Effect of nebulized albuterol on circulating leukocyte counts in normal subjects

AbstractNebulized β2-receptor agonists may cause neutrophil demargination and result in misleading total circulating leukocyte counts (WBCs) in patients with acute bronchospasm. Varying underlying adrenergic stimulation in these patients also makes interpretation of these data difficult. This study examined the direct effect of these agents on the measured WBCs of healthy adults without evidence of bronchospasm or illness.A prospective, blinded, randomized study of 30 healthy volunteers (aged 18–50 years) was performed in a controlled environment. Subjects were excluded if they were pregnant, had a known underlying medical disorder or have had a prior reaction to albuterol or similar medications. Participants in the study were given either a nebulized albuterol treatment or nebulized normal saline (control group). Leukocyte counts were then obtained before and after treatments. Paired data were analysed using a one-tailed t-test while considering an increase of 40% in WBCs to be significant, P=0·05, and β=0·10.Mean leukocyte counts were 5·9 (± 1·2) before treatment as compared to 6·0 (± 1·3) after albuterol nebulization. Using the coefficient of variance of WBCs in normal humans as c. 50% (6000 ± 3000 cells mm−1) we were unable to demonstrate a significant difference in variation in post-nebulized leukocyte counts between the control group and the nebulized albuterol group.While there is concern that the treatment of patients experiencing acute bronchospasm with β2 agonists may result in factitious elevations in peripheral leukocyte counts, we found no direct effect of these agents on measured counts in normal subjects

Hydrogen permeation through VPD and CVD tungsten films on palladium

Isobars and isotherms were measured for hydrogen permeation through porous tungsten films on palladium, activation energy values were calculated for various Pd-W systems. The analysis of the obtained data and its comparison with the ones for dense tungsten coatings are carried out.Представлено результати дослідження ізобар та ізотерм проникнення водню крізь пористі плівки вольфраму на паладії, визначені величини енергії активації водневої проникності у системах Pd-W. Проведено аналіз одержаних даних і порівняння з даними що до щільних вольфрамових покриттів.Представлены результаты исследований изобар и изотерм проникновения водорода через пористые пленки вольфрама на палладии, определены величины энергии активации водородопроницаемости в различных системах Pd-W. Проведен анализ полученных данных и сравнение с данными для плотных вольфрамовых покрытий

Influence of porosity on erosion behavior and hydrogen permeability of tungsten films

The erosion characteristics of dense and porous W-films deposited on Pd substrates were measured under impact of mirror Penning discharge nitrogen plasma. It is shown that the erosion rate of high porous tungsten films (up to 45% porosity) is similar to that for dense (1 – 3% porosity) tungsten films. At the same time hydrogen permeation through porous tungsten films essentially higher than for dense W coatings and in some cases it approaches to values as for bare Pd. The activation energies of hydrogen permeability measured for two-layer Pd-W systems with high porosity are higher than for dense W-films on Pd (15.44 kJ/mol and 12.8 kJ/mol, accordingly), but these values much lower than the ones for bulk W under gas-driven permeation experiments. The possible reasons of such erosion and permeation behavior are discussed.Зміряні ерозійні характеристики щільних і пористих плівок вольфраму на паладії при дії азотної плазми відбивних розрядів Пеннінга. Показано, що швидкість ерозії високопористих плівок вольфраму (пористість близько 45%) практично не відрізняється від такої для щільних плівок W (пористість 1 – 3%). У теж час проникнення водню крізь високопористі плівки вольфраму багато вище, ніж крізь щільні покриття W і в деяких випадках величини проникності можуть бути близькі до такої для Pd без покриття. Енергії активації водневої проникності зміряні для двошарових систем Pd-W з високою пористістю W вище, ніж для щільних W-плівок на Pd (15,44 кДж/моль і 12,8 кДж/моль, відповідно), але в обох випадках ці величини багато нижче, ніж для масивного W в умовах пронuкновения з молекулярної фази. Обговорюються можливі причини такої поведінки ерозії і водневої проникності.Измерены эрозионные характеристики плотных и пористых пленок вольфрама на палладии при воздействии азотной плазмы отражательных разрядов Пеннинга. Показано, что скорость эрозии высокопористых пленок вольфрама (пористость около 45%) практически не отличается от таковой для плотных W пленок (пористость 1 – 3%). В тоже время проникновение водорода через высокопористые пленки вольфрама много выше, чем через плотные W покрытия и в некоторых случаях величины проницаемости могут быть близки к таковой для Pd без покрытия. Энергии активации водородопроницаемости измереннные для двухслойных Pd-W систем с высокой пористостью W выше, чем для плотных W-пленок на Pd (15,44 кДж/моль и 12,8 кДж/моль, соответственно), но в обоих случаях эти величины много ниже, чем для массивного W в условиях проникновения из молекулярной фазы. Обсуждаются возможные причины такого поведения эрозии и водородопроницаемости

