2018 – 2019 Kentucky Agricultural Economic Situation and Outlook

This publication covers the situation and outlook for 2018-2019 in the following areas: U.S. Agricultural Economy; Kentucky’s Agricultural Economy; Selected Commodity Profiles - Cattle; Poultry; Hogs; Equine; Dairy; Corn; Soybeans; Wheat; Tobacco; Fruits, Vegetables and Greenhouse; and Forestry

A Novel Waveform to Extract Exercise Gas Exchange Response Dynamics: The Chirp Waveform

Characterizing exercise gas exchange response dynamics reveals important information about physiological control processes and cardiopulmonary dysfunction. However, current methods for extracting exercise response dynamics typically use multiple step-wise transitions, limiting applicability of this technique. PURPOSE: We designed a new protocol (chirp waveform) to extract exercise gas exchange response dynamics in a single visit. We tested the hypothesis that gas exchange response dynamics extracted from chirp forcing would be similar to those extracted from step-wise transitions. METHODS: Thirty-one participants (14 young healthy, 7 older healthy, and 10 patients with chronic obstructive pulmonary disease) visited the laboratory on three occasions. On visit 1, participants performed a ramp incremental test to determine the gas exchange threshold (GET). On visits 2-3, participants performed either a chirp or step-wise protocol in a randomized order. Chirp forcing consisted of sinusoidal fluctuations in work rate with constant amplitude and progressive shortening of sine periods. Square protocol consisted of 3 square-wave transitions each of 6 min duration. Work rate amplitude (from 20 W to ~95% of the individual’s GET) and exercise duration (30 min) were the same in both protocols. The input-output relationship was characterized using a first-order linear transfer function containing a system gain (K) and time constant (τ) [G(s)= K/(τ×s+1)]. Parameter identification was performed in Matlab using the Matlab System Identification toolbox. Agreement between measures was established using Bland-Altman analysis and Rothery’s Concordance Coefficient (RCC). RESULTS: No systematic bias (mean difference of chirp minus square-wave; Δmean) and good reliability was found for V̇O2 K [Δmean: 0.25(1.03) mL/min/W, p=0.179; RCC: 0.773, p=0.004], V̇O2 τ [Δmean: 0.30(7.08) s, p=0.815; RCC: 0.837, p2 K [Δmean: -0.19(1.57) mL/min/W, p=0.512; RCC: 0.827, pp=0.009] and good reliability (RCC: 0.794, p2 τ. CONCLUSION: The chirp waveform allows extraction of gas exchange response dynamics similar to those obtained from standard methods, thus overcoming the need for multiple tests

2016 – 2017 Kentucky Agricultural Economic Situation and Outlook

Topics: U.S. Agricultural Economy; Kentucky’s Agricultural Economy

Is a Two-Day Cardiopulmonary Exercise Test a Valid Tool for The Diagnosis of Post-Exertional Malaise in Long COVID?

A two-day cardiopulmonary exercise testing (CPET) protocol (maximal ramp-incremental cycle test repeated 24hr apart) in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients has suggested that day-2 performance is decreased relative to day-1. This difference has been attributed to post-exertional malaise (PEM), suggesting the two-day CPET as a protocol to investigate PEM in Long COVID (LC) patients. PURPOSE: We aimed to investigate any effects of PEM on exercise performance and cardiorespiratory and perceptual responses to a two-day CPET in LC patients to determine whether the day-1 CPET would impair performance, cardiorespiratory responses or perceptions of exercise at day-2. METHODS: Fifteen LC patients with one or more symptoms persisting for more than three months after their initial infection [n=7 females; n=1 hospitalized; mean(SD); age 53(11) yrs; body mass index 32.2(8.5) kg/m2; time between COVID-19 onset and CPET 13(7) months; forced expiratory volume in 1 second 89(15) %pred; forced vital capacity 92(14) %pred; diffusing capacity of the lungs for carbon monoxide 92(15) %pred; total lung capacity 86(12) %pred] were studied. Prior to any exercise testing, PEM was assessed relative to the past six months using the modified DePaul Symptom Questionnaire (mDSQ) (0-4 symptoms frequency and severity scores). Each performed a two-day CPET protocol; ramp was 10-20 W/min, with the same ramp rate used for the day-1 and day-2 CPET. Peak oxygen uptake, peak work rate, and gas exchange threshold were measured using standard techniques. Ratings of perceived dyspnea and leg effort during cycling were recorded at peak exercise using the modified Borg’s Scale (0-10). One-sample t-tests were used to assess significance of test-retest mean difference. RESULTS: The mDSQ indicated the presence of PEM symptoms in 80% of participants. However, no significant differences between day-1 and day-2 CPET were found in any of the variables assessed. CONCLUSION: The absence of any difference in cardiorespiratory and perceptual responses in 2-day CPET testing, despite patient reported presence of PEM symptoms, suggests that the two-day CPET protocol may not be a valid tool for the diagnosis of PEM in LC patients

Multiple Overimputation to Address Missing Data and Measurement Error: Application to HIV Treatment During Pregnancy and Pregnancy Outcomes

