Technology use among patients with cardiovascular disease: an assessment of patient need for a technology enabled behavioural change intervention.

Effective Cardiac Rehabilitation (CR) can significantly improve mortality and morbidity rates in relation to cardiovascular disease; however, uptake of traditional community-based long-term is very low. PATHway (Physical Activity Towards Health) will provide individualized rehabilitation programs, through an internet-enabled sensor-based home exercise platform that allows remote participation. The purpose of this study was to assess the level of interest and use of technology by individuals living with CVD in order to inform the design of a technology-enabled CR programme. Method: A technology usage questionnaire based on a previous study investigating the role of technology and mHealth in a CVD population was used (Dale et al., 2014) to ascertain the current level of technology use. All patients attending the Phase Four community cardiac rehabilitation HeartSmart programme (MedEx) were recruited (N=67; 66.2 years, SD= 8.55, Males =76.1%, Females=20.9%). Results: Technology usage was high with 60% of participants owning a smartphone and 85% accessing the internet (54% of whom access it everyday). Participants endorsed the idea of technology enabled cardiac rehabilitation, indicating that they found the idea ‘ appealing’. 79% were interested in receiving ongoing CR support via their smartphones, 79% were interested in receiving CR via the internet. It was found that 52% of patients found the idea of a virtual rehabilitation class appealing. Conclusion: This study provides support for the patient need for a technology enabled behavioural change intervention, specifically through the provision of an internet-enabled sensor-based home exercise platform that allows remote participation in CR exercise programs

A genetic predisposition score for muscular endophenotypes predicts the increase in aerobic power after training: the CAREGENE study

<p>Abstract</p> <p>Background</p> <p>It is widely accepted that genetic variability might explain a large part of the observed heterogeneity in aerobic capacity and its response to training. Significant associations between polymorphisms of different genes with muscular strength, anaerobic phenotypes and body composition have been reported. Muscular endophenotypes are positively correlated with aerobic capacity, therefore, we tested the association of polymorphisms in twelve muscular related genes on aerobic capacity and its response to endurance training.</p> <p>Methods</p> <p>935 Coronary artery disease patients (CAD) who performed an incremental exercise test until exhaustion at baseline and after three months of training were included. Polymorphisms of the genes were detected using the invader assay. Genotype-phenotype association analyses were performed using ANCOVA. Different models for a genetic predisposition score (GPS) were constructed based on literature and own data and were related to baseline and response VO₂scores.</p> <p>Results</p> <p>Carriers of the minor allele in the R23K polymorphism of the glucocorticoid receptor gene (<it>GR</it>) and the ciliary neurotrophic factor gene (<it>CNTF</it>) had a significantly higher increase in peakVO₂after training (p < 0.05). Carriers of the minor allele (C34T) in the adenosine monophosphate deaminase (<it>AMPD1</it>) gene had a significantly lower relative increase (p < 0.05) in peakVO₂. GPS of data driven models were significantly associated with the increase in peakVO₂after training.</p> <p>Conclusions</p> <p>In CAD patients, suggestive associations were found in the <it>GR, CNTF </it>and the <it>AMPD1 </it>gene with an improved change in aerobic capacity after three months of training. Additionally data driven models with a genetic predisposition score (GPS) showed a significant predictive value for the increase in peakVO₂.</p

PATHway: decision support in exercise programmes for cardiac rehabilitation

Rehabilitation is important for patients with cardiovascular diseases (CVD) to improve health outcomes and quality of life. However, adherence to current exercise programmes in cardiac rehabilitation is limited. We present the design and development of a Decision Support System (DSS) for telerehabilitation, aiming to enhance exercise programmes for CVD patients through ensuring their safety, personalising the programme according to their needs and performance, and motivating them toward meeting their physical activity goals. The DSS processes data originated from a Microsoft Kinect camera, a blood pressure monitor, a heart rate sensor and questionnaires, in order to generate a highly individualised exercise programme and improve patient adherence. Initial results within the EU-funded PATHway project show the potential of our approach

