Bronchodilator Responsiveness in Tobacco-Exposed People With or Without COPD

Background: Bronchodilator responsiveness (BDR) in obstructive lung disease varies over time and may be associated with distinct clinical features. Research Question: Is consistent BDR over time (always present) differentially associated with obstructive lung disease features relative to inconsistent (sometimes present) or never (never present) BDR in tobacco-exposed people with or without COPD? Study Design and Methods: We retrospectively analyzed data from 2,269 tobacco-exposed participants in the Subpopulations and Intermediate Outcome Measures in COPD Study with or without COPD. We used various BDR definitions: change of ≥ 200 mL and ≥ 12% in FEV1 (FEV1-BDR), change in FVC (FVC-BDR), and change in in FEV1, FVC or both (ATS-BDR). Using generalized linear models adjusted for demographics, smoking history, FEV1 % predicted after bronchodilator administration, and number of visits that the participant completed, we assessed the association of BDR group: (1) consistent BDR, (2) inconsistent BDR, and (3) never BDR with asthma, CT scan features, blood eosinophil levels, and FEV1 decline in participants without COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 0) and the entire cohort (participants with or without COPD). Results: Both consistent and inconsistent ATS-BDR were associated with asthma history and greater small airways disease (%parametric response mapping functional small airways disease) relative to never ATS-BDR in participants with GOLD stage 0 disease and the entire cohort. We observed similar findings using FEV1-BDR and FVC-BDR definitions. Eosinophils did not vary consistently among BDR groups. Consistent BDR was associated with FEV1 decline over time relative to never BDR in the entire cohort. In participants with GOLD stage 0 disease, both the inconsistent ATS-BDR group (OR, 3.20; 95% CI, 2.21-4.66; P < .001) and consistent ATS-BDR group (OR, 9.48; 95% CI, 3.77-29.12; P < .001) were associated with progression to COPD relative to the never ATS-BDR group. Interpretation: Demonstration of BDR, even once, describes an obstructive lung disease phenotype with a history of asthma and greater small airways disease. Consistent demonstration of BDR indicated a high risk of lung function decline over time in the entire cohort and was associated with higher risk of progression to COPD in patients with GOLD stage 0 disease

Conducting Assessments in Technology Needs: From Assessment to Implementation

Practitioners with an expertise in assistive technology and technology assessments are in demand to be full participants in the selection, planning, and implementation of instruction for students with mild disabilities. Frequently, practitioners with knowledge of assistive technology are assigned to evaluate students with sensory, physical, language, or severe disabilities. Our article highlights aspects of technology assessments and progress monitoring that can be used for students with mild disabilities. Given the impact that technology integration can have on the access that students with mild disabilities have to the general education classroom, we argue that all practitioners should be cognizant of protocols for assistive technology assessment and evaluation and that all evaluation teams should include an assistive technology specialist.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Clinical significance of bronchodilator responsiveness evaluated by forced vital capacity in COPD: SPIROMICS cohort analysis

Objective: Bronchodilator responsiveness (BDR) is prevalent in COPD, but its clinical implications remain unclear. We explored the significance of BDR, defined by post-bronchodilator change in FEV1 (BDRFEV1) as a measure reflecting the change in flow and in FVC (BDRFVC)reflecting the change in volume. Methods: We analyzed 2974 participants from a multicenter observational study designed to identify varying COPD phenotypes (SPIROMICS). We evaluated the association of BDR with baseline clinical characteristics, rate of prospective exacerbations and mortality using negative binomial regression and Cox proportional hazards models. Results: A majority of COPD participants exhibited BDR (52.7%). BDRFEV1 occurred more often in earlier stages of COPD, while BDRFVC occurred more frequently in more advanced disease. When defined by increases in either FEV1 or FVC, BDR was associated with a self-reported history of asthma, but not with blood eosinophil counts. BDRFVC was more prevalent in subjects with greater emphysema and small airway disease on CT. In a univariate analysis, BDRFVC was associated with increased exacerbations and mortality, although no significance was found in a model adjusted for post-bronchodilator FEV1. Conclusion: With advanced airflow obstruction in COPD, BDRFVC is more prevalent in comparison to BDRFEV1 and correlates with the extent of emphysema and degree of small airway disease. Since these associations appear to be related to the impairment of FEV1,BDRFVC itself does not define a distinct phenotype nor can it be more predictive of outcomes, but it can offer additional insights into the pathophysiologic mechanism in advanced COPD. Clinical trials registration: ClinicalTrials.gov: NCT01969344T4

Automated High Resolution Determination of the Trace Elements Iron and Aluminium in the Surface Ocean Using a Towed Fish Coupled to Flow Injection Analysis

A towed surface sampling device coupled to two automated flow injection analysis (FIA) systems is described. The towed system permits uncontaminated sampling of seawater from research vessels while underway at full speed. Coupling the sampler to the FIA systems permits automatic determination of Al and Fe in surface waters at natural levels at 5 min intervals, equivalent to similar to 1.5 km spacing at a ship speed of 10 knots (5 m s(-1)). Results from the tropical Atlantic indicate significant (50%) variation in concentrations of both Al and Fe on space scales of less than 90 km. The combined system facilitates surface mapping of large regions of the ocean for dissolved Al and Fe, thus identifying the sites and magnitude of eolian deposition to the surface ocean. In combination with the determination of nutrients and other biological parameters this permits the investigation of the role that eolian deposition plays in modifying surface water biogeochemical cycles. (C) 2000 Elsevier Science Ltd. All rights reserved

Late‐stage calcites in the Permian Capitan Formation and its equivalents, Delaware Basin margin, west Texas and New Mexico: evidence for replacement of precursor evaporites

Comparison of Upper Guadalupian fore‐reef, reef and back‐reef strata from outcrops in the Guadalupe Mountains with equivalent subsurface cores from the northern and eastern margins of the Delaware Basin indicates that extensive evaporite diagenesis has occurred in both areas. In both surface and subsurface sections, the original sediments were extensively dolomitized and most primary and secondary porosity was filled with anhydrite. These evaporites were emplaced by reflux of evaporitic fluids from shelf settings through solution‐enlarged fractures and karstic sink holes into the underlying strata. Outcrop areas today, however, contain no preserved evaporites in reef and fore‐reef sections and only partial remnants of evaporites are retained in back‐reef settings. In their place, these rocks contain minor silica, very large volumes of coarse sparry calcite and some secondary porosity. The replacement minerals locally form pseudomorphs of their evaporite precursors and, less commonly, contain solid anhydrite inclusions. Some silicification, dissolution of anhydrite and conversion of anhydrite to gypsum have occurred in these strata where they are still buried at depths in excess of 1 km; however, no calcite replacements were noted from any subsurface core samples. Subsurface alteration has also led to the widespread, late‐stage development of large‐ and small‐scale dissolution breccias. The restriction of calcite cements to very near‐surface sections, petrographic evidence that the calcites post‐date hydrocarbon emplacement, and the highly variable but generally ‘light’carbon and oxygen isotopic signatures of the spars all indicate that calcite precipitation is a very late diagenetic (telogenetic) phenomenon. Evaporite dissolution and calcitization reactions have only taken place where Permian strata were flushed with meteoric fluids as a consequence of Tertiary uplift, tilting and breaching of regional hydrological seals. A typical sequence of alteration involves initial corrosion of anhydrite, one or more stage