Can HRCT be used as a marker of airway remodelling in children with difficult asthma?

BACKGROUND: Whole airway wall thickening on high resolution computed tomography (HRCT) is reported to parallel thickening of the bronchial epithelial reticular basement membrane (RBM) in adult asthmatics. A similar relationship in children with difficult asthma (DA), in whom RBM thickening is a known feature, may allow the use of HRCT as a non-invasive marker of airway remodelling. We evaluated this relationship in children with DA. METHODS: 27 children (median age 10.5 [range 4.1-16.7] years) with DA, underwent endobronchial biopsy from the right lower lobe and HRCT less than 4 months apart. HRCTs were assessed for bronchial wall thickening (BWT) of the right lower lobe using semi-quantitative and quantitative scoring techniques. The semi-quantitative score (grade 0-4) was an overall assessment of BWT of all clearly identifiable airways in HRCT scans. The quantitative score (BWT %; defined as [airway outer diameter - airway lumen diameter]/airway outer diameter x100) was the average score of all airways visible and calculated using electronic endpoint callipers. RBM thickness in endobronchial biopsies was measured using image analysis. 23/27 subjects performed spirometry and the relationships between RBM thickness and BWT with airflow obstruction evaluated. RESULTS: Median RBM thickness in endobronchial biopsies was 6.7(range 4.6-10.0) microm. Median qualitative score for BWT of the right lower lobe was 1(range 0-1.5) and quantitative score was 54.3 (range 48.2-65.6)%. There was no relationship between RBM thickness and BWT in the right lower lobe using either scoring technique. No relationship was found between FEV1 and BWT or RBM thickness. CONCLUSION: Although a relationship between RBM thickness and BWT on HRCT has been found in adults with asthma, this relationship does not appear to hold true in children with D

'This is what democracy looks like' : New Labour's blind spot and peripheral vision

New Labour in government since 1997 has been roundly criticized for not possessing a clear, coherent and consistent democratic vision. The absence of such a grand vision has resulted, from this critical perspective, in an absence of 'joined-up' thinking about democracy in an evolving multi-level state. Tensions have been all too apparent between the government's desire to exert central direction - manifested in its most pathological form as 'control freakery' - and its democratising initiatives derived from 'third-way' obsessions with 'decentralising', 'empowering' and 'enabling'. The purpose of this article is to examine why New Labour displayed such apparently impaired democratic vision and why it appeared incapable of conceiving of democratic reform 'in the round'. This article seeks to explain these apparent paradoxes, however, through utilising the notion of 'macular degeneration'. In this analysis, the perceived democratic blind spot of New Labour at Westminster is connected to a democratic peripheral vision, which has envisaged innovative participatory and decentred initiatives in governance beyond Westminster

Aerobic exercise alone results in clinically significant weight loss for men and women: Midwest Exercise Trial-2

This is the peer reviewed version of the following article: Donnelly, J. E., Honas, J. J., Smith, B. K., Mayo, M. S., Gibson, C. A., Sullivan, D. K., Lee, J., Herrmann, S. D., Lambourne, K. and Washburn, R. A. (2013), Aerobic exercise alone results in clinically significant weight loss for men and women: Midwest exercise trial 2. Obesity, 21: E219–E228. doi:10.1002/oby.20145, which has been published in final form at http://doi.org/10.1002/oby.20145. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Exercise is recommended by public health agencies for weight management; however, the role of exercise is generally considered secondary to energy restriction. Few studies exist that have verified completion of exercise, measured the energy expenditure of exercise, and prescribed exercise with equivalent energy expenditure across individuals and genders. OBJECTIVE The objective of this study was to evaluate aerobic exercise, without energy restriction, on weight loss in sedentary overweight and obese men and women. DESIGN AND METHODS This investigation was a randomized, controlled, efficacy trial in 141 overweight and obese participants (body mass index, 31.0 ± 4.6 kg/m2; age 22.6 ± 3.9 years). Participants were randomized (2:2:1 ratio) to exercise at either 400 kcal/session or 600 kcal/session or to a non-exercise control. Exercise was supervised, 5 days/week, for 10 months. All participants were instructed to maintain usual ad libitum diets. Due to the efficacy design, completion of ≥ 90% of exercise sessions was an a priori definition of per protocol, and these participants were included in the analysis. RESULTS Weight loss from baseline to 10 months for the 400 and 600 kcal/session groups was 3.9 ± 4.9kg (4.3%) and 5.2 ± 5.6kg (5.7%), respectively compared to weight gain for controls of 0.5 ± 3.5kg (0.5%) (p<0.05). Differences for weight loss from baseline to 10 months between the exercise groups and differences between men and women within groups were not statistically significant. CONCLUSIONS Supervised exercise, with equivalent energy expenditure, results in clinically significant weight loss with no significant difference between men and women

Nearby Supernova Factory Observations of SN 2007if: First Total Mass Measurement of a Super-Chandrasekhar-Mass Progenitor

We present photometric and spectroscopic observations of SN 2007if, an overluminous (M_V = -20.4), red (B-V = 0.16 at B-band maximum), slow-rising (t_rise = 24 days) type Ia supernova in a very faint (M_g = -14.10) host galaxy. A spectrum at 5 days past B-band maximum light is a direct match to the super-Chandrasekhar-mass candidate SN Ia 2003fg, showing Si II and C II at ~9000 km/s. A high signal-to-noise co-addition of the SN spectral time series reveals no Na I D absorption, suggesting negligible reddening in the host galaxy, and the late-time color evolution has the same slope as the Lira relation for normal SNe Ia. The ejecta appear to be well mixed, with no strong maximum in I-band and a diversity of iron-peak lines appearing in near-maximum-light spectra. SN2007 if also displays a plateau in the Si II velocity extending as late as +10 days, which we interpret as evidence for an overdense shell in the SN ejecta. We calculate the bolometric light curve of the SN and use it and the \ion{Si}{2} velocity evolution to constrain the mass of the shell and the underlying SN ejecta, and demonstrate that SN2007 if is strongly inconsistent with a Chandrasekhar-mass scenario. Within the context of a "tamped detonation" model appropriate for double-degenerate mergers, and assuming no host extinction, we estimate the total mass of the system to be 2.4 +/- 0.2 solar masses, with 1.6 +/- 0.1 solar masses of nickel-56 and with 0.3-0.5 solar masses in the form of an envelope of unburned carbon/oxygen. Our modeling demonstrates that the kinematics of shell entrainment provide a more efficient mechanism than incomplete nuclear burning for producing the low velocities typical of super-Chandrasekhar-mass SNeIa.Comment: 23 pages, 13 figures, 4 tables, emulateapj format; v2 fixed some typos and added a reference; v3 included minor copy-editing changes + fixed typos in Figure 9, Table 4; accepted to Ap

Hydrogen-poor superluminous stellar explosions

Supernovae (SNe) are stellar explosions driven by gravitational or thermonuclear energy, observed as electromagnetic radiation emitted over weeks or more. In all known SNe, this radiation comes from internal energy deposited in the outflowing ejecta by either radioactive decay of freshly-synthesized elements (typically 56Ni), stored heat deposited by the explosion shock in the envelope of a supergiant star, or interaction between the SN debris and slowly-moving, hydrogen-rich circumstellar material. Here we report on a new class of luminous SNe whose observed properties cannot be explained by any of these known processes. These include four new SNe we have discovered, and two previously unexplained events (SN 2005ap; SCP 06F6) that we can now identify as members. These SNe are all ~10 times brighter than SNe Ia, do not show any trace of hydrogen, emit significant ultra-violet (UV) flux for extended periods of time, and have late-time decay rates which are inconsistent with radioactivity. Our data require that the observed radiation is emitted by hydrogen-free material distributed over a large radius (~10^15 cm) and expanding at high velocities (>10^4 km s^-1). These long-lived, UV-luminous events can be observed out to redshifts z>4 and offer an excellent opportunity to study star formation in, and the interstellar medium of, primitive distant galaxies.Comment: Accepted to Nature. Press embargoed until 2011 June 8, 18:00 U

Waterfowl recently infected with low pathogenic avian influenza exhibit reduced local movement and delayed migration

Understanding relationships between infection and wildlife movement patterns is important for predicting pathogen spread, especially for multispecies pathogens and those that can spread to humans and domestic animals, such as avian influenza viruses (AIVs). Although infection with low pathogenic AIVs is generally considered asymptomatic in wild birds, prior work has shown that influenza-infected birds occasionally delay migration and/or reduce local movements relative to their uninfected counterparts. However, most observational research to date has focused on a few species in northern Europe; given that influenza viruses are widespread globally and outbreaks of highly pathogenic strains are increasingly common, it is important to explore influenza–movement relationships across more species and regions. Here, we used telemetry data to investigate relationships between influenza infection and movement behavior in 165 individuals from four species of North American waterfowl that overwinter in California, USA. We studied both large-scale migratory and local overwintering movements and found that relationships between influenza infection and movement patterns varied among species. Northern pintails (Anas acuta) with antibodies to avian influenza, indicating prior infection, made migratory stopovers that averaged 12 days longer than those with no influenza antibodies. In contrast, greater white-fronted geese (Anser albifrons) with antibodies to avian influenza made migratory stopovers that averaged 15 days shorter than those with no antibodies. Canvasbacks (Aythya valisineria) that were actively infected with influenza upon capture in the winter delayed spring migration by an average of 28 days relative to birds that were uninfected at the time of capture. At the local scale, northern pintails and canvasbacks that were actively infected with influenza used areas that were 7.6 and 4.9 times smaller than those of uninfected ducks, respectively, during the period of presumed active influenza infection. We found no evidence for an influence of active influenza infection on local movements of mallards (Anas platyrhynchos). These results suggest that avian influenza can influence waterfowl movements and illustrate that the relationships between avian influenza infection and wild bird movements are context- and species-dependent. More generally, understanding and predicting the spread of multihost pathogens requires studying multiple taxa across space and time

Assessing nest attentiveness of Common Terns via video cameras and temperature loggers

While nest attentiveness plays a critical role in the reproductive success of avian species, nest attentiveness data with high temporal resolution is not available for many species. However, improvements in both video monitoring and temperature logging devices present an opportunity to increase our understanding of this aspect of avian behavior. To investigate nest attentiveness behaviors and evaluate these technologies, we monitored 13 nests across two Common Tern (Sterna hirundo) breeding colonies with a paired video camera - temperature logger approach, while monitoring 63 additional nests with temperature loggers alone. Observations occurred from May to August of 2017 on Poplar (Chesapeake Bay, Maryland, USA) and Skimmer Islands (Isle of Wight Bay, Maryland, USA). We examined data respective to four times of day: Morning (civil dawn‒11:59), Peak (12:00‒16:00), Cooling (16:01‒civil dusk), and Night (civil dusk‒civil dawn). While successful nests had mostly short duration off-bouts and maintained consistent nest attentiveness throughout the day, failed nests had dramatic reductions in nest attentiveness during the Cooling and Night periods (p  0.05), video-monitored nests did have significantly lower clutch sizes (p < 0.05). The paired use of iButtons and video cameras enabled a detailed description of the incubation behavior of COTE. However, while promising for future research, the logistical and potential biological complications involved in the use of these methods suggest that careful planning is needed before these devices are utilized to ensure data is collected in a safe and successful manner.https://doi.org/10.1186/s40657-020-00208-

Waterfowl Spring Migratory Behavior and Avian Influenza Transmission Risk in the Changing Landscape of the East Asian-Australasian Flyway

Avian influenza has advanced from a regional concern to a global health issue with significant economic, trade, and public health implications. Wild birds, particularly waterfowl (Anseriformes), are known reservoirs for low-pathogenic avian influenza viruses (AIV) and recent studies have shown their potential in the spread of highly pathogenic forms of virus. East Asia remains an epicenter for the emergence of novel strains of AIV, however, information on movement ecology of waterfowl, and subsequently a clearer understanding of disease transmission risks in this region has been greatly lacking. To address this, we marked two species of wild waterfowl, northern pintail (Anas acuta) and Eurasian wigeon (Anas penelope), with satellite transmitters on their wintering grounds in Hong Kong, China to study the northward spring migration in the East Asian-Australasian Flyway in relation to disease transmission factors. Northern pintail were found to initiate migration 42 days earlier, travel 2,150 km farther, and perform 4.4 more stopovers than Eurasian wigeon. We found both species used similar stopover locations including areas along the Yangtze River near Shanghai, Bohai Bay and Korea Bay in rapidly developing regions of the Yellow Sea, and the Sea of Okhotsk where the species appeared to funnel through a migratory bottleneck. Both species appeared to exhibit strong habitat selection for rice paddies during migration stopovers, a habitat preference which has the potential to influence risks of AIV outbreaks as rapid land use and land cover changes occur throughout China. Both species had greatest association with H5N1 outbreaks during the early stages of migration when they were at lower latitudes. While Eurasian wigeon were not associated with outbreaks after the mean date of wintering ground departures, northern pintail were associated with outbreaks until the majority of individuals departed from the Yellow Sea, a migratory stopover location. Our results show species-level differences in migration timing and behavior for these common and widespread species, demonstrating the need to consider their unique temporal and spatial movement ecology when incorporating wild birds into AIV risk modeling and management

