Determinants of exercise capacity in patients with type 2 diabetes

OBJECTIVE - Type 2 diabetes is associated with reduced exercise capacity, but the cause of this association is unclear. We sought the associations of impaired exercise capacity in type 2 diabetes. RESEARCH DESIGN AND METHODS - Subclinical left ventricular (LV) dysfunction was sought from myocardial strain rate and the basal segmental diastolic velocity (Em) of each wall in 170 patients with type 2 diabetes (aged 56 +/- 10 years, 91 men), good quality echocardiographic images, and negative exercise echocardiograms. The same measurements were made in 56 control subjects (aged 53 +/- 10 years, 29 men). Exercise capacity was calculated in metabolic equivalents, and heart rate recovery (HRR) was measured as the heart rate difference between peak and 1 min after exercise. In subjects with type 2 diabetes, exercise capacity was correlated with clinical, therapeutic, biochemical, and echocardiographic variables, and significant independent associations were sought using a multiple linear regression model. RESULTS - Exercise capacity, strain rate, Em, and HRR were significantly reduced in type 2 diabetes. Exercise capacity was associated with age (r- = -0.37, P < 0.001), male sex (r = 0.26, P = 0.001), BMI (r = -0.19, P = 0.012), HbA(1c) (AlC; r = -0.22, P = 0.009), Em (r = 0.43, P < 0.001), HRR (r = 0.42, P < 0.001), diabetes duration (r = -0.18, P = 0.021), and hypertension history (r = -0.28, P < 0.001). Age (P < 0.001), male sex (P = 0.007), BMI (P = 0.001), Em (P = 0.032), HRR (P = 0.013), and AlC (P = 0.0007) were independent predictors of exercise capacity. CONCLUSIONS - Reduced exercise capacity in patients with type 2 diabetes is associated with diabetes control, subclinical LV dysfunction, and impaired HRR.

Epidemiological analysis of electroconvulsive therapy in Victoria, Australia

Objective: To determine the population-based utilization rate of electroconvulsive therapy (ECT) in Victoria between 1998-1999, to examine the characteristics of the ECT treated group, and to identify patient factors independently associated with differential rates of ECT treatment. Method: Electroconvulsive therapy is reported under statute in Victoria, Australia. Crude, age-adjusted and age-sex specific utilization rates were calculated using this statutory data for the 1998-1999 financial year and estimated mid-year populations from the Australian Bureau of Statistics. Descriptive characteristics of those treated with ECT were derived from the statutory data. Patient factors associated with an increased likelihood of ECT in the public sector were explored with logistic regression analysis, using non-ECT treated mental health patients from the Victorian Psychiatric Case Register as the reference population. Results: The crude treated-person and age-adjusted rates for the State (both public and private sectors) were 39.9 and 44.0 persons per 100 000 resident population per annum, respectively. The crude and age-adjusted administration rates were 330.3 and 362.6 ECT administrations per 100 000 resident population per annum, respectively. Age-sex specific rates varied by age and sex, with rates generally increasing with age and female sex. Overall, 62.8% of the treated group were women, 32.9% aged over 64, and 75.2% had depression. Diagnosis, age and sex each independently predicted ECT in the public sector, with diagnosis the most important factor, followed by age then sex. Conclusions: Despite decades of use, the appropriate rate of ECT utilization is still unclear. Further research should be directed at exploring the factors, including provider variables, determining ECT treatment.

Why do eastern curlews Numenius madagascariensis feed on prey that lowers intake rate before migration?

