Australian cardiac rehabilitation exercise parameter characteristics and perceptions of high-intensity interval training: a cross-sectional survey

Purpose: This study explored current demographics, characteristics, costs, evaluation methods, and outcome measures used in Australian cardiac rehabilitation (CR) programs. It also determined the actual usage and perceptions of high-intensity interval training (HIIT). Methods: A cross-sectional observational web-based survey was distributed to 328 Australian CR programs nationally. Results: A total of 261 programs completed the survey (79.6% response rate). Most Australian CR programs were located in a hospital setting (76%), offered exercise sessions once a week (52%) for 6–8 weeks (49%) at moderate intensity (54%) for 46–60 min (62%), and serviced 101–500 clients per annum (38%). HIIT was reported in only 1% of programs, and 27% of respondents believed that it was safe while 42% of respondents were unsure. Lack of staff (25%), monitoring resources (20%), and staff knowledge (18%) were the most commonly reported barriers to the implementation of HIIT. Overall, Australian CR coordinators are unsure of the cost of exercise sessions. Conclusion: There is variability in CR delivery across Australia. Only half of programs reassess outcome measures postintervention, and cost of exercise sessions is unknown. Although HIIT is recommended in international CR guidelines, it is essentially not being used in Australia and clinicians are unsure as to the safety of HIIT. Lack of resources and staff knowledge were perceived as the biggest barriers to HIIT implementation, and there are inconsistent perceptions of prescreening and monitoring requirements. This study highlights the need to educate health professionals about the benefits and safety of HIIT to improve its usage and patient outcomes

High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation:a systematic review and meta-analysis

Aerobic capacity has been shown to be inversely proportionate to cardiovascular mortality and morbidity and there is growing evidence that high-intensity interval training (HIIT) appears to be more effective than moderate-intensity continuous training (MICT) in improving cardiorespiratory fitness within the cardiac population. Previously published systematic reviews in cardiovascular disease have neither investigated the effect that the number of weeks of intervention has on cardiorespiratory fitness changes, nor have adverse events been collated.We aimed to undertake a systematic review and meta-analysis of randomized controlled trials (RCTs) within the cardiac population that investigated cardiorespiratory fitness changes resulting from HIIT versus MICT and to collate adverse events.A critical narrative synthesis and meta-analysis was conducted after systematically searching relevant databases up to July 2017. We searched for RCTs that compared cardiorespiratory fitness changes resulting from HIIT versus MICT interventions within the cardiac population.Seventeen studies, involving 953 participants (465 for HIIT and 488 for MICT) were included in the analysis. HIIT was significantly superior to MICT in improving cardiorespiratory fitness overall (SMD 0.34 mL/kg/min; 95% confidence interval [CI; 0.2-0.48]; p6-week duration. Programs of 7-12 weeks' duration resulted in the largest improvements in cardiorespiratory fitness for patients with coronary artery disease. HIIT appears to be as safe as MICT for CR participants

Fibrinogen and red blood cells in venous thrombosis

Deep vein thrombosis and pulmonary embolism, collectively termed venous thromboembolism (VTE), affect over 1 million Americans each year. VTE is triggered by inflammation and blood stasis leading to the formation of thrombi rich in fibrin and red blood cells (RBCs). However, little is known about mechanisms regulating fibrin and RBC incorporation into venous thrombi, or how these components mediate thrombus size or resolution. Both elevated circulating fibrinogen (hyperfibrinogenemia) and abnormal fibrin(ogen) structure and function, including increased fibrin network density and resistance to fibrinolysis, have been observed in plasmas from patients with VTE. Abnormalities in RBC number and/or function have also been associated with VTE risk. RBC contributions to VTE are thought to stem from their effects on blood viscosity and margination of platelets to the vessel wall. More recent studies suggest RBCs also express phosphatidylserine, support thrombin generation, and decrease fibrinolysis. RBC interactions with fibrin(ogen) and cells, including platelets and endothelial cells, may also promote thrombus formation. The contributions of fibrin(ogen) and RBCs to the pathophysiology of VTE warrants further investigation

Association between plasma neutrophil gelatinase-associated lipocalin and cardiac disease hospitalizations and deaths in older women

