scholarly journals The impact of neoadjuvant chemotherapy on cardiopulmonary physical fitness in gastro-oesophageal adenocarcinoma

2016 ◽  
Vol 98 (6) ◽  
pp. 396-400 ◽  
Author(s):  
RCF Sinclair ◽  
M Navidi ◽  
SM Griffin ◽  
K Sumpter
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Oxygen Uptake ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Perioperative Risk ◽  
Oesophageal Adenocarcinoma ◽  
Before And After ◽  
Student’S T ◽  
The Uk ◽  
The Impact

Introduction Operable oesophagogastric adenocarcinoma management in the UK includes three cycles of neoadjuvant chemotherapy (NAC) followed by resection. Determination of oxygen uptake at the anaerobic threshold (AT) with cardiopulmonary exercise testing (CPET) is used to objectively measure cardiorespiratory reserve. Oxygen uptake at AT predicts perioperative risk, with low values associated with increased morbidity. Previous studies indicate NAC may have a detrimental impact on cardiorespiratory reserve. Methods CPET was completed by 30 patients before and after a standardised NAC protocol. The ventilatory AT was determined using the V-slope method, and the peak oxygen uptake and ventilatory equivalents for carbon dioxide measured. Median AT before and after chemotherapy was compared using a paired Student’s t-test. Results Median oxygen uptake at AT pre- and post-NAC was 13.9±3.1 ml/kg/min and 11.5±2.0 ml/kg/min, respectively. The mean decrease was 2.4 ml/kg/min (95% confidence interval [CI] 1.3–3.85; p<0.001). Median peak oxygen delivery also decreased by 2.17 ml/kg/min (95% CI 1.02–3.84; p=0.001) after NAC. Ventilatory equivalents were unchanged. Conclusions This reduction in AT objectively quantifies a decrease in cardiorespiratory reserve after NAC. Patients with lower cardiorespiratory reserve have increased postoperative morbidity and mortality. Preventing this decrease in cardiorespiratory reserve during chemotherapy, or optimising the timing of surgical resection after recovery of AT, may allow perioperative risk-reduction.

P142 IMPACT OF NEO-ADJUVANT CHEMOTHERAPY ON CARDIORESPIRATORY RESERVE, SARCOPENIA AND QUALITY OF LIFE IN OESOPHAGO-GASTRIC CARCINOMA

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
M Navidi ◽  
A Phillips ◽  
M Griffin ◽  
G Petrides ◽  
J Perthen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Neoadjuvant Chemotherapy ◽  
Oxygen Uptake ◽  
Muscle Mass ◽  
Locally Advanced ◽  
Perioperative Risk ◽  
Poor Prognostic Factor ◽  
Quality Life ◽  
The Impact

Abstract Background The management of locally advanced oesophago-gastric (OG) adenocarcinoma in the UK includes three cycles of MAGIC protocol neoadjuvant chemotherapy (NAC). NAC may have a detrimental impact on fitness, quality of life and sarcopenia. Determination of the oxygen uptake at the anaerobic threshold (AT) by cardiopulmonary exercise testing (CPET) objectively measures cardiorespiratory reserve (fitness). AT can be used to predict perioperative risk. Sarcopenia is defined by decreased skeletal muscle mass and is a poor prognostic factor. Patients view their health by means of quality of life (QOL) rather than traditional clinical outcomes. This study was conducted to determine the impact of neoadjuvant chemotherapy on fitness, sarcopenia and quality of life following neoadjuvant chemotherapy. Methods Patients with locally advanced OG adenocarcinoma were recruited. CPET, sarcopenia and QOL were measured before and following NAC. AT and peak oxygen uptake (VO2 Peak) were used to assess fitness. CT images at staging and upon completion of NAC were used to measure sarcopenia (muscle mass and function). EORTC QOL-Core 30 and QLQ-Oesophagogastric 25 questionnaires assessed QOL. Results 31 patients with a median age of 65 (41-81) were recruited, 27 patients completed all three cycles of NAC. The results of pre and post NAC measured parameters are outlined in the table below. Conclusion NAC significantly impacts fitness, sarcopenia levels and QOL. Preventing this reduction through development of ‘prehabilitation’ strategies, or optimising timing of surgery after recovery of the observed decline, may decrease perioperative risk, reduce postoperative complications and improve quality life. This should be the focus of future studies.

