Change in lung volume in asthma with particular reference to obesity

Over the last 20 years both asthma and obesity have increased in prevalence. What is the link? There are data to suggest that increasing obesity is a risk for the increase in prevalence of asthma. A number of mechanisms have been postulated including the effects of reduced lung volume on bronchial reactivity and mechanical changes with lower lung volumes. Other possibilities include other obesity-induced co-morbidities including gastro-oesophageal reflux. The aim of this thesis was to evaluate the link between asthma and obesity in both adult and childhood populations and to undertake experimental studies to examine the effects of changes in lung volume on bronchial reactivity. In chapter 1, the literature is reviewed. The current literature suggests that there is a link between diagnosis of asthma, new onset of asthma, symptoms of shortness of breath and wheeze. In chapter 2, data on 1997 adults in 3 population studies were analysed and the association between body mass index (BMI) and symptoms of shortness of breath and wheeze, diagnosis of asthma, medication usage for asthma, lung function and bronchial responsiveness were studied. This study showed that obesity was a risk for recent asthma (OR 2.04; 95%CI 1.02-3.76, p=0.048), symptoms of shortness of breath and wheeze (OR 2.6; 95%CI 1.46- 4.70, p=0.001), and medication usage for asthma (OR 2.53; 95%CI 1.36-4.70, p=0.003). There was a reduction in lung volume as measured by forced vital capacity (FVC), but there was no increase in bronchial hyperresponsiveness (BHR) (OR 0.87; 95% CI 0.35-2.21, p=0.78). Thus although the symptoms of asthma are increased there were no increases in BHR, despite significantly reduced lung volumes. The increase the medication usage is unlikely to have normalised the BHR, as there were ongoing symptoms suggestive of asthma. In chapter 3, data on 5993 children in 7 population studies were analysed and the association between BMI percentile and symptoms of cough, wheeze, ix diagnosis of asthma, medication usage for asthma, atopy, lung function and bronchial responsiveness was studied. After adjusting for atopy, sex, age, smoking and family history, BMI was a significant risk factor for wheeze ever (OR=1.06; 95%CI 1.01-1.10, p=0.008) and cough (OR=1.09; 95%CI 1.05-1.14, p=0.001) but not for recent asthma (OR=1.02; 95%CI 0.98-1.07 p=0.43), or bronchial hyperresponsiveness (OR=0.97; 95%CI 0.95-1.04 p=0.77). In girls, a higher BMI was significantly associated with higher prevalence of atopy (x2 trend 7.9, p=0.005), wheeze ever (x2 trend 10.4, p=0.001), and cough (x2 trend 12.3, p<0.001). These were not significant in boys. With increasing BMI in children, there was no reduction in lung volume, no increase in airway obstruction and no increase in bronchial responsiveness. In chapter 4, the hypothesis that obesity per se is associated with bronchial responsiveness was tested. Six obese women without asthma were compared to 6 non-obese women without asthma with high dose methacholine challenges to assess the bronchial responsiveness. There was no increase in bronchial responsiveness, and no difference in the position or shape of the high dose methacholine curve despite the fact that these women had reduced lung volumes associated with their obesity. In chapter 5, the hypothesis whether reduced lung volume per se would cause a change in greater mechanical effect, ie more marked airway narrowing in both non-asthmatic and asthmatic subjects was tested. Lung volumes and methacholine challenges were undertaken in the supine and erect position on different days. As expected in normal subjects there was a small reduction in lung volume on lying down, this was associated with an increase in the measure of bronchial reactivity DRR. In contrast, in asthmatics, there was no acute fall in lung volume and there were variable changes in the index of reactivity suggesting non-homogeneity in the lung function abnormality. This suggests changes in bronchial reactivity can occur without any relationship to lung volume change. These negative results suggest that lung volume changes that may occur in obesity are unlikely contributors to the apparent increase in asthma symptoms. In chapter 6, the hypothesis that the supposed increase in asthma symptoms in the obese were due to the effects of gastro-oesophageal reflux were assessed in 147 obese subjects graded for gastro-oesophageal reflux severity using manometry and gastroscopy. This study showed that subjects with increased gastro-oesophageal reflux did not have subjective increases in asthma prevalence, obstructive sleep apnoea, or snoring however they had a clear worsening of gas transfer as measured by carbon monoxide transfer suggesting a greater level of parenchymal disease. The overall results are that there is an increase of diagnosis of asthma, increase in symptoms of asthma and medication usage for the treatment of asthma in the obese. Objectively despite reductions in lung volume, there is no increase in bronchial responsiveness in this group suggesting that these symptoms are not related to true asthma, but to alternative co-morbidities associated with obesity such as gastro-oesophageal reflux. Notably gastrooesophageal reflux was not associated with increased asthma prevalence or airway obstruction. However it was associated with reduced gas transfer suggesting parenchymal disease. This suggests that the increase in symptoms of wheeze and shortness of breath in the obese should not be attributed to asthma in the absence of variable airflow limitation that is reversible spontaneously or with treatment, or with an increase in the existing bronchial hyperresponsiveness (BHR) to a variety of stimuli

‘Shaken, but not stirred’: six decades defining social innovation

Ingenio Working Paper SeriesThis paper examines the evolution in the conceptualization of Social Innovation (SI) under the assumption of SI as a trans-disciplinary construct which comprises a diversity of discourses from different fields and actors. We performed a comprehensive and systematic literature review along six decades (1950-2014), extracting definitions of SI through a search of 2,339 documents in various languages retrieved from Web of Science, SCOPUS and Google scholar. To guide the inductive analysis of pluri-vocal discourses we assume innovation to be a learning-based process, introducing the notion of social practice linked to its intertwined institutional and sociocultural dimensions. We applied mixed qualitative methodologies, combining content analysis based on a social constructionist/interpretivist ontology with cognitive mapping techniques. Our findings identify some core and secondary elements underpinning two complementary perspectives (transformative and instrumental) of SI as scientific construct. They also point to a number of promising avenues for research towards the advancement of a socio-technical theory of innovation.This work has been partly funded by the JAE-Doc grant for the programme ‘Junta para la Ampliación de Estudios’, co-financed by the European Social Fund and the Spanish Ministry of Science (2011-2014).N

Pulmonary function evaluation during and following Skylab space flights

Previous experience during the Apollo postflight exercise testing indicated no major changes in pulmonary function. Although pulmonary function has been studied in detail following exposure to hypoxic and hyperoxic environments, few studies have dealt with normoxic environments at reduced total pressure as encountered during the Skylab missions. Forced vital capacity was measured during the preflight and postflight periods of the Skylab 2 mission. Initial in-flight measurements of vital capacity were obtained during the last two weeks of the second manned mission (Skylab 3). Comprehensive pulmonary function screening was accomplished during the Skylab 4 mission. The primary measurements made during Skylab 4 testing included residual volume determination, closing volume, vital capacity, and forced vital capacity and its derivatives. In addition, comprehensive in-flight vital capacity measurements were made during the Skylab 4 mission. Vital capacity was decreased slightly during flight in all Skylab 4 crewmen. No major preflight to postflight changes were observed in the other parameters

The influence of ambipolarity on plasma confinement and the performace of ECRIS

International audienceCharge diffusion in an ECRIS discharge is usually characterized by non ambipolar behavior. While the ions are transported to the radial walls, electrons are lost axially from the magnetic trap. Global neutrality is maintained via compensating currents in the conducting walls of the vacuum chamber. It is assumed that this behavior reduces the ion breeding times compared to a truly ambipolar plasma. We have carried out a series of dedicated experiments in which the ambipolarity of the ECRIS plasma was influenced by inserting special metal-dielectric structures (MD layers) into the plasma chamber of the Frankfurt 14GHz ECRIS. The measurements demonstrate the positive influence on the source performance when the ECR plasma is changed towards more ambipolar behavior

What Is the Landscape of Early Childhood Coaching in Nebraska?

