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Exercise as it relates to Disease/Does playing the Wii Fit video game assist the balance of children with Cerebral Palsy?

Article being critiqued: Effects of Nintendo Wii-Fit® video games on balance in children with mild cerebral palsy

https://doi.org/10.1111/ped.12942

Contents

 * 1What is the background to this research?
 * 2Where is the research from?
 * 3What kind of research was this?
 * 4What did the research involve?
 * 5What were the basic results?
 * 6What conclusions can we take from this research?
 * 7Practical advice
 * 8Further information/resources
 * 9References

What is the background to this research?[edit | edit source]
A common motor disorder that impairs one's ability to move and maintain balance is cerebral palsy (CP). CP can develop before, during, or up to a year after birth when there is abnormal brain development or injury to the developing brain. It is regarded as a chronic illness and the most common cause of physical disability in children. People with CP struggle with postural control, which makes activities like walking, reaching, gripping, and balance particularly challenging. Therefore, CP rehabilitation focuses on improving these from a young age. Clinicians have come up with many methods to do this, including neural development treatment (NDT), reactive balance training and interactive computer play (ICP).

ICP can be modified to provide balance training while simulating real-world situations using Virtual Reality (VR). It is used in rehabilitation to create a play environment where people can feel at ease and allows users and clinicians to monitor performance via a spacial representation on a screen. A small-scale study was conducted earlier using CP-diagnosed participants and VR play-based interventions and it pointed favourably towards the success of such rehabilitation methods.

The study conducted in "Effects of Nintendo Wii-Fit® video games on balance in children with mild cerebral palsy" takes this a step further, with a larger scale investigation undertaken comparing the effects of Nintendo Wii-Fit® balance-based video games and conventional balance training in children with mild CP. There is very little research into this, so the study assists the broadening of options for CP treatment.

It is critical that research into therapy methods continues because CP is currently incurable. The more that is understood about this illness, the simpler it will be to treat. The goal of rehabilitation is to increase the functionality and health of people with CP in order to improve their quality of life.

Where is the research from?[edit | edit source]
The study was conducted by a team of researchers from the Faculty of Health Science at the Istanbul University, Turkey. It was published in the peer -reviewed International Journal of Pediatrics, which has an above average impact factor of 1.617. .

Three of the four authors have multiple publications in the journal. All authors declared no conflicts of interest in relation to the article.

The Clinical Research Ethics Committee at the Istanbul Faculty of Medicine approved the study. It complied with the standards set in the Declaration of Helsinki for medical research involving human beings.

What kind of research was this?[edit | edit source]
This study involved a randomised controlled trial (RCT) with 30 CP-diagnosed ambulatory (able to walk) participants. Randomised studies conducted in  controlled setting are regarded as a very effective technique to gauge an intervention's effectiveness. . Randomisation ensures participant characteristics are balanced and bias is reduced, while the controlled aspect allows outcomes to be directly attributed to the various interventions the groups were exposed to.

What did the research involve?[edit | edit source]
30 children, aged 5 to 18, were divided into two groups for the study. One group, the "control" group, performed conventional balance. The other group used the Wii-Fit video game's balance board to improve their balance.

The CP patients were recruited from the pediatric neurology clinic of the Department of Pediatric Neurology, Faculty of Medicine of Istanbul University (where the researchers were based).

To be included as part of this trial there was specific selection criteria:

 * Had to be diagnosed with CP
 * Fitted in either level 1, 2 or 3 of the Gross Gross Motor Function Classification System (GMFCS)
 * A score of less than 2 on the Modified Ashworth Scale
 * A confirmed mental ability to be able to adapt to exercise

This could be considered a limiting factor, as the selection criteria narrows down the number of people this trial (and the subsequent results) applies to. The very small sample size (30 people only) also brings into question the validity of the study. Each group performed a 12 week exercise program of either conventional balance training or Wii-Fit balance training on the board. Outcome measures of certain tests (balance, posture and muscle strength) were taken before and after the 12 weeks to assess the success of the programs. There were two sessions conducted per week for balance training. Each session was supervised by a physiotherapist who supported and motivated the patients throughout their time in the program.

The methodology used makes sense to assess the different outcomes that may occur based on training type. The main goal of research into rehabilitation methods for patients with CP is to figure out how to best improve balance and posture, which can be judged using appropriately chosen outcome measures. In this study, the assessments done before and after the exercise program would have given researchers a very solid idea of the success of each training type.

What were the basic results?[edit | edit source]
According to the study's results, the WiiFit group improved more in the outcome measure tests after training than the control group did. Tests done using the WiiFit games also found that the group that trained on them scored higher then the group doing conventional training, but this could be attributed to the fact that they had practise on the games.

The researchers were very positive regarding the results of this study. They believed that while both groups showed improvements in balance and body control, the actual transfer of these skills ,from the WiiFit VR environment to real life was the key differentiator and possibly something that could be important to consider when conducting CP rehabilitation.

The small sample size is a limiting factor, but the researchers noted this. They were of the opinion that their trial results were of a significant enough difference between the groups to be used as the basis for a more longterm, larger-scale clinical trial to gain a better understanding of the effects of WiiFit training.

What conclusions can we take from this research?[edit | edit source]
The main objective of CP rehabilitation is to improve walking and balance, and good postural control is essential to this. The findings of this study suggest that including WiiFit into rehabilitation programmes may lead to improvements in these areas. The WiiFit method benefits from the nature of ICP treatment, which makes it a more enjoyable form of rehabilitation for kids than conventional approaches.

A systematic review of the WiiFit balance training approach for CP therapy was conducted in 2021. Eleven RCTs were included (270 children) and the paper concluded that this approach to rehabilitation was viable, especially when incorporated with more traditional methods.

Practical advice[edit | edit source]
Rehabilitation ought to begin as early as feasible in order to improve quality of life as CP patients become older. Although research is being conducted to learn ways to prevent CP, for now, the only option is treatment. This study, along with others, provides clinicians with another method for treating the CP patients they are responsible for. Given that WiiFit training looks to be quite beneficial, take into account including it into the care of these individuals.

Further information/resources[edit | edit source]
For more CP information see below;

 * https://worldcpday.org/
 * https://www.cdc.gov/ncbddd/cp/features/cerebral-palsy-11-things.html
 * https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/interventions/


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User talk:CooperSheather

Welcome, CooperSheather!

If you have any questions, you can ask in the assistance reading room or possibly contact me personally.

--Xania   talk 11:19, 5 September 2022 (UTC)

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: User talk:CooperSheather


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User talk:2600:1700:6641:5450:4D11:AF16:4CDC:8FF6

--Xania   talk 11:22, 5 September 2022 (UTC)


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User talk:Irsyadullah

Your recent edits to Persian/Lesson 7 were undone because you removed large amounts of text without explaining your edits in the Edit Summary field.--Xania   talk 11:23, 5 September 2022 (UTC)

title: User talk:Irsyadullah


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User:Rahulpandit9501

Electrical level-luffing crane is a crane which are mostly used at sea dockyard (Port) for handling Cargoes. This cranes are used for handles a variety of cargoes like coal,Grain,Fertilizer,minerals,ores,steel,Edible Oils, Chemicals etc. Putted on the containers and then crane lifft that containers to ship. The Electrical level-luffing cranes are an electric operater crane. There are various types of ELectrical level-luffing crane on the basis of their capacity.

title: User:Rahulpandit9501


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General Ring Theory/Greatest common divisors

Definition(Greatest Common Divisor):

Let a and b be integers,not both zero.Then the greatest common divisor of a and b written as (a,b) or gcd(a,b) is the largest possible integer d such that d|a and d|b [that is d divides a and d divides b]


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Hobo tourism/Viktor Pinchuk's expedition to the Islands of Oceania

The expedition to the islands of Oceania is a project of the Russian traveler Viktor Pinchuk, where the goal was to explore places rarely visited by travelers. The most notable part of the route is the ethnic village of Bunlap on the Pentecost Island, inhabited by aboriginal people who have retained ancestral traditions.

General information

 * Duration: 2,5 months.
 * Period: 15. 12. 2018 — 09. 03. 2019.
 * Idea: Viktor Pinchuk.
 * Number of participants: 1 (one).
 * Transit through: Irkutsk.
 * Starting point: Incheon International Airport (Seoul, South Korea).
 * Number of countries visited: 8 (eight), including 20 Islands.
 * Way to get: plane.
 * Ways to move: air transport, land transport, water transport, pedestrian routes.
 * Nature of the journey: creative trip.
 * Purpose: to learn about the Aboriginal way of life, preparing material for a book
 * Format: standard hobo tour, bum tour.

Places visited

 * South Korea (Korean Peninsula, islands: Ganghwado, Seongmodo, Yeong-do, Jodo). Localities: Seoul, Suwon, Sokcho, Busan.
 * Taiwan. Localities: Taipei, Hualien City, Fangliao, Hengchun.
 * Philippines (islands: Cebu, Palawan, Luzon, Cadlao, Miniloc). Localities: Mandaue, Liloan, Cebu City, Badian, Puerto Princesa, El Nido, Angeles, Vigan, Tagudin, Baguio, Kabayan, Manila.
 * Singapore (main island, Sentosa Island).
 * Fiji (Viti Levu Island). Localities: Nadi, Lautoka.
 * Vanuatu (islands: Efate, Pentecost). Localities: Port Vila, Pango, Saama, Bayhemu, Ranwas, Ratap, Bunlap, Wali.
 * Tonga (islands: Tongatapu, ʻEua). Localities: Nuku'alofa,'Ohonua, Lapaha.
 * Samoa (islands: Upolu, Savaiʻi, Manono). Localities: Apia, Lotofaga, Vaisala, Falealupo, Vaipua, Taga, Palauli, Gautavai, Satupaitea.

