The use of the practice walk test in pulmonary rehabilitation program: National COPD Audit Pulmonary Rehabilitation Workstream

Our aim was to evaluate the use and impact of the practice walk test on enrolment, completion, and clinical functional response to pulmonary rehabilitation (PR) using the 2015 UK National Chronic Obstructive Pulmonary Disease (COPD) Pulmonary Rehabilitation audit data. Patients were assessed according to whether a baseline practice walk test was performed or not. Study outcomes included use of the practice walk test, baseline and change in incremental shuttle walk test distance (ISWD) or 6-minute walk test distance (6MWD), and enrolment to and completion of PR program. Of 7,355 patients, only 1,666 (22.6%) had a baseline practice test. At baseline, the practice walk test group walked further as compared to the no practice walk test group: ISWD, 17.9 m [95% confidence interval (CI) 8.2–27.5 m] and 6MWD, 34.8 m (95% CI 24.7–44.9 m). The practice walk test group were 2.2 times (95% CI 1.8–2.6) more likely to enroll and 17% (95% CI 1.03–1.34) more likely to complete PR. Although the change in ISWD and 6MWD with PR was lower in the practice walk test group, they walked further at discharge assessment. Only 22.6% of the patients in the 2015 National PR audit had a practice walk test at assessment. Those who did had better enrolment, completion, and better baseline walking distance, from which the prescription is set

Exact, E=0, Solutions for General Power-Law Potentials. I. Classical Orbits

For zero energy, $E=0$, we derive exact, classical solutions for {\em all} power-law potentials, $V(r)=-\gamma/r^\nu$, with $\gamma>0$ and $-\infty <\nu<\infty$. When the angular momentum is non-zero, these solutions lead to the orbits $\r(t)= [\cos \mu (\th(t)-\th_0(t))]^{1/\mu}$, for all $\mu \equiv \nu/2-1 \ne 0$. When $\nu>2$, the orbits are bound and go through the origin. This leads to discrete discontinuities in the functional dependence of $\th(t)$ and $\th_0(t)$, as functions of $t$, as the orbits pass through the origin. We describe a procedure to connect different analytic solutions for successive orbits at the origin. We calculate the periods and precessions of these bound orbits, and graph a number of specific examples. Also, we explain why they all must violate the virial theorem. The unbound orbits are also discussed in detail. This includes the unusual orbits which have finite travel times to infinity and also the special $\nu = 2$ case.Comment: LaTeX, 27 pages with 12 figures available from the authors or can be generated from Mathematica instructions at end of the fil

Magneto-elastic torsional oscillations of magnetars

We extend a general-relativistic ideal magneto-hydrodynamical code to include the effects of elasticity. Using this numerical tool we analyse the magneto-elastic oscillations of highly magnetised neutron stars (magnetars). In simulations without magnetic field we are able to recover the purely crustal shear oscillations within an accuracy of about a few per cent. For dipole magnetic fields between 5 x 10^13 and 10^15 G the Alfv\'en oscillations become modified substantially by the presence of the crust. Those quasi-periodic oscillations (QPOs) split into three families: Lower QPOs near the equator, Edge QPOs related to the last open field line and Upper QPOs at larger distance from the equator. Edge QPOs are called so because they are related to an edge in the corresponding Alfv\'en continuum. The Upper QPOs are of the same kind, while the Lower QPOs are turning-point QPOs, related to a turning point in the continuous spectrum.Comment: 6 pages, 1 figure, 1 table, Proceedings of NEB14, to appear in J. Phys.: Conf. Se

Ventilatory requirements of quadriceps resistance training in people with COPD and healthy controls.

BACKGROUND: It is proposed that resistance training (RT) does not activate the cardiopulmonary system to the same extent as whole-body exercise. This is important for patients with chronic obstructive pulmonary disease (COPD) who are ventilatory limited. OBJECTIVE: The aim was to assess the ventilatory response to an isokinetic quadriceps RT program in people with COPD and healthy controls. DESIGN: Observational. REGISTRATION NUMBER: ISRCTN22764439. SETTING: Outpatient, university teaching hospital. PARTICIPANTS AND OUTCOME MEASURES: People with COPD (n=14) and healthy controls (n=11) underwent breath-by-breath analysis of their ventilation during an RT session (five sets of 30 maximal knee extensions at 180°/sec). Subjects performed a maximal cycle ergometry test (CET) at baseline. Peak ventilation (VE; L/min) and oxygen consumption (VO2; mL/kg/min) were collected. The same system measured VO2 and VE during the RT session. Parameters are presented as a percentage of the maximal CET. Isokinetic workload, symptom scores, heart rate (HR), and oxygen saturation were documented post-training. RESULTS: People with COPD worked at higher percentages of their maximal capacity than controls (mean range between sets 1-5 for VO2 =49.1%-60.1% [COPD], 45.7%-51.43% [controls] and for VE =57.6%-72.2% [COPD], 49.8%-63.6% [controls]), although this was not statistically significant (P>0.1 in all cases). In absolute terms, the difference between groups was only significant for actual VO2 on set 2 (P<0.05). Controls performed more isokinetic work than patients with COPD (P<0.05). Median Borg symptom scores after RT were the same in both groups (3 breathlessness, 13 exertion), no de-saturation occurred, and both groups were training at ≥65% of their maximum HR. CONCLUSION: No statistically significant differences were found between people with COPD and healthy controls for VO2 and VE achieved during training. The symptoms associated with training were within acceptable limits

