam station and then the procedure/advanced care room . All people received a basic eye exam and reading glasses were given as appropriate. Most children’s eyes were examined for parasites . We also diagnosed many cases of ptygerium. We assessed for cataracts and made a list of patients who may be appropriate surgical candidates. In the procedure room, we drained boils, assessed open pressure sores (the newly developed Mat Injury Scale , (due to long periods of time sitting on woven mats) was used), skin conditions such as leprosy, scabies, impetigo, and others, infections of any kind requiring antibiotics, we adjusted BP and diabetic medications.
By the second island on the second day, we started as a group to find our groove and things went quite well. The people dressed in their finest and were always happy to see us. They spoke native Fijian, however , there was always the Island staff nurse and the community health worker who spoke English and could translate. We were very fortunate to have Miri RN and Timoce , Royco, to translate also if necessary. Sometimes it took some charades, demonstrations and an interpretive dance or two, hahaha, but we could usually communicate well. There was frequently lots of talking and laughing.
Each day we were graciously served lunch by the woman of the community. They frequently cooked their best food for us, which included lots and lots of fish heads and coconut sauces. The food was delicious and we felt quite honored at these small banquets.
For me the sailing was sublime. As a sailor of 20 years of the Great Lakes in Michigan, I had never really done any open ocean sailing and found it quite exhilarating. Al and Jill are excellent sailors and made the trip very comfortable for us all. I had great admiration for their skill and bravery to undergo such a trip. Nothing is marked on these islands and tides are a critical issue. They certainly made the sailing look easy! They fished off the back of the boat by trolling daily, and it was fun to catch our food. Jill cooked for us everyday and I must say, all the meals were absolutely delicious. I was even more appreciative, knowing how difficult planning meals on a boat for a group can be.
This trip combined my love of sailing with my passion for health care. I feel very fortunate to have had this experience. I would do it again in a heartbeat.

industry_corpus2: Travel & Geography


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Glenwood Springs–The Glenwood Caverns Adventure Park may one day add more adventures and thrills atop Iron Mountain. The Garfield County Board of Commissioners will consider amending the park’s current land use code to expand services.
Rifle–Eastbound I-70 was closed for over four hours yesterday near Rifle after two semi-trucks crashed. The crash was one of several to occur yesterday along snowy, icy stretches of the corridor. Three people involved in a rollover near Rifle suffered minor injuries.
Denver–Colorado may have it’s own set of guidelines for roadless protection. State officials are waiting for the Obama administration to decide between a state rule or a national rule that would impact about 4 million acres in Colorado.
Eagle–The major water agreement between the Western Slope and Denver Water is about to get it’s first signatures of approval. Leaders from Eagle County have agreed to sign the Colorado River Cooperative Agreement.
be up to local governments to decide what to about traffic cameras.
A Senate committee is hearing the bill this afternoon.
chemicals mimic the effects of powerful drugs such as cocaine.
officer approached the man because he was “acting suspiciously.
Police say they don’t know why the man opened fire.


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I gave notice at work. Two weeks from today, I will be unemployed! I tried to leave last year, but for a number of reasons, decided the timing wasn't right. I switched to part time, and that was fantastic, but over the last few weeks, I've been dreading work. And even worse, dreading a bunch of upcoming projects. So, it was time. Now I feel like the next two weeks will never pass, but I always feel that way when looking forward to (or hoping to survive past) something in the future, so I know it'll be here soon enough.
I'm not quite sure what I'll do next. I have a bunch of volunteer plans, and I hope to take some classes. I have enough savings to take a significant chunk of time off, which I know is rare and I'm grateful for the flexibility.
One thing I will work on is my anxiety. I'm doing fine, but not as well as I want to. I'll certainly have the time now, so that's no excuse!
This is so exciting, Ann! Life is too short to keep at a job that you dread. And it sounds like you have planned to be able to not work. Good for you! It's an open world out there. Do what you love!
Oh wow, great for you, Ann! I hope it's a wonderful and refreshing time.
I agree with Tina. How exciting! I look forward to hearing about your new adventures.


text: I am taking full advantage of this spring teaser we are experiencing. I'm opting for lighter booties and brighter colours lately, and it's really got me gearing up for the warmer temps! I know it might be a little hasty, but I like to seize the day. I busted out the magenta cardigan and matching tights because, why not? I added a pleated metallic midi and a grey gingham shirt to tone down the pops of colour. I really loved this neutral, yet bright outfit. The two shades balance each other well and the grey grounded the look. Metallic skirts are so fun to wear and are actually easy to style. You can really dress it up or down. How would you style one for spring?