Мap of the route

The methods applied
In the process of moving along the route the following accommodation options were used:
 * In hostels — in South Korea, Taiwan, Singapore, Fiji, Tonga, Samoa.
 * At the cemetery — near Fangliao, Taiwan.
 * In Aboriginal dwellings — in Ranwas village and a detached hut between Beimu and Wali on Pentecost Island, Vanuatu.
 * On the coast of the ocean, in jungle thickets — in El Nido on Palawan and Badian on Cebu (Philippines); on Eua; in Vaisala village on Savaii (Samoa),
 * On objects under construction — in Vigan & Baguio (Philippines)
 * In low-cost accommodation — in the Philippines.
 * In abandoned buildings — in Port Vila (Vanuatu), on the island of ʻEua (Tonga).
 * In a one-and-a-half-metre security booth at the entrance to airport of of Puerto Princesa (Philippines).
 * On the floor of a railway terminal in Hualien City, Taiwan.
 * On the floor of seaport terminal, Savaiʻi Island (Samoa).
 * In the lounges of international airports: Nadi (Fiji) and Faleolo (Samoa).

Outcomes and results
— Collected visual historical and geographical information: — A number of articles have been prepared for the Russian Wikipedia illustrated by the author’s photographs, including on the little-known waterfalls of Oceania:
 * about the oldest mound in Polynesia, Pulemelei, discovered by archaeologists on the island of Savaiʻi in Samoa;
 * about the ancient burials on the island of Tongatapu (Tonga), called terraced tombs;
 * about the dolmens on Ganghwa Island (South Korea);
 * about hanging coffins and caves of mummies in the Philippines.
 * Афу-Аау
 * Сопоага
 * Фуипизия
 * Тогитогига
 * Папапапаи-Таи
 * Му-Пагоа
 * Папасееа-Слайдин-Рок
 * Меле

— Based on the materials of the trip written the book "Two months of wandering and 14 days behind bars".

Problems, difficult moments
An unforeseen circumstance — deportation by the Fiji authorities with a two-week sentence "under house arrest" — prevented the continuation of the route and completion of the intended.

Quotes
''"Good place for a overnight staying", — I thought, looking at one of the graves — a crypt with a high stone fence. It is interesting that the photos of the deceased and the dates of their lives are missing. Otherwise, the portrait of the deceased, on whose grave I spent the night, having materialized into an image, could appear in a dream.''

Passing the vegetable gardens stretched along the highway, after a few kilometers I noticed a comfortable wasteland and, like a partisan, disappeared into the bushes. «The main thing is not to rain at night», - thought, pulling out sleeping gear. The inhabitants of the small house were busy celebrating the coming New Year two hundred meters from my sleeping place but noisy cries reached me in a muffled state.

Different information
Moving in transit through Irkutsk (from where the solo expedition was taken), the traveler gave lectures in two libraries of the northern city.

Gallery
Illustrations from the book "Two months of wandering and 14 days behind bars"

authors: Виктор Пинчук


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User:Cjacks0937/sandbox

iiiiii

title: User:Cjacks0937/sandbox


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User talk:Cjacks0937/sandbox

a Cjacks0937 (discuss • contribs) 20:13, 5 September 2022 (UTC)

title: User talk:Cjacks0937/sandbox


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Exercise as it relates to Disease/Inflammation effects following exercise in chemotherapy patients

What is the background to this research?
Kleckner et al. 2019 study about exercise and inflammation during chemotherapy identifies possible chemotherapy-related toxicities, such as fatigue, believed to be a result of inflammation. The trial of 293 participants uses a control group and an exercise intervention group. The two groups are assessed before and after the 6-week trial to measure inflammatory cytokines and how they differ between the two groups.

Kleckner et al. as well as other studies are discovering that exercise is improving the quality of life of cancer patients both during and after treatment. Because of studies like these, medical professionals are able to make educated physical activity recommendations for populations receiving chemotherapy, so that existing and future chemotherapy patients can have an improved quality of life.

Improving quality of life is specifically important for those facing a possibly life-threatening disease. The physical and psychological effects of cancer and cancer treatments can lead to an increase in mental health disorders such as anxiety, social function and depression. An improved quality of life plays a big part in the prevention and treatment of these mental disorders.

Where is the research from?
This study is published in Supportive Care in Cancer, a reputable peer-reviewed journal that is published by Springer Science. The majority of this study's authors hold degrees from the University of Rochester Medical Center. Which is considered the 37th best medical school in medical research.

What kind of research was this?
This is a randomised clinical trial. Randomised clinical trials are considered to be one of the more reliable types of studies as bias is less likely to occur. Particularly selection bias due to randomisation.

What did the research involve?
Participants were randomly assorted into two groups at a 1:1 ratio. The two groups were to undertake either standard chemotherapy or standard chemotherapy and an exercise program for 6 weeks. The participants provided written informed consent and underwent the pre-intervention assessments, which included: questionnaires, daily diaries, wearing a pedometer and providing blood samples.

There were multiple requirements to be an eligible participant, which were as follows: 21 or older, primary diagnosis of cancer except for leukaemia, chemotherapy-naive, have a Karnofsky Performance Status of at least 70, radiation therapy-naive, able to perform low-to-moderate intensity exercise, and not been identified as in the active or maintenance stage of exercise behaviour.

Exercise Intervention Group

Participants randomly placed in the exercise intervention group were given a 6-week low-to-moderate intensity, at-home, walking and resistance training based program, that commenced on the first day of chemotherapy treatment. Per week, daily step requirements increased by 5-20%. Resistance-based exercises were performed as follows, 1-4 sets and 8-15 repetitions which increased over time.

Control Group

Participants randomly placed in the control group commenced chemotherapy treatment. They were also offered the exercise program after the study was complete.

The methodology used showed that safety was assured by making sure participants were able to perform everyday tasks as well as low-to-moderate intensity exercise. The exercise program is very realistic in its demands which will allow for fewer dropped-out participants in the exercise intervention group. Validity is also preserved by assuring participants are chemotherapy and radiation therapy-naive allowing for more reliable results. Ethically it is also a good approach. Participants in the control group are offered the exercise program after the study is complete so they are not denied the opportunity to become healthier and improve their quality of life.

Limitations

Although being chemotherapy and radiation therapy-naive is a requirement of this trial, that is not always a population easily acquired, especially in a short period. After cancer is diagnosed it is in the patient's best interest to start treatment early, with treatment starting usually only weeks after a diagnosis and no more than 2 months after. This gives the researchers approximately 60 days to recruit as many chemotherapy-naive cancer patients who are also willing to participate in a clinical trial. Another limitation is dropout rates. Due to the differing demands of the two groups, more participants dropped out of the exercise intervention group than the control group affecting the 1:1 ratio, however, results were not significantly affected.

What were the basic results?
Three hypotheses were tested.

Hypothesis 1

States, exercise during chemotherapy strengthens correlations between changes in concentrations of IL-6 and IL-10. Participants in the exercise intervention group displayed positive correlations between changes in IL-6 and IL-10, more so than seen in the control group.

Hypothesis 2

States, exercise during chemotherapy strengthens correlations between changes in concentrations of other cytokines. It was found that participants in the exercise intervention group showed stronger correlations in changes in cytokine and receptor concentration than those in the control group. The major correlation values were IL-10:IL-6, IL-10:IL-1β, and IL-10:sTNFR1.

Hypothesis 3

States exercise during chemotherapy produces a more favourable inflammatory state. It was found that for the exercise intervention group, all three of the pro-inflammatory markers decreased significantly, and all three of the anti-inflammatory markers increased significantly. Whereas, for the control group, it was found that only one pro-inflammatory marker decreased significantly and only two anti-inflammatory markers increased significantly.

Due to the results, the researchers are able to confidently say that their findings have shown that a 6-week exercise intervention of low-to-moderate intensity exercise correlates with changes in cytokine concentration during chemotherapy. And through this change in cytokine concentration of specifically IL-6 and IL-10, inflammation is positively regulated.

What conclusions can we take from this research?
Chemotherapy can cause short-term and chronic issues. But with consistent low-to-moderate intensity exercise some of these effects can be reduced due to the effects exercise has on anti- and pro-inflammatory responses.

Practical advice
This research not only shows that exercise is beneficial towards the inflammatory response of chemotherapy patients, but also what type of exercise is beneficial. This study used home-based, low-to-moderate intensity exercise of walking and resistance training. This is an achievable exercise program for chemotherapy patients as it can be done in the convenience of their own home, reducing costs, and reducing the risk of the patient getting sick, as chemotherapy suppresses the immune system due to a decline in white blood cells.

Further information/resources
van Vulpen et al. 2017 study is another looking at the effects of exercise on inflammatory responses in chemotherapy patients, specifically breast cancer. The study is similar to Kleckner et al. study, discussing the cytokine IL-6. It provides the audience with further evidence and a better understanding of the implications of exercise on inflammation and chemotherapy, but in a slightly more specific population.

For an audience seeking a simpler explanation, The American Cancer Society has a website clearly explaining how exercise is beneficial for cancer patients by improving quality of life and symptoms such as fatigue.


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Exercise as it relates to Disease/Impact of a long term exercise intervention on participants with type 2 diabetes

This is an analysis of the journal article Effect of regular exercise training on changes in HbA1c, BMI and VO2 max among patients with type 2 diabetes mellitus: an 8-year trial by Farzad Najafipour et al.

What is the background to this research?[edit | edit source]
Type 2 diabetes is a chronic disease that occurs when blood glucose levels are chronically too high. In the past 30 years, the incidence of type 2 diabetes has increased in countries all around the world, regardless of income level. Data from 2012 shows that 31.1 percent of the global population is physically inactive, and that inactivity levels rise as age increases. Obesity and inactivity are linked to insulin resistance, and so an exercise intervention was chosen to examine the effects of a long term program on the health of diabetes patients. This paper aims to asses how biological indicators of Hba1c, BMI and Vo2 max in patients presenting with type 2 diabetes respond to an eight year aerobic exercise trial. Though there are many studies showing the positive effects of an exercise intervention, most only track patients from 12 weeks up to 1 year, and thus the long term effects of sustained exercise is unclear. This study fills the gap in the research and follows patients on an eight year exercise journey.

Where is the research from?[edit | edit source]
Location

The Study was conducted in Iran, with the participants being chosen from from 'Endocrine and Metabolic Clinics, Tabriz University of Medical Sciences, Iran'.

Journal + Authors

The study was published in the BMJ Open Diabetes Research & Care which is an open access journal which publishes content related to diabetes mellitus type 1 and 2 and treatment.

