Recommendations for high intensity upper body exercise testing

Introduction: For given submaximal and maximal peak power outputs aerobic responses to upper body exercise are different to those for lower body exercise (Sawka, 1986: Exercise & Sport Sciences Reviews, 14, 175-211). However, much less is known regarding responses to exercise intensities at and around peak oxygen up take (VO2peak). Purpose: The purpose of this study was to determine the metabolic responses during arm crank ergometry (ACE) below, at and above peak oxygen uptake and to help establish exercise testing guidelines for high intensity upper body exercise. Methods: Following institutional ethical approval fourteen male students (Age 21.1, s = 6.1 years and 2.44 s=0.44 VO2peak) volunteered to take part in this study. Each participant exercised on a table mounted cycle ergometer (Monark 894E, Monark Exercise AB, Sweden). After habituation peak minute power (PMP) was calculated from an incremental test. Subsequently each participant completed four continuous work tests (CWT) to volitional exhaustion at 80%, 90%, 100% and 110% of PMP. All tests were completed at 70 rev∙min-1 with a minimum of 48-h between tests and the order was counterbalanced. Each CWT was preceded by a 5 min warm-up, loaded with a mass corresponding to the participants 80% PMP for 20 s at minutes 2, 3 and 4. Oxygen uptake (VO2), respiratory exchange ratio (RER), heart rate (HR) and ratings of perceived exertion for the arms (local (RPEL) and cardiorespiratory strain (RPECR) were recorded at 1 min, 2 min and at volitional exhaustion. The EMG responses at three sites (flexor carpi ulnaris, biceps brachii and triceps brachii lateral) were recorded using double-differential (16-3000 Hz bandwidth, x300 gain), bipolar, active electrodes (MP-2A, Linton, Norfolk, UK). Electromyographic data were sampled at 1000 Hz and filtered using a 20 to 500 Hz band-pass filter (MP150 Data Acquisition and AcqKnowledge 4.0, Biopac, Goleta, CA). The EMG signals for each muscle were root mean squared (RMS) with a 500-ms sample window. The signal was then normalised, prior to each CWT, as a percentage of the mean of 3 sets of 10 duty cycles completed during the warm-up (see above) when the participants 80% PMP for 20 s was applied. Time to exhaustion (Tlim) was recorded as the performance outcome measure. Data for Tlim were analysed using one-way analysis of variance. Differences in EMG, VO2, RER, HR, RPEL and RPECR were analysed using separate two-way analysis of variance with repeated measures (trial x time). All analyses were performed using the Statistical Package for Social Sciences ( 17.0; SPSS Inc., Chicago, IL). Individual differences in means were located using Bonferroni post-hoc correction. Significance was accepted at P < 0.05. Results: As resistive load increased Tlim decreased (611 s=194, 397 s=99, 268 s=90, 206 s=67s, respectively; P < 0.001, ES = 0.625). Post-hoc analysis revealed that Tlim using 80%PMP was longer than for 90%, 100% and 110% PMP trials (P < 0.001) and 90% was longer than both 100% and 110% PMP trials (P = 0.079, P = 0.001). At exhaustion VO2 was similar across trials (P = 0.413, ES = 0.053), although 80% PMP VO2 tended to be less (2.10 s=0.32 l·min-1) than for 90% (2.29 s=0.37), 100% (2.33 s=0.49) and 110% (2.26 s=0.34). Also, 80% PMP VO2 was less than VO2peak (P = 0.013). There were differences in RER at Tlim (P < 0.001, ES = 0.593) with values increasing with % PMP (1.15 s=0.07, 1.26 s=0.07, 1.36 s=0.10, 1.40 s=0.09, respectively). There were no differences across trials for HR at Tlim (~173 (12); P = 0.834, ES = 0.016) and HR was proportional to %PMP at 1 min, and 2 min. For flexor carpi ulnaris there was an increase in activation as exercise intensity increased (P < 0.001, ES = 0.245). There were a similar responses for biceps brachii and triceps brachii demonstrating an increase in activation with exercise intensity (P <0.001, ES = 0.137, P < 0.001, ES = 0.163, respectively). No differences for RPEL and RPECR were observed at Tlim. Discussion: There was a clear response of Tlim with intensity as expected for lower body exercise (Hill et al., 2002: Medicine and Science in Sports and Exercise, 34(4), 709-714). Despite differences in Tlim across exercise intensities VO2, HR and RPE were similar at exhaustion indicating a functional cardiorespiratory maximum had been reached. As indicated by the RER an increased activation of the anaerobic metabolism with greater exercise intensities (100% and 110%) is likely and therefore this may represent a greater anaerobic component at these two intensities. The increase in EMG activity with intensity could indicate an increase activity with an increase in exercise intensity. Conclusion: It is recommended that due to the combination of muscle activation, oxygen uptake and Tlim that an exercise intensity of 90% or 100% of PMP could be used for high intensity upper body exercise testing

