Reducing the use of inhaled corticosteroids in mild-moderate COPD: an observational study in east London

Inhaled corticosteroids (ICS) are often prescribed for worsening breathlessness, exacerbation frequency or lung function in chronic obstructive pulmonary disease (COPD). In mild-moderate disease and infrequent exacerbations, treatment risks may outweigh benefits and ICS may be withdrawn safely under supervision. A systematic ICS deprescribing programme for patients with mild-moderate COPD was introduced in an east London Clinical Commissioning Group (CCG) in April 2017. Primary care patient record analysis found that prescribing fell from 34.9% (n = 701) in the 18 months pre-intervention to 26.9% (n = 538) by the second year of implementation, decreasing 0.84% per quarter post intervention (p = 0.006, linear regression). The relative decrease was greater than the comparison CCG (23.0% vs. 9.9%). Only South Asian ethnicity was associated with increased cessation (odds ratio 1.48, confidence interval (CI) 1.09-2.01), p = 0.013, logistic regression). Patient outcome data were not collected. A primary care-led programme comprising local education, financial incentivisation and consultant support led to a significant decrease in ICS prescribing

Senior Recital: Patrick Collins, trumpet and Junior Recital: Ra Sheed Lemon II, trumpet

This recital is presented in partial fulfillment of requirements for the degrees Bachelor of Music in Music Education and Bachelor of Music in Performance. Mr. Collins and Mr. Lemon study trumpet with Douglas Lindsey.https://digitalcommons.kennesaw.edu/musicprograms/2013/thumbnail.jp

Surfactant status and respiratory outcome in premature infants receiving late surfactant treatment.

BACKGROUND:Many premature infants with respiratory failure are deficient in surfactant, but the relationship to occurrence of bronchopulmonary dysplasia (BPD) is uncertain. METHODS:Tracheal aspirates were collected from 209 treated and control infants enrolled at 7-14 days in the Trial of Late Surfactant. The content of phospholipid, surfactant protein B, and total protein were determined in large aggregate (active) surfactant. RESULTS:At 24 h, surfactant treatment transiently increased surfactant protein B content (70%, p < 0.01), but did not affect recovered airway surfactant or total protein/phospholipid. The level of recovered surfactant during dosing was directly associated with content of surfactant protein B (r = 0.50, p < 0.00001) and inversely related to total protein (r = 0.39, p < 0.0001). For all infants, occurrence of BPD was associated with lower levels of recovered large aggregate surfactant, higher protein content, and lower SP-B levels. Tracheal aspirates with lower amounts of recovered surfactant had an increased proportion of small vesicle (inactive) surfactant. CONCLUSIONS:We conclude that many intubated premature infants are deficient in active surfactant, in part due to increased intra-alveolar metabolism, low SP-B content, and protein inhibition, and that the severity of this deficit is predictive of BPD. Late surfactant treatment at the frequency used did not provide a sustained increase in airway surfactant

First Look at the Occurrence of Horizontally Oriented Ice Crystals over Summit, Greenland

The microphysical properties of clouds play a significant role in determining their radiative effect; one of these properties is the orientation of ice crystals. A source of error in current microphysical retrievals and model simulations is the assumption that clouds are composed of only randomly oriented ice crystals (ROIC). This assumption is frequently not true, as evidenced by optical phenomena such as parhelia (commonly referred to as sundogs). Here, observations from the Cloud, Aerosol and Polarization Backscatter Lidar (CAPABL) at Summit, Greenland are utilized along with instruments that are part of the Integrated Characterization of Energy, Clouds, Atmospheric state and Precipitation at Summit (ICECAPS) project in order to determine when, where and under what conditions horizontally oriented ice crystals (HOIC) occur at Summit, Greenland. Between July 2015 and May 2016, HOIC are observed on 86 days of the 335-day study. HOIC occurred within stratiform clouds on 48 days, in precipitation on 32 days and in cirrus clouds on 14 days. Analysis of all of the cases found that, on average, in comparison to ROIC, HOIC occur at higher temperatures, higher wind speeds and lower heights above ground level. Differences were also present in the relative humidities (RHs) at which HOIC and ROIC occurred in stratiform clouds and precipitation but not in cirrus clouds. Analysis over the whole study period revealed monthly variations in the abundance of HOIC with the number of detections peaking in April and October. Monthly changes were also present in the number of days containing HOIC. The results presented here aim to be the first step towards a comprehensive climatology and understanding of the microphysical processes that lead to the formation of HOIC at Summit, Greenland

