Pulmonary Rehabilitation in COPD: Current Practice and Future Directions

This chapter will review the rationale for and the need for pulmonary rehabilitation in patients with Chronic Obstructive Pulmonary Disease (COPD). Its clinical effectiveness will be considered, including the evidence supporting a role for rehabilitation in improving exercise tolerance in COPD as measured. While the influence of pulmonary rehabilitation on dyspnoea, exercise tolerance and quality-of-life is clear, evidence for the benefits of rehabilitation on reducing healthcare utilisation such as admission to hospital or attendance at out-of-hours services is limited. The chapter will provide guidance on the setting up of a pulmonary rehabilitation programme and clinical staff required and the suitability of patients to enter such programmes will be outlined. There will be discussion on the key components of a programme including education, nutritional advice and the management of dyspnoea. Exercise is the central component of pulmonary rehabilitation. Assessment of the patient and prescription of an exercise programme will be outlined as will assessing a patient’s improvement. One key goal of pulmonary rehabilitation is ongoing lifestyle modification to encourage patients to undertake a more active lifestyle in the future. Ways of activating patients to do this will be discussed and the evidence for the use of telehealth in this area will be reviewed

Shedding Light on Capillary-Based Backscattering Interferometry

Capillary-based backscattering interferometry has been used extensively as a tool to measure molecular binding via interferometric refractive index sensing. Previous studies have analysed the fringe patterns created in the backscatter direction. However, polarisation effects, spatial chirps in the fringe pattern and the practical impact of various approximations, and assumptions in existing models are yet to be fully explored. Here, two independent ray tracing approaches are applied, analysed, contrasted, compared to experimental data, and improved upon by introducing explicit polarisation dependence. In doing so, the significance of the inner diameter, outer diameter, and material of the capillary to the resulting fringe pattern and subsequent analysis are elucidated for the first time. The inner diameter is shown to dictate the fringe pattern seen, and therefore, the effectiveness of any dechirping algorithm, demonstrating that current dechirping methods are only valid for a subset of capillary dimensions. Potential improvements are suggested in order to guide further research, increase sensitivity, and promote wider applicability

An Analysis of Semicircular Channel Backscattering Interferometry Through Ray Tracing Simulations

Recent backscattering interferometry studies utilise a single channel microfluidic system, typically approximately semicircular in cross-section. Here, we present a complete ray tracing model for on-chip backscattering interferometry with a semicircular cross-section, including the dependence upon polarisation and angle of incidence. The full model is validated and utilised to calculate the expected fringe patterns and sensitivities observed under both normal and oblique angles of incidence. Comparison with experimental data from approximately semicircular channels using the parameters stated shows that they cannot be explained using a semicircular geometry. The disagreement does not impact on the validity of the experimental data, but highlights that the optical mechanisms behind the various modalities of backscattering interferometry would benefit from clarification. From the analysis presented here, we conclude that for reasons of ease of analysis, data quality, and sensitivity for a given radius, capillary-based backscattering interferometry affords numerous benefits over on-chip backscattering interferometry

Measuring the Refractive Index and Sub-Nanometre Surface Functionalisation of Nanoparticles in Suspension

Direct measurements to determine the degree of surface coverage of nanoparticles by functional moieties are rare, with current strategies requiring a high level of expertise and expensive equipment. Here, a practical method to determine the ratio of the volume of the functionalisation layer to the particle volume based on measuring the refractive index of nanoparticles in suspension is proposed. As a proof of concept, this technique is applied to poly(methyl methacrylate) (PMMA) nanoparticles and semicrystalline carbon dots functionalised with different surface moieties, yielding refractive indices that are commensurate to those from previous literature and Mie theory. In doing so, it is demonstrated that this technique is able to optically detect differences in surface functionalisation or composition of nanometre-sized particles. This non-destructive and rapid method is well-suited for in situ industrial particle characterisation and biological applications

Experiences of youth who transition to adulthood out of care: Developing a theoretical framework

Adverse adulthood outcomes are well documented among youth who age out of foster care. However, not all youth who age out of care experience deleterious adult outcomes, despite struggling with similar challenges during the transition from adolescence to adulthood. Childhood maltreatment, which places youth at greater risk for later maladaptive functioning and psychopathology, may partially explain poor adjustment outcomes in adulthood. Similarly, a history of unstable placements and residing in institutional congregate care settings may also contribute to hardship during this time. However, none of these factors help to explain how some young people aging out of care manage to achieve stability while transitioning into adulthood. This article reviews the literature through the lens of the identity capital framework, and discusses the applicability of this framework to the experiences of youth aging out of foster care. © 2014 Elsevier Ltd