Blood eosinophils and inhaled corticosteroid/long-acting β-2 agonist efficacy in COPD

Objective We performed a review of studies of fluticasone propionate (FP)/salmeterol (SAL) (combination inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA)) in patients with COPD, which measured baseline (pretreatment) blood eosinophil levels, to test whether blood eosinophil levels ≥2% were associated with a greater reduction in exacerbation rates with ICS therapy. Methods Three studies of ≥1-year duration met the inclusion criteria. Moderate and severe exacerbation rates were analysed according to baseline blood eosinophil levels (<2% vs ≥2%). At baseline, 57–75% of patients had ≥2% blood eosinophils. Changes in FEV1 and St George’s Respiratory Questionnaire (SGRQ) scores were compared by eosinophil level. Results For patients with ≥2% eosinophils, FP/SAL was associated with significant reductions in exacerbation rates versus tiotropium (INSPIRE: n=719, rate ratio (RR)=0.75, 95% CI 0.60 to 0.92, p=0.006) and versus placebo (TRISTAN: n=1049, RR=0.63, 95% CI 0.50 to 0.79, p<0.001). No significant difference was seen in the <2% eosinophil subgroup in either study (INSPIRE: n=550, RR=1.18, 95% CI 0.92 to 1.51, p=0.186; TRISTAN: n=354, RR=0.99, 95% CI 0.67 to 1.47, p=0.957, respectively). In SCO30002 (n=373), no significant effects were observed (FP or FP/SAL vs placebo). No relationship was observed in any study between eosinophil subgroup and treatment effect on FEV1 and SGRQ. Discussion Baseline blood eosinophil levels may represent an informative marker for exacerbation reduction with ICS/LABA in patients with COPD and a history of moderate/severe exacerbations

Reproducibility of arterial stiffness and wave reflections in chronic obstructive pulmonary disease: The contribution of lung hyperinflation and a comparison of techniques

SummarySignificant cardiovascular morbidity and mortality exists in chronic obstructive pulmonary disease (COPD). Arterial stiffness is raised in COPD and may be a mechanistic link. Non-invasive assessment of arterial stiffness has the potential to be a surrogate outcome measure, although no reproducibility data exists in COPD patients.Two studies (23 and 33 COPD patients) were undertaken to 1) assess the Vicorder reproducibility of carotid-femoral pulse wave velocity and Augmentation index in COPD; 2) compare it to SphygmoCor; and 3) assess the contribution of lung hyperinflation to measurement variability.There were excellent correlations and good agreement between repeat Vicorder measurements for carotid-femoral pulse wave velocity (r = 0.96 (p < 0.001); mean difference ±SD = −0.03 ± 0.36 m/s (p = 0.65); co-efficient of reproducibility = 4.02%; limits of agreement = −0.68–0.75 m/s). Augmentation index significantly correlated (r = 0.736 (p < 0.001); mean difference ±SD = 0.72 ± 4.86% (p = 0.48), however limits of agreement were only 10.42–9.02%, with co-efficient of reproducibility of 27.93%. Comparing devices, Vicorder values were lower but there was satisfactory agreement. There were no correlation between lung hyperinflation (as measured by residual volume percent predicted, total lung capacity percent predicted or the ratio of inspiratory capacity to residual volume) and variability of measurements in either study.In COPD, measurement of carotid-femoral pulse wave velocity is highly reproducible, not affected by lung hyperinflation and suitable as a surrogate endpoint in research studies. Day-to-day variation in augmentation index highlights the importance of such studies prior to the planning and undertaking of clinical COPD research

The Separation From Nature: Implications On Human Well-Being And The Future Of Our Planet

Research suggests that the amount of time people spend outside is the lowest it has been in human history (Larson and Verma, 1999; Louv, 2008; Pergams and Zaradic, 2006). Spending time outside is valuable and plays a great importance in childhood development. However, the decline in time people spend in time is adversely affecting childhood development, human health, and well-being (Barker et al., 2014; Moffitt et al., 2010). Three questions focus my research. Why is spending time outside is crucial for human well-being and the well-being of our planet? What factors are driving the decline in human time spent in nature? What can we do to mend the gap between humans and nature

Mental health professionals' knowledge of aphasia

Aphasia is an acquired language disorder that affects an individual’s ability to use languageeffectively and efficiently in all modalities. Its management often involves multiple healthprofessionals including but not limited to speech-language pathologists, occupational therapists,physical therapists, clinical social workers, counselors, psychiatrists, nurses, doctors, and otherrehabilitation specialists. Given the necessity of language in many aspects of our lives, it is nothard to imagine the presence of emotional consequences of the disorder such as depression. Theproposed thesis project is aimed at examining mental health professionals’ knowledge andunderstanding of aphasia using an online survey. North Carolina Psychology Board membersand North Carolina Board of Licensed Professionals Counselors members were recruited byelectronic-mail invitation. After providing consent to participate, survey questions werepresented addressing the participants’ certifications and training; years of practice; knowledge ofaphasia; history of service provision to this population; continuing education completed on thetopic of aphasia; and self-reported confidence in providing potential therapy to a person withaphasia. General findings suggested that the majority of respondents had heard of aphasia andcorrectly defined it as a language disorder, and more advanced degrees and more years in clinicalpractice was often associated with increased likelihood of experience with the population and confidence in providing service to this population. Interestingly, most of the participants, whowere familiar with aphasia, first learned of the disorder while in an academic program for theirrespective field; however, very few indicated that they had participated in a continuing educationcourse on the topic. The results of the survey provided useful information for future educationand training in this area with hopes of promoting awareness of aphasia and the potential mentalhealth issues that can accompany the disorder. Through proper management of depression, it isbelieved that final outcomes of aphasias management will be more positive and that quality oflife will improve

Safety and practices during stress cardiac magnetic resonance in COPD: A 3-year experience from a tertiary referral centre

This is an author-submitted, peer-reviewed version of a manuscript that has been accepted for publication in the European Respiratory Journal, prior to copy-editing, formatting and typesetting. This version of the manuscript may not be duplicated or reproduced without prior permission from the copyright owner, the European Respiratory Society. The publisher is not responsible or liable for any errors or omissions in this version of the manuscript or in any version derived from it by any other parties. The final, copy-edited, published article, which is the version of record, is available without a subscription 18 months after the date of issue publication

The search for early markers of AD: hippocampal atrophy and memory deficits.

There is increasing interest in finding markers of Alzheimer's disease (AD) that are discriminative even at an early, pre-dementia stage. This interest is driven partly by a desire to improve clinical diagnosis in more mildly affected individuals, and also by the recent paradigm shift in thinking about clinical trials for AD. This shift is a result of concern that the recent failures of high-profile clinical trials conducted in patients with mild to moderate AD may have been because therapy was “too little, too late.” The implication being that if only treatments had been trialled earlier they would have had a greater chance of success. Certainly, lessons from other aspects of medicine have shown that treatments may be most, or in some cases only, effective if given early in disease. If we did have therapies that could slow disease progression at a very early stage that would increase the interest in early markers of disease. Ideally, such therapies would be given when the minimum of functional decline and irreversible neuronal loss had already occurred. From economic and public health standpoints, delaying symptom onset would be very important: a delay of five years has been estimated to reduce projections for prevalence of symptomatic AD by about 50% (Brookmeyer et al., 1998)

Standards-based grading : moving toward equality of opportunity and advancement of learning for all students

This disquisition aims to identify and explore: (1) the unintended, negative consequences of traditional classroom grading practices, (2) an alternative grading practice—standards-based grading—with its positive outcomes, and (3) a process for implementing reform via standards-based grading at a small, rural high school. The authors begin by critically examining the literature surrounding four traditional, common grading practices and detailing two shared and concerning outcomes: traditional grading practices (1) do not allow for the equitable treatment of students, and (2) hinder learning. Following this examination, the authors detail an alternative grading practice—standards-based grading—including its associated, positive outcomes and literature support.The authors detail their improvement initiative for transitioning one high school from a traditional to a standards-based-grading model. The implementation process included a full transition of two teachers’ courses from traditional to standards-based grading. Following their proposed improvement initiative, the authors evaluated the effectiveness of the intervention, including an analysis of stakeholder interviews and focus group results. Data obtained shed light on the advantages and disadvantages of the implementation process, as well as the positive and negative outcomes experienced by students, parents, teachers, and school leaders who participated in the transition from traditional to standards-based grading

Chronic Obstructive Pulmonary Disease as a Predictor of Cardiovascular Risk: A Case-Control Study.

