Incremental Effort Research Articles

Breathing Pattern Response after 6 Weeks of Inspiratory Muscle Training during Exercise.

(1) Background: The breathing pattern is defined as the relationship between the tidal volume (VT) and breathing frequency (BF) for a given VE. The aim of this study was to evaluate whether inspiratory muscle training influenced the response of the breathing pattern during an incremental effort in amateur cyclists. (2) Methods: Eighteen amateur cyclists completed an incremental test to exhaustion, and a gas analysis on a cycle ergometer and spirometry were conducted. Cyclists were randomly assigned to two groups (IMTG = 9; CON = 9). The IMTG completed 6 weeks of inspiratory muscle training (IMT) using a PowerBreathe K3® device at 50% of the maximum inspiratory pressure (Pimax). The workload was adjusted weekly. The CON did not carry out any inspiratory training during the experimental period. After the 6-week intervention, the cyclists repeated the incremental exercise test, and the gas analysis and spirometry were conducted. The response of the breathing pattern was evaluated during the incremental exercise test. (3) Results: The Pimax increased in the IMTG (p < 0.05; d = 3.1; +19.62%). Variables related to the breathing pattern response showed no differences between groups after the intervention (EXPvsCON; p > 0.05). Likewise, no differences in breathing pattern were found in the IMTG after training (PREvsPOST; p > 0.05). (4) Conclusions: IMT improved the strength of inspiratory muscles and sport performance in amateur cyclists. These changes were not attributed to alterations in the response of the breathing pattern.

Cardiopulmonary capacity and muscle strength in transgender women on long-term gender-affirming hormone therapy: a cross-sectional study

ObjectiveFor transgender women (TW) on oestrogen therapy, the effects of prior exposure to testosterone during puberty on their performance, mainly cardiopulmonary capacity (CPC), while exerting physical effort are unknown. Our...

Normative values for heart rate response to exercise in young athletes at 10–18 years old

ABSTRACT The assessment of the chronotropic response during acute physical exertion can allow the discovery of many cardiovascular diseases even at a young age. However, the increase in heart rate (HR) depends on the age and sex of the subject and the modality of the graded exercise test. This study aims to provide sex- and age-related normative values for heart rate performance in young athletes aged 10–18. A retrospective study was carried out on 7896 young athletes (5356 males and 2540 females) aged between 10 and 18 who underwent pre-participation screening to obtain eligibility for competitive sport. First, anthropometric parameters, performance data, and HR are reported. Thus, each age calculated third, tenth, twenty-fifth, fiftieth, seventy-fifth, ninetieth, and ninety-seventh percentiles for the stage-by-stage HR response, according to sex and graded exercise test modality category. Young female athletes of all ages showed lower performance with fewer stages performed on the cycle ergometer and the treadmill. Young male athletes on treadmill and cycle ergometers show lower HR values at submaximal intensities. The treadmill allows a longer duration than the cycle ergometer for males and females. Sex, age, and the specificity of the movement performed must be considered in assessing the chronotropic response in the young population, particularly for those who carry out a training program. In addition, providing reference values of HR response to acute physical exertion may allow for a better functional assessment of the young athletes. Highlights Growth and physical training induce continuous changes in the cardiovascular system. However, each young athlete shows individual features. The chronotropic response to incremental load is a common method for assessing health and fitness. Comparing the heart rate data obtained from the incremental effort with the reference percentiles can provide information in a short time in the evaluation of young athletes and the general youth population. Therefore, this methodology is regularly performed in the evaluation of anthropometric growth. In evaluating the chronotropic response to physical exertion, in addition to age and sex, should take the specificity of the movement performed during the test into account.

Noise suppression using a near-source wavelet

Denoising becomes a nontrivial task when the noise and signal overlap in multiple domains, such as time, frequency, and velocity. Fortunately, signal and noise waveforms, in general, tend to remain morphologically different and such differences can be used to separate body-wave signals from other waveforms such as ground roll and cultural noise. The key in denoising using a near-source wavelet is to find a wavelet that is a close approximation of the true source signature and remains uncontaminated by the Green’s function in any significant manner. An inverse filter designed using such a wavelet selectively compresses the body waves that can be extracted using median and low-pass filters. The overall phenomenon is explained with a synthetic example. The idea is also tested on a land data set generated using a large weight-drop source in which the wavelet recorded approximately 3 m from the source location fulfills the criteria set in our method. The results suggest that the incremental effort of recording an extra trace close to the source location during acquisition may provide previously unavailable denoising opportunities during processing, although the trace itself may be redundant for imaging.

First Evidence of Cardiopulmonary Adaptation to Physical Effort in Transgender Women After Long-Term Hormone Therapy: A Cross-Sectional Study

Introduction: Cisgender men (CM) and women (CM) present different acute cardiopulmonary (CP) adaptation to effort. The smallest arteriovenous difference in oxygen (O2) and cardiac output (CO) in CW determine a lower maximum VO2 (VO2max) than CM. CP capacity adaptation to effort of TW undergoing gender-affirming hormone therapy (GAHT) was not yet reported. Objective: To evaluate CP capacity of TW in long-term GAHT. Methods: A cross-sectional study was carried out with 8 TW (average age of 34.0 ±4.8 yo), 8 CM and 8 CW matched on age, body mass index and activity level. All TW were non-gonadectomized subjects and were in estrogen [transdermal estradiol (n=2), oral estradiol (n=3) and conjugated estrogen (n=3)], plus cyproterone acetate (n=8) therapy in an average time of 15.6 ±8.7 years. Body composition was assessed by InBody 720, and participants’ level of physical activity by IPAQ (International Physical Activity Questionnaire) short form. Total testosterone (ng/dL) levels of TW, CW and CM were 83,5 (12,0;637,0), 20,5 (12,0;41,0) and 480,5 (264,0;843,0), respectively. Hemoglobin levels of TW, CW and CM were 14,2 (13,5;14,9), 14,35 (12,8;14,7) and 15,35 (14,0;18,2), respectively. Everyone performed a CP exercise testing on a treadmill with an incremental effort. Results: Mean VO2max (L/min) in the group of TW was 2648±575.5, of CW 2128±394.0 and of CM 3235±554.0 (TWvsCW p=0.1311; TWvsCM p=0.0806; CWvsCM p=0.009). Free fat mass (FFM) of TW was 55.56±6.88 kg, CW 38.98±4,09 kg, and CM 64,98±6,29 kg (TWvsCW p<0,0001; TWvsCM p=0,024; CWvsCM p<0,0001). Analysis of VO2max/FFM (L/min/kg), TW′s rate was 46.6±6.2, CW′s was 54.6±8.4 and CM′s was 49.4±6.1 (TWvsCW p=0.0770;TWvsCM p=0.6942; CWvsCM p=0.3185). O2 pulse, VE/VO2 (ventilatory equivalents for O2) and VE/VCO2 (ventilatory equivalents for carbon dioxide) were similar in all groups. There was high correlation of O2pulse and free fat mass/height2 (FFM/Hgt2) of TW (r 0,925;p 0,008), not observed in CW (r 0.614;p0.105) or CM (r 0.737; p 0.037).% predicted Heart Rate (%HR) at effort was higher in TW (104) than in CW (95.8)(p=0.0221) and CM (100.3)(p=0.3334). Discussion: Aerobic capacity of TW was intermediate between CM and CW. Regards VO2 / FFM ratio, TW had a lower index than other groups. Since changes in pulmonary O2 diffusion, CO and blood circulation were ruled out as causing such data, it could be related to O2 uptake drops by the muscle. Increased sympathetic activity and %HR in TW and high correlation of O2pulse and FFM/Hgt2 make up compatible framework with exacerbation of ergoreflex. Conclusion: Our results support the finding of a VO2max similar between TW undergoing long-term GAHT and CW groups, despite the previous expose of TWs to testosterone during puberty. We hypothesized the presence of an increased ergoreflex sensitivity in TW individuals. These preliminary results should be confirmed by increasing the number of individuals studied.

Politically Connected Boards and Audit Pricing: U.S. Evidence

SYNOPSISThis study investigates the impact of political connections, as measured by having directors that previously held political positions, on audit pricing. We document that auditors charge higher fees to politically connected firms than to similar non-connected firms. Our findings are robust to a battery of additional analyses and the inclusion of transaction-based measures of political connections (campaign contributions and lobbying expenditures) in the model. The effect of political connections on audit fees is mitigated by independent monitoring. Moreover, the effect is stronger in firms with complicated operational structures and higher litigation risk, but weaker for distressed firms. Although our findings suggest that auditors exert greater effort at connected clients, we show that connected clients report higher discretionary accruals, consistent with auditors' incremental effort being insufficient to offset the audit risk inherent in these engagements. Collectively, our study illuminates how auditors perceive political connections and their impact on financial reporting quality.Data Availability: All data are publicly available from sources quoted in the text.

Enhancing supply chain sensing capability through social media: an environmental scanning perspective

PurposeThe purpose of this study is to investigate the relationship between social media and sensing capability for supply chain management (SCM) from an environmental scanning perspective. The authors consider upstream supply and downstream customer markets as two aspects of social media-enabled environmental scanning (SMES). The moderating effects of three uncertainties are explored.Design/methodology/approachThe data were collected from 178 supply chain professionals through a survey. Generalized estimating equations (GEE) were used to analyze the data.FindingsSMES in both supply and customer markets enhance sensing capability. Interestingly, the results reveal an accelerating effect on sensing by the incremental effort of SMES-supply. However, that of SMES-customer leads to a decelerating outcome for sensing. Also, uncertainties, especially the demand- and technology-related, play a series of interacting effects according to SMES levels.Research limitations/implicationsThis research contributes to the literature of operations and supply chains regarding social media strategies and dynamic capabilities. It opens the black box of environmental scanning behavior on social media and adds new knowledge on the dynamic influence of such behavior toward organizational sensing capability for SCM. In addition, further understanding on supply chain uncertainty as a moderator is also strengthened through this research.Originality/valueThis research is the first to empirically uncover the effect of social media on sensing capability for SCM through the lens of environmental scanning. The results support the employment of social networking for improving supply and demand sensing.

A Maximal Incremental Test in Cyclists Causes Greater Peripheral Fatigue in Biceps Femoris

ABSTRACT Purpose: The aim of this study was to determine the changes in neuromuscular contractile properties in elite cyclists associated to the peripheral fatigue produced in a maximal incremental test in cycle ergometer. Methods: Forty-eight volunteers’ well-trained male cyclists were evaluated during the competition season within a recovery microcycle. Tensiomyography was used before and after performing an incremental test until exhaustion in cycle ergometer to measure the radial muscle belly displacement of the vastus lateralis (VL), rectus femoris (RF), and biceps femoris (BF) on the dominant leg. Maximum radial muscle belly displacement (Dm), contraction time (Tc), delay time (Td), sustain time (Ts), and radial displacement velocity (Vrd) were measured. Mixed-design factorial analysis of variance was used to detect changes in the mechanical and neuromuscular characteristics after a maximal incremental exercise test. Results: The results show in the evaluated muscles a moderate-large decrease (p < .01, η2 = 0.06–0.51) in Tc, Td, Dm, Ts, and Vrd. This decrease occurs more sharply in the BF than in RF or VL. Conclusion: An incremental effort until exhaustion produces peripheral fatigue associated with a decrease in Dm, Tc, Td, Ts, and Vrd, being more pronounced in biceps femoris than in vastus lateralis and rectus femoris. Coaches can use these changes found in the contractile properties as a reference to detect the muscle fatigue degree that certain training models pose for the cyclist.

The validity of Keiser-M3 stationary bicycle with standard ergometer for physiological measurements associated with maximum effort

Abstract Aim: This study aims to investigate the concordance between two cycle ergometers for variables measured in the test of maximum incremental effort. Methods: This correlation study enrolled 15 inactive women (19,2 ± 4,0 years old). At random, the participants performed two maximal effort incremental tests (MEIT), using cycle ergometers (Keiser-M3 and Ergo-167) on different days with a minimum interval of 72 hours. The test had stages of two minutes, and two-step increments were carried out at the end of each stage. Lactate concentration ([LAC]), and rated perceived exertion (RPE) were collected, in addition to monitoring oxygen uptake (VO2) and heart rate (HR). The Paired t-test was carried out to compare physiologic variables, Lin's test was used for correlation, and Bland Altman was used to measuring concordances among variables. Results: The correlations between physiologic parameters were considered strong for HR on the anaerobic threshold (Keiser M3 = 146 ± 14 bpm; Ergo-167 = 149 ± 9 bpm; r = 0.762), greater blood lactate value (Keiser M3 = 9,97 ± 2,51 mmol/L; Ergo-167 = 9.71 ± 2.56 mmol/L; r = 0.820), VO2max (Keiser M3 = 38,37 ± 6,97 mL/kg/min; Ergo-167 = 36.06 ± 8.4 mL/kg/min; r = 0,806) and HRmax (Keiser M3 = 186 ± 53 bpm; Ergo-167 = 188 ± 11 bpm; r = 0.716). Conclusion: The results show the feasibility of using the cycle ergometer Keiser, model M3, to perform the maximal effort incremental test, whereas there was high concordance in the physiologic responses in both ergometers for inactive women.

Effects of resistance training on serum iron, total iron-binding capacity and transferrin saturation in police working dogs

The aim of this research was to evaluate the effects of a resistance training protocol on iron metabolism of police working dogs. Understanding of how physical exercise influences biochemical parameters is essential for a proper interpretation of exams and adjustments of nutritional and conditioning programs. Nine dogs, being four Belgian Malinois and five German Shepherd, 18.56±0.53 months old, were evaluated before (M1) and six weeks after (M2) a training program using a treadmill. Training sessions were performed twice/week including a 20-min of treadmill activity on a speed compatible with 60-80% of HRpeak on weeks 1 and 2; same exercise of weeks 1 and 2 with a 5% grade added between 7.5 and 12.5 min on weeks 3 and 4; and, same protocol of weeks 3 and 4 with three short bursts of strenuous exercise 60 min after the end of the treadmill exercise on weeks 5 and 6. On both moments (M1 and M2), animals were examined and blood samples were obtained before (T0) and after (T1) an incremental effort test and at 30 min (T2) and 120 min (T3) of recovery. Serum iron (Fe), total iron-binding capacity (TIBC) and transferrin saturation (TS) were determined. All variables were analysed using Tukey test, with P&lt;0.05. Iron parameters were not modified by the current exercise protocol for training police working dogs.

Abstract OT1-13-01: MammaPrint, BluePrint, and full-genome data linked with clinical data to evaluate new gene expression profiles (FLEX)

Abstract BACKGROUND: Genomic signatures are revolutionizing the definition, identification, and treatment of breast cancer subtypes. The ability of genomic signatures to enable fine grained stratification of breast cancers to the granular disease level is still generally untested because of the difficulties in aggregating large clinical data sets. In order to stratify breast cancers into actionable subtypes both the full genome data and clinical data must be collected for patients at scale. DESIGN &amp; METHODS: FLEX is designed as a novel, large-scale, population based, prospective registry. All patients with stage I-III breast cancer who receive MammaPrint (MP) or BluePrint (BP) testing on a primary breast tumor are eligible. FLEX utilizes an adaptive design which enables additional study arms at low incremental effort and cost by allowing targeted substudies to be added. Patients who are enrolled in the initial study will also be eligible for inclusion in any additional study arm where they meet all criteria. Additional study arms and substudies may be investigator-initiated. SPECIFIC AIMS: Primary: Create a big-data registry of full genome expression data and clinical data to investigate new gene associations with prognostic and/or predictive value. Secondary: Generate hypotheses for targeted subset analyses and trials based on full genome data. To date the following substudies have been proposed: DR. JENNIFER A. CROZIER, BAPTIST MD ANDERSON CANCER CENTER (1) MP and BP in male breast cancer TYPE: SUBSTUDY; NO ADDITIONAL CONSENT (ICF) REQUIRED. ARMS: ALL (2) MP BP evaluation in breast cancer patients ≥70. TYPE: SUBSTUDY; NO ADDITIONAL ICF REQUIRED. ARMS: ALL (3) FG evaluation in ILC. TYPE: SUBSTUDY; NO ADDITIONAL ICF REQUIRED. ARMS: ALL (4,5) MP BP relation to PR positivity, Ki67. TYPE: SUBSTUDY; NO ADDITIONAL ICF REQUIRED. ARMS: ALL (6) MP BP in metaplastic breast cancer. TYPE: SUBSTUDY; NO ADDITIONAL ICF REQUIRED. ARMS: ALL DR. ADAM M. BRUFSKY, UNIVERSITY OF PITTSBURGH MEDICAL CENTER MAGEE WOMENS HOSPITAL (1) Response to standard chemotherapy regimens in clinically ER+/PR+/HER2+ (triple positive) patients according to BP molecular subtypes. (2) Expression signatures by response to bisphosphonates in ER+ patients receiving adjuvant therapy, or for osteoporosis after primary treatment. (3) Gene expression in breast cancer patients with obesity. TYPE: SUBSTUDY; DUAL ICF UTILIZED. ARMS: NEOADJUVANT AND ADJUVANT DR. IAN GRADY, NORTH VALLEY BREAST CLINIC Impact of genomic risk classification on travel time to receive breast cancer care. TYPE: SUBSTUDY; NO ADDITIONAL ICF REQUIRED. ARMS: ALL DR. THOMAS LOMIS, VALLEY BREAST CARE Complementary data collection for patients participating in the ODM-201 trial. FLEX provides gene expression for exploratory and signature discovery. TYPE: COMPLEMENTARY; DUAL ICF UTILIZED. ARM: NEOADJUVANT DR. PAT WHITWORTH, NASHVILLE BREAST CENTER Genomic reclassification of large tumors eligible to receive NCT therapy. TYPE: SUBSTUDY; NO ADDITIONAL ICF REQUIRED. ARM: NEOADJUVANT ELIGIBILITY, ACCRUAL FLEX will enroll a minimum of 10000 patients aged ≥18 with stage I-III breast cancer who sign ICF. Enrollment began April 2017 and 623 patients have been enrolled as of June 2018. Citation Format: Brufsky AM, Crozier JA, Grady I, Lomis T, Whitworth P, Rehmus E, Srkalovic G, Lee L, Blumencranz P, Baron P, Mavromatis B, Untch S, Blumencranz L, Yoder EB, Audeh W, FLEX Investigators Group. MammaPrint, BluePrint, and full-genome data linked with clinical data to evaluate new gene expression profiles (FLEX) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-13-01.

A hospital wide predictive model for unplanned readmission using hierarchical ICD data

Background and objectiveHospitals already acquire a large amount of data, mainly for administrative, billing and registration purposes. Tapping on these already available data for additional purposes, aiming at improving care, without significant incremental effort and cost. This potential of secondary patient data is explored through modeling administrative and billing data, as well as the hierarchical structure of pathology codes of the International Classification of Diseases (ICD) in the prediction of unplanned readmissions, as a clinically relevant outcome parameter that can be impacted on in a quality improvement program. MethodsIn this single-center, hospital-wide observational cohort study, we included all adult patients discharged in 2016 after applying an exclusion protocol (n = 29,702). In addition to administrative variables, such as age and length of stay, structured pathology data were taken into account in predictive models. As a first research question, we compared logistic regression against penalized logistic regression, gradient boosting and Random Forests to predict unplanned readmission. As a second research goal, we investigated the level of hierarchy within the pathology data needed to achieve the best accuracy. Finally, we investigated which prediction variables play a prominent role in predicting hospital readmission. The performance of all models was evaluated using the Area Under the ROC Curve (AUC) measure. ResultsAll models have the best predictive results using Random Forests. An added value of 7% is observed compared to a baseline method such as logistic regression. The best model, based on Random Forests, achieved an AUC of 0.77, using the diagnosis category and procedure code as lowest level of the hierarchical pathology data. ConclusionsThe most accurate model to predict hospital wide unplanned readmission is based on Random Forests and includes the ICD hierarchy, especially diagnosis category. Such an approach lowers the number of predictor variables and yields a higher interpretability than a model based on a detailed diagnosis. The performance of the model proved high enough to be used as a decision support tool.