scholarly journals Modeling and Estimating Volatility of Day-Ahead Electricity Prices

Mathematics ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 750
Author(s):  
Sherzod N. Tashpulatov
Keyword(s):  
Heavy Tails ◽  
Price Level ◽  
Power Market ◽  
Error Distribution ◽  
Electricity Prices ◽  
Volatility Model ◽  
Generalized Error Distribution ◽  
Student’S T ◽  
The Uk ◽  
The Impact

We model day-ahead electricity prices of the UK power market using skew generalized error distribution. This distribution allows us to take into account the features of asymmetry, heavy tails, and a peak higher than in normal or Student’s t distributions. The adequacy of the estimated volatility model is verified using various tests and criteria. A correctly specified volatility model can be used for analyzing the impact of reforms or other events. We find that, after the start of the COVID-19 pandemic, price level and volatility increased.

scholarly journals Can wearable technology be used to approximate cardiopulmonary exercise testing metrics?

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Laura Jones ◽  
Laura Tan ◽  
Suzanne Carey-Jones ◽  
Nathan Riddell ◽  
Richard Davies ◽  
...  
Keyword(s):  
Physical Activity ◽  
High Risk ◽  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Exercise Testing ◽  
Low Cost ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Wearable Device ◽  
Cardiopulmonary Exercise

Abstract Background Consumer wrist-worn wearable activity monitors are widely available, low cost and are able to provide a direct measurement of several markers of physical activity. Despite this, there is limited data on their use in perioperative risk prediction. We explored whether these wearables could accurately approximate metrics (anaerobic threshold, peak oxygen uptake and peak work) derived using formalised cardiopulmonary exercise testing (CPET) in patients undergoing high-risk surgery. Methods Patients scheduled for major elective intra-abdominal surgery and undergoing CPET were included. Physical activity levels were estimated through direct measures (step count, floors climbed and total distance travelled) obtained through continuous wear of a wrist worn activity monitor (Garmin Vivosmart HR+) for 7 days prior to surgery and self-report through completion of the short International Physical Activity Questionnaire (IPAQ). Correlations and receiver operating characteristic (ROC) curve analysis explored the relationships between parameters provided by CPET and physical activity. Device selection Our choice of consumer wearable device was made to maximise feasibility outcomes for this study. The Garmin Vivosmart HR+ had the longest battery life and best waterproof characteristics of the available low-cost devices. Results Of 55 patients invited to participate, 49 (mean age 65.3 ± 13.6 years; 32 males) were enrolled; 37 provided complete wearable data for analyses and 36 patients provided full IPAQ data. Floors climbed, total steps and total travelled as measured by the wearable device all showed moderate correlation with CPET parameters of peak oxygen uptake (peak VO2) (R = 0.57 (CI 0.29–0.76), R = 0.59 (CI 0.31–0.77) and R = 0.62 (CI 0.35–0.79) respectively), anaerobic threshold (R = 0.37 (CI 0.01–0.64), R = 0.39 (CI 0.04–0.66) and R = 0.42 (CI 0.07–0.68) respectively) and peak work (R = 0.56 (CI 0.27–0.75), R = 0.48 (CI 0.17–0.70) and R = 0.50 (CI 0.2–0.72) respectively). Receiver operator curve (ROC) analysis for direct and self-reported measures of 7-day physical activity could accurately approximate the ventilatory equivalent for carbon dioxide (VE/VCO2) and the anaerobic threshold. The area under these curves was 0.89 for VE/VCO2 and 0.91 for the anaerobic threshold. For peak VO2 and peak work, models fitted using just the wearable data were 0.93 for peak VO2 and 1.00 for peak work. Conclusions Data recorded by the wearable device was able to consistently approximate CPET results, both with and without the addition of patient reported activity measures via IPAQ scores. This highlights the potential utility of wearable devices in formal assessment of physical functioning and suggests they could play a larger role in pre-operative risk assessment. Ethics This study entitled “uSing wearable TEchnology to Predict perioperative high-riSk patient outcomes (STEPS)” gained favourable ethical opinion on 24 January 2017 from the Welsh Research Ethics Committee 3 reference number 17/WA/0006. It was registered on ClinicalTrials.gov with identifier NCT03328039.

