Symptomatic oxygen for non-hypoxaemic chronic obstructive pulmonary disease.

Dyspnoea is a common symptom in chronic obstructive pulmonary disease (COPD). People who are hypoxaemic may be given long-term oxygen relief therapy (LTOT) to improve their life expectancy and quality of life. However, the symptomatic benefit of home oxygen therapy in mildly or non-hypoxaemic people with COPD with dyspnoea who do not meet international funding criteria for LTOT (PaO(2)< 55 mmHg or other special cases) is unknown. To determine the efficacy of oxygen versus medical air for relief of subjective dyspnoea in mildly or non-hypoxaemic people with COPD who would not otherwise qualify for home oxygen therapy. The main outcome was patient-reported dyspnoea and secondary outcome was exercise tolerance. We searched the Cochrane Airways Group Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, to November 2009, to identify randomised controlled trials. We handsearched reference lists of included articles. We only included randomised controlled trials of oxygen versus medical air in mildly or non-hypoxaemic people with COPD. Two review authors independently assessed articles for inclusion. One review author completed data extraction and methodological quality assessment. A second review author then over-read evidence tables to assess for accuracy. Twenty-eight trials on 702 patients met the criteria for inclusion; 18 trials (431 participants) were included in the meta-analysis. Oxygen reduced dyspnoea with a standardised mean difference (SMD) of -0.37 (95% confidence interval (CI) -0.50 to -0.24, P < 0.00001). We observed significant heterogeneity. Oxygen can relieve dyspnoea in mildly and non-hypoxaemic people with COPD who would not otherwise qualify for home oxygen therapy. Given the significant heterogeneity among the included studies, clinicians should continue to evaluate patients on an individual basis until supporting data from ongoing, large randomised controlled trials are available

Methodology for the comparative assessment of the Satellite Power System (SPS) and alternative technologies

The energy systems concerned are the satellite power system, several coal technologies, geothermal energy, fission, fusion, terrestrial solar systems, and ocean thermal energy conversion. Guidelines are suggested for the characterization of these systems, side-by-side analysis, alternative futures analysis, and integration and aggregation of data. A description of the methods for assessing the technical, economic, environmental, societal, and institutional issues surrounding the development of the selected energy technologies is presented

Chronic Systemic Immune Dysfunction in African-Americans with Small Vessel-Type Ischemic Stroke

The incidence of small vessel-type (lacunar) ischemic strokes is greater in African-Americans compared to whites. The chronic inflammatory changes that result from lacunar stroke are poorly understood. To elucidate these changes, we measured serum inflammatory and thrombotic biomarkers in African-Americans at least 6 weeks post-stroke compared to control individuals. Cases were African-Americans with lacunar stroke (n = 30), and controls were age-matched African-Americans with no history of stroke or other major neurologic disease (n = 37). Blood was obtained \u3e 6 weeks post-stroke and was analyzed for inflammatory biomarkers. Freshly isolated peripheral blood mononuclear cells were stimulated with lipopolysaccharide (LPS) to assess immune responsiveness in a subset of cases (n = 5) and controls (n = 4). After adjustment for covariates, the pro-inflammatory biomarkers, soluble vascular cadherin adhesion molecule-1 (sVCAM-1) and thrombin anti-thrombin (TAT), were independently associated with lacunar stroke. Immune responsiveness to LPS challenge was abnormal in cases compared to controls. African-Americans with lacunar stroke had elevated blood levels of VCAM-1 and TAT and an abnormal response to acute immune challenge \u3e 6 weeks post-stroke, suggesting a chronically compromised systemic inflammatory response

Prime osservazioni italiane di attivit\ue0 predatoria da parte dello sciacallo dorato (Canis aureus) su ovini domestici nel Carso goriziano

La presenza della specie sciacallo dorato Canis aureus moreoticus (I. Geoffrey, 1835) documentata per il Friuli Venezia-Giulia a partire dagli anni 80 \ue8 in continua espansione ed incremento con un particolare riferimento all\u2019area carsica. Nel territorio preso in esame, una porzione di landa e boscaglia carsica in cui \ue8 ubicato un parco rurale di circa 100 ha con annesso allevamento ovino, la presenza di sciacallo dorato, documentata anche con l\u2019uso di foto trappole, \ue8 passata da casi sporadici ad un numero certo di 7 esemplari che frequentano l\u2019area. Congiuntamente all\u2019aumento di presenza si sono avuti casi di predazione su ovini adulti mantenuti allo stato semibrado senza ricovero notturno. Sono state esaminate tre carcasse di ovini trovati morti in giornate successive. Le pecore appartenevano tutte alla classe adulta ed in particolare superavano gli 8 anni di et\ue0. Le valutazioni anatomopatologiche delle carcasse, a diversi stadi di decomposizione, hanno messo in evidenza lesioni di carattere lacero contuso dei diversi piani tissutali nella regione del collo e nei garretti causate da morsi, con un consumo, costituito prevalentemente dai tessuti molli delle cavit\ue0 toraciche ed addominali, variabile in base al tempo intercorso tra il ritrovamento ed il decesso. Dall\u2019esame dei morsi ed in particolare dalla misurazione della distanza tra i canini, unite alle caratteristiche della predazione hanno permesso di riferirla a sciacallo dorato. Tale ipotesi \ue8 stata successivamente confermata con il fototrappolaggio. Dopo tali episodi, gli ovini sono stati ricoverati ogni notte in ovile chiuso e protetto. Tale metodologia gestionale \ue8 stata sufficiente a ridurre notevolmente l\u2019impatto della predazione da sciacallo dorato sugli animali allevati

Modelling the impact of the AN-ACC in Australia.The Resource Utilisation and Classification Study: Report 4

A national study to develop a new methodology for determining appropriate funding for places in residential aged care homes, the ‘Resource Utilisation and Classification Study’ (RUCS), was commissioned by the Commonwealth Department of Health (the Department) in August 2017 and undertaken by the Australian Health Services Research Institute (AHSRI) at the University of Wollongong. This report is the fourth in a series, written to present the results of this important national study. Each report deals with a different aspect of the project, as described in Appendix 1. In this report, Report 4, the findings from Study Three of the RUCS are presented. The purpose of the casemix profiling study covered in this report was to develop a national casemix profile of residents in residential aged care facilities in Australia, to identify any differences in resident casemix by facility type (i.e. by location, ownership type and size), and to model and test the likely financial impact of implementing the blended payment model nationally. To do so, a nationally representative sample was used to model patterns of resident need and to investigate the funding implications of a new payment model based on resident casemix

AMP second national workshop. Asthma Management Program

Powerpoint presentation presented at the Asthma Management Program: Second National Workshop, Stamford Plaza Sydney Airport Hote

Quality of anticoagulation and use of warfarin-interacting medications in long-term care: A chart review

<p>Abstract</p> <p>Background</p> <p>Maintenance of therapeutic International Normalized Ratio (INR) in the community is generally poor. The supervised environment in long-term care facilities may represent a more ideal setting for warfarin therapy since laboratory monitoring, compliance, dose adjustment, and interacting medications can all be monitored and controlled. The objectives of this study were to determine how effectively warfarin was administered to a cohort of residents in long-term care facilities, to identify the proportion of residents prescribed warfarin-interacting drugs and to ascertain factors associated with poor INR control.</p> <p>Methods</p> <p>A chart review of 105 residents receiving warfarin therapy in five long-term care facilities in Hamilton, Ontario was performed. Data were collected on INR levels, warfarin prescribing and monitoring practices, and use of interacting medications.</p> <p>Results</p> <p>Over a 12 month period (28,555 resident-days, 78.2 resident years) 3065 INR values were available. Residents were within, below and above the therapeutic range 54%, 35% and 11% of the time, respectively. Seventy-nine percent of residents were prescribed at least one warfarin-interacting medication during the period in review. Residents receiving interacting medications spent less time in the therapeutic range (53.0% vs. 58.2%, OR = 0.93, 95% confidence interval 0.88 to 0.97, P = 0.002). Adequacy of anticoagulation varied significantly between physicians (time in therapeutic range 45.9 to 63.9%).</p> <p>Conclusion</p> <p>In this group of long-term care residents, warfarin control was suboptimal. Both prescriber and co-prescription of interacting medications were associated with poorer INR control. Future studies should seek strategies to improve prescriber skill and decrease use of interacting medications.</p