Kinetics of hydrogen permeation through W-Pd bimetallic systems

The experimental investigations had been carried out of the kinetics of hydrogen permeation through W-Pd bimetallic systems. The possible mechanisms had been suggested and analyzed to explain the observed anomalies in the hydrogen permeation behavior of such systems, on the assumption of measured isotherms and isobars of hydrogen permeability, energy state of hydrogen in W-Pd system, and theory of hydrogen diffusion in the systems, which contains large number of closed and interconnecting poresПроведено експериментальні дослідження кінетики проникнення водню через W-Pd біметалічні системи. Запропоновано можливі механізми для пояснення виявлених аномалій у поводженні воднепроникнення таких систем, виходячи з обмірюваних ізотерм і ізобар проникнення водню, енергетичного стану водню в системі W-Pd і теорії дифузії в системах з великою кількістю замкнутих і сполучених пор.Проведены экспериментальные исследования кинетики проникновения водорода через W-Pd биметаллические системы. Предложены возможные механизмы для объяснения обнаруженных аномалий в поведении водородопроницаемости таких систем, исходя из измеренных изотерм и изобар водородопроницаемости, энергетического состояния водорода в системе W-Pd и теории диффузии в системах с большим количеством замкнутых и сообщающихся пор

Pd-W bimetallic systems: erosion behavior and hydrogen permeability

Erosion and hydrogen behavior are examined in the dense and high porous W-films on Pd. The obtained results are discussed from the viewpoint of plasma facing diffusion system creation for hydrogen isotope recycling control or tritium extraction

Factors associated with syphilis seroprevalence in women with and at-risk for HIV infection in the Women's Interagency HIV Study (1994-2015)

Objective Syphilis rates among women in the USA more than doubled between 2014 and 2018. We sought to identify correlates of syphilis among women enrolled in the Women's Interagency HIV Study (WIHS) to inform targeted interventions. Methods The retrospective cross-sectional analysis of secondary data included women with HIV or at-risk of HIV who enrolled in the multisite US WIHS cohort between 1994 and 2015. Syphilis screening was performed at baseline. Infection was defined serologically by a positive rapid plasma reagin test with confirmatory treponemal antibodies. Sociodemographic and behavioural characteristics stratified by baseline syphilis status were compared for women enrolled during early (1994-2002) and recent (2011-2015) years. Multivariable binomial modelling with backward selection (p>0.2 for removal) was used to model correlates of syphilis. Results The study included 3692 women in the early cohort and 1182 women in the recent cohort. Syphilis prevalence at enrolment was 7.5% and 3.7% in each cohort, respectively (p100 lifetime sex partners (all p<0.05). In the recent cohort, age (adjusted prevalence OR (aPOR) 0.2, 95% CI 0.1 to 0.6 for 30-39 years; aPOR 0.5, 95% CI 0.2 to 1.0 for 40-49 years vs ≥50 years), hepatitis C seropositivity (aPOR 2.1, 95% CI 1.0 to 4.1) and problem alcohol use (aPOR 2.2, 95% CI 1.1 to 4.4) were associated with infection. Conclusions Syphilis screening is critical for women with HIV and at-risk of HIV. Targeted prevention efforts should focus on women with hepatitis C and problem alcohol use

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2•72 (95% uncertainty interval [UI] 2•66–2•79) in 2000 to 2•31 (2•17–2•46) in 2019. Global annual livebirths increased from 134•5 million (131•5–137•8) in 2000 to a peak of 139•6 million (133•0–146•9) in 2016. Global livebirths then declined to 135•3 million (127•2–144•1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2•1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27•1% (95% UI 26•4–27•8) of global livebirths. Global life expectancy at birth increased from 67•2 years (95% UI 66•8–67•6) in 2000 to 73•5 years (72•8–74•3) in 2019. The total number of deaths increased from 50•7 million (49•5–51•9) in 2000 to 56•5 million (53•7–59•2) in 2019. Under-5 deaths declined from 9•6 million (9•1–10•3) in 2000 to 5•0 million (4•3–6•0) in 2019. Global population increased by 25•7%, from 6•2 billion (6•0–6•3) in 2000 to 7•7 billion (7•5–8•0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58•6 years (56•1–60•8) in 2000 to 63•5 years (60•8–66•1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global burden of 87 risk factors in 204 countries and territories, 1990�2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk�outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk�outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk�outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95 uncertainty interval UI 9·51�12·1) deaths (19·2% 16·9�21·3 of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12�9·31) deaths (15·4% 14·6�16·2 of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253�350) DALYs (11·6% 10·3�13·1 of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0�9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10�24 years, alcohol use for those aged 25�49 years, and high systolic blood pressure for those aged 50�74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens