No effect of omeprazole on pH of exhaled breath condensate in cough associated with gastro-oesophageal reflux

BACKGROUND: Endogenous airway acidification evaluated as pH in exhaled breath condensate (EBC) has been described in patients with chronic cough. Proton pump inhibitors improve gastro-oesophageal reflux (GOR)-associated cough. METHODS: We examined pH levels in EBC and capsaicin cough response in 13 patients with chronic cough (mean age 41 years, SD 9) associated with GOR before and after omeprazole treatment (40 mg/day for 14 days) and its relationship with clinical response. RESULTS: Omeprazole abolished symptoms associated with GOR. Patients with chronic cough had an EBC pH of 8.28 (SD 0.13) prior to treatment but this did not change with omeprazole treatment. There was a significant improvement in the Leicester Cough Questionnaire symptom scores from 80.8 points (SD 13.2) to 95.1 (SD 17) (p = 0.02) and in a 6-point scale of cough scores, but there was no change in capsaicin cough response. CONCLUSION: An improvement in GOR-associated cough was not associated with changes in EBC pH or capsaicin cough response. These parameters are not useful markers of therapeutic response

Fundamental MHD scales -- II: the kinematic phase of the supersonic small-scale dynamo

The small-scale dynamo (SSD) amplifies weak magnetic fields exponentially fast via kinetic motions. While there exist well-established theories for SSDs in incompressible flows, many astrophysical SSDs operate in supersonic turbulence. To understand the impact of compressibility on amplified magnetic fields, we perform an extensive set of visco-resistive SSD simulations, covering a wide range of sonic Mach number $\mathcal{M}$, hydrodynamic Reynolds number Re, and magnetic Prandtl number Pm. We develop robust methods for measuring kinetic and magnetic energy dissipation scales $\ell_\nu$ and $\ell_\eta$, as well as the scale at which magnetic fields are strongest $\ell_p$ during the kinematic phase of these simulations. We show that $\ell_\nu/\ell_\eta \sim$ Pm$^{1/2}$ is a universal feature in the kinematic phase of Pm $\geq 1$ SSDs, regardless of $\mathcal{M}$ or Re, and we confirm earlier predictions that SSDs operating in incompressible plasmas (either $\mathcal{M} \leq 1$ or Re $<$ Re$_{\rm crit} \approx 100$) concentrate magnetic energy at the smallest scales allowed by magnetic dissipation, $\ell_p \sim \ell_\eta$, and produce fields organised with field strength and field-line curvature inversely correlated. However, we show that these predictions fail for compressible SSDs ($\mathcal{M} > 1$ and Re $>$ Re$_{\rm crit}$), where shocks concentrate magnetic energy in large-scale, over-dense, coherent structures, with size $\ell_p \sim (\ell_{\rm turb} / \ell_{\rm shock})^{1/3} \ell_\eta \gg \ell_\eta$, where $\ell_{\rm shock} \sim \mathcal{M}^2 / [$Re $(\mathcal{M} - 1)^2]$ is shock width, and $\ell_{\rm turb}$ is the turbulent outer scale; magnetic field-line curvature becomes almost independent of the field strength. We discuss the implications for galaxy mergers and for cosmic-ray transport models in the interstellar medium that are sensitive to field-line curvature statistics.Comment: 25 pages, 15 figures, submitted to MNRAS, json-file w/ dat

Trajectory analyses of adherence patterns in a real-life moderate to severe asthma population

