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Fourteen Native Canadian intermediate students identified as creatively gifted were assigned to experimental or control groups. Pre- and posttests of creative potential indicated significant gains in originality scores of the experimental groups, who received training in fluency, flexibility, and originality through formation of objects and patterns with blocks, sticks, and anagrams. (JW)

Home-based exercise is an alternative exercise mode to a structured supervised program to improve symptoms in patients with peripheral artery disease (PAD), but little is known about whether the slow-paced and less intense home program also elicits changes in vascular and inflammatory biomarkers. In an exploratory analysis from a randomized controlled trial, we compared changes in vascular and inflammatory biomarkers in patients with symptomatic PAD (typical and atypical of claudication) after home-based exercise and supervised exercise programs and in an attention-control group. A total of 114 patients were randomized into one of the three groups (n = 38 per group). Two groups performed exercise interventions, consisting of home-based and supervised programs of intermittent walking to mild to moderate claudication pain for 12 weeks; a third group performed light resistance training as a nonwalking attention-control group. Before and after intervention, patients were characterized on treadmill performance and endothelial effects of circulating factors present in sera by a cell culture-based bioassay on primary human arterial endothelial cells, and they were further evaluated on circulating vascular and inflammatory biomarkers. Treadmill peak walking time increased (P =.008) in the two exercise groups but not in the control group (P >.05). Cultured endothelial cell apoptosis decreased after home-based exercise (P <.001) and supervised exercise (P =.007), and the change in the exercise groups combined was different from that in the control group (P =.005). For circulating biomarkers, increases were found in hydroxyl radical antioxidant capacity (P =.003) and vascular endothelial growth factor A (P =.037), and decreases were observed in E-selectin (P =.007) and blood glucose concentration (P =.012) after home-based exercise only. The changes in hydroxyl radical antioxidant capacity (P =.005), vascular endothelial growth factor A (P =.008), and E-selectin (P =.034) in the exercise groups combined were different from those in the control group. This exploratory analysis found that both home-based and supervised exercise programs are efficacious to decrease cultured endothelial cell apoptosis in patients with symptomatic PAD. Furthermore, a monitored home-based exercise program elicits additional vascular benefits by improving circulating markers of endogenous antioxidant capacity, angiogenesis, endothelium-derived inflammation, and blood glucose concentration in patients with symptomatic PAD. The novel clinical significance is that important trends were found in this exploratory analysis that a contemporary home-based exercise program and a traditional supervised exercise program may favorably improve vascular and inflammatory biomarkers in addition to the well-described ambulatory improvements in symptomatic patients with PAD. [ABSTRACT FROM AUTHOR]

Background We compared (1) cellular reactive oxygen species (ROS) production, inflammation, and apoptosis of cultured endothelial cells treated with sera and (2) circulating inflammatory measures, antioxidant capacity, vascular biomarkers, and calf muscle hemoglobin oxygen saturation (StO 2 ) in men and women with peripheral artery disease (PAD). A secondary aim was to compare exercise performance and daily ambulatory activity between men and women. We hypothesized that women would have more impaired endothelial cellular ROS, inflammation, and apoptosis than men as well as worse systemic inflammation, antioxidant capacity, vascular biomarkers, calf muscle StO 2 , exercise performance, and daily ambulatory activity. Methods The 148 symptomatic men and women with PAD were characterized on the endothelial effects of circulating factors present in the sera by a cell culture-based bioassay on primary human arterial endothelial cells. Patients were further evaluated by circulating inflammatory and vascular biomarkers, physical examination and medical history, exercise performance, and calf muscle StO 2 during exercise, and ambulatory activity was monitored during 1 week. Results Cellular ROS production was higher in African American women than in men ( P = .021), but there was no gender difference in white individuals ( P = .537). Men and women were not significantly different on endothelial cell apoptosis ( P = .833) and nuclear factor κB activity ( P = .465). For circulating factors, additional gender differences were found when comparisons were made within each race. In African Americans, women had higher intercellular adhesion molecule 1 ( P = .022) and leptin ( P < .001); whereas in white individuals, women had higher matrix metallopeptidase 9 ( P = .047), higher vascular cell adhesion molecule 1 ( P = .047), and lower hepatocyte growth factor ( P = .046). Overall, women had higher apolipoprotein CIII ( P = .035), lower pain-free distance ( P = .048) and total distance ( P < .001) during the 6-minute walk test, shorter time for calf muscle StO 2 to reach the minimum value during exercise ( P = .027), and slower average cadence ( P = .004) during daily ambulation. Conclusions African American women with symptomatic PAD have a heightened oxidative status, likely resulting in increased endothelial oxidative stress, compared with men. Furthermore, women exhibit a more pronounced proinflammatory profile of circulating biomarkers as well as more limited peripheral microcirculation, exercise performance, and ambulatory activity than men do. The clinical significance is that women with symptomatic PAD are in greater need than men of clinical intervention to improve oxidative stress, inflammation, and microcirculation, which may in turn have a favorable impact on their lower exercise performance and daily activity. [ABSTRACT FROM AUTHOR]

