A pilot study of the impact of high-frequency chest wall oscillation in chronic obstructive pulmonary disease patients with mucus hypersecretion

Introduction: Chronic obstructive pulmonary disease (COPD) patients with mucus hypersecretion tend to demonstrate increased frequency of infective exacerbations and a steeper slope of decline in lung function. Enhanced mucociliary clearance with high-frequency chest wall oscillation (HFCWO) devices previously used in cystic fibrosis and bronchiectasis patients may offer the opportunity for community-based, self-managed therapy to improve quality of life and lung function. Study design and methods: A randomized controlled crossover pilot study of HFCWO compared with conventional treatment was conducted in 22 patients with moderate to severe COPD and mucus hypersecretion. Patients spent 4 weeks using an HFCWO (SmartVest®) device and 4 weeks in a conventional phase with a 2-week washout. Eleven patients started with HFCWO and changed to conventional treatment, whereas the other eleven patients started conventional treatment and crossed over to HFCWO. Results: The patients were elderly with a mean age of 71 (standard deviation [SD] 10) years and were at the upper end of the normal range of body mass index (25 [SD 4.2] kg/m2). The majority of patients had moderate to severe COPD with a mean percentage predicted forced expiratory volume in 1 second of 41 (SD 15.6) and percentage predicted forced vital capacity of 73 (SD 17.7). Baseline sputum production was negatively correlated to lung function and positively to St George's Respiratory Questionnaire. Symptom scores and St George's Respiratory Questionnaire symptom dimension improved significantly (-8, P < 0.05). Sputum production showed a declining trend in the HFCWO phase, although not reaching statistical significance. The HFCWO device was well tolerated with good reported compliance. Conclusion: This pilot study demonstrated that patients with advanced COPD and mucus hypersecretion at increased risk of declining lung function tolerated the HFCWO treatment well, leading to improvement in quality of life and reduced symptoms

A triad of rhenium-mediated transformations

The title transformations are oxygen atom transfer, twin isomerization and regiospecific imine oxidation.Bispyridyldiazole ligands have furnished new oxygen atom transfer reagents of coordination type ReVOCl3(NN) which undergo a slower transfer to PPh3 than the corresponding azole reagents. The rate of twin isomerization (linkage and geometrical) of meridional azole complexes of coordination type ReIII(OPnP)Cl3(NN) to facial ReIII(PnPO)Cl3(NN) decreases rapidly asn increases in the interval 1-4 (PnP is Ph2P(CH2)nPPh2). An &#945;-diimine chelate of type ReV(NPh)Cl3(NN) is shown to undergo facile oxidation to the corresponding iminoamide complex ReVI(NPh)Cl3(NN) upon treating with dilute nitric acid. The reaction proceeds via regiospecific nucleophilic addition of waterto the more polarized imine function

Evaluation of mosquito larvicidal activity of Azolla pinnata leaf extracts against the filarial vector Culex quinquefasciatus

52-59Vector control is a major challenge now-a-days when they became resistance against commonly available insecticides. As an alternative, preliminary laboratory evaluation of Azolla pinnata crude and chloroform: methanol solvent extract was carried out under laboratory trials for control of Culex quinquefasciatus. Crude and solvent extract (chloroform: methanol) extracts of A. pinnata leaves were examined for the larvicidal activity against all the larval instars (1st to 4th) of C. quinquefasciatus. Dose-dependent mortality assays were performed using the extracts. Further, determinations of LC50 and LC95 values were accomplished through log-probit analyses and regression analyses. The larvicidal activity was statistically justified through ANOVA analyses. Effects of the extracts were examined on non-target water fauna. Exposure to A. pinnata crude and chloroform: methanol extract increased the mortality of first to fourth-instar C. quinquefasciatus. All the graded concentrations showed significant (P <0.05) larval mortality and the results of the regression equation revealed that the mortality rates were positively correlated with the concentrations of the extracts (R2 close to 1). LC50 values of all instars after 24 h of exposure were between 86.99-294.06 ppm for crude and 48.87-111.44 ppm for chloroform: methanol extract. Chloroform: methanol extract is better than crude because the nature of biological components can be enhanced in presence of solvent and secondly the stronger extraction capacity could have produced a greater number of active constituents. The residual effect is noted even at the end of 72 h. A negligible toxicity to the larvae of Chironomus circumdatus was noticed as non-target organisms

Does Gender or Religion Contribute to the Risk of COVID-19 in Hospital Doctors?

This webpage details and provides the research study conducted in the United Kingdom through online surveys focusing on the relationship between healthcare workplace prevention efforts, COVID-19 risks, religious identity, and gender. The research study focuses on healthcare workers, primarily hospital doctors and mental health doctors. A PDF of the entire study is available on the webpage

Structural Inequalities and Intersectionality are the Root Causes of Gender Discrimination & Sexual Harassment

Sexual harassment and gender discrimination overlap affecting people (including children) of all genders, however data shows an overwhelmingly high prevalence of violence or harassment experienced by women in areas of conflict, professional life and in their homes as well as in the healthcare workplace. It is pervasive, persistent and all too common. Workplace sexual harassment an discrimination although illegal, is particularly is more common in women who are young, early in their careers, in temporary employment, from under-represented or marginalised groups based on ethnicity, immigrant status, gender non-conformity or disability. Majority of perpetrators are men, who are older and enjoy the privilege of disproportionate power and in certain toxic male-dominated healthcare environments. Two recent stories of sexual harassment in healthcare prompted many women to follow suit and share similar stories referring to flashbacks, post-traumatic stress, damage to careers, pressure to leave their job, self-harm and suicidal thoughts, brought about by their experiences. Yet there are examples of women as role models breaking down historical barriers such as Hilary and Chandi in their polar adventures. Tackling such structural inequality requires remedies that go beyond incremental approaches focussed on individuals and include transformation of the organisational and societal climate by interventions, affirmative policies and courageous, compassionate leadership. Workplace sexual harassment and discrimination is unacceptable, not inevitable and needs to be eradicated

Feasibility study to assess the effect of a brief mindfulness intervention for patients with chronic obstructive pulmonary disease: A randomized controlled trial

Psychological distress is common among patients with chronic obstructive pulmonary disease (COPD). This study aimed to assess whether a 10-minute mindfulness intervention reduces distress and breathlessness, improves mood and increases mindfulness among hospital inpatients following acute exacerbation of COPD.Fifty patients were recruited following an acute admission. The immediate effects of a 10-minute mindfulness-based body scan were compared with a control intervention. Participants were randomized to receive either a mindfulness-based body scan (n = 24) or a control condition (n = 26) via a 10-minute audio recording. Participants completed a self-assessment survey, including the Borg scale for breathlessness, Philadelphia Mindfulness Scale and Hospital Anxiety and Depression Scale. They then completed six brief single item measures of dyspnoea, anxiety, depression, happiness, stress and mindfulness before and after the intervention daily for three consecutive days. Acceptability was rated according to ‘usefulness’ and whether they would recommend the intervention to other patients. Results showed that there was a tendency for change in most outcomes, but no significant differences between the groups. Most participants rated the intervention as useful and would recommend it. Existing knowledge of mindfulness interventions among these patients is very limited and this study may be helpful in the development of other brief interventions. © The Author(s) 2018

Rapidly progressive Bronchiolitis Obliterans Organising Pneumonia presenting with pneumothorax, persistent air leak, acute respiratory distress syndrome and multi-organ dysfunction: a case report

<p>Abstract</p> <p>Introduction</p> <p>Bronchiolitis Obliterans Organising Pneumonia (BOOP) may often present initially as a recurrent spontaneous pneumothorax and then develop multi-system complications.</p> <p>Case presentation</p> <p>A 17-year-old boy presented with a pneumothorax, which developed into rapidly progressive Bronchiolitis Obliterans Organising Pneumonia (BOOP). He developed multi-organ dysfunction (including adult respiratory distress syndrome, oliguric renal failure, acute coronary syndrome, cardiac failure and a right atrial thrombus) which necessitated prolonged intensive care. Diagnosis was confirmed on open lung biopsy and he responded well to treatment with corticosteroids.</p> <p>Conclusion</p> <p>BOOP is exquisitely sensitive to oral corticosteroids but if the diagnosis is not considered in such patients and appropriate treatment instituted early, BOOP may often lead to prolonged hospital admission with considerable morbidity.</p

Health technology assessment of continuous positive airway pressure devices in sleep apnoea hypopnoea syndrome

A. 1 Background The need to assess safety as well as clinical and economic effectiveness of health care innovations and thus prioritise health care provision, created the need for structured health technology assessment (HTA) programs [Gafni et al. 1993b; Henshall et al. 1997; Stevens et al. 20041. Sleep apnoea hypopnoea syndrome (SAHS) affects 2-4% of the adult population [Young et al. 1993] who are disabled by daytime dysfunction [Hardinge et al. 1995; Johns 1993b; Mitler 1993; Sauter et al. 200l and a heightened mortality and morbidity [Greenberg et al. 1995; Kiely et al. 2000; Peker et al. 1999; Sanner et al. 1997; Tremel et al. 1999; Wilcox et al. 1998; Moruzzi et al 1999; Malone et al. 1991]. The advent of continuous positive airway pressure devices (CPAP) [Sullivan et al 1981] made it possible to treat safely, patients over a wider spectrum of disease severity [Borak et al. 1996; Mar et al. 2003; Engleman et al 1997a], yet its diffusion and adoption appears to follow a heterogenous pattern. A. 2 Study design A retrospective case-control study of 603 SAHS patients was followed by a prospective, randomised, parallel group trial (RCT) of CPAP compared to lifestyle intervention (including weight reduction and sleep hygiene strategy) comparing clinical, health related quality of life (HRQL) and cost-utility ratios (CUR). The final study is a qualitative survey assessing the factors influencing the diffusion and adoption of CPAP among 303 Primary care trusts (PCT) and 261 Respiratory physicians in the UYA. 3 Results SAHS patients had a (5x) higher risk of death and (2x) of hypertension, compared to controls. Among 71 SAHS patients in the RCT, those on CPAP demonstrated greater clinical effectiveness (sleep latency, apnoea hypopnoea index, excessive daytime sleepiness & neuropsychiatriefunction) and HRQL (social functioning, mental health & energylvitality) compared to lifestyle intervention. Utilities improved on CPAP and the CUR were lower (E'716-E2027 vs. F-326444243). The diffusion survey demonstrated that the characteristics of CPAP as an innovation, would favour its adoption compared to alternative therapies, except in patient tolerability (PCT respondents). However there appeared to be no regular system for the diffusion of innovation knowledge within the NHS and hindrances in SAHS management due to deficiencies in resources, specialists and facilities. A. 4 Conclusions The results presented in this thesis provide a logical framework for the assessment of the progression of an innovation from the stage of establishing the clinical burden of disease and treatment needs, to its adoption and may help identify potentially modifiable factors in slow diffusion scenarios

The first family of trigonal prismatic M(bidentate)<SUB>2</SUB>(monodentate)2 complexes: synthesis and characterization of halobis(2-amidothiophenolato)triphenylphosphinerhenium(V)

The 1:2 reaction of [Re<SUP>V</SUP>OCl<SUB>3</SUB>(PPh<SUB>3</SUB>)<SUB>2</SUB>] with 2-aminothiophenol (H<SUB>2</SUB>atp) in toluene has afforded red-brown [Re<SUP>V</SUP>(atp)<SUB>2</SUB>(Cl)(PPh<SUB>3</SUB>)]. The corresponding bromo and iodo complexes have been similarly obtained from [Re<SUP>V</SUP>O(OEt)Br<SUB>2</SUB>(PPh<SUB>3</SUB>)<SUB>2</SUB>] and [Re<SUP>V</SUP>O(OEt)I<SUB>2</SUB>(PPh<SUB>3</SUB>)<SUB>2</SUB>], respectively. The X-ray structure of the solvate [Re(atp)<SUB>2</SUB>(Cl)(PPh<SUB>3</SUB>)]&#183;2CH<SUB>2</SUB>Cl<SUB>2</SUB> has revealed trigonal prismatic geometry for the ReS<SUB>2</SUB>N<SUB>2</SUB>ClP coordination sphere in which the two triangular faces are defined by the S, S,P and N, N, Cl triads. The twist angle between them is 8.0&#176;. The [Re(atp)<SUB>2</SUB>(X)(PPh<SUB>3</SUB>)](X=Cl, Br, I) complexes are diamagnetic (Re<SUP>V</SUP>, spin-paired d<SUP>2</SUP>) and in acetonitrile solution these display a quasireversible Re<SUP>VI</SUP>-Re<SUP>V</SUP> response near 0.7 V. Reaction with H<SUB>2</SUB>atp in air converts [Re<SUP>V</SUP>(atp)<SUB>2</SUB>(X)(PPh<SUP>3</SUP>)] to the tris chelate [Re<SUP>VI</SUP>(atp)<SUB>3</SUB>]