Co-morbid disease in COPD – more than a coincidence

Alan J Crockett, David Pric

COPD: The end of the beginning

Richard Russell, Dave Singh, Irfan Rahman and Alan J Crocketthttp://www.dovepress.com/editorial-copd-the-end-of-the-beginning--free-paper-peer-reviewed-article-COPD-recommendation

Barriers and outcomes of an evidence-based approach to diagnosis and management of chronic obstructive pulmonary disease (COPD) in Australia: a qualitative study

Background. Chronic obstructive pulmonary disease (COPD) is commonly managed in primary care but there is poor awareness of evidence-based guidelines and the quality and interpretation of spirometry is suboptimal. Objectives. The aims of this qualitative study were to explore how an intervention involving case finding and management of COPD was implemented, and the extent to which the GPs and practice nurses (PNs) worked in partnership to diagnose and manage COPD. Methods. Semi-structured interviews with PNs (n = 7), GPs (n = 4) and patients (n = 26) who had participated in the Primary care EarLy Intervention for Copd mANagement (PELICAN) study. The Theoretical Domains Framework was used to guide the coding and analysis of the interviews with PN and GPs. The patient interviews were analysed thematically. Results. PNs developed technical skills and understood the requirements for good-quality spirometry. However, many lacked confidence in its interpretation and felt this was not part of their professional role. This was reflected in responses from the GPs. Once COPD was diagnosed, the GPs tended to manage the patients with the PNs less involved. This was in contrast with PNs’ active role in managing patients with other chronic diseases such as diabetes. The extent to which the GPs and PNs worked in partnership to manage COPD varied. Conclusions. PNs improved their skills and confidence in performing spirometry. Beliefs about their professional role, identity and confidence influenced the extent to which PNs were involved in interpretation of the spirometry results and managing the patient in partnership with the GP

A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams : Study Protocol

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of disability, hospitalization, and premature mortality. General practice is well placed to diagnose and manage COPD, but there is a significant gap between evidence and current practice, with a low level of awareness and implementation of clinical practice guidelines. Under-diagnosis of COPD is a world-wide problem, limiting the benefit that could potentially be achieved through early intervention strategies such as smoking cessation, dietary advice, and exercise. General practice is moving towards more structured chronic disease management, and the increasing involvement of practice nurses in delivering chronic care. Design: A pragmatic cluster randomised trial will test the hypothesis that intervention by a practice nurse-general practitioner (GP) team leads to improved health-related quality of life and greater adherence with clinical practice guidelines for patients with newly-diagnosed COPD, compared with usual care. Forty general practices in greater metropolitan Sydney Australia will be recruited to identify patients at risk of COPD and invite them to attend a case finding appointment. Practices will be randomised to deliver either practice nurse-GP partnership care, or usual care, to patients newly-diagnosed with COPD. The active intervention will involve the practice nurse and GP working in partnership with the patient in developing and implementing a care plan involving (as appropriate), smoking cessation, immunisation, pulmonary rehabilitation, medication review, assessment and correction of inhaler technique, nutritional advice, management of psycho-social issues, patient education, and management of co-morbidities. The primary outcome measure is health-related quality of life, assessed with the St George’s Respiratory Questionnaire 12 months after diagnosis. Secondary outcome measures include validated disease-specific and general health related quality of life measures, smoking and immunisation status, medications, inhaler technique, and lung function. Outcomes will be assessed by project officers blinded to patients’ randomization groups. Discussion: This study will use proven case-finding methods to identify patients with undiagnosed COPD in general practice, where improved care has the potential for substantial benefit in health and healthcare utilization. The study provides the capacity to trial a new model of team-based assessment and management of newly diagnosed COPD in Australian primary care

Reviews

The following publications have been reviewed by the authors; Programmes of Study for Design & Technology - Reviewed by Jim PattersonManaging Design & Technology in the National Curriculum - Reviewed by David DickinsonFocus on Technology - Reviewed by Ian McLintockAccommodating Technology in Schools - Reviewed byJ.R. MathiasDesigning and Making - Reviewed by Paul SpencerTreasury of Historic Pattern and Design - Reviewed by Geoff SmithDesign & Technology in Process - Reviewed by Jonty CrockettTechnology Through Home Economics - Reviewed by Rhona HumphriesThe Soft Toy Workshop - Reviewed by Margaret Jeavons02 PAGES (Quarterly) - Reviewed by AIf MerricksAdventures in Technology - Reviewed by John EvansDesigning Starts here - Reviewed by Trevor TaylorTechnology Shaping Our World - Reviewed by Alan TruemanIntroducing Design: Technology Across the Curriculum - Reviewed by Norman CassonThe Tapestry Makers - Reviewed by Goeff SmithWoodcut with Rigby Graham - Reviewed by John Lancaste

