Submaximal oxygen uptake efficiency slope as a predictor of VO2max in men with cardiovascular disease

Purpose: Although V̇O2 max is considered the gold standard measure of cardiorespiratory fitness (CRF), it can be difficult to attain in patients with cardiovascular disease (CVD). The submaximal oxygen uptake efficiency slope (OUES) integrates cardiovascular, musculoskeletal and respiratory function during incremental exercise into a single index and has been proposed as an alternative and effort independent measure of cardiopulmonary reserve (Baba et al., 1996). The purpose of this study was to examine the relation between V̇O2 max and both submaximal absolute OUES and relative OUES (OUES.kg-1). Methods: A total of 55 men ((mean ± SD) age, 59.08 ± 9.03 yr; VO2 max, 1.94 ± 0.53 L.min-1and 22.73 ± 5.95 mL.kg-1.min-1) were recruited during induction to a community based exercise referral program following completion of phase 2 cardiac rehabilitation. Participants performed a graded exercise test on a cycle ergometer with breath-by-breath open circuit spirometry and a 12 lead ECG. Absolute OUES and OUES.kg-1 were calculated by plotting VO2 in mL.min-1 on the x-axis, and the log transformed VE on the y-axis (VO2 = a log 10 VE + b). Exercise data up to the ventilatory anaerobic threshold (VAT) was included in the analysis. Results: The %V̇O2 max corresponding to the VAT was 55.72 ± 11.81. Absolute OUES and OUES.kg-1 were 2164.42 ± 540.96 and 25.28 ± 5.99, respectively. There was a significant positive correlation between V̇O2 max (L.min-1) and OUES (r= 0.775; p<0.001) and between V̇O2 max (mL.kg-1.min-1) and OUES.kg-1 (r= 0.78; p<0.001). Conclusion: Determination of V̇O2 max is not often feasible in individuals with CVD where maximal exercise testing is contraindicated or when performance may be impaired by pain, dyspnea or angina. The findings from the present study indicate that the OUES and OUES.kg-1 are significantly related to absolute and relative V̇O2 max, respectively and may be used as a valid sub maximal effort independent measure of CRF

Relation between physical activity and oxygen uptake efficiency in men with CVD

Purpose: The oxygen uptake efficiency slope (OUES) represents the rate of increase in V̇O2 in response to a given V̇E during incremental exercise, indicating how effectively oxygen is taken in by the lungs, transported and used in the periphery. OUES, calculated using only submaximal exercise data is identical to the OUES calculated over the entire duration of a cardiopulmonary exercise test (CEPT) , and both maximal and submaximal OUE are significantly related to cardiorespiratory fitness (CRF) measured as V̇O2peak. Currently, little research has been published on how physical activity (PA) assessed by accelerometers is related to submaximal and maximal OUES. The purpose of this study was to determine the relation light (LIPA), moderate (MIPA) and vigorous (VIPA) intensity physical activity and maximal and submaximal OUES in men with cardiovascular disease (CVD). Methods: A total of 56 men (mean ( SD): age of 59.3 ± 9.2 yr., V̇O2 peak (L/min) 2.0 0.50, V̇O2 peak (mL/kg/min) 23.6 5.8, were recruited during an induction to a community-based exercise referral program following completion of phase 2 cardiac rehabilitation program. Participants underwent a graded exercise test on a cycle ergometer with breath by breath open circuit spirometry after which they wore a wrist worn accelerometer (Actigraph) for 7 d. Absolute and relative submaximal and maximal OUES were calculated by plotting V̇O2 in mL/min on the x axis, and the log transformed VE on the y axis (V̇O2 = a log 10 VE + b). Exercise data up to the ventilatory anaerobic threshold and maximal exercise were used to calculate submaximal and maximal OUE, respectively. Results: Participants performed 584.49 73.87 min of daily LIPA, 145.45 60.85 min of MIPA and no daily min of VIPA. There was a significant relation between absolute submaximal OUES (r=0.386; p<0.01), submaximal OUES/Kg (r=0.296; p<0.05) and LIPA. There was a significant relation between maximal OUES (r=0.286; p<0.05), maximal OUES/Kg (r=0.279; p<0.05) and MIPA. Conclusion: Submaximal and maximal OUE are related to levels of LIPA and MIPA, respectively. Submaximal OUES can potentially be used as an objective, effort independent test to estimate LIPA levels among men with CVD

Physical activity patterns and cardiorespiratory fitness in men with cardiovascular disease

Purpose: Cardiorespiratory fitness (CRF) is generally regarded as an objective and reproducible measure of recent habitual physical activity (PA). Considering that the majority of daily PA is performed at light intensity, it is likely that CRF benefits will be detected at submaximal rather than maximal exercise. The purpose of this study was to evaluate daily minutes of light (LIPA), moderate (MIPA) and vigorous (VIPA) intensity physical activity among men with cardiovascular disease (CVD), and to determine the relation between PA and submaximal (oxygen uptake efficiency slope (OUES)) and maximal (V̇O2 peak) indices of CRF. Methods: A total 32 male participants (mean ( SD): age of 60.0 ± 8.7 yr, V̇O2 peak (L/min) 2.0 0.45, V̇O2 peak (mL/kg/min) 23.3 5.7, were recruited during an induction to a community based exercise referral program following completion of phase 2 cardiac rehabilitation. Participants underwent a graded exercise test on a cycle ergometer with breath by breath open circuit spirometry after which they wore a wrist worn accelerometer (Actigraph) for 7 d. Absolute and relative submaximal OUES were calculated by plotting V̇O2 in mL/min on the x axis, and the log transformed VE on the y axis (V̇O2 = a log 10 VE + b). Exercise data up to the ventilatory anaerobic threshold was included in the analysis. Results: Participants performed 589.05 69.41 min of daily LIPA, 161.38 66.16 min of MIPA and no daily min of VIPA. There was no significant relation between peak V̇O2 and either LIPA or MIPA. There was a significant correlation between submaximal OUES (r=0.44; p<0.01) and LIPA. The relation between submaximal OUES/kg and LIPA min almost reached statistical significance (r=0.33; p<0.07). There was no significant relation between MIPA and OUES or OUES/kg. Conclusion: Men with CVD spend the majority (78%) of their day performing LIPA. OUES, a submaximal measure of CRF was related LIPA whereas no relation was found between V̇O2 peak and LIPA

Integrating testing for sexually transmissible infections into annual health assessments for Aboriginal and Torres Strait Islander young people: a cross-sectional analysis

Background In the context of an expanding syphilis epidemic, we assessed the integration of sexually transmissible infection (STI) testing within annual health assessments for Aboriginal and Torres Strait Islander young people aged 16–29 years in Aboriginal Community Controlled Health Services between 2018 and 2020. Methods Using routinely collected electronic medical record data from a national sentinel surveillance system (ATLAS), we performed a cross-sectional analysis to calculate the proportion of assessments that integrated any or all of the tests for chlamydia, gonorrhoea, syphilis, and HIV. We used logistic regression to identify correlates of integration of any STI test. Results Of the13 892 assessments, 23.8% (95% CI 23.1, 24.6) integrated a test for any STI and 11.5% (95% CI 10.9, 12.0) included all four STIs. Of assessments that included a chlamydia/gonorrhoea test, 66.9% concurrently included a syphilis test. Integration of any STI test was associated with patients aged 20–24 years (OR 1.2, 95% CI 1.1–1.4) and 25–29 years (OR 1.1, 95% CI 1.0–1.2) compared to 16–19 years and patients residing in very remote (OR 4.2, 95% CI 3.7–4.8), remote (OR 2.4, 95% CI 2.1–2.8), and regional areas (OR 2.5, 95% CI 2.2–2.8) compared to metropolitan areas. There was no association with patient sex. Conclusions Integration of STI testing into annual health assessments for Aboriginal and Torres Strait Islander young people was higher in remote areas where disease burden is greatest. Integration is similar in men and women, which contrasts with most studies that have found higher testing in women

Remote Aboriginal-led primary care services integrate testing for sexually transmitted infections into comprehensive annual preventive health assessments in regions with highest prevalence

Top Abstracts of the Joint Australasian Sexual Health and HIV & AIDS Conferences, Held 29 August-1 September 2022 at the Sunshine Coast Convention Centre

Motherhood Together: Effects of an Adapted Prenatal Curriculum on Mother and Infant Outcomes

Background: Research shows that pregnant women experiencing housing insecurity are more likely to face barriers to prenatal care that can lead to negative health outcomes for both mother and infant. Previous studies have also shown that prenatal education programs provide pregnant mothers with the knowledge and resources that increase the likelihood of positive health outcomes. An interprofessional healthcare team in Central Arkansas modified an existing prenatal education program to create Motherhood Together, a program specifically tailored for pregnant women facing house insecurity. Methods: The purpose of this initial evaluation of the Motherhood Together program was to identify the feasibility of the program and preliminary outcomes. This evaluation sought to better understand the demographic composition of the population participating in Motherhood Together (n = 19), as well as the effect of the program on infant outcomes, health literacy, and maternal self-care. The overall participant experience and feedback to enhance the program was also obtained. Results: The average age of participants was 24.6 years old and 77.8% reported high school as their highest level of educational attainment. The majority of participants identified as Black/African American (77.8%) and 22.2% identified as White. Participants scored the experience of Motherhood Together sessions positively with an overall score of 3.75/4.00. Participants reported an average gestational age at delivery being 36.9 weeks with 25% reporting preterm births following the program. Multivitamins were reported as being taken by 100% of participants following participation. Conclusion: Tailoring the pre-existing educational program to create the Motherhood Together program was clearly feasible and continues to serve as a critical resource for improving equity in infant and maternal outcomes in central Arkansas