Background: It is not clear whether subgroups of patients with peripheral artery disease (PAD) and claudication respond more favorably to exercise rehabilitation than others. We determined whether sex and diabetes were factors associated with the response to exercise rehabilitation in patients with claudication. Methods: Eighty patients were randomized to home-based and supervised exercise programs, and 60 finished with complete exercise intervention data. Exercise consisted of intermittent walking to near maximal claudication pain for 3 months. Primary outcome measures included claudication onset time (COT) and peak walking time. Patients were partitioned into diabetic and nondiabetic groups and then further partitioned by sex to form four groups. Results: Overall, exercise adherence was high (84%), and there was no significant difference (P > .05) in the amount of exercise completed among the four groups. All groups had significant improvements (P < .05) in COT and peak walking time after exercise rehabilitation, except for diabetic women (P > .05). Only 37% of women with diabetes had an increase in COT compared with 100% of men with diabetes (P < .01), and their risk ratio for nonresponse was 9.2 (P < .0001). Conclusions: Women with PAD and claudication, particularly those with diabetes, represent a vulnerable subgroup of patients who respond poorly to a program of exercise rehabilitation. Diabetic women with PAD and claudication may need a greater dose of exercise or another intervention separate from or in combination with exercise to elicit improvements in claudication measures that are similar to nondiabetic women and to diabetic and nondiabetic men. [Copyright &y& Elsevier]

Abstract: Objective: To compare arterial elasticity in children, adolescents, and young adults with and without metabolic syndrome (MetS), and to assess which MetS components, demographic measures, and body composition measures are associated with arterial elasticity. Materials/Methods: Two-hundred six subjects (107 females and 99 males) between the ages of 10 and 20years were recruited by local newspaper advertisements, university email advertisements, and informational flyers. Subjects were assessed on MetS components, demographic measures, body composition measures, and arterial elasticity via radial tonometry. Forty-five subjects (22%) had MetS, as defined by the International Diabetes Federation, and 161 subjects (78%) did not. Results: The primary novel finding was that group differences were not observed for large artery elasticity index (LAEI) (MetS=16.1±4.4 (ml×mmHg−1)×10 (mean±SD), control=15.4±4.9, (ml×mmHg−1)×10, p=0.349), and small artery elasticity index (SAEI) (MetS=9.2±2.7 (ml×mmHg−1)×100, control=8.4±2.9, (ml×mmHg−1)×100, p=0.063). In the MetS group, fat free mass was positively associated with arterial elasticity, and was the strongest multivariate predictor of LAEI (partial R2 =0.41) and SAEI (partial R2 =0.29). Conclusions: Youth with MetS did not exhibit differences in LAEI and SAEI compared to controls. Furthermore, fat free mass of youth with MetS was positively associated with arterial elasticity, and was the strongest predictor of both LAEI and SAEI. The clinical implication is that exercise intervention designed to increase fat free mass might increase arterial elasticity in youth, particularly in youth with MetS. [Copyright &y& Elsevier]

