Patient-managed interventions for adults with bronchiectasis: evidence, challenges and prospects

Bronchiectasis is a chronic lung condition which is characterised by recurrent chest infections, chronicsputum production and cough, and limited exercise tolerance. While bronchiectasis may be caused byvarious aetiologies, these features are shared by most patients with bronchiectasis regardless of the cause.This review consolidates the existing evidence on patient-managed interventions for adults withbronchiectasis, while also outlining areas for future research. Airway clearance techniques andhyperosmolar agents are key components of the bronchiectasis management and consistently recommendedfor clinical implementation. Questions around their prescription, such as optimal sequence of delivery, arestill to be answered. Pulmonary rehabilitation and exercise are also recommended for patients withbronchiectasis. Relatively strong evidence underpins this recommendation during a clinically stable stage ofthe disease, although the role of pulmonary rehabilitation following an exacerbation is still unclear.Additionally, self-management programmes feature prominently in bronchiectasis treatment, yet the lack ofconsensus regarding their definition and outcomes presents hurdles to establishing a cohesive evidencebase. Moreover, cough, a cardinal symptom of bronchiectasis, warrants closer examination. Althoughmanaging cough in bronchiectasis may initially appear risky, further research is necessary to ascertainwhether strategies employed in other respiratory conditions can be safely and effectively adapted tobronchiectasis, particularly through identifying patient responder populations and criteria where cough maynot enhance airway clearance efficacy and its control is needed. Overall, there is a growing recognition ofthe importance of patient-managed interventions in the bronchiectasis management. Efforts to improveresearch methodologies and increase research funding are needed to further advance our understanding ofthese interventions, and their role in optimising patient care and outcomes

The AMS-RICH velocity and charge reconstruction

The AMS detector, to be installed on the International Space Station, includes a Ring Imaging Cerenkov detector with two different radiators, silica aerogel (n=1.05) and sodium fluoride (n=1.334). This detector is designed to provide very precise measurements of velocity and electric charge in a wide range of cosmic nuclei energies and atomic numbers. The detector geometry, in particular the presence of a reflector for acceptance purposes, leads to complex Cerenkov patterns detected in a pixelized photomultiplier matrix. The results of different reconstruction methods applied to test beam data as well as to simulated samples are presented. To ensure nominal performances throughout the flight, several detector parameters have to be carefully monitored. The algorithms developed to fulfill these requirements are presented. The velocity and charge measurements provided by the RICH detector endow the AMS spectrometer with precise particle identification capabilities in a wide energy range. The expected performances on light isotope separation are discussed.Comment: Contribution to the ICRC07, Merida, Mexico (2007); Presenter: F. Bara

The RICH detector of the AMS-02 experiment: status and physics prospects

The Alpha Magnetic Spectrometer (AMS), whose final version AMS-02 is to be installed on the International Space Station (ISS) for at least 3 years, is a detector designed to measure charged cosmic ray spectra with energies up to the TeV region and with high energy photon detection capability up to a few hundred GeV. It is equipped with several subsystems, one of which is a proximity focusing RICH detector with a dual radiator (aerogel+NaF) that provides reliable measurements for particle velocity and charge. The assembly and testing of the AMS RICH is currently being finished and the full AMS detector is expected to be ready by the end of 2008. The RICH detector of AMS-02 is presented. Physics prospects are briefly discussed.Comment: 5 pages. Contribution to the 10th ICATPP Conference on Astroparticle, Particle, Space Physics, Detectors and Medical Physics Applications (Como 2007). Presenter: Rui Pereir

Systematic search for VHE gamma-ray emission from X-ray bright high-frequency BL Lac objects

All but three (M87, BL Lac and 3C 279) extragalactic sources detected so far at very high energy (VHE) gamma-rays belong to the class of high-frequency peaked BL Lac (HBL) objects. This suggested to us a systematic scan of candidate sources with the MAGIC telescope, based on the compilation of X-ray blazars by Donato et al. (2001). The observations took place from December 2004 to March 2006 and cover sources on the northern sky visible under small zenith distances zd < 30 degrees at culmination. The sensitivity of the search was planned for detecting X-ray bright F(1 keV) > 2 uJy) sources emitting at least the same energy flux at 200 GeV as at 1 keV. In order to avoid strong gamma-ray attenuation close to the energy threshold, the redshift of the sources was constrained to values z<0.3. Of the fourteen sources observed, 1ES 1218+304 and 1ES 2344+514 have been detected in addition to the known bright TeV blazars Mrk 421 and Mrk 501. A marginal excess of 3.5 sigma from the position of 1ES 1011+496 was observed and has been confirmed as a source of VHE gamma-rays by a second MAGIC observation triggered by a high optical state (Albert et al. 2007). For the remaining sources, we present here the 99% confidence level upper limits on the integral flux above ~200 GeV. We characterize the sample of HBLs (including all HBLs detected at VHE so far) by looking for correlations between their multi-frequency spectral indices determined from simultaneous optical, archival X-ray, and radio luminosities, finding that the VHE emitting HBLs do not seem to constitute a unique subclass. The absorption corrected gamma-ray luminosities at 200 GeV of the HBLs are generally not higher than their X-ray luminosities at 1 keV.Comment: 15 pages, 7 figures, 5 tables, submitted to ApJ (revised version

