Despite legislation on diversity in the workplace, people with disabilities still do not experience the same access to work opportunities as do their counterparts without disabilities. Many employers ...have been shown to harbor sincere yet ill-founded views about the work-related abilities of people with disabilities; these negative views are often a result of interrelated concerns that permeate the entire employment cycle. In this paper, we provide evidence-based responses to 11 specific concerns that employers have about people with disabilities, from pre-employment and entry experiences to the final dissolution of the employment relationship. At each stage of the employment cycle, we summarize and evaluate the relevant empirical evidence and provide recommendations for organizations committed to creating more effective, equitable, and inclusive workplaces for all individuals. We also suggest avenues for future research.
Changing diet and physical activity behaviour is one of the cornerstones of type 2 diabetes treatment, but changing behaviour is challenging. The objective of this study was to identify behaviour ...change techniques (BCTs) and intervention features of dietary and physical activity interventions for patients with type 2 diabetes that are associated with changes in HbA
and body weight.
We performed a systematic review of papers published between 1975-2015 describing randomised controlled trials (RCTs) that focused exclusively on both diet and physical activity. The constituent BCTs, intervention features and methodological rigour of these interventions were evaluated. Changes in HbA
and body weight were meta-analysed and examined in relation to use of BCTs.
Thirteen RCTs were identified. Meta-analyses revealed reductions in HbA
at 3, 6, 12 and 24 months of -1.11 % (12 mmol/mol), -0.67 % (7 mmol/mol), -0.28 % (3 mmol/mol) and -0.26 % (2 mmol/mol) with an overall reduction of -0.53 % (6 mmol/mol 95 % CI -0.74 to -0.32, P < 0.00001) in intervention groups compared to control groups. Meta-analyses also showed a reduction in body weight of -2.7 kg, -3.64 kg, -3.77 kg and -3.18 kg at 3, 6, 12 and 24 months, overall reduction was -3.73 kg (95 % CI -6.09 to -1.37 kg, P = 0.002). Four of 46 BCTs identified were associated with >0.3 % reduction in HbA
: 'instruction on how to perform a behaviour', 'behavioural practice/rehearsal', 'demonstration of the behaviour' and 'action planning', as were intervention features 'supervised physical activity', 'group sessions', 'contact with an exercise physiologist', 'contact with an exercise physiologist and a dietitian', 'baseline HbA
>8 %' and interventions of greater frequency and intensity.
Diet and physical activity interventions achieved clinically significant reductions in HbA
at three and six months, but not at 12 and 24 months. Specific BCTs and intervention features identified may inform more effective structured lifestyle intervention treatment strategies for type 2 diabetes.
The ca. 3.48 Ga Dresser Formation, Pilbara Craton, Western Australia, is well known for hosting some of Earth's earliest convincing evidence of life (stromatolites, fractionated sulfur/carbon ...isotopes, microfossils) within a dynamic, low-eruptive volcanic caldera affected by voluminous hydrothermal fluid circulation. However, missing from the caldera model were surface manifestations of the volcanic-hydrothermal system (hot springs, geysers) and their unequivocal link with life. Here we present new discoveries of hot spring deposits including geyserite, sinter terracettes and mineralized remnants of hot spring pools/vents, all of which preserve a suite of microbial biosignatures indicative of the earliest life on land. These include stromatolites, newly observed microbial palisade fabric and gas bubbles preserved in inferred mineralized, exopolymeric substance. These findings extend the known geological record of inhabited terrestrial hot springs on Earth by ∼3 billion years and offer an analogue in the search for potential fossil life in ancient Martian hot springs.
Approximately 1·5 billion people worldwide live with a physical, mental, sensory, or intellectual disability, about 80% of which are in low-income and middle-income countries. This Series paper ...provides a global overview of the prevalence, benefits, and promotion policies for physical activity for people living with disabilities (PLWD). PLWD are 16–62% less likely to meet physical activity guidelines and are at higher risk of serious health problems related to inactivity than people without disabilities. Meta-analyses have shown that physical activity has beneficial effects on cardiovascular fitness (average standardised mean difference SMD 0·69 95% CI 0·31–1·01), musculoskeletal fitness (0·59 0·31–0·87), cardiometabolic risk factors (0·39 0·04–0·75), and brain and mental health outcomes (0·47 0·21–0·73). These meta-analyses also show that health benefits can be achieved even with less than 150 min of physical activity per week, and suggest that some physical activity is better than none. Meta-analyses of interventions to increase physical activity for PLWD have reported effect sizes ranging from SMD 0·29 (95% CI 0·17–0·41, k=10) to 1·00 (0·46–1·53, k=10). There is increasing awareness among policy makers of the needs of PLWD for full participation in physical activity. Physical activity action plans worldwide must be adequately resourced, monitored, and enforced to truly advance the fundamental rights of PLWD to fully participate in physical activity.