A virtual reality food court to study meal choices in youth: design and assessment of usability

BACKGROUND: Regular consumption of take-out and fast foods with sugary drinks is associated with poor quality diets and higher prevalence of obesity. Among the settings where such food is consumed is the food court typically found in shopping malls prominent in many countries. OBJECTIVE: The objective of this research was to develop a virtual reality food court that could be used to test food environmental interventions, such as taxation, and ultimately to facilitate the selection of healthier food choices. METHODS: Fourteen food courts in Sydney, Australia were selected to include those in the city center and suburbs of high and low socioeconomic status. Researchers visited the courts to collect information on number and type of food outlets, all menu items for sale, cost of foods and beverages and sales promotions. This information was used to assemble 14 food outlets typically found in food courts, and representative menus were compiled. The UNITY gaming platform was used to design a virtual reality food court that could be used with HTC VIVE goggles. Participants navigated the virtual reality food court using the head-mounted display, keyboard, and mouse and selected a lunch meal, including food and beverage. A validated questionnaire on presence within the virtual reality food court and system usability was completed at the end of the session. The constructs for presence included a sense of control, sensory fidelity, realism, distraction, and involvement. Questions were rated on a scale from 1 (worst) through 7 (best) for each of 28 questions giving a maximum total score of 196. The systems usability scale (SUS) that gives a final score out of 100 was also assessed. RESULTS: One hundred and sixty-two participants with a mean age of 22.5 (SD 3.1) years completed the survey. The mean score for total presence was 144 (SE 1.4) consisting of control: 62.1 (SE 0.8), realism: 17.5 (SE 0.2), involvement: 9.6 (SE 0.2), sensory fidelity: 34.9 (SE 0.4), and distraction: 24.0 (SE 0.3). The mean SUS was 69 (SE 1.1). CONCLUSIONS: Virtual reality shows promise as a tool to study food choice for test interventions to inform practice and policy

Chlorpromazine for schizophrenia: a Cochrane systematic review of 50 years of randomised controlled trials

BACKGROUND: Chlorpromazine (CPZ) remains one of the most common drugs used for people with schizophrenia worldwide, and a benchmark against which other treatments can be evaluated. Quantitative reviews are rare; this one evaluates the effects of chlorpromazine in the treatment of schizophrenia in comparison with placebo. METHODS: We sought all relevant randomised controlled trials (RCT) comparing chlorpromazine to placebo by electronic and reference searching, and by contacting trial authors and the pharmaceutical industry. Data were extracted from selected trials and, where possible, synthesised and random effects relative risk (RR), the number needed to treat (NNT) and their 95% confidence intervals (CI) calculated. RESULTS: Fifty RCTs from 1955–2000 were included with 5276 people randomised to CPZ or placebo. They constitute 2008 person-years spent in trials. Meta-analysis of these trials showed that chlorpromazine promotes a global improvement (n = 1121, 13 RCTs, RR 0.76 CI 0.7 to 0.9, NNT 7 CI 5 to 10), although a considerable placebo response is also seen. People allocated to chlorpromazine tended not to leave trials early in both the short (n = 945, 16 RCTs, RR 0.74 CI 0.5 to 1.1) and medium term (n = 1861, 25 RCTs, RR 0.79 CI 0.6 to 1.1). There were, however, many adverse effects. Chlorpromazine is sedating (n = 1242, 18 RCTs, RR 2.3 CI 1.7 to 3.1, NNH 6 CI 5 to 8), increases a person's chances of experiencing acute movement disorders, Parkinsonism and causes low blood pressure with dizziness and dry mouth. CONCLUSION: It is understandable why the World Health Organization (WHO) have endorsed and included chlorpromazine in their list of essential drugs for use in schizophrenia. Low- and middle-income countries may have more complete evidence upon which to base their practice compared with richer nations using recent innovations

Spirometry reference equations for central European populations from school age to old age.

