Satisfaction and Experience with a Supervised Home-Based Real-Time Videoconferencing Telerehabilitation Exercise Program in People with Chronic Obstructive Pulmonary Disease (COPD)

Telerehabilitation, consisting of supervised home-based exercise training via real-time videoconferencing, is an alternative method to deliver pulmonary rehabilitation with potential to improve access. The aims were to determine the level of satisfaction and experience of an eight-week supervised home-based telerehabilitation exercise program using real-time videoconferencing in people with COPD. Quantitative measures were the Client Satisfaction Questionnaire-8 (CSQ-8) and a purpose-designed satisfaction survey. A qualitative component was conducted using semi-structured interviews. Nineteen participants (mean (SD) age 73 (8) years, forced expiratory volume in 1 second (FEV1) 60 (23) % predicted) showed a high level of satisfaction in the CSQ-8 score and 100% of participants reported a high level of satisfaction with the quality of exercise sessions delivered using real-time videoconferencing in participant satisfaction survey. Eleven participants undertook semi-structured interviews. Key themes in four areas relating to the telerehabilitation service emerged: positive virtual interaction through technology; health benefits; and satisfaction with the convenience and use of equipment. Participants were highly satisfied with the telerehabilitation exercise program delivered via videoconferencing.

Adrenergic gene polymorphisms and cardiovascular risk in the NHLBI-sponsored Women's Ischemia Syndrome Evaluation

<p>Abstract</p> <p>Background</p> <p>Adrenergic gene polymorphisms are associated with cardiovascular and metabolic phenotypes. We investigated the influence of adrenergic gene polymorphisms on cardiovascular risk in women with suspected myocardial ischemia.</p> <p>Methods</p> <p>We genotyped 628 women referred for coronary angiography for eight polymorphisms in the α_1A-, β₁-, β₂- and β₃-adrenergic receptors (<it>ADRA1A</it>, <it>ADRB1, ADRB2</it>, <it>ADRB3</it>, respectively), and their signaling proteins, G-protein β 3 subunit (<it>GNB3</it>) and G-protein α subunit (<it>GNAS</it>). We compared the incidence of death, myocardial infarction, stroke, or heart failure between genotype groups in all women and women without obstructive coronary stenoses.</p> <p>Results</p> <p>After a median of 5.8 years of follow-up, 115 women had an event. Patients with the <it>ADRB1 </it>Gly389 polymorphism were at higher risk for the composite outcome due to higher rates of myocardial infarction (adjusted hazard ratio [HR] 3.63, 95% confidence interval [95%CI] 1.17–11.28; Gly/Gly vs. Arg/Arg HR 4.14, 95%CI 0.88–19.6). The risk associated with <it>ADRB1 </it>Gly389 was limited to those without obstructive CAD (n = 400, P_interaction= 0.03), albeit marginally significant in this subset (HR 1.71, 95%CI 0.91–3.19). Additionally, women without obstructive CAD carrying the <it>ADRB3 </it>Arg64 variant were at higher risk for the composite endpoint (HR 2.10, 95%CI 1.05–4.24) due to subtle increases in risk for all of the individual endpoints. No genetic associations were present in women with obstructive CAD.</p> <p>Conclusion</p> <p>In this exploratory analysis, common coding polymorphisms in the β₁- and β₃-adrenergic receptors increased cardiovascular risk in women referred for diagnostic angiography, and could improve risk assessment, particularly for women without evidence of obstructive CAD.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov NCT00000554.</p

A Chandra X-ray Analysis of Abell 1664: Cooling, Feedback and Star Formation in the Central Cluster Galaxy

The brightest cluster galaxy (BCG) in the Abell 1664 cluster is unusually blue and is forming stars at a rate of ~ 23 M_{\sun} yr^{-1}. The BCG is located within 5 kpc of the X-ray peak, where the cooling time of 3.5x10^8 yr and entropy of 10.4 keV cm^2 are consistent with other star-forming BCGs in cooling flow clusters. The center of A1664 has an elongated, "bar-like" X-ray structure whose mass is comparable to the mass of molecular hydrogen, ~ 10^{10} M_{\sun} in the BCG. We show that this gas is unlikely to have been stripped from interloping galaxies. The cooling rate in this region is roughly consistent with the star formation rate, suggesting that the hot gas is condensing onto the BCG. We use the scaling relations of Birzan et al. 2008 to show that the AGN is underpowered compared to the central X-ray cooling luminosity by roughly a factor of three. We suggest that A1664 is experiencing rapid cooling and star formation during a low-state of an AGN feedback cycle that regulates the rates of cooling and star formation. Modeling the emission as a single temperature plasma, we find that the metallicity peaks 100 kpc from the X-ray center, resulting in a central metallicity dip. However, a multi-temperature cooling flow model improves the fit to the X-ray emission and is able to recover the expected, centrally-peaked metallicity profile.Comment: 15 pages, 13 figure

