103 research outputs found
Adolescents in clinical remission of atopic asthma have elevated exhaled nitric oxide levels and bronchial hyperresponsiveness
Symptoms of atopic asthma often decrease or even seem to disappear around
puberty. The aim of this study was to investigate whether this so-called
clinical remission is accompanied by remission of airway inflammation,
since symptoms relapse in a substantial proportion of subjects later in
life. To assess indicators of inflammation and/or structural damage of the
airways, exhaled nitric oxide (eNO) and bronchial responsiveness to
adenosine-5'-monophosphate (AMP) and methacholine (MCh) were determined in
21 subjects in clinical remission of atopic asthma. Clinical remission was
defined as complete absence of symptoms of asthma without the use of any
medication in the year preceding the study. Results were compared with
those of 21 patients with current asthma and 18 healthy control subjects.
We found significantly higher eNO values in the remission group than in
healthy controls (geometric mean, 18.9 and 1.0 ppb, respectively; p <
0.001) whereas eNO values of the remission group and those of the subjects
with current asthma (geometric mean, 21.9 ppb) were similar (p = 0.09).
The responsiveness to both AMP and MCh of subjects in clinical remission
was significantly higher as compared with responsiveness of healthy
controls, and lower than responsiveness of subjects with current asthma. A
significant correlation could be established between eNO and
responsiveness to AMP, but not between eNO and responsiveness to MCh. The
results of this study are suggestive of persistent airway inflammation
during clinical remission of atopic asthma. We speculate that subclinical
inflammation is a risk factor for asthma relapse later in life, and that
eNO and responsiveness to both AMP and MCh can be used as different,
noninvasive indices of the inflammatory process of the airways
Dyspnoea perception during clinical remission of atopic asthma
Symptoms of atopic asthma often disappear around puberty. The authors
recently demonstrated that this clinical remission is accompanied with
ongoing airways inflammation in most subjects. The discrepancy between
lack of symptoms and persistent airway inflammation suggests that
perception of the symptoms is unclear. In the present study, young adults
in clinical remission of atopic asthma assigned themselves a modified Borg
score during methacholine and adenosine-5'-monophosphate induced
bronchoconstriction. Borg scores of subjects in clinical remission were
compared with those of symptomatic asthmatic subjects. A marked variation
in the Borg scores at a 20% fall in the forced expiratory volume in one
second was found. Significant differences in Borg scores between remission
patients and asthmatics could not be detected. It was concluded that
perception of dyspnoea, induced with methacholine and adenosine challenge,
is similar in young adults in clinical remission of atopic asthma compared
to that of patients with symptomatic asthma. Hence, an unclear perception
seems to be an unlikely explanation for the discrepancy between lack of
symptoms and ongoing inflammation. Other factors, including both physical
and psychological ones, may play a role in the apparent absence of
symptoms, thereby potentially leading to undertreatment
Simulating an integrated critiquing system
OBJECTIVE: To investigate factors that determine the feasibility and
effectiveness of a critiquing system for asthma/COPD that will be
integrated with a general practitioner's (GP's) information system.
DESIGN: A simulation study. Four reviewers, playing the role of the
computer, generated critiquing comments and requests for additional
information on six electronic medical records of patients with
asthma/COPD. Three GPs who treated the patients, playing users, assessed
the comments and provided missing information when requested. The GPs were
asked why requested missing information was unavailable. The reviewers
reevaluated their comments after receiving requested missing information.
MEASUREMENTS: Descriptions of the number and nature of critiquing comments
and requests for missing information. Assessment by the GPs of the
critiquing comments in terms of agreement with each comment and judgment
of its relevance, both on a five-point scale. Analysis of causes for the
(un-)availability of requested missing information. Assessment of the
impact of missing information on the generation of critiquing comments.
RESULTS: Four reviewers provided 74 critiquing comments on 87 visits in
six medical records. Most were about prescriptions (n = 28) and the GPs'
workplans (n = 27). The GPs valued comments about diagnostics the most.
The correlation between the GPs' agreement and relevance scores was 0.65.
However, the GPs' agreements with prescription comments (complete
disagreement, 31.3%; disagreement, 20.0%; neutral, 13.8%; agreement,
17.5%; complete agreement, 17.5%) differed from their judgments of these
comments' relevance (completely irrelevant, 9.0%; irrelevant, 24.4%;
neutral, 24.4%; relevant, 32.1%; completely relevant, 10.3%). The GPs were
able to provide answers to 64% of the 90 requests for missing information.
Reasons available information had not been recorded were: the GPs had not
recorded the information explicitly; they had assumed it to be common
knowledge; it was available elsewhere in the record. Reasons information
was unavailable were: the decision had been made by another; the GP had
not recorded the information. The reviewers left 74% of the comments
unchanged after receiving requested missing information. CONCLUSION: Human
reviewers can generate comments based on information currently available
in electronic medical records of patients with asthma/COPD. The GPs valued
comments regarding the diagnostic process the most. Although they judged
prescription comments relevant, they often strongly disagreed with them, a
discrepancy that poses a challenge for the presentation of critiquing
comments for the future critiquing system. Requested additional
information that was provided by the GPs led to few changes. Therefore, as
system developers faced with the decision to build an integrated,
non-inquisitive or an inquisitive critiquing system, the authors choose
the former
Quality of life and psychosocial outcomes in children with severe acute asthma and their parents
Objectives: To prospectively evaluate quality of life (QoL) and psychosocial outcomes in children with severe acute asthma (SAA) after pediatric intensive care (PICU) admission compared to children with SAA who were admitted to a general ward (GW). In addition, we assessed posttraumatic stress (PTS) and asthma-related QoL in the parents. Methods: A preplanned follow-up of 3 to 9 months of our nationwide prospective multicenter study, in which children with SAA admitted to a Dutch PICU (n = 110) or GW (n = 111) were enrolled between 2016 and 2018. Asthma-related QoL, PTS symptoms, emotional and behavioral problems, and social impact in children and/or parents were assessed with validated web-based questionnaires. Results: We included 100 children after PICU and 103 after GW admission, with a response rate of 50% for the questionnaires. Median time to follow-up was 5 months (range: 1-12 months). Time to reach full schooldays after admission was significantly longer in the PICU group (mean of 10 vs 4 days, P =.001). Parents in the PICU group reported more PTS symptoms (intrusion P =.01, avoidance P =.01, arousal P =.02) compared to the GW group. Conclusion: No significant differences were found between PICU and GW children on self-reported outcome domains, except for the time to reach full schooldays. PICU parents reported PTS symptoms more often than the GW group. Therefore, monitoring asthma symptoms and psychosocial screening of children and parents after PICU admission should both be part of standard care after SAA. This should identify those who are at risk for developing PTSD, to timely provide appropriate interventions
Criticality in confined ionic fluids
A theory of a confined two dimensional electrolyte is presented. The positive
and negative ions, interacting by a potential, are constrained to move on
an interface separating two solvents with dielectric constants and
. It is shown that the Debye-H\"uckel type of theory predicts that
the this 2d Coulomb fluid should undergo a phase separation into a coexisting
liquid (high density) and gas (low density) phases. We argue, however, that the
formation of polymer-like chains of alternating positive and negative ions can
prevent this phase transition from taking place.Comment: RevTex, no figures, in press Phys. Rev.
Modification of the Two-Point Scaling Theory for the Description of the Phase Transition in Solution. Analysis of Sodium Octanoate Aqueous Solutions
On the basis of conventional scaling theory, the two-point scaling theory was modified in order to describe the influence of composition on the partial molar heat capacity and volume during the micellization process. To verify the theory, isobaric heat capacities and densities of aqueous sodium octanoate solutions were measured over wide composition and temperature ranges and the modified approach was used to analyze the calculated partial molar heat capacities and volumes of the surfactant in water. The results obtained indicate that the micellization process is subject to the scaling laws. The results were compared with those for other systems. Peculiar behavior of the critical indices was observed and correlated with the structure of the micelles
Children with severe acute asthma admitted to Dutch PICUs: A changing landscape
The number of children requiring pediatric intensive care unit (PICU) admission for severe acute asthma (SAA) around the world has increased. Objectives: We investigated whether this trend in SAA PICU admissions is present in the Netherlands. Methods: A multicenter retrospective cohort study across all tertiary care PICUs in the Netherlands. Inclusion criteria were children (2-18 years) hospitalized for SAA between 2003 and 2013. Data included demographic data, asthma diagnosis, treatment, and mortality. Results: In the 11-year study period 590 children (660 admissions) were admitted to a PICU with a threefold increase in the number of admissions per year over time. The severity of SAA seemed unchanged, based on the first blood gas, length of stay and mortality rate (0.6%). More children received highflow nasal cannula (P<0.001) and fewer children needed invasive ventilation (P<0.001). In 58% of the patients the maximal intravenous (IV) salbutamol infusion rate during PICU admission was 1mcg/kg/min. However, the number of patients treated with IV salbutamol in the referring hospitals increased significantly over time (P=0.005). The proportion of steroid-naĂŻve patients increased from 35% to 54% (P=0.004), with a significant increase in both age groups (2-4 years [P=0.026] and 5-17 years [P=0.036]). Conclusions: The number of children requiring PICU admission for SAA in the Netherlands has increased. We speculate that this threefold increase is explained by an increasing number of steroid-naĂŻve children, in conjunction with a lowered threshold for PICU admission, possibly caused by earlier use of salbutamol IV in the referring hospitals
Does high-dose metformin cause lactic acidosis in type 2 diabetic patients after CABG surgery? A double blind randomized clinical trial
Metformin is a dimethyl biguanide oral anti-hyperglycemic agent. Lactic acidosis due to metformin is a fatal metabolic condition that limits its use in patients in poor clinical condition, consequently reducing the number of patients who benefit from this medication. In a double blind randomized clinical trial, we investigated 200 type 2 diabetic patients after coronary artery bypass surgery in the open heart ICU of the Mazandaran Heart Center, and randomly assigned them to equal intervention and control groups. The intervention group received regular insulin infusion along with 2 metformin 500 mg tablets every twelve hours, while the control group received only intravenous insulin with 2 placebo tablets every twelve hours. Lactate level, pH, base excess, blood glucose and serum creatinine were measured over five 12 h periods, with data averaged for each period. The primary outcome in this study was high lactate levels. Comparison between the 2 groups was made by independent Studentâs t-test. To compare changes in multiple measures in each group and analysis of group interaction, a repeated measurement ANOVA test was used
Dipolar origin of the gas-liquid coexistence of the hard-core 1:1 electrolyte model
We present a systematic study of the effect of the ion pairing on the
gas-liquid phase transition of hard-core 1:1 electrolyte models. We study a
class of dipolar dimer models that depend on a parameter R_c, the maximum
separation between the ions that compose the dimer. This parameter can vary
from sigma_{+/-} that corresponds to the tightly tethered dipolar dimer model,
to R_c --> infinity, that corresponds to the Stillinger-Lovett description of
the free ion system. The coexistence curve and critical point parameters are
obtained as a function of R_c by grand canonical Monte Carlo techniques. Our
results show that this dependence is smooth but non-monotonic and converges
asymptotically towards the free ion case for relatively small values of R_c.
This fact allows us to describe the gas-liquid transition in the free ion model
as a transition between two dimerized fluid phases. The role of the unpaired
ions can be considered as a perturbation of this picture.Comment: 16 pages, 13 figures, submitted to Physical Review
Nationalism, resistance, and patriarchy: the poetry of Saharawi women
The arts, and in particular poetry, have been swords of resistance for the Saharawis since the 1975 Moroccan and Mauritanian invasion and subsequent occupation of their country. In this article, I aim to investigate whether Saharawi women writers go further than the more common objects of Saharawi resistance and fight against patriarchy. Firstly, I focus on the work of the Saharawi 'Friendship Generation' of writers, exploring the Generation's collective (nationalist) aims. Secondly, I look at the construction of gender in Saharawi poetry, analysing how gender, particularly the idea of woman and femininity, are imagined according to the sex-identification of the author
- âŠ