Diseases Which Mimic Asthma and Chronic Obstructive Pulmonary Disease (COPD)

The American Thoracic Society defines asthma as a disease characterized by increased responsiveness of the trachea and bronchi to various stimuli and manifested by widespread narrowing of the airways that changes in severity either spontaneously or as a result of therapy. In this context asthma is a physiologic diagnosis. It is most often recognized when a patient complains of episodic wheezing and dyspnea and most often confirmed by the demonstration of variable airways obstruction on spirometric testing

Screening Pulmonary Function Tests

The role of the Pulmonary Function Laboratory has been expanded in recent years by the commercial development and marketing of equipment capable of measuring accurately and easily static lung volumes, diffusing capacity, and arterial blood gases. These sophisticated measurements, which were once the purview of research physiologists, are now readily attainable as screening measurements in most community hospitals. This review is intended not as a summary of the entire field or as a technical guide for performance of pulmonary function tests but as a survey of some clinical applications and pitfalls of screening tests and a statement of guidelines for their use. It is assumed that the reader already has some experience in ordering and interpreting routine spirograms and arterial blood gases

Aneurysmectomy with partial nephrectomy on a living donor renal allograft: a case report.

Vascular anomalies among living kidney donors are seldom encountered and their presence offers a complex opportunity for every transplant surgeon. Furthermore, there has been an increasing trend with the use of marginal or kidneys with pathology to address the shortage of organs. We report a rare case of a kidney allograft with a saccular aneurysm and renal cortical cysts for which an excision with primary repair and partial nephrectomy were done, respectively. The recipient was a 45-year-old female with lupus nephritis and significant comorbidities who had excellent recovery and outcome. With good surgical techniques, these types of grafts continue to provide acceptable outcome but safety of the donor should be of utmost importance

Anti-interleukin-2 receptor antibodies—basiliximab and daclizumab—for the prevention of acute rejection in renal transplantation

The use of antibody induction after kidney transplantation has increased from 25% to 63% in the past decade and roughly one half of the induction agent used is anti-interleukin-2 receptor antibody (IL-2RA, ie, basiliximab or daclizumab). When combined with calcineurin inhibitor (CNI)-based immunosuppression, IL-2RAs have been shown to reduce the incidence of acute rejection, one of the predictors of poor graft survival, without increasing risks of infections and malignancies in kidney transplantation. For low-immunological-risk patients, IL-2RAs, as compared with lymphocyte-depleting antibodies, are equally efficacious and have better safety profiles. For high-risk patients, however, IL-2RAs may be inferior to lymphocyte-depleting antibodies for the prophylaxis of acute rejection. In an effort to reduce toxicities of other immunosuppressive medications without increasing the risk of acute rejection and chronic graft loss, IL-2RAs have often been combined with steroid- and CNI-sparing immunosuppression protocols. More data support the benefits of early steroid withdrawal with IL-2RA in low-risk patients, but preferred induction therapy for high-risk patients has yet to be determined. Although CNI-sparing protocols with IL-2RA may preserve renal function and improve long-term survival in selected patients, further studies are needed to identify those who benefit most from this strategy

Mechanistic understanding of ocean acidification impacts on larval feeding physiology and energy budgets of the mussel M. californianus

Ocean acidification (OA) - a process describing the ocean’s increase in dissolved carbon dioxide (PCO2) and a reduction in pH and aragonite saturation state (Ωar) due to higher concentrations of atmospheric CO2 – is considered a threat to bivalve mollusks and other marine calcifiers. While many studies have focused on the effects of OA on shell formation and growth, we present findings on the separate effects of PCO2, Ωar, and pH on larval feeding physiology (initiation of feeding, gut fullness, and ingestion rates) of the California mussel Mytilus californianus. We found elevated PCO2 delays initiation of feeding, while gut fullness and ingestion rates were best predicted by Ωar; however, pH was not found to have a significant effect on these feeding processes under the range of OA conditions tested. We also modeled how OA impacts on initial shell development and feeding physiology might subsequently affect larval energy budget components (e.g. scope for growth) and developmental rate to 260 µm shell length, a size at which larvae typically become pediveligers. Our model predicted that Ωar impacts on larval shell size and ingestion rates over the initial 48 h period of development would result in a developmental delay to the pediveliger stage of \u3e 4 days, compared with larvae initially developing in supersaturated conditions (Ωar \u3e 1). Collectively, these results suggest that predicted increases in PCO2 and reduced Ωar values may negatively impact feeding activity and energy balances of bivalve larvae, reducing their overall fitness and recruitment success

