Cough reflex sensitivity improves with speech language pathology management of refractory chronic cough

Rationale: Speech language pathology is an effective management intervention for chronic cough that persists despite medical treatment. The mechanism behind the improvement has not been determined but may include active cough suppression, reduced cough sensitivity or increased cough threshold from reduced laryngeal irritation. Objective measures such as cough reflex sensitivity and cough frequency could be used to determine whether the treatment response was due to reduced underlying cough sensitivity or to more deliberate control exerted by individual patients. The number of treatments required to effect a response was also assessed. Objective: The aim of this study was to investigate subjective and objective measures of cough before, during and after speech language pathology treatment for refractory chronic cough and the mechanism underlying the improvement. Methods: Adults with chronic cough (n = 17) were assessed before, during and after speech language pathology intervention for refractory chronic cough. The primary outcome measures were capsaicin cough reflex sensitivity, automated cough frequency detection and cough-related quality of life. Results: Following treatment there was a significant improvement in cough related quality of life (Median (IQR) at baseline: 13.5 (6.3) vs. post treatment: 16.9 (4.9), p = 0.002), objective cough frequency (Mean ± SD at baseline: 72.5 ± 55.8 vs. post treatment: 25 ± 27.9 coughs/hr, p = 0.009), and cough reflex sensitivity (Mean ± SD log C5 at baseline: 0.88 ± 0.48 vs. post treatment: 1.65 ± 0.88, p < 0.0001). Conclusions: This is the first study to show that speech language pathology management is an effective intervention for refractory chronic cough and that the mechanism behind the improvement is due to reduced laryngeal irritation which results in decreased cough sensitivity, decreased urge to cough and an increased cough threshold. Speech language pathology may be a useful and sustained treatment for refractory chronic cough. Trial Registration: Australian New Zealand Clinical Trials Register, ACTRN12608000284369

Older working adults in the HEAF study are more likely to report loneliness after two years of follow-up if they have negative perceptions of their work quality

Bevilacqua, Gregorio D'Angelo, Stefania Ntani, Georgia Syddall, Holly Emma Harris, Elizabeth Clare Linaker, Cathy Stevens, Martin Cooper, Cyrus Walker-Bone, Karen eng England BMC Public Health. 2021 Mar 23;21(1):574. doi: 10.1186/s12889-021-10610-5.Peer reviewedPublisher PD

Oklahoma Agricultural Experiment Station, Bulletin no. 33, March 1898: Experiments with field crops, 1897

The Oklahoma Agricultural Experiment Station periodically issues revisions to its publications. The most current edition is made available. For access to an earlier edition, if available for this title, please contact the Oklahoma State University Library Archives by email at [email protected] or by phone at 405-744-6311

Work participation and risk factors for health-related job loss among older workers in the Health and Employment after Fifty (HEAF) study: Evidence from a 2-year follow-up period

Funding KWB The HEAF study is funded by grant awards from Versus Arthritis (formerly Arthritis Research UK) (19817 and 20665) and the Medical Research Council programme grant (MC_UU_12011/5); and the Economic and Social Research Council and Medical Research Council jointly (ES/L002663/1); the study is coordinated by the MRC Lifecourse Epidemiology Unit, Southampton. https://www.versusarthritis.org https://mrc.ukri.org/ https://esrc.ukri.org/ The funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Acknowledgments We wish to thank the Clinical Practice Research Datalink and the 24 general practices that supported data collection; also, the staff of the MRC Lifecourse Epidemiology Unit who provided data entry and computing support (notably Vanessa Cox). Finally, we thank the HEAF participants for giving their time so generously to participate in the study.Peer reviewedPublisher PD

Oklahoma Agricultural Experiment Station, Bulletin no. 28, June 1897: Experiments with wheat, 1896-7

The Oklahoma Agricultural Experiment Station periodically issues revisions to its publications. The most current edition is made available. For access to an earlier edition, if available for this title, please contact the Oklahoma State University Library Archives by email at [email protected] or by phone at 405-744-6311

Vitamin D and Cardiovascular Disease

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90252/1/phco.29.6.691.pd

Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the arm pain trial)

&lt;b&gt;Background&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods/Design&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.&lt;p&gt;&lt;/p&gt; We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Discussion&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms

Determination of the Acceleration Region Size in a Loop-structured Solar Flare

In order to study the acceleration and propagation of bremsstrahlung-producing electrons in solar flares, we analyze the evolution of the flare loop size with respect to energy at a variety of times. A GOES M3.7 loop-structured flare starting around 23:55 on 2002 April 14 is studied in detail using \textit{Ramaty High Energy Solar Spectroscopic Imager} (\textit{RHESSI}) observations. We construct photon and mean-electron-flux maps in 2-keV energy bins by processing observationally-deduced photon and electron visibilities, respectively, through several image-processing methods: a visibility-based forward-fit (FWD) algorithm, a maximum entropy (MEM) procedure and the uv-smooth (UVS) approach. We estimate the sizes of elongated flares (i.e., the length and width of flaring loops) by calculating the second normalized moments of the intensity in any given map. Employing a collisional model with an extended acceleration region, we fit the loop lengths as a function of energy in both the photon and electron domains. The resulting fitting parameters allow us to estimate the extent of the acceleration region which is between $\sim 13 \rm{arcsec}$ and $\sim 19 \rm{arcsec}$. Both forward-fit and uv-smooth algorithms provide substantially similar results with a systematically better fit in the electron domain.The consistency of the estimates from these methods provides strong support that the model can reliably determine geometric parameters of the acceleration region. The acceleration region is estimated to be a substantial fraction ($\sim 1/2$) of the loop extent, indicating that this dense flaring loop incorporates both acceleration and transport of electrons, with concurrent thick-target bremsstrahlung emission.Comment: 8 pages, 5 figures, accepted to Astronomy and Astrophysics journa