Differences between physician and patient in the perception of symptoms and their severity in COPD

SummaryChronic Obstructive Pulmonary Disease (COPD) impairs quality of life and presents symptoms that affect the lives of patients. Our study analysed the degree of concordance between the patients and their pulmonologists in the perception of the severity of symptoms. A cross-sectional, descriptive, multicentre study was conducted in patients with COPD. From a list of 10 symptoms (cough, dry mouth, chest pain, expectoration, wheezing/whistling in the lungs, depression/sadness/discouragement, fatigue/tiredness/general lack of energy, anxiety/nervousness, breathlessness/shortness of breath upon exertion and difficulty sleeping/sleep disorders) each investigator and patient assessed those which, in their opinion, most concerned or affected the patient. A total of 450 patients were included in the study (91.3% males, 66.7 years old (SD = 10.2), FEV1(%) 51.7% (SD = 12.7%)). At an aggregate level, breathlessness/shortness of breath, fatigue/tiredness and coughing were identified by patients and physicians as being the most relevant symptoms. However, according to the concordance analysis conducted with individual pairs (each pulmonologist with his/her patient), only 52.8% coincided when identifying the symptom that most concerned or affected the life of the patient. The concordance analysed by the Kappa index between patients and physicians was poor (<0.42). The degree of physician–patient concordance was greater in patients with more severe COPD. The patients and their pulmonologists identified the same three main symptoms of COPD but showed low concordance when assessing the impact of the symptoms of the illness

COPD severity score as a predictor of failure in exacerbations of COPD. The ESFERA study

SummaryBackgroundExacerbations are a frequent cause of morbidity and mortality in COPD. It is crucial to identify risk factors for failure after treatment of exacerbations of COPD. This study evaluates the COPD severity score (COPDSS) as a predictor of clinical failure, together with other severity, activity and quality of life measurements, in patients with exacerbated COPD.MethodMulticenter, prospective, observational study in ambulatory patients with exacerbation of COPD. The patients completed the COPDSS, the London Chest Activities of Daily Living (LCADL) and the EuroQol 5D (EQ-5D). A follow-up visit was scheduled one month after presentation with the exacerbation to assess the clinical evolution.ResultsA total of 346 patients were included (mean age 68.5 years (SD = 9.5 years and 90.7% male) and mean FEV1(% predicted) 46.9% (SD = 17)). After one month, 28.2% of episodes were classified as failures, with half of them requiring hospital admission. Patients who failed were more frequently active smokers, with more severe dyspnoea at presentation and worse lung function. They had significantly worse scores of COPDSS, LCADL, EQ-5D index and EQ-5D visual analogue score (VAS) and shorter mean time walking per day. ROC analysis of relationship between COPDSS and failure gave AUC 0.72, which improved only to 0.77 when the other significant variables in univariate analysis were considered.ConclusionsClinical failure after ambulatory treatment of exacerbation of COPD is frequent. Usual markers of severity (impaired lung function, active smoking and severe dyspnoea) are associated with failure; however, a short severity questionnaire (COPDSS) provides better predictive value than the usual variables

Mechanical behaviour of brushite and hydroxyapatite coatings electrodeposited on newly developed FeMnSiPd alloys

Calcium phosphate coatings (CaP) (i.e., brushite and hydroxyapatite) were grown by pulsed current electrodeposition on FeMnSiPd alloys, a newly developed material proposed for biomedical implants. The electrolytic baths contained Ca(NO₃)₂·4H₂O and NH₄H₂PO₄ as precursors. Bath additives, such as H₂O₂ and NaOH, were used to promote hydroxyapatite (HAp) coating formation directly from the bath. The effect of the electrodeposition parameters on the structure, morphology and mechanical performance of the coatings was investigated. Increasing the electrodeposition time from 900s to 3600s resulted in an increase of HAp over the dominant brushite structure. Addition of 2000 ppm of NaOH or 3000 ppm of H₂O₂ also promoted an increase of HAp fraction when compared to the coatings obtained from the additive-free bath. Nonetheless, pure HAp was only achieved with the addition of 4000 ppm of NaOH to the electrolyte. The morphologies of the CaP particles in the coatings ranged from needle- to plate-like structures depending on the electrodeposition parameters and the resulting phases. The mechanical behaviour of the coatings was studied by scratch testing and nanoindentation. As a general trend, the Young's modulus and hardness values of the electrodeposited coatings were lower than those reported for fully-dense HAp, independently of the deposition conditions, because of the porous morphology of the coatings. No signs of cracking or delamination were observed during nanoindentation or scratch tests except for the coating prepared form the electrolyte containing 3000 ppm of H₂O₂

“For sale: empty Spain” Raising awareness on abandoned buildings and depopulated villages

