What is the preferred treatment for a child with mild persistent asthma?

Low-dose inhaled corticosteroids are the preferred treatment for children with mild persistent asthma because they demonstrate superior reduction in severity and frequency of asthma exacerbations compared with alternatives (strength of recommendation [SOR]: A, based on multiple randomized controlled trials). As add-on therapy, nedocromil, theophylline, and cromolyn have all demonstrated a modest benefit in symptom control; leukotriene receptor antagonists are also recommended based on data from older children (SOR: B, cohort study). Unlike treatment of moderate or severe asthma, long-acting beta-agonists are not recommended (SOR: A, randomized trials)

Sea ice biogeochemistry and material transport across the frozen interface

Author Posting. © Oceanography Society, 2011. This article is posted here by permission of Oceanography Society for personal use, not for redistribution. The definitive version was published in Oceanography 24 no. 3 (2011): 202–218, doi:10.5670/oceanog.2011.72.The porous nature of sea ice not only provides a habitat for ice algae but also opens a pathway for exchanges of organic matter, nutrients, and gases with the seawater below and the atmosphere above. These constituents permeate the ice cover through air-ice gas exchange, brine drainage, seawater entrainment into the ice, and air-sea gas exchange within leads and polynyas. The central goal in sea ice biogeochemistry since the 1980s has been to discover the physical, biological, and chemical rates and pathways by which sea ice affects the distribution and storage of biogenic gases (namely CO2, O2, and dimethyl sulfide) between the ocean and the atmosphere. Historically, sea ice held the fascination of scientists for its role in the ocean heat budget, and the resulting view of sea ice as a barrier to heat and mass transport became its canonical representation. However, the recognition that sea ice contains a vibrant community of ice-tolerant organisms and strategic reserves of carbon has brought forward a more nuanced view of the "barrier" as an active participant in polar biogeochemical cycles. In this context, the organisms and their habitat of brine and salt crystals drive material fluxes into and out of the ice, regulated by liquid and gas permeability. Today, scientists who study sea ice are acutely focused on determining the flux pathways of inorganic carbon, particulate organics, climate-active gases, excess carbonate alkalinity, and ultimately, the role of all of these constituents in the climate system. Thomas and Dieckmann (2010) recently reviewed sea ice biogeochemistry, and so we do not attempt a comprehensive review here. Instead, our goal is to provide a historical perspective, along with some recent discoveries and observations to highlight the most outstanding questions and possibly useful avenues for future research

Frazil ice Growth and Production during Katabatic Wind Events in the Ross Sea, Antarctica

Katabatic winds in coastal polynyas expose the ocean to extreme heat loss, causing intense sea ice production and dense water formation around Antarctica throughout autumn and winter. The advancing sea ice pack, combined with high winds and low temperatures, has limited surface ocean observations of polynyas in winter, thereby impeding new insights into the evolution of these ice factories through the dark austral months. Here, we describe oceanic observations during multiple katabatic wind events during May 2017 in the Terra Nova Bay and Ross Sea polynyas. Wind speeds regularly exceeded 20 m s−1, air temperatures were below −25 ∘C, and the oceanic mixed layer extended to 600 m. During these events, conductivity–temperature–depth (CTD) profiles revealed bulges of warm, salty water directly beneath the ocean surface and extending downwards tens of meters. These profiles reflect latent heat and salt release during unconsolidated frazil ice production, driven by atmospheric heat loss, a process that has rarely if ever been observed outside the laboratory. A simple salt budget suggests these anomalies reflect in situ frazil ice concentration that ranges from 13 to 266×10-3 role= presentation style= box-sizing: border-box; display: inline; line-height: normal; word-spacing: normal; word-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; position: relative; \u3e266×10−3 kg m−3. Contemporaneous estimates of vertical mixing reveal rapid convection in these unstable density profiles and mixing lifetimes from 7 to 12 min. The individual estimates of ice production from the salt budget reveal the intensity of short-term ice production, up to 110 cm d−1 during the windiest events, and a seasonal average of 29 cm d−1. We further found that frazil ice production rates covary with wind speed and with location along the upstream–downstream length of the polynya. These measurements reveal that it is possible to indirectly observe and estimate the process of unconsolidated ice production in polynyas by measuring upper-ocean water column profiles. These vigorous ice production rates suggest frazil ice may be an important component in total polynya ice production

Practice Coaching model to embed the culture of enhanced recovery: a service evaluation

Poster presented at 'The Future Nurse: enriching people's experience of care' University of Exeter Academy of Nursing, RD&E Hospital, 3rd October 2019

Pangolins and bats living together in underground burrows in Lopé National Park, Gabon

First paragraph: In light of recent publications (e.g. Lam et al., 2020; Shang et al., 2020) that indicate a link between pangolin and bat coronaviruses related to SARS‐CoV‐2 (severe acute respiratory syndrome coronavirus 2), we believe that recent observations of pangolins and bats sharing burrows in Lopé, Central Gabon, is of general interest. Our observations were made during an ecological and spatial movement study of the giant pangolin, Smutsia gigantea

Multi-scale and cross-dimensional TMS mapping: A proof of principle in patients with Parkinson’s disease and deep brain stimulation