Catecholamine response to exercise in patients with non-obstructive hypertrophic cardiomyopathy.

Intense physical activity, a potent stimulus for sympathetic nervous system activation, is thought to increase the risk of malignant ventricular arrhythmias among patients with hypertrophic cardiomyopathy (HCM). As a result, the majority of patients with HCM deliberately reduce their habitual physical activity after diagnosis and this lifestyle change puts them at risk for sequelae of a sedentary lifestyle: weight gain, hypertension, hyperlipidaemia, insulin resistance, coronary artery disease, and increased morbidity and mortality. We show that plasma catecholamine levels remain stably low at exercise intensities below the ventilatory threshold, a parameter that can be defined during cardiopulmonary exercise testing, but rise rapidly at higher intensities of exercise. These findings suggest that cardiopulmonary exercise testing may be a useful tool to provide an individualized moderate-intensity exercise prescription for patients with HCM. Intense physical activity, a potent stimulus for sympathetic nervous system activation, is thought to increase the risk of malignant ventricular arrhythmias among patients with hypertrophic cardiomyopathy (HCM). However, the impact of exercise intensity on plasma catecholamine levels among HCM patients has not been rigorously defined. We conducted a prospective observational case-control study of men with non-obstructive HCM and age-matched controls. Laboratory-based cardiopulmonary exercise testing coupled with serial phlebotomy was used to define the relationship between exercise intensity and plasma catecholamine levels. Compared to controls (C, n=5), HCM participants (H, n=9) demonstrated higher left ventricular mass index (115±20 vs. 90±16g/m2 , P=0.03) and maximal left ventricular wall thickness (16±1 vs. 8±1mm, P<0.001) but similar body mass index, resting heart rate, peak oxygen consumption (H=40±13 vs. C=42±7ml/kg/min, P=0.81) and heart rate at the ventilatory threshold (H=78±6 vs. C=78±4% peak heart rate, P=0.92). During incremental effort exercise in both groups, concentrations of adrenaline and noradrenaline were unchanged through low- and moderate-exercise intensity until reaching a catecholamine threshold (H=82±4 vs. C=85±3% peak heart rate, P=0.86) after which levels of both molecules rose rapidly. In patients with mild non-obstructive HCM, plasma catecholamine levels remain stably low at exercise intensities below the ventilatory threshold but rise rapidly at higher intensities of exercise. Routine cardiopulmonary exercise testing may be a useful tool to provide an individualized moderate-intensity exercise prescription for patients with HCM.

Warm-up Optimizes Postural Control but Requires Some Minutes of Recovery.

Paillard, T, Kadri, MA, Nouar, MB, and Noé, F. Warm-up optimizes postural control but requires some minutes of recovery. J Strength Cond Res 32(10): 2725-2729, 2018-The aim was to compare monopedal postural control between the dominant leg (D-Leg) and the nondominant leg (ND-Leg) in pre- and post-warm-up conditions. Thirty healthy male sports science students were evaluated before and after a warm-up exercise (12 minutes of pedaling with an incremental effort on a cycle ergometer with a controlled workload). Monopodal postural control was assessed for the D- and ND-Legs before and immediately, 2, 5, 10, and 15 minutes after the warm-up exercise, using a force platform and calculating the displacement velocity of the center of foot pressure on the mediolateral (COPML velocity) and anteroposterior (COPAP velocity) axes. No significant difference was observed between the D-Leg and ND-Leg for both COPML and COPAP velocity in all the periods. In comparison with pre-warm-up, COPML decreased after 15-minute and 10-minute recovery periods for the D-Leg and the ND-Leg, respectively (p < 0.05), whereas COPAP decreased after 10-minute and 15-minute recovery periods (p < 0.001; p < 0.01, respectively) for the D-Leg, and after a 10-minute recovery period for the ND-Leg (p < 0.001). The warm-up optimized monopedal postural control but did not make it possible to distinguish a difference between the D-Leg and the ND-Leg. Some minutes of recovery are required between the end of the whole-body warm-up exercise and the beginning of the postural test to optimize postural control. The optimal duration of recovery turns out to be about 10-15 minutes.

Influence of the Lower Body on Seated Arm Cranking Performance.

During upper-body tasks, use of the lower body is important for minimizing physiological strain and maximizing performance. The lower body has an integral role during standing upper-body tasks, however, it is less clear if it is also important during seated upper-body tasks. We determined the extent to which the lower body influenced seated arm cranking performance. Eleven males performed incremental (40+20 W·3 min-1) and short-duration maximal effort (5 s, 120 rpm) arm cranking trials with and without lower-body restriction. The lower body was restricted by securing the legs to the seat and suspending them off the floor. Upper-body peak oxygen consumption (V̇O2peak) and maximal power were determined. At the end of the incremental protocol, lower-body restriction reduced V̇O2peak by 14±12% (P<0.01) compared to normal arm cranking. At greater submaximal stages (60-100% isotime) heart rate, ventilation, RER, and arm-specific exertion increased to a greater extent (all P<0.05) with lower-body restriction. During short duration maximal arm cranking, lower-body restriction decreased maximal power by 23±9% (P<0.01). Results indicated that lower-body restriction limited aerobic capacity, increased physiological strain during high-intensity submaximal exercise, and compromised maximal power generating capacity. These results imply that use of the lower body is critical when performing seated arm cranking. Our findings have implications for exercise testing, training and rehabilitation.

Sustainable Strategic Growth through Aligned Diversification

Sustainable growth is a strategy that is complex in an ever-changing environment. It is challenging to consistently achieve a positive reward over a sequence of product or service lifecycles. A single case study is discussed in which a conglomerate achieved consistent success over a globally supported supply chain that serviced clients across multiple life-cycles. To solidify its dominant market position, the company implemented a unique organizational structure. This structure empowered the locations to succeed in their emerging markets with minimal incremental effort. Success was consistently achieved through the efficient exploitation of relatedness, a selective focus, and synergy exploitation.

Development and Feasibility of Bundled Payments for the Multidisciplinary Treatment of Head and Neck Cancer: A Pilot Program.

Despite growing interest in bundled payments to reduce the costs of care, this payment method remains largely untested in cancer. This 3-year pilot tested the feasibility of a 1-year bundled payment for the multidisciplinary treatment of head and neck cancers. Four prospective treatment-based bundles were developed for patients with selected head and neck cancers. These risk-adjusted bundles covered 1 year of care that began with primary cancer treatment. Manual processes were developed for patient identification, enrollment, billing, and payment. Patients were prospectively identified and enrolled, and bundled payments were made at treatment start. Operational metrics tracked incremental effort for pilot processes and average payment cycle time compared with fee-for-service (FFS) payments. This pilot confirmed the feasibility of a 1-year prospective bundled payment for head and neck cancers. Between November 2014 and October 2016, 88 patients were enrolled successfully with prospective bundled payments. Through September 2017, 94% of patients completed the pilot with 6% still enrolled. Manual pilot processes required more effort than anticipated; claims processing was the most time-consuming activity. The production of a bundle bill took an additional 15 minutes versus FFS billing. The average payment cycle time was 37 days (range, 15 to 141 days) compared with a 15-day average under FFS. Prospective bundled payments were successfully implemented in this pilot. Additional pilots should study this payment method in higher-volume cancers. Robust systems are needed to automate patient identification, enrollment, billing, and payment along with policies that reduce administrative burden and allow for the introduction of novel cancer therapies.

