The impact of age, sex, cardio-respiratory fitness, and cardiovascular disease risk on dynamic cerebral autoregulation and baroreflex sensitivity.

BACKGROUND: Humans display an age-related decline in cerebral blood flow and increase in blood pressure (BP), but changes in the underlying control mechanisms across the lifespan are less well understood. We aimed to; (1) examine the impact of age, sex, cardiovascular disease (CVD) risk, and cardio-respiratory fitness on dynamic cerebral autoregulation and cardiac baroreflex sensitivity, and (2) explore the relationships between dynamic cerebral autoregulation (dCA) and cardiac baroreflex sensitivity (cBRS). METHODS: 206 participants aged 18-70 years were stratified into age categories. Cerebral blood flow velocity was measured using transcranial Doppler ultrasound. Repeated squat-stand manoeuvres were performed (0.10 Hz), and transfer function analysis was used to assess dCA and cBRS. Multivariable linear regression was used to examine the influence of age, sex, CVD risk, and cardio-respiratory fitness on dCA and cBRS. Linear models determined the relationship between dCA and cBRS. RESULTS: Age, sex, CVD risk, and cardio-respiratory fitness did not impact dCA normalised gain, phase, or coherence with minimal change in all models (P > 0.05). cBRS gain was attenuated with age when adjusted for sex and CVD risk (young-older; ß = - 2.86 P < 0.001) along with cBRS phase (young-older; ß = - 0.44, P < 0.001). There was no correlation between dCA normalised gain and phase with either parameter of cBRS. CONCLUSION: Ageing was associated with a decreased cBRS, but dCA appears to remain unchanged. Additionally, our data suggest that sex, CVD risk, and cardio-respiratory fitness have little effect.

Using in-abattoir 3-dimensional measurements from images of beef carcasses for the prediction of EUROP classification grade and carcass weight.

Imaging technology can aid the automatic extraction of measurements from beef carcasses, which can be used for objective grading. Many abattoirs, however, rely on manual grading due to the required infrastructure and cost, making technology unfeasible. This study explores 3-dimensional (3D) imaging technology, requiring limited infrastructure, and its ability to predict carcass weight, conformation class and fat class for non-invasive, objective classification. Time-of-flight near-infrared cameras captured 3-dimensional point clouds of beef carcasses, on-line in one commercial abattoir in Scotland, over a 6-month period. Thirty-five 3D images were captured per carcass and processed using machine vison software. Seventy-four measurements were extracted from each point cloud. Removal of extreme outliers resulted in 285,109 datapoints for 17,250 carcasses. Coefficients of variation (CV) for each measurement on a per-animal basis were low and consistent, and measurements were averaged across images. Using a training and validation dataset (70:30), multiple linear regression models predicted EUROP conformation class, fat class, and carcass weight. Stepwise models included fixed effects (sex, breed type, kill date (and cold carcass weight for conformation and fat class)), and 3D image measurements. Including 3D measurements resulted in prediction accuracies of 70%, 50% and 23% for cold carcass weight, conformation, and fat class respectively. Mapping predictions on the traditional EUROP grid used in the UK showed that 99% of conformation classes and 93% of fat classes were classified within the correct or neighbouring grade. The results of this study indicate the potential for non-invasive, in-abattoir technology requiring limited infrastructure to predict carcass traits objectively.

Stroke-heart syndrome: Incidence and clinical outcomes of cardiac complications following intracerebral haemorrhage.

INTRODUCTION: Newly diagnosed cardiovascular complications following an ischaemic stroke, termed stroke-heart syndrome, are common and associated with worse outcomes. Little is known regarding stroke-heart syndrome in relation to intracerebral haemorrhage (ICH). This study aimed to investigate the incidence and 5-year major adverse cardiovascular events (MACE; acute myocardial infarction, ischaemic stroke, all-cause mortality and recurrent ICH) of newly diagnosed cardiovascular complications following incident ICH, using a global federated database. PATIENTS AND METHODS: A retrospective cohort study was conducted using anonymised electronic medical records. Patients aged ⩾ 18 years with non-traumatic ICH and 5-year follow-up were included. Patients with newly diagnosed cardiovascular complications within 4-weeks following the initial ICH were 1:1 propensity score-matched with patients without new-onset cardiovascular complications. Each cardiovascular complications were investigated as a composite stroke-heart syndrome cohort and separately for associated MACE. Cox hazard regression models were used to determine 5-year incidence of MACE. RESULTS: Before propensity score matching, 171,489 patients with non-traumatic ICH, 15% (n = 26,449) experienced ⩾1 newly diagnosed cardiovascular complication within 4 weeks. After matching, patients with ICH and cardiovascular complications were associated with a significantly higher risk of 5-year MACE (HR 1.35 [95% CI 1.32-1.38]), and in each composite compared to matched controls. There was no significant risk of rehospitalisation over 5-year follow-up [HR 0.90 [0.73-1.13]). The risk of MACE was significantly higher in patients with newly diagnosed cardiovascular complications. DISCUSSION AND CONCLUSIONS: Newly diagnosed cardiovascular complications following ICH (i.e. stroke-heart syndrome) were common and associated with a significantly worsened 5-year prognosis.

