Support needs of patients with COPD: a systematic literature search and narrative review

Introduction: Understanding the breadth of patients’ support needs is important for the delivery of person-centered care, particularly in progressive long-term conditions such as chronic obstructive pulmonary disease (COPD). Existing reviews identify important aspects of managing life with COPD with which patients may need support (support needs); however, none of these comprehensively outlines the full range of support needs that patients can experience. We therefore sought to systematically determine the full range of support needs for patients with COPD to inform development of an evidence-based tool to enable person-centered care. Methods: We conducted a systematic search and narrative review of the literature. Medline (Ovid), EMBASE, PsycINFO, Cochrane Library, and CINAHL were systematically searched for papers which included data addressing key aspects of support need, as identified by patients with COPD. Relevant data were extracted, and a narrative analysis was conducted. Results: Thirty-one papers were included in the review, and the following 13 domains (broad areas) of support need were identified: 1) understanding COPD, 2) managing symptoms and medication, 3) healthy lifestyle, 4) managing feelings and worries, 5) living positively with COPD, 6) thinking about the future, 7) anxiety and depression, 8) practical support, 9) finance work and housing, 10) families and close relationships, 11) social and recreational life, 12) independence, and 13) navigating services. These 13 domains of support need were mapped to three of the four overarching categories of need commonly used in relevant national strategy documents (ie, physical, psychological, and social); however, support needs related to the fourth category (spiritual) were notably absent. Conclusion: This review systematically identifies the comprehensive set of domains of support need for patients with COPD. The findings provide the evidence base for a tool to help patients identify and express their support needs, which underpins a proposed intervention to enable the delivery of person-centered care: the Support Needs Approach for Patients (SNAP)

Cellulosomal expansin: functionality and incorporation into the complex

Additional file 1: Figure S1. Cellulases GH48 and GH9 work in a synergistic manner. The recombinant putative C. clariflavum exoglucanase GH48 and endoglucanase GH9 were used for degradation of PASC (phosphoric acid-swollen cellulose) alone or combined. Reaction tubes were supplemented with 0.5 µM of each enzyme, or 1 µM in total of the two enzymes combined. The duration of the reaction was 3 h, and the level of cellulose degradation was assessed by measuring the amount of released reducing sugars. The combination of the two enzymes resulted in 1.29-fold enhancement of PASC degradation. Synergy was calculated by summation of the released reducing sugars from the degradation by each enzyme alone, and comparing it to the amount of released reducing sugars by the action of the two enzymes together

Effect of the glucocorticoid receptor antagonist Org 34850 on fast and delayed feedback of corticosterone release

We investigated the effect of the glucocorticoid receptor (GR) antagonist Org 34850 on fast and delayed inhibition of corticosterone secretion in response to the synthetic glucocorticoid methylprednisolone (MPL). Male rats were implanted with a catheter in the right jugular vein, for blood sampling and MPL administration, and with an s.c. cannula for Org 34850 administration. All experiments were conducted at the diurnal hormonal peak in the late afternoon. Rats were connected to an automated sampling system and blood samples were collected every 5 or 10 min. Org 34850 (10 mg/kg, s.c.) or vehicle (5% mulgofen in saline) was injected at 1630 h; 30 min later, rats received an injection of MPL (500 μg/rat, i.v.) or saline (0.1 ml/rat). We found that an acute administration of MPL rapidly decreased the basal corticosterone secretion and this effect was not prevented by acute pretreatment with Org 34850. However, blockade of GR with Org 34850 prevented delayed inhibition of MPL on corticosterone secretion measured between 4 and 12 h after MPL administration. Our data suggest an involvement of GR in modulating delayed, but not fast, inhibition induced by MPL on basal corticosterone secretion

The Professional Socialisation of Project 2000 Student Nurses: A Longitudinal Qualitative Investigation into the Effect(s) of Supernumerary Status and Mentorship on Student Nurses

The aim of this three year longitudinal qualitative study was to explore the effect(s) of supernumerary status and mentorship on students undertaking a Higher Education Diploma in Nursing course. A purposive sample of seventeen students was used. Ten students volunteered to be interviewed throughout their course and to keep a diary to record their experiences of mentorship during their practice placements. Each of the ten students agreed to a tape-recorded in-depth interview on five occasions during their course. Students brought their diary to their interviews to act as an aide memoir, A further seven students volunteered to participate by diary-only. These students kept written accounts of their experiences of being supernumerary and having a mentor whilst on their practice placements. Data were analysed with the aid of NUD.IST and subjected to the constant comparative method of grounded theory until themes and categories emerged. Literature was used to support or refute emerging themes and categories, which were subsequently interwoven into the findings to support, illuminate or contradict findings where appropriate. The categories of anticipation of the first practice placement; reality dawns; becoming a branch student, total surrender of supernumerary status; and the end is nigh were used to present a unique account of the process of professional socialisation from the perspective of students undergoing the HE Diploma in Nursing course. Apart from professional socialisation of HE Diploma in Nursing students, a number of other areas have been highlighted in this study that have not been reported elsewhere. These were the development of intuition in third year HE Diploma in Nursing students, and what constitutes good mentoring from the students' perspective with the incorporation of a time dimension Findings were submitted to member and outside validation and credibility of the findings was established

Ray tracing & averaging in Szekeres cosmological models.

In this thesis, we perform ray tracing analyses of the COMPOSITE dataset of 4534 galaxy redshifts and distances using quasi-spherical Szekeres models. The Szekeres models are a class of exact inhomogeneous dust solutions of the Einstein equations, which we utilise as toy models of local inhomogeneous structures for distances ≲ 150 h⁻¹ Mpc. In our case, we choose specific models that asymptote to the FLRW model beyond ≃ 100 h⁻¹ Mpc, to restrict attention to the effects of ‘local structure’. These solutions allow us to simulate light propagation through a local under-dense void with an adjacent over-dense structure, as measured by an observer situated at different points within the structures of the model. By ray tracing null geodesics over the sky of this observer while performing ra- dial and angular averages, we have attempted to constrain the Szekeres models to match the Hubble expansion anisotropy of the COMPOSITE dataset, as well as the dipole and quadrupole anisotropies of the Cosmic Microwave Background (CMB). Previous ray tracing investigations undertaken by Bolejko et al. [1] have indicated potential non-kinematic contributions to the CMB dipole anisotropy due to relativistic differential expansion on the scale of local inhomogeneities. We revisit these results with corrections applied to a bug in their null vector initialisation procedure that led to some incorrect conclusions. We find that the application of Haantjes transformations to their Szekeres model is a promising avenue for obtaining a full match to the Hubble expansion anisotropy present in the COMPOSITE dataset

A phylogenomic look into the systematics of oceanic squids (order Oegopsida)

Fernández-Álvarez, Fernando Á, Taite, Morag, Vecchione, Michael, Villanueva, Roger, Allcock, A Louise (2022): A phylogenomic look into the systematics of oceanic squids (order Oegopsida). Zoological Journal of the Linnean Society 194 (4): 1212-1235, DOI: 10.1093/zoolinnean/zlab069, URL: https://academic.oup.com/zoolinnean/article/194/4/1212/637713

Are within-person Numerical Rating Scale (NRS) ratings of breathlessness 'on average' valid in advanced disease for patients and for patients' informal carers?

INTRODUCTION: The Numerical Rating Scale (NRS) is frequently used to assess patient-reported breathlessness in both a research and clinical context. A subgroup of patients report average breathlessness as worse than their worst breathlessness in the last 24 hours (paradoxical average). The Peak/End rule describes how the most extreme and current breathlessness influence reported average. This study seeks to highlight the existence of a subpopulation who give 'paradoxical averages using the NRS, to characterise this group and to investigate the explanatory relevance of the 'Peak/End' rule. METHODS: Data were collected within mixed method face-to-face interviews for three studies: the Living with Breathlessness Study and the two subprotocols of the Breathlessness Intervention Service phase III randomised controlled trial. Key variables from the three datasets were pooled (n=561), and cases where participants reported a paradoxical average (n=45) were identified. These were compared with non-cases and interview transcripts interrogated. NRS ratings of average breathlessness were assessed for fit to Peak/End rule. RESULTS: Patients in the paradoxical average group had higher Chronic Respiratory Questionnaire physical domain scores on average p=0.042). Peak/End rule analysis showed high positive correlation (Spearman's rho=0.756, p<0.001). CONCLUSIONS: The NRS requires further standardisation with reporting of question order and construction of scale used to enable informed interpretation. The application of the Peak/End rule demonstrates fallibility of NRS-Average as a construct as it is affected by current breathlessness. Measurement of breathlessness is important for both clinical management and research, but standardisation and transparency are required for meaningful results

Establishment of background water quality conditions in the Great Zab River catchment:influence of geogenic and anthropogenic controls on developing a baseline for water assessment and resource management

The Great Zab River catchment is a major left-bank tributary of the River Tigris and drains a substantial part of the Kurdistan Region, an autonomous region of Northern Iraq. Within Kurdistan, the water resources of the Great Zab River catchment are under pressure from population increase and are utilized for potable, domestic and agricultural and industrial supply. As with many parts of the world, effective management of water resources within Kurdistan is hindered by a lack of water quality data and established background concentrations. This study therefore represents the first regional survey of river water chemistry for the Great Zab River catchment and presents data on the spatial and temporal trends in concentrations of As, Ba, Ca, Cd, Co, Cr, Cu, Fe, Hg, Li, Mn, Mo, Ni, Pb, Sr, Zn, NO3?, SO42?, F?, Cl? and PO43?, in addition to pH, electrical conductivity, dissolved oxygen and turbidity. As a tool for underpinning the management and monitoring of water quality, background concentrations were defined for the Great Zab catchment using three methods. The influences of geogenic and anthropogenic controls upon spatial and temporal trends in water chemistry are also evaluated. The influence of geogenic loading from underlying bedrock was identifiable within the observed spatial trends, with the most notable differences found between waters sampled from the relatively more volcanic-rich Zagros zone to the north and those sampled from the lower catchment underlain by younger clay-, sand- and siltstones. The greatest anthropogenic influence, identifiable through elements such as Cl? and NO3?, is present in the more highly populated lower catchment. The background concentrations identified in the Great Zab catchment would be those expected as a result of geogenic loading with some anthropogenic influence and represent a more conservative value when compared to those such as the World Health Organization Maximum Admissible Concentration. However, background concentrations represent a powerful tool for identifying potential anthropogenic impacts on water quality and informing management of such occurrencespublishersversionPeer reviewe