Investigations of the association of combination antiretroviral therapy (ART) with pregnancy outcomes often rely on routinely collected clinical data, which are prone to missing data and measurement error. Measurement error in gestational age may bias the relationship between combination ART and gestational age-based outcomes

A new bronchodilator response grading strategy ıdentifies distinct patient populations

Rationale: A positive bronchodilator response (BDR) according to American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines require both 200 ml and 12% increase in forced expiratory volume in 1 second (FEV1) or forced vital capacity (FVC) after bronchodilator inhalation. This dual criterion is insensitive in those with high or low FEV1. Objectives: To establish BDR criteria with volume or percentage FEV1 change. Methods: The largest FEV1 and FVC were identified fromthree pre- and three post-bronchodilator maneuvers in COPDGene (Genetic Epidemiology of COPD) participants. A total of 7,741 individuals with coefficient of variation less than 15% for both FEV1 and FVC formed bronchodilator categories of FEV1 response: negative (0.00% to 0.00 L to 9.00% to 16.00% to 0.16 L to 26.00% or >0.26 L). These response size categories are based on empirical limits considering average FEV1 increase of approximately 160 ml and the clinically important difference for FEV1. To compare flow and volume response characteristics, BDR-FEV1 category assignments were applied for the BDR-FVC response. Results: Twenty percent met mild and 31% met moderate or marked BDR-FEV1 criteria, whereas 12% met mild and 33% met moderate or marked BDR-FVC criteria. In contrast, only 20.6% met ATS/ERS positive criteria. Compared with the negative BDR-FEV1 category, the minimal, mild, moderate, and marked BDR-FEV1 categories were associated with greater 6-minute-walk distance and lower St. George's Respiratory Questionnaire and modified Medical Research Council dyspnea scale scores. Compared with negative BDR, moderate and marked BDR-FEV1 categories were associated with fewer exacerbations, and minimal BDR was associated with lower computed tomography airway wall thickness. Compared with the negative category, all BDR-FVC categories were associated with increasing emphysema percentage and gas trapping percentage. Moderate and marked BDR-FVC categories were associated with higher St. George's Respiratory Questionnaire scores but fewer exacerbations and lower dyspnea scores. Conclusions: BDR grading by FEV1 volume or percentage response identified subjects otherwise missed by ATS/ERS criteria. BDR grades were associated with functional exercise performance, quality of life, exacerbation frequency, dyspnea, and radiological airway measures. BDR grades in FEV1 and FVC indicate different clinical and radiological characteristics.United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Heart Lung & Blood Institute (NHLBI)National Center for Advancing Translational Sciences through UCLA CTSI Gran

Identifying a Heart Rate Recovery Criterion After a 6-Minute Walk Test in COPD

Background: Slow heart rate recovery (HRR) after exercise is associated with autonomic dysfunction and increased mortality. What HRR criterion at 1-minute after a 6-minute walk test (6MWT) best defines pulmonary impairment?. Study Design and Methods: A total of 5008 phase 2 COPDGene (NCT00608764) participants with smoking history were included. A total of 2127 had COPD and, of these, 385 were followed-up 5-years later. Lung surgery, transplant, bronchiectasis, atrial fibrillation, heart failure and pacemakers were exclusionary. HR was measured from pulse oximetry at end-walk and after 1-min seated recovery. A receiver operator characteristic (ROC) identified optimal HRR cut-off. Generalized linear regression determined HRR association with spirometry, chest CT, symptoms and exacerbations. Results: HRR after 6MWT (bt/min) was categorized in quintiles: ≤ 5 (23.0% of participants), 6– 10 (20.7%), 11– 15 (18.9%), 16– 22 (18.5%) and ≥ 23 (18.9%). Compared to HRR≤ 5, HRR≥ 11 was associated with (p\u3c 0.001): lower pre-walk HR and 1-min post HR; greater end-walk HR; greater 6MWD; greater FEV1%pred; lower airway wall area and wall thickness. HRR was positively associated with FEV1%pred and negatively associated with airway wall thickness. An optimal HRR ≤ 10 bt/min yielded an area under the ROC curve of 0.62 (95% CI 0.58– 0.66) for identifying FEV1\u3c 30%pred. HRR≥ 11 bt/min was the lowest HRR associated with consistently less impairment in 6MWT, spirometry and CT variables. In COPD, HRR≤ 10 bt/min was associated with (p\u3c 0.001): ≥ 2 exacerbations in the previous year (OR=1.76[1.33– 2.34]); CAT≥ 10 (OR=1.42[1.18– 1.71]); mMRC≥ 2 (OR=1.42[1.19– 1.69]); GOLD 4 (OR=1.98[1.44– 2.73]) and GOLD D (OR=1.51[1.18– 1.95]). HRR≤ 10 bt/min was predicted COPD exacerbations at 5-year follow-up (RR=1.83[1.07– 3.12], P=0.027). Conclusion: HRR≤ 10 bt/min after 6MWT in COPD is associated with more severe expiratory flow limitation, airway wall thickening, worse dyspnoea and quality of life, and future exacerbations, suggesting that an abnormal HRR≤ 10 bt/min after a 6MWT may be used in a comprehensive assessment in COPD for risk of severity, symptoms and future exacerbations