scholarly journals Importance of physiotherapy/nursing multidisciplinary integration about update newborn position in the neonatal intensive care unit

2015 ◽  
Vol 28 (3) ◽  
pp. 437-445 ◽  
Author(s):  
Vanessa da Silva Neves Moreira Arakaki ◽  
Alana Monteiro de Oliveira ◽  
Trícia Bogossian ◽  
Viviane Saraiva de Almeida ◽  
Gustavo Dias da Silva ◽  
...  
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Physical Therapist ◽  
Body Position ◽  
Effective Care ◽  
Before And After ◽  
Student’S T ◽  
The Impact ◽  
Clinical Stability

AbstractIntroduction The high-risk newborns may require long periods of hospitalization until they reach clinical stability for hospital discharge. Avoiding babies to be in only one body position may be an effective way to cause respiratory and neuro-psycho-motor benefits, comfort and preventing pressure ulcers.Objectives This study investigated the impact of physiotherapy/nursing integration in update on body positioning of the newborn in the Neonatal Intensive Care Unit.Methods A questionnaire was administered to nurses and nursing technicians of the neonatal unit of Maternity School of UFRJ and nurses of the Advanced Course in Neonatal Nursing from the same institution. Two classes were taught by the physical therapist of the sector and the questions answered before and after these lessons. It was also a brief characterization of professional participants of the study. We used the Student's t test to compare the correct answers before (PRE) and after (POST) the classes, considering p < 0.05.Results There was a significant increase in the degree of knowledge of nurses and nursing technicians when compared the responses before (nurses: 68.8%; technicians: 70.1%) and after classes (nurses: 78.4 %; technicians: 88.9%). The nurses were less than five years of graduated (45%) and little time of professional experience in neonatology (60%). Forty-seven percent of technicians had less than five years of training and 82% had less than 10 years of experience.Conclusion The use of training by the nursing staff was significant, showing the importance of multidisciplinary approach and the integration of knowledge in the search for a humanized and effective care.

scholarly journals Mismatch between self-estimated and objectively assessed exercise capacity in patients with congenital heart disease varies in regard to complexity of cardiac defects

2020 ◽  
pp. 1-7
Author(s):  
Julius M. Woile ◽  
Stefan Dirks ◽  
Friederike Danne ◽  
Felix Berger ◽  
Stanislav Ovroutski
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Oxygen Uptake ◽  
Exercise Capacity ◽  
Congenital Heart ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Subjective Rating ◽  
Cardiac Defects ◽  
Cardiopulmonary Exercise

Abstract Aim: Regular evaluation of physical capacity takes a crucial part in long-term follow-up in patients with congenital heart disease (CHD). This study aims to examine the accuracy of self-estimated exercise capacity compared to objective assessments by cardiopulmonary exercise testing in patients with CHD of various complexity. Methods: We conducted a single centre, cross-sectional study with retrospective analysis on 382 patients aged 8–68 years with various CHD who completed cardiopulmonary exercise tests. Peak oxygen uptake was measured. Additionally, questionnaires covering self-estimation of exercise capacity were completed. Peak oxygen uptake was compared to patient’s self-estimated exercise capacity with focus on differences between complex and non-complex defects. Results: Peak oxygen uptake was 25.5 ± 7.9 ml/minute/kg, corresponding to 75.1 ± 18.8% of age- and sex-specific reference values. Higher values of peak oxygen uptake were seen in patients with higher subjective rating of exercise capacity. However, oxygen uptake in patients rating their exercise capacity as good (mean oxygen uptake 78.5 ± 1.6%) or very good (mean oxygen uptake 84.8 ± 4.8%) was on average still reduced compared to normal. In patients with non-complex cardiac defects, we saw a significant correlation between peak oxygen uptake and self-estimated exercise capacity (spearman-rho −0.30, p < 0.001), whereas in patients with complex cardiac defects, no correlation was found (spearman-rho −0.11, p < 0.255). Conclusion: The mismatch between self-estimated and objectively assessed exercise capacity is most prominent in patients with complex CHD. Registration number at Charité Universitätsmedizin Berlin Ethics Committee: EA2/106/14.