Allergic rhinitis and asthma: inflammation in a one-airway condition

BACKGROUND: Allergic rhinitis and asthma are conditions of airway inflammation that often coexist. DISCUSSION: In susceptible individuals, exposure of the nose and lungs to allergen elicits early phase and late phase responses. Contact with antigen by mast cells results in their degranulation, the release of selected mediators, and the subsequent recruitment of other inflammatory cell phenotypes. Additional proinflammatory mediators are released, including histamine, prostaglandins, cysteinyl leukotrienes, proteases, and a variety of cytokines, chemokines, and growth factors. Nasal biopsies in allergic rhinitis demonstrate accumulations of mast cells, eosinophils, and basophils in the epithelium and accumulations of eosinophils in the deeper subepithelium (that is, lamina propria). Examination of bronchial tissue, even in mild asthma, shows lymphocytic inflammation enriched by eosinophils. In severe asthma, the predominant pattern of inflammation changes, with increases in the numbers of neutrophils and, in many, an extension of the changes to involve smaller airways (that is, bronchioli). Structural alterations (that is, remodeling) of bronchi in mild asthma include epithelial fragility and thickening of its reticular basement membrane. With increasing severity of asthma there may be increases in airway smooth muscle mass, vascularity, interstitial collagen, and mucus-secreting glands. Remodeling in the nose is less extensive than that of the lower airways, but the epithelial reticular basement membrane may be slightly but significantly thickened. CONCLUSION: Inflammation is a key feature of both allergic rhinitis and asthma. There are therefore potential benefits for application of anti-inflammatory strategies that target both these anatomic sites

Physical activity and academic achievement across the curriculum (A + PAAC): rationale and design of a 3-year, cluster-randomized trial

Abstract Background Improving academic achievement and reducing the rates of obesity in elementary school students are both of considerable interest. Increased physical activity during academic instruction time during school offers a potential intervention to address both issues. A program titled &#8220;Physical Activity Across the Curriculum&#8221; (PAAC) was developed in which classroom teachers in 22 elementary schools were trained to deliver academic instruction using physical activity with a primary aim of preventing increased BMI. A secondary analysis of data assessed the impact of PAAC on academic achievement using the Weschler Individual Achievement Test-II and significant improvements were shown for reading, math and spelling in students who participated in PAAC. Based on the results from PAAC, an adequately powered trial will be conducted to assess differences in academic achievement between intervention and control schools called, &#8220;Academic Achievement and Physical Activity Across the Curriculum (A&#8201;+&#8201;PAAC).&#8221; Methods/design Seventeen elementary schools were cluster randomized to A&#8201;+&#8201;PAAC or control for a 3-year trial. Classroom teachers were trained to deliver academic instruction through moderate-to-vigorous physical activity with a target of 100+ minutes of A&#8201;+&#8201;PAAC activities per week. The primary outcome measure is academic achievement measured by the Weschler Individual Achievement Test-III, which was administered at baseline (Fall 2011) and will be repeated in the spring of each year by assessors blinded to condition. Potential mediators of any association between A&#8201;+&#8201;PAAC and academic achievement will be examined on the same schedule and include changes in cognitive function, cardiovascular fitness, daily physical activity, BMI, and attention-to-task. An extensive process analysis will be conducted to document the fidelity of the intervention. School and student recruitment/randomization, teacher training, and baseline testing for A&#8201;+&#8201;PAAC have been completed. Nine schools were randomized to the intervention and 8 to control. A random sample of students in each school, stratified by gender and grade (A&#8201;+&#8201;PAAC&#8201;=&#8201;370, Control&#8201;=&#8201;317), was selected for outcome assessments from those who provided parental consent/child assent. Baseline data by intervention group are presented. Discussion If successful, the A&#8201;+&#8201;PAAC approach could be easily and inexpensively scaled and disseminated across elementary schools to improve both educational quality and health. Funding source: R01- DK85317. Trial registration: US NIH Clinical Trials, http://NCT01699295.Peer Reviewe