Magnetofluid dynamics of magnetized cosmic plasma: firehose and gyrothermal instabilities

Both global dynamics and turbulence in magnetized weakly collisional cosmic plasmas are described by general magnetofluid equations that contain pressure anisotropies and heat fluxes that must be calculated from microscopic plasma kinetic theory. It is shown that even without a detailed calculation of the pressure anisotropy or the heat fluxes, one finds the macroscale dynamics to be generically unstable to microscale Alfvenically polarized fluctuations. Two instabilities are considered in detail: the parallel firehose instability (including the finite-Larmor-radius effects that determine the fastest growing mode) and the gyrothermal instability (GTI). The latter is a new result - it is shown that a parallel ion heat flux destabilizes Alfvenically polarized fluctuations even in the absence of the negative pressure anisotropy required for the firehose. The main conclusion is that both pressure anisotropies and heat fluxes trigger plasma microinstabilities and, therefore, their values will likely be set by the nonlinear evolution of these instabilities. Ideas for understanding this nonlinear evolution are discussed. It is argued that cosmic plasmas will generically be "three-scale systems," comprising global dynamics, mesoscale turbulence and microscale plasma fluctuations. The astrophysical example of cool cores of galaxy clusters is considered and it is noted that observations point to turbulence in clusters being in a marginal state with respect to plasma microinstabilities and so it is the plasma microphysics that is likely to set the heating and conduction properties of the intracluster medium. In particular, a lower bound on the scale of temperature fluctuations implied by the GTI is derived.Comment: 10 pages, MNRAS tex style, 1 figur

Galaxy Motions, Turbulence and Conduction in Clusters of Galaxies

Unopposed radiative cooling in clusters of galaxies results in excessive mass deposition rates. However, the cool cores of galaxy clusters are continuously heated by thermal conduction and turbulent heat diffusion due to minor mergers or the galaxies orbiting the cluster center. These processes can either reduce the energy requirements for AGN heating of cool cores, or they can prevent overcooling altogether. We perform 3D MHD simulations including field-aligned thermal conduction and self-gravitating particles to model this in detail. Turbulence is not confined to the wakes of galaxies but is instead volume-filling, due to the excitation of large-scale g-modes. We systematically probe the parameter space of galaxy masses and numbers. For a wide range of observationally motivated galaxy parameters, the magnetic field is randomized by stirring motions, restoring the conductive heat flow to the core. The cooling catastrophe either does not occur or it is sufficiently delayed to allow the cluster to experience a major merger that could reset conditions in the intracluster medium. Whilst dissipation of turbulent motions is negligible as a heat source, turbulent heat diffusion is extremely important; it predominates in the cluster center. However, thermal conduction becomes important at larger radii, and simulations without thermal conduction suffer a cooling catastrophe. Conduction is important both as a heat source and to reduce stabilizing buoyancy forces, enabling more efficient diffusion. Turbulence enables conduction, and conduction enables turbulence. In these simulations, the gas vorticity---which is a good indicator of trapped g-modes--increases with time. The vorticity growth is approximately mirrored by the growth of the magnetic field, which is amplified by turbulence.Comment: Submitted to MNRA

Loss of cardiomyocyte CYB5R3 impairs redox equilibrium and causes sudden cardiac death