Imprints of Nuclear Symmetry Energy on Properties of Neutron Stars

Significant progress has been made in recent years in constraining the density dependence of nuclear symmetry energy using terrestrial nuclear laboratory data. Around and below the nuclear matter saturation density, the experimental constraints start to merge in a relatively narrow region. At supra-saturation densities, there are, however, still large uncertainties. After summarizing the latest experimental constraints on the density dependence of nuclear symmetry energy, we highlight a few recent studies examining imprints of nuclear symmetry energy on the binding energy, energy release during hadron-quark phase transitions as well as the $w$-mode frequency and damping time of gravitational wave emission of neutron stars.Comment: 10 pages. Invited talk given in the Nuclear Astrophysics session of INPC2010, July 4-9, 2010, Vancouver, Canada; Journal of Physics: Conference Series (2011

Depression and sickness behavior are Janus-faced responses to shared inflammatory pathways

It is of considerable translational importance whether depression is a form or a consequence of sickness behavior. Sickness behavior is a behavioral complex induced by infections and immune trauma and mediated by pro-inflammatory cytokines. It is an adaptive response that enhances recovery by conserving energy to combat acute inflammation. There are considerable phenomenological similarities between sickness behavior and depression, for example, behavioral inhibition, anorexia and weight loss, and melancholic (anhedonia), physio-somatic (fatigue, hyperalgesia, malaise), anxiety and neurocognitive symptoms. In clinical depression, however, a transition occurs to sensitization of immuno-inflammatory pathways, progressive damage by oxidative and nitrosative stress to lipids, proteins, and DNA, and autoimmune responses directed against self-epitopes. The latter mechanisms are the substrate of a neuroprogressive process, whereby multiple depressive episodes cause neural tissue damage and consequent functional and cognitive sequelae. Thus, shared immuno-inflammatory pathways underpin the physiology of sickness behavior and the pathophysiology of clinical depression explaining their partially overlapping phenomenology. Inflammation may provoke a Janus-faced response with a good, acute side, generating protective inflammation through sickness behavior and a bad, chronic side, for example, clinical depression, a lifelong disorder with positive feedback loops between (neuro)inflammation and (neuro)degenerative processes following less well defined triggers

An aesthetic of the unknown

This paper begins to establish an 'aesthetic of the unknown' by drawing together theorists and approaches from mainstream art criticism to provide a starting-point for an aesthetic sympathetic with Jungian perspectives, in an attempt to bridge a gap between contemporary abstract painting, contemporary art theory and Jungian studies. This is a framework for approaching the abstract painting not as an object awaiting interpretation or 'reading', but rather as something that offers a numinous experience (or experience of the unknown), which can be thought about but may remain ultimately unknowable and irreducible. Such experience - involving both the unconscious and conscious mind - would provide glimpsesof forms of meaning not accessible to full rational exposition. This type of uncosciously understood meaning is explored, acknowledging that there is a need to preserve this encounter with the unknown and a need for a contemporary critical, theoretical framework that recognises the importance of this within abstract painting

Persistence of serogroup C antibody responses following quadrivalent meningococcal conjugate vaccination in United States military personnel

AbstractSerogroup C meningococcal (MenC) disease accounts for one-third of all meningococcal cases and causes meningococcal outbreaks in the U.S. Quadrivalent meningococcal vaccine conjugated to diphtheria toxoid (MenACYWD) was recommended in 2005 for adolescents and high risk groups such as military recruits. We evaluated anti-MenC antibody persistence in U.S. military personnel vaccinated with either MenACYWD or meningococcal polysaccharide vaccine (MPSV4). Twelve hundred subjects vaccinated with MenACYWD from 2006 to 2008 or MPSV4 from 2002 to 2004 were randomly selected from the Defense Medical Surveillance System. Baseline serologic responses to MenC were assessed in all subjects; 100 subjects per vaccine group were tested during one of the following six post-vaccination time-points: 5–7, 11–13, 17–19, 23–25, 29–31, or 35–37 months. Anti-MenC geometric mean titers (GMT) were measured by rabbit complement serum bactericidal assay (rSBA) and geometric mean concentrations (GMC) by enzyme-linked immunosorbent assay (ELISA). Continuous variables were compared using the Wilcoxon rank sum test and the proportion of subjects with an rSBA titer ≥8 by chi-square. Pre-vaccination rSBA GMT was <8 for the MenACWYD group. rSBA GMT increased to 703 at 5–7 months post-vaccination and decreased by 94% to 43 at 3 years post-vaccination. GMT was significantly lower in the MenACWYD group at 5–7 months post-vaccination compared to the MPSV4 group. The percentage of MenACWYD recipients achieving an rSBA titer of ≥8 decreased from 87% at 5–7 months to 54% at 3 years. There were no significant differences between vaccine groups in the proportion of subjects with a titer of ≥8 at any time-point. GMC for the MenACWYD group was 0.14μg/mL at baseline, 1.07μg/mL at 5–7 months, and 0.66μg/mL at 3 years, and significantly lower than the MPSV4 group at all time-points. Anti-MenC responses wane following vaccination with MenACYWD; a booster dose is needed to maintain protective levels of circulating antibody