Semiautomatic Training Load Determination in Endurance Athletes

Background: Despite endurance athletes recording their training data electronically, researchers in sports cardiology rely on questionnaires to quantify training load. This is due to the complexity of quantifying large numbers of training files. We aimed to develop a semiautomatic postprocessing tool to quantify training load in clinical studies. Methods: Training data were collected from two prospective athlete’s heart studies (Master Athlete’s Heart study and Prospective Athlete Heart study). Using in-house developed software, maximal heart rate (MaxHR) and training load were calculated from heart rate monitored during cumulative training sessions. The MaxHR in the lab was compared with the MaxHR in the field. Lucia training impulse score, based on individually based exercise intensity zones, and Edwards training impulse, based on MaxHR in the field, were compared. A questionnaire was used to determine the number of training sessions and training hours per week. Results: Forty-three athletes recorded their training sessions using a chest-worn heart rate monitor and were selected for this analysis. MaxHR in the lab was significantly lower compared with MaxHR in the field (183 ± 12 bpm vs. 188 ± 13 bpm, p < .01), but correlated strongly (r = .81, p < .01) with acceptable limits of agreement (±15.4 bpm). An excellent correlation was found between Lucia training impulse score and Edwards training impulse (r = .92, p < .0001). The quantified number of training sessions and training hours did not correlate with the number of training sessions (r = .20) and training hours (r = −.12) reported by questionnaires. Conclusion: Semiautomatic measurement of training load is feasible in a wide age group. Standard exercise questionnaires are insufficiently accurate in comparison to objective training load quantification

Imaging PARP with [18F]rucaparib in pancreatic cancer models

PURPOSE: Rucaparib, an FDA-approved PARP inhibitor, is used as a single agent in maintenance therapy to provide promising treatment efficacy with an acceptable safety profile in various types of BRCA-mutated cancers. However, not all patients receive the same benefit from rucaparib-maintenance therapy. A predictive biomarker to help with patient selection for rucaparib treatment and predict clinical benefit is therefore warranted. With this aim, we developed [18F]rucaparib, an 18F-labelled isotopologue of rucaparib, and employed it as a PARP-targeting agent for cancer imaging with PET. Here, we report the in vitro and in vivo evaluation of [18F]rucaparib in human pancreatic cancer models. METHOD: We incorporated the positron-emitting 18F isotope into rucaparib, enabling its use as a PET imaging agent. [18F]rucaparib binds to the DNA damage repair enzyme, PARP, allowing direct visualisation and measurement of PARP in cancerous models before and after PARP inhibition or other genotoxic cancer therapies, providing critical information for cancer diagnosis and therapy. Proof-of-concept evaluations were determined in pancreatic cancer models. RESULTS: Uptake of [18F]rucaparib was found to be mainly dependent on PARP1 expression. Induction of DNA damage increased PARP expression, thereby increasing uptake of [18F]rucaparib. In vivo studies revealed relatively fast blood clearance of [18F]rucaparib in PSN1 tumour-bearing mice, with a tumour uptake of 5.5 ± 0.5%ID/g (1 h after i.v. administration). In vitro and in vivo studies showed significant reduction of [18F]rucaparib uptake by addition of different PARP inhibitors, indicating PARP-selective binding. CONCLUSION: Taken together, we demonstrate the potential of [18F]rucaparib as a non-invasive PARP-targeting imaging agent for pancreatic cancers

[123I]CC1:A PARP-Targeting, Auger Electron-Emitting Radiopharmaceutical for Radionuclide Therapy of Cancer

Poly(adenosine diphosphate ribose) polymerase (PARP) has emerged as an effective therapeutic strategy against cancer that targets the DNA damage repair enzyme. PARP-targeting compounds radiolabeled with an Auger electron-emitting radionuclide can be trapped close to damaged DNA in tumor tissue, where high ionizing potential and short range lead Auger electrons to kill cancer cells through the creation of complex DNA damage, with minimal damage to surrounding normal tissue. Here, we report on [ 123I]CC1, an 123I-labeled PARP inhibitor for radioligand therapy of cancer.Methods: Copper-mediated 123I iododeboronation of a boronic pinacol ester precursor afforded [ 123I]CC1. The level and specificity of cell uptake and the therapeutic efficacy of [ 123I]CC1 were determined in human breast carcinoma, pancreatic adenocarcinoma, and glioblastoma cells. Tumor uptake and tumor growth inhibition of [ 123I]CC1 were assessed in mice bearing human cancer xenografts (MDA-MB-231, PSN1, and U87MG).Results: In vitro and in vivo studies showed selective uptake of [ 123I]CC1 in all models. Significantly reduced clonogenicity, a proxy for tumor growth inhibition by ionizing radiation in vivo, was observed in vitro after treatment with as little as 10 Bq [ 123I]CC1. Biodistribution at 1 h after intravenous administration showed PSN1 tumor xenograft uptake of 0.9 ± 0.06 percentage injected dose per gram of tissue. Intravenous administration of a relatively low amount of [ 123I]CC1 (3 MBq) was able to significantly inhibit PSN1 xenograft tumor growth but was less effective in xenografts that expressed less PARP. [ 123I]CC1 did not cause significant toxicity to normal tissues.Conclusion: Taken together, these results show the potential of [ 123I]CC1 as a radioligand therapy for PARP-expressing cancers. </p