Stardust-NExT, Deep Impact, and the Accelerating Spin of 9P/Tempel One

The evolution of the spin rate of comet 9P/Tempel 1 through two perihelion passages (CYs 2000 and 2005) is determined from 1922 Earth-based observations taken over a period of 13y as part of a World-Wide observing campaign and 2888 observations taken over a period of 50d from the Deep Impact spacecraft. We determine the following sidereal spin rates (periods): 209.023 +/- 0.025 degrees /day (41.335 +/- 0.005 h) prior to the 2000 perihelion passage, 210.448 +/- 0.016 degrees/day (41.055 +/- 0.003 h) for the interval between the 2000 and 2005 perihelion passages, 211.856 +/- 0.030 degrees/day (40.783 +/- 0.006 h) from Deep Impact photometry just prior to the 2005 perihelion passage, and 211.625 +/- 0.012 degrees /day (40.827 +/- 0.002 h) in the interval 2006-2010 following the 2005 perihelion passage. The period decreased by 16.8 +/- 0.3 min during the 2000 passage and by 13.7 +/- 0.2 min during the 2005 passage suggesting a secular decrease in the net torque. The change in spin rate is asymmetric with respect to perihelion with the maximum net torque being applied on approach to perihelion. The Deep Impact data alone show that the spin rate was increasing at a rate of 0.024 +/- 0.003 degree/d/d at JD2453530.60510 (i.e., 25.134 d before impact) and provides independent confirmation of the change seen in the Earth-based observations. The rotational phase of the nucleus at times before and after each perihelion and at the Deep Impact encounter is estimated based on the Thomas et al. pole and longitude system. The possibility of a 180 degree error in the rotational phase is assessed and found to be significant. Analytical and physical modeling of the behavior of the spin rate through of each perihelion is presented and used as a basis to predict the rotational state of the nucleus at the time of the nominal (i.e., prior to February 2010) Stardust-NExT encounter on 2011 February 14 20:42. We find that a net torque in the range of 0.3 - 2.5 x 10(exp 7) kg.square m2/square s acts on the nucleus during perihelion passage. The spin rate initially slows down on approach to perihelion and then passes through a minimum. It then accelerates rapidly as it passes through perihelion eventually reaching a maximum post-perihelion. It then decreases to a stable value as the nucleus moves away from the sun. We find that the pole direction is unlikely to precess by more than approximately 1 degree/perihelion passage. The trend of the period with time and the fact that the modeled peak torque that occurs before perihelion is in agreement with published accounts of trends in water production rate and suggests that widespread H2O out-gassing from the surface is largely responsible for the observed spin-up

Seasonal pulses of Marburg virus circulation in juvenile Rousettus aegyptiacus bats coincide with periods of increased risk of human infection

Marburg virus (family Filoviridae) causes sporadic outbreaks of severe hemorrhagic disease in sub-Saharan Africa. Bats have been implicated as likely natural reservoir hosts based most recently on an investigation of cases among miners infected in 2007 at the Kitaka mine, Uganda, which contained a large population of Marburg virus-infected Rousettus aegyptiacus fruit bats. Described here is an ecologic investigation of Python Cave, Uganda, where an American and a Dutch tourist acquired Marburg virus infection in December 2007 and July 2008. More than 40,000 R. aegyptiacus were found in the cave and were the sole bat species present. Between August 2008 and November 2009, 1,622 bats were captured and tested for Marburg virus. Q-RT-PCR analysis of bat liver/spleen tissues indicated ,2.5% of the bats were actively infected, seven of which yielded Marburg virus isolates. Moreover, Q-RT-PCR-positive lung, kidney, colon and reproductive tissues were found, consistent with potential for oral, urine, fecal or sexual transmission. The combined data for R. aegyptiacus tested from Python Cave and Kitaka mine indicate low level horizontal transmission throughout the year. However, Q-RT-PCR data show distinct pulses of virus infection in older juvenile bats (,six months of age) that temporarily coincide with the peak twiceyearly birthing seasons. Retrospective analysis of historical human infections suspected to have been the result of discrete spillover events directly from nature found 83% (54/65) events occurred during these seasonal pulses in virus circulation, perhaps demonstrating periods of increased risk of human infection. The discovery of two tags at Python Cave from bats marked at Kitaka mine, together with the close genetic linkages evident between viruses detected in geographically distant locations, are consistent with R. aegyptiacus bats existing as a large meta-population with associated virus circulation over broad geographic ranges. These findings provide a basis for developing Marburg hemorrhagic fever risk reduction strategies.The Department of Health and Human Serviceshttp://www.plospathogens.or

Father’s Presence and Young Children’s Behavioral and Cognitive Adjustment

The impact of fathers on the development and well-being of their children has been the focus of much recent research and debate (e.g., Furstenberg, 1988; Hawkins & Eggebeen, 1991; Lamb, 1987). Traditionally, fathers have been assumed to play an important role in the socialization of their children and, consequently, father-absence has been hypothesized to result in a variety of cognitive and psychosocial vulnerabilities. The need to understand the influence of fathers becomes especially acute at a time when high rates of divorce and nonmarital childbearing lead to the prediction that the majority of children will experience some period of father-absence (Bumpass, 1984; Bumpass & Sweet, 1989)