What effect do inhaled steroids have on delaying the progression of COPD?

The annual rate of decline in forced expiratory volume for 1 second (FEV1) has been researchers' gold standard as an objective measure for progression of chronic obstructive pulmonary disease (COPD). Inhaled corticosteroids (ICS) do not consistently have a statistically significant impact on FEV1 decline, and thus on the progression of COPD (strength of recommendation [SOR]: B, 2 conflicting meta-analyses and numerous conflicting randomized controlled trials). In those studies that did show improvements in FEV1 decline, the change does not appear to be clinically significant (7.7 to 9.0 mL/year). These findings do not take into account the potential impact of ICS on such patient oriented outcomes as exacerbation rates, quality of life, outpatient visits, hospitalization, and mortality

Ursodeoxycholic acid improves bilirubin but not albumin in primary biliary cirrhosis: further evidence for nonefficacy.

BACKGROUND/AIM: In randomised controlled trials (RCTs) of ursodeoxycholic acid (UDCA), although serum bilirubin is frequently reduced, its effect on disease progression and mortality is unclear. As serum albumin is an established independent prognostic marker, one might expect less deterioration of serum albumin values in a UDCA-treated group. We therefore modelled the typical evolution of serum bilirubin and albumin levels over time in UDCA-untreated patients and compared it with the observed levels in UDCA RCTs. METHODS: Multilevel modelling was used to relate the evolution of serum albumin to serum bilirubin and time since patient referral. For each considered RCT, the derived model was used to predict the relationship between final mean serum albumin and bilirubin concentration, adjusted for mean serum albumin at referral and followup duration. RESULTS: Five RCTs were eligible in terms of available data, of which two had long followup. In all trials, serum albumin did not significantly differ between UDCA- and placebo-treated patients, despite the UDCA effect on serum bilirubin. Therefore, there is no evidence over time for changes or maintenance of albumin levels for UDCA-treated patients above the levels predicted for placebo-treated patients. CONCLUSIONS: Our findings suggest that UDCA does not alter serum albumin in a way that is consistent with its effect on serum bilirubin. Therefore, reductions in serum bilirubin of UDCA-treated PBC do not parallel another validated and independent prognostic marker, further questioning the validity of serum bilirubin reduction with UDCA as a surrogate therapeutic marker

Three Factors Leading to the Failure of Communications in Emergency Situations

The failure of communications, particularly related to interoperability, between police and firefighters responding to dangerous situations has resulted in death or injury to themselves or those they strive to protect. Using Grebner\u27s and Shannon and Weaver\u27s conceptualizations of communications theory as the foundation, the purpose of this general qualitative study was to evaluate, from the perspective of first responders, what barriers exist that may impede opportunities for interoperability of communications systems. Data were collected through semi-structured interviews with a purposive sample of 18 experienced first responders from the states of California, New York, and Texas. Interview data were deductively coded and subjected to a thematic analysis procedure. Key findings indicated that participants perceived differences in technology among agencies as a primary source of frustration and impediment to full interoperability. Further, participants identified policy barriers, a lack of inter-agency training opportunities, and budgetary constraints as frustrating the efforts toward interoperability. The positive social change implications of this study include recommendations to policy makers and first responder agency leadership to support policy change, including appropriations, that encourage increased interoperability among first responder agencies to foster a more expeditious response to large scale emergencies

An approach to directing America hurrah by Jean-Claude van Itallie

The purpose of this thesis was to study the script, develop an approach to the play, produce the play, and evaluate the production of Jean-Claude van Itallie’s America Hurrah. The preliminary part includes the following: (1) historical and stylistic analyses of the play, (2) character descriptions and analyses, (3) a discussion of the function and mood of the set, and (4) justification for the director's choice of the script for production. The second part includes the director's prompt book of the production, performed on April 10, 11, and 12, 1970, in Taylor Theatre at the University of North Carolina at Greensboro. Types of notations included are: (1) movement, composition and picturization, (2) rhythm and tempo notes, and stage business, and (3) sound notes. Floor plans and production photographs implement this record. Part III contains the director's critical evaluation of his work with the production. Discussed in this chapter are: (1) goals and aims of interpretation, style, and mood, (2) actor-director relationships during the rehearsal period, and (3) audience reaction to the production

Evidence of reproductive endocrine effects in women with occupational fuel and solvent exposures.

Hydrocarbons (HCs) found in fuels and solvents are ubiquitous in the environment, yet we know little about their effects on the endocrine system. The objective of this study was to assess the potential reproductive endocrine effects of low-dose HCs encountered by female U.S. Air Force personnel with fuel (primarily JP-8 jet fuel) and solvent exposures (n = 63). We estimated the internal dose of HCs in fuels and solvents by measuring their levels in exhaled breath, including the sum of aliphatic HCs (C6H14-C16H34) and the sum of aromatic HCs (benzene, ethylbenzene, toluene, and m,p,o-xylenes). Adverse outcome measures included urinary endocrine markers that have been associated with nonconceptive (vs. conceptive) menstrual cycles in ovulatory women: lower preovulatory luteinizing hormone (LH) and mid-luteal phase pregnanediol 3-glucuronide (Pd3G) and estrone 3-glucuronide, and higher follicle phase Pd3G. We also obtained reproductive and exposure information from baseline questionnaires and daily diaries. Toluene was the most frequently found analyte in the breath, with values up to 52.0 ppb, and benzene breath levels were up to 97.5 ppb. Regression analysis revealed that preovulatory LH levels were significantly lower (p = 0.007) among women whose total aliphatic HC levels were above the median. The relationship between elevated aliphatic HC exposure and lowered preovulatory LH levels in the present study suggests that compounds in fuels and some solvents may act as reproductive endocrine disruptors. Confirmation of these findings is needed, not only to determine if fuel and solvent exposure may impact other LH-dependent physiologic functions but also to examine effects of fuels and solvents on conception

Synthesis of 2,6-trans- and 3,3,6-Trisubstituted Tetrahydropyran-4-ones from Maitland-Japp Derived 2H-Dihydropyran-4-ones: A Total Synthesis of Diospongin B

6-Substituted-2H-dihydropyran-4-one products of the Maitland-Japp reaction have been converted into tetrahydropyrans containing uncommon substitution patterns. Treatment of 6-substituted-2H-dihydropyran-4-ones with carbon nucleophiles led to the formation of tetrahydropyran rings with the 2,6-trans-stereochemical arrangement. Reaction of the same 6-substituted-2H-dihydropyran-4-ones with l-Selectride led to the formation of 3,6-disubstituted tetrahydropyran rings, while trapping of the intermediate enolate with carbon electrophiles in turn led to the formation 3,3,6-trisubstituted tetrahydropyran rings. The relative stereochemical configuration of the new substituents was controlled by the stereoelectronic preference for pseudo-axial addition of the nucleophile and trapping of the enolate from the opposite face. Application of these methods led to a synthesis of the potent anti-osteoporotic diarylheptanoid natural product diospongin B

Bostonia. Volume 4

Founded in 1900, Bostonia magazine is Boston University's main alumni publication, which covers alumni and student life, as well as university activities, events, and programs

Assessing the Validity of Several Heart Rate Monitors in Wearable Technology While Mountain Biking

International Journal of Exercise Science 16(7): 1440-1450, 2023. Purpose: This study sought to assess the validity of several heart rate (HR) monitors in wearable technology during mountain biking (MTB), compared to the Polar H7® HR monitor, used as the criterion device. Methods: A total of 20 participants completed two MTB trials while wearing six HR monitors (5 test devices, 1 criterion). HR was recorded on a second-by-second basis for all devices analyzed. After data processing, validity measures were calculated, including 1. error analysis: mean absolute percentage errors (MAPE), mean absolute error (MAE), and mean error (ME), and 2. Correlation analysis: Lin’s concordance correlation coefficient (CCC) and Pearson’s correlation coefficient (r). Thresholds for validity were set at MAPE \u3c 10% and CCC \u3e 0.7. Results: The only device that was found to be valid during mountain biking was the Suunto Spartan Sport watch with accompanying HR monitor, with a MAPE of 0.66% and a CCC of 0.99 for the overall, combined data. Conclusion: If a person would like to track their HR during mountain biking, for pacing, training, or other reasons, the devices best able to produce valid results are chest-based, wireless electrocardiogram (ECG) monitors, secured by elastic straps to minimize the movement of the device, such as the Suunto chest-based HR monitor