[EN] Population density is one of the most influential factors in the conservation of historic vernacular buildings. This factor is not directly linked with the constructive technique used but with the conservation and abandonment of traditional buildings. Since the mid-20th century many rural areas in the Iberian Peninsula, mostly inland, have suffered a loss of population. This is partly due to the start of industrialization which caused the population to move to the cities, as well as the high levels of poverty and abandonment in small inland towns which remain very isolated, even today. It is in this context that the Empty Spain teaching initiative arises, applicable to architectural preservation subjects taught at the ETS of Architecture (Universitat Politècnica de València, Spain), and encouraged by the Sustainable Development Goals of the 2030 Agenda promoted by United Nations. Raising awareness on global issues affecting society is essential in the awareness of social responsibility in education . This is even more the case for any professionals in training, especially architects, directly involved in key decisions on forms of construction and choice of materials. From the start it was felt that this involvement could help shape the framework needed to prompt motivation and undertake the changes to follow.This paper has been possible thanks to the initiative “UPV_PC_ACTS 2022 Propuestas Culturales de Arte, Ciencia, Tecnología y Sociedad” and in the frame of project “VerSus+ ǀ Heritage for PEOPLE” (financed by Creative Europe Programme) and project “RISK-Terra. Earthen architecture in the Iberian Peninsula: study of natural, social and anthropic risks and strategies to improve resilience” (funded by Spanish Ministry of Science, Innovation and Universities).Cristini, V.; Baró Zarzo, JL.; Mileto, C.; Vegas, F.; Caruso, M.; Tortajada Montalva, E. (2022). “For sale: empty Spain” Raising awareness on abandoned buildings and depopulated villages. Editorial Universitat Politècnica de València. 553-558. https://doi.org/10.4995/HERITAGE2022.2022.1576855355

Mechanical Properties and Corrosion Behaviour of Nanostructured Cu-rich CuNi Electrodeposited Films

Nanocrystalline Cu-rich CuNi alloy thin films (with copper content ranging from 22 to 97 at%) have been grown by electrodeposition, using galvanostatic conditions in an electrolytic bath containing Ni and Cu sulphates with a [Ni(II)]/[Cu(II)] molar ratio of 11. The Cu content is tuned by varying the applied current density during deposition. The nanoscrystalline nature of Cu-rich CuNi thin films has been achieved using saccharine as a grain refinement agent, although for high Cu content (> 90 at%) the refinement effect is less pronounced. Due to the nanocrystalline character of the films, low surface roughness, good compactness, and outstanding mechanical properties (e.g. nanoindentation hardness values off approximately 7 GPa) are obtained, particularly for Cu percentages below 70 at%. The presence of stacking faults also contributes to the observed high strength. The films show good corrosion protective behaviour in a 3.5 wt% NaCl medium, with corrosion potentials more positive than the bare substrate (pure-Cu) and lower corrosion current density values ranging from 1.8 to 5.4 [mi]A/square centimeter

Influence of the shot-peening intensity on the structure and near-surface mechanical properties of Ti40Zr10Cu38Pd12 bulk metallic glass

This article may be downloaded for personal use only. Any other use requires prior permission of the author and the American Institute of Physics.Shot-peening (SP) changes the near-surface structure and mechanical properties of a Ti40Zr10 Cu 38Pd12 bulk metallic glass. Near the surface, the hardness, Young's modulus, and elastic strain limit are all reduced. Measurements of the heat of relaxation show that an exceptionally high stored energy of cold work can be induced, implying a large increase in free volume. At the highest SP intensity there is partial nanocrystallization enabled by the increased free volume and not by the increase in temperature

Synthesis of α-Fe2O3 and Fe-Mn oxide foams with highly tunable magnetic properties by the replication method from polyurethane templates

Open cell foams consisting of Fe and Fe-Mn oxides are prepared from metallic Fe and Mn powder precursors by the replication method using porous polyurethane (PU) templates. First, reticulated PU templates are coated by slurry impregnation. The templates are then thermally removed at 260 °C and the debinded powders are sintered at 1000 °C under N2 atmosphere. The morphology, structure, and magnetic properties are studied by scanning electron microscopy, X-ray diffraction and vibrating sample magnetometry, respectively. The obtained Fe and Fe-Mn oxide foams possess both high surface area and homogeneous open-cell structure. Hematite (α-Fe2O3) foams are obtained from the metallic iron slurry independently of the N2 flow. In contrast, the microstructure of the FeMn-based oxide foams can be tailored by adjusting the N2 flow. While the main phases for a N2 flow rate of 180 L/h are α-Fe2O3 and FeMnO3, the predominant phase for high N2 flow rates (e.g., 650 L/h) is Fe2MnO4. Accordingly, a linear magnetization versus field behavior is observed for the hematite foams, while clear hysteresis loops are obtained for the Fe2MnO4 foams. Actually, the saturation magnetization of the foams containing Mn increases from 5 emu/g to 52 emu/g when the N2 flow rate (i.e., the amount of Fe2MnO4) is increased. The obtained foams are appealing for a wide range of applications, such as electromagnetic absorbers, catalysts supports, thermal and acoustic insulation systems or wirelessly magnetically-guided porous objects in fluids

