Clinician-facilitated physical activity intervention versus pulmonary rehabilitation for improving physical activity in COPD: a feasibility study

Pulmonary rehabilitation (PR) may not suit all individuals with chronic obstructive pulmonary disease (COPD) and may not result in increased physical activity. Higher levels of physical activity are associated with reduced mortality and morbidity. The aim of this study was to assess the feasibility of conducting a trial to investigate the effectiveness of a clinician-facilitated physical activity intervention (PAI) versus PR in improving physical activity in patients with COPD referred to PR. In this randomised controlled mixed methods feasibility study, all patients referred to PR who were eligible and willing were assessed at baseline and then randomised to the PAI or to PR. The assessments were repeated post-intervention and at 3-month follow-up. The main outcome was step count measured by Actigraph. Semi-structured interviews were conducted post-intervention. The N = 50 patients; mean (SD) age, 64.1(8.6) years, 24M were recruited and randomised; N = 23 (PAI) and n = 26 (PR): one patient was excluded from the analysis as that person did not meet the GOLD diagnostic criteria. Key feasibility criteria were met; recruitment was 11%, dropouts in PAI were 26% (n = 6) and 50% (n = 13/26) PR. Participants in both groups experienced a range of health benefits from their respective programmes. The PAI appears to be effective in increasing step counts in people with COPD: mean change (standard deviation) [confidence interval] for the PAI group was 972.0(3230.3)[–1080.3 to 3024.4], n = 12 and 4.3(662.7)[-440.9 to 449.5], n = 11 for the PR group. The PAI met all domains of fidelity. This study provides key information to inform a future-randomised controlled trial in physical activity

Rates, risks and routes to reduce vascular dementia (R4vad), a UK-wide multicentre prospective observational cohort study of cognition after stroke: Protocol

Background: Stroke commonly affects cognition and, by definition, much vascular dementia follows stroke. However, there are fundamental limitations in our understanding of vascular cognitive impairment, restricting understanding of prevalence, trajectories, mechanisms, prevention, treatment and patient-service needs. Aims: Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD) is an observational cohort study of post-stroke cognition. We aim to recruit a wide range of patients with stroke, presenting to geographically diverse UK hospitals, into a longitudinal study to determine rates of, and risk factors for, cognitive and related impairments after stroke, to assess potential mechanisms and improve prediction models. Methods: We will recruit at least 2000 patients within six weeks of stroke with or without capacity to consent and collect baseline demographic, clinical, socioeconomic, lifestyle, cognitive, neuropsychiatric and informant data using streamlined patient-centred methods appropriate to the stage after stroke. We will obtain more detailed assessments at four to eight weeks after the baseline assessment and follow-up by phone and post yearly to at least two years. We will assess diagnostic neuroimaging in all and high-sensitivity inflammatory markers, genetics, blood pressure and diffusion tensor imaging in mechanistic sub-studies. Planned outputs: R4VaD will provide reliable data on long-term cognitive function after stroke, stratified by prior cognition, stroke- and patient-related variables and improved risk prediction. It will create a platform enabling sharing of data, imaging and samples. Participants will be consented for re-contact, facilitating future clinical trials and providing a resource for the stroke and dementia research communities

Intracellular signalling processes during ischaemic neurodegeneration

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

An evaluation of three remedial action alternatives for a site with lead-contaminated soils

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DEVELOPMENT OF ANALYTICAL METHODS FOR THE QUANTIFICATION OF THE CHEMICAL FORMS OF MERCURY AND OTHER TARGET POLLUTANTS IN COAL-FIRED BOILER FLUE GAS

Since approximately 55% of the electrical power produced in the U. S. is generated by coal-based power utility plants, there is serious concern about the massive amounts of coal combustion products emitted into the atmosphere annually. Furthermore, Title III of the 1990 Clean Air Act Amendments (CAAA) requires the measurement and inventory of a possible 189 hazardous air pollutants (HAPs) from any stationary source producing more than 10 tons per year of any one pollutant or more than 25 tons per year of total pollutants. Although power utilities are not presently included on the list of source categories, the CAAA requires the U. S. Environmental Protection Agency to carry out a study of emissions from electricity generation using fossil fuels. Since many of these HAPs are known to be present in coal derived flue gas, coal-fired electric power utilities may be subject to regulation following these studies if Congress considers it necessary. In a cooperative effort with the U. S. Environmental Protection Agency (EPA), the U. S. Department of Energy (DOE) through its Federal Energy Technology Center (FETC) initiated such a study in 1991. DOE-FETC commissioned five primary contractors to conduct emission studies at eight different coal-fired electric utilities. The eight sites represented a cross section of feed coal type, boiler designs, and particulate and gaseous pollutant control technologies. The major goal of these studies was to determine the sampling and analytical methodologies that could be used efficiently to perform these emission tests while producing representative and reliable emission data. The successful methodology could then be recommended to the EPA for use in compliance testing in the event the regulation of air toxic emissions from coal-fired power plants is implemented. A secondary purpose of the testing was to determine the effectiveness of the control technologies in reducing target hazardous air pollutants. Advanced Technology Systems, Inc. (ATS) as a secondary DOE contractor on this project, assessed the sampling and analytical plans and the emission reports of the five primary contractors to determine how successful the contractors were in satisfying their defined objectives. ATS identified difficulties and inconsistencies in a number of sampling and analytical methodologies in these studies. In particular there was uncertainty as to the validity of the sampling and analytical methods used to differentiate the chemical forms of mercury observed in coal flue gas. Considering the differences in the mercury species with regard to human toxicity, the rate of transport through the ecosystem and the design variations in possible emission control schemes, DOE sought an accurate and reliable means to identify and quantify the various mercury compounds emitted by coal-fired utility boilers. ATS, as a contractor for DOE, completed both bench- and pilot-scale studies on various mercury speciation methods. The final validation of the modified Ontario-Hydro Method, its acceptance by DOE and submission of the method for adoption by ASTM was a direct result of these studies carried out in collaboration with the University of North Dakota's Energy and Environmental Research Center (UNDEERC). This report presents the results from studies carried out at ATS in the development of analytical methods to identify and quantify various chemical species, particularly those of mercury, in coal derived flue gas. Laboratory- and pilot-scale studies, not only on mercury species, but also on other inorganics and organics present in coal combustion flue gas are reported

Title: Optimization of Sampling Conditions to Minimize the Adverse Effect of Sulfur Dioxide on the Ability of the Ontario-Hydro Method to Accurately Distinguish the Chemical Forms of Mercury in Coal Flue Gas Optimization of Sampling Conditions to Minimize

Background As a consequence of findings from the Phase I Emissions Studies, the U. S. Department of Energy's Federal Energy Technology Center (DOE-FETC) has focused its efforts on identifying a sampling and analytical method to differentiate and quantify the chemical forms of mercury emitted from coal-fired electric utility boilