Maintenance of non-pharmacological strategies 6 months after patients with chronic obstructive pulmonary disease (COPD) attend a breathlessness service: a qualitative study

Objectives This study aimed to explore the degree to which non-pharmacological strategies for chronic breathlessness are sustained 6 months after completing a breathlessness service in patients with chronic obstructive pulmonary disease (COPD), and patient perceptions regarding the need for ongoing support. Design A qualitative approach was taken using semistructured telephone interviews. Thematic analysis used an integrative approach. Setting The Westmead Breathlessness Service (WBS) trains patients with COPD to self-manage chronic breathlessness over an 8-week programme with multidisciplinary input and home visits. Participants Patients with moderate to very severe COPD who had completed the WBS programme 6 months earlier. Results Thirty-two participants were interviewed. One or more breathlessness self-management strategies were sustained by most participants, including breathing techniques (n=22; 69%), the hand-held fan (n=17; 53%), planning/pacing and exercise (n=14 for each; 44%) and strategic use of a four-wheeled walker (n=8; 25%). However, almost a third of participants appeared to be struggling psychologically, including some who had refused psychological intervention. A ‘chaos narrative’ appeared to be prevalent, and many participants had poor recall of the programme. Conclusions Self-management strategies taught by breathlessness services to patients with moderate to very severe COPD have potential to be sustained 6 months later. However, psychological coping may be more challenging to maintain. Research is needed on ways to improve resilience to set-backs and uptake of psychological interventions, as well as to understand and address the implications of poor recall for self-management. Trial registration number ACTRN1261700049938

Emotional well-being in children and adolescents treated with atomoxetine for attention-deficit/hyperactivity disorder: Findings from a patient, parent and physician perspective using items from the pediatric adverse event rating scale (PAERS)

<p>Abstract</p> <p>Background</p> <p>The objective of this analysis was to measure changes in items on the Pediatric Adverse Event Rating Scale (PAERS) that relate to emotional well-being of children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) during treatment with atomoxetine for up to 24 weeks from the perspective of the patient, the parent, and the physician.</p> <p>Methods</p> <p>Patients aged 6–17 years with ADHD were treated with atomoxetine (target dose 1.2 mg/kg/day). In the two studies on which this secondary analysis is based the PAERS was used to assess the tolerability of atomoxetine in children and adolescents. This scale has a total of 48 items. The ten items that reflect emotional well-being were selected to measure changes over time from a patient, parent, and physician perspective.</p> <p>Results</p> <p>421 patients were treated with atomoxetine. 355 patients completed the 8-week treatment period, and 260 patients completed the 24-week treatment period. The ten items that reflect emotional well-being were grouped in five dimensions: depressed mood, self-harm, irritability/agitation, drowsiness, and euphoria. The scores of these dimensions decreased over time, both from a patient as well as from a parent and physician perspective. Only the dimension self-harm was extremely low at baseline and stayed low over time. The mean scores for the ten items depended on the rater perspective.</p> <p>Conclusion</p> <p>The emotional well-being of children and adolescents with ADHD improved in terms of depressed mood, irritability/agitation, drowsiness, and euphoria during treatment with atomoxetine for up to 24 weeks.</p

Motor development of children with attention deficit hyperactivity disorder

Objective: To compare both global and specific domains of motor development of children with attention deficit hyperactivity disorder (ADHD) with that of typically developing children. Methods: Two hundred children (50 children with clinical diagnoses of ADHD, according to the DSM-IV-TR and 150 typically developing controls), aged 5 to 10 years, participated in this crosssectional study. The Motor Development Scale was used to assess fine and global motricity, balance, body schema, and spatial and temporal organization. Results: Between-group testing revealed statistically significant differences between the ADHD and control groups for all domains. The results also revealed a deficit of nearly two years in the motor development of children with ADHD compared with the normative sample. Conclusion: The current study shows that ADHD is associated with a delay in motor development when compared to typically developing children. The results also suggested difficulties in certain motor areas for those with ADHD. These results may point to plausible mechanisms underlying the relationship between ADHD and motor difficulties

Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits and Neuronal Brain Injury

BACKGROUND: Childhood obstructive sleep apnea (OSA) is associated with neuropsychological deficits of memory, learning, and executive function. There is no evidence of neuronal brain injury in children with OSA. We hypothesized that childhood OSA is associated with neuropsychological performance dysfunction, and with neuronal metabolite alterations in the brain, indicative of neuronal injury in areas corresponding to neuropsychological function. METHODS AND FINDINGS: We conducted a cross-sectional study of 31 children (19 with OSA and 12 healthy controls, aged 6–16 y) group-matched by age, ethnicity, gender, and socioeconomic status. Participants underwent polysomnography and neuropsychological assessments. Proton magnetic resonance spectroscopic imaging was performed on a subset of children with OSA and on matched controls. Neuropsychological test scores and mean neuronal metabolite ratios of target brain areas were compared. Relative to controls, children with severe OSA had significant deficits in IQ and executive functions (verbal working memory and verbal fluency). Children with OSA demonstrated decreases of the mean neuronal metabolite ratio N-acetyl aspartate/choline in the left hippocampus (controls: 1.29, standard deviation [SD] 0.21; OSA: 0.91, SD 0.05; p = 0.001) and right frontal cortex (controls: 2.2, SD 0.4; OSA: 1.6, SD 0.4; p = 0.03). CONCLUSIONS: Childhood OSA is associated with deficits of IQ and executive function and also with possible neuronal injury in the hippocampus and frontal cortex. We speculate that untreated childhood OSA could permanently alter a developing child's cognitive potential

Shared Services weltweit integriert. | Ergebnisse einer Studie zur Implementierung des Global Business Services-Modells in der Praxis.

The Global Business Services Model is often suggested for organizing the shared service centers of a company. An explorative study on the GBS model in practice is conducted in four companies. It shows many benefits, but also challenges, for which, however, companies have found solutions. While the overall assessment of the GBS model is positive, there are circumstances under which it is recommended

Etude expérimentale et modélisation du comportement en fatigue multiaxiale d'un polymère renforcé pour application automobile

This thesis...Cette thèse contribue à la compréhension du comportement en fatigue des thermoplastiques renforcés par des fibres de verre courtes. Deux différents matériaux sont étudiés : Un mélange de polybutylène téréphtalate et polyéthylène téréphtalate (PBT+PET GF30) et un polyamide 66 (PA66 GF35). Les enjeux scientifiques de la thèse concernent les chargements multiaxiaux, l'influence de la contrainte moyenne et l'orientation de fibres sur la tenue en fatigue. En outre, les mécanismes de rupture sont abordés au travers de techniques dédiées et ciblées ce qui a permis de proposer un scénario de rupture en fatigue pour le PBT+PET GF30. L'enjeu industriel est de développer un outil de dimensionnement en fatigue. Afin de répondre à ces objectifs, des essais de fatigue sont effectués dans le domaine de la durée de vie limitée (103-106 cycles) et à amplitude constante pour les rapports de charge de R=0,1 et R=-1. L'effet de l'orientation de fibres est étudié sur la base d'essais à différentes orientations en traction ainsi qu'en cisaillement sur des éprouvettes plates. Des chargements multiaxiaux sont appliqués à des éprouvettes tubulaires afin d'évaluer la tenue en fatigue multiaxiale. Dans le but de réduire le nombre d'essais d'identification tout en conservant les effets à décrire (triaxialité, rapport de charge et orientation), un nouveau critère est proposé. L'effet de l'orientation des fibres est simulé en utilisant l'approche de Mori Tanaka afin de calculer les contraintes moyennées. Le critère est implanté dans une chaîne de calcul allant de la mise en œuvre jusqu'à la durée de vie et il est validé sur deux matériaux et une large base de donnée expérimentale