Background: This study compared calf muscle hemoglobin oxygen saturation (Sto 2) and exercise performance during standardized treadmill exercise in patients with peripheral artery disease (PAD) who describe different types of exertional leg pain and compared secondary outcomes consisting of daily ambulatory activity and exercise performance during a 6-minute walk test (6MWT). Methods: Leg pain symptoms were evaluated in 114 patients with PAD using the San Diego Claudication Questionnaire, by which atypical exertional leg pain was defined in 31, claudication in 37, and leg pain on exertion and rest in 46. Patients were evaluated on a standardized, graded treadmill test during which calf muscle Sto 2 was continuously monitored. The 6MWT distance, Walking Impairment Questionnaire (WIQ), and ambulatory activity were monitored during 1 week. Results: All patients experienced symptoms during the treadmill test consistent with claudication. The groups were not significantly different on the primary outcomes of time to reach the minimum calf muscle Sto 2 (P = .350) or peak walking time (P = .238) during treadmill exercise. Patients with atypical leg pain had the highest daily ambulatory activity for total strides per day (P = .032), average daily cadence (P = .010), maximum cadences for durations between 5 minutes (P = .035) and 60 minutes (P = .029), speed score on the WIQ (P = .006), and lowest rating of perceived exertion at the end of the 6MWT (P = .017). Conclusions: PAD patients with atypical leg pain have vascular-mediated limitations in exercise performance during standardized treadmill testing similar to patients with claudication and patients with leg pain on exertion and rest but have higher levels of daily ambulatory activity in the community setting and higher perceived ambulatory function. [ABSTRACT FROM AUTHOR]

Background: This prospective, randomized controlled clinical trial determined whether an optimal exercise program length exists to efficaciously change claudication onset time (COT) and peak walking time (PWT) in patients with peripheral artery disease and claudication. Methods: The study randomized 142 patients to supervised exercise (n = 106) or a usual care control group (n = 36), with 80 completing the exercise program and 27 completing the control intervention. The exercise program consisted of intermittent walking to nearly maximal claudication pain 3 days per week. COT and PWT were the primary outcomes obtained from a treadmill exercise test at baseline and bimonthly during the study. Results: After exercise, changes in COT (P < .001) and PWT (P < .001) were consistently greater than changes after the control intervention. In the exercise program, COT and PWT increased from baseline to month 2 (P < .05) and from months 2 to 4 (P < .05) but did not significantly change from months 4 to 6 (P > .05). When changes were expressed per mile walked during the first 2 months, middle 2 months, and final 2 months of exercise, COT and PWT only increased during the first 2 months (P < .05). Conclusions: Exercise-mediated gains in COT and PWT occur rapidly within the first 2 months of exercise rehabilitation and are maintained with further training. The clinical significance is that a relatively short 2-month exercise program may be preferred to a longer program to treat claudication because adherence is higher, costs associated with personnel and use of facilities are lower per patient, and more patients can be trained for a given amount of personnel time and resource utilization. [Copyright &y& Elsevier]

Objective: Arteriovenous fistulas (AVFs) are the preferred choice for hemodialysis vascular access (AV access); however, there is debate over the utility of AVFs in older patients, particularly concerning access maturation and functionality. We reviewed our AV access experience in patients ≥65 years of age. Methods: We analyzed consecutive AV access patients ≥65 years old with access operations between March 2003 and December 2009. All patients had ultrasound vessel mapping. In addition to overall outcomes review, the data for patients ≥65 years old were stratified into three 10-year increments by age for further analysis. We compared functional patency data for our older patients with those of our non-elderly patients aged 21 to 64 years treated during the same time period. Results: Four hundred sixty-one consecutive AV access patients new to our practice were included in this study. Ages were 65 to 94 years (mean, 73 years). Two hundred thirty-six (51.2%) were female, 276 (59.9%) patients were diabetic, and 103 (22.3%) were obese. One hundred seven (23.2%) patients had previous access operations. Radiocephalic AVFs were constructed in 29 (6.3%) patients, 99 (21.5%) patients had brachial artery inflow AVFs, 330 (71.6%) had proximal radial artery AVFs, and three were based on the femoral artery. Transposition AVFs were used in 124 (26.9%) patients. No grafts were used for AV access in any patient during the study period. Time to AVF use was 0.5 to 6 months (mean, 1.5 months). Primary, primary assisted, and cumulative patency for patients aged 65 to 94 years were 59.9%, 93.7%, and 96.9% at 12 months and 45.3%, 90.1%, and 94.6% at 24 months, respectively. Follow-up was 1.5 to 77 months (mean, 17.0 months). Subgroup age stratification (65-74 [n = 268], 75-84 [n = 167], 85-94 [n = 26] years) found no statistical difference in functional access outcomes. Primary, primary assisted, and cumulative patency rates were not statistically different in the elderly and non-elderly populations (P = .29, .27, and .37, respectively). One hundred fifty-six patients died during the study period, 1.3 to 61 months (mean, 20 months) after access creation. No deaths were related to access operations. Conclusions: AVFs are feasible and offer functional and timely AV access in older patients. There was no difference in functional access outcomes for older patients with subgroup age stratification. AVF patency rates were not statistically different in the elderly and non-elderly populations. Cumulative AVF patency for patients ≥65 years of age was 96.9% at 12 months and 94.6% at 24 months. [Copyright &y& Elsevier]

