Comparison of the effects of salmeterol and ipratropium bromide on exercise performance and breathlessness in patients with stable chronic obstructive pulmonary disease

AbstractTo compare the effects of salmeterol, an adrenergic drug, and ipratropium bromide, an anticholinergic drug, on breathlessness and gas exchange during exercise in patients with chronic obstructive lung disease (COPD), we performed a progressive treadmill exercise test on 15 patients on 3 days (24 h apart), after inhalation placebo, ipratropium bromide (120 μg) or salmeterol (50 μg) in a randomized fashion. Dyspnoea during exercise was evaluated from the regression slope between Borg scale (BS) scores and distance walked each minute on the treadmill. The regression was expressed as the distance walked at BS score 5, the threshold load of dyspnoea (TLD) and breakpoint load of dyspnoea. During and after the exercise, oxygen saturation was monitored by pulse oxymeter and we measured the lower SaO2 during exercise and the recovery time of SaO2 after exercise.In comparison to placebo inhalation we found the same small but significant improvement in airflow limitation after salmeterol or ipratropium inhalation, also the distance walked on treadmill increased after bronchodilators. After bronchodilators the magnitude of oxyhaemoglobin desaturation with exercise was similar to that observed after placebo but the duration of the recovery from sustained SaO2 desaturation after exercise was shorter to the same extent as after ipratropium or salmeterol. Dyspnoeic sensation, when assessed by the TLD and by the distance walked at BS score 5, was decreased after salmeterol and after ipratropium bromide to a similar extent.We conclude that the salmeterol, when given in conventional doses, produces significant improvement in the airway obstruction in the recovery of postexercise HbO2 desaturation and in dyspnoeic sensation in patients with COPD, effects which were similar to those observed after inhalation of the anticholinergic agent ipratropium bromide

Variable geometry inlet design for scram jet engine

The present invention relates to an improved variable geometry inlet for a scram jet engine having at least one combustor module. The variable geometry inlet comprises each combustor module having two sidewalls. Each of the sidewalls has a central portion with a thickness and a tapered profile forward of the central portion. The tapered profile terminates in a sharp leading edge. The variable geometry inlet further comprises each module having a lower wall and a movable cowl flap positioned forward of the lower wall. The movable cowl flap has a leading edge and the leading edges of the sidewalls intersect the leading edge of the cowl flap

A Method to Assess Localized Impact of Better Floodplain Topography on Flood Risk Prediction

Many studies have highlighted the need for a higher accuracy global digital elevation model (DEM), mainly in river floodplains and deltas and along coastlines. In this paper, we present a method to infer the impact of a better DEM on applications and science using the Lower Zambezi basin as a use case. We propose an analysis based on a targeted observation algorithm to evaluate potential data acquisition subregions in terms of their impact on the prediction of flood risk over the entire study area. Consequently, it becomes trivial to rank these subregions in terms of their contribution to the overall accuracy of flood prediction. The improvement from better topography data may be expressed in terms of economic output and population affected, providing a multifaceted assessment of the value of acquiring better elevation data. Our results highlight the notion that having higher resolution measurements would improve our current large-scale flood inundation prediction capabilities in the Lower Zambezi by at least 30% and significantly reduce the number of people affected as well as the economic loss associated with high magnitude flooding. We believe this procedure to be simple enough to be applied to other regions where high quality topographic and hydrodynamic data are currently unavailable

A simple global river bankfull width and depth database

Hydraulic and hydrologic modeling has been moving to larger spatial scales with increased spatial resolution, and such models require a global database of river widths and depths to facilitate accurate river flow routing. Hydraulic geometry relationships have a long history in estimating river channel characteristics as a function of discharge. A simple near-global database of bankfull widths and depths (along with confidence intervals) was developed based on hydraulic geometry equations and the HydroSHEDS hydrography data set. The bankfull width estimates were evaluated with widths derived from Landsat imagery for reaches of nine major rivers, showing errors ranging from 8 to 62% (correlation of 0.88), although it was difficult to verify whether the satellite observations corresponded to bankfull conditions. Bankfull depth estimates were compared with in situ measurements at sites in the Ohio and Willamette rivers, producing a mean error of 24%. The uncertainties in the derivation approach and a number of caveats are identified, and ways to improve the database in the future are discussed. Despite these limitations, this is the first global database that can be used directly in hydraulic models or as a set of constraints in model calibration. Key Points Developed a global river database Used hydraulic geometry equations Leveraged existing hydrologic datasets

Wound myiasis caused by Lucilia sericata in an open femoral fracture treated with external fixation

