How do informal self-care strategies evolve among patients with chronic obstructive pulmonary disease managed in primary care? A qualitative study

Background: There is much description in the literature of how patients with chronic obstructive pulmonary disease (COPD) manage their breathlessness and engage in self-care activities; however, little of this is from the perspective of those with less severe disease, who are primarily managed in primary care. This study aimed to understand the self-care experiences of patients with COPD who are primarily managed in primary care, and to examine the challenges of engaging in such behaviors. Methods: Semistructured interviews were carried out with 15 patients with COPD as part of a larger project evaluating a self-management intervention. Thematic analysis was supported by NVivo software (version 8, QSR International, Melbourne, Australia). Results: Three main themes are described, ie, experiencing and understanding symptoms of COPD, current self-care activities, and the importance of family perceptions in managing COPD. Conclusion: Self-care activities evolved spontaneously as participants experienced symptoms of COPD. However, there was a lack of awareness about whether these strategies would impact upon symptoms. Perceptions of COPD by family members posed a challenge to self-care for some participants. Health care professionals should elicit patients' prior disease experiences and utilize spontaneous attempts at disease management in future self-management. These findings have implications for promoting self-management and enhancing quality of life

The development and pilot testing of the Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD)

Purpose: There is no independent standardized self-management approach available for chronic obstructive pulmonary disease (COPD). The aim of this project was to develop and test a novel self-management manual for individuals with COPD. Patients: Participants with a confirmed diagnosis of COPD were recruited from primary care. Methods: A novel self-management manual was developed with health care professionals and patients. Five focus groups were conducted with individuals with COPD (N = 24) during development to confirm and enhance the content of the prototype manual. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD) manual was developed as the focus of a comprehensive self-management approach facilitated by health care professionals. Preference for delivery was initial face-to-face consultation with telephone follow-up. The SPACE for COPD manual was piloted with 37 participants in primary care. Outcome measures included the Self-Report Chronic Respiratory Questionnaire, Incremental Shuttle Walk Test, and Endurance Shuttle Walking Test (ESWT); measurements were taken at baseline and 6 weeks. Results: The pilot study observed statistically significant improvements for the dyspnea domain of the Self-Report Chronic Respiratory Questionnaire and ESWT. Dyspnea showed a mean change of 0.67 (95% confidence interval 0.23–1.11, P = 0.005). ESWT score increased by 302.25 seconds (95% confidence interval 161.47–443.03, P < 0.001). Conclusion: This article describes the development and delivery of a novel self-management approach for COPD. The program, incorporating the SPACE for COPD manual, appears to provoke important changes in exercise capacity and breathlessness for individuals with COPD managed in primary care

Ventilatory requirements of quadriceps resistance training in people with COPD and healthy controls.

BACKGROUND: It is proposed that resistance training (RT) does not activate the cardiopulmonary system to the same extent as whole-body exercise. This is important for patients with chronic obstructive pulmonary disease (COPD) who are ventilatory limited. OBJECTIVE: The aim was to assess the ventilatory response to an isokinetic quadriceps RT program in people with COPD and healthy controls. DESIGN: Observational. REGISTRATION NUMBER: ISRCTN22764439. SETTING: Outpatient, university teaching hospital. PARTICIPANTS AND OUTCOME MEASURES: People with COPD (n=14) and healthy controls (n=11) underwent breath-by-breath analysis of their ventilation during an RT session (five sets of 30 maximal knee extensions at 180°/sec). Subjects performed a maximal cycle ergometry test (CET) at baseline. Peak ventilation (VE; L/min) and oxygen consumption (VO2; mL/kg/min) were collected. The same system measured VO2 and VE during the RT session. Parameters are presented as a percentage of the maximal CET. Isokinetic workload, symptom scores, heart rate (HR), and oxygen saturation were documented post-training. RESULTS: People with COPD worked at higher percentages of their maximal capacity than controls (mean range between sets 1-5 for VO2 =49.1%-60.1% [COPD], 45.7%-51.43% [controls] and for VE =57.6%-72.2% [COPD], 49.8%-63.6% [controls]), although this was not statistically significant (P>0.1 in all cases). In absolute terms, the difference between groups was only significant for actual VO2 on set 2 (P<0.05). Controls performed more isokinetic work than patients with COPD (P<0.05). Median Borg symptom scores after RT were the same in both groups (3 breathlessness, 13 exertion), no de-saturation occurred, and both groups were training at ≥65% of their maximum HR. CONCLUSION: No statistically significant differences were found between people with COPD and healthy controls for VO2 and VE achieved during training. The symptoms associated with training were within acceptable limits

Models and metaphors: complexity theory and through-life management in the built environment

Complexity thinking may have both modelling and metaphorical applications in the through-life management of the built environment. These two distinct approaches are examined and compared. In the first instance, some of the sources of complexity in the design, construction and maintenance of the built environment are identified. The metaphorical use of complexity in management thinking and its application in the built environment are briefly examined. This is followed by an exploration of modelling techniques relevant to built environment concerns. Non-linear and complex mathematical techniques such as fuzzy logic, cellular automata and attractors, may be applicable to their analysis. Existing software tools are identified and examples of successful built environment applications of complexity modelling are given. Some issues that arise include the definition of phenomena in a mathematically usable way, the functionality of available software and the possibility of going beyond representational modelling. Further questions arising from the application of complexity thinking are discussed, including the possibilities for confusion that arise from the use of metaphor. The metaphor of a 'commentary machine' is suggested as a possible way forward and it is suggested that an appropriate linguistic analysis can in certain situations reduce perceived complexity

