Nasal lysine aspirin challenge in the diagnosis of aspirin - exacerbated respiratory disease

Background Aspirin-exacerbated respiratory disease is under-diagnosed and therefore effective and inexpensive therapy with aspirin desensitization is rarely performed. Methods We present an audit of 150 patients with difficult to treat nasal polyposis, 132 of whom also had asthma, 131 of whom underwent challenge with the only soluble form of aspirin, lysine aspirin (LAS), to confirm or exclude the diagnosis of aspirin-exacerbated respiratory disease (AERD). Results One hundred patients proved positive on nasal challenge, 31 who were negative went onto oral LAS challenge and a further 14 gave positive results, leaving 17 who were negative to a dose equivalent to over 375 mg of aspirin. Nineteen were not challenged because of contraindications. With the exception of one patient who developed facial angioedema and two patients with > 20% drop in FEV1 (following nasal plus oral challenge) no other severe adverse events occurred. No hospitalization was required for these three patients. Nasal inspiratory peak flow monitoring was less sensitive to obstruction caused by aspirin than was acoustic rhinometry – which should be employed when aspirin challenge is an outpatient procedure. Conclusions Provided patients are carefully chosen and monitored LAS challenge is suitable for ENT day case practice where respiratory physician help with asthma is available and should reduce the under-diagnosis of this condition

Serviceability of non-prismatic concrete beams: Combined-interaction method

Interest in the shape optimisation of concrete members is increasing alongside the availability of fabric formwork as a relatively simple technique to cast non-prismatic concrete structures. Research has shown that up 40% of concrete can be saved when shape optimised concrete beams are cast in fabric forms. However, optimisation results in members with non-uniform cross-sections and the resulting beam is less stiff than an equivalent strength prismatic beam. Serviceability, rather than strength, may govern the design of such members and therefore understanding the serviceability behaviour (deflection and cracking) of shape optimised concrete members becomes is a critical design consideration. There are many methods which can be used to evaluate serviceability behaviour of reinforced concrete beams, including the full-interaction method, which assumes no slip between the reinforcement and the surrounding concrete, and the partial-interaction method which accounts for slip. The full-interaction method is based on a smeared crack approach and so is unsuited for the prediction of cracking behaviour. The partial-interaction method, on the other hand, assumes that cracks form through bond-stress transfer only. In the case of non-prismatic concrete beams, the cracking capacity varies along the member. Therefore, cracking can occur over extended regions (full and partial bond interaction regions) and so it can be argued that neither of these models is fully suitable for the prediction of deflections and cracking of shape-optimised concrete beams. In this paper, a novel combined-interaction method is, for the first time, presented to predict the serviceability behaviour of non-prismatic concrete beams by simulating both full and partial bond interactions at different cracked and uncracked regions along the length of the member. In order to validate this approach, two non-prismatic simply supported beams were cast and tested. The test results for deflections, crack widths and crack spacings were in good agreement with the predicted results

Impact of a Modified Early Warning Score Tool on Nurses’ Ability to Recognize and Respond to Clinical Deterioration

Timely recognition of signs of impending clinical deterioration in acute care hospitalized patients can prevent an unexpected illness from becoming a fatal event. Failure to recognize the precursors of impending doom can have many factors, but the most influential of these is the role of the bedside nurse in detecting the subtle signs of decline. The Modified Early Warning Score (MEWS) has been used successfully to detect clinical deterioration in hospitalized patients, while simulation has been used successfully to provide an environment to test reaction to acute patient decline without harm to actual patients. A translational research project implemented the MEWS tool through an educational intervention that included simulated patient experiences. The aims of this project were to 1) increase awareness of bedside nurses to acute patient deterioration in the rural hospital setting and 2) increase action of bedside nurses to acute patient deterioration in the rural hospital setting. Results indicate that use of the MEWS increases nurses’ use of other deterioration screening tools as well as their knowledge and confidence in responding to a deterioration event. The usefulness of simulation as a method to provide education in post-licensure nurses is also discussed. Finally, the MEWS tool was shown to accurately predict patient deterioration of hospitalized clients if completed consistently. Future research should focus on how to increase usage of deterioration tools to detect acute clinical decline earlier in the deterioration process

Intranasal lysine-aspirin administration decreases polyp volume in patients with aspirin-intolerant asthma

