Peak Volume Research Articles

Ultrashort inspiratory times homogenize ventilation distribution in an inhomogeneous two-compartment model of the neonatal lung.

Inhomogeneous lung ventilation and pulmonary air leaks are common adverse effects of mechanical ventilation in preterm infants suffering from respiratory distress syndrome. We hypothesized that shortening of inspiratory times can improve the homogeneity of lung aeration. We assumed that ultrashort inspiratory times lead to a full build-up of pressure in regions with low compliance while maintaining incomplete filling of regions with high compliance. We connected a two-compartment model of the lung with different compliances of the two compartments to a neonatal ventilator. Pressures and flow rates were measured separately for each compartment at inspiratory times ranging from 0.1 to 0.8 s and various combinations of tidal volumes. An inspiratory time of 0.8 s resulted in near total pressure equalization between the airway pressure and the two compartments, as 97% of the maximum applied peak pressure was reached in the low compliance compartment and 95% in the high compliance compartment. The distribution of the tidal volume was proportional to the compartment compliance. Ultrashort inspiratory times lowered the peak pressure and tidal volume in the high compliance compartment but maintained higher pressure and volume in the low compliance compartment. An inspiratory time of 0.2 s resulted in a peak pressure of 80% of peak airway pressure in the low compliance compartment and in 61% of peak airway pressure in the high compliance compartment (p < .001). Ventilation with ultrashort inspiratory times may improve homogeneity of air distribution in inhomogeneous lungs of ventilated preterm or term infants.

Patient Inspiratory Maneuver Performance; Peak Lungpower, Acceleration and Volume.

Background: Use of drug delivery devices between nebulizers, dry powder inhalers (DPIs), or metered dose inhalers (MDIs), for treating patients with asthma and chronic obstructive pulmonary disease (COPD), is based on patients' capability of coordinating the inhalation maneuver and achieving sufficient airflow. There are limited data available with regard to how patients meet the requirements of successful inhalation performance, and how the concept of inspiratory lungpower could be applied. The aim of this work was to study the patient inspiratory airflow profile performance in large data sets. We analyzed how the Kamin-Haidl inhalation criteria were met by patients with DPIs such as Easyhaler for combination therapy (EH-combi), Easyhaler for monotherapy (EH-mono), Diskus, and Turbuhaler (TH), and applied peak lungpower instead of peak inspiratory flow rate as an indicator of patient performance.Materials and Methods: Data sets gathered in two previous studies for DPIs, that is, EH-combi, EH-mono, Diskus, and TH, were used to analyze how inspiratory lungpower representing inspiratory muscle power, flow acceleration, and volume after peak met the inhalation criteria. The measured patient airflow profiles through inhalers were assessed for patients with asthma or COPD.Results: Based on the Kamin-Haidl inhalation criteria, successful inhalation requirements were met with EH-combi in 96.1% and with EH-mono in 92.6% of patients. The success rates were 89.5% and 84.6% with Diskus and TH, respectively, (p < 0.0001 between devices). In patients with asthma or COPD, the mean lungpower was 7.51 and 6.15 W for EH-combi, 8.79 and 6.88 W for EH-mono, 7.18 and 4.36 W for Diskus, and 9.65 and 6.86 W for TH, respectively, when patients followed the manufacturer's written instructions.Conclusions: Lungpower applied to the Kamin-Haidl inhalation criteria concept could be an applicable method for reviewing patient performance for different DPIs despite DPIs' characteristic differences in airflow resistance. In light of these results, DPIs provide a feasible treatment option for a large majority of respiratory patients.

Statistical Structure of Nighttime O2 Aurora From SABER and Its Dependence on Geomagnetic and Solar Activities in Winter

AbstractO2 aurora is one kind of important molecular aurorae that is not fully understood yet. It is hard to be investigated due to the contamination by nightglow. In this work, we studied O2 aurora based on the observations of O2 emission at 1.27 μm from the Sounding of the Atmosphere using Broadband Emission Radiometry (SABER) instrument during the nighttime over 18 years. The horizontal structure of O2 auroral zone is given for the first time, and the vertical profile of O2 auroral volume emission rate is obtained after removing O2 nightglow contamination. The O2 auroral intensity and the peak height and peak volume emission rate of the vertical profile averaged over the O2 auroral zone are studied in detail. For Kp Levels 1–5, the O2 auroral peak height varies between 104 and 112 km and is negatively correlated with the auroral intensity and peak volume emission rate. The O2 auroral intensity varies between 0.14 and 5.97 kR, and the peak volume emission rate varies between 0.97 × 102 and 41.01 × 102 photons cm−3 s−1. Furthermore, the dependences of the O2 aurora on geomagnetic and solar activities are analyzed. The O2 auroral intensity and peak volume emission rate exponentially increases with increasing Kp index, whereas the peak height decreases with increasing Kp index. The O2 auroral intensity and peak volume emission rate under solar minimum condition are larger than those under solar maximum condition. The peak height under solar minimum condition is lower than that under solar maximum condition.

Impact of gonadectomy on maturational changes in brain volume in adolescent macaques

Adolescence is a transitional period between childhood and adulthood characterized by significant changes in global and regional brain tissue volumes. It is also a period of increasing vulnerability to psychiatric illness. The relationship between these patterns and increased levels of circulating sex steroids during adolescence remains unclear. The objective of the current study was to determine whether gonadectomy, prior to puberty, alters adolescent brain development in male rhesus macaques. Ninety-six structural MRI scans were acquired from 12 male rhesus macaques (8 time points per animal over a two-year period). Six animals underwent gonadectomy and 6 animals underwent a sham operation at 29 months of age. Mixed-effects models were used to determine whether gonadectomy altered developmental trajectories of global and regional brain tissue volumes. We observed a significant effect of gonadectomy on the developmental trajectory of prefrontal gray matter (GM), with intact males showing peak volumes around 3.5 years of age with a subsequent decline. In contrast, prefrontal GM volumes continued to increase in gonadectomized males until the end of the study. We did not observe a significant effect of gonadectomy on prefrontal white matter or on any other global or regional brain tissue volumes, though we cannot rule out that effects might be detected in a larger sample. Results suggest that the prefrontal cortex is more vulnerable to gonadectomy than other brain regions.

Mechanical Properties and Damage in Lignite under Combined Cyclic Compression and Shear Loading

In this paper, uniaxial cyclic compression and shear test was carried out for lignite samples. The effects of inclination angle (θ) and upper limit of cyclic stress (σmax) on mechanical properties of coal samples were analyzed, and the damage variables of coal samples were studied based on energy dissipation theory. The results show that the uniaxial compressive strength (UCS) of coal samples after uniaxial cyclic compression and shear tests decreases with the increase of the upper limit of cyclic stress and inclination angle. The shear stress component generated by the increase of inclination angle can effectively reduce the UCS and increase the damage degree of coal samples. With the increase of inclination angle, the failure mode of coal samples is changed from tensile failure (θ = 0°), the combined tensile failure and shear failure (θ = 5°) to shear failure (θ = 10°). The peak axial and radial strain of coal samples first increases rapidly and then stagnates. The peak volume strain rapid increases and then stagnates (θ = 0° and θ = 5°). When the inclination angle is 10°, the peak volume strain first decreases rapidly and then stagnates. Even if the upper limit of cyclic stress is lower than its UCS, it will still promote the propagation of micro cracks and the generation of new cracks and increase the internal damage of coal samples. With the increase of the cycle number, damage variables of coal samples after uniaxial cyclic compression and shear tests nonlinearly increase, and the growth rate decreases gradually.

Interregional Transfers for Pandemic Surges.

BackgroundHospital inpatient and intensive care unit (ICU) bed shortfalls may arise due to regional surges in volume. We sought to determine how inter-region transfers could alleviate bed shortfalls during a pandemic.MethodsWe used estimates of past and projected inpatient and ICU cases of COVID-19 from February 4, 2020 to October 1, 2020. For regions with bed shortfalls (where the number of patients exceeded bed capacity), transfers to the nearest region with unused beds were simulated using an algorithm that minimized total inter-region transfer distances across the U.S. Model scenarios used a range of predicted COVID-19 volumes (lower, mean, and upper bounds) and non-COVID-19 volumes (20%, 50%, or 80% of baseline hospital volumes). Scenarios were created for each day of data, and worst-case scenarios were created treating all regions’ peak volumes as simultaneous. Mean per-patient transfer distances were calculated by scenario.ResultsFor the worst-case scenarios, national bed shortfalls ranged from 669 to 58,562 inpatient beds and 3,208 to 31,190 ICU beds, depending on model volume parameters. Mean transfer distances to alleviate daily bed shortfalls ranged from 23 to 352 miles for inpatient and 28 to 423 miles for ICU patients, depending on volume. Under all worst-case scenarios except the highest-volume ICU scenario, inter-regional transfers could fully resolve bed shortfalls. To do so, mean transfer distances would be 24 to 405 miles for inpatients and 73 to 476 miles for ICU patients.ConclusionsInter-region transfers could mitigate regional bed shortfalls during pandemic hospital surges.

Construct validation of the leisure time physical activity questionnaire for people with SCI (LTPAQ-SCI).

Cross-sectional construct validation study. To test the construct validity of the Leisure Time Physical Activity Questionnaire for People with Spinal Cord Injury (LTPAQ-SCI) by examining associations between the scale responses and cardiorespiratory fitness (CRF) in a sample of adults living with spinal cord injury (SCI). Three university-based laboratories in Canada. Participants were 39 adults (74% male; M age: 42 ± 11 years) with SCI who completed the LTPAQ-SCI and a graded exercise test to volitional exhaustion using an arm-crank ergometer. One-tailed Pearson's correlation coefficients were computed to examine the association between the LTPAQ-SCI measures of mild-, moderate-, heavy-intensity and total minutes per week of LTPA and CRF (peak volume of oxygen consumption [V̇O2peak] and peak power output [POpeak]). Minutes per week of mild-, moderate- and heavy-intensity LTPA and total LTPA were all positively correlated with V̇O2peak. The correlation between minutes per week of mild intensity LTPA and V̇O2peak was small-medium (r = 0.231, p = 0.079) while all other correlations were medium-large (rs ranged from 0.276 to 0.443, ps < 0.05). Correlations between the LTPAQ-SCI variables and POpeak were also positive but small (rs ranged from 0.087 to 0.193, ps > 0.05), except for a medium-sized correlation between heavy-intensity LTPA and POpeak (r = 0.294, p = 0.035). People with SCI who report higher levels of LTPA on the LTPAQ-SCI also demonstrate greater levels of CRF, with stronger associations between moderate- and heavy-intensity LTPA and CRF than between mild-intensity LTPA and CRF. These results provide further support for the construct validity of the LTPAQ-SCI as a measure of LTPA among people with SCI.

Cardiac Reserve and Exercise Capacity: Insights from Combined Cardiopulmonary and Exercise Echocardiography Stress Testing