Η μυΐαση είναι η τέταρτη πιο κοινή δερματική ασθένεια στον άνθρωπο που σχετίζεται με ταξίδια ενώ η δερματική μυΐαση είναι η συνηθέστερη κλινική μορφή. Αναφέρεται σε μη-ιατρογενή μόλυνση των ιστών από προνύμφες διπτέρων εντόμων και εμφανίζεται κυρίως σε ασθενείς που έχουν κακή υγιεινή, με συνθήκες κακής στέγασης, διανοητική καθυστέρηση, προχωρημένη ηλικία, διαβήτη, ακινητοποίηση και χαμηλό ανοσοποιητικό σύστημα. Ασθενής 14 ετών, ο οποίος είχε υποβληθεί πριν 6 μήνες σε εξωτερική οστεοσύνθεση μηριαίου λόγω κατάγματος διάφυσης μηριαίου, προσήλθε στα επείγοντα ιατρεία με άλγος στην περιοχή των βελονών. Κατά την εξέταση του τραύματος διαπιστώθηκε ερυθρότητα, οίδημα αλλά και η παρουσία ζωντανών προνυμφών διπτέρων εντόμων. Αφού ελέγχθηκε ακτινολογικά το κάταγμα της διάφυσης αφαιρέθηκε σε πρώτο χρόνο το σώμα της εξωτερικής οστεοσύνθεσης και έγινε σχολαστικότατος καθαρισμός. Με κατάλληλα χειρουργικά εργαλεία, απομονώθηκαν όλες οι προνύμφες από το τραύμα και τοποθετήθηκαν σε κατάλληλο υπόστρωμα για περαιτέρω εξέταση και προσδιορισμό του είδους. Έπειτα από μικροσκοπική εξέταση των προνυμφών και με βάση κατάλληλες μορφολογικές κλείδες προσδιορίστηκαν ως προνύμφες 3ης ηλικίας του είδους Lucilia sericata (Meigen) (Diptera: Calliphoridae). Έπειτα από 7 ημέρες αντιβιοτικής αγωγής ευρέως φάσματος, κλινοστατισμού, σχολαστικής περιποίησης των τραυμάτων και αφού είχαμε σαφή βελτίωση της περιοχής γύρω από τις βελόνες έγινε αφαίρεση αυτών. Κατά τις επανεξετάσεις έως και 6 μήνες μετά, τόσο κλινικά όσο και ακτινολογικά τα αποτελέσματα ήταν πολύ καλά.On examination of the wound of a patient who was treated previously with external fixation for a diaphysial fracture of the femur, we observed the presence of multiple living larvae (maggots) of dipterous flies. Treatment included removal of the maggots and use of antibiotic. The importance of hygiene and sanitation is discussed

HUBUNGAN PENINGKATAN BERAT BADAN FE4NGAN KONVERSI SPUTUM PADA PASIEN TUBERKULOSIS DI RSUDZA BANDA ACEH

ABSTRAKKonversi sputum pada fase awal pengobatan merupakan salah satu indikator awal keberhasilan terapi obat anti tuberkulosis (OAT). Nutrisi merupakan faktor penting yang juga mempengaruhi kesembuhan pasien tuberkulosis Penelitian ini bertujuan untuk mengetahui hubungan peningkatan berat badan dengan konversi sputum setelah fase awal pada pasien TB di Rumah Sakit Umum dr. Zainoel Abidin Banda Aceh (RSUDZA). Jenis penelitian yang digunakan adalah Cross sectional. Subjek penelitian terdiri atas 92 pasien tuberkulosis di poliklinik DOTS RSUDZA Banda Aceh yang diperoleh dengan metode total sampling terhitung dari Januari sampai dengan Desember 2013. Hasil penelitian dianalisis menggunakan uji statistik Fisher dengan Confident interval 95%. Hasil uji statistik menunjukkan p = 0,107 (p > 0,05) yang menunjukkan bahwa tidak ada hubungan antara peningkatan berat badan dengan konversi sputum pada penderita tuberkulosis yang telah mendapatkan OAT fase awal. Diharapkan adanya penelitian yang lebih lanjut mengenai hubungan nutrisi dengan konversi sputum dengan jumlah sampel yang lebih besar dan desain penelitian yang lebih baik. Kata Kunci : Tuberkulosis, Konversi sputum, Berat badan ABSTRACTSputum conversion at the initial phase of treatment is one of the early indicators of the success of anti-tuberculosis drug therapy (OAT). Nutrition is an important factor that also effects the recovery of tuberculosis patients The aim of this study was to determine the relationship of weight gain and sputum conversion after the initial phase of TB patients at the General Hospital dr. Zainoel Abidin Banda Aceh (RSUDZA). This research was cross sectional study. Subjects consisted of 92 outpatient DOTS tuberculosis in RSUDZA Banda Aceh obtained with total sampling method starting from January to December 2013. Results were analyzed using Fisher test with 95% confident interval. Statistical test results p= 0,107 (p > 0,05) that showed there is no association between increased weight to conversion of sputum in patients with tuberculosis who have earned OAT initial phase, It is expected that the presence of further reaserh on the relationship of nutrition with sputum convertion with a larger number of sampel and design better research. Keywords: Tuberculosis, Sputum conversion, Weight los

Probabilistic Evaluation of Drought in CMIP6 Simulations

As droughts have widespread social and ecological impacts, it is critical to develop long-term adaptation and mitigation strategies to reduce drought vulnerability. Climate models are important in quantifying drought changes. Here, we assess the ability of 285 CMIP6 historical simulations, from 17 models, to reproduce drought duration and severity in three observational data sets using the Standardized Precipitation Index (SPI). We used summary statistics beyond the mean and standard deviation, and devised a novel probabilistic framework, based on the Hellinger distance, to quantify the difference between observed and simulated drought characteristics. Results show that many simulations have less than error in reproducing the observed drought summary statistics. The hypothesis that simulations and observations are described by the same distribution cannot be rejected for more than of the grids based on our distance framework. No single model stood out as demonstrating consistently better performance over large regions of the globe. The variance in drought statistics among the simulations is higher in the tropics compared to other latitudinal zones. Though the models capture the characteristics of dry spells well, there is considerable bias in low precipitation values. Good model performance in terms of SPI does not imply good performance in simulating low precipitation. Our study emphasizes the need to probabilistically evaluate climate model simulations in order to both pinpoint model weaknesses and identify a subset of best-performing models that are useful for impact assessments