Physical activity (PA) interventions in people with spinal cord injury (SCI) have been limited by a shortage of (1) evidence for sufficient increases in unsupervised PA to improve aerobic fitness and ...(2) stakeholder involvement in intervention design.
This study examined the effects of a theory-based PA intervention, developed in collaboration with nearly 300 stakeholders, on PA levels, aerobic fitness, and psychosocial predictors of PA among individuals with SCI.
A randomized controlled trial (RCT) was conducted with 28 men and women with chronic SCI (age 45.0 ± 11.5 years, years post-injury 16.4 ± 12.4). Participants randomized to the intervention group (n = 14) received an introductory personal training session followed by eight weekly 15-min PA behavioral coaching sessions per week. PA was assessed using self-report and accelerometers. Aerobic fitness and psychosocial predictors of exercise were evaluated using an incremental exercise test and survey methods, respectively.
At post-intervention, controlling for baseline, the intervention group showed fivefold greater self-reported moderate to vigorous physical activity mean difference 247.9 min/day; 95% confidence interval (CI) 92.8-403.1; p = 0.026, d = 1.04, 17% greater accelerometer-measured PA (mean difference 3.9 × 10
vector magnitude counts; 95% CI 1.1 × 10
-7.7 × 10
; p = 0.014, d = 0.31), and 19% higher peak oxygen uptake (VO
; mean difference 0.23 L/min; 95% CI 0.12-0.33; p < 0.001, d = 0.54) compared with the control group. Mean values of psychosocial predictors of PA were also significantly improved in the intervention group compared with controls.
To our knowledge, this co-created behavioral intervention produced the largest effect size to date for change in self-reported PA in an RCT involving people with physical disability. This is also the first RCT in people with SCI to demonstrate that a behavioral intervention can sufficiently increase unsupervised PA to improve aerobic fitness.
ClinicalTrials.gov, NCT03111030, 12 April 2017, https://clinicaltrials.gov/ct2/show/NCT03111030?term=NCT03111030&rank=1 .
To conduct a systematic review of evidence surrounding the effects of exercise training on physical fitness, mobility, fatigue, and health-related quality of life in adults with multiple sclerosis ...(MS).
The databases included EMBASE, 1980 to 2011 (wk 12); Ovid MEDLINE and Ovid OLDMEDLINE, 1947 to March (wk 3) 2011; PsycINFO, 1967 to March (wk 4) 2011; CINAHL all-inclusive; SPORTDiscus all-inclusive; Cochrane Library all-inclusive; and Physiotherapy Evidence Database all-inclusive.
The review was limited to English-language studies (published before December 2011) of people with MS that evaluated the effects of exercise training on outcomes of physical fitness, mobility, fatigue, and/or health-related quality of life.
One research assistant extracted data and rated study quality. A second research assistant verified the extraction and quality assessment.
From the 4362 studies identified, 54 studies were included in the review. The extracted data were analyzed using a descriptive approach. There was strong evidence that exercise performed 2 times per week at a moderate intensity increases aerobic capacity and muscular strength. The evidence was not consistent regarding the effects of exercise training on other outcomes.
Among those with mild to moderate disability from MS, there is sufficient evidence that exercise training is effective for improving both aerobic capacity and muscular strength. Exercise may improve mobility, fatigue, and health-related quality of life.
Interval exercise training can elicit physiological adaptations similar to those of traditional endurance training, but with reduced time. However, the intense nature of specific protocols, ...particularly the "all-out" efforts characteristic of sprint interval training (SIT), may be perceived as being aversive. The purpose of this study was to determine whether listening to self-selected music can reduce the potential aversiveness of an acute session of SIT by improving affect, motivation, and enjoyment, and to examine the effects of music on performance.
