Australian cardiac rehabilitation exercise parameter characteristics and perceptions of high-intensity interval training: a cross-sectional survey

Purpose: This study explored current demographics, characteristics, costs, evaluation methods, and outcome measures used in Australian cardiac rehabilitation (CR) programs. It also determined the actual usage and perceptions of high-intensity interval training (HIIT). Methods: A cross-sectional observational web-based survey was distributed to 328 Australian CR programs nationally. Results: A total of 261 programs completed the survey (79.6% response rate). Most Australian CR programs were located in a hospital setting (76%), offered exercise sessions once a week (52%) for 6–8 weeks (49%) at moderate intensity (54%) for 46–60 min (62%), and serviced 101–500 clients per annum (38%). HIIT was reported in only 1% of programs, and 27% of respondents believed that it was safe while 42% of respondents were unsure. Lack of staff (25%), monitoring resources (20%), and staff knowledge (18%) were the most commonly reported barriers to the implementation of HIIT. Overall, Australian CR coordinators are unsure of the cost of exercise sessions. Conclusion: There is variability in CR delivery across Australia. Only half of programs reassess outcome measures postintervention, and cost of exercise sessions is unknown. Although HIIT is recommended in international CR guidelines, it is essentially not being used in Australia and clinicians are unsure as to the safety of HIIT. Lack of resources and staff knowledge were perceived as the biggest barriers to HIIT implementation, and there are inconsistent perceptions of prescreening and monitoring requirements. This study highlights the need to educate health professionals about the benefits and safety of HIIT to improve its usage and patient outcomes

Impact of incomplete ventricular coverage on diagnostic performance of myocardial perfusion imaging.

In the context of myocardial perfusion imaging (MPI) with cardiac magnetic resonance (CMR), there is ongoing debate on the merits of using technically complex acquisition methods to achieve whole-heart spatial coverage, rather than conventional 3-slice acquisition. An adequately powered comparative study is difficult to achieve given the requirement for two separate stress CMR studies in each patient. The aim of this work is to draw relevant conclusions from SPECT MPI by comparing whole-heart versus simulated 3-slice coverage in a large existing dataset. SPECT data from 651 patients with suspected coronary artery disease who underwent invasive angiography were analyzed. A computational approach was designed to model 3-slice MPI by retrospective subsampling of whole- heart data. For both whole-heart and 3-slice approaches, the diagnostic performance and the stress total perfusion deficit (TPD) score-a measure of ischemia extent/severity-were quantified and compared. Diagnostic accuracy for the 3-slice and whole-heart approaches were similar (area under the curve: 0.843 vs. 0.855, respectively; P = 0.07). The majority (54%) of cases missed by 3-slice imaging had primarily apical ischemia. Whole-heart and 3-slice TPD scores were strongly correlated (R2 = 0.93, P < 0.001) but 3-slice TPD showed a small yet significant bias compared to whole-heart TPD (- 1.19%; P < 0.0001) and the 95% limits of agreement were relatively wide (- 6.65% to 4.27%). Incomplete ventricular coverage typically acquired in 3-slice CMR MPI does not significantly affect the diagnostic accuracy. However, 3-slice MPI may fail to detect severe apical ischemia and underestimate the extent/severity of perfusion defects. Our results suggest that caution is required when comparing the ischemic burden between 3-slice and whole-heart datasets, and corroborate the need to establish prognostic thresholds specific to each approach

Gamma-ray Emission From Advection-Dominated Accretion Flows Around Black Holes: Application to the Galactic Center

We calculate the flux and spectrum of \gamma-rays emitted by a two-temperature advection-dominated accretion flow (ADAF) around a black hole. The \gamma-rays are from the decay of neutral pions produced through proton-proton collisions. We discuss both thermal and power-law distributions of proton energies and show that the \gamma-ray spectra in the two cases are very different. We apply the calculations to the \gamma-ray source, 2EG J1746-2852, detected by EGRET from the direction of the Galactic Center. We show that the flux and spectrum of this source are consistent with emission from an ADAF around the supermassive accreting black hole Sgr A^* if the proton distribution is a power-law. The model uses accretion parameters within the range made likely by other considerations. If this model is correct, it provides evidence for the presence of a two temperature plasma in Sgr A^*, and predicts \gamma-ray fluxes from other accreting black holes which could be observed with more sensitive detectors.Comment: 19 pages (Latex), 4 Figures. ApJ 486. Revised Tables and Figure

Are Particles in Advection-Dominated Accretion Flows Thermal?