Policy opportunities

Recommendations are given regarding National Science Foundation (NSF) astronomy programs and the NASA Space Astrophysics program. The role of ground based astronomy is reviewed. The role of National Optical Astronomy Observatories (NOAO) in ground-based night-time astronomical research is discussed. An enhanced Explored Program, costs and management of small and moderate space programs, the role of astrophysics within NASA's space exploration initiative, suborbital and airborne astronomical research, the problems of the Hubble Space Telescope, and astronomy education are discussed. Also covered are policy issues related to the role of science advisory committees, international cooperation and competition, archiving and distribution of astronomical data, and multi-wavelength observations of variable sources

Screening for prediabetes and type 2 diabetes in dental offices

ObjectivesMost Americans see dentists at least once a year. Chair‐side screening and referral may improve diagnosis of prediabetes and diabetes. In this study, we developed a multivariate model to screen for dysglycemia (prediabetes and diabetes defined as HbA1c ≥5.7 percent) using information readily available to dentists and assessed the prevalence of dysglycemia in general dental practices.MethodsWe recruited 1,033 adults ≥30 years of age without histories of diabetes from 13 general dental practices. A sample of 181 participants selected on the basis of random capillary glucose levels and periodontal status underwent definitive diagnostic testing with hemoglobin A1c. Logistic models were fit to identify risk factors for dysglycemia, and sample weights were applied to estimate the prevalence of dysglycemia in the population ≥30 years of age.ResultsIndividuals at high risk for dysglycemia could be identified using a questionnaire that assessed sex, history of hypertension, history of dyslipidemia, history of lost teeth, and either self‐reported body mass index ≥35 kg/m2 (severe obesity) or random capillary glucose ≥110 mg/dl. We estimate that 30 percent of patients ≥30 years of age seen in these general dental practices had dysglycemia.ConclusionsThere is a substantial burden of dysglycemia in patients seen in general dental practices. Simple chair‐side screening for dysglycemia that includes or does not include fingerstick random capillary glucose testing can be used to rapidly identify high‐risk patients.Practical implicationsFurther studies are needed to demonstrate the acceptability, feasibility, effectiveness, and cost‐effectiveness of chair‐side screening.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113762/1/jphd12082.pd

Towards More Precise Survey Photometry for PanSTARRS and LSST: Measuring Directly the Optical Transmission Spectrum of the Atmosphere

Motivated by the recognition that variation in the optical transmission of the atmosphere is probably the main limitation to the precision of ground-based CCD measurements of celestial fluxes, we review the physical processes that attenuate the passage of light through the Earth's atmosphere. The next generation of astronomical surveys, such as PanSTARRS and LSST, will greatly benefit from dedicated apparatus to obtain atmospheric transmission data that can be associated with each survey image. We review and compare various approaches to this measurement problem, including photometry, spectroscopy, and LIDAR. In conjunction with careful measurements of instrumental throughput, atmospheric transmission measurements should allow next-generation imaging surveys to produce photometry of unprecedented precision. Our primary concerns are the real-time determination of aerosol scattering and absorption by water along the line of sight, both of which can vary over the course of a night's observations.Comment: 41 pages, 14 figures. Accepted PAS

Multiwavelength Monitoring of the Narrow-Line Seyfert 1 Galaxy Akn 564. I. ASCA Observations and the Variability of the X-ray Spectral Components

We present a 35 day ASCA observation of the NLS1 Akn 564, which was part of a multiwavelength AGN Watch monitoring campaign. Akn 564 shows a photon index varying across the range 2.45--2.72. The presence of the soft hump component below 1 keV, previously detected in ASCA data, is confirmed. Time-resolved spectroscopy with ~daily sampling reveals a distinction in the variability of the soft hump and power-law components over a timescale of weeks, with the hump varying by a factor of 6 across the 35-day observation compared to a factor 4 in the power-law. Flux variations in the power-law component are measured down to a timescale of ~1000s and accompanying spectral variability suggests the soft hump is not well-correlated with the power-law on such short timescales. We detect Fe Ka and a blend of Fe Kb plus Ni Ka, indicating an origin in highly ionized gas. Variability measurements constrain the bulk of the Fe Ka to originate within a light week of the nucleus. The large EW of the emission lines may be due to high metallicity in NLS1s, supporting some evolutionary models for AGN.Comment: 41 pages, 15 figures. Accepted for publication in the Astrophysical Journal (v3 has final fixes for publication