Eastern curlews Numenius madagascariensis spending the nonbreeding season in eastern Australia foraged on three intertidal decapods: soldier crab Mictyris longicarpus, sentinel crab Macrophthalmus crassipes and ghost-shrimp Trypaea australiensis. Due to their ecology, these crustaceans were spatially segregated (=distributed in 'patches') and the curlews intermittently consumed more than one prey type. It was predicted that if the curlews behaved as intake rate maximizers, the time spent foraging on a particular prey (patch) would reflect relative availabilities of the prey types and thus prey-specific intake rates would be equal. During the mid-nonbreeding period (November-December), Mictyris and Macrophthalmus were primarily consumed and prey-specific intake rates were statistically indistinguishable (8.8 versus 10.1 kJ x min(-1)). Prior to migration (February), Mictyris and Trypaea were hunted and the respective intake rates were significantly different (8.9 versus 2.3 kJ x min(-1)). Time allocation to Trypaea-hunting was independent of the availability of Mictyris. Thus, consumption of Trypaea depressed the overall intake rate. Six hypotheses for consuming Trypaea before migration were examined. Five hypotheses: the possible error by the predator, prey specialization, observer overestimation of time spent hunting Trypaea, supplementary prey and the choice of higher quality prey due to a digestive bottleneck, were deemed unsatisfactory. The explanation for consumption of a low intake-rate but high quality prey (Trypaea) deemed plausible was diet optimisation by the Curlews in response to the pre-migratory modulation (decrease in size/processing capacity) of their digestive system. With a seasonal decrease in the average intake rate, the estimated intake per low tide increased from 1233 to 1508 kJ between the mid-nonbreeding and pre-migratory periods by increasing the overall time spent on the sandflats and the proportion of time spent foraging.

Effect of moisture content on the R-70 self-heating rate of Callide coal

Strip samples from the Boundary Hill pit at Callide have been tested in an adiabatic oven to assess the effect of moisture on the R-70 self-heating rate of coal. The two strip samples tested had R-70 self-heating rate values of 10.23 and 8.61 degrees C/h. As the moisture content of the coal was progressively increased, from the dry state of the test, the R-70 value decreased dramatically. At approximately 40-50% of the moisture holding capacity of the coal, the self-heating rate becomes measurable. Above this critical level of moisture content, the heat produced by oxidation is dissipated by moisture evaporation and coal self-heating is significantly delayed. (c) 2005 Elsevier B.V All rights reserved.

Myocardial and vascular dysfunction and exercise capacity in the metabolic syndrome

The metabolic syndrome (MS) is associated with cardiovascular risk exceeding that expected from atherosclerotic risk factors, but the mechanism of this association is unclear. We sought to determine the effects of the MS on myocardial and vascular function and cardiorespiratory fitness in 393 subjects with significant risk factors but no cardiovascular disease and negative stress echocardiographic findings. Myocardial function was assessed by global strain rate, strain, and regional systolic velocity (s(m)) and diastolic velocity (e(m)) using tissue Doppler imaging. Arterial compliance was assessed using the pulse pressure method, involving simultaneous radial applanation tonometry and echocardiographic measurement of stroke volume. Exercise capacity was measured by expired gas analysis. Significant and incremental variations in left ventricular systolic (s(m), global strain, and strain rate) and diastolic (e(m)) function were found according to the number of components of MS (p <0.001). MS contributed to reduced systolic and diastolic function even in those without left ventricular hypertrophy (p <0.01). A similar dose-response association was present between the number of components of the MS and exercise capacity (p <0.001) and arterial compliance. The global strain rate and em were independent predictors of exercise capacity. In conclusion, subclinical left ventricular dysfunction corresponded to the degree of metabolic burden, and these myocardial changes were associated with reduced cardiorespiratory fitness.' Subjects with MS who also have subclinical myocardial abnormalities and reduced cardiorespiratory fitness may have a higher risk of cardiovascular disease events and heart failure. (C) 2005 Elsevier Inc. All rights reserved.

Effect of nitrogen supply on leaf appearance, leaf growth, leaf nitrogen economy and photosynthetic capacity in maize (Zea mays L.)