Sudden cardiac death (SCD) in patients with heart failure (HF) is allied with an imbalance in reduction and oxidation (redox) signaling in cardiomyocytes; however, the basic pathways and mechanisms governing redox homeostasis in cardiomyocytes are not fully understood. Here, we show that cytochrome b5 reductase 3 (CYB5R3), an enzyme known to regulate redox signaling in erythrocytes and vascular cells, is essential for cardiomyocyte function. Using a conditional cardiomyocyte-specific CYB5R3-knockout mouse, we discovered that deletion of CYB5R3 in male, but not female, adult cardiomyocytes causes cardiac hypertrophy, bradycardia, and SCD. The increase in SCD in CYB5R3-KO mice is associated with calcium mishandling, ventricular fibrillation, and cardiomyocyte hypertrophy. Molecular studies reveal that CYB5R3-KO hearts display decreased adenosine triphosphate (ATP), increased oxidative stress, suppressed coenzyme Q levels, and hemoprotein dysregulation. Finally, from a translational perspective, we reveal that the high-frequency missense genetic variant rs1800457, which translates into a CYB5R3 T117S partial loss-of-function protein, associates with decreased event-free survival (~20%) in Black persons with HF with reduced ejection fraction (HFrEF). Together, these studies reveal a crucial role for CYB5R3 in cardiomyocyte redox biology and identify a genetic biomarker for persons of African ancestry that may potentially increase the risk of death from HFrEF.These studies were supported by NIH grants R35 HL 161177 (to ACS), R01 HL 133864 (to ACS), R01 HL 128304 (to ACS), R41 HL15098 (to GS), R01 GM 122091 (to PHT), GM125944 (to FJS), R01 DK112854 (to FJS), R21 NS112787 (to MF), NS121706 (to YLW), EB023507 (to YLW), F31 HL149241 (to HMS), and F31 HL151173 (to JCG). Support was also provided by American Heart Association grants 19EIA34770095 (to ACS), AHA 18CDA34140024 (to YLW), and 19PRE34380152 (to NTC); the Spanish Ministry of Health (grant FIS PI17-01286); Junta de Andalucía BIO-177 and the FEDER Funding Program from the European Union and CIBERER (U729)-ISCIII (to PN); Department of Defense W81XWH1810070 (to YLW); and Vitalant. This research was supported in part by the University of Pittsburgh Center for Research Computing through the resources provided. Specifically, this work used the HTC cluster, which is supported by NIH award number S10OD028483.Peer reviewe

International Coercion, Emulation and Policy Diffusion: Market-Oriented Infrastructure Reforms, 1977-1999

Why do some countries adopt market-oriented reforms such as deregulation, privatization and liberalization of competition in their infrastructure industries while others do not? Why did the pace of adoption accelerate in the 1990s? Building on neo-institutional theory in sociology, we argue that the domestic adoption of market-oriented reforms is strongly influenced by international pressures of coercion and emulation. We find robust support for these arguments with an event-history analysis of the determinants of reform in the telecommunications and electricity sectors of as many as 205 countries and territories between 1977 and 1999. Our results also suggest that the coercive effect of multilateral lending from the IMF, the World Bank or Regional Development Banks is increasing over time, a finding that is consistent with anecdotal evidence that multilateral organizations have broadened the scope of the “conditionality” terms specifying market-oriented reforms imposed on borrowing countries. We discuss the possibility that, by pressuring countries into policy reform, cross-national coercion and emulation may not produce ideal outcomes.http://deepblue.lib.umich.edu/bitstream/2027.42/40099/3/wp713.pd

Sex and age differences in sST2 in cardiovascular disease

AimsThe goal of this study was to determine whether sex and age differences exist for soluble ST2 (sST2) for several cardiovascular diseases (CVDs).MethodsWe examined sST2 levels using an ELISA kit for myocarditis (n = 303), cardiomyopathy (n = 293), coronary artery disease (CAD) (n = 239), myocardial infarct (MI) (n = 159), and congestive heart failure (CHF) (n = 286) and compared them to controls that did not have CVDs (n = 234).ResultsMyocarditis occurred in this study in relatively young patients around age 40 while the other CVDs occurred more often in older individuals around age 60. We observed a sex difference in sST2 by age only in myocarditis patients (men aged 38, women 46, p = 0.0002), but not for other CVDs. Sera sST2 levels were significantly elevated compared to age-matched controls for all CVDs: myocarditis (p ≤ 0.0001), cardiomyopathy (p = 0.0009), CAD (p = 0.03), MI (p = 0.034), and CHF (p &lt; 0.0001) driven by elevated sST2 levels in females for all CVDs except myocarditis, which was elevated in both females (p = 0.002) and males (p ≤ 0.0001). Sex differences in sST2 levels were found for myocarditis and cardiomyopathy but no other CVDs and were higher in males (myocarditis p = 0.0035; cardiomyopathy p = 0.0047). sST2 levels were higher in women with myocarditis over 50 years of age compared to men (p = 0.0004) or women under 50 years of age (p = 0.015). In cardiomyopathy and MI patients, men over 50 had significantly higher levels of sST2 than women (p = 0.012 and p = 0.043, respectively) but sex and age differences were not detected in other CVDs. However, women with cardiomyopathy that experienced early menopause had higher sST2 levels than those who underwent menopause at a natural age range (p = 0.02).ConclusionWe found that sex and age differences in sera sST2 exist for myocarditis, cardiomyopathy, and MI, but were not observed in other CVDs including CAD and CHF. These initial findings in patients with self-reported CVDs indicate that more research is needed into sex and age differences in sST2 levels in individual CVDs