Introduction: Nasal polyposis associated with aspirin-intolerant asthma tends to be difficult to control, with frequent recurrences. We examined the effect of intranasal lysine-aspirin administration on resistant nasal polyps of asthmatic, aspirin-intolerant patients, when used in addition to routine therapy. Patients and methods: Thirteen patients with asthma and intolerance to aspirin were recruited. All but one had undergone numerous polypectomies and were uncontrolled on standard therapy with intranasal corticosteroids, leukotriene receptor antagonists and nasal douching. Aspirin treatment involved one drop (100 mu l) of 30 mg/ml lysine-aspirin solution to each nostril, initially daily, increased every two or three days up to a maximal of 18 drops (54 mg lysine-aspirin) a day. Nasal symptoms, nitric oxide level, nasal inspiratory peak flow rate, peak expiratory flow rate and nasendoscopic grading were assessed prior to therapy and three months later. We also compared the change in endoscopic polyp scores during three months of lysine-aspirin administration with the changes which had occurred during the three months prior to administration (during which time other therapies had been identical). Results: Nasal blockage symptoms tended to decrease; other nasal symptoms were unchanged. Significant changes were seen in nasal inspiratory peak flow rate (103.3 +/- 18.9 and 140.0 +/- 16.71/min before and after aspirin, respectively; p = 0.014), but not in peak expiratory flow rate (438.7 +/- 33.4 and 440.0 +/- 28.4 1/min before and after aspirin, respectively; p = 0.700). Nasal nitric oxide levels rose significantly (in both sides, p = 0.028). Expired chest nitric oxide levels did not change. Nasal polyp scores on nasendoscopic examination were significantly reduced (right side, p = 0.027; left side, p = 0.018). Compared with the preceding three months, adding intranasal lysine-aspirin application had the effect on decreasing nasal polyp volume (right side, p = 0.031; left side, p = 0.016). Conclusion: This open study suggests that intranasal lysine-aspirin administration reduces nasal polyp volume in aspirin-intolerant patients, without any adverse affect on concomitant asthma. This was a preliminary study and should be followed by a placebo-controlled, double-blind trial

Multiplicity counting using organic scintillators to distinguish neutron sources: An advanced teaching laboratory

In this advanced instructional laboratory, students explore complex detection systems and nondestructive assay techniques used in the field of nuclear physics. After setting up and calibrating a neutron detection system, students carry out timing and energy deposition analyses of radiation signals. Through the timing of prompt fission neutron signals, multiplicity counting is used to carry out a special nuclear material (SNM) nondestructive assay. Our experimental setup is comprised of eight trans-stilbene organic scintillation detectors in a well-counter configuration, and measurements are taken on a spontaneous fission source as well as two ({\alpha},n) sources. By comparing each source's measured multiplicity distribution, the resulting measurements of the ({\alpha},n) sources can be distinguished from that of the spontaneous fission source. Such comparisons prevent the spoofing, i.e., intentional imitation, of a fission source by an ({\alpha},n) neutron source. This instructional laboratory is designed for nuclear engineering and physics students interested in organic scintillators, neutron sources, and nonproliferation radiation measurement techniques.Comment: 29 pages, 17 figures, pre-proof accepted to AJP, AJP number AJP22-AR-01524R2 (DOI: 10.1119/5.0139531

Discrete Particle Swarm Optimization for the minimum labelling Steiner tree problem

Particle Swarm Optimization is an evolutionary method inspired by the social behaviour of individuals inside swarms in nature. Solutions of the problem are modelled as members of the swarm which fly in the solution space. The evolution is obtained from the continuous movement of the particles that constitute the swarm submitted to the effect of the inertia and the attraction of the members who lead the swarm. This work focuses on a recent Discrete Particle Swarm Optimization for combinatorial optimization, called Jumping Particle Swarm Optimization. Its effectiveness is illustrated on the minimum labelling Steiner tree problem: given an undirected labelled connected graph, the aim is to find a spanning tree covering a given subset of nodes, whose edges have the smallest number of distinct labels

Prevalence of hyperventilation syndrome in an allergy clinic, compared with a routine ENT clinic

Objectives: A high prevalence of chronic hyperventilation syndrome in patients with asthma has been reported. We examined whether this phenomenon extended to allergy clinic patients in general and whether the prevalence was higher in patients attending a general allergy clinic compared with those attending a routine ENT clinic in our hospital.Methods: We examined the prevalence of hyperventilation syndrome in unselected, consecutive patients (n = 100) seen in an allergy clinic. The validated Nijmegen questionnaire was completed by patients in the waiting room. We also administered the questionnaire to unselected, consecutive patients (n = 100) in a routine ENT clinic.Results: There was no significant difference in prevalence of hyperventilation between allergy clinic and routine ENT clinic patients (25/100 vs 23/100).Conclusion: The result indicates a high prevalence of hyperventilation amongst hospital attendees in general. Consideration should perhaps be given to the possible role of hyperventilation in symptomatology

Properties of purified enzymes induced by pathogenic drug-resistant mutants of herpes simplex virus. Evidence for virus variants expressing normal DNA polymerase and altered thymidine kinase

The DNA polymerases and thymidine kinases induced by three drug-resistant mutants of herpes simplex virus type 1 (S1, Tr7, and B3) and their common parent strain, SC16, have been purified and their properties compared. No significant differences were seen in the affinities of the polymerases for TTP and dGTP, or for the triphosphates of 9-(2-hydroxyethyloxymethyl)guanine (acyclovir) or (E)-5-(2-bromovinyl)-2'-deoxyuridine (BVdU) (drugs used in their isolation). In contrast all three mutants induced abnormal thymidine kinases. Those induced by the acyclovir-resistant mutants, S1 and Tr7, showed reduced affinities for thymidine, acyclovir, and also BVdU. Thymidine kinase induced by the BVdU-resistant mutant B3 showed reduced affinity for BVdU, but its affinities for thymidine and acyclovir were similar to those of the wild type enzyme. Thus, it appears that these variants of herpes simplex virus express altered thymidine kinases with impaired ability to phosphorylate particular nucleoside analogue drugs and these characteristics probably account for the drug resistance of the viruses. This strategy for resistance is important as it may result in variants with undiminished pathogenicity