Objectives To compare the pattern of daily ambulatory activity in men and women with intermittent claudication, and to determine whether calf muscle hemoglobin oxygen saturation (StO 2 ) is associated with daily ambulatory activity. Methods Forty men and 41 women with peripheral arterial disease limited by intermittent claudication were assessed on their community-based ambulatory activity patterns for 1 week with an ankle-mounted step activity monitor and on calf muscle StO 2 during a treadmill test. Results Women had lower adjusted daily maximal cadence (mean ± SE) for 5 continuous minutes of ambulation (26.2 ± 1.2 strides/min vs 31.0 ± 1.2 strides/min; P = .009), for 1 minute of ambulation (43.1 ± 0.9 strides/min vs 47.2 ± 0.9 strides/min; P = .004), and for intermittent ambulation determined by the peak activity index (26.3 ± 1.2 strides/min vs 31.0 ± 1.2 strides/min; P = .009). Women also had lower adjusted time to minimum calf muscle StO 2 during exercise ( P = .048), which was positively associated with maximal cadence for 5 continuous minutes ( r = 0.51; P < .01), maximal cadence for 1 minute ( r = 0.42; P < .05), and peak activity index ( r = 0.44; P < .05). These associations were not significant in men. Conclusion Women with intermittent claudication ambulate slower in the community setting than men, particularly for short continuous durations of up to 5 minutes and during intermittent ambulation at peak cadences. Furthermore, the daily ambulatory cadences of women are correlated with their calf muscle StO 2 during exercise, as women who walk slower in the community setting reach their minimum calf muscle StO 2 sooner than those who walk at faster paces. Women with intermittent claudication should be encouraged to not only walk more on a daily basis, but to do so at a pace that is faster than their preferred speed. [ABSTRACT FROM AUTHOR]

Objective: To assess the gender and ethnic differences in arterial compliance in patients with intermittent claudication. Methods: A total of 114 patients participated, including 38 Caucasian men, 32 Caucasian women, 16 African American men, and 28 African American women. Patients were assessed on large artery elasticity index (LAEI), small artery elasticity index (SAEI), age, weight, body mass index, ankle-brachial index (ABI), smoking status, and metabolic syndrome components. Results: Group differences were found for LAEI (P = .042), SAEI (P = .019), body mass index (P = .020), prevalence of elevated fasting glucose (P = .001), and prevalence of abdominal obesity (P = .025). Significant covariates for LAEI included age (P = .0002) and elevated triglycerides (P = .0719). LAEI (units = 10 mL × mm Hg) adjusted for age and triglycerides was 39% lower (P = .0005) in African Americans (11.4 ± .90; mean ± SE) than in Caucasians (15.8 ± 0.72), whereas no significant difference (P = .7904) existed between men (13.8 ± 0.81) and women (13.5 ± 0.79). Significant covariates for SAEI included age (P = .0001), abdominal obesity (P = .0030), and elevated blood pressure (P = .0067). SAEI (units = 100 mL × mm Hg) adjusted for age, abdominal obesity, and elevated blood pressure was 32% lower (P = .0007) in African-Americans (2.8 ± 0.3) than in Caucasians 4.1 ± 0.2), and was 18% lower (P = .0442) in women (3.1 ± 0.2) than in men (3.8 ± 0.2). Conclusion: African American patients with intermittent claudication have more impaired macrovascular and microvascular function than Caucasian patients, and women have more impaired microvascular function than men. These ethnic and gender differences in arterial compliance are evident even though ABI was similar among groups, suggesting that arterial compliance provides unique information to quantify vascular impairment in patients with intermittent claudication. [Copyright &y& Elsevier]

Purposes: We tested the hypotheses that women have greater impairment in calf muscle hemoglobin oxygen saturation (StO2) in response to exercise than men, and that the sex-related difference in calf muscle StO2 would partially explain the shorter claudication distances of women. Methods: The study comprised 27 men and 24 women with peripheral arterial disease limited by intermittent claudication. Patients were characterized on calf muscle StO2 before, during, and after a graded treadmill test, as well as on demographic and cardiovascular risk factors, ankle-brachial index (ABI), ischemic window, initial claudication distance (ICD), and absolute claudication distance (ACD). Results: Women had a 45% lower ACD than men (296 ± 268 m vs 539 ± 288 m; P = .001) during the treadmill test. Calf muscle StO2 declined more rapidly during exercise in women than in men; the time to reach minimum StO2 occurred 54% sooner in women (226 ± 241 vs 491 ± 426 seconds; P = .010). The recovery time for calf muscle StO2 to reach the resting value after treadmill exercise was prolonged in women (383 ± 365 vs 201 ± 206 seconds; P = .036). Predictors of ACD included the time from start of exercise to minimum calf muscle StO2, the average rate of decline in StO2 from rest to minimum StO2 value, the recovery half-time of StO2, and ABI (R 2 = 0.70; P < .001). The ACD of women remained lower after adjusting for ABI (mean difference, 209 m; P = .003), but was no longer significantly lower (mean difference, 72 m; P = .132) after further adjustment for the StO2 variables for the three calf muscles. Conclusion: In patients limited by intermittent claudication, women have lower ACD and greater impairment in calf muscle StO2 during and after exercise than men, the exercise-mediated changes in calf muscle StO2 are predictive of ACD, and women have similar ACD as men after adjusting for calf StO2 and ABI measures. [Copyright &y& Elsevier]

Purpose: This study was conducted to determine the association between the characteristics of calf muscle hemoglobin oxygen saturation (StO2) and exercise performance in patients with intermittent claudication. Methods: The study comprised 39 patients with peripheral arterial disease limited by intermittent claudication. Patients were characterized on calf muscle StO2 before, during, and after a graded treadmill test, as well as on demographic and cardiovascular risk factors, ankle-brachial index (ABI), ischemic window, initial claudication distance (ICD), and absolute claudication distance (ACD). Results: Calf muscle StO2 decreased 72%, from 55% ± 18% (mean ± SD) saturation at rest to the minimum value of 17% ± 19% saturation attained 459 ± 380 seconds after the initiation of exercise. After exercise, recovery half-time of calf muscle StO2 was attained at 129 ± 98 seconds, whereas full recovery to the resting value was reached at 225 ± 140 seconds. After adjusting for sex, race, and grouping according to the initial decline constant in calf muscle StO2 during exercise, the exercise time to minimum calf muscle StO2 was correlated with the ischemic window (r = −0.493, P = .002), ICD (r = 0.339, P = .043), and ACD (r = 0.680, P < .001). After treadmill exercise, the recovery half-time of calf muscle StO2 was correlated with the ischemic window (r = 0.531, P < .001), ICD (r = −0.598, P < .001), and ACD (r = −0.491, P = .003). Conclusion: In patients limited by intermittent claudication, shorter ICD and ACD values are associated with reaching a minimum value in calf muscle StO2 sooner during treadmill exercise and with having a delayed recovery in calf muscle StO2 after exercise. [Copyright &y& Elsevier]