MAGIC upper limits on the very high energy emission from GRBs

The fast repositioning system of the MAGIC Telescope has allowed during its first data cycle, between 2005 and the beginning of year 2006, observing nine different GRBs as possible sources of very high energy gammas. These observations were triggered by alerts from Swift, HETE-II, and Integral; they started as fast as possible after the alerts and lasted for several minutes, with an energy threshold varying between 80 and 200 GeV, depending upon the zenith angle of the burst. No evidence for gamma signals was found, and upper limits for the flux were derived for all events, using the standard analysis chain of MAGIC. For the bursts with measured redshift, the upper limits are compatible with a power law extrapolation, when the intrinsic fluxes are evaluated taking into account the attenuation due to the scattering in the Metagalactic Radiation Field (MRF).Comment: 25 pages, 9 figures, final version accepted by ApJ. Changet title to "MAGIC upped limits on the VERY high energy emission from GRBs", re-organized chapter with description of observation, removed non necessaries figures, added plot of effective area depending on zenith angle, added an appendix explaining the upper limit calculation, added some reference

Constraints on the steady and pulsed very high energy gamma-ray emission from observations of PSR B1951+32/CTB 80 with the MAGIC Telescope

We report on very high energy gamma-observations with the MAGIC Telescope of the pulsar PSR B1951+32 and its associated nebula, CTB 80. Our data constrain the cutoff energy of the pulsar to be less than 32 GeV, assuming the pulsed gamma-ray emission to be exponentially cut off. The upper limit on the flux of pulsed gamma-ray emission above 75 GeV is 4.3*10^-11 photons cm^-2 sec^-1, and the upper limit on the flux of steady emission above 140 GeV is 1.5*10^-11 photons cm^-2 sec^-1. We discuss our results in the framework of recent model predictions and other studies.Comment: 7 pages, 7 figures, replaced with published versio

Upper limit for gamma-ray emission above 140 GeV from the dwarf spheroidal galaxy Draco

The nearby dwarf spheroidal galaxy Draco with its high mass to light ratio is one of the most auspicious targets for indirect dark matter searches. Annihilation of hypothetical DM particles can result in high-energy gamma-rays, e.g. from neutralino annihilation in the supersymmetric framework. With the MAGIC telescope a search for a possible DM signal originating from Draco was performed during 2007. The analysis of the data results in a flux upper limit of 1.1x10^-11 photons cm^-2 sec^-1 for photon energies above 140 GeV, assuming a point like source. Furthermore, a comparison with predictions from supersymmetric models is given. While our results do not constrain the mSUGRA phase parameter space, a very high flux enhancement can be ruled out.Comment: Accepted for publication by Astrophysical Journa

Maximal respiratory pressure reference equations in healthy adults and cut-off points for defining respiratory muscle weakness

[Abstract] Introduction: Maximal inspiratory and expiratory pressures (PImax/PEmax) reference equations obtained in healthy people are needed to correctly interpret respiratory muscle strength. Currently, no clear cut-off points defining respiratory muscle weakness are available. We aimed to establish sex-specific reference equations for PImax/PEmax in a large sample of healthy adults and to objectively determine cut-off points for respiratory muscle weakness. Methods: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy non-smoking volunteers aged 18-80 years stratified by sex and age were recruited. PImax/PEmax were assessed using uniform methodology according to international standards. Multiple linear regressions were used to obtain reference equations. Cut-off points for respiratory muscle weakness were established by using T-scores. Results: The final sample consisted of 610 subjects (314 females; 48 [standard deviation, SD: 17] years). Reference equations for PImax/PEmax included body mass index and a squared term of the age as independent variables for both sexes (p<0.01). Cut-off points for respiratory muscle weakness based on T-scores ≥2.5 SD below the peak mean value achieved at a young age were: 62 and 83cmH2O for PImax and 81 and 109cmH2O for PEmax in females and males, respectively. Conclusion: These reference values, based on the largest dataset collected in a European population to date using uniform methodology, help identify cut-off points for respiratory muscle weakness in females and males. These data will help to better identify the presence of respiratory muscle weakness and to determine indications for interventions to improve respiratory muscle function

Simultaneous multi-frequency observation of the unknown redshift blazar PG 1553+113 in March-April 2008

The blazar PG 1553+113 is a well known TeV gamma-ray emitter. In this paper, we determine its spectral energy distribution using simultaneous multi-frequency data in order to study its emission processes. An extensive campaign was carried out between March and April 2008, where optical, X-ray, high-energy (HE) gamma-ray, and very-high-energy (VHE) gamma-ray data were obtained with the KVA, Abastumani, REM, RossiXTE/ASM, AGILE and MAGIC telescopes, respectively. This is the first simultaneous broad-band (i.e., HE+VHE) gamma-ray observation, though AGILE did not detect the source. We combine data to derive source's spectral energy distribution and interpret its double peaked shape within the framework of a synchrotron self compton modelComment: 5 pages, 2 figures, publishe