Background on Early Childhood Coaching in Nebraska Coaches have become an integral component of supporting teachers and adults working with young children and families nationally (Schachter, 2015). In the state of Nebraska, early childhood (EC) coaching has increasingly become important for this type of work (Jayaraman, Knoche, Marvin, & Bainter, 2014). Indeed, multiple initiatives within the state utilize coaches as a mechanism for supporting change in adult learners that leads to positive outcomes for young children and families. In general, coaching is a unique form of professional development that is relationship-based, whereby coaches work one-on-one or in small groups with adult learners to improve knowledge, skills, and dispositions (Aikens & Akers, 2011). Coaching can take place in adults’ immediate context and tends to be ongoing rather than a single, one-time training (Joyce & Showers, 1980; Rush & Shelden, 2005). As such, coaching has the potential to provide high-quality learning experiences for adults to support high-quality experiences in EC. Based on this growing use of coaching across the state, key stakeholders have collaborated to develop mechanisms that support coach training and development. Since this collaborative work began in 2009–10, a semiannual coach training was developed to provide foundational coaching skills and competencies relevant for all coaching initiatives, such as developing relationships and facilitating coaching conversations. The collaborative group also came to understand that coaches needed ongoing support and initiated the offering of regular “booster” sessions to support coaches’ professional development once they are in the field and actively serving coachees. In efforts to better understand who was coaching and perceptions of the training coaches received, stakeholders conducted an initial survey in 2014 (Jayaraman et al. 2014). Results of this survey (n = 35) revealed that coaches liked the work of coaching and, in particular, coaches commented that they enjoyed building relationships with coachees and observing positive changes. Although these coaches were generally positive about the training they received, myriad challenges were also reported, particularly with regards to the coaching process and their own training and professional development needs. Present Study Since the 2014 study, coaching in various EC initiatives has grown across the state. In 2018, the Nebraska Early Childhood Coach Collaboration team was interested in reassessing the process of coaching in Nebraska. This included understanding who is doing the work of coaching, what constitutes the coaching process, how coaches perceive their work, and how coaches were prepared to do their work. Thus, a new survey was created to understand more about coaching in the state of Nebraska. It contained a variety of questions consisting of both fixed-choice and open-response comments. Data collection was led by Dr. Schachter from the University of Nebraska–Lincoln and was reviewed by the Institutional Review Board. Participants were invited by email to complete an online survey that took approximately 20 minutes to complete. The survey was emailed to key stakeholders in the Spring of 2018 with requests that the survey be forwarded to anyone doing the work of EC coaching in Nebraska. In total, 101 individuals completed the survey. Importantly, all participants self-identified as a “coach.” Participants were able to enter into a raffle to win one of five iPad minis. Survey responses were analyzed descriptively. Next, we present our findings regarding who are the coaches, what is the content of coaching, how coaches perceive their work, how coaches know that coaching is working, and how coaches were prepared. We conclude with recommendations for advancing the work of coaching in the state of Nebraska

Radio Luminosities and Classificatory Criteria of BL Lacertae Objects

Using the sample of radio selected BL Lacertae objects (RBLs) and X-ray selected BL Lacertae objects (XBLs) presented by Sambruna et al. (1996), we calculated the luminosities of radio, optical and X-ray of each source and made the statistical analysis among the luminosities at different wave-bands, broad-band spectral indices from radio to X-ray ($\alpha_{\rm rx}$) and peak frequencies ($\nu_p$). Our results are as follows: (i) there is a positive correlation between radio luminosity $L_{\rm r}$ and $\alpha_{\rm rx}$ and a negative correlation between $L_{\rm r}$ and $\nu_p$. High-energy peak BL Lacs (HBLs) and low-energy peak BL Lacs (LBLs) can be distinguished very well, the dividing lines are probably those of $\log {L_{\rm r}}=43.25$ (erg/sec) and $\alpha_{\rm rx}>$(or $\leq$)0.75 for $L_{\rm r}$ - $\alpha_{\rm rx}$ plot and those of $\log {L_{\rm r}}\leq 43.25$ (erg/sec) and $\log {\nu_p}>14.7$ for the $L_{\rm r}$ - $\nu_p$ plot; (ii) there is a weak positive correlation between optical luminosity $L_o$ and $\alpha_{\rm rx}$ and a negatively weak correlation between $L_{\rm o}$ and $\nu_p$; (iii) there is no correlation between X-ray luminosity $L_X$ and $\alpha_{\rm rx}$ or between $L_X$ and $\nu_p$. From our analysis, we find that synchrotron radiation is the main X-ray radiation mechanism for HBLs while inverse Compton scattering for LBLs.Comment: 9 pages, 3 figures. Submitted to A&

Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse

This handbook is the culmination of a multiphase, multidisciplinary research project that used grounded theory and participatory action research to illuminate ways that healthcare providers can work sensitively (in a trauma-informed way) with adult survivors of childhood sexual abuse. The research identified nine Principles of Sensitive Practice: respect, rapport, taking time, sharing information and control, respecting boundaries, fostering mutual learning, understanding non-linear healing and demonstrating an understanding of trauma to patients. Specific guidelines were developed for a wide variety of issues pertinent to clinical practice such as, removal of clothing, touch, responding to disclosures of abuse, managing triggers among others. The methodology included interviews with women and men adult survivors of childhood sexual abuse from across Canada about how healthcare practitioners can be sensitive to their needs as survivors. It also included learnings from group meetings where survivors and healthcare practitioners discussed together ways healthcare practice could better respond to the needs of survivors. Written feedback received from physicians, nurses, dentists and dental hygienists, physical and occupational therapists, massage therapists, chiropractors, kinesiologists, professional regulators, mental health professionals and survivors from across Canada ensured that suggestions for clinical practice reflected both survivor needs and the realities of clinical practice. We concluded that because healthcare providers are not always aware that they are working with individuals who have experienced childhood trauma, clinicians should apply these principles and guidelines universally in order to work in a trauma-informed manner with all patients