Mobile health biometrics to prescribe immediate remote physical activity for enhancing uptake to cardiac rehabilitation (MOTIVATE-CR+): protocol for a randomised controlled feasibility trial.

INTRODUCTION: Cardiac rehabilitation (CR) can reduce cardiovascular mortality and improve health-related quality of life. In the United Kingdom, patient uptake of CR remains low (52%), falling well short of the target in the 2019 National Health Service long-term plan (85%). Mobile health (mHealth) technologies, offering biometric data to patients and healthcare professionals, may bridge the gap between supervised exercise and physical activity advice, enabling patients to engage in regular long-term physically active lifestyles. This randomised controlled trial (RCT) will evaluate the feasibility of mHealth technology when incorporated into a structured home-based walking intervention, in people with recent myocardial infarction. METHODS AND ANALYSIS: This is a feasibility, assessor blinded, parallel group RCT. Participants will be allocated to either CR standard care (control group) or CR standard care+mHealth supported exercise counselling (mHealth intervention group). Feasibility outcomes will include the number of patients approached, screened and eligible; the percentage of patients who decline CR (including reasons for declining), agree to CR and consent to being part of the study; the percentage of patients who enrol in standard CR and reasons for drop out; and the percentage of participants who complete clinical, physical and psychosocial outcomes to identify a suitable primary outcome for a future definitive trial. ETHICS AND DISSEMINATION: The trial was approved in the UK by the Northwest-Greater Manchester East Research Ethics Committee (22/NW/0301) and is being conducted in accordance with the Declaration of Helsinki and Good Clinical Practice. Results will be published in peer-reviewed journals and presented at national and international scientific meetings. TRIAL REGISTRATION NUMBERS: NCT05774587.

Establishment of clinical exercise physiology as a regulated healthcare profession in the UK: a progress report.

In 2021, a 'call to action' was published to highlight the need for professional regulation of clinical exercise physiologists to be established within UK healthcare systems to ensure patient safety and align training and regulation with other health professions. This manuscript provides a progress report on the actions that Clinical Exercise Physiology UK (CEP-UK) has undertaken over the past 4 years, during which time clinical exercise physiologists have implemented regulation and gained formal recognition as healthcare professionals in the UK. An overview of the consultation process involved in creating a regulated health profession, notably the development of policies and procedures for both individual registration and institutional master's degree (MSc) accreditation is outlined. Additionally, the process for developing an industry-recognised scope of practice, a university MSc-level curriculum framework, the Academy for Healthcare Science Practitioner standards of proficiency and Continuing Professional Development opportunities is included. We outline the significant activities and milestones undertaken by CEP-UK and provide insight and clarity for other health professionals to understand the training and registration process for a clinical exercise physiologist in the UK. Finally, we include short, medium and long-term objectives for the future advocacy development of this workforce in the UK.

Different microbial genera drive methane emissions in beef cattle fed with two extreme diets.

The ratio of forage to concentrate in cattle feeding has a major influence on the composition of the microbiota in the rumen and on the mass of methane produced. Using methane measurements and microbiota data from 26 cattle we aimed to investigate the relationships between microbial relative abundances and methane emissions, and identify potential biomarkers, in animals fed two extreme diets - a poor quality fresh cut grass diet (GRASS) or a high concentrate total mixed ration (TMR). Direct comparisons of the effects of such extreme diets on the composition of rumen microbiota have rarely been studied. Data were analyzed considering their multivariate and compositional nature. Diet had a relevant effect on methane yield of +10.6 g of methane/kg of dry matter intake for GRASS with respect to TMR, and on the centered log-ratio transformed abundance of 22 microbial genera. When predicting methane yield based on the abundance of 28 and 25 selected microbial genera in GRASS and TMR, respectively, we achieved cross-validation prediction accuracies of 66.5 ± 9% and 85 ± 8%. Only the abundance of Fibrobacter had a consistent negative association with methane yield in both diets, whereas most microbial genera were associated with methane yield in only one of the two diets. This study highlights the stark contrast in the microbiota controlling methane yield between animals fed a high concentrate diet, such as that found on intensive finishing units, and a low-quality grass forage that is often found in extensive grazing systems. This contrast must be taken into consideration when developing strategies to reduce methane emissions by manipulation of the rumen microbial composition.