We investigate the form of the momentum distribution function for protons and electrons in an advection-dominated accretion flow (ADAF). We show that for all accretion rates, Coulomb collisions are too inefficient to thermalize the protons. The proton distribution function is therefore determined by the viscous heating mechanism, which is unknown. The electrons, however, can exchange energy quite efficiently through Coulomb collisions and the emission and absorption of synchrotron photons. We find that for accretion rates greater than \sim 10^{-3} of the Eddington accretion rate, the electrons have a thermal distribution throughout the accretion flow. For lower accretion rates, the electron distribution function is determined by the electron's source of heating, which is primarily adiabatic compression. Using the principle of adiabatic invariance, we show that an adiabatically compressed collisionless gas maintains a thermal distribution until the particle energies become relativistic. We derive a new, non-thermal, distribution function which arises for relativistic energies and provide analytic formulae for the synchrotron radiation from this distribution. Finally, we discuss its implications for the emission spectra from ADAFs.Comment: 29 pages (Latex), 3 Figures. Submitted to Ap

High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation:a systematic review and meta-analysis

Aerobic capacity has been shown to be inversely proportionate to cardiovascular mortality and morbidity and there is growing evidence that high-intensity interval training (HIIT) appears to be more effective than moderate-intensity continuous training (MICT) in improving cardiorespiratory fitness within the cardiac population. Previously published systematic reviews in cardiovascular disease have neither investigated the effect that the number of weeks of intervention has on cardiorespiratory fitness changes, nor have adverse events been collated.We aimed to undertake a systematic review and meta-analysis of randomized controlled trials (RCTs) within the cardiac population that investigated cardiorespiratory fitness changes resulting from HIIT versus MICT and to collate adverse events.A critical narrative synthesis and meta-analysis was conducted after systematically searching relevant databases up to July 2017. We searched for RCTs that compared cardiorespiratory fitness changes resulting from HIIT versus MICT interventions within the cardiac population.Seventeen studies, involving 953 participants (465 for HIIT and 488 for MICT) were included in the analysis. HIIT was significantly superior to MICT in improving cardiorespiratory fitness overall (SMD 0.34 mL/kg/min; 95% confidence interval [CI; 0.2-0.48]; p6-week duration. Programs of 7-12 weeks' duration resulted in the largest improvements in cardiorespiratory fitness for patients with coronary artery disease. HIIT appears to be as safe as MICT for CR participants

Scaling Laws for Advection Dominated Flows: Applications to Low Luminosity Galactic Nuclei

We present analytical scaling laws for self-similar advection dominated flows. The spectra from these systems range from 10$^{8}$ - 10$^{20}$ Hz, and are determined by considering cooling of electrons through synchrotron, bremsstrahlung, and Compton processes. We show that the spectra can be quite accurately reproduced without detailed numerical calculations, and that there is a strong testable correlation between the radio and X-ray fluxes from these systems. We describe how different regions of the spectrum scale with the mass of the accreting black hole, $M$, the accretion rate of the gas, $\dot{M}$, and the equilibrium temperature of the electrons, $T_e$. We show that the universal radio spectral index of 1/3 observed in most elliptical galaxies (Slee et al. 1994) is a natural consequence of self-absorbed synchrotron radiation from these flows. We also give expressions for the total luminosity of these flows, and the critical accretion rate, $\dot{M}_{crit}$, above which the advection solutions cease to exist. We find that for most cases of interest the equilibrium electron temperature is fairly insensitive to $M$, $\dot{M}$, and parameters in the model. We apply these results to low luminosity black holes in galactic nuclei. We show that the problem posed by Fabian & Canizares (1988) of whether bright elliptical galaxies host dead quasars is resolved, as pointed out recently by Fabian & Rees (1995), by considering advection-dominated flows.Comment: 30 pages, 5 postscript files. Accepted to ApJ. Also available http://cfa-www.harvard.edu/~rohan/publications.htm

Probing thermal expansion of graphene and modal dispersion at low-temperature using graphene NEMS resonators

We use suspended graphene electromechanical resonators to study the variation of resonant frequency as a function of temperature. Measuring the change in frequency resulting from a change in tension, from 300 K to 30 K, allows us to extract information about the thermal expansion of monolayer graphene as a function of temperature, which is critical for strain engineering applications. We find that thermal expansion of graphene is negative for all temperatures between 300K and 30K. We also study the dispersion, the variation of resonant frequency with DC gate voltage, of the electromechanical modes and find considerable tunability of resonant frequency, desirable for applications like mass sensing and RF signal processing at room temperature. With lowering of temperature, we find that the positively dispersing electromechanical modes evolve to negatively dispersing ones. We quantitatively explain this crossover and discuss optimal electromechanical properties that are desirable for temperature compensated sensors.Comment: For supplementary information and high resolution figures please go to http://www.tifr.res.in/~deshmukh/publication.htm