scholarly journals WHEN SEXUAL INFIDELITY TRIGGERS MURDER: EXAMINING THE IMPACT OF HOMICIDE LAW REFORM ON JUDICIAL ATTITUDES IN SENTENCING

2015 ◽  
Vol 74 (2) ◽  
pp. 307-328 ◽  
Author(s):  
Jeremy Horder ◽  
Kate Fitz-Gibbon
Keyword(s):  
Case Law ◽  
Law Reform ◽  
Loss Of Control ◽  
Sexual Infidelity ◽  
Before And After ◽  
Key Features ◽  
Homicide Law ◽  
The Uk ◽  
Substantive Law ◽  
The Impact

AbstractIn October 2010, the UK Parliament brought into effect law that replaced the partial defence to murder of provocation with a new partial defence of “loss of control”, applicable to England, Wales, and Northern Ireland. Although it retained some key features of its controversial predecessor, the new partial defence was in part designed better to address the gendered contexts within which a large number of homicides are committed. In examining the impact of the reforms, we will focus on long-held concerns about the treatment of sexual infidelity as a trigger for loss of control in murder cases. The article undertakes an analysis of English case law to evaluate the way in which sexual infidelity-related evidence has influenced perceptions of a homicide defendant's culpability, for the purposes of sentencing, both before and after the implementation of reform. The analysis reveals that, in sentencing offenders post reform, the higher courts have failed to follow the spirit of the reforms respecting the substantive law by effecting a corresponding change in sentencing practice.

scholarly journals Endurance Training Improves Oxygen Uptake and Endurance Capacity in Patients With Moderate to Severe Valvular Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Karin Vonbank ◽  
Daniel Haubenberger ◽  
Raphael Rosenhek ◽  
Matthias Schneider ◽  
Stefan Aschauer ◽  
...  
Keyword(s):  
Heart Disease ◽  
Oxygen Uptake ◽  
Endurance Training ◽  
Valvular Heart Disease ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Endurance Capacity ◽  
Working Capacity ◽  
Endurance Test ◽  
Cardiopulmonary Exercise

Aim: Peak oxygen uptake (peakVO2) is one of the strongest predictors of survival in patients with valvular heart disease. The purpose of this study was to determine whether endurance training improves peakVO2 and endurance capacity in patients with moderate-severe aortic and mitral valve disease.Methods: 30 patients with moderate-severe valvular heart disease were randomly assigned to 12 weeks of endurance training (TG) (n = 16) or standard care (SC) (n = 14). PeakVO2 and maximum working capacity (Wattmax) were assessed by cardiopulmonary exercise testing, as well as submaximal endurance test at 80% of peakVO2 at baseline and after 12 weeks.Results: There was a significant improvement in peakVO2 from 27.2 ± 5.9 ml/kg to 30.4 ± 6.3 ml/kg (P &lt; 0.001) in TG compared to the SC (peakVO2 from 24.6 ± 4.4 to 24.7 ± 3.8) and in the Wattmax from 151.8 ± 41.0 Watt to 171.2 ± 49.7 Watt in the TG compared to the SC (152.9 ± 35.6 Watt to 149.2 ± 28.4 Watt). The endurance capacity increased significantly from 17.0 ± 9.4 min to 32.8 ± 16.8 min (p = 0.003) in the TG compared to the SC (11.7 ± 6.2 min to 11.2 ± 7.6 min). The heart rate during the endurance test decreased in the TG from 154 ± 14 b/min to 142 ± 20 b/min for the same workload. No changes could be seen in the SC.Conclusion: Endurance training in patients with moderate to severe valvular heart disease increased significantly the peakVO2 as well as the endurance capacity.

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