IntroductionTranscranial magnetic stimulation (TMS) mapping has become a critical tool for exploratory studies of the human corticomotor (M1) organization. Here, we propose to gather existing cutting-edge TMS-EMG and TMS-EEG approaches into a combined multi-dimensional TMS mapping that considers local and whole-brain excitability changes as well as state and time-specific changes in cortical activity. We applied this multi-dimensional TMS mapping approach to patients with Parkinson’s disease (PD) with Deep brain stimulation (DBS) of the sub-thalamic nucleus (STN) ON and OFF. Our goal was to identifying one or several TMS mapping-derived markers that could provide unprecedent new insights onto the mechanisms of DBS in movement disorders.MethodsSix PD patients (1 female, mean age: 62.5 yo [59–65]) implanted with DBS-STN for 1 year, underwent a robotized sulcus-shaped TMS motor mapping to measure changes in muscle-specific corticomotor representations and a movement initiation task to probe state-dependent modulations of corticospinal excitability in the ON (using clinically relevant DBS parameters) and OFF DBS states. Cortical excitability and evoked dynamics of three cortical areas involved in the neural control of voluntary movements (M1, pre-supplementary motor area – preSMA and inferior frontal gyrus – IFG) were then mapped using TMS-EEG coupling in the ON and OFF state. Lastly, we investigated the timing and nature of the STN-to-M1 inputs using a paired pulse DBS-TMS-EEG protocol.ResultsIn our sample of patients, DBS appeared to induce fast within-area somatotopic re-arrangements of motor finger representations in M1, as revealed by mediolateral shifts of corticomuscle representations. STN-DBS improved reaction times while up-regulating corticospinal excitability, especially during endogenous motor preparation. Evoked dynamics revealed marked increases in inhibitory circuits in the IFG and M1 with DBS ON. Finally, inhibitory conditioning effects of STN single pulses on corticomotor activity were found at timings relevant for the activation of inhibitory GABAergic receptors (4 and 20 ms).ConclusionTaken together, these results suggest a predominant role of some markers in explaining beneficial DBS effects, such as a context-dependent modulation of corticospinal excitability and the recruitment of distinct inhibitory circuits, involving long-range projections from higher level motor centers and local GABAergic neuronal populations. These combined measures might help to identify discriminative features of DBS mechanisms towards deep clinical phenotyping of DBS effects in Parkinson’s Disease and in other pathological conditions

Adherence to cancer screening guidelines in Australian survivors of allogeneic blood and marrow transplantation (BMT)

Allogeneic Blood and Marrow Transplant (BMT) survivors are at high risk of secondary cancers. Although current guidelines endorse survivors following Country-specific general population screening recommendations to mitigate this risk, little is known about cancer screening adherence in Australian BMT survivors. We conducted a cross-sectional survey of 441 BMT survivors who were >1 year post transplant, to explore rates of screening for secondary cancers and to identify barriers to cancer screening recommendations. Survey instruments included the Sydney Post-BMT Survey, FACT-BMT, DASS 21, The Chronic Graft versus Host Disease (GVHD) Activity Assessment–Patient Self-Report (Form B), the Lee Chronic GVHD Symptom Scale, Fear of Cancer Recurrence Scale, and The Post Traumatic Growth Inventory. Fifty-seven percent of respondents were male, median age 54 years, and 40% were >6 years post-BMT. Rates of cancer screening adherence were as follows: cervical 63.4%, breast 53.3%, skin 52.4%, and bowel 32.3%. Older BMT survivors and those >2 years post transplant were more likely to undergo cancer screening. Improved quality of life was associated with screening for skin, breast, and cervical cancer. Fear of cancer recurrence negatively impacted on cervical screening. For those who had not undergone screening, the majority reported not being advised to do so by their treatment team. This study is the largest and most comprehensive to date exploring cancer screening adherence in BMT survivors in Australia. These data provide the basis for health service reform to better meet the needs of BMT survivors and provide evidence to support counseling and education of both patients and professionals. Keywords: Australia, blood and marrow transplant (BMT), cancer screening, late effects, secondary cancers, survivorsfunded by the New South Wales Agency for Clinical Innovation, Blood and Marrow Transplant Network and supported by the Northern Blood Research Centr

Adherence to cancer screening guidelines in Australian survivors of allogeneic blood and marrow transplantation (BMT)

Allogeneic Blood and Marrow Transplant (BMT) survivors are at high risk of secondary cancers. Although current guidelines endorse survivors following Country-specific general population screening recommendations to mitigate this risk, little is known about cancer screening adherence in Australian BMT survivors. We conducted a cross-sectional survey of 441 BMT survivors who were >1 year post transplant, to explore rates of screening for secondary cancers and to identify barriers to cancer screening recommendations. Survey instruments included the Sydney Post-BMT Survey, FACT-BMT, DASS 21, The Chronic Graft versus Host Disease (GVHD) Activity Assessment–Patient Self-Report (Form B), the Lee Chronic GVHD Symptom Scale, Fear of Cancer Recurrence Scale, and The Post Traumatic Growth Inventory. Fifty-seven percent of respondents were male, median age 54 years, and 40% were >6 years post-BMT. Rates of cancer screening adherence were as follows: cervical 63.4%, breast 53.3%, skin 52.4%, and bowel 32.3%. Older BMT survivors and those >2 years post transplant were more likely to undergo cancer screening. Improved quality of life was associated with screening for skin, breast, and cervical cancer. Fear of cancer recurrence negatively impacted on cervical screening. For those who had not undergone screening, the majority reported not being advised to do so by their treatment team. This study is the largest and most comprehensive to date exploring cancer screening adherence in BMT survivors in Australia. These data provide the basis for health service reform to better meet the needs of BMT survivors and provide evidence to support counseling and education of both patients and professionals. Keywords: Australia, blood and marrow transplant (BMT), cancer screening, late effects, secondary cancers, survivorsfunded by the New South Wales Agency for Clinical Innovation, Blood and Marrow Transplant Network and supported by the Northern Blood Research Centr