Background: Global Initiative for Asthma step 5 therapies (GINA-5), other than inhaled corticosteroids and long-acting β-agonists in fixed dose combinations (ICS/LABA FDC), often entail more expensive (eg, monoclonal biologics) or less safe (eg, maintenance oral corticosteroids [OCS]) treatments. It is therefore important to assess poor inhaler adherence as a possible cause of suboptimal response to ICS/LABA FDC before additional GINA-5. Objective: To determine rates of, and time to, additional GINA-5 after first-year ICS/LABA FDC use, and their association with inhaler adherence. Methods: Patients initiating ICS/LABA FDC between 2013 and 2017 were identified from Australian national dispensing data. Group-based trajectory modeling was used to estimate medication adherence patterns. Multivariable Cox proportional hazards models were used to examine the association between adherence trajectories and GINA-5 addition during 2-year follow-up. Results: In total, 3062 new ICS/LABA FDC users were identified, of whom 120 (3.9%) received additional GINA-5 (OCS: 89; long-acting muscarinic antagonists: 39; biologics: &lt;3). Mean time to commencing additional GINA-5 was 705.2 (standard deviation, 1.7) days. Adherence trajectories were nonpersistent use (20%), seasonal use (8%), poor adherence (58%), and good adherence (13%). Although poor adherence was associated with longer time to additional GINA-5 (adjusted hazard ratio: 0.58; 95% confidence interval: 0.35-0.95), over 80% of additional GINA-5 was commenced in poorly adherent patients. Use of ≥2 OCS/antibiotic courses also predicted additional GINA-5. Conclusions: Almost 1 in 20 people with asthma commenced additional GINA-5 after ICS/LABA initiation, most of whom (&gt;80%) were poorly adherent to inhaled preventers. There is a substantial unmet need for inhaler adherence to be addressed before prescribing additional GINA-5.</p

Quantitative and Qualitative Trade-Off Analysis of Drowsy Driver Detection Methods: Single Electrode Wearable EEG Device, Multi-Electrode Wearable EEG Device, and Head-Mounted Gyroscope

Drowsy driving impairs motorists’ ability to operate vehicles safely, endangering both the drivers and other people on the road. The purpose of the project is to find the most effective wearable device to detect drowsiness. Existing research has demonstrated several options for drowsiness detection, such as electroencephalogram (EEG) brain wave measurement, eye tracking, head motions, and lane deviations. However, there are no detailed trade-off analyses for the cost, accuracy, detection time, and ergonomics of these methods. We chose to use two different EEG headsets: NeuroSky Mindwave Mobile (single-electrode) and Emotiv EPOC (14- electrode). We also tested a camera and gyroscope-accelerometer device. We can successfully determine drowsiness after five minutes of training using both single and multi-electrode EEGs. Devices were evaluated using the following criteria: time needed to achieve accurate reading, accuracy of prediction, rate of false positives vs. false negatives, and ergonomics and portability. This research will help improve detection devices, and reduce the number of future accidents due to drowsy driving

Cluster analysis of inflammatory biomarker expression in the International Severe Asthma Registry (ISAR)

Funding: ISAR is conducted by Optimum Patient Care Global Ltd, and co-funded by OPC Global Ltd and AstraZeneca.Peer reviewedPublisher PD

Asthma phenotyping in primary care : applying the International Severe Asthma Registry eosinophil phenotype algorithm across all asthma severities.

Funding: The OPCRD is established and maintained by Optimum Patient Care (OPC) Ltd. This study was funded by AstraZeneca and conducted collaboratively with the OPRI Pte Ltd and OPC Global Ltd. Acknowledgements We thank James Zangrilli, MD, and the entire ISAR Steering Committee for their valued contribution to the design of the study and interpretation of findingsPeer reviewedPublisher PD

BET bromodomains regulate transforming growth factor-beta-induced proliferation and cytokine release in asthmatic airway smooth muscle

Airway smooth muscle (ASM) mass is increased in asthma, and ASM cells from patients with asthma are hyperproliferative and release more IL-6 and CXCL8. The BET (bromo- and extra-terminal) family of proteins (Brd2, Brd3, and Brd4) govern the assembly of histone acetylation-dependent chromatin complexes. We have examined whether they modulate proliferation and cytokine expression in asthmatic ASM cells by studying the effect of BET bromodomain mimics JQ1/SGCBD01 and I-BET762. ASM cells from healthy individuals and nonsevere and severe asthmatics were pretreated with JQ1/SGCBD01 and I-BET762 prior to stimulation with FCS and TGF-β. Proliferation was measured by BrdU incorporation. IL-6 and CXCL8 release was measured by ELISA, and mRNA expression was measured by quantitative RT-PCR. ChIP using a specific anti-Brd4 antibody and PCR primers directed against the transcriptional start site of IL-6 and CXCL8 gene promoters was performed. Neither JQ1/SGCBD01 nor I-BET762 had any effect on ASM cell viability. JQ1/SGCBD01 and I-BET762 inhibited FCS+TGF-β-induced ASM cell proliferation and IL-6 and CXCL8 release in healthy individuals (≥ 30 nm) and in nonsevere and severe asthma patients (≥100 nm), with the latter requiring higher concentrations of these mimics. JQ1/SGCBD01 reduced Brd4 binding to IL8 and IL6 promoters induced by FCS+TGF-β. Mimics of BET bromodomains inhibit aberrant ASM cell proliferation and inflammation with lesser efficiency in those from asthmatic patients. They may be effective in reducing airway remodeling in asthma

Asthma exacerbation and steroid burden in Australian primary care

Peer reviewedPostprin

The Place of Scripture in the Trajectories of a Distinct Religious Identity among Ravidassias in Britain: Guru Granth Sahib or Amritbani Guru Ravidass

This article highlights narratives, collected as informant testimonies, relating to trajectories of a distinct religious identity among the Ravidassia community in Britain. Current tensions surround the replacement of the Guru Granth Sahib with the Amritbani Guru Ravidass in Ravidassia places of worship. This is primarily in response to cartographies of the Ravidassia identity as distinct from Sikh identity. The opinions of Ravidassia individuals, from a varied age range, expressed in interviews conducted at various periods during 2010–2012, are considered in relation to dominant discourses emphasising the importance of one hegemonic ‘Ravidassia’ scripture. The interview data highlight three main positions among the followers of Guru Ravidass: (1) Ravidassias seeking a distinct identity but preferring to retain the Guru Granth Sahib in Ravidassia places of worship, (2) Ravidassias demanding a distinct identity by installing the Amritbani Guru Ravidass, (3) Ravidassias wanting to maintain their link with the Panth as Sikhs or as Ravidassi Sikhs

Induction of IgG2 and IgG4 B-cell memory following sublingual immunotherapy for ryegrass pollen allergy

Background: While treatment for atopic rhinitis is aimed mostly to relieve symptoms, only allergen-specific immunotherapy (AIT) is targeted to modify the natural history of allergic diseases. This results in sustained clinical tolerance, even when treatment has stopped. The immunomodulatory effects of AIT are attributed mainly to increased regulatory T-cell function and increased allergen-specific IgG4, yet little is known about the effect on the memory B-cell compartment. Objective: We aimed to examine the effects of AIT on the IgE- and IgG subclass-expressing memory B cells. Methods: We recruited 29 patients with atopic seasonal rhinoconjunctivitis and performed a longitudinal analysis of the peripheral immune compartment before, during, and after sublingual immunotherapy (SLIT) for allergy to temperate grass pollen, predominantly to ryegrass pollen (RGP; Lolium perenne). Using flow cytometry on peripheral blood mononuclear cells and serum immunoassays, we analyzed the effects of a 4 months preseasonal treatment regimen comprising two or three courses in consecutive years on circulating IgE+ and IgG+ memory B cells and allergen-specific Ig levels. Results: SLIT increased RGP-specific serum IgG2 and IgG4, as well as the frequencies of IgG2 + and IgG4 + memory B cells, whereas no effect was observed on the IgE+ memory B-cell compartment. Furthermore, SLIT enhanced proportions of regulatory T cells specific to RGP. These changes were associated with clinical improvement. Conclusion: Our data provide evidence for immunological effects of SLIT on B-cell memory. Skewing responses toward IgG2 and IgG4 subclasses might be a mechanism to suppress IgE-mediated allergic responses