Spirometry reference values are important for the interpretation of spirometry results. Reference values should be updated regularly, derived from a population as similar to the population for which they are to be used and span across all ages. Such spirometry reference equations are currently lacking for central European populations. To develop spirometry reference equations for central European populations between 8 and 90 years of age. We used data collected between January 1993 and December 2010 from a central European population. The data was modelled using "Generalized Additive Models for Location, Scale and Shape" (GAMLSS). The spirometry reference equations were derived from 118'891 individuals consisting of 60'624 (51%) females and 58'267 (49%) males. Altogether, there were 18'211 (15.3%) children under the age of 18 years. We developed spirometry reference equations for a central European population between 8 and 90 years of age that can be implemented in a wide range of clinical settings

Control of wrist movement in deafferented man: evidence for a mixed strategy of position and amplitude control

© 2017 The Author(s) There is a continuing debate about control of voluntary movement, with conflicted evidence about the balance between control of movement vectors (amplitude control) that implies knowledge of the starting position for accuracy, and equilibrium point or final position control, that is independent of the starting conditions. We tested wrist flexion and extension movements in a man with a chronic peripheral neuronopathy that deprived him of proprioceptive knowledge of his wrist angles. In a series of experiments, we demonstrate that he could scale the amplitude of his wrist movements in flexion/extension, even without visual feedback, and appeared to adopt a strategy of moving via a central wrist position when asked to reach target angles from unknown start locations. When examining the relationship between positional error at the start and end of each movement in long sequences of movements, we report that he appears to have three canonical positions that he can reach relatively successfully, in flexion, in extension and in the centre. These are consistent with end-point or position control. Other positions were reached with errors that suggest amplitude control. Recording wrist flexor and extensor EMG confirmed that the flexion and extension canonical positions were reached by strong flexor and extensor activity, without antagonist activity, and other positions were reached with graded muscle activation levels. The central canonical position does not appear to be reached by either maximal co-contraction or by complete relaxation, but may have been reached by matched low-level co-contraction

Microbial ligand costimulation drives neutrophilic steroid-refractory asthma

Funding: The authors thank the Wellcome Trust (102705) and the Universities of Aberdeen and Cape Town for funding. This research was also supported, in part, by National Institutes of Health GM53522 and GM083016 to DLW. KF and BNL are funded by the Fonds Wetenschappelijk Onderzoek, BNL is the recipient of an European Research Commission consolidator grant and participates in the European Union FP7 programs EUBIOPRED and MedALL. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Self-adaptive Authorisation in OpenStack Cloud Platform

Although major advances have been made in protection of cloud platforms against malicious attacks, little has been done regarding the protection of these platforms against insider threats. This paper looks into this challenge by introducing self-adaptation as a mechanism to handle insider threats in cloud platforms, and this will be demonstrated in the context of OpenStack. OpenStack is a popular cloud platform that relies on Keystone, its identity management component, for controlling access to its resources. The use of self-adaptation for handling insider threats has been motivated by the fact that self-adaptation has been shown to be quite effective in dealing with uncertainty in a wide range of applications. Insider threats have become a major cause for concern since legitimate, though malicious, users might have access, in case of theft, to a large amount of information. The key contribution of this paper is the definition of an architectural solution that incorporates self-adaptation into OpenStack Keystone in order to handle insider threats. For that, we have identified and analysed several insider threats scenarios in the context of the OpenStack cloud platform, and have developed a prototype that was used for experimenting and evaluating the impact of these scenarios upon the self-adaptive authorisation system for the cloud platforms