Farzad Najafipour, Majid Mobasseri, Abbas Yavari and Akbar Aliasgarzadeh were the four contributors conducting the research over the eight year trial. They all work for the Tabriz University of Medical Sciences, and have an extensive track record within diabetes research with many papers published, including but not limited to:

- Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis (cited by 228 papers)

- Insulin controls inflammation and metabolic endotoxemia in women with type 2 diabetes mellitus: a randomized-controlled clinical trial (cited by 168 papers)

What kind of research was this?[edit | edit source]
Researchers for this study conducted a quasi-experimental trial with pre-test post-test design.

What did the research involve?[edit | edit source]
The participants in the experimental group undertook three aerobic training sessions per week, lasting approximately 60 - 80 minutes at 50 - 80% of Vo2 max. The training largely consisted of treadmill, elliptical or bicycle ergometers for 40 - 50 minutes, with time either side for warm up and cool down. Vo2 max was assessed before and after trial using a submaximal one mile track walk. This will not give a completely reliable vo2 max score, however given that the mean age of the participants was over 57 years old and therefore having greater risk factors ascosiated with vigorous exercise, a submax test is a good approach.

Although this study was unique in its approach to evaluate patients over a long time period (>8 years), it failed to take into account any physical activity undertaken by patients in their own time, separate from the study. This includes; structured training sessions, commutes to work (walking/riding vs vehicle) and occupation. An experimental study by Balducci S et al , took into account activity/conditioning undertaken by participants outside of structured exercise required, with results showing that cardiovascular risk factors were significantly lowered in participants that did more conditioning as well as structured exercise.

The study did make the criteria for inclusion having a 'previous sedentary lifestyle', but was not specific on what qualified as sedentary. For example, total sitting time/ expending 1-1.5 met/s or not meeting total physical activity guidelines of 150minutes of moderate physical activity per week . This distinction matters for the participants in the control group, who were instructed to maintain their current lifestyle.

What were the basic results?[edit | edit source]
After the eight year trial, all three indicators - Hba1c, BMI and Vo2 max were all greatly improved in the experimental group. Hba1c markers showed a continual decrease in each follow up, with the experimental group's levels decreasing from 8.33% to 6.49% (diff of 1.84%).

The Vo2 max levels showed a post trial difference of 31.92 to 19.49 (+12.43) between the experimental and control groups respectively. This seems to be a big difference, however the pre vo2 max levels from either group were not shown, possibly indicating that the participants in the experimental group were already fitter than those in the control group. For this reason, Vo2 max findings may be over-emphasised.

What conclusions can we take from this research?[edit | edit source]
The results from this eight year trial show that type 2 diabetes mellitus does not have to be a progressive disease that requires increasing amounts of medication to control. The mean age of the participants was 57.2 at the start of the trial. After eight years many of those patients would be at or approaching retirement age, where people in general start to become more sedentary and have increased risk for cardiovascular diseases that can cause stroke, heart attack etc. Exercising at a minimum for 3 times per week or >150m/w can decrease risk factors for diabetes in older adults and improve overall cardiovascular fitness (Vo2max), essentially reversing markers of type 2 diabetes at any age.

The reduction in Hba1c levels in response to physical activity is consistent throughout the available research. One example includes

- Associations between physical fitness and HbA1c in type 2 diabetes mellitus, by J Larose et al ,

In regards to BMI, findings from other research are more contentious, with Krousel-Wood M et al showing a decrease in BMI and Boulé NG et al, showing no statistically significant difference post study. These varied findings are largely a result in the length of the studies undertaken, with short term studies (<1year) not long enough to produce meaningful weight loss.

The eight year trial being analysed focused solely on aerobic training. A trial by Sigal RJ et al showed that combined aerobic and resistance exercise is more effective at reducing Hba1c levels than either aerobic or resistance training alone.

Practical advice[edit | edit source]
Physical Activity Recommendations

This study aligns with specific recommendations from the 'World Health Organisations' stance on physical activity. This includes:

- 150 - 300 minutes of moderate-intensity aerobic physical activity

- Reducing the amount of time being sedentary (1-1.5 met's)

- 75–150 minutes of vigorous-intensity aerobic physical activity

Further information/resources[edit | edit source]
- World Health organisation - provides a basic overview of diabetes, its causes symptoms and treatments - https://www.who.int/health-topics/diabetes#tab=tab_3

- Epidemiology of Type 2 Diabetes – Global Burden of Disease and Forecasted Trends - this paper assesses the prevalence of type 2 diabetes globally and the burden it places on society - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310804/


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Exercise as it relates to Disease/The effect of resistance training on cardiovascular function in patients with Peripheral Artery Disease

A critical appraisal of the research article 'Effects of Resistance Training on Cardiovascular Function in Patients With Peripheral Artery Disease: A Randomized Controlled Trial' by Gomes et al., 2018 and published in The Journal of Strength and Conditioning Research.

What is the background to this research?
Peripheral artery disease (PAD) is characterised as decreased arterial perfusion mainly affecting the body's lower extremities. The disease affects over 200 million people worldwide and is most prevalent in older adults, with its occurrence being 20% of people aged 70 years and above. Patients with PAD may suffer from pain in the thighs and calves which can negate their walking capacity, therefore resistance training (RT) may be an effective intervention to both improve a patient's gait as well as quality of life outcomes. Patients with PAD have increased risk of stroke, myocardial infarction and many other cardiovascular related diseases and morbidity. Therefore the main aim of this artcle was to investigate whether RT can reduce cardiovascular risk factors, particularly resting and ambulatory (24-hour) blood pressure.

Previous research on the effect of RT on blood pressure in patients with PAD has been conflicting. One study found a decrease in resting blood pressure following a 24-week intervention, whilst others have found no significant difference. This article being appraised builds on previous knowledge by assessing both resting BP and ambulatory BP, whereas all previous studies have only looked at clinical BP. Ambulatory BP measurements have been shown to be a more compelling predictor of all-cause and cardiovascular mortality than clinical measurements. Furthermore, The variation in BP that is obtained from ambulatory measurements is an independent risk factor of cardiovascular related events and death.

Where is the research from?
The article being appraised is published in the Journal of Strength and Conditioning Research (JSCR). This journal is monthly peer-reviewed and releases articles of all kinds related to physical activity, performance, health and diseased populations.

All authors on the article are associated with various University's across Brazil. The lead author, Ana Gomes, is a part of the Associated Graduate Program in Physical Education UPE/UFPB at the University of Pernambuco in Recife-PE, Brazil. This author has a particular interest in peripheral artery disease, although is only involved in one other publication in 2015, potentially impacting the credibility of the current article due to lack of experience.

The study was supported through grants from Brazilian Federal Government organisations including The Brazilian National Council for Scientific and Technological Development. It has been declared there are no conflicts of interest and the results of the study would not financially endorse the authors in any way.

What kind of research was this?
The article being appraised was conducted as a randomised controlled trial. This involved the subjects being assigned randomly using randomizer.org to either an experiment group or a control group. randomised controlled trials are the most precise way of investigating a cause-effect relationship between the treatment and the outcome.

These are more effective than non-randomised trials as they produce the least possible bias and can be assured that the outcome did not come from any factors outside the treatment intervention.

What did the research involve?
Participants with peripheral artery disease between the ages of 40 and 80 were recruited to participate. The study went for 12 weeks and clinical and ambulatory cardiovascular measurements were taken before and after. A strength of the procedure was taking BP measurements at the same of day, which was done to avoid the influence of circadian variation. Participants were also told to withhold from alcohol, caffiene and smoking at least 24 hours before measurements were taken, although there was no indication of testing for this and therfore BP may have been affected if the subjects didn't comply.

Participants were randomly assigned to one of two groups:

Resistance training group:

 * Approximately 40 minute sessions
 * 2 sessions per week
 * 3 sets of 10 repetitions per exercise with 2 minute rest intervals
 * All exercises were performed at moderate intensity of 5-7/10 rate of perceived exertion on the OMNI scale

Control group:

 * Approximately 40 minute sessions
 * Whole body stretching and relaxation exercises
 * Used to equalise attention with the experiment group and retain subjects throughout

table 1: exercises performed in RT and control groups

9 out of the original 30 participants dropped out of the study, leaving only 11 subjects in the RT group and 10 subjects in the control group completing the study. This sample size was far too small which may be a contributing factor to the limited results.

What were the basic results?
Main findings:

 * Resistance training resulted in a decrease in diastolic BP variability across 24 hours (table 2)
 * No significant change in resting BP and cardiovascular parameters between groups
 * No significant change in 24-hour BP between groups

table 2: Diastolic BP variability in the RT group

Blood pressure variability was the only parameter be reduced by resistance training. Resting and 24-hour blood pressure levels showed no statistical difference between groups.

What conclusions can we take from this research?
It is evident through this appraised article that a resistance training intervention can have a positive effect on cardiovascular parameters through the reduction in blood pressure variability across 24 hours. As previously mentioned, patients with PAD have an increased risk of stroke, myocardial infarction and other cardiovascular complications, and therefore making it important to reduce risk factors such as high blood pressure levels and variability.

In a similar article, it was found that after a 12-week resistance training intervention, resting blood pressure was reduced in patients with intermittent claudication. However, subjects in this trial were exercising at 11-13 on 15 grade Borg scale. As participants were only training at moderate intensity (5-7 OMNI scale) in the appraised article, it may not have been intense enough to elicit resting blood pressure adaptations.

Further research should also look into the utilisation of other forms of exercise such as aerobic training to supplement resistance training.

Practical advice

 * The findings of RT being linked to decreased blood pressure variability propose that it can be used as an effective treatment option in reducing risk factors for cardiovascular related complications.

 * Regular physical activity of any kind is extremely important as is has been associated with lower blood pressure, reduced risk of stroke and other cardiovascular complications.
 * People suffering from PAD should always seek professional guidance when exercising to ensure safety, especially when it comes to resistance training and the potential risks associated with it.

Further information/resources
Peripheral artery disease information

 * Centers for Disease Control and Prevention
 * Heart Foundation

Further research

 * Combined Aerobic and Resistance Exercise in Walking Performance of Patients With Intermittent Claudication: Systematic Review
 * Exercise Training and Peripheral Arterial Disease


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User talk:Wikieducators

First of all, what is computer literacy? Computer literacy refer to the ability of having the knowledge of using a computer and technical devices. Others state that it is the ability to use applications rather than to program. Wikipedia define the term as the ability and knowledge to use computers and related technology efficiently, with skill levels ranging from elementary use to computer programming and advanced problem solving.

The importance of computer literacy
First of all, what is computer literacy? Computer literacy refer to the ability of having the knowledge of using a computer and technical devices. Others state that it is the ability to use applications rather than to program. Wikipedia define the term as the ability and knowledge to use computers and related technology efficiently, with skill levels ranging from elementary use to computer programming and advanced problem solving.

Furthermore, meaning being computer literate is not just about one knowing how to press the computer but its about having the knowledge to deal with computers. Computer literacy enable people to work efficiently without wasting waste and they also increase productivity. Say for instance drawing has to be done for 10 companies so instead of using a pencil and a paper to draw one can use the computer to draw which will in turn not consume a lot of time. In simple terms being literate when it come to computers it is very productive and fast. Some common computer skills are Microsoft media, email communication, social media and graphic design. Wikieducators (discuss • contribs) 07:21, 6 September 2022 (UTC)

This is very useful Esther Ndjavera (discuss • contribs) 06:12, 27 September 2022 (UTC)

It is something which we all need to have especially in this 21st century we live in. Wikieducators (discuss • contribs) 06:18, 27 September 2022 (UTC)

By knowing the importance of computer a person will be able to be access to technology Wikieducators (discuss • contribs) 06:19, 27 September 2022 (UTC)

more inform; IUM

Very useful Wikieducators (discuss • contribs) 21:46, 3 October 2022 (UTC)

title: User talk:Wikieducators


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User talk:Mspenina

Technology nowadays is not a safe place for little ones, so children must be inspected by an adult while using the internet. Its a free page where anyone can put on what they want and even so if there are age restrictions the young ones do not consider that they feel that it is their phones and no one can decide for them. We must all consider and analyse and study what we put on the internet having in mind all age groups in our minds and how the information uploaded will affect them.

title: User talk:Mspenina


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Exercise as it relates to Disease/Relationship between physical activity and coronary heart disease in women

This Wikibook is an evidence-based analysis and critique of the research article:"Physical Activity and Coronary Heart Disease in Women" Lee I, Rexrode KM, Cook NR, Manson JE, Buring JE. 2001;285(11):1447–1454. doi:10.1001/jama.285.11.1447

What is the background to this research?
Coronary heart disease (CHD) is considered to be a type of heart disease which can be characterised by the narrowing of an individual’s arteries specifically the coronary arteries causing inability for the arteries to supply enough oxygen rich blood to the heart. Arteries which have become extremely narrow can lead to chest pain and shortness of breath during Physical activity (PA). If a coronary artery is completely blocked, it can result to a myocardial infarction (heart attack). CHD cause the highest amount of death in American women with statistics indicating an estimate of 18.2 million (7.2%) American adults living with CHD according to the Centres for Disease Control and Prevention (CDC). A survey conducted by National Health and Nutrition Examination Survey (NHANES) in 2020 concluded that 6.2% of women aged 20 and above have CHD, with even more recent data concluding modifiable risk factors for CHD including obesity, hypertension, diabetes, and sedentary behaviour are on a rapid incline.

The research paper to be critiqued by Dr Lee at el., studies the relationship between PA particularly walking (at light-moderate intensity based on pace), and CHD in women including those at high risk for developing CHD. The importance of studying this relationship between PA and CHD allows us to further understand the how beneficial PA is and the optimal type of PA (that yields the greatest benefits to lowering risks associated with CHD in women).

Where is the research from?
This publication was written by a team of 5 doctors all being in the Division of Preventive Medicine. Dr’s Lee, Manson and Burning specifically having done their PhD’s in the Department of Medicine Relating to women’s health. All authors have published numerous studies relating to women’s health and Cardiovascular disease with the authors having publish more the 80 research articles combined. All authors are well respected and highly reputable in terms of their educational backgrounds and as well as their fields of research relating to PA and its implications on health.

This research was conducted in the United States. American and Puerto Rican women were the subjects of the study however its implications are still relevant to women worldwide. This study was then published by Journal of the American Medical Association (JAMA) which is the most widely circulated medical journals in the world. JAMA has been ranked as one of the top leading journals in the discipline of medicine.

What kind of research was this?
This research was conducted in the form of a cohort (longitudinal) study due to all participants being followed over a period of 7 years. Subjects were selected from a Women's Health Study, which was a randomised double-blind, placebo-controlled trial where administration of low-dosage aspirin and vitamin E for primary prevention of cardiovascular disease, which Dr’s Lee, Cook and Burning took part in the research as well.

What did the research involve?
The research had a total of 39,372 participants who were healthy female health professionals aged 45 and over. These women were free of CHD. Participants were sent detailed questionnaires to complete that analysed their sociodemographic characteristics, health habits, and medical history. Follow up questionnaires were sent every 6 months participants to indicate their health behaviours as well as recent medical history. Baseline and follow up questionnaires asked women to estimate average time spent on exercise, pace of walking was also asked. Participants could choose from: no regular walks, walking 3.2 km/h (easy), 3.2-4.7 km/h (normal) and 4.8-6.3 km/h (brisk) and the number of flights of stairs climbed daily between 0 to ≥15. In a recent study results showed that the validity of a Self-Administered PA Questionnaire is reliable and valid as a measure of PA assessment.

Variables that could possibly influence the relationship between PA and CHD risk was accessed in the given questionnaires. Variables included age, weight, height, cigarette smoking status, diet (including alcohol consumption), history of hypertension, elevated cholesterol level, diabetes history, and family history of CHD.

What were the basic results?
Women that walked an average of 1 hour per week or and whose usual walking pace was at about 4.8 km/h had about a 50% decreased risk of developing CHD compared to women who did not walk regularly. Based on the questionnaire data women that engaged in high levels PA where less likely to engage in behaviour that increased CHD risk. Moreover, energy that’s expended during vigorous PA least 6 METs was examined. The results showed that when the highest and lowest categories of women were compared, there was a lower risk of CHD among the most active women that was of borderline significance (RR, 0.63; 95% CI, 0.38-1.04).

The study also examined whether there were any differences in the relationship between physical activity and CHD risk in women without and with CHD risk factors. There were no findings which led there to be an inverse association between women of normal weight and overweight women (P for interaction = .95). Also, there was no evidence regarding the inverse relationship differing between women without and with elevated cholesterol level (P for interaction = .71).

What conclusions can we take from this research?
Coronary heart disease leading cause of death for women world worldwide hence why it is important to study the relationship between PA and CHD. The data from the study was highly valuable and indicated the great benefits that PA has in lowering coronary heart disease in women. Results indicated that light to moderate activity predicted to lower risk. These finding are also congruent with a meta-analysis by Berlin et at., which concluded physically active individuals reduced risk of CHD by 50% compared those who were sedentary. Although the study being critiqued was conducted in the late 90s and early 2000s the results are still relevant. More research needs to be done as the optimal type, intensity and the duration of PA associated with lowering risk isn’t clear therefore, more research on the topic is crucial.

Practical advice
With the study been conducted in the late 90’s and early 2000’s and its findings still being relevant and give an important insight that demonstrates the positive effect that PA on CHD in women.

Women 45 or older including those at high risk of developing CHD can decrease their risk by:

 * Engaging in light to moderate PA up to 1 hour per week regardless of pace which the study has shown to lower risk compared to those who don’t participate in any form of PA. Moreover, the study showed encouraging results as vigorous activities were not necessary for lower CHD rates.

 * It is important that when exercising to increase intensity and minutes of exercise in the week overtime as this lowers risk of CHD more significantly and up to 2 times when comparing those who aren’t active

Further information/resources
Further information regarding the relationship between Coronary heart disease and physical activity have been listed below:

[https://jamanetwork.com/journals/jama/fullarticle/195439#:~:text=Multiple%20epidemiologic%20studies%20have%20shown,those%20performing%20high%2Dintensity%20exercise.&text=However%2C%20the%20optimal%20level%20of%20exercise%20for%20preventing%20CHD%20is%20unclear. https://jamanetwork.com/journals/jama/fullarticle/195439#:~:text=Multiple%20epidemiologic%20studies%20have%20shown,those%20performing%20high%2Dintensity%20exercise.&text=However%2C%20the%20optimal%20level%20of%20exercise%20for%20preventing%20CHD%20is%20unclear .]

https://academic.oup.com/aje/article-abstract/132/4/612/102184?login=false

https://www.ahajournals.org/doi/full/10.1161/JAHA.117.007725


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Minecraft/Sandstone

Can be used as decoration.

title: Minecraft/Sandstone


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Minecraft/Red Sandstone

Can be used as decoration.

title: Minecraft/Red Sandstone


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User talk:JustinReyes1

Welcome
Welcome to Wikibooks, JustinReyes1!

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(Would you like to provide feedback on this message?) Thanks for your contributions! L10nM4st3r / Roar at me 13:39, 6 September 2022 (UTC)

title: User talk:JustinReyes1


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Adventist Youth Honors Answer Book/Nature/Katydids

= 1. What does a katydid look like? = Katydids are insects with a manible and also green color. Their legs are longer on males,     with jumping and all are blending.

Female katydids are much larger, and have a scrutuce  of their little stable stinger. They are used for laying more eggs than the males do,  and this often works.


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Fundamental Actuarial Mathematics/Mortality Models

Learning objectives
The Candidate will understand key concepts concerning parametric and non-parametric mortality models for individual lives.

Learning outcomes
The Candidate will be able to:
 * 1) Understand parametric survival models, life tables, and the relationships between them.
 * 2) Given a parametric survival model, calculate survival and mortality probabilities, the force of mortality function, and curtate and complete moments of the future lifetime random variable.
 * 3) Identify and apply standard actuarial notation for future lifetime distributions and moments, including select and ultimate functions.
 * 4) Given a life table, calculate survival and mortality probabilities, the force of mortality function, and curtate and complete moments of the future lifetime random variable, using appropriate fractional age assumptions where necessary.
 * 5) Understand and apply select life tables.
 * 6) Identify common features of population mortality curves.

Survival distributions
In the model discussed in this chapter, it describes the length of survival (or time until death) of an individual. Thus, the will be the basic building block.

Age-at-death random variable
In this section, we will discuss a special case for the time-until-death random variable, in which the time until death is applicable to newborn (i.e. people aged zero). We denote this kind of random variable by $$T_0$$. We can observe that $$T_0$$ also represents the age at death, since the age is counted starting from the beginning of life.

Since time-until-death random variable is describing time, it is a continuous random variable. Also, time is nonnegative, so the support (or "domain") of time-until-death random variable is $$[0,\infty)$$.

To describe the time until death for newborn, we need to determine the distribution of $$T_0$$ completely. There are several ways to do this. You should have learnt about cdf and pdf when learning about probability, but may not have learnt about survival function and force of mortality. Thus, we will discuss them here.
 * cumulative distribution function (cdf): $$F_0(t)=\mathbb P(T_0\le t)$$
 * probability density function (pdf): $$f_0(t)=F'_0(t)$$ if $$F_0(t)$$ is differentiable.

Survival function
As suggested by the name " function", we may guess that this function is somewhat related to survival. This is actually true. Take the time-until-death random variable $$T_0$$ as an example, when the newborn survives for, say, $$t$$ units of time, what is its probability? It is $$\mathbb P(T_0>t)$$ (or $$\mathbb P(T_0\ge t)$$, but since $$T_0$$ is continuous, it does not matter). This probability corresponding to the input $$t$$ is actually the survival function, which is defined below:

Force of mortality
In financial mathematics, you should have learnt about, which can be interpreted as the , and it is given by $$\frac{A'(t)}{A(t)}$$ in which the notation has its usual meaning in financial mathematics. Why do we call it force of ? This is because the interest refers to an increase (or positive change) in the amount.

We may guess that the force of is defined similarly, in the sense that it can also be interpreted as the relative rate of change of something. We know that the interest refers to change in amount, but what change does mortality refer to? Since mortality means the state of being susceptible to death, it refers to the (or negative change) in survival rate, and the "higher" the mortality, the larger decrease in survival rate. Recall that the is related to survival rate (probability of surviving for a certain time) in some sense. So, we can make use of survival function to define mortality.

However, there is a difference between force of and force of, namely for force of interest, interest refers to an  in amount, while for force of mortality, mortality refers to a  in survival rate. So the changes are in opposite direction, and thus if we define force of mortality in an exact analogous manner, its value will be negative (the relative rate of change will be negative). To make the force of mortality positive, we can define the as follows:

After that, we will introduce some propositions related to the and.

Future lifetime of a life aged $x$
Now, we our discussion from future lifetime of a life aged zero (a newborn) to a life aged $$x$$ ($$x\ge 0$$). For simplicity of presentation, we denote a life aged $$x$$ by $$(x)$$.

Similarly, we denote the future lifetime of $$(x)$$ by $$T_x$$ (recall that we denote the future lifetime of $$(0)$$ (newborn) by $$T_0$$). We the distribution of $$T_x$$ mathematically (and quite naturally) as the  of $$T_0-x$$,  $$T_0>x$$.

To understand this, consider the following reasoning: Refer to the following timeline: death x      T_x   | - 0        x                 t      T_0 We can observe that $$T_x=T_0-x$$ if $$T_0>x$$ (or $$T_0\ge x$$, but since $$T_0$$ is continuous, it does not matter). So, if $$T_0>x$$, then $$T_x=T_0-x$$.
 * -|---v

On the other hand, if $$T_0x$$.
 * ---v-|

From this definition, we have $$\mathbb P(T_x\le t)=\mathbb P(T_0-x\le t|T_0>x)$$, $$\mathbb P(T_x>t)=\mathbb P(T_0-x>t|T_0>x)$$, etc.. This is quite important since it is the basis for the calculations of probabilities related to $$T_x$$.

For the pdf, cdf and survival function of $$T_x$$, we have similar notations as follows:
 * $$f_x(t)$$: pdf of $$T_x$$
 * $$F_x(t)$$: cdf of $$T_x$$
 * $$S_x(t)$$: survival function of $$T_x$$

In particular, we have some special actuarial notations for the cdf and survival function, as follows: In actuarial notations, "$$q$$" often refers to something related to, while "$$p$$" often refers to something related to. In this context, this holds since $$_tq_x$$ refers to the probability for $$(x)$$ to within $$t$$ time units, and $$_tp_x$$ refers to the probability for $$(x)$$ to  for $$t$$ time units.
 * $$_tq_x=F_x(t)=\mathbb P(T_x\le t)$$
 * $$_tp_x=S_x(t)=\mathbb P(T_x>t)=1-{}_tq_x$$

For simplicity, if $$t=1$$, we write $$_1q_x$$ as $$q_x$$ and $$_1p_x$$ as $$p_x$$.

Using the relationship between $$T_x$$ and $$T_0$$, we can develop some useful formulas for $$_tp_x$$ and $$_tq_x$$, as follows:

We can also express the pdf of $$T_x$$ as follows:

We have a special notation for the probability for $$(x)$$ to ages $$x+t$$ and $$x+t+u$$ ($$x,t,u\ge 0$$), namely $$_{t|u}q_x$$ (we use "$$q$$" here since this is related to death). Thus, we have by definition $$_{t|u}q_x=\mathbb P(t<T_x<t+u))$$. We have the following proposition for another formula of $$_{t|u}q_x$$.

Curtate-future-lifetime of a life aged $x$
The is just like the future lifetime in previous sections, except that it is.

Similarly, we would like to completely determine the distribution of $$K_x$$, as in the case for $$T_x$$. We can do this using cdf or probability mass function (pmf). Its pmf is given by the following proposition.

Life tables
In a life table, the values of $$q_x$$ and other functions for different (integer) ages $$x$$ are tabulated. The values are assumed to be based on the survival distribution discussed in previous sections. In this section, we will discuss more functions appearing in a life table.

In previous sections, we have discussed time-until-death random variable for one person, and we will consider multiple people here. Suppose there are $$\ell_0$$ newborns. Let the indicator function $$\mathbf 1_j(x)=\begin{cases}1,&\text{if life }j\text{ survives to age }x;\\ 0,&\text{otherwise}. \end{cases}$$ Also let $$\mathcal L(x)$$ be the sum of all such indicator functions $$\mathbf 1_j(x)$$, i.e. $$\mathcal L(x)=\sum_{j=1}^{\ell_0}\mathbf 1_j(x)$$. We can interpret $$\mathcal L(x)$$ as the number of survivors to age $$x$$ for the $$\ell_0$$ newborns.

We denote the of $$\mathcal L(x)$$ by $$\ell_x$$.

As a corollary, $$\ell'_x=(\ell_0S_0(x))'=\ell_0S'_0(x)$$ ($$\ell_0$$ is constant with respect to $$x$$). Also, $$\frac{-\ell'_x}{\ell_x}=\frac{-\ell_0S'_0(x)}{\ell_0S_0(x)}=\frac{-S'_0(x)}{S_0(x)}=\mu_x$$. Also, we can use $$\ell_x$$ to calculate probabilities like $$_t p_x$$ and $$_t q_x$$, as follows: $$_t p_x=\frac{S_0(x+t)}{S_0(x)}=\frac{\ell_0S_0(x+t)}{\ell_0S_0(x)}=\frac{\ell_{x+t}}{\ell_x}$$, and thus $$_t q_x=1-{}_t p_x=1-\frac{\ell_{x+t}}{\ell_x}$$. In a later section in which selection age is involved in the life table (select table), we will use these formulas to calculate these probabilities from such life table, to incorporate the effect of selection.

We have discussed about the number of to age $$x$$, and we will discuss the "opposite thing" in the following, namely the number of  to age $$x$$ (i.e. between age 0 and $$x$$), or in general, between age $$x$$ and $$x+n$$.

We denote the of such number of deaths by $$_n d_x$$.

Apart from the life table functions $$\ell_x$$ and $$_n d_x$$ which are related to the expectation of of survivors and deaths respectively, we will also discuss two more life table functions, that is related to the expectation of.

There are two types of expectation of life: one is discrete and another is continuous, and they are called curtate-expectation-of-life and complete-expectation-of-life respectively.

The following are recursion relations for $$\overset{\circ}{e}_x$$ and $$e_x$$, which can be useful when we want to find the complete/curtate-expectation-of-life of $$(x)$$ given the expectation of a life with some other ages, say $$x+1$$ and $$x+2$$.

We will state the recursion relations as a form of proposition, and then prove them formally. After the proof, we will try to give some intuitive explanations about the recursion relation for $$e_x$$.

An intuitive explanation of this recursion relation is as follows:
 * for LHS, $$e_x$$ is the curtate-expectation-of-life of $$(x)$$;
 * for RHS, $$e_{x+1}$$ is the curtate-expectation-of-life of $$(x+1)$$, and we want to "transform" it to the expectation of $$(x)$$. The first step is adding 1 to it, since this is the expectation with respect to $$(x+1)$$, but we want the expectation from the perspective of $$(x)$$, which is 1 year younger. But only this step is not enough, since "$$e_{x+1}$$" assumes the life already lives for $$x+1$$ years, but for $$e_x$$, the life is only assumed to live for $$x$$ years. Hence, we also need to multiply the probability for $$(x)$$ to live for one year, $$p_x$$, to "get to" $$e_{x+1}$$.
 * Now, "the expectation of life from age $$x+1$$ onward" is done through $$e_{x+1}$$. How about "the expectation of life from age $$x$$ to age $$x+1$$"? Indeed, when the life dies within age $$x$$ and $$x+1$$, $$K=0$$. This means such "expectation of life" is zero.

Assumptions for fractional ages
Previously, we have discussed the continuous random variable $$T_x$$ and discrete random variable $$K_x$$. A life table can specify the distribution of $$K_x$$ since the values of $$q_x$$ for different integer $$x$$ can be obtained from the life table. However, the life table is not enough to specify the distribution of $$T_x$$, since we do not know the value of $$q_x$$ when $$x$$ is not an integer. Thus, in order to specify a distribution of $$T_x$$ using a life table, we need to make some assumptions about the fractional (non-integer) ages.

In actuarial science, three assumptions are widely used, namely (UDD) (or linear interpolation),  (or exponential interpolation), and  (or Balducci) assumption (or harmonic interpolation). We will define them each using survival functions, as follows:

Under UDD assumption, we have some "nice" and simple expressions for various probabilities related to mortality. We can obtain those expressions by substituting $$S_0(x+t)$$ by the RHS of the equation mentioned in the assumption.

For the three assumption mentioned, there is a particularly "nice" and simple result for each of them, and we may use those "nice" results for the calculation in practice, rather than applying the definitions. The "nice" result for UDD assumption is mentioned in a previous example: when $$0\le t\le 1$$, $${}_tq_x=t(q_x)$$. The "nice" results for the other two assumptions are as follows:

An interesting result under the UDD assumption is related to the independence of two random variables.

To simplify the notations, from now on, we let $$T=T_x$$ and $$K=K_x$$ unless otherwise specified.

Define a continuous random variable $$S$$ by $$T=K+S,\quad S\in (0,1)$$. That is, $$S$$ is the random variable representing the lived in the year of death of $$(x)$$. For example, if $$S=0.5$$, then $$(x)$$ lives for half year in the year of death.

Then, $$K$$ and $$S$$ are independent under UDD assumption. This is because $$\mathbb P(K=k\text{ and }S\le s)=\mathbb P(k\le T\le k+s)={}_{k}p_{x}{}_{s} q_{x+k}={}_kp_x\cdot s\cdot q_{x+k}=(_{k|}q_x)\cdot s=\mathbb P(K=k)\mathbb P(S\le s)$$ under UDD assumption. Also, we can observe that the cdf of $$S$$ is $$\mathbb P(S\le s)=s=\frac{s-0}{1-0}$$, which is the cdf of uniform distribution with support $$(0,1)$$. This means $$S$$ follows the uniform distribution on $$(0,1)$$ under UDD assumption. Hence, $$\mathbb E[S]=\frac{1}{2}$$ and $$\operatorname{Var}(S)=\frac{1}{12}$$. This gives rise to results under UDD assumptions: These two results give us an alternative way to calculate the mean and variance of $$T$$ where only things are used in the calculation. However, we should be careful that these results hold, so we cannot use these results without UDD assumption.
 * $$\overset{\circ}{e}_x=\mathbb E[T]=\mathbb E[K+S]=\mathbb E[K]+\mathbb E[S]=e_x+\frac{1}{2}$$.
 * $$\operatorname{Var}(T)=\operatorname{Var}(T)\overset{\text{ independence }}{=}\operatorname{Var}(K)+\operatorname{Var}(S)=\left(\sum_{k=1}^{\infty}(2k-1){}_k p_x\right)-(e_x)^2+\frac{1}{12}$$.

Laws of mortality
In this section, we will introduce some simple laws of mortality (i.e. some specified distributions for mortality). Some of these laws may be appropriate to model the human mortality for ages, but it is commonly believed that none of these laws is appropriate to model the human mortality for ages.

Indeed, if we want to model the human mortality using some probability distribution, we may need a of distributions, since the mortality should be distributed in a different manner when human is in different ages, and thus different distributions should be used in different ages. To choose a suitable distribution for some ages, we may investigate the shape of corresponding empirical distribution based on the actual human mortality data, and pick a suitable distribution accordingly. For example, if the mortality increases exponentially for some ages, then we may select a distribution for which the force of mortality also increases exponentially.

In practice, to calculate the probabilities related to human mortality, we usually use life tables for the calculations. This is usually the case for insurance companies. Each insurance company has its own life table, based on the mortality data of, possibly its clients. Since such life table is constructed using the human mortality data based on past experiences, the life table is usually deemed to be more accurate than a specific distribution.

Nevertheless, having a law for mortality allows us to simplify the calculation of the probabilities related to mortality.

Select and ultimate table
When a person purchases a life insurance policy offered by an insurance company, he needs to give some personal information to the insurance company, e.g. some information about his health status. For the insurance company to decide whether it should sell the policy to the person, those information provided by that person is accessed through the process of. For underwriting, the check the information to see whether the risk in insuring that person is appropriate.

Without underwriting, it is likely that people will only purchase life insurance policy when they think they will die soon (e.g. they have a very serious disease), so that they will likely have early claims. In this case, the insurance company may need to pay a large amount of money and suffer a great loss in a short time, and then bankrupt. This shows the necessity of underwriting.

Basically, the "select" in the section title arises from the underwriting process, and when we say an individual is "selected" at age $$x$$, he is underwritten at age $$x$$ (so the most recent information about the individual is known). Since there are some new information about the individual when he is underwritten (or selected), we will expect there is some update in his survival distribution, and therefore his probabilities related to mortality will change as well. Because of this, we need to have some changes in the actuarial notations, depending on the selection age.

In such actuarial notations, we usually add square brackets around the age at selection, and the numbers in the subscript change accordingly. For example, $$q_{25}$$ becomes $$q_{[25]}$$ if the selection age is 25, $$q_{[12]+13}$$ if the selection age is 12.

Since when a person is underwritten long time ago, he may have poorer health condition (e.g. getting older having some new diseases) from the time at which he is underwritten to now, we will intuitively expect that the longer time passed from the time at which a person aged $$x$$ is underwritten, the more likely that person will be die in the coming year. That is, $$q_{[0]+x}>q_{[1]+x}>\dotsb>q_{[x-1]+1}>q_{[x]}$$.

The impact on the survival distribution from the selection age may decrease when the time passed from the selection is longer. Beyond a certain time period, say $$r$$ years, the "$$q$$"'s at the same attained age (i.e. selection age plus the time passed from it to now) but different selection ages will be very close. In other words, $$q_{[x-j]+r+j}\approx q_{[x]+r},\quad 0\le j\le x$$ (the condition on $$j$$ is to ensure that the selection age at LHS $$x-j\ge 0$$). Such $$r$$ years is called the. Because the "$$q$$"'s mentioned above will be very close, all such "$$q$$"'s will only be written as $$q_{x+r}$$, without any square brackets (since the effect of selection is basically "gone", and so the square brackets are gone). For example, if the selection period is 2 years, then $$q_{[10]+2}$$ and $$q_{[5]+7}$$ will be both written as $$q_{12}$$ simply. However, we will not write $$q_{[15]+1}$$ and $$q_{[16]}$$ as $$q_{16}$$, since these two "$$q$$"'s are "quite different" because of the selection impact is still "quite large".

The following are some terms related to life table.
 * An is a life table in which the functions are only given for.
 * A is a life table in which some function involves the age at selection.
 * An is usually appended to a select table as a last column to reflect the setting of select table. The combination of a select table and an ultimate table in such a way is called a  table.

For example, an excerpt of select-and-ultimate table with select period 2 years may look like: The last column is the ultimate table. We can observe that we do not need additional columns for $$q_{x+3},q_{x+4}$$ etc., since we can already get such values in the "$$q_{x+2}$$" value in a different row (with different $$x$$).

Given a select-and-ultimate table, we can do various calculations based on it.


text:
Hobo tourism/Third African trip

Third African trip (ru. Третья афровылазка) — the first literary work of the Russian traveler Viktor Pinchuk, who traveled several continents, practicing the methods of hobo tourism.

The work in the travel essay genre describes the author’s third African journey, which included six countries where the priority was to visit Sudan. The book details the itinerary of the trip and all the related details: ways of travel, street cuisine, the accommodation options used — on construction sites, in the open air, at the Aboriginals, and the first-tried method of sleeping in the police station.

Some thriller touches are added to the book by the narrator's unexpected getting into uninhabited territory following an unsuccessful attempt to swim across the river at the lower reaches of the Epupa Falls.

General information

 * Year of publication: 2013.
 * Number of pages: 56.
 * Illustrations: the author.
 * Color of illustrations: black and white.
 * Language of publication: Russian.
 * Genre: journalism, travel essays, road adventures.
 * Topics: country studies.
 * Continents: Africa.
 * Style: artistic publicism.
 * Designed: for a wide range of readers.
 * Where published: Simferopol.
 * Additional data: ISBN 978-617-671-039-4.

Quote
''On December 3, 2010, from the Nativity of Christ, with a small camping backpack behind my back, I left the house, running away from the routine of pale gray days, which look like twins in a morgue. In the backpack — a monthly supply of oatmeal, a metal bowl and a mug, in the passport — not a single visa, in the head — dreams, ideas and a vague future.''

title: Hobo tourism/Third African trip


text:
Hobo tourism/Japan for free

Japan for free (ru. Япония даром) — a book by the Russian traveler Viktor Pinchuk, who visited several continents, practicing non-standard methods.

The booklet, in the genre of travel memoirs recounts a two-week bum tour through January Japan, detailing the author's adventures: moving around the country using the kiseru method, the first tried option of sleeping in a cemetery, the usual ways of international bum for staying overnight in halls and stairwells, staying at homes with locals as well as in Tokyo police, where the author found himself late at night, not anticipating such a turn of events.

General information

 * Year of publication: 2016.
 * Number of pages: 31.
 * Illustrations: the author.
 * Color of illustrations: black and white.
 * Language of publication: Russian.
 * Genre: travel essays, road adventures.
 * Topics: country studies.
 * Continents: Asia.
 * Style: artistic publicism.
 * Designed: for a wide range of readers.
 * Where published: Simferopol.
 * Additional data: ISBN 978-5-9908234-1-9.

Quote
... packed in the backpack a rusks and rolled oats, I sat down on the carpet in accordance with the oriental tradition (furniture is in short supply in Asia, so people sit on the floor) and stepping out into the yard, confidently walked forward: towards difficulties, street sleepovers, winter cold and other things, without which human life is like the existence of a mole.

title: Hobo tourism/Japan for free


text:
Cookbook:Instant Noodles

Instant noodles are a prepackaged, shelf-stable food typically consisting of a precooked and dried block of noodles along with accompanying flavorings and/or toppings. The noodles are designed to be reconstituted by boiling or soaking in hot water for a short period. The precooked nature of the noodles shortens the cooking process, making instant noodles a popular convenience food. They are often prepared as specified by the manufacturer directions, but many recipes exist that use instant noodles as an ingredient in a more complex final dish.