Objective: We examined whether all-cause mortality was predicted by physical activity level in peripheral arterial disease (PAD) patients limited by intermittent claudication. Methods: This retrospective, natural history follow-up study determined survival status of each patient. Patients with stable symptoms of intermittent claudication were evaluated in the Geriatrics, Research, Education, and Clinical Center at the Maryland Veterans Affairs Health Care System (MVAHCS) at Baltimore between 1994 and 2002, and were classified into a physically sedentary group (n = 299) or a physically active group (n =135), and followed in 2004 using the Social Security Death Index. Results: Median follow-up was 5.33 years (range = 0.25 to 8.33 years) for the physically active group, and 5.0 years (range = 0.17 to 8.5 years) for the sedentary group. At follow-up, 108 patients (24.9%) had died, consisting of 86 (28.8%) in the sedentary group and 22 (16.3%) in the active group. Unadjusted risk of mortality was lower (P = .005) in the physically active group (hazard ratio [HR] = 0.510, 95% CI = 0.319 to 0.816). In multivariate Cox proportional hazards analysis, age (HR = 1.045, 95% CI = 1.019 to 1.072, P < 0.001), body mass index (BMI) (HR = 0.943, 95% CI = 0.902 to 0.986, P = 0.009), ankle-brachial index (ABI) (HR = 0.202, 95% CI = 0.064 to 0.632, p = 0.006), and physical activity status (HR = 0.595, 95% CI = 0.370 to 0.955, P = .031) were predictors of mortality. Conclusion: Patients limited by intermittent claudication who engage in any amount of weekly physical activity beyond light intensity at baseline have a lower mortality rate than their sedentary counterparts who perform either no physical activity or only light-intensity activities. The protective effect of physical activity persists even after adjusting for other predictors of mortality, which include age, ABI, and BMI. [Copyright &y& Elsevier]

Purpose: This study was conducted to (1) examine the effect of metabolic syndrome on intermittent claudication, physical function, health-related quality of life, and peripheral circulation in patients with peripheral arterial disease (PAD), and (2) determine whether peripheral vascular function was predictive of intermittent claudication and physical function in patients with metabolic syndrome. Methods: Patients limited by intermittent claudication and who had metabolic syndrome (n = 133) were compared with those without metabolic syndrome (n = 201). Patients were assessed on metabolic syndrome characteristics, PAD-specific measures consisting of ankle/brachial index and claudication distances, physical function measures, health-related quality of life, and calf blood flow and transcutaneous oxygen tension responses after 3 minutes of vascular occlusion. Results: Initial claudication distance (mean ± SD) was 29% shorter (P = .018) in patients with metabolic syndrome than in the controls (128 ± 121 meters vs 180 ± 166 meters), and absolute claudication distance was 22% shorter (P = .025) in those with metabolic syndrome (319 ± 195 meters vs 409 ± 255 meters). Furthermore, patients with metabolic syndrome had lower peak oxygen uptake (P = .037), a shorter 6-minute walk distance (P = .027), lower values on six domains of health-related quality of life (P < .05), reduced calf hyperemia (P = .028), and greater calf ischemia (P < .001) after vascular occlusion. In the group with metabolic syndrome, calf ischemia was correlated with initial claudication distance (r = 0.30, P = .004), absolute claudication distance (r = 0.40, P < .001), and peak oxygen uptake (r = 0.52, P < .001). Conclusion: Metabolic syndrome worsens intermittent claudication, physical function, health-related quality of life, and peripheral circulation in patients with PAD. Calf ischemia in those with metabolic syndrome was predictive of intermittent claudication and physical function. The additive burden of metabolic syndrome thus places patients who are limited by intermittent claudication at an even greater risk for living a functionally dependent lifestyle. Aggressive risk-factor modification designed to treat components of metabolic syndrome should be evaluated for efficacy in modifying physical and vascular function in patients with intermittent claudication. [Copyright &y& Elsevier]

The problem addressed by this study was to determine the influences of personal and motivational factors on leisure-time physical activity (LTPA) among Native Americans (NAs). Based on Pender's Revised Health Promotion Model, the study purpose was to 1) discover the best filling and most parsimonious model that describes the relationship between LTPA and explanatory variables, and 2) to discover model differences between men and women regarding personal and motivating factors for LTPA. Only the variables of self-motivation, physical self-efficacy, and barriers were common to both men and women as an explanation for exercising behavior. The model for females correctly identified 32.3% of the non exercisers and 92.2% of the exercisers, with an overall correct identification rate of 74.3%. For the male model, corresponding values were 63.7%, 83.3%, and 74.8%. These findings suggest that variables that explain exercising behavior in the Caucasian population may also fit the Native American population. [ABSTRACT FROM AUTHOR]

Describes an electronic mail system used by the Horseheads (New York) Central School Distict's eight schools and central office that saves time and enhances productivity. This software calls up information from the district's computer network and sends it to other users' special files--electronic "mailboxes" set aside for messages and documents. (MLH)