Elevated levels of inflammatory cytokines predict survival in idiopathic and familial pulmonary arterial hypertension

BACKGROUND: Inflammation is a feature of pulmonary arterial hypertension (PAH), and increased circulating levels of cytokines are reported in patients with PAH. However, to date, no information exists on the significance of elevated cytokines or their potential as biomarkers. We sought to determine the levels of a range of cytokines in PAH and to examine their impact on survival and relationship to hemodynamic indexes. METHODS AND RESULTS: We measured levels of serum cytokines (tumor necrosis factor-alpha, interferon-gamma and interleukin-1beta, -2, -4, -5, -6, -8, -10, -12p70, and -13) using ELISAs in idiopathic and heritable PAH patients (n=60). Concurrent clinical data included hemodynamics, 6-minute walk distance, and survival time from sampling to death or transplantation. Healthy volunteers served as control subjects (n=21). PAH patients had significantly higher levels of interleukin-1beta, -2, -4, -6, -8, -10, and -12p70 and tumor necrosis factor-alpha compared with healthy control subjects. Kaplan-Meier analysis showed that levels of interleukin-6, 8, 10, and 12p70 predicted survival in patients. For example, 5-year survival with interleukin-6 levels of >9 pg/mL was 30% compared with 63% for patients with levels < or = 9 pg/mL (P=0.008). In this PAH cohort, cytokine levels were superior to traditional markers of prognosis such as 6-minute walk distance and hemodynamics. CONCLUSIONS: This study illustrates dysregulation of a broad range of inflammatory mediators in idiopathic and familial PAH and demonstrates that cytokine levels have a previously unrecognized impact on patient survival. They may prove to be useful biomarkers and provide insight into the contribution of inflammation in PAH

Design and Preliminary Performance Testing of Electronegative Gas Plasma Thruster

In classical gridded electrostatic ion thrusters, positively charged ions are generated from a plasma discharge of noble gas propellant and accelerated to provide thrust. To maintain overall charge balance on the propulsion system, a separate electron source is required to neutralize the ion beam as it exits the thruster. However, if high-electronegativity propellant gases (e.g., sulfur hexafluoride) are instead used, a plasma discharge can result consisting of both positively and negatively charged ions. Extracting such electronegative plasma species for thrust generation (e.g., with time-varying, bipolar ion optics) would eliminate the need for a separate neutralizer cathode subsystem. In addition for thrusters utilizing a RF plasma discharge, further simplification of the ion thruster power system may be possible by also using the RF power supply to bias the ion optics. Recently, the PEGASES (Plasma propulsion with Electronegative gases) thruster prototype successfully demonstrated proof-of-concept operations in alternatively accelerating positively and negatively charged ions from a RF discharge of a mixture of argon and sulfur hexafluoride.i In collaboration with NASA Marshall Space Flight Center (MSFC), the Georgia Institute of Technology High-Power Electric Propulsion Laboratory (HPEPL) is applying the lessons learned from PEGASES design and testing to develop a new thruster prototype. This prototype will incorporate design improvements and undergo gridless operational testing and diagnostics checkout at HPEPL in April 2014. Performance mapping with ion optics will be conducted at NASA MSFC starting in May 2014. The proposed paper discusses the design and preliminary performance testing of this electronegative gas plasma thruster prototype

Somatotyping of Division I Athletes

Somatotyping has previously examined athletes\u27 genetic morphology. Categorization of somatotyping can be utilized in athletes for specialized, adaptive sports performance. PURPOSE: The purpose of this study was to report somatotyping differences (ectomorph, mesomorph, and endomorph) in selected Division I athletes. METHOD: 39 male football athletes and seven female softball Division I athletes were recruited for this investigation. Height (m), weight (kg), waist-to-hip ratio (cm), and a 4-site skinfold measurement was collected. Skinfold locations were recorded from the triceps (mm), subscapular (mm), supraspinal (mm), and the medial calf (mm). Biepicondylar breadth measures of the humerus (cm), and the femur (cm) were recorded at a respective 90°. Additionally, the girth of the subject’s dominant upper arm (cm) and dominant calf (cm) were recorded. All measurement locations were taken from the Heath-Carter Anthropometric protocol, respectfully. The Heath Carter Somatotype Worksheet consists of a rating scale that is based on a 3-component categorization. All measures are considered when calculating a participant\u27s score. Scores between .5 and 2.5 are low, 3 to 5 are moderate, 5.5 to 7 are high and anything over a 7.5 is considered very high. The first component calculated scores of endomorphy, the second calculated mesomorphy scores, and the last component calculated ectomorph scores. Using these measurements, equations are used to determine a participant’s score to a specific somatotype. The athletes\u27 numbers were then processed and plotted on a 2-D graph plotting the somatotype (X= ectomorph-endomorph, Y=2 x mesomorphy- (endomorphy+ectomorph)). RESULTS: There was a clear indication that somatotyping had variety based on sports and position specialization in football athletes. Football athletes consisted of 6 endomorphs, 30 mesomorphs, and 3 ectomorphs, while softball athletes consisted of 7 meso-endomorphs. CONCLUSION: Due to the anthropometric position differences in male football athletes there was a considerable amount of variety and lack of specificity, while the female softball athletes consisted of a lesser variety in anthropometric measures

The effectiveness, safety and cost-effectiveness of cytisine versus varenicline for smoking cessation in an Australian population: a study protocol for a randomized controlled non-inferiority trial

Smoking cessation medications are effective but often underutilised because of costs and side effects. Cytisine is a plant-based smoking cessation medication with over 50 years of use in Central and Eastern Europe. While cytisine has been found to be well-tolerated and more effective than nicotine replacement therapy, direct comparison with varenicline have not been conducted. This study evaluates the effectiveness, safety and cost-effectiveness of cytisine compared with varenicline.Two arm, parallel group, randomised, non-inferiority trial, with allocation concealment and blinded outcome assessment.Australian population-based study.Adult daily smokers (N=1266) interested in quitting will be recruited through advertisements and Quitline telephone-based cessation support services.Eligible participants will be randomised (1:1 ratio) to receive either cytisine capsules (25-day supply) or varenicline tablets (12-week supply), prescribed in accordance with the manufacturer's recommended dosing regimen. The medication will be mailed to each participant's nominated residential address. All participants will also be offered standard Quitline behavioural support (up to six 10-12 minute sessions).Assessments will be undertaken by telephone at baseline, 4- and 7-months post-randomisation. Participants will also be contacted twice (two and four weeks post-randomisation) to ascertain adverse events, treatment adherence and smoking status. The primary outcome will be self-reported 6-month continuous abstinence from smoking, verified by carbon monoxide at 7-month follow-up. We will also evaluate the relative safety and cost-effectiveness of cytisine compared with varenicline. Secondary outcomes will include self-reported continuous and 7-day point prevalence abstinence and cigarette consumption at each follow-up interview.If cytisine is as effective as varenicline, its lower cost and natural plant-based composition may make it an acceptable and affordable smoking cessation medication that could save millions of lives worldwide

Initial Thrust Measurements of Marshall's Ion-ioN Thruster

Electronegative ion thrusters are a variation of tradition gridded ion thruster technology differentiated by the production and acceleration of both positive and negative ions. Benefits of electronegative ion thrusters include the elimination of lifetime-limiting cathodes from the thruster architecture and the ability to generate appreciable thrust from both charge species. Following the continued development of electronegative ion thruster technology as exhibited by the PEGASES (Plasma Propulsion with Electronegative GASES) thruster, direct thrust measurements are required to push interest in electronegative ion thruster technology forward. For this work, direct thrust measurements of the MINT (Marshall's Ion-ioN Thruster) will be taken on a hanging pendulum thrust stand for propellant mixtures of Sulfur Hexafluoride and Argon at volumetric flow rates of 5-25 sccm at radio frequency power levels of 100-600 watts at a radio frequency of 13.56 MHz. Acceleration grid operation is operated using a square waveform bias of +/-300 volts at a frequency of 25 kHz

The pH-responsive PacC transcription factor of Aspergillus fumigatus governs epithelial entry and tissue invasion during pulmonary aspergillosis

Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. Raw data have been deposited in the Gene Expression Omnibus (GEO) (http://www.ncbi.nlm.nih.gov/geo/) under accession number GSE54810. Funding: This work was supported in part by grants to EMB from the MRC (G0501164) and BBSRC (BB/G009619/1), to EMB and NDR from the Wellcome Trust (WT093596MA), to MB from Imperial College London (Division of Investigative Sciences PhD Studentship), to HH from the ERA-NET PathoGenoMics project TRANSPAT, Austrian Science Foundation (FWF I282-B09), to SGF from the National Institutes of Health, USA (R01AI073829). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Mesenchymal stromal cells in bronchoalveolar lavage as predictors of bronchiolitis obliterans syndrome

Rationale: Bronchoalveolar lavage fluid (BAL) from human lung allografts demonstrates the presence of a multipotentmesenchymal stromal cell population. However, the clinical relevance of this novel cellular component of BAL and its association with bronchiolitis obliterans syndrome (BOS), a disease marked by progressive airflow limitation secondary to fibrotic obliteration of the small airways, remains to be determined. Objectives: In this study we investigate the association of number of mesenchymal stromal cells in BAL with development of BOS in human lung transplant recipients. Methods:Mesenchymal colony-forming units (CFUs)were quantitated in a cohort of 405 BAL samples obtained from 162 lung transplant recipients. Poisson generalized estimating equations were used to determine the predictors of BAL mesenchymal CFU count. Measurements and Main Results: Higher CFU counts were noted early post-transplantation; time from transplant to BAL of greater than 3 months predicted 0.4-fold lower CFU counts (P = 0.0001). BOS diagnosis less than or equal to 365 days before BAL was associated with a 2.11-fold higher CFU count (P = 0.02). There were 2.62- and 2.70-fold higher CFU counts noted in the presence of histologic diagnosis of bronchiolitis obliterans (P = 0.05) and organizing pneumonia (0.0003), respectively. In BAL samples obtained from BOS-free patients greater than 6 months post-transplantation (n = 173), higher mesenchymal CFU counts (>=10) significantly predicted BOS onset in both univariate (hazard ratio, 5.61; 95%CI, 3.03–10.38; P < 0.0001) andmultivariate (hazard ratio, 5.02; 95%CI, 2.40–10.51; P < 0.0001) Cox regression analysis. Conclusions: Measurement of mesenchymal CFUs in the BAL provides predictive information regarding future BOS onset.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91951/1/2011 AJRCCM Mesenchymal stromal cells in bronchoalveolar lavage as predictors of bronchiolitis obliterans syndrome.pd

Implementing early mobilisation after knee or hip arthroplasty to reduce length of stay : a quality improvement study with embedded qualitative component

Background: Models of care for managing total knee or hip arthroplasty (TKA, THA) incorporating early mobilisation are associated with shorter acute length-of-stay (LOS). Few studies have examined the effect of implementing early mobilisation in isolation, however. This study aimed to determine if an accelerated mobilisation protocol implemented in isolation is associated with a reduced LOS without undermining care. Method: A Before-After (quasi-experimental) study was used. Standard practice pre-implementation of the new protocol was physiotherapist-led mobilisation once per day commencing on post-operative Day 1 (Before phase). The new protocol (After phase) aimed to mobilise patients four times by end of Day 2 including an attempt to commence on Day 0; physiotherapy weekend coverage was necessarily increased. Poisson regression modelling was used to determine associations between study period and LOS. Additional outcomes to 12 weeks post-surgery were monitored to identify unintended consequences of the new protocol. Time to first mobilisation (hours) and proportion mobilising Day 0 were monitored to assess protocol compliance. An embedded qualitative component captured staff perspectives of the new protocol. Results: Five hundred twenty consecutive patients (n = 278, Before; n = 242, After) were included. The new protocol was associated with no change in unadjusted LOS, a small reduction in adjusted LOS (8.1%, p = 0.046), a reduction in time to first mobilisation (28.5 (10.8) vs 22.6 (8.1) hrs, p < 0.001), and an increase in the proportion mobilising Day 0 (0 vs 7%, p < 0.001). Greater improvements were curtailed by an unexpected decrease in physiotherapy staffing (After phase). There were no significant changes to the rates of complications or readmissions, joint-specific pain and function scores or health-related quality of life to 12 weeks post-surgery. Qualitative findings of 11 multidisciplinary team members highlighted the importance of morning surgery, staffing, and well-defined roles. Conclusion: Small reductions in LOS are possible utilising an early mobilisation protocol in isolation after TKA or THA although staff burden is increased likely undermining both sustainability and the magnitude of the change. Simultaneous incorporation of other changes within the pathway would likely secure larger reductions in LOS