Fox River Watershed Investigation: Stratton Dam to the Illinois River: Phase II Blackberry Creek and Poplar Creek Hydrologic and Water Quality Simulation Models: Executive Summary

Fox River Study Group, Inc.published or submitted for publicationis peer reviewe

Development of a 10 metre shuttle walking test to access patients with chronic airways limitation

The purpose of this study was to develop an incremental field exercise test of disability to use in the assessment of functional capacity in patients with chronic airways limitation (CAL). The test was modified from the 20m shuttle running test, employed to predict the maximal oxygen uptake of sporting individuals. The protocol devised for the patients was adapted from the running speeds proposed by Leger and Lambert (1982). The shuttle walking test requires patients to walk up and down a 10m course at speeds dictated by a series of audio signals played from a tape cassette, increasing each minute to a symptom limited maximum performance. Examination of the reproducibility of the test revealed strong test/retest reliability, after just one practice walk. The mean between trial difference (test 2 vs test 3) was -2m,(n=10), (95% CI -21.9 to 17.9m). The shuttle walking test was validated against the traditional measurement of peak oxygen uptake (Vo2pmk) measured conventionally during an incremental maximal treadmill test with Douglas bags (n=19). The results from this exercise test were compared against the patients' performance (distance achieved) on the shuttle walking test (after one practice walk) and revealed a strong relationship between the two variables (r=0.88). The validity and the resistance to breathing, of a portable oxygen consumption meter was examined. Validation, again in comparison to Douglas bag measurements, involved four cohorts (two healthy and two patient groups). After some modifications to the equipment, measurements of lib2 by the two different methods were not significantly different. The patients' response to the shuttle walking test was examined (n=10). The heart rate, ventilation and 7Orck2 increased gradually in response to the increasing intensity of the shuttle walking test. Again Vo 2wa measurements related strongly to the patients performance (r=0.81). A further study employing a treadmill test and shuttle walking test confirmed that the latter provided a comparable metabolic and physiological challenge to the patients as the conventional treadmill test. Comparison with the 6 minute walking test (6MWT), one of the most commonly employed field exercise tests in this patient population) revealed that the heart rate response was significantly higher in the shuttle walking test than the 6 MWT and graded, a response not observed in the 6MWT. The shuttle test reflected the true extent of the patients disability more accurately than the 6MWT. The shuttle walking test provides a simple, reproducible exercise test of disability in patients with CAL that relates well to Vb2puk . The external pacing of the test allows more valid intra- and inter- subject comparison than has previously been possible with field tests alone

City of Charleston public water supply: analysis of drought yields from the Charleston side-channel reservoir

"Prepared for the City of Charleston.""April 1996.

Basinwide instream flow assessment model to evaluate instream flow needs

Quantification of sufficient or minimum flows needed to sustain the aquatic habitat is necessary for satisfactory resolution of water use conflicts and planning of water allocation strategies. The Instream Flow Group (IFG) of the U.S. Fish and Wildlife Service has developed a methodology to gage the quantity of suitable habitat in a stream. Application of the methodology requires information on the local variations of depth and velocity in a stream reach. Conventional flow models are inadequate for this application, and evaluation of aquatic habitats requires extensive field work. Results obtained in a study reach cannot be applied to other reaches with dissimilar areas. To address the problem of defining the local variation of depths and velocities for regional habitat evaluation, a probabilistic flow model is developed. The probabilistic model incorporates hydraulic geometry relationships to evaluate average flow parameter values without the necessity of field observations. Local variations of depth and velocity values are evaluated from probability distribution models developed from field data collected on the Sangamon and South Fork Sangamon River basins. The flow model simulation for calculating stream habitat suitability with the IFG methodology is illustrated.U.S. Geological SurveyU.S. Department of the InteriorOpe

Self-management programme of activity coping and education-SPACE for COPD(C)-in primary care: a pragmatic randomised trial

INTRODUCTION: We have previously developed a supported self-management programme (SMP): Self-management Programme of Activity, Coping and Education for chronic obstructive pulmonary disease (COPD), which was successfully delivered on an individual basis. Payers expressed an interest in delivering the intervention in groups. AIM: To explore the feasibility, acceptability and clinical effectiveness of the intervention delivered and supported by healthcare professionals (HCPs) in groups within primary care. METHODS: A prospective, single-blinded randomised controlled trial was conducted, with follow-up at 6 and 9 months. Participants were randomly assigned to control (usual care) or intervention (a six-session, group-based SMP delivered over 5 months). The primary outcome was change in COPD Assessment Test (CAT) at 6 months. Semistructured focus groups were conducted with intervention participants to understand feasibility and acceptability. A focus group was conducted with HCPs who delivered the intervention to gain insight into any potential facilitators/barriers to implementing the intervention in practice. All qualitative data were analysed thematically. RESULTS: 193 participants were recruited, (median Medical Research Council (MRC) grade 2). There was no significant difference between the intervention and control group for the primary outcome (CAT). However, an improvement in self-reported patient activation (at 6 and 9 months), knowledge (at 6 months), mastery (at 6 and 9 months) and fatigue (at 6 months), in the intervention group compared with usual care was demonstrated. Qualitative results indicated that the intervention was acceptable to patients who took part in the intervention and HCPs valued the intervention, suggesting it might be best delivered early in the disease process. CONCLUSIONS: A supported self-management intervention is feasible and acceptable when delivered as a group-based intervention, by HCPs in the community