A comparison between fine-grained and nanocrystalline electrodeposited Cu-Ni films. Insights on mechanical and corrosion performance

This is the author's version of a work that was accepted for publication in Surface & coating technology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Surface & coating technology, Vol. 205, Núm. 23-24 (Sep 2011), p. 2585-5293 DOI 10.1016/j.surfcoat.2011.05.047Cu1−x-Nix (0.43 ≤ x ≤ 1.0) films were electrodeposited from citrate-sulphate baths at different current densities onto Cu/Ti/Si (100) substrates with the addition of saccharine as a grain-refining agent. The Cu-Ni alloy films produced from saccharine-free baths were fine-grained (crystallite size of ~400 nm). The addition of saccharine to the electrolytic solution induced a dramatic decrease in crystal size (down to ~27 nm) along with a reduction in surface roughness. Although the effect of saccharine on pure Ni films was less obvious, significant changes were observed due to the presence of saccharine in the bath during the alloying of Cu with Ni. Compared to fine-grained Cu-Ni films, the nanocrystalline films exhibited lower microstrains and a larger amount of stacking faults as observed by X-ray diffraction. These features enhance the mechanical properties of the Cu-Ni alloys, making the nanocrystalline Cu-Ni films superior to both the corresponding fine-grained films and pure Ni films. In particular, hardness in fine-grained films varied from 4.2 (x=0.43) to 5.4 GPa (x=0.86), whereas hardness varied between 6.7 and 8.2 GPa for nanocrystalline films of similar composition. In addition, wear resistance and elastic recovery were enhanced. Nanostructuring did not significantly affect corrosion resistance of Cu-Ni alloys in chloride media. Although the corrosion potential shifted slightly towards more negative values, the corrosion current density decreased, thereby making the electrodeposition nanostructuring process an effective tool to improve the overall properties of the Cu-Ni system

Micelle-assisted electrodeposition of highly mesoporous Fe-Pt nodular films with soft magnetic and electrocatalytic properties

Mesoporous Fe-Pt nodular films (with a regular spatial arrangement of sub-15 nm pores) are grown onto evaporated Au, Cu and Al conductive layers by micelle-assisted electrodeposition from metal chloride salts in the presence of Pluronic P123 tri-block copolymer dissolved in the aqueous electrolytic bath. This synthetic approach constitutes a simple, one-step, versatile procedure to grow multifunctional mesoporous layers appealing for diverse applications that take advantage of materials with an ultra-high surface area-to-volume ratio. The films exhibit tuneable composition with relative Fe/Pt weight ratios, disregarding oxygen, varying from 4/96 to 52/48. All the mesoporous alloys show a soft magnetic behaviour with tuneable saturation magnetization and coercivity values (the latter ranging from ca. 5 Oe to 40 Oe). In addition, the Au/Fe-Pt deposits (even the ones with higher Fe content) exhibit good performance towards hydrogen evolution reaction in both alkaline and acidic media due to the inherent mesoporosity, with excellent stability after running 50 cycles. The interest of alloying Fe with Pt is thus two-fold: (i) to confer magnetic properties to the mesoporous alloys and (ii) to reduce the amount of the costly noble metal in the electrocatalyst in an environmentally sustainable manner

Development of a questionnaire to assess patient satisfaction with allergen-specific immunotherapy in adults: item generation, item reduction, and preliminary validation

Journal Article;BACKGROUND Allergen-specific immunotherapy (SIT) is a treatment capable of modifying the natural course of allergy, so ensuring good adherence to SIT is fundamental. Up until now there has not existed an instrument specifically developed to measure patient satisfaction with SIT, although its assessment could help us to comprehend better and improve treatment adherence and effectiveness. The aim of this study was to develop an instrument to measure adult patient satisfaction with SIT. METHODS Items were generated from a literature review, focus groups with allergic adult patients undergoing SIT, and a meeting with experts. Potential items were administered to allergic patients undergoing SIT in an observational, cross-sectional, multicenter study. Item reduction was based on quantitative and qualitative criteria. A preliminary assessment of feasibility, reliability, and validity of the retained items was performed. RESULTS An initial pool of 70 items was administered to 257 patients undergoing SIT. Fifty-four items were eliminated resulting in a provisional instrument with 16 items. Factor analysis yielded four factors that were identified as perceived efficacy, activities and environment, cost-benefit balance, and overall satisfaction, explaining 74.8% of variance. Ceiling and floor effects were negligible for overall score. Overall score was associated with the type and intensity of symptoms. CONCLUSION This is the first attempt to develop a satisfaction with SIT measure from the perspective of the allergic patient, and evidence has been found in favor of its reliability and validity.Ye