The Inhalation Characteristics of Patients When They Use Different Dry Powder Inhalers

Background: The characteristics of each inhalation maneuver when patients use dry powder inhalers (DPIs) are important, because they control the quality of the emitted dose. Methods: We have measured the inhalation profiles of asthmatic children [CHILD; n=16, mean forced expiratory volume in 1 sec (FEV1) 79% predicted], asthmatic adults (ADULT; n=53, mean predicted FEV1 72%), and chronic obstructive pulmonary disease (COPD; n=29, mean predicted FEV1 42%) patients when they inhaled through an Aerolizer, Diskus, Turbuhaler, and Easyhaler using their “real-life” DPI inhalation technique. These are low-, medium-, medium/high-, and high-resistance DPIs, respectively. The inhalation flow against time was recorded to provide the peak inhalation flow (PIF; in L/min), the maximum pressure change (ΔP; in kPa), acceleration rates (ACCEL; in kPa/sec), time to maximum inhalation, the length of each inhalation (in sec), and the inhalation volume (IV; in liters) of each inhalation maneuver. Results: PIF, ΔP, and ACCEL values were consistent with the order of the inhaler's resistance. For each device, the inhalation characteristics were in the order ADULT>COPD>CHILD for PIF, ΔP, and ACCEL (p4 L and ΔP >4 kPa. Conclusion: The large variability of these inhalation characteristics and their range highlights that if inhalation profiles were used with compendial in vitro dose emission measurements, then the results would provide useful information about the dose patients inhale during routine use. The inhalation characteristics highlight that adults with asthma have greater inspiratory capacity than patients with COPD, whereas children with asthma have the lowest. The significance of the inhaled volume to empty doses from each device requires investigation

Atrial Remodeling in Pregnant Hypertensive Women: Comparison between Chronic and Gestational Hypertension

Objectives: Left atrial (LA) enlargement is a common finding in hypertensive patients (pts), however little information is available on LA changes during pregnancy. The present study evaluated LA size and function in pregnant women with hypertension.Methods: Patients population included 30 women with chronic hypertension and 30 patients with gestational hypertension.A control group of 16 normotensive pregnant women was selected. Serial echocardiography was performed at 12 and 24 week of gestation in chronic hypertension and at 24 week in gestational hypertension and after delivery. LA diameters andvolumes were measured and compared. LA conduit volume, passive and active emptying volumes were calculated.Patients were divided in 2 groups according to max LAV Index > 32 ml/m2 at 24 week of gestation.Results: Patients with chronic hypertension showed higher LA diameters (42 \ub1 2.0 vs. 36.5 \ub1 1.8; p 32 ml/m2 had more clinical complications evaluated as increase of therapy, fluid retention that need diuretic and hospitalization.Conclusion: Patients with chronic hypertension showed a more marked increased of LA volumes compared to gestationalhypertension due to a remodeling of atrial shape as effect of chronic overload. Patients with more dilated LA volumes developed a greater number of clinical complications suggesting that a dilated LA could be a parameter of hemodynamic instability

Health promotion initiative for booster seats: A school-based educational intervention.

The purpose of this study was to investigate the effect of a booster seat educational intervention on the purchasing/obtainment behavior of parents. A quasi-experimental methodology was utilized, including an educational seminar for parents and their children. Data analysis combined a mixed factorial ANOVA, with one between subjects factor (group; intervention vs. control) and one within subjects factor (session; pretest vs. post-test). Pre-test and post-test scores were examined related to the dependent variables of use and obtainment. Analysis of differences in retention of information and child\u27s cooperation using the booster seat were also examined as independent variables. Findings support the development of educational programs focused on parents and children. The information compiled during this study can be used to guide future development of educational programs by advanced practice nurses in the community, as well as in the family practice setting. (Abstract shortened by UMI.) Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis2003 .M324. Source: Masters Abstracts International, Volume: 42-02, page: 0568. Thesis (M.Sc.)--University of Windsor (Canada), 2003

Specifications for modelling fuel cell and combustion-based residential cogeneration device within whole-building simulation programs

This document contains the specifications for a series of residential cogeneration device models developed within IEA/ECBCS Annex 42. The devices covered are: solid oxide and polymer exchange membrane fuel cells (SOFC and PEM), and internal combustion and Stirling engine units (ICE and SE). These models have been developed for use within whole-building simulation programs and one or more of the models described herein have been integrated into the following simulation packages: ESP-r, EnergyPlus, TRNSYS and IDA-ICE. The models have been designed to predict the energy performance of cogeneration devices when integrated into a residential building (dwelling). The models account for thermal performance (dynamic thermal performance in the case of the combustion engine models), electrochemical and combustion reactions where appropriate, along with electrical power output. All of the devices are modelled at levels of detail appropriate for whole-building simulation tools

The development of a generic systems-level model for combustion-based domestic cogeneration

The provision of heat and power to dwellings from micro-cogeneration systems is gaining credence around the developed world as a possible means to reduce the significant carbon emissions associated with the domestic sector. However, achieving the optimum performance for these systems requires that building design practitioners are equipped with robust, integrated models, which will provide a realistic picture of the cogeneration performance in-situ. A long established and appropriate means to evaluate the energy performance of buildings and their energy systems is through the use of dynamic building simulation tools. However, until now, only a very limited number of micro-cogeneration device models have been available to the modelling community and generally these have not been appropriate for use within building simulation codes. This paper describes work undertaken within the International Energy Agency's Energy Conservation in Building and Community Systems Annex 42 to address this problem through the development of a generic, combustion based cogeneration device model that is suitable for integration within building simulation tools and can be used to simulate the variety of Internal Combustion Engine (ICE) and Stirling Engine (SE) cogeneration devices that are and will be available for integration into dwellings. The model is described in detail along with details of how it has been integrated into the ESP-r, Energy Plus and TRNSYS simulation platforms

Diverging volumetric trajectories following pediatric traumatic brain injury.

Traumatic brain injury (TBI) is a significant public health concern, and can be especially disruptive in children, derailing on-going neuronal maturation in periods critical for cognitive development. There is considerable heterogeneity in post-injury outcomes, only partially explained by injury severity. Understanding the time course of recovery, and what factors may delay or promote recovery, will aid clinicians in decision-making and provide avenues for future mechanism-based therapeutics. We examined regional changes in brain volume in a pediatric/adolescent moderate-severe TBI (msTBI) cohort, assessed at two time points. Children were first assessed 2-5 months post-injury, and again 12 months later. We used tensor-based morphometry (TBM) to localize longitudinal volume expansion and reduction. We studied 21 msTBI patients (5 F, 8-18 years old) and 26 well-matched healthy control children, also assessed twice over the same interval. In a prior paper, we identified a subgroup of msTBI patients, based on interhemispheric transfer time (IHTT), with significant structural disruption of the white matter (WM) at 2-5 months post injury. We investigated how this subgroup (TBI-slow, N = 11) differed in longitudinal regional volume changes from msTBI patients (TBI-normal, N = 10) with normal WM structure and function. The TBI-slow group had longitudinal decreases in brain volume in several WM clusters, including the corpus callosum and hypothalamus, while the TBI-normal group showed increased volume in WM areas. Our results show prolonged atrophy of the WM over the first 18 months post-injury in the TBI-slow group. The TBI-normal group shows a different pattern that could indicate a return to a healthy trajectory

Recent advances on recursive filtering and sliding mode design for networked nonlinear stochastic systems: A survey

Copyright © 2013 Jun Hu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Some recent advances on the recursive filtering and sliding mode design problems for nonlinear stochastic systems with network-induced phenomena are surveyed. The network-induced phenomena under consideration mainly include missing measurements, fading measurements, signal quantization, probabilistic sensor delays, sensor saturations, randomly occurring nonlinearities, and randomly occurring uncertainties. With respect to these network-induced phenomena, the developments on filtering and sliding mode design problems are systematically reviewed. In particular, concerning the network-induced phenomena, some recent results on the recursive filtering for time-varying nonlinear stochastic systems and sliding mode design for time-invariant nonlinear stochastic systems are given, respectively. Finally, conclusions are proposed and some potential future research works are pointed out.This work was supported in part by the National Natural Science Foundation of China under Grant nos. 61134009, 61329301, 61333012, 61374127 and 11301118, the Engineering and Physical Sciences Research Council (EPSRC) of the UK under Grant no. GR/S27658/01, the Royal Society of the UK, and the Alexander von Humboldt Foundation of Germany

Quality of medicines commonly used in the treatment of soil transmitted helminths and Giardia in Ethiopia: a nationwide survey

Background: The presence of poor quality medicines in the market is a global threat on public health, especially in developing countries. Therefore, we assessed the quality of two commonly used anthelminthic drugs [mebendazole (MEB) and albendazole (ALB)] and one antiprotozoal drug [tinidazole (TNZ)] in Ethiopia. Methods/Principal Findings: A multilevel stratified random sampling, with as strata the different levels of supply chain system in Ethiopia, geographic areas and government/privately owned medicines outlets, was used to collect the drug samples using mystery shoppers. The three drugs (106 samples) were collected from 38 drug outlets (government/privately owned) in 7 major cities in Ethiopia between January and March 2012. All samples underwent visual and physical inspection for labeling and packaging before physico-chemical quality testing and evaluated based on individual monographs in Pharmacopoeias for identification, assay/content, dosage uniformity, dissolution, disintegration and friability. In addition, quality risk was analyzed using failure mode effect analysis (FMEA) and a risk priority number (RPN) was assigned to each quality attribute. A clinically rationalized desirability function was applied in quantification of the overall quality of each medicine. Overall, 45.3% (48/106) of the tested samples were substandard, i.e. not meeting the pharmacopoeial quality specifications claimed by their manufacturers. Assay was the quality attribute most often out-of-specification, with 29.2% (31/106) failure of the total samples. The highest failure was observed for MEB (19/42, 45.2%), followed by TNZ (10/39, 25.6%) and ALB (2/25, 8.0%). The risk analysis showed that assay (RPN = 512) is the most critical quality attribute, followed by dissolution (RPN = 336). Based on Derringer's desirability function, samples were classified into excellent (14/106,13%), good (24/106, 23%), acceptable (38/106, 36%%), low (29/106, 27%) and bad (1/106,1%) quality. Conclusions/Significance: This study evidenced that there is a relatively high prevalence of poor quality MEB, ALB and TNZ in Ethiopia: up to 45% if pharmacopoeial acceptance criteria are used in the traditional, dichotomous approach, and 28% if the new risk-based desirability approach was applied. The study identified assay as the most critical quality attributes. The country of origin was the most significant factor determining poor quality status of the investigated medicines in Ethiopia