Landowners’ Сolonization of Bashkiria

The “closed city” practice, exercised in Ufa province before 1735, together with the unfavourable political situation led to the bad crisis of estate landownership of the Ufa district. The population polls of the mid-XVII — beginning of XVIII cc. justify the fact that Ufa noblemen had to succumb to the fate of socially deprived Siberian nobility, practically devoid of serf peasants. The beginning of the largest-scale Bashkir insurrection of 1735–1736 made the administration review its attitude to the former ban on Bashkir estate lands sale. In the history of Bashkir landowners’ colonization the edict dated February 11th, 1736, allowing the local officers and officials to buy lands from Bashkir communities, was of principal importance. This procedure was exercised simultaneously with the establishment of the Russian government military control over the south-eastern border, separating Bashkir estate lands from Kazakh migratory tribes. From this moment on there is a stop in diplomatic contacts of the Bashkir elite with the governors of the Middle Asia, Kazakhstan and Turkey that meant the complete loss of political subjection by the Bashkirs. Bashkir communities become active participants of economic relations with Russian landowners, plant owners and the state institutions. Russian government preserved estate dynastic rights with the Bashkirs and refused from large-scale operations on the expropriation of Bashkir lands, transferring the mission of colonization to private persons, who had to arrange the issue with the local communities by themselves. The permission to sell estate lands forced landowners to active participation in the system of Russian legal relations, to contact the Russian government and customers

Isometric exercise training for hypertension

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: We will aim to conduct a systematic review and meta-analysis quantifying the effects of IRT on systolic, diastolic, mean arterial and 24-hour ambulatory blood pressure. We will also quantify changes in heartrate and heartrate variability, and will attempt to determine which patient demographics and exercise program characteristics are associated with the largest blood pressure changes

The development and co-design of the PATHway intervention: a theory-driven eHealth platform for the self-management of cardiovascular disease.

Background Cardiovascular diseases (CVD) are a leading cause of premature death and disability and an economic burden worldwide. International guidelines recommend routine availability and delivery of all phases of cardiac rehabilitation (CR). Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based CR programmes is low, with community-based CR rates and individual long-term exercise maintenance even lower. Home-based CR programs have been shown to be equally effective in clinical and health-related quality of life outcomes, and yet are not readily available. Purpose The aim of the current study was to develop the PATHway intervention (Physical Activity Towards Health) for the self-management of cardiovascular disease. Increasing physical activity in individuals with CVD was the primary behaviour. Methods The PATHway intervention was theoretically informed by the Behaviour Change Wheel (BCW) and Social Cognitive Theory (SCT). All relevant intervention functions, behaviour change techniques (BCTs) and policy categories were identified and translated into intervention content. Furthermore, a person-centred approach was adopted involving an iterative co-design process and extensive user-testing. Results Education, enablement, modelling, persuasion, training and social restructuring were selected as appropriate intervention functions. Twenty-two BCTs, linked to the 6 intervention functions and 3 policy categories were identified for inclusion and translated into PATHway intervention content. Conclusions This paper details the use of the BCW and SCT within a person-centred framework to develop an eHealth intervention for the self-management of CVD. The systematic and transparent development of the PATHway intervention will facilitate the evaluation of intervention effectiveness and future replication. The Template for Intervention Description and Replication (TIDieR) checklist was used to specify details of the intervention including the who, what, how and where of proposed intervention delivery