Cardiopulmonary exercise testing (CPET) represents the gold standard to estimate peak oxygen consumption (VO2) noninvasively. To improve the analysis of the mechanisms behind effort intolerance, we examined whether exercise stress echocardiography measurements relate to directly measured peak VO2 during exercise in a large cohort of patients within the heart failure (HF) spectrum. We performed a symptom-limited graded ramp bicycle CPET exercise stress echocardiography in 30 healthy controls and 357 patients: 113 at risk of developing HF (American College of Cardiology/American Heart Association stage A-B) and 244 in HF stage C with preserved (HFpEF, n=101) or reduced ejection fraction (HFrEF, n=143). Peak VO2 significantly decreased from controls (23, 21.7-29.7mL/kg/minute; median, interquartile range) to stage A-B (18, 15.4-20.7mL/kg/minute) and stage C (HFpEF: 13.6, 11.8-16.8mL/kg/minute; HFrEF: 14.2, 10.7-17.5mL/kg/minute). A regression model to predict peak VO2 revealed that peak left ventricular (LV) systolic annulus tissue velocity (S'), peak tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (right ventricle-pulmonary artery coupling), and low-load left atrial (LA) reservoir strain/E/e' (LA compliance) were independent predictors, in addition to peak heart rate, stroke volume, and workload (adjusted R2=0.76, P<.0001). The model was successfully tested in subjects with atrial fibrillation (n=49) and with (n=224) and without (n=163) beta-blockers (all P<.01). Peak S' showed the highest accuracy in predicting peak VO2<10mL/kg/minute (cut point≤7.5cm/sec, area under the curve=0.92, P<.0001) and peak VO2>20mL/kg/minute (cut point>12.5cm/sec, area under the curve=0.84, P<.0001) in comparison with the other cardiac variables of the model (P<.05). Peak VO2 is directly related to measures of LV systolic function, LA compliance, and right ventricle-pulmonary artery coupling, in addition to heart rate and stroke volume and independently of workload, age, and sex. The evaluation of cardiac mechanics may provide more insights into the causes of effort intolerance in subjects from HF stages A-C.

Bivariate Hydrologic Risk Assessment of Flood Episodes using the Notation of Failure Probability

Floods are becoming the most severe and challenging hydrologic issue at the Kelantan River basin in Malaysia. Flood episodes are usually thoroughly characterized by flood peak discharge flow, volume and duration series. This study incorporated the copula-based methodology in deriving the joint distribution analysis of the annual flood characteristics and the failure probability for assessing the bivariate hydrologic risk. Both the Archimedean and Gaussian copula family were introduced and tested as possible candidate functions. The copula dependence parameters are estimated using the method-of-moment estimation procedure. The Gaussian copula was recognized as the best-fitted distribution for capturing the dependence structure of the flood peak-volume and peak-duration pairs based on goodness-of-fit test statistics and was further employed to derive the joint return periods. The bivariate hydrologic risks of flood peak flow and volume pair, and flood peak flow and duration pair in different return periods (i.e., 5, 10, 20, 50 and 100 years) were estimated and revealed that the risk statistics incrementally increase in the service lifetime and, at the same instant, incrementally decrease in return periods. In addition, we found that ignoring the mutual dependency can underestimate the failure probabilities where the univariate events produced a lower failure probability than the bivariate events. Similarly, the variations in bivariate hydrologic risk with the changes of flood peak in the different synthetic flood volume and duration series (i.e., 5, 10, 20, 50 and 100 years return periods) under different service lifetimes are demonstrated. Investigation revealed that the value of bivariate hydrologic risk statistics incrementally increases over the project lifetime (i.e., 30, 50, and 100 years) service time, and at the same time, it incrementally decreases in the return period of flood volume and duration. Overall, this study could provide a basis for making an appropriate flood defence plan and long-lasting infrastructure designs. Doi: 10.28991/cej-2020-03091599 Full Text: PDF

Volume Flow and Peak Systolic Velocity of the Arteriovenous Circuit in Patients after Percutaneous Deep Venous Arterialization.

Percutaneous deep venous arterialization (pDVA) is a developing technique for limb salvage in patients with chronic limb-threatening ischemia by creating an arteriovenous (AV) circuit. After pDVA, patency of the AV circuit is evaluated using duplex ultrasound (DUS) imaging. Peak systolic velocity (PSV) and volume flow (VF) values for maintaining a patent AV circuit are undefined; therefore, guidance about when a reintervention should be performed is lacking. The objective of this study was to interpret post-pDVA PSV and VF values in relation to AV circuit preservation. This was performed by analyzing DUS results of 22 post-pDVA patients. A total of 670 PSV and 623 VF measurements were collected. A PSV value of ≤55 cm/s and a VF value of ≤195 mL/min were found predictive for failure. The reliability of PSV and VF measurements in patent AV-circuits was good (intraclass correlation coefficient; PSV, 0.85; VF, 0.88). In conclusion, this study is the first to analyze DUS measurements in post-pDVA patients and showed that DUS can be used to anticipate for failure. The thresholds found can be used to help interpret DUS measurements in post-pDVA patients. More research in a larger patient population is needed to prospectively validate these thresholds.

Pre-Sleep Low Glycemic Index Modified Starch Does Not Improve Next-Morning Fuel Selection or Running Performance in Male and Female Endurance Athletes

To determine the effects of pre-sleep supplementation with a novel low glycemic index (LGI) carbohydrate (CHO) on next-morning substrate utilization, gastrointestinal distress (GID), and endurance running performance (5-km time-trial, TT). Using a double-blind, randomized, placebo (PLA) controlled, crossover design, trained participants (n = 14; 28 ± 9 years, 8/6 male/female, 55 ± 7 mL/kg/min) consumed a LGI, high glycemic index (HGI), or 0 kcal PLA supplement ≥ 2 h after their last meal and <30 min prior to sleep. Upon arrival, resting energy expenditure (REE), substrate utilization, blood glucose, satiety, and GID were assessed. An incremental exercise test (IET) was performed at 55, 65, and 75% peak volume of oxygen consumption (VO2peak) with GID, rating of perceived exertion (RPE) and substrate utilization recorded each stage. Finally, participants completed the 5-km TT. There were no differences in any baseline measure. During IET, CHO utilization tended to be greater with LGI (PLA, 56 ± 11; HGI, 60 ± 14; LGI, 63 ± 14%, p = 0.16, η2 = 0.14). GID was unaffected by supplementation at any point (p > 0.05). Performance was also unaffected by supplement (PLA, 21.6 ± 9.5; HGI, 23.0 ± 7.8; LGI, 24.1 ± 4.5 min, p = 0.94, η2 = 0.01). Pre-sleep CHO supplementation did not affect next-morning resting metabolism, BG, GID, or 5-km TT performance. The trend towards higher CHO utilization during IET after pre-sleep LGI, suggests that such supplementation increases morning CHO availability.

Stressed volume estimated by finite element analysis predicts the fatigue life of human cortical bone: The role of vascular canals as stress concentrators.

The fatigue life of cortical bone can vary several orders of magnitude, even in identical loading conditions. A portion of this variability is likely related to intracortical microarchitecture and the role of vascular canals as stress concentrators. The size, spatial distribution, and density of canals determine the peak magnitude and volume of stress concentrations. This study utilized a combination of experimental fatigue testing and image-based finite element (FE) analysis to establish the relationship between the stressed volume (i.e., volume of bone above yield stress) associated with vascular canals and the fatigue life of cortical bone. Thirty-six cortical bone samples were prepared from human femora and tibiae from five donors. Samples were allocated to four loading groups, corresponding to stress ranges of 60, 70, 80, and 90MPa, then cyclically loaded in zero-compression until fracture. Porosity, canal diameter, canal separation, and canal number for each sample was quantified using X-ray microscopy (XRM) after testing. FE models were created from XRM images and used to calculate the stressed volume. Stressed volume was a good predictor of fatigue life, accounting for 67% of the scatter in fatigue-life measurements. An increase in stressed volume was most strongly associated with higher levels of intracortical porosity and larger canal diameters. The findings from this study suggest that a large portion of the fatigue-life variance of cortical bone in zero-compression is driven by intracortical microarchitecture, and that fatigue failure may be predicted by quantifying the stress concentrations associated with vascular canals.

Multivariable flood risk and its dynamics considering project reasonable service life in a changing environment

Concern over the impacts of changing environments on extreme floods has made the multivariable flood risk assessment paid more attention by the whole world. Recent studies have taken the combination of flood peak, flood volume, and duration into account when assessing flood risk. Nevertheless, the dynamics of multivariable flood risk considering project reasonable service life remains unresolved. To this end, flood peak and flood volume were considered, and Copula function was used to describe their dependent structure, considering project effective service life based on the joint return period to calculate the risk rate for characterizing flood risk. Then, a sliding window of 25 years was adopted to explore its dynamics, and attribution analysis was subsequently conducted. The Pai-lung River, which belongs to the Yangtze River Basin in China, was selected as a case study. Results show that: (1) on basis of “and (∩)” joint return period, considering 50-year reasonable service life, the risks of slight, moderate, severe, and extreme floods are 1.00, 0.96, 0.66, and 0.06, respectively; (2) the flood risk dynamics vary with different levels, where the risks of slight and moderate floods tend to decrease whilst the risk of severe and extreme floods shows a significant increase; (3) the risk dynamics of severe and extreme floods are positively related to Sunspots, El Niño Southern Oscillation and Arctic Oscillation, while Pacific Decadal Oscillation has a weaker influence on flood risk dynamics. Generally, this study sheds new insights into multivariable flood risk assessment in a changing environment.

Evaluating the performance of low impact development practices in urban runoff mitigation through distributed and combined implementation

Abstract Rapid urbanization and increasing impervious surfaces in cities lead to a serious reduction in infiltration rate of the surface and cause challenges in stormwater management. The Low Impact Development (LID) concept is considered as a potential solution for sustainable urban growth by contributing in urban flood mitigation. However, its effects on hydrologic response of the urbanized catchments, especially in broad scale implementation, are not fully understood and practically examined. In this study a hydrologic-hydraulic model of a small catchment was developed in EPA storm water management model (SWMM) program and calibrated and validated through field measurements. The hydrologic response of the catchment was investigated after replacing proportions of impervious surfaces with combinations of LID practices such as green roof, permeable pavement and bio-retention cell, through four land cover conversion scenarios and under five different designed storm events. The simulation results which are derived by comparison of outflow hydrographs between each scenario and conventional drainage system indicated that implementing 5–20% of LIDs has a noticeable impact on runoff peak flow and volume reduction, especially in storm events with shorter return periods. Also the runoff reduction trends show a linear response due to the increase in LID implementation ratio in the study area.

Global Infodemiology of COVID-19: Analysis of Google Web Searches and Instagram Hashtags.

BackgroundAlthough “infodemiological” methods have been used in research on coronavirus disease (COVID-19), an examination of the extent of infodemic moniker (misinformation) use on the internet remains limited.ObjectiveThe aim of this paper is to investigate internet search behaviors related to COVID-19 and examine the circulation of infodemic monikers through two platforms—Google and Instagram—during the current global pandemic.MethodsWe have defined infodemic moniker as a term, query, hashtag, or phrase that generates or feeds fake news, misinterpretations, or discriminatory phenomena. Using Google Trends and Instagram hashtags, we explored internet search activities and behaviors related to the COVID-19 pandemic from February 20, 2020, to May 6, 2020. We investigated the names used to identify the virus, health and risk perception, life during the lockdown, and information related to the adoption of COVID-19 infodemic monikers. We computed the average peak volume with a 95% CI for the monikers.ResultsThe top six COVID-19–related terms searched in Google were “coronavirus,” “corona,” “COVID,” “virus,” “corona virus,” and “COVID-19.” Countries with a higher number of COVID-19 cases had a higher number of COVID-19 queries on Google. The monikers “coronavirus ozone,” “coronavirus laboratory,” “coronavirus 5G,” “coronavirus conspiracy,” and “coronavirus bill gates” were widely circulated on the internet. Searches on “tips and cures” for COVID-19 spiked in relation to the US president speculating about a “miracle cure” and suggesting an injection of disinfectant to treat the virus. Around two thirds (n=48,700,000, 66.1%) of Instagram users used the hashtags “COVID-19” and “coronavirus” to disperse virus-related information.ConclusionsGlobally, there is a growing interest in COVID-19, and numerous infodemic monikers continue to circulate on the internet. Based on our findings, we hope to encourage mass media regulators and health organizers to be vigilant and diminish the use and circulation of these infodemic monikers to decrease the spread of misinformation.

Effects of Lasers and Their Delivery Characteristics on Machined and Micro-Roughened Titanium Dental Implant Surfaces.

The aim of the study was to investigate the effects of neodymium: yttrium aluminium garnet (Nd:YAG) (1064 nm) and erbium: yttrium aluminium garnet (Er:YAG) (2940 nm) laser energy on titanium when delivered with conventional optics (focusing handpieces or plain ended optical fibres) or with a conical tip. Machined and micro-roughened implant discs were subjected to laser irradiation under a variety of energy settings either dry (without water) or wet (with water). Samples were scanned using a 3D non-contact laser profilometer and analysed for surface roughness, volume of peaks and the maximum diameter of the ablated area. Conical tip designs when used with both lasers showed no surface effect at any power setting on both machined and micro-roughened implant surfaces, regardless of the irrigation condition. When used with conventional delivery systems, laser effects on titanium were dose related, and were more profound with the Nd:YAG than with the Er:YAG laser. High laser pulse energies caused surface fusion which reduced the roughness of micro-roughened titanium surfaces. Likewise, repeated pulses and higher power densities also caused greater surface modifications. The presence of water reduced the influence of laser irradiation on titanium. It may be concluded that conical fibres can reduce unwanted surface modification, and this may be relevant to clinical protocols for debridement or disinfection of titanium dental implants.

Effect of exercise on hepatic steatosis: Are benefits seen without dietary intervention? A systematic review and meta-analysis.

Interventions involving both exercise and dietary modification are effective in reducing steatosis in nonalcoholic fatty liver disease (NAFLD). However, exercise alone may reduce liver fat and is known to have other positive effects on health. The primary aim of this study was to systematically review the effect of exercise alone without dietary intervention on NAFLD and to examine correlations across changes in liver fat and metabolic markers during exercise. Relevant online databases were searched from earliest records to May 2020 by two researchers. Studies were included where the trial was a randomized controlled trial, participants were adults, exercise intervention was longer than 4 weeks, no dietary intervention occurred, and the effect of the intervention on liver fat was quantified via magnetic resonance imaging/proton magnetic resonance spectroscopy. Of 21 597 studies retrieved, 16 were included involving 706 participants. Exercise was found to have a beneficial effect on liver fat without dietary modification (-2.4%, -3.13 to -1.66) (mean, 95% CI). Pearson correlation showed significant relationships between change in liver fat and change in weight (r = 0.67, P = .007), liver enzymes aspartate aminotransferase (r = 0.76, P = .002) and alanine aminotransferase (r = 0.91, P < .001), and cardiorespiratory fitness VO2 peak (peak volume oxygen consumption) (r = -0.88, P = .004). By multivariate regression, change in weight and change in VO2 peak significantly contributed to change in liver fat (R2 = 0.84, P = .01). This systematic review found that exercise without dietary intervention improves liver fat and that clinical markers may be useful proxies for quantifying liver fat changes.

Effect of reservoir models and climate change on flood analysis in arid regions

Dams are built in arid regions across watersheds for flood control among other purposes. Capacity-elevation (C-E) curves are vital for reservoir routing and dam operation. Different models are available for representing C-E relationships. Power and logarithmic laws are evaluated and tested for reservoir routing. The evaluation is based on the analysis of 136 reservoirs across different regions of Saudi Arabia (SA). The analysis revealed that 75.7% of the reservoirs are of flood plain foothill type. A case study on Al-Lith dam basin is utilized for application based on measured events. The resulting routed outflow hydrographs showed that the logarithmic law is better to represent the reservoir than the power law. With respect to the climate change effect, the results show that the predicted rainfall from Representative Concentration Pathways scenario (RCP4.5) increased by about 20 to 31.4% from 5 to 100 years return periods respectively with an average of 27%. While for scenario RCP8.5, the predicted rainfall increased by 42% to about 55% from 5 to 100 years return periods respectively with an average of 49%. For the RCP4.5 scenario, the peak flows, Qp, and volumes, W, increased by an average of 69% and 67% respectively. While for the RCP8.5 scenario, the same parameters increased by an average of 139% and 134% respectively. The effect of transmission losses in the results seems to be minor with respect to climate change signal (for RCP4.5, Qp and W are lowered on average by 2% and 0.5% respectively, and for RCP8.5, Qp and W are lowered on average by 4.5% and 1.3% respectively). The results of this research recommend to use the logarithmic law and to take into account the effect of climate change on future dam projects in SA.

Parametric Vine Copula Construction for Flood Analysis for Kelantan River Basin in Malaysia

The multivariate approach of flood characteristics such as flood peak flow (P), volume (V), and duration (D) is much beneficial in recognizing the critical behaviour of flood episodes at a river basin scale. The incorporation of 2-dimensional copulas for establishing bivariate flood dependency frequently appears, but it could be more comprehensive if we focus all the three flood characteristic simultaneously. In such circumstances, incorporation of vine or Pair-Copula Construction (PCC) could produce a better approximation of joint probability density and much practical approach in the uncertainty analysis, in comparison with conventional trivariate copula distribution. This study demonstrated the efficacy of parametric vine copula in the modelling of trivariate flood characteristics for the Kelantan River basin in Malaysia. The D-vine tree structure is selected where the Gaussian and Frank copula is recognized for bivariate flood pairs (P-V) and (P-D) pairs in the first stage, using the maximum-pseudo-likelihood (MPL) estimation procedure. Similarly, the Gumbel copula is selected in the modelling of conditioned data obtained through the conditional distribution function of bivariate copulas selected in the previous stage based on the partial differentiation, also called h-function. Finally, the full density function of the 3-dimension structure is derived and compared with the observed flood characteristics. Furthermore, tail dependence properties and behaviour of D-vine copula are also investigated, which reveals for well capturing the general behaviour of Gaussian and Frank copula fitted to flood pair (P-V) and (V-D) and reproduces the overall flood correlation structure fairely well. Both the primary ‘OR’ and ‘AND’ joint return periods for trivariate flood events are estimated which pointing that ‘AND’ joint case produces higher return value than ‘OR’ case.

Pulmonary Vascular Pressures and Gas Exchange Response to Exercise in Heart Failure With Preserved Ejection Fraction

Elevated left ventricular filling pressure (measured as mean pulmonary capillary wedge pressure) at rest or with exercise is diagnostic of heart failure with preserved ejection fraction. However, the capacity of the right ventricle to compensate for a high mean pulmonary capillary wedge pressure and thus maintain an appropriate transpulmonary gradient (TPG) and perfusion of the pulmonary capillaries is likely an important contributor to gas exchange efficiency and exercise capacity. Therefore, this study aimed to determine whether a higher TPG at peak exercise is associated with superior exercise capacity and gas exchange. Gas exchange data from dyspneic patients referred for exercise right heart catheterization were retrospectively analyzed and patients were split into two groups based on TPG. Patients with a higher TPG at peak exercise had a higher peak VO2 (1025 ± 227 vs 823 ± 276, P = .038), end-tidal partial pressure of carbon dioxide (42.2 ± 7.9 vs 38.0 ± 4.7, P = .044), and gas exchange estimates of pulmonary vascular capacitance (408 ± 90 vs 268 ± 108, P = .001). A higher TPG at peak exercise correlated with a higher peak oxygen uptake, O2 pulse, and stroke volume (R = 0.42, 0.44 and 0.42, respectively, all P < 0.05). These findings indicate that a greater TPG with exercise might be important for improving exercise capacity in heart failure with preserved ejection fraction.