ISHLT primary graft dysfunction incidence, risk factors and outcome: a UK national study

Background: Heart transplantation (HTx) remains the most effective long-term treatment for advanced heart failure. Primary graft dysfunction (PGD) continues to be a potentially life-threatening early complication. In 2014, a consensus statement released by ISHLT established diagnostic criteria for PGD. We studied the incidence of PGD across the UK. Methods: We analysed the medical records of all adult patients who underwent heart transplantation between October 2012-October 2015 in the 6 UK heart transplant centers Preoperative donor and recipient characteristics, intraoperative details and posttransplant complications were compared between the PGD and non PGD groups using the ISHLT definition. Multivariable analysis was performed using logistic regression. Results: The incidence of ISHLT PGD was 36%. Thirty-day all-cause mortality in those with and without PGD was 31(19%) vs 13(4.5%) (p=0.0001). Donor, recipient and operative factors associated with PGD were: recipient diabetes mellitus (p=0.031), recipient preoperative BIVAD(p<0.001) and preoperative ECMO (p=0.023), female donor to male recipient gender mismatch(p=0.007) older donor age (p=0.010) and intracerebral haemorrhage/thrombosis in donor (p=0.023). Intra-operatively, implant time (p=0.017) and bypass time(p<0.001) were significantly longer in the PGD cohort. Perioperatively, patients with PGD received more blood products (p<0.001). Risk factors identified by multivariable logistic regression were donor age (p=0.014), implant time (p=0.038), female: male mismatch (p=0.033), recipient diabetes (p=0.051) and preoperative VAD/ECMO support (p=0.012), Conclusion: This is the first national study to examine the incidence and significance of PGD after heart transplantation using the ISHLT definition. PGD remains a frequent early complication of heart transplantation and is associated with increased mortality

Exercise induced skeletal muscle metabolic stress is reduced after pulmonary rehabilitation in COPD

SummaryIn COPD, skeletal muscle ATP resynthesis may be insufficient to meet demand during exercise due to excessive anaerobic and reduced oxidative (mitochondrial) energy production, leading to metabolic stress. We investigated the effect of outpatient pulmonary rehabilitation (PR) on the metabolic response (measured by exercise-induced accumulation of plasma ammonia) and determined whether this response predicted functional improvement following PR.25 subjects with stable COPD [mean (SD) age 67 (8)years and FEV1 47 (18)% predicted] performed maximal cycling ergometry before and after PR. Plasma ammonia was measured at rest, during exercise and 2 min post-exercise.Following PR, there were significant increases in peak cycle WR and ISWT performance (Mean (SEM) changes 13.1 (2.0) W and 93 (15) m respectively, p < 0.001). Mean (SEM) rise in plasma ammonia was reduced at peak (Pre vs Post-PR: 29.0 (4.5) vs 20.2 (2.5) μmol/l, p < 0.05) and isotime (Pre vs Post-PR: 29.0 (4.5) vs 10.6 (1.7) μmol/l, p < 0.001) exercise. Improvements in exercise performance after PR were similar among subgroups who did versus those who did not show a rise in ammonia at baseline.The results suggest that muscle cellular energy production was better matched to the demands of exercise following PR. We conclude that a pragmatic outpatient PR programme involving high intensity walking exercise results in significant adaptation of the skeletal muscle metabolic response with a reduction in exercise-related metabolic stress. However, the outcome of PR could not be predicted from baseline metabolic response

Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial

Introduction: Patients with COPD experience exacerbations that may require hospitalization. Patients do not always feel supported upon discharge and frequently get readmitted. A Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD), a brief self-management program, may help address this issue. Objective: To investigate if SPACE for COPD employed upon hospital discharge would reduce readmission rates at 3 months, compared with usual care. Methods: This is a prospective, single-blinded, two-center trial (ISRCTN84599369) with participants admitted for an exacerbation, randomized to usual care or SPACE for COPD. Measures, including health-related quality of life and exercise capacity, were taken at baseline (hospital discharge) and at 3 months. The primary outcome measure was respiratory readmission at 3 months. Results: Seventy-eight patients were recruited (n=39 to both groups). No differences were found in readmission rates or mortality at 3 months between the groups. Ten control patients were readmitted within 30 days compared to five patients in the intervention group (P>0.05). Both groups significantly improved their exercise tolerance and Chronic Respiratory Questionnaire (CRQ-SR) results, with between-group differences approaching statistical significance for CRQ-dyspnea and CRQ-emotion, in favor of the intervention. The “Ready for Home” survey revealed that patients receiving the intervention reported feeling better able to arrange their life to cope with COPD, knew when to seek help about feeling unwell, and more often took their medications as prescribed, compared to usual care (P<0.05). Conclusion: SPACE for COPD did not reduce readmission rates at 3 months above that of usual care. However, encouraging results were seen in secondary outcomes for those receiving the intervention. Importantly, SPACE for COPD appears to be safe and may help prevent readmission with 30 days