Determining the Impact of Probicon L28 and BioPlus 2B on Finishing Pig Growth Performance and Carcass Characteristics

These data represent the growth performance of pigs enrolled in a study to determine the impact of two direct fed microbial products on Salmonella and Escherichia coli prevalence pre- and post-harvest. A total of 650 finishing pigs in two groups were randomly assigned to pen via a completely randomized design, and pens were assigned to one of three treatments: 1) a control treatment with pigs fed a standard corn-soybean meal finishing diet (with no added probiotic); 2) the control diets with Probicon L28 (NexGen Innovations, LLC, Lubbock, TX) supplemented through water lines using a water medicator system at a target concentration of 1.0 × 106 CFU/head/day; and 3) the control diet with added BioPlus 2B (5.0 × 108 CFU/lb of feed; ~3.0 × 109 CFU/ head/day; CHR Hansen, Inc, Milwaukee, WI). No evidence of difference (P \u3e 0.10) between treatments was observed for overall ADG, ADFI, or F/G or any of the carcass traits. However, there was a tendency for a treatment effect for loin depth (P = 0.070). Pigs fed the BioPlus 2B treatment had numerically greater loin depth compared to other treatments, but there were no significant pairwise differences between treatments (P \u3e 0.05). The results of this study suggested that probiotics used in this study and supplied through the water or feed had no impact on growth or carcass characteristics of finishing pigs

Exploring the Use of Probicon L28 and BIOPLUS 2B as Direct-Fed Microbials to Reduce Salmonella and Shiga Toxin-Producing Escherichia coli in Market Pigs

Pigs are hosts for Salmonella and Shiga toxin-producing Escherichia coli (STEC) and these pathogens can commonly be isolated from the pig farm environment. Pigs can carry pathogens to the abattoir and contaminate pork products, posing a risk to public health. Identifying an intervention that effectively reduces pathogens in commercial pigs before harvest is imperative. Due to the need for effective pre-harvest interventions in the pig industry, the objective of this study was to investigate BIOPLUS 2B (Bacillus licheniformis and Bacillus subtilis) and Probicon L28 (Lactobacillus salivarius L28) as pre-harvest interventions to reduce Salmonella and STEC in commercial growing-finishing pigs. Two groups of pigs (group 1, N = 294; group 2, N = 356, initial body weight = 106.6 lb) were fed a standard corn-soybean meal (SBM) finishing diet according to the following treatments: Probicon L28 supplementation through water lines at 1.0 × 106 CFU/head/day (Probicon); BIOPLUS 2B supplemented at 3.0 × 109 CFU/head/day (BIOPLUS 2B); and a control with no added probiotic (Control). With each group of pigs, 12 pens were used per treatment (N = 24 total), for a total of 36 pens per group (N = 72 pens total). Each group was sampled upon arrival/baseline, midway through the grow-finish phase/6 weeks post-placement, and prior to loadout/13 weeks post-placement to collect fecal samples (4 pigs/pen), boot covers (2/pen), and ropes (1/pen). Market pigs were followed to the abattoir and superficial inguinal lymph nodes (SILNs) were collected. All samples were analyzed for STEC (stx, eae genes, and O157:H7, and O26, O111, O121 O45, O103, and O145 serogroups) and Salmonella using the BAX System (real-time polymerase chain reaction). Overall, Salmonella and O111 prevalence was very low for all sample types, and Escherichia coli O157:H7 was not detected in any samples throughout the study. When compared to the control, there was no evidence (P \u3e 0.05) that BIOPLUS 2B and Probicon L28 impacted the prevalence of STEC (stx and eae genes) or serogroups O26, O121, O45, O103, and O145 in feces, boot covers, ropes, and SILNs of market pigs

Bureaucracy as a Lens for Analyzing and Designing Algorithmic Systems

Scholarship on algorithms has drawn on the analogy between algorithmic systems and bureaucracies to diagnose shortcomings in algorithmic decision-making. We extend the analogy further by drawing on Michel Crozier’s theory of bureaucratic organizations to analyze the relationship between algorithmic and human decision-making power. We present algorithms as analogous to impartial bureaucratic rules for controlling action, and argue that discretionary decision-making power in algorithmic systems accumulates at locations where uncertainty about the operation of algorithms persists. This key point of our essay connects with Alkhatib and Bernstein’s theory of ’street-level algorithms’, and highlights that the role of human discretion in algorithmic systems is to accommodate uncertain situations which inflexible algorithms cannot handle. We conclude by discussing how the analysis and design of algorithmic systems could seek to identify and cultivate important sources of uncertainty, to enable the human discretionary work that enhances systemic resilience in the face of algorithmic errors.Peer reviewe

The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure