The performance of Mini Wright peak flow meters after prolonged use

AbstractThe accuracy of 84 new and 35 old Mini Wright peak flow meters were tested using a servo-controlled pump system. The 95% confidence limits for flow measurement across the range of the new meters was between ± 151 min−1 at the lower end of the range and ± 281 min−1 at the top of the range. The readings for 22 (63%) of the old meters (age range 1–13 yr) were within these 95% confidence limits. For the remaining 13 old meters (age range 1–13 yr) whose readings were not within these limits, there were 11 meters with readings falling below and two meters with readings above these limits. Twelve of these old meters were washed and retested and there was no significant change in their readings. Twenty of the new meters were retested after 1 yr of continuous use and their readings were significantly higher with a median value of 51 min−1 across the range, although only two of these 20 meters had readings outside the 95% confidence limits set from the 84 new meters. It is concluded that whilst Mini Wright meters aged up to 14 yr can give readings which are as good as new meters, some meters demonstrate significant changes in readings after only 1 yr and washing did not correct this change. It is recommended that clinicians prescribing peak expiratory flow (PEF) meters should be responsible for checking the patient's meter as well as their PEF readings at clinic visits

Defining and investigating difficult asthma: Developing quality indicators

SummaryBackgroundThere is no agreed definition of ‘difficult asthma’ or what investigations should be available to investigate these patients. Patients with difficult asthma remain symptomatic on high levels of treatment and are high users of medical resources.AimTo develop a set of quality indicators for the definition and investigation of difficult asthma.MethodModified RAND Appropriateness Method was used. An expert panel composed of nine hospital asthma specialists who run ‘difficult’ asthma clinics and were identified from a shortlist of key workers in the field. Indicators were rated as necessary to define and investigate difficult asthma.ResultsDifficult asthma was defined as ‘symptoms persisting beyond therapy consistent with step 4 of the British Thoracic Society (BTS) guidelines’ (high dose inhaled corticosteroids and long acting β2-agonists). Eighty-three indicators were identified (40 relating to definition and 43 relating to investigations). Of these 32 (39%) were rated as necessary: 7 out of 40 (18%) for defining difficult asthma and 23 out of 43 (53%) for investigations. Indicators of high medical resource usage were characteristic of the ‘difficult’ nature of the management of patient with difficult asthma. A framework for the investigation of these patients was created.ConclusionThe listed performance indicators identify a range of requirements that are necessary to define difficult asthma. Targeting of real needs in this group of patients will lead to better patient care and reduction of ‘waste’ in provision of healthcare

Genetic characterization of cassava (Manihot esculenta) landraces in Brazil assessed with simple sequence repeats

Based on nine microsatellite loci, the aim of this study was to appraise the genetic diversity of 42 cassava (Manihot esculenta) landraces from selected regions in Brazil, and examine how this variety is distributed according to origin in several municipalities in the states of Minas Gerais, São Paulo, Mato Grosso do Sul, Amazonas and Mato Grosso. High diversity values were found among the five above-mentioned regions, with 3.3 alleles per locus on an average, a high percentage of polymorphic loci varying from 88.8% to 100%, an average of 0.265 for observed heterozygosity and 0.570 for gene diversity. Most genetic diversity was concentrated within the regions themselves (HS = 0.52). Cluster analysis and principal component based scatter plotting showed greater similarity among landraces from São Paulo, Mato Grosso do Sul and Amazonas, whereas those from Minas Gerais were clustered into a sub-group within this group. The plants from Mato Grosso, mostly collected in the municipality of General Carneiro, provided the highest differentiation. The migration of human populations is one among the possible reasons for this closer resemblance or greater disparity among plants from the various regions