Leaf area growth and nitrogen concentration per unit leaf area, N-a (g m(-2) N) are two options plants can use to adapt to nitrogen limitation. Previous work indicated that potato (Solanum tuberosum L.) adapts the size of leaves to maintain Na and photosynthetic capacity per unit leaf area. This paper reports on the effect of N limitation on leaf area production and photosynthetic capacity in maize, a C4 cereal. Maize was grown in two experiments in pots in glasshouses with three (0.84-6.0 g N pot(-1)) and five rates (0.5-6.0 g pot(-1)) of N. Leaf tip and ligule appearance were monitored and final individual leaf area was determined. Changes with leaf age in leaf area, leaf N content and light-saturated photosynthetic capacity, P a,, were measured on two leaves per plant in each experiment. The final area of the largest leaf and total plant leaf area differed by 16 and 29% from the lowest to highest N supply, but leaf appearance rate and the duration of leaf expansion were unaffected. The N concentration of expanding leaves (N-a or %N in dry matter) differed by at least a factor 2 from the lowest to highest N supply. A hyperbolic function described the relation between P-max and N-a. The results confirm the 'maize strategy': leaf N content, photosynthetic capacity, and ultimately radiation use efficiency is more sensitive to nitrogen limitation than are leaf area expansion and light interception. The generality of the findings is discussed and it is suggested that at canopy level species showing the 'potato strategy' can be recognized from little effect of nitrogen supply on radiation use efficiency, while the reverse is true for species showing the 'maize strategy' for adaptation to N limitation. (c) 2004 Elsevier B.V. All rights reserved.

Item validity of the physical demands from the Dictionary of Occupational Titles for the functional capacity evaluation of clients with chronic back pain

This study assessed the item validity of 15 of the physical demands from the Dictionary of Occupational Titles (DOT), as evaluated in a new approach to functional capacity evaluation (FCE) for clients with chronic back pain, the Gibson Approach to FCE (GAPP FCE). Fifty-two occupational therapists were sent the specifications of the items in the GAPP FCE procedures and were asked to rate the items in terms of item-objective congruence, relevance and difficulty. A response rate of 59.2% was obtained. The majority of the therapists agreed that most of the items were congruent with the objectives based on the definition of the physical demands from the DOT. The items evaluating Balancing and Pushing and Pulling had the lowest item-objective congruence. The evaluation of Balancing and the Lifting, Carrying and Pushing and Pulling of loads greater than light-medium weight (10–16 kg) were not considered significantly relevant. Concerns were raised about the difficulty and safety of the evaluation of Lifting, Carrying and Pushing and Pulling with clients with chronic back pain, particularly if the therapist evaluates the manual handling of medium to heavy loads. These results may have implications for other FCEs, particularly those which are based on the DOT, or when assessing clients with chronic back pain.

The effects of ionizing radiation on the reproductive capacity of adult Penaeus (Marsupenaeus) japonicus (Bate)

The reproductive capacity of adult Penaeus (Marsupenaeus) japonicus (Bate) was assessed after exposure to ionizing gamma radiation from a cobalt-60 source. Males and females were each exposed to 0, 10 and 20 Gray (Gy) of ionizing radiation (IR) and reciprocally crossed to give nine mating combinations. Fecundity and hatch rate of resulting spawnings were used as measures of reproductive capacity. IR significantly (P

Lack of an osmotic constraint on intake rate of the eastern curlew Numenius madagascariensis

Rates of food intake in animals consuming abundant prey can be constrained by the rates of digestion or excretion of ingested substances, such as salt, particularly so in the animals that regularly migrate between freshwater and saltwater environments. We tested this hypothesis in a long-distance migrant shorebird, the eastern curlew Numenius madagascariensis (suborder Charadrii), foraging on intertidal decapods in eastern Australia. We predicted that if food intake rates are constrained osmotically, individuals with access to freshwater and less saline prey (FW group) would have higher rates of food and water intake than individuals with seawater-only access (SW group). Food intake rates did not differ between the FW and SW groups (0.14 g ash-free dry mass min(-1)), nor did the water influx rates (0.75 g min(-1)). Salt intake rates were lower at FW sites (19.3 versus 23.3 mg NaCl min(-1)) and overall they were similar to those of marine birds. Food intake rate in the eastern curlew appeared limited by digestive rather than by osmoregulatory capacity.

