Telehealth in COPD: the GP Perspective

Objectives: There is increasing interest in using assistive technologies in the management of chronic diseases.  We aim to establish the views of the UK GPs on the use of telehealth in the management of COPD. Methods: A randomly selected group of GPs in England were invited to complete an online questionnaire.  GPs were asked to rate their response on a 5-point Likert scale and to provide free-text comments with each question.   Free text comments were analysed thematically. Results: 100/264 (38%) of GPs returned completed questionnaires.  GPs were concerned about the cost effectiveness of telehealth, the potential of increasing their workload and poor communication with telehealth service providers. Conclusion: A better engagement of GPs is needed in order to integrate telehealth interventions successfully in primary care settings

An audit of COPD: Diagnosis and management in general practice

Introduction: COPD is a spectrum of disorders primarily caused by smoking and characterised by progressive, not fully reversible airflow obstruction with a forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <0.7. Methods: From November 2016 to March 2017 we audited patients with COPD in five general practices in Hull and East Riding, UK. We looked at deviation from the locally agreed guidelines. We extracted data on severity, exacerbations, medication and eosinophil count. Results: We assessed 1088 records. Median age was 70.9 years; 577 (53%) were male. About two-thirds of patients on the COPD register have an FEV1/FVC ratio in the diagnostic range for COPD, however, 388 (36%) out of 1088 had a ratio of ⩾0.7. In the patients with a ratio of ⩾0.7, 259 (67%) out of 388 had an FEV1 <80% of predicted. Patients with frequent exacerbations were more likely to be prescribed inhaled corticosteroid (ICS)-containing inhalers (incidence rate ratio of 2). FEV1 % predicted was a poor indicator of exacerbation frequency; however, the presence of elevated blood eosinophil counts (EOS) on at least two occasions was highly predictive of exacerbations. When ICSs, FEV1, EOS were examined in combination, they were highly significant predictors for exacerbations. Conclusion: FEV1 maybe a more accurate diagnostic parameter in primary care. Historical evidence of blood eosinophilia is a better predictor than FEV1. The combination of biomarkers may prove more accurate indicator of future exacerbation frequency, leading to targeted intervention

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

In situ diesel desulfurization in divided-cell trickle bed electrochemical reactor

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] Crude oil contains natural organic components such as organosulfur compounds, and these compounds largely remain in refined petroleum products such as gasoline, diesel and jet fuel products. During fuel combustion, sulfur was emitted as sulfur dioxide or sulfate, which is one of the main causes of air pollution and acid rain. The oil price is inversely proportional to the sulfur content because upgrade of heavy, high-sulfur-containing oil is much more difficult than the light feeds. Many regulations have been established by different countries to control sulfur level in fuels; in the U.S. the maximum required concentration is 15 ppm (parts per million) sulfur in diesel. The most commonly used technology to remove sulfur from diesel fuel is hydrodesulfurization (HDS). The major drawback of HDS is the harsh operating conditions that require high temperatures and pressures with consumption of a large amount of hydrogen. The HDS process is only able to reduce sulfur content to about 500 ppm in diesel. Further reduction requires more intense processing with a significant increase in hydrogen usage, particularly in removing the refractory sulfur compounds, such as benzothiophene (BT), dibenzothiophene (DBT), and their alkyl derivatives. In this dissertation, an efficient and cost-effective process for oxidation of organosulfur compounds (OSCs) in diesel has been developed and investigated. A divided-cell trickle bed electrochemical reactor (TBER) was first developed to produce hydrogen peroxide. The divided-cell trickle bed electrochemical reactor (TBER) has a porous cathode composed of carbon black and polytetrafluoroethylene. It was designed and fabricated to have hydrophobic and hydrophilic components for liquid and gas flows. Hydrogen peroxide generation was successfully demonstrated from reducing oxygen in concentrated alkaline electrolyte solutions. An important feature of the reactor was a cathode made with stainless steel meshes that divide it into four packed-bed cells. This division into sectional cathode resulted in a concentration of hydrogen peroxide that more than doubles that produced in an undivided cathode. The much-improved performance was attributed to the even distribution of the electrolyte and oxygen in the cathode bed, as well as an effective mass transport of oxygen from the gas phase to the electrolyte-cathode interface. After the successful production of hydrogen peroxide, the TBER was employed for in situ oxidation desulfurization of diesel fuel. The possibility of diesel desulfurization with in situ generated hydrogen peroxide in the presence of DBT was systematically investigated. The maximum concentration of hydrogen peroxide after two-hour electrolysis was 31.79 mM without diesel, whereas in the presence of 10% diesel (by volume) in the electrolyte was 18.0 mM. DBT was successfully oxidized in situ in the TBER, with conversion efficiency of 97.75% in six hours. To further improve the efficiency of the hydrogen peroxide production, cathode was modified with MnO2, a potentially more active catalyst for hydrogen peroxide production in alkaline electrolytes. It was found that incorporation of MnO2 indeed promoted in situ oxidation of DBT which was attributed to more hydrogen peroxide produced. The results showed the in situ oxidation process in the divided-cell TBER is a promising and environmentally friendly approach for desulfurization of diesel.Includes bibliographical reference

The value of telehealth in the early detection of chronic obstructive pulmonary disease exacerbations: A prospective observational study

© 2014 The Author(s). We aim to establish the value of telemonitoring in the early detection of chronic obstructive pulmonary disease exacerbations. We followed up patients undergoing chronic obstructive pulmonary disease telemonitoring for 4 months. We studied changes in the telemonitored data in the week prior to admission or to community chronic obstructive pulmonary disease exacerbation. A total of 183 patients were studied. In all, 30 chronic obstructive pulmonary disease-related hospital admissions and 68 chronic obstructive pulmonary disease community exacerbations were recorded. Changes in telehealth parameters occurred in 80 per cent (24/30) of admissions and 82 per cent (56/68) of community exacerbations. Although changes in telehealth data occurred in the majority of exacerbations, most individual symptoms was present in less than half the exacerbations and almost 20 per cent of exacerbations were not preceded by any change in telemonitoring data. Cough created significantly more alerts by those treated in the community (p = 0.008), whereas a drop in oxygen saturation created significantly more alerts pre-hospitalisation (p = 0.049). We conclude that further work is required to develop methods of identifying impending chronic obstructive pulmonary disease exacerbations with greater sensitivity and specificity

The value of telehealth in the early detection of chronic obstructive pulmonary disease exacerbations: A prospective observational study

© 2014 The Author(s). We aim to establish the value of telemonitoring in the early detection of chronic obstructive pulmonary disease exacerbations. We followed up patients undergoing chronic obstructive pulmonary disease telemonitoring for 4 months. We studied changes in the telemonitored data in the week prior to admission or to community chronic obstructive pulmonary disease exacerbation. A total of 183 patients were studied. In all, 30 chronic obstructive pulmonary disease-related hospital admissions and 68 chronic obstructive pulmonary disease community exacerbations were recorded. Changes in telehealth parameters occurred in 80 per cent (24/30) of admissions and 82 per cent (56/68) of community exacerbations. Although changes in telehealth data occurred in the majority of exacerbations, most individual symptoms was present in less than half the exacerbations and almost 20 per cent of exacerbations were not preceded by any change in telemonitoring data. Cough created significantly more alerts by those treated in the community (p = 0.008), whereas a drop in oxygen saturation created significantly more alerts pre-hospitalisation (p = 0.049). We conclude that further work is required to develop methods of identifying impending chronic obstructive pulmonary disease exacerbations with greater sensitivity and specificity

Assessment of external and internal geogrid confinement of reinforced concrete columns

Geogrid is a geosynthetic material commonly used for soil stability purposes in road embankments and reinforced earth walls due to its tensile reinforcing capability. Recent research has shown the efficiency of Geogrid as an internal reinforced concrete column confinement that increases significantly the ductility, but slightly decreases the axial compressive strength of the column. The study reported in this paper investigated the feasibility of using geogrids as external column confinement. It was important to compare external geogrid confinement with internal geogrid confinement on one hand and with bitumen coated E-glass textile sheets on the other. A total of 22 small-scale reinforced concrete (RC) column specimens were tested under uniaxial compression. Each specimen had a 240 mm diameter, 500 mm length, and was reinforced with four 10 mm longitudinal bars confined with three 6 mm ties spaced at 200 mm. The test variables were the confinement material (Geogrid, or Bitumen coated E-glass textile), type of geogrid (uniaxial or biaxial), number of confinement layers (one or two), and confinement location (internal or external). Assessment of the variables was done by analyzing the axial load-displacement behavior, the modes of failure, and the structural ductility measured by fracture energy and energy dissipation. Available analytical models for FRP confined specimens were modified to be applicable to the tested geogrid and bitumen textile confined specimens. A performance-to-cost analysis was also conducted. Results showed that external confinement of reinforced concrete columns using geogrid significantly enhanced the strength, ductility, and energy capacity of the tested specimens