Background Neutrophil gelatinase-associated lipocalin ( NGAL ) or lipocalin 2 may promote atherosclerosis and plaque instability leading to increased risk of cardiac events. We investigated the relationships between plasma NGAL , cardiovascular disease biomarkers, and long-term cardiac events. Methods and Results The study population consisted of 1131 ambulant older white women (mean age 75 years) without clinical coronary heart disease ( CHD ) and measures of plasma NGAL in the Perth Longitudinal Study of Ageing Women with 14.5-year CHD and heart failure hospitalizations or death (events) captured using linked records. Over 14.5 years, 256 women had CHD events, while 118 had heart failure events. Per SD increase in log-transformed NGAL there was a 35% to 37% increase in relative hazards for CHD and heart failure events in unadjusted analyses, which remained significant after adjustment for conventional risk factors for CHD events (hazard ratio 1.29, 95% CI 1.13-1.48, P0.05). Women in the highest 2 quartiles of NGAL had higher relative hazards for CHD events compared with women in the lowest quartile hazard ratio 1.61, 95% CI 1.08-2.39, P=0.019 and hazard ratio 1.97, 95% CI 1.33-3.93, P=0.001, respectively. These associations were independent of high-sensitivity cardiac troponin I, homocysteine, and estimated renal function. NGAL correctly reclassified 1 in 4 women who sustained a CHD event up in risk and 1 in 10 women without CHD events down in risk. Conclusions NGAL was associated with increased risk of long-term CHD events, independent of conventional risk factors and biomarkers. These findings provide mechanistic insight into the role of NGAL with cardiac events

Effects and Detectability of Quasi-Single Field Inflation in the Large-Scale Structure and Cosmic Microwave Background

Quasi-single field inflation predicts a peculiar momentum dependence in the squeezed limit of the primordial bispectrum which smoothly interpolates between the local and equilateral models. This dependence is directly related to the mass of the isocurvatons in the theory which is determined by the supersymmetry. Therefore, in the event of detection of a non-zero primordial bispectrum, additional constraints on the parameter controlling the momentum-dependence in the squeezed limit becomes an important question. We explore the effects of these non-Gaussian initial conditions on large-scale structure and the cosmic microwave background, with particular attention to the galaxy power spectrum at large scales and scale-dependence corrections to galaxy bias. We determine the simultaneous constraints on the two parameters describing the QSF bispectrum that we can expect from upcoming large-scale structure and cosmic microwave background observations. We find that for relatively large values of the non-Gaussian amplitude parameters, but still well within current uncertainties, galaxy power spectrum measurements will be able to distinguish the QSF scenario from the predictions of the local model. A CMB likelihood analysis, as well as Fisher matrix analysis, shows that there is also a range of parameter values for which Planck data may be able distinguish between QSF models and the related local and equilateral shapes. Given the different observational weightings of the CMB and LSS results, degeneracies can be significantly reduced in a joint analysis.Comment: 27 pages, 14 figure

Non-gaussianity from the inflationary trispectrum

We present an estimate for the non-linear parameter \tau_NL, which measures the non-gaussianity imprinted in the trispectrum of the comoving curvature perturbation, \zeta. Our estimate is valid throughout the inflationary era, until the slow-roll approximation breaks down, and takes into account the evolution of perturbations on superhorizon scales. We find that the non-gaussianity is always small if the field values at the end of inflation are negligible when compared to their values at horizon crossing. Under the same assumption, we show that in Nflation-type scenarios, where the potential is a sum of monomials, the non-gaussianity measured by \tau_NL is independent of the couplings and initial conditions.Comment: 15 pages, uses iopart.sty. Replaced with version accepted by JCAP; journal reference adde

Whole Genome Sequence Analysis of Cryptococcus gattii from the Pacific Northwest Reveals Unexpected Diversity

A recent emergence of Cryptococcus gattii in the Pacific Northwest involves strains that fall into three primarily clonal molecular subtypes: VGIIa, VGIIb and VGIIc. Multilocus sequence typing (MLST) and variable number tandem repeat analysis appear to identify little diversity within these molecular subtypes. Given the apparent expansion of these subtypes into new geographic areas and their ability to cause disease in immunocompetent individuals, differentiation of isolates belonging to these subtypes could be very important from a public health perspective. We used whole genome sequence typing (WGST) to perform fine-scale phylogenetic analysis on 20 C. gattii isolates, 18 of which are from the VGII molecular type largely responsible for the Pacific Northwest emergence. Analysis both including and excluding (289,586 SNPs and 56,845 SNPs, respectively) molecular types VGI and VGIII isolates resulted in phylogenetic reconstructions consistent, for the most part, with MLST analysis but with far greater resolution among isolates. The WGST analysis presented here resulted in identification of over 100 SNPs among eight VGIIc isolates as well as unique genotypes for each of the VGIIa, VGIIb and VGIIc isolates. Similar levels of genetic diversity were found within each of the molecular subtype isolates, despite the fact that the VGIIb clade is thought to have emerged much earlier. The analysis presented here is the first multi-genome WGST study to focus on the C. gattii molecular subtypes involved in the Pacific Northwest emergence and describes the tools that will further our understanding of this emerging pathogen