Noodles
The noodles are typically wheat-based, although rice- and buckwheat-based varieties also exist. The dough usually contains an alkaline solution called kansui, which increases the chewy texture of the noodles. Other additives such as starches or gums may also be included. After shaping, the noodles are steamed as a form of pre-cooking, and they are then either fried or air-dried to dehydrate and preserve them.

Flavoring
The flavorings can generally be classified as powders, liquids/oils, and granules, depending on the ingredients and degree of dehydration. Basic seasonings include salt, soy sauce, vinegar, sugar, and dehydrated stock or meat/vegetable extracts. Various other spices and seasonings are included to further develop the flavor of the final product.

Other
Depending on the variety, instant noodles may come with dehydrated toppings to be reconstituted along with the noodles. These may include dried meat, seafood, and/or vegetables.

Preparation
Instant noodle preparation depends on the type. Some quick-cooking varieties come in a paper or styrofoam cup, and only need a brief soak in boiling water. With others, the noodles must be boiled or microwaved in water for slightly longer. Depending on the brand, the seasonings and/or toppings may either be pre-combined with the noodles or separately packaged into small packets.

Recipes

 * Nigerian Fried Noodles

title: Cookbook:Instant Noodles


text:
Hobo tourism/Six months by islands... and countries

Six months by islands... and countries (ru. Полгода по островам… и странам) — a book by the Russian traveler Viktor Pinchuk, who traveled around several continents, practicing the methods of hobo tourism.

A literary work in the genre of travel essays describes the author's six-month solo expedition that included nine exotic countries: Malaysia, Brunei, Indonesia, Papua New Guinea, China, Hong Kong, Laos, Cambodia and Thailand. The dominant feature of the project was a visit to the provincial areas of PNG, where the Aborigines do not often see white people and where they met a Russian for the first time. An unexpected dengue fever contagion slightly disrupted plans, and overnight stays in police stations, abandoned ruins, the open air and in the company of native homeless people are trifles for the experienced wanderer.

General information

 * Year of publication: 2016.
 * Number of pages: 216.
 * Illustrations: the author.
 * Color of illustrations: black and white.
 * Language of publication: Russian.
 * Genre: journalism, travel essays, road adventures.
 * Topics: country studies.
 * Continents: Asia, Oceania.
 * Style: artistic publicism.
 * Designed: for a wide range of readers.
 * Where published: Simferopol.
 * Additional data: ISBN 978-5-9908234-0-2.

Quote
''Will share the secrets of my street sleepovers. If you get into an unfamiliar city, can stay anywhere, even on the central avenue under the walls of buildings, but on one condition: you need to deploy after midnight, and leave before six in the morning. At six, the first passerby may appear, probably suffering from insomnia, in half an hour there will be several of them, and closer to seven — a lot.''

authors: Виктор Пинчук


text:
Salam, Jonathan!/kapitule 1

1a os maye
bate eni site. bate kitci in dibuke. bate wi site.

ki bate eni site? ha, lo eni site.

ki bate eni bate? ne, lo ne eni bate. lo eni site.

ki bate eni vage? ne, lo ne eni vage. lo eni site. bate eni site.

ki bate kitci in dibuke? ha, lo kitci in dibuke.

ki dibuke kitci in bate? ne, dibuke ne kitci in bate. dibuke ne kitci. bate kitci. tia bate kitci in dibuke.

ki site wi bate? ne, site ne wi bate. site ne wi. bate wi. ki bate wi site? ha, bate wi site.

kien bate? lo eni site. kie bate kitci? lo kitci dibuke. kie bate wi? lo wi site. lo eni site, ni lo kitci dibuke, ni lo wi site.

ki bate ini dibuke? ne, lo kitci in dibuke. ki bate wi bate? ne, lo ne wi bate, lo wi site.

bate si alta. bate si bona, ni bate si cesabla. lo meni. lo meni tem site. lo meni: "site si kie? ki site si bona? ki site si gua?"

ki bate kitci site? ne, lo ne kitci site; site si gua. lo kitci dibuke; dibuke ni si gua.

ki dibuke meni tem bate? ne, dibuke ne meni. bate meni. lo meni tem dibuke, ni lo meni tem site.

ni lo kitci in dibuke. lo kitci tem site. lo kitci: "site si bona, ni site si gua."

lo meni: "site si bona"; lo meni site si bona. lo meni tem site, ni lo meni tem dibuke.

dibuke si kie? dibuke si in bate kitci. in dibuke, bate kitci tem site. in dibuke, bate ne kitci tem vage; bate ini site, ne ini vage. lo ne meni tem vage; lo meni tem site, site munhen.

kia site? si munhen. kien munhen? si en bate eni. kien bate? lo eni munhen.

ha, munhen si gua site, ni bona site. bate meni munhen si bona site, ni lo meni si si gua site. bate si cesabla. lo peli: "salam, munhen!". lo si bona bate.

bate pedi ni meni: "kien vage?" lo wi… lo wi vage! lo meni: "vage!" nuo lo ne meni tem dibuke nio ne lo meni tem site; lo meni tem vage!

|1

title: Salam, Jonathan!/kapitule 1


text:
Exercise as it relates to Disease/The effects of physical activity on the social behaviour of children with Autism

This Wiki-book aims to critique the research study The Effects of Structured Physical Activity Program on Social Interaction and Communication for Children with Autsm by Mengxian Zhao and Shihui Chen.

What is the background to this research?
Autsm Spectrum Disorder is a neurological and developmental disease causing many deficits in children’s social interactions and communication skills. This results in not only consequences for the child but also for their families and/or caretakers. Children with this disorder struggle with everyday activities creating great barriers towards interacting in social environments. This disease is becoming more and more prevalent, with a recent study in the United States revealing that 1 in every 44 (2.3%) eight- year-old's are being diagnosed with autsm spectrum disorder. Autsm can be diagnosed in children as young as 18 months of age making it vital to have early interventions available to reduce the significance of the disease. Children suffering from autsm are at a greater risk of developing further diseases due to their limited opportunities to participate in physical exercise. Inactivity in children poses a great threat to their health, development and overall quality of life. The proposed intervention aims at investigating the effectiveness of physical activity on the communication skills of children living with autsm spectrum disorder.

Where is the research from?
The study was published in 2018 in the BioMed Research International Journal which publishes original research articles from a range of biomedical topics. The journal publication states that all researchers and editors are specialised experts in their field of study and all articles are peer reviewed and meet standards of academic excellence. The authors of the article are Mengxian Zhao and Shihui Chen. The authors declared that there were no conflicts of interest regarding the publication of the article, as well as providing information on their credentials adding to the credibility of the article.

What kind of research was this?
A quasi-experimental design with an experimental group and a control group was utilized in this study to investigate the effects of a 12-week exercise program on children with autsm spectrum disorder. Using a quasi-experimental design means the participants were not randomly assigned but were put into groups based on non-random criteria. A recent study on the integrity of quasi-experimental designs suggests the lack of random assignment could weaken the study as questions arise regarding alternative explanations for causation.

What did the research involve?
The study involved 50 participants aged 5 to 8 years old, selected from a special school of Shandong Province. The participants were recruited based on the DSM-V criteria. 25 of the participants were placed in the experimental group to participate in a structured physical activity program, while the remaining 25 were placed in the control group for regular physical activity. The 12-week structured program ran for 60 minutes per session with a total of 24 sessions. The intervention comprised of four parts; get-ready and warm up activities, one-to-five small group instructions, whole-group exercises and cool down. Both groups adopted the pre-test, interim-test and post-test design to monitor the progressive changes in the participants behaviour and social interactions. The intervention utilized the [https://raisingchildren.net.au/autism/therapies-guide/teacch#:~:text=What%20is%20TEACCH%3F,on%20these%20to%20promote%20development. Treatment and Education of Autistic and Communication Handicapped Children model]. The program was specialized to meet the needs of children with autsm, following specific recommendations and guidelines. Further tools were used to reduce drop-out rates such as a reward system to encourage the participants.

The short length of the study limited opportunities to observe long-term effects of the intervention and whether barriers to progression were present. The sample size of participants was small. This small sample size limited the possibility that generalisations could be accurately made from the study. Further, the cohort was selected from a specific school which limits applicability to the wider community and raises the question of causation.

What were the basic results?
The main results from this study were collected using [https://www.abs.gov.au/websitedbs/D3310114.nsf/Home/Statistical+Language+-+quantitative+and+qualitative+data#:~:text=Quantitative%20data%20are%20measures%20of,symbol%2C%20or%20a%20number%20code. quantitative] and [https://www.abs.gov.au/websitedbs/D3310114.nsf/Home/Statistical+Language+-+quantitative+and+qualitative+data#:~:text=Quantitative%20data%20are%20measures%20of,symbol%2C%20or%20a%20number%20code. qualitative] instruments. The results from the experimental group showed overall improvements made in social skills, communication and cooperation (p < 0.005). SSIS and ABLIS-R results showed improvements in social skills and interactions across interim and post-tests in the experimental group p= 0.001 (p<0.005). Conversely, there were no statistically significant results in the control group (0 > 0.005). Parents, interviewers and volunteers responded to questionnaires which indicated significant changes in the participants social interactions by the end of the program. Changes were identified through improved eye contact, group participation and relationship building between the teachers and participants.

Researchers conclusion

The conclusions made by the researchers seem plausible and align with previous studies, promoting the idea of physical activity for children with autsm. The authors made note of the minor effects physical activity had in some aspects as well as the bigger impacts it had in other aspects of behaviour. Recognition of withdrawals were made by the authors, concluding that out of the fifty original participants, forty-one completed the full 12-weeks.

What conclusions can we take from this research?
The study provides evidence suggesting that physical activity provides improvements in communication and social skills in children with Autsm Spectrum Disorder. A common barrier when working with this population is adherence and motivation. This was overcome by constructing an adaptive and purposeful program which naturally integrated communication elements into regular physical activities. A literature review looked at the fitness levels of children with autsm. While this doesn’t directly relate to implications in communication skills, it provides insight to the level of physical activity this population is participating in. The study found that children with autsm have a much weaker level of physical fitness compared with their peers, reinforcing the importance of finding ways to combat the low levels of physical activity within this population. Further research in this area is necessary to support the findings from this intervention allowing the results to become more applicable to the wider population.