Twenty moderately active adults (22 ± 4 yr) unfamiliar with interval exercise completed an acute session of SIT under two different conditions: music and no music. The exercise consisted of four 30-s "all-out" Wingate Anaerobic Test bouts on a cycle ergometer, separated by 4 min of rest. Peak and mean power output, RPE, affect, task motivation, and perceived enjoyment of the exercise were measured. Mixed-effects models were used to evaluate changes in dependent measures over time and between the two conditions.
Peak and mean power over the course of the exercise session were higher in the music condition (coefficient = 49.72 SE = 13.55 and coefficient = 23.65 SE = 11.30; P < 0.05). A significant time by condition effect emerged for peak power (coefficient = -12.31 SE = 4.95; P < 0.05). There were no between-condition differences in RPE, affect, or task motivation. Perceived enjoyment increased over time and was consistently higher in the music condition (coefficient = 7.00 SE = 3.05; P < 0.05).
Music enhances in-task performance and enjoyment of an acute bout of SIT. Listening to music during intense interval exercise may be an effective strategy for facilitating participation in, and adherence to, this form of training.
Progressive depletion of midbrain dopamine neurons (PDD) is associated with deficits in the initiation, speed, and fluidity of voluntary movement. Models of basal ganglia function focus on initiation ...deficits; however, it is unclear how they account for deficits in the speed or amplitude of movement (vigor). Using an effort-based operant conditioning task for head-fixed mice, we discovered distinct functional classes of neurons in the dorsal striatum that represent movement vigor. Mice with PDD exhibited a progressive reduction in vigor, along with a selective impairment of its neural representation in striatum. Restoration of dopaminergic tone with a synthetic precursor ameliorated deficits in movement vigor and its neural representation, while suppression of striatal activity during movement was sufficient to reduce vigor. Thus, dopaminergic input to the dorsal striatum is indispensable for the emergence of striatal activity that mediates adaptive changes in movement vigor. These results suggest refined intervention strategies for Parkinson’s disease.
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•A mouse model of Parkinson’s disease produces a persistent reduction in effort•The neural representation of movement vigor in striatum requires dopamine•Acute suppression of striatal activity during execution enervates movement•Dopamine repletion is sufficient to restore striatal activity and invigorate movement
Movement vigor, reduced in Parkinson’s disease, is regulated by dopamine-dependent activity in the striatum.
The coenzyme nicotinamide adenine dinucleotide (NAD
) has key roles in the regulation of redox status and energy metabolism. NAD
depletion is emerging as a major contributor to the pathogenesis of ...cardiac and renal diseases and NAD
repletion strategies have shown therapeutic potential as a means to restore healthy metabolism and physiological function. The pleotropic roles of NAD
enable several possible avenues by which repletion of this coenzyme could have therapeutic efficacy. In particular, NAD
functions as a co-substrate in deacylation reactions carried out by the sirtuin family of enzymes. These NAD
-dependent deacylases control several aspects of metabolism and a wealth of data suggests that boosting sirtuin activity via NAD
supplementation might be a promising therapy for cardiac and renal pathologies. This Review summarizes the role of NAD
metabolism in the heart and kidney, and highlights the mitochondrial sirtuins as mediators of some of the beneficial effects of NAD
-boosting therapies in preclinical animal models. We surmise that modulating the NAD
-sirtuin axis is a clinically relevant approach to develop new therapies for cardiac and renal diseases.
Within the context of physical disability, participation has typically been conceptualized in terms of one's performance of different roles and activities. This perspective, however, ignores the ...meanings and satisfactions that a person derives from participating. Without an accepted conceptualization of participation that accounts for people's subjective perceptions and experiences, it is challenging for decision-makers and service providers to design meaningful participation-enhancing services, programs, and policies. Accordingly, our objectives were (1) to conduct a review of definitions and conceptualizations of participation that extend beyond performance and capture people's subjective experiences of participating and (2) to identify key experiential aspects of participation that can be used as a basis for conceptualizing and operationalizing the concept more broadly. The project involved a systematic, configurative review of relevant literature. Ten relevant articles were identified. Information on characteristics associated with experiential aspects of participation was extracted and subjected to a thematic analysis. The following 6 themes emerged: autonomy, belongingness, challenge, engagement, mastery, and meaning. Drawing on these findings, it is recommended that the individual's subjective perceptions of autonomy, belongingness, challenge, engagement, mastery, and meaning associated with participating be incorporated into conceptualizations and operationalizations of the participation construct. This recommendation provides a starting point for clinicians, researchers, and policymakers to conceptualize and measure the participation concept more consistently and more broadly.
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