Phosphorus nutrition of Caustis blakei grown with two phosphorus sources of different solubility in two soils of differing phosphorus adsorption capacity

A barrier to the domestication of the phosphorus (P) sensitive Australian species Caustis blakei (Cyperaceae) is the standard production systems used commercially which invariably result in problems associated either with P deficiency or P toxicity. This paper reports on the growth responses of Caustis blakei cv. M63 to applications of fertiliser P as either monocalcium phosphate (MCP) or granulated Guano Gold (R) rock phosphate (RP) in two soils with different capacities to adsorb P. The Caustis M63 plants grown in the two soils did not show P toxicity symptoms when fertilised with RP, but shoot dry weight was 30-60% lower than the control in both soils at the highest rate of MCP-P application (156 kg ha(-1), 184 g m(-3)) and this was associated with visible symptoms of drying of the tips of the ultimate branchlets, in the Mt Cotton soil only. The greatest shoot and root dry weights were achieved by plants grown in the higher P adsorbing Palmwoods soil fertilised with RP at P rates of 30-184 g m(-3). Caustis plants grown in the Palmwoods soil had 2.3 times greater root dry weights than plants grown in the Mt Cotton soil irrespective of the P fertiliser type used. Caustis plants growing in Mt Cotton soil which did not receive P showed significantly lower shoot and root dry weight when compared to plants in the Palmwoods soil, probably due to the low initial bicarbonate-extractable P and the high buffering capacity of the Mt Cotton soil. The P concentration in shoots of Caustis fertilised with MCP at 184 g m(-3) was higher when grown in Mt Cotton soil (0.22%) than in the Palmwoods soil (0.15%). The P concentration was lower in the terminal ultimate branchlets (TUB); 0.15% for the Mt Cotton soil and 0.10% for the Palmwoods soil, suggesting that shoots would provide a more useful indicator of P toxicity than the TUB. It is interesting to speculate as to why plants in the Palmwoods soil showed greater root growth and fewer symptoms of P toxicity. This could be because the Palmwoods soil had the greater P adsorption capacity. These results indicate in ground production of Caustis cut foliage will require careful management of P nutrition and understanding of the complex soil/plant interactions associated with the acquisition of P. (c) 2006 Elsevier B.V. All rights reserved.

Overcoming the problem of loss-in-capacity of calcium oxide in CO2 capture

Calcium oxide has been identified to be one of the best candidates for CO2 capture in zero-emission power-generation systems. However, it suffers a well-known problem of loss-in-capacity (i.e., its capacity of CO2 capture decreases after it undergoes cycles of carbonation/decarbonation). This problem is a potential obstacle to the adoption of the new technologies. This paper proposes a method of fabricating a CaO-based adsorbent without the problem of loss-in-capacity. An adsorbent was fabricated using the method and tested on a thermogravimetric analyzer. It was shown that the sorbent attained a utilization efficiency of more than 90% after 9 cycles of carbonation/decarbonation.

Prediction of functional capacity in chronic heart failure patients using myocardial tissue Doppler

Background. Exercise therapy improves functional capacity in CHF, but selection and individualization of training would be helped by a simple non-invasive marker of peak VO2. Peak VO2 in these pts is difficult to predict without direct measurement, and LV ejection fraction is a poor predictor. Myocardial tissue velocities are less load-dependent, and may be predictive of the exercise response in CHF pts. We sought to use tissue velocity as a predictor of peak VO2 in CHF pts. Methods. Resting 2D-echocardiography and tissue Doppler imaging were performed in 182 CHF pts (159 male, age 62±10 years) before and after metabolic exercise testing. The majority of these patients (129, 71%) had an ischemic cardiomyopathy, with resting EF of 35±13% and a peak VO2 of 13.5±4.7 ml/kg/min. Results. Neither resting EF (r=0.15) nor peak EF (r=0.18, both p=NS) were correlated with peak VO2. However, peak VO2 correlated with peak systolic velocity in septal (Vss, r=0.31) and lateral walls (Vsl, r=0.26, both p=0.01). In a general linear model (r2 = 0.25), peak VO2 was calculated from the following equation: 9.6 + 0.68*Vss - 0.09*age + 0.06*maximum HR. This model proved to be a superior predictor of peak VO2 (r=0.51, p=0.01) than the standard prediction equations of Wasserman (r= -0.12, p=0.01). Conclusions. Resting tissue Doppler, age and maximum heart rate may be used to predict functional capacity in CHF patients. This may be of use in selecting and following the response to therapy, including for exercise training.