Practical advice

 * Physical activity not only helps children with autsm better engage with their environment but also promotes a healthy lifestyle, reducing further risk factors for this population.
 * Research from other studies have found keeping exercise programs simple and easy to follow, while including a variety of different activities that promote fitness, social interaction and independence important factors when constructing a program for this population . The current intervention implemented these factors providing a good example for further studies.
 * The program did not result in any injuries or illnesses from the participants, deeming it safe for this population. Practitioners and caretakers of children with autsm should look to use a similar program to the one implemented in this study.

Further information/resources
For further information on this topic please visit:

 * 1) https://www.healthdirect.gov.au/autism
 * 2) https://www.autismspeaks.org/expert-opinion/autism-exercise-benefits
 * 3) https://raisingchildren.net.au/autism/learning-about-autism/about-autism/asd-overview


text:
User:Phanma/sandbox

Bản Quyền ✓© AIphanbade ™

__DISAMBIG__

title: User:Phanma/sandbox


text:
User:MustardOnCheese/vector.css

body { font-family: Verdana, 'DejaVu Sans', DejaVu Serif; line-height: 1.5em; font-size: 1.5em !important; }

title: User:MustardOnCheese/vector.css


text:
Hobo tourism/Mongolian huyvaldagch

Mongolian huyvaldagch (ru. Монгольский хуйвалдагч) is a book by the Russian traveler Viktor Pinchuk, who has traveled several continents, practicing non-standard methods.

The literary work in the genre of travel notes tells about the author’s two-week trip to Mongolia, which can be described as "Cultural travel": the goal of the project was to study the way of life and traditions not very clear to us, in the past powerful, cruel and merciless people, as well as some linguistic features of the Mongolian language.

General information

 * Year of publication: 2017.
 * Number of pages: 40.
 * Illustrations: the author.
 * Color of illustrations: black and white.
 * Language of publication: Russian.
 * Genre: journalism, travel essays.
 * Topics: regional geography.
 * Continents: Asia.
 * Style: artistic publicism.
 * Designed: for a wide range of readers.
 * Where published: Simferopol.
 * Additional data: ISBN 978-5-9909912-1-7.

Quote
''As for the inhabitants of the once formidable empire, it is easy to learn a certain number of their words for the Russian-speaking, because in the Mongolian language, we often find a well-known word that at first slightly cuts the hearing. However, not so devile: in the homeland of Genghis Khan, the combination of three letters does not act as an obscenity, but as a root, forming a multitude of words for different purposes. One should not be surprised by such a phenomenon: because it is the invasions of the Mongol horde that have enriched" our speech with this vocabulary.''

authors: Виктор Пинчук

title: Hobo tourism/Mongolian huyvaldagch


text:
General Relativity/What is a tensor?/Answers

User : 109.246.48.3 (June 2021)

1) a ball bouncing off a wall or a light ray passing through a boundary 2) use multiple tensors multiplied of added together 3) no

- User :

1)

2)

3)


text:
Exercise as it relates to Disease/Is physical activity associated with an increased risk of testicular cancer?

Background Research
Testicular cancer (TC) is perhaps one of the more well-known cancers affecting people biologically born men. It is considered an uncommon type of cancer, but is the second most prevalent cancer in young men between 20 and 39. Causes for TC are relatively typical, such as family history, personal health history and infertility. In Australia there were 31 deaths out of 964 cases during 2022, and previously around 10,000 deaths out of 52,000 cases worldwide in 2008. It is estimated that there is a 0.02% chance of dying from TC in 2022, with a 97% chance of surviving at least 5 years post diagnosis.

Physical activity has long been considered an essential part of life and has been proven through numerous studies to reduce certain types of cancers and diseases. However, in regards to TC, research is now beginning to consistently find correlation between higher levels of physical activity and increased TC risk. One study by Anil Srivastava and Nancy Kreiger in 2000 was one the first to find a strong relationship between the two.

This is a conflicting revelation and future studies are paramount within this area to verify the relationship.

Where is the research from?
This research was based on data collected in Ontario, Canada between 1995 and 1996. It’s authors, Anil Srivastava and Nancy Kreiger, are two high level Canadian graduate researchers who released their work in the year 2000.

Their study was conducted at the Johnx Hopkins Bloomberg School of Public Health, currently ranked #1 by U.S. News & World Report.

The research was then presented through the American Journal of Epidemiology (published by Oxford Academic, the largest university press in the world). The American Journal of Epidemiology has been considered a reliable source of information for many decades with consistent impact factor scores ranging between 5.745 (2010) and 4.322 (2017), as well as consistently ranking within the top 6 journal rankings for public, environmental and occupational health until 2011.

What kind of research is this?
The design of this study is that of a Multicentre design. It originally set out to look at multiple different provinces within Canada but only data from 1 was utilised for the final study. It used a medium-sized case-control study methodology.

What did the research involve?
The Data

The data utilised was from the Enhanced Cancer Surveillance Study in the Ontario province in Canada.

- Cases of men diagnosed with TC between January 1, 1995, and December 31, 1996 from the Ontario Cancer Registry were looked at.

- Eligible men between the ages of 20 to 74 were mailed self-administered questionnaires, which resulted in a 76% return rate and totalling 212 cases.

- To create a control group, 904 subjects were randomly selected from the Ontario Ministry of Finance Property Assessment database. This yielded a 64% return from the same mailed-out questionnaire, from which 251 matched control subjects were selected

The Questionnaire

The questionnaire focused on questions regarding frequency and intensity of physical activity during certain life periods; their teens, early 30s and early 50s. Subjects were not asked specifically about the intensity of the exercise they participate in, but rather given examples of activities, such as walking for moderate levels and running for at least 20 minutes for strenuous levels. Questions were also targeted at the subjects’ perceived intensity of physical activity during their occupation, also split by life periods.

Information around BMI, age, height, education, marital status, smoker/non-smoker, vegetable consumption and fruit consumption were also collected.

A concern for the study was the reliance on self-reporting, which could lead to some unreliability. It's well known that people tend to underreport bad habits (smoking in this case) and overreport good habits (amount of exercise, fruit and vegetable consumption). As this was self-administered, there was no possibility for clarification on questions or making sure the numbers reported were accurate. This may lead to the results from the study not accurately reflecting a true relationship.

In the future, it may be more reliable to us an over-the-phone collection method or a face-to-face interview where a discussion can be had to strengthen the reliability of any significant results that might be seen.

Basic Results
The results indicate that high participation levels in strenuous and/or moderate physical activity increased the potential adverse effects regarding risk of TC in multiple populations.

Further broken down it was found that:

• Teens that were active greater than 5 times a week were found to have significant adverse effects in their risk of developing TC (odds ratio (OR) = 2.36, 95 percent confidence interval (CI): 1.20, 4.64)

• Men who worked jobs that involved a moderate or strenuous amount of physical activity within their early 20s displayed a 70-85% increase in their risk of developing TC (strenuous, OR = 1.67, 95 percent CI: 0.92-3.00; moderate, OR = 1.85, 95 percent CI: 1.05-3.26) compared to those men who worked in jobs that involved sedentary behaviour (such as sitting) who had a significantly lower risk

What conclusions can be made from this research?
The research presents a compelling conclusion in that frequent levels (5 or more sessions per week) of moderate-strenuous physical activity during teenage years increases the risk of developing TC later in life. Occupations that include high levels of activity also saw a huge increase of up to 85% in the risk of developing TC during early 20s.

However, something to note is that although that the research presents solid data coming from a reliable source, there are many other research studies concluding the opposite, that there is no association between physical activity and risk of TC,. ]. It is also widely accepted that there is no current effective prevention from developing TC.

This would suggest that seeking to locate and conduct further research is critical in being able to draw confident conclusions regarding the relationship and the risk.

Practical advice
Although this study indicates that physical activity increases adverse effects to the risk of developing TC, it would be unwise to suggest decreasing a man’s physical activity level would be beneficial. This is because physical activity is important in several other factors, such as cardiovascular health, mental health and reducing risks of other cancers and diseases. Although there is a strong correlation seen here, there are many other factors such as family history and infertility which play a much stronger role in the risk of developing TC, not just frequent moderate and strenuous physical activity recreationally or in occupation

However, we cannot disregard the research entirely.

A practical compromise would be developing an age-appropriate screening checklist for risk of developing TC to be used by exercise practitioners which considers all risk factors, including activity levels. If a patient or client indicates high levels of vulnerability, referral to an appropriate medical practitioner would be encouraged for regular screening. This advice not only gives the best possibility for early detection of TC, but also avoids undesirably decreasing physical activity levels and increasing potential health concerns elsewhere.

Further information
Information on causes, symptoms and how to check your testes for signs of TC - https://www.cancer.org.au/cancer-information/types-of-cancer/testicular-cancer

Access to the full research study - https://academic.oup.com/aje/article/151/1/78/89036?login=false


text:
ORCID Advocacy Toolkit

This is the index page for the ORCID Advocacy Toolkit, developed by the UK ORCID Consortium during the Advocacy Toolkit Sprint in November 2022. Further work continued during 2023.

Do you have a need to talk about ORCID to your colleagues, researchers, administrators, funders or anyone else at your institution or wider? Do you have responsibility for describing how to use ORCID or communicate about its benefits?

This project is developed and shared by the UK ORCID Consortium community. It contains links to resources and captures the know-how that we have acquired between us on how to do ORCID advocacy. It is the result of effort that has been spent preparing materials, considering audiences, evaluating information or developing practice guidelines for running events. This is our platform for sharing our knowledge and resource examples.

This sharing helps to reduce effort and showcase best practice, so we can learn from each other and pool resources.

Would you like to contribute? You can help shape the project, add resources or other guidance. See the section How to Contribute.

If you are looking for resources or inspiration, use the index for different ways to navigate our content.

Chapters
/About this book/

What is Advocacy?

Audiences (who needs to hear about ORCID)

Platforms that integrate with ORCID

Resources

So you would like to.... Contributors

Do you want to practice using Wikibooks? We've provided a place to do that! Go to the Sandbox

title: ORCID Advocacy Toolkit