How are nitrogen availability, fine-root mass, and nitrogen uptake related empirically? Implications for models and theory

We gratefully acknowledge funding from Loyola University Chicago; suggestions for improvement by David Robinson and anonymous peer reviewers; logistical support from K. Erickson; help with maintenance and harvests from O. Urbanski, L. Papaioannou, H. Roudebush, & V. Roudebush; and tissue and substrate analyses from Z. Zhu. The authors have no conflicts of interest to report.Peer reviewedPostprin

The vitamin D binding protein axis modifies disease severity in lymphangioleiomyomatosis

Background: Lymphangioleiomyomatosis (LAM) is a rare disease of women. Decline in lung function is variable making appropriate targeting of therapy difficult. We used unbiased serum proteomics to identify markers associated with outcome in LAM.Methods: 101 women with LAM and 22 healthy controls were recruited from the National Centre for LAM (Nottingham, UK). 152 DNA and serum samples with linked lung function and outcome data were obtained from patients in the NHLBI LAM Registry (USA). Proteomic analysis was performed on a discovery cohort of 50 LAM and 20 control sera using a SCIEX SWATH mass spectrometric workflow. Protein levels were quantitated by ELISA and SNPs in GC encoding Vitamin D Binding Protein (VTDB) genotyped.Results: Proteomic analysis showed VTDB was 2.6 fold lower in LAM than controls. Serum VTDB was lower in progressive compared with stable LAM (p=0.001) and correlated with diffusing capacity (p=0.01). Median time to death or lung transplant was reduced by 46?months in those with CC genotypes at rs4588 and 38?months in those with non-A containing haplotypes at rs7041/4588 (p=0.014 and 0.008 respectively).Conclusions: The VTDB axis is associated with disease severity and outcome, and GC genotype could help predict transplant free survival in LAM

The TBC/RabGAP Armus Coordinates Rac1 and Rab7 Functions during Autophagy

Autophagy is an evolutionarily conserved process that enables catabolic and degradative pathways. These pathways commonly depend on vesicular transport controlled by Rabs, small GTPases inactivated by TBC/RabGAPs. The Rac1 effector TBC/RabGAP Armus (TBC1D2A) is known to inhibit Rab7, a key regulator of lysosomal function. However, the precise coordination of signaling and intracellular trafficking that regulates autophagy is poorly understood. We find that overexpression of Armus induces the accumulation of enlarged autophagosomes, while Armus depletion significantly delays autophagic flux. Upon starvation-induced autophagy, Rab7 is transiently activated. This spatiotemporal regulation of Rab7 guanosine triphosphate/guanosine diphosphate cycling occurs by Armus recruitment to autophagosomes via interaction with LC3, a core autophagy regulator. Interestingly, autophagy potently inactivates Rac1. Active Rac1 competes with LC3 for interaction with Armus and thus prevents its appropriate recruitment to autophagosomes. The precise coordination between Rac1 and Rab7 activities during starvation suggests that Armus integrates autophagy with signaling and endocytic trafficking

Implementation of child-centred outcome measures in routine paediatric healthcare practice: a systematic review

Background: Person-centred outcome measures (PCOMs) are commonly used in routine adult healthcare to measure and improve outcomes, but less attention has been paid to PCOMs in children’s services. The aim of this systematic review is to identify and synthesise existing evidence of the determinants, strategies, and mechanisms that influence the implementation of PCOMs into paediatric healthcare practice. Methods: The review was conducted and reported in accordance with PRISMA guidelines. Databased searched included CINAHL, Embase, Medline, and PsycInfo. Google scholar was also searched for grey literature on 25th March 2022. Studies were included if the setting was a children’s healthcare service, investigating the implementation or use of an outcome measure or screening tool in healthcare practice, and reported outcomes relating to use of a measure. Data were tabulated and thematically analysed through deductive coding to the constructs of the adapted-Consolidated Framework for Implementation Research (CFIR). Results were presented as a narrative synthesis, and a logic model developed. Results: We retained 69 studies, conducted across primary (n = 14), secondary (n = 13), tertiary (n = 37), and community (n = 8) healthcare settings, including both child self-report (n = 46) and parent-proxy (n = 47) measures. The most frequently reported barriers to measure implementation included staff lack of knowledge about how the measure may improve care and outcomes; the complexity of using and implementing the measure; and a lack of resources to support implementation and its continued use including funding and staff. The most frequently reported facilitators of implementation and continued use include educating and training staff and families on: how to implement and use the measure; the advantages of using PCOMs over current practice; and the benefit their use has on patient care and outcomes. The resulting logic model presents the mechanisms through which strategies can reduce the barriers to implementation and support the use of PCOMs in practice. Conclusions: These findings can be used to support the development of context-specific implementation plans through a combination of existing strategies. This will enable the implementation of PCOMs into routine paediatric healthcare practice to empower settings to better identify and improve child-centred outcomes. Trial registration: Prospero CRD 42022330013