Enteric Methane Emissions from Dairy-Beef Steers Supplemented with the Essential Oil Blend Agolin Ruminant.

Agriculture is the largest source of methane globally, and enteric methane accounts for 32% of methane emissions globally. Dairy-beef is an increasingly important contributor to the beef industry. The objective of this study was to investigate if supplementation with a blend of essential oils (Agolin Ruminant) reduced enteric methane emissions from dairy-bred steers. Methane was measured from thirty-six Holstein Friesian steers (18 control and 18 treatment) in open-circuit respiration chambers, at three time-points relative to the introduction of Agolin Ruminant: (i) -3 (pre-additive introduction co-variate), (ii) 46 days after introduction, and (iii) 116 days after introduction. A significantly lower methane yield was observed in treated animals compared to control animals at both 46 days (p < 0.05) and 116 days (p < 0.01) after the introduction of Agolin Ruminant, although there was no difference in methane production (g/day). Control animals appeared to be more affected by isolation in respiration chambers than animals receiving Agolin Ruminant, as indicated by a significant reduction in dry matter intake by control animals in respiration chambers.

Passive breath monitoring of livestock: using factor analysis to deconvolve the cattle shed.

Respiratory and metabolic diseases in livestock cost the agriculture sector billions each year, with delayed diagnosis a key exacerbating factor. Previous studies have shown the potential for breath analysis to successfully identify incidence of disease in a range of livestock. However, these techniques typically involve animal handling, the use of nasal swabs or fixing a mask to individual animals to obtain a sample of breath. Using a cohort of 26 cattle as an example, we show how the breath of individual animals within a herd can be monitored using a passive sampling system, where no such handling is required. These benefits come at the cost of the desired breath samples unavoidably mixed with the complex cocktail of odours that are present within the cattle shed. Data were analysed using positive matrix factorisation (PMF) to identify and remove non-breath related sources of volatile organic compounds. In total three breath factors were identified (endogenous-, non-endogenous breath and rumen) and seven factors related to other sources within and around the cattle shed (e.g. cattle feed, traffic, urine and faeces). Simulation of a respiratory disease within the herd showed that the abnormal change in breath composition was captured in the residuals of the ten factor PMF solution, highlighting the importance of their inclusion as part of the breath fraction. Increasing the number of PMF factors to 17 saw the identification of a 'diseased' factor, which coincided with the visits of the three 'diseased' cattle to the breath monitor platform. This work highlights the important role that factor analysis techniques can play in analysing passive breath monitoring data.

Seven-day remote ischaemic preconditioning improves endothelial function in patients with type 2 diabetes mellitus: a randomised pilot study.

BACKGROUND: Remote ischaemic preconditioning (rIPC) may improve cardiac/cerebrovascular outcomes of ischaemic events. Ischaemic damage caused by cardiovascular/cerebrovascular disease are primary causes of mortality in type 2 diabetes mellitus (T2DM). Due to the positive effects from a bout of rIPC within the vasculature, we explored if daily rIPC could improve endothelial and cerebrovascular function. The aim of this pilot study was to obtain estimates for the change in conduit artery and cerebrovascular function following a 7-day rIPC intervention. METHODS: Twenty-one patients with T2DM were randomly allocated to either 7-day daily upper-arm rIPC (4 × 5 min 220 mmHg, interspaced by 5-min reperfusion) or control. We examined peripheral endothelial function using flow mediated dilation (FMD) before and after ischemia-reperfusion injury (IRI, 20 min forearm ischaemic-20 min reperfusion) and cerebrovascular function, assessed by dynamic cerebral autoregulation (dCA) at three time points; pre, post and 8 days post intervention. RESULTS: For exploratory purposes, we performed statistical analysis on our primary comparison (pre-to-post) to provide an estimate of the change in the primary and secondary outcome variables. Using pre-intervention data as a covariate, the change from pre-post in FMD was 1.3% (95% CI: 0.69 to 3.80; P = 0.09) and 0.23 %cm/s %/mmHg mmHg/% (-0.12, 0.59; P = 0.18) in dCA normalised gain with rIPC versus control. Based upon this, a sample size of 20 and 50 for FMD and normalised gain, respectively, in each group would provide 90% power to detect statistically significant (P < 0.05) between-group difference in a randomised controlled trial. CONCLUSION: We provide estimates of sample size for a randomised control trial exploring the impact of daily rIPC for 7 days on peripheral endothelial and cerebrovascular function. The directional changes outline from our pilot study suggest peripheral endothelial function can be enhanced by daily rIPC in patients with T2DM.