Syracuse University, School of Architecture

The work presented here is the product of a year-long process that is the culminating experience of a professional education in architecture. It is a process that stresses inquiry and product, research and design, writing and visualization. It has been along-established goal at Syracuse that the final efforts of both the undergraduate and graduate prgrams be indistinguishable from ont another; thus the mixture of undergraduate and graduate award winners. Each student is advised by a committee of three and the final reviews are graded by a committee of five. Following the final reviews a panel of outside experts is invited to Superjury to see the best of the work. At the end of the day the entire faculty assembles to award the prizes that are recognized here. The James A. Britton prizes for best thesis are awarded annually. The runner-up Dean\u27s Citations and Thesis Citations are awarded to all students participating in the Superjury. -Bruce Abbey Students:Yanel De Angel, M. Arch, Palio Ritual and Market Siena, ItalyGonzalo Diez, M. Arch, Rural school EcuadorRyan Dillon, B. Arch, Ansel Adams Gallery CaliforniaChristian Daniels, B. Arch, Virtual Dwelling Los Angeles, CaliforniaAmador Pons, B. Arch, Housing the Homeless New York, New YorkH. Philipp Walter, B. Arch, A Studio Gallery Addition to the Everson Museum of Art Syracuse, New YorkMaria Agostini, M. Arch, Carmelite Monastery Puerto RicoHeidi Christianson, B. Arch, Community Church, Well, and Market HaitiD. Jason Olsen, B. Arch, Digital Library and Community Archive New York, New YorkMaricel Ramos, M. Arch, Registration Center and Public Entry San Juan, Puerto RicoRyan Samsa, B. Arch, Urban Housing Rochester, New YorkJeffrey Zynda, INS Border Station Alexandria Bay, New Yor

Introduction of the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Costing Tool: A User-Friendly Spreadsheet Program to Estimate Costs of Providing Patient-Centered Interventions

Background—Patient-centered health care interventions, such as heart failure disease management programs, are under increasing pressure to demonstrate good value. Variability in costing methods and assumptions in economic evaluations of such interventions limit the comparability of cost estimates across studies. Valid cost estimation is critical to conducting economic evaluations and for program budgeting and reimbursement negotiations. Methods and Results—Using sound economic principles, we developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure (TEAM-HF) Costing Tool, a spreadsheet program that can be used by researchers and health care managers to systematically generate cost estimates for economic evaluations and to inform budgetary decisions. The tool guides users on data collection and cost assignment for associated personnel, facilities, equipment, supplies, patient incentives, miscellaneous items, and start-up activities. The tool generates estimates of total program costs, cost per patient, and cost per week and presents results using both standardized and customized unit costs for side-by-side comparisons. Results from pilot testing indicated that the tool was well-formatted, easy to use, and followed a logical order. Cost estimates of a 12-week exercise training program in patients with heart failure were generated with the costing tool and were found to be consistent with estimates published in a recent study. Conclusions—The TEAM-HF Costing Tool could prove to be a valuable resource for researchers and health care managers to generate comprehensive cost estimates of patient-centered interventions in heart failure or other conditions for conducting high-quality economic evaluations and making well-informed health care management decisions

Learning to be Waste Wise

The Learning to be Waste Wise Activity Guide is a series of curriculum-linked activity packs written for the Waste Wise Schools Program. Each booklet covers a different topic including a general introduction to waste, the ‘3Rs’ (Reduce, Reuse and Recycle), ‘Worms’ and ‘Compost’. The activities are designed to complement the school’s ongoing waste minimisation projects, and to support learning at every stage of a school’s Waste Wise journey. In turn, Waste Wise projects provide real life context to curriculum outcomes while directly involving students in their own learning. By reinforcing Waste Wise principles through the curriculum in an engaging and practical way, teachers will find it easier to incorporate waste reduction practices in their school. In addition, the involvement of students and the modelling of positive behaviours, reinforces the environmental principles and curriculum outcomes. The activities are designed to be fun; to promote life-long learning; to empower and enable students, teachers and the rest of the school community to take responsibility for their waste minimisation actions; to develop positive environmental values and to promote long-term behaviour change