This is an Accepted Manuscript of an article published by Taylor & Francis in on 13 December 2019, available online: https://doi.org/10.1080/15412555.2019.1694501Chronic obstructive pulmonary disease (COPD) is a complex multi-morbid disorder with significant cardiac mortality. Current cardiovascular risk prediction models do not include COPD. We investigated whether COPD modifies future cardiovascular risk to determine if it should be considered in risk prediction models.Case-control study using baseline data from two randomized controlled trials performed between 2012 and 2015. Of the 90 eligible subjects, 26 COPD patients with lung hyperinflation were propensity matched for 10-year global cardiovascular risk score (QRISK2) with 26 controls having normal lung function. Patients underwent cardiac magnetic resonance imaging, arterial stiffness and lung function measurements. Differences in pulse wave velocity (PWV), total arterial compliance (TAC) and aortic distensibility were main outcome measures.PWV (mean difference 1.0 m/s, 95% CI 0.02-1.92; p = 0.033) and TAC (mean difference -0.27 mL/m2/mmHg, 95% CI 0.39-0.15; p < 0.001) were adversely affected in COPD compared to the control group. The PWV difference equates to an age, sex and risk-factor adjusted increase in relative risk of cardiovascular events and mortality of 14% and 15%, respectively.There were no differences in aortic distensibility. In the whole cohort (n = 90) QRISK2 (β = 0.045, p = 0.005) was associated with PWV in multivariate analysis. The relationship between QRISK2 and PWV were modified by COPD, where the interaction term reached significance (p = 0.014). FEV1 (β = 0.055 (0.027), p = 0.041) and pulse (B = -0.006 (0.002), p = 0.003) were associated with TAC in multivariate analysis.Markers of cardiovascular outcomes are adversely affected in COPD patients with lung hyperinflation compared to controls matched for global cardiovascular risk. Cardiovascular risk algorithms may benefit from the addition of a COPD variable to improve risk prediction and guide management.HAPPY London ClinicalTrials.gov: NCT01911910 and HZC116601; ClinicalTrials.gov: NCT01691885.The COPD trial was funded by GlaxoSmithKline (GSK), London, United Kingdom (HZC116601); SmithKline Beecham Pharma; The HAPPY London Study was funded by The Barts Charity (437/1412), London, United Kingdom

Deconstructing Tryon Palace : exploring the colonial revival in twentieth century New Bern, North Carolina

This thesis examines Tryon Palace, the reconstructed colonial governor’s mansion of North Carolina. Located in New Bern, the Palace was originally designed and constructed from 1767-1770 by John Hawks for Royal Governor William Tryon. In 1798, the Palace burned after a fire accidentally started in the basement. Homes, businesses, and a highway were built on the original site of the Palace. A movement to reconstruct the Palace began in the 1930s, but did not gain real strength until the 1940s when Maude Moore Latham, a Greensboro resident and native of New Bern, established a trust fund for the reconstruction of the Palace. Based on original plans of the Palace found in New York and England, the reconstructed Palace opened to the public in 1959. Today, Tryon Palace still operates as a historic house museum. This thesis will trace the history of the original and reconstructed Tryon Palace, examine the motives for the reconstruction in the 1940s and 1950s, discuss the impact of the Colonial Revival movement on New Bern and the restoration, and explain the significance of Tryon Palace for North Carolina. This thesis draws upon a variety of sources to suggest new perspectives on Tryon Palace. By examining the roots and context of the founding of the Palace, we will be better able to understand the messages conveyed at the Palace. This thesis argues that the reconstruction of Tryon Palace in the 1950s connected the people of New Bern and North Carolina to their colonial past while creating a shared identity that revolved around idealized notions of history that were typical of the Colonial Revival of the twentieth century

Racial microaggressions, racial identity, and working alliance in cross-racial counseling supervision relationships between Black supervisors and White supervisees

Racial microaggressions, a term that evolved from Pierce's (1970, 1978) research in the field of media studies, are subtle, yet offensive behaviors steeped in stereotypes of people of color (POC). These brief acts may not be intentional in nature, but have been found to be pervasive in the everyday lives of POC (Sue, Capodilupo et al., 2007). Racial microaggressions also have been found to arise in cross-racial counseling relationships (Constantine, 2007), cross-racial counseling supervision relationships (Constantine &amp; Sue, 2007), and amongst faculty in counseling and counseling psychology programs (Constantine, Smith, Reddington, &amp; Owens, 2008). Few empirical studies have given attention to the experiences of Black supervisors in cross-racial counseling supervision relationships with White supervisees. As the number of Black students entering doctoral counseling programs has increased, it has become increasingly important to further examine the experiences of Black counselor educators and supervisors in order to provide suggestions for handling issues that may arise in cross-racial counseling supervision relationships. The purpose of this study was to determine the impact perceptions of racial microaggressions and racial identity attitudes have on the supervisory working alliance. Thirty-four doctoral students and recent doctoral graduates of CACREP-accredited counseling programs participated in this study. Results indicated that Black supervisors who perceived, and were more bothered by, racial microaggressions in the supervisory relationship reported lower perceptions of the working alliance with White supervisees. Implications of the findings are presented and suggestions for future research are provided