Rationale and design of the Exercise Intensity Trial (EXCITE): A randomized trial comparing the effects of moderate versus moderate to high-intensity aerobic training in women with operable breast cancer.

BACKGROUND: The Exercise Intensity Trial (EXcITe) is a randomized trial to compare the efficacy of supervised moderate-intensity aerobic training to moderate to high-intensity aerobic training, relative to attention control, on aerobic capacity, physiologic mechanisms, patient-reported outcomes, and biomarkers in women with operable breast cancer following the completion of definitive adjuvant therapy. METHODS/DESIGN: Using a single-center, randomized design, 174 postmenopausal women (58 patients/study arm) with histologically confirmed, operable breast cancer presenting to Duke University Medical Center (DUMC) will be enrolled in this trial following completion of primary therapy (including surgery, radiation therapy, and chemotherapy). After baseline assessments, eligible participants will be randomized to one of two supervised aerobic training interventions (moderate-intensity or moderate/high-intensity aerobic training) or an attention-control group (progressive stretching). The aerobic training interventions will include 150 mins.wk⁻¹ of supervised treadmill walking per week at an intensity of 60%-70% (moderate-intensity) or 60% to 100% (moderate to high-intensity) of the individually determined peak oxygen consumption (VO₂peak) between 20-45 minutes/session for 16 weeks. The progressive stretching program will be consistent with the exercise interventions in terms of program length (16 weeks), social interaction (participants will receive one-on-one instruction), and duration (20-45 mins/session). The primary study endpoint is VO₂peak, as measured by an incremental cardiopulmonary exercise test. Secondary endpoints include physiologic determinants that govern VO₂peak, patient-reported outcomes, and biomarkers associated with breast cancer recurrence/mortality. All endpoints will be assessed at baseline and after the intervention (16 weeks). DISCUSSION: EXCITE is designed to investigate the intensity of aerobic training required to induce optimal improvements in VO₂peak and other pertinent outcomes in women who have completed definitive adjuvant therapy for operable breast cancer. Overall, this trial will inform and refine exercise guidelines to optimize recovery in breast and other cancer survivors following the completion of primary cytotoxic therapy. TRIAL REGISTRATION: NCT01186367.

Lightning mapping observation of a terrestrial gamma-ray flash

We report the observation with the North Alabama Lightning Mapping Array (LMA) related to a terrestrial gamma-ray flash (TGF) detected by RHESSI on 26 July 2008. The LMA data explicitly show the TGF was produced during the initial development of a compact intracloud (IC) lightning flash between a negative charge region centered at about 8.5 km above sea level (-22C temperature level) a higher positive region centered at 13 km, both confined to the convective core of an isolated storm in close proximity to the RHESSI footprint. After the occurrence of an LMA source with a high peak power (26 kW), the initial lightning evolution caused an unusually large IC current moment that became detectable 2 ms after the first LMA source and increased for another 2 ms, during which the burst of gamma-rays was produced. This slowly building current moment was most likely associated with the upward leader progression, which produced an uncommonly large IC charge moment change (+90 Ckm) in 3 ms while being punctuated by a sequence of fast discharge. These observations suggest that the leader development may be involved in the TGF production. Copyright © 2010 by the American Geophysical Union.