Technology in respiratory medicine

Technological advances have allowed complex respiratory physiology measurements to be made outside of dedicated pulmonary function laboratories. Office spirometry is an essential component of the effective management of respiratory disease, particularly asthma and COPD. Spirometers for consulting room use need to conform to technical standards recommended by the American Thoracic Society. Regular calibration of all pulmonary function testing is mandatory. The most reliable results from pulmonary function tests are obtained when the operator is a qualified clinical technologist or has undergone appropriate training in the tests to be performed. Reliable spirometry results require maximum inspiratory and expiratory efforts and technically acceptable curves. At last 3 acceptable curves are necessary and at least 2 should have re producible values. Reference values that have been demonstrated to be applicable to the population under study should be used. The ECCS reference equations are generally appropriate for South African use although an allowance may need to be made for individuals of non-European ancestry. Complex pulmonary function and exercise tests should be reserved for dedicated respiratory physiology laboratories as specialised testing gases, more complex equipment and appropriately trained and qualified staff are essential

Cardiorespiratory fitness levels and body mass index of pre-adolescent children and older adults during the COVID-19 pandemic

Introduction The social and behavioral effects of the COVID-19 pandemic have impacted the health and physiology of most people, including those never diagnosed with COVID-19. While the impact of the pandemic has been felt across the lifespan, its effects on cardiorespiratory fitness (commonly considered a reflection of total body health) of older adults and children may be particularly profound due to social distancing and stay-at-home advisories, as well as the closure of sport facilities and non-essential businesses. The objective of this investigation was to leverage baseline data from two ongoing clinical trials to determine if cardiorespiratory fitness and body mass index were different during COVID-19 relative to before COVID-19 in older adults and children.Methods Healthy older individuals (N = 593; 65-80 years) and 200 typically developing children (8-10 years) completed a graded maximal exercise test and had their height and weight measured.Results Results revealed that older adults and children tested during COVID-19 had significantly lower cardiorespiratory fitness levels than those tested before COVID-19 shutdowns (older adults: 30% lower; children: 53% lower; p's & LE; 0.001). In addition, older adults and children tested during COVID-19 had significantly higher BMI (older adults: 31.34 +/- 0.57 kg/m(2), p = 0.004; children: 19.27 +/- 0.44 kg/m(2), p = 0.05) than those tested before COVID-19 shutdowns (older adults: 29.51 +/- 0.26 kg/m(2), children: 18.13 +/- 0.35 kg/m(2)). However, these differences in BMI did not remain significant when controlling for cardiorespiratory fitness.Discussion Results from this investigation indicate that the COVID-19 pandemic, and behavior changes taken to reduce potential exposure, may have led to lower cardiorespiratory fitness levels in older adults and children, as well as higher body mass index. These findings provide relevant public health information as lower cardiorespiratory fitness levels and higher body mass indexes recorded during the pandemic could have far-reaching and protracted health consequences. Public health guidance is needed to encourage physical activity to maintain cardiorespiratory fitness and healthy body composition.United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute on Aging (NIA) R01AG053952 United States Department of Health & Human Services National Institutes of Health (NIH) - USANIH Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) R01HD09405

The impact of Clinical Nurse Specialists on the decision making process in cancer multidisciplinary team meetings: A qualitative study

PURPOSE: There are well-documented barriers to nurse participation in cancer multidisciplinary team (MDT) meetings. This paper aims to identify the approaches used by Clinical Nurse Specialists (CNSs) in this setting to contribute during discussion, and to consider the impact of these approaches on the decision making process. In doing so it aims to highlight ways that CNSs can increase their influence, and enhance multidisciplinary engagement. METHODS: This study is based on analysis of observation data from 122 MDT meetings in gynaecology, haematology and skin cancer MDTs. Field notes were reviewed, identifying 58 cases where CNSs contributed to MDT discussion. Audio recordings of the relevant sections were then transcribed and analysed thematically. RESULTS: Five approaches were used by CNSs to contribute in MDT meetings: sharing information, asking questions, providing practical suggestions, framing and using humour. These approaches influenced three key intermediary processes identified during the analysis ('successful contributions'): prompting discussion, influencing a treatment plan and facilitating teamwork. CNSs contributed successfully in cases where medical factors (such as relapsed disease or complex comorbidities) or non-medical factors (such as strong patient preference), had the potential to impact on the ability of teams to deliver treatment. CONCLUSIONS: CNSs have an important role in cancer MDT meetings. By focusing on a subset of cases where CNSs contributed during MDT discussion, this study has provided an insight into approaches that can be adopted by CNSs to increase their influence on the decision making process, enabling teams to capitalise on their knowledge and expertise in MDT meetings

Mid-Miocene cooling and the extinction of tundra in continental Antarctica

A major obstacle in understanding the evolution of Cenozoic climate has been the lack of well dated terrestrial evidence from high-latitude, glaciated regions. Here, we report the discovery of exceptionally well preserved fossils of lacustrine and terrestrial organisms from the McMurdo Dry Valleys sector of the Transantarctic Mountains for which we have established a precise radiometric chronology. The fossils, which include diatoms, palynomorphs, mosses, ostracodes, and insects, represent the last vestige of a tundra community that inhabited the mountains before stepped cooling that first brought a full polar climate to Antarctica. Paleoecological analyses, 40Ar/39Ar analyses of associated ash fall, and climate inferences from glaciological modeling together suggest that mean summer temperatures in the region cooled by at least 8°C between 14.07 ± 0.05 Ma and 13.85 ± 0.03 Ma. These results provide novel constraints for the timing and amplitude of middle-Miocene cooling in Antarctica and reveal the ecological legacy of this global climate transition

On the puzzle of Bremsstrahlung as described by coaccelerated observers

We consider anew some puzzling aspects of the equivalence of the quantum field theoretical description of Bremsstrahlung from the inertial and accelerated observer's perspectives. More concretely, we focus on the seemingly paradoxical situation that arises when noting that the radiating source is in thermal equilibrium with the thermal state of the quantum field in the wedge in which it is located, and thus its presence does not change there the state of the field, while it clearly does not affect the state of the field on the opposite wedge. How then is the state of the quantum field on the future wedge changed, as it must in order to account for the changed energy momentum tensor there? This and related issues are carefully discussed.Comment: 29 pages, 1 figure; Revtex, minor changes, PACS correcte

Comparative Analysis of Colorfastness of Extracted Pigment from Kangkong (Ipomoea aquatica) with Varied Alcohol Solutions

Inorganic pigments are the most preferred pigments to be produced due to their greater resistance to fade, efficiency in the application, and how it is overall easier and faster to produce. However, natural water is polluted, and close vegetation is damaged because of the affected water channels that have been damaged due to improper disposal by the manufacturing industry. This paper reviews a comparative analysis of the colorfastness of extracted pigment from kangkong with varied alcohol solutions. A total of 7 varying ethyl alcohol solutions with concentrations ranging from 10% to 70% were obtained using the dilution equation. Kangkong leaves were then utilized for the extraction of chlorophyll due to its high leaf yield rate. The Brightness levels and Saturation levels had an inverse and direct correlation to the alcohol concentration, respectively. This suggests that a greater alcohol concentration is more effective and efficient in the extraction of chlorophyll because the samples had a better expression of colors. After observing the color value before and after administering the colorfastness test, the alcohol concentration in the extraction of chlorophyll has an inverse relationship with the colorfastness of the pigment on textile material