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The heart and lungs are anatomically coupled through the pulmonary circulation and coexist within the sealed thoracic cavity, making the function of these systems highly interdependent. Understanding of the complex mechanical interactions between cardiac and pulmonary systems has evolved over the last century to appreciate that changes in respiratory mechanics significantly impact pulmonary hemodynamics and ventricular filling and ejection. Furthermore, given that the left and right heart share a common septum and are surrounded by the nondistensible pericardium, direct ventricular interaction is an important mediator of both diastolic and systolic performance. Although it is generally considered that cardiopulmonary interaction in healthy individuals at rest minimally affects hemodynamics, the significance during exercise is less clear. Adverse heart-lung interaction in respiratory disease is of growing interest as it may contribute to the pathogenesis of comorbid cardiovascular dysfunction and exercise intolerance in these patients. Similarly, heart failure represents a pathological uncoupling of the cardiovascular and pulmonary systems, whereby cardiac function may be impaired by the normal ventilatory response to exercise. Despite significant research contributions to this complex area, the mechanisms of cardiopulmonary interaction in the intact human and the clinical consequences of adverse interactions in common respiratory and cardiovascular diseases, particularly during exercise, remain incompletely understood. The purpose of this review is to present the key physiological principles of cardiopulmonary interaction as they pertain to resting and exercising hemodynamics in healthy humans and the clinical implications of adverse cardiopulmonary interaction during exercise in chronic obstructive pulmonary disease (COPD), pulmonary hypertension, and heart failure.

Augmented negative intrathoracic pressures (nITP) and dynamic hyperinflation (DH) are adverse breathing mechanics (ABM) associated with chronic obstructive pulmonary disease (COPD) that attenuate left ventricular (LV) preload and augment afterload. In COPD, hypertension (elevated systemic arterial load) commonly adds additional afterload to the LV. Combined ABM and hypertension may profoundly challenge ventricular-vascular coupling and attenuate stroke volume (SV), particularly if LV systolic reserve is limited. However, even in the healthy heart, the combined impact of ABM and systemic arterial loading on LV function and ventricular-vascular coupling has not been fully elucidated. Healthy volunteers (10 M/9 F, 24 ± 3 yr old) were challenged with mild (-10 cmH

Purpose: The purpose of this study was to explore whether methods adapted from oncology pharmacological trials have utility in reporting adherence (tolerability) of exercise treatment in cancer. Methods: Using a retrospective analysis of a randomized trial, 25 prostate cancer patients received an aerobic training regimen of 72 supervised treadmill walking sessions delivered thrice weekly between 55% and 100% of exercise capacity for 24 consecutive weeks. Treatment adherence (tolerability) was assessed using conventional (lost to follow-up and attendance) and exploratory (e.g., permanent discontinuation, dose modification, and relative dose intensity) outcomes. Results: The mean total cumulative ‘‘planned’’ and ‘‘completed’’ dose was 200.7 T 47.6 and 153.8 T 68.8 METIh, respectively, equating to a mean relative dose intensity of 77% T 24%. Two patients (8%) were lost to follow-up, and mean attendance was 79%. A total of 6 (24%) of 25 patients permanently discontinued aerobic training before week 24. Aerobic training was interrupted (missing Q3 consecutive sessions) or dose reduced in a total of 11 (44%) and 24 (96%) patients, respectively; a total 185 (10%) of 1800 training sessions required dose reduction owing to both health-related (all nonserious) and non–health-related adverse events. Eighteen (72%) patients required at least one session to be terminated early; a total of 59 (3%) sessions required early termination. Conclusions: Novel methods for the conduct and reporting of exercise treatment adherence and tolerability may provide important information beyond conventional metrics in patients with cancer.

Background The investigation of exercise training in metastatic breast cancer has received minimal attention. This study determined the feasibility and safety of aerobic training in metastatic breast cancer. Methods Sixty-five women (age, 21-80 years) with metastatic (stage IV) breast cancer (57% were receiving chemotherapy, and >40% had ≥ 2 lines of prior therapy) were allocated to an aerobic training group (n = 33) or a stretching group (n = 32). Aerobic training consisted of 36 supervised treadmill walking sessions delivered thrice weekly between 55% and 80% of peak oxygen consumption (VO2peak ) for 12 consecutive weeks. Stretching was matched to aerobic training with respect to location, frequency, duration, and intervention length. The primary endpoint was aerobic training feasibility, which was a priori defined as the lost to follow-up (LTF) rate ( Results One of the 33 patients (3%) receiving aerobic training was LTF, whereas the mean attendance rate was 63% ± 30%. The rates of permanent discontinuation and dose modification were 27% and 49%, respectively. Intention-to-treat analyses indicated improvements in PROs, which favored the attention control group (P values > .05). Per protocol analyses indicated that 14 of 33 patients (42%) receiving aerobic training had acceptable tolerability (relative dose intensity ≥ 70%), and this led to improvements in VO2peak and functional capacity (P values Conclusions Aerobic training at the dose and schedule tested is safe but not feasible for a significant proportion of patients with metastatic breast cancer. The acceptable feasibility and promising benefit for select patients warrant further evaluation in a dose-finding phase 1/2 study. Cancer 2018;124:2552-60. © 2018 American Cancer Society.

The study is intended to improve the performance of gas turbine engines in order to meet both electrical power demand and peak load in the power plant. In this paper, evaporative cooling system had been applied to improve the performance of gas turbine in Pesanggaran power plant in southern Bali Island, Indonesia. Moreover, the economic analysis was conducted to determine the capacity cost, operating cost and payback period due to the investment cost of the system. Based on the evaluation results, the power improvement for the three gas turbine units (GT1, GT2 and GT3) are 2.09%, 1.38%, and 1.28%, respectively. These results were not very significant when compared to the previous studies as well as on the aspects of SFC (Specific Fuel Consumption), heat rate and thermal efficiency. Based on the evaluation of the economic aspects, the reduction of production costs due to the application of evaporative cooling system was not economical, because it could not compensate the investment cost of the system and it resulted a very long payback period. These unsatisfactory results could be caused by the high relative humidity. Therefore, further studies are needed to investigate the other alternative technologies which are more suitable to the climate conditions in Indonesia.

The field of exercise-oncology has increased dramatically over the past two decades, with close to 100 published studies investigating the efficacy of structured exercise training interventions in patients with cancer. Of interest, despite considerable differences in study population and primary study end point, the vast majority of studies have tested the efficacy of an exercise prescription that adhered to traditional guidelines consisting of either supervised or home-based endurance (aerobic) training or endurance training combined with resistance training, prescribed at a moderate intensity (50-75% of a predetermined physiological parameter, typically age-predicted heart rate maximum or reserve), for two to three sessions per week, for 10 to 60 min per exercise session, for 12 to 15 weeks. The use of generic exercise prescriptions may, however, be masking the full therapeutic potential of exercise treatment in the oncology setting. Against this background, this opinion paper provides an overview of the fundamental tenets of human exercise physiology known as the principles of training, with specific application of these principles in the design and conduct of clinical trials in exercise-oncology research. We contend that the application of these guidelines will ensure continued progress in the field while optimizing the safety and efficacy of exercise treatment following a cancer diagnosis.

Combustion turbine combined cycle (CTCC) plants have generally been the “power plant of choice” over the past two decades for a number of reasons, including first cost, efficiency, and low emissions. Combustion (Gas) turbine (CT) based plants now account for over 30% of the electric power capacity in the United States. Despite the significant reliance on this technology, the electric Independent System Operators (ISOs) have yet to recognize and acknowledge in their production templates, test forms and performance predicting software the Brayton Cycle limitations, most notably how humidity affects output for CT plants equipped with evaporative cooling systems. Such plants account for an estimated 48% of the CT power installed in the last 10 years. Ignoring the impact of humidity on these plants can lead to errors in production predictions beyond the normal tolerance band of 3% to as high as 9% during peak ambient temperatures for certain units. As such the electric ISO’s prediction of available generation and the associated capacity reserve margins have the potential to be overestimated. The article explores the situation in more depth, presents examples within the NYISO, quantifies the potential impact and recommends easy solutions to close the gap.Copyright © 2010 by Sigma Energy Solutions Inc.

Cable engineers have recognized for many years that losses which occur in the steel pipe of pipe cable systems appreciably increase ac resistance and greatly reduce possible ampacity of such systems. Nonmagnetic pipes did not offer a practical solution to the problem since available materials contributed essentially the same degree of loss to the system as steel pipes. Hence, from time to time, engineers have focused their attention on nonmetallic pipes as a means of reducing losses. This work shows that one of three plastic pipes examined by the authors effectively stopped the entrance of moisture and caused no deterioration of the cable or pipe oil. Therefore, from a technical standpoint, it provided an effective enclosure for pipe cable. However, the cost of such pipes is still too high to make them economically feasible.