Effects of pulmonary rehabilitation on cardiac magnetic resonance parameters in patients with persistent dyspnea following pulmonary embolism

Background: Persistent dyspnea and reduced exercise capacity is common in pulmonary embolism (PE) survivors. Although improved right ventricular function after pulmonary rehabilitation has been demonstrated in chronic thromboembolic pulmonary hypertension, it is still unknown whether a similar effect also occurs in other patients with dyspnea after pulmonary embolism.Purpose: The aim of this study was to explore potential effects of a pulmonary rehabilitation program on cardiac structure and function as assessed with cardiac magnetic resonance (CMR).Material and methods: Twenty-six PE survivors with persistent dyspnea were included. Right and left ventricular assessment with CMR was performed before and after an eight-week pulmonary rehabilitation program.Results: Dyspnea as measured by the Shortness of Breath Questionnaire improved significantly after rehabilitation: 15 (IQR: 7-31) versus 8 (IQR: 3-17). Absolute right ventricular global longitudinal strain by CMR was reduced from 19% to 18% (95% CI of difference: 0-3 percent points), and absolute RV lateral strain from 26% to 24% (95% CI of difference: 1-4 percent points). Right ventricular mass was reduced after rehabilitation from 49 g to 44 g (95% CI of difference: 2-8 g).Conclusion: Although there was a substantial improvement in dyspnea after rehabilitation, we found only a minor reduction in absolute right ventricular longitudinal strain and right ventricular mass. No other CMR parameter changed. We therefore suggest that rehabilitation effect of in this patient group was not primarily mediated by cardiac adaptions.Thrombosis and Hemostasi

Effects of pulmonary rehabilitation on cardiac magnetic resonance parameters in patients with persistent dyspnea following pulmonary embolism

Background: Persistent dyspnea and reduced exercise capacity is common in pulmonary embolism (PE) survivors. Although improved right ventricular function after pulmonary rehabilitation has been demonstrated in chronic thromboembolic pulmonary hypertension, it is still unknown whether a similar effect also occurs in other patients with dyspnea after pulmonary embolism.Purpose: The aim of this study was to explore potential effects of a pulmonary rehabilitation program on cardiac structure and function as assessed with cardiac magnetic resonance (CMR).Material and methods: Twenty-six PE survivors with persistent dyspnea were included. Right and left ventricular assessment with CMR was performed before and after an eight-week pulmonary rehabilitation program.Results: Dyspnea as measured by the Shortness of Breath Questionnaire improved significantly after rehabilitation: 15 (IQR: 7-31) versus 8 (IQR: 3-17). Absolute right ventricular global longitudinal strain by CMR was reduced from 19% to 18% (95% CI of difference: 0-3 percent points), and absolute RV lateral strain from 26% to 24% (95% CI of difference: 1-4 percent points). Right ventricular mass was reduced after rehabilitation from 49 g to 44 g (95% CI of difference: 2-8 g).Conclusion: Although there was a substantial improvement in dyspnea after rehabilitation, we found only a minor reduction in absolute right ventricular longitudinal strain and right ventricular mass. No other CMR parameter changed. We therefore suggest that rehabilitation effect of in this patient group was not primarily mediated by cardiac adaptions

National parks policy and planning: a comparative analysis of friluftsliv (Norway) and the dual mandate (New Zealand)

This is an original manuscript / preprint of an article published by Taylor & Francis in Journal of Policy Research in Tourism, Leisure and Events on 26.02.2016, available online: http://www.tandfonline.com/10.1080/19407963.2016.1145688.Conservation management in Norway is anchored in the historical tradition of friluftsliv although Norway's evolving economic policy signals that growing priority is being given to recreation and nature-based tourism development in association with protected natural areas (PNAs). Here we present the results of an international comparative study that examined conservation policy and recreation/tourism management in Norway and New Zealand, where a legislated dual mandate of conservation and tourism in PNAs is longstanding. Our analysis of conservation policy and planning documents in Norway and New Zealand highlights important contrasts in conservation and recreation/tourism management that are deeply embedded in national socio-historical contexts. Our findings highlight lessons that may be learned and applied in Norway. However we also caution that the application of lessons from New Zealand's ‘utilitarian conservation’ policy context may require a reformulation or refinement of the friluftsliv tradition.submittedVersio

Angiostoma norvegicum n. sp. (Nematoda:Angiostomatidae) a parasite of arionid slugs in Norway

This study was funded by the Research Council of Norway (Yggdrasil Grant No. 210948 and project number 803194) and by the Russian Foundation for Basic Research (RFBR) (Grant No. 14-04-01513). Open access through Springer Compact AgreementPeer reviewedPublisher PD