Effects of resistance training on electrocardiographic and blood parameters of police dogs

The aims of this study were to evaluate effects of a 6 week resistance training on electrocardiographic (ECG) and blood parameters of police dogs. Our hypothesis was that this training protocol improves fitness, contributing to the welfare of these animals. Nine dogs, 18.56±0.53 months old, were evaluated before (M1) and six weeks after (M2) a training protocol using treadmill. Their training program was performed 2 times/week, and included 20 min of treadmill activity on a speed compatible with 60-80% of HRmax on weeks 1 and 2, same exercise of weeks 1 and 2 with a 5% grade added between 7.5 and 12.5 min in weeks 3 and 4, and, finally, same exercise of weeks 3 and 4 with three short bursts of strenuous exercise, 60 min after the end of treadmill activity. On both moments, animals were examined before (T0) and after (T1) an incremental effort test, and at 30 (T2) and 120 min (T3) of recovery, measuring heart rate, respiratory rate and body temperature. Blood samples were taken to determine erythrogram, aspartate aminotransferase, creatine kinase, triglycerides, lactate and glucose. Electrocardiographic variables were analysed at T0 and T1. All variables were analysed by one-way ANOVA and Tukey tests, with P≤0.05. After training, there was an increase on the length of work on treadmill of 41.5% for the German Shepherd (P=0.0139) and 21.4% for the Belgian Malinois (P=0.0085) along with a increase of maximal speed of 34.0% for the German Shepherd (P=0.0084) and 15.9% for the Belgian Malinois (P=0.0241). It was observed in physiological, blood and ECG parameters differences between M1 and M2 (P&lt;0.05). Other findings included a lower rest QTc value at T0 after training (P=0.0194). The chosen training led to a better fitness of the police dogs as all of them worked more intensively with a low cardiovascular requirement in M2. In conclusion, current exercise protocol in a treadmill improved dogs fitness, when we analysed ECG, physiological and blood parameters, making possible that animals may be used in more extended and multiple missions, contributing welfare of these animals.

The Role of Professional Ethics in Individual and Organizational Outcomes

The Role of Professional Ethics in Individual and Organizational Outcomes

A maximal incremental effort alters tear osmolarity depending on the fitness level in military helicopter pilots

PurposeFitness level modulates the physiological responses to exercise for a variety of indices. While intense bouts of exercise have been demonstrated to increase tear osmolarity (Tosm), it is not known if fitness level can affect the Tosm response to acute exercise. This study aims to compare the effect of a maximal incremental test on Tosm between trained and untrained military helicopter pilots. MethodsNineteen military helicopter pilots (ten trained and nine untrained) performed a maximal incremental test on a treadmill. A tear sample was collected before and after physical effort to determine the exercise-induced changes on Tosm. ResultsThe Bayesian statistical analysis demonstrated that Tosm significantly increased from 303.72 ± 6.76 to 310.56 ± 8.80 mmol/L after performance of a maximal incremental test. However, while the untrained group showed an acute Tosm rise (12.33 mmol/L of increment), the trained group experienced a stable Tosm physical effort (1.45 mmol/L). There was a significant positive linear association between fat indices and Tosm changes (correlation coefficients [r] range: 0.77–0.89), whereas the Tosm changes displayed a negative relationship with the cardiorespiratory capacity (VO2 max; r = −0.75) and performance parameters (r = −0.75 for velocity, and r = −0.67 for time to exhaustion). ConclusionsThe findings from this study provide evidence that fitness level is a major determinant of Tosm response to maximal incremental physical effort, showing a fairly linear association with several indices related to fitness level. High fitness level seems to be beneficial to avoid Tosm changes as consequence of intense exercise.