Prevalence of airflow limitation in outpatients with cardiovascular diseases in Japan.

Background and objectives: Cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) commonly coexist and share common risk factors. The prevalence of COPD in outpatients with a smoking history and CVD in Japan is unknown. The aim of this study was to determine the proportion of Japanese patients with a smoking history being treated for CVD who have concurrent airflow limitation compatible with COPD. A secondary objective was to test whether the usage of lung function tests performed in the clinic influenced the diagnosis rate of COPD in the patients identified with airflow limitation. Methods: In a multicenter observational prospective study conducted at 17 centers across Japan, the prevalence of airflow limitation compatible with COPD (defined as forced expiratory volume (FEV)1/FEV6 <0.73, by handheld spirometry) was investigated in cardiac outpatients ≥40 years old with a smoking history who routinely visited the clinic for their CVD. Each patient completed the COPD Assessment Test prior to spirometry testing. Results: Data were available for 995 patients with a mean age of 66.6±10.0 years, of whom 95.5% were male. The prevalence of airflow limitation compatible with COPD was 27.0% (n=269), and 87.7% of those patients (n=236) did not have a prior diagnosis of COPD. The prevalence of previously diagnosed airflow limitation was higher in sites with higher usage of lung function testing (14.0%, 15.2% respectively) compared against sites where it is performed seldom (11.1%), but was still low. Conclusion: The prevalence of airflow limitation in this study indicates that a quarter of outpatients with CVD have COPD, almost all of whom are undiagnosed. This suggests that it is important to look routinely for COPD in CVD outpatients

Characterization of FhuA 104/149C: a Double Cysteine FhuA Mutant with Normal Binding and Diminished Transport

Iron is an essential element for most bacteria and is commonly acquired by siderophores, molecules secreted under iron restricted environment to bind ferric iron. Gram negative cells actively uptake these complexes via outer membrane-transport proteins such as FhuA in Escherichia coli. Structural analysis of receptors revealed a conserved β-barrel occluded by an N-terminal plug domain. The cell membrane TonB/ExbB/ExbD complex presumably supplies energy via interaction between the FhuA N-terminal TonB box and the C-terminal domain of TonB. In order to better understand the mechanism of action the FhuA mutant 104/149C, tethering the central β-strands 4 and 6 of the plug domain, was studied and showed severely reduced transport of radio-labeled ferrichrome. In the course of this study, this protein was HPLC purified for structural studies by crystallization and X-ray diffraction. In addition, protein interaction studies were performed with purified TonB-C terminal revealing no impact of the mutation on FhuA-TonB interactions

The relationship between the COPD Assessment Test score and airflow limitation in Japan in patients aged over 40 years with a smoking history.

BACKGROUND: A large number of chronic obstructive pulmonary disease (COPD) patients in Japan remain undiagnosed, primarily due to the underuse of spirometry. Two studies were conducted to see whether the COPD Assessment Test (CAT) in primary care has the potential to identify those patients who need spirometry for a diagnosis of COPD and to determine whether patients with cardiovascular disease had airflow limitation, which could be detected by CAT. MATERIALS AND METHODS: Two multicenter, noninterventional, prospective studies (studies 1 and 2) were conducted across Japan. Patients in both studies were ≥40 years old with a smoking history. Those in study 1 were seen in primary care and had experienced repeated respiratory tract infections, but had no diagnosis of COPD. Patients in study 2 were identified in cardiovascular disease clinics when routinely visiting for their cardiovascular disease. All patients completed the CAT prior to lung-function testing by hand-held spirometry. The presence of airflow limitation was defined as a forced expiratory volume in 1 second (FEV1)/FEV6 ratio<0.73. RESULTS: A total of 3,062 subjects completed the CAT (2,067 in study 1, 995 in study 2); 88.8% were male, and the mean age (±standard deviation) was 61.5±11.6 years. Airflow limitation was found in 400 (19.4%) patients in study 1, and 269 (27.0%) in study 2. The CAT score in patients with airflow limitation was significantly higher than in patients without airflow limitation in both studies: 8.6 (95% confidence interval [CI] 7.9-9.2) versus 7.4 (95% CI 7.1-7.6) in study 1, and 8.3 (95% CI 7.5-9.2) versus 6.4 (95% CI 6.0-6.8) in study 2 (both P<0.001). CONCLUSION: These findings suggest that the CAT has the potential to identify patients with cardiovascular disease or a history of frequent chest infections who need spirometry to diagnose COPD

Prolonging assembly through dissociation:A self assembly paradigm in microtubules

We study a one-dimensional model of microtubule assembly/disassembly in which GTP bound to tubulins within the microtubule undergoes stochastic hydrolysis. In contrast to models that only consider a cap of GTP-bound tubulin, stochastic hydrolysis allows GTP-bound tubulin remnants to exist within the microtubule. We find that these buried GTP remnants enable an alternative mechanism of recovery from shrinkage, and enhances fluctuations of filament lengths. Under conditions for which this alternative mechanism dominates, an increasing depolymerization rate leads to a decrease in dissociation rate and thus a net increase in assembly.Comment: accepted for publication in Physical Review

Progress through partnership: Providing Holistic Services VIA SERVICE LEARNING to Benefit Students, the University and the Community

poster abstractIn 2012, the presenters developed a new service learning opportunity through an interdisciplinary partnership between the schools of Law and Social Work. The purpose of the project was to enhance the joint JD/MSW program, as well as the experiences of JD and MSW students respectively. The presenters redesigned a Civil Practice Clinic, which had formerly involved only law students, to now pair law students and social work students in order to serve the holistic needs of clients. Referrals for the clinic are obtained through a variety of partner referrals. All of the clinic’s clients do not have the resources to retain legal counsel or services by other means. The law students address the clients’ legal issues and the social work students ensure the clients are connected with appropriate social services, such as domestic violence counseling and social welfare benefits. The teamwork between students increases law students’ aptitude in client-centered lawyering, and familiarizes social work students with the legal rights and resources available to clients. The presenters have adapted pedagogies of engagement, most notably through problem-based and peer-led interdisciplinary team teaching and learning. Students more effectively and efficiently serve community members in need of legal counsel and social services, resulting in a clinic that is beneficial for both students and community members. The partnership resulted after years of witnessing law students struggle with interpersonal skills how to handle client emotions (and a perceived inability to help connect to services) while social work students struggled with an awareness of the law, litigation process/strategy and the roles/responsibilities involved in legal case management. Key to this partnership was not only the development of the interdisciplinary model and structure, but also assessing both disciplines and the success of the pairings. Quantitative data is gathered through an interpersonal skills survey pretest and posttest research design, and qualitative data is gathered through a survey of open ended questions. All students were given the same questions, and responses were anonymous, with surveys administered by a third party. Using the generated responses, the presenters reformat the course each semester based upon feedback, as well as promote the use of this sort of model to other institutions and at various conferences. Other interdisciplinary partnerships are also explored based on student feedback, client and clinic needs. The initial surveys focused on a main goal of increasing law students’ interpersonal skills – as far too often law students’ focus is on the legal tasks and not the human components of interactions with clients. Data analysis found a statistically significant improvement in law students’ interpersonal skills, and level of comfort in dealing with clients in emotional situation. The second round of surveys have been submitted to both disciplines and hope to show two increases: 1) that the law students’ interpersonal skills maintain improvement; and 2) that social work students have a better understanding of the law and legal processes via their participation in the interdisciplinary clinic

Social Work and Law: The Educational Benefits of Collaboration

poster abstractLow income clients seeking civil legal services are rarely in need of only legal assistance. Instead, the issues that drove them to seek an attorney typically overlap into multiple mental health and social service needs. The poster will explain how a newly piloted clinical partnership between the School of Social Work and the School of Law improved the educational outcomes of students, and also enhanced the services offered to clients. The clinic historically served the legal needs of low income clients in Indianapolis. In 2012, an interdisciplinary collaboration involving law and social work students and faculty from both fields was implemented in order to provide holistic services to clients. The poster will describe the model, including how the clinic is structured and the roles for students and faculty. Preliminary data on the educational benefits for both law and social work students will be provided. The clinic has been found to address both student learning needs and the needs of clients in the local community

A study to assess COPD Symptom-based Management and to Optimise treatment Strategy in Japan (COSMOS-J) based on GOLD 2011

Background and objective: The Global initiative for chronic Obstructive Lung Disease(GOLD) Committee has proposed a chronic obstructive pulmonary disease (COPD) assessment framework focused on symptoms and on exacerbation risk. This study will evaluate a symptom and exacerbation risk-based treatment strategy based on GOLD in a real-world setting in Japan. Optimal management of COPD will be determined by assessing symptoms using the COPD Assessment Test (CAT) and by assessing the frequency of exacerbations. Methods: This study (ClinicalTrials.gov identifier: NCT01762800) is a 24-week, multicenter, randomized, double-blind, double-dummy, parallel-group study. It aims to recruit 400 patients with moderate-to-severe COPD. Patients will be randomized to receive treatment with either salmeterol/fluticasone propionate (SFC) 50/250μg twice daily or with tiotropium bromide 18μg once daily. Optimal management of patients will be assessed at four-weekly intervals and, if patients remain symptomatic, as measured using the CAT, or experience an exacerbation, they have the option to step up to treatment with both drugs, ie, SFC twice daily and tiotropium once daily (TRIPLE therapy). The primary endpoint of the study will be the proportion of patients who are able to remain on the randomized therapy. Results: No data are available. This paper summarizes the methodology of the study in advance of the study starting. Conclusion: The results of this study will help physicians to understand whether TRIPLE therapy is more effective than either treatment strategy alone in controlling symptoms and exacerbations in patients with moderate-to-severe COPD. It will also help physicians to understand the GOLD recommendation work in Japan

Defect-mediated turbulence in systems with local deterministic chaos

We show that defect-mediated turbulence can exist in media where the underlying local dynamics is deterministically chaotic. While many of the characteristics of defect-mediated turbulence, such as the exponential decay of correlations and a squared Poissonian distribution for the number of defects, are identical to those seen in oscillatory media, the fluctuations in the number of defects differ significantly. The power spectra suggest the existence of underlying correlations that lead to a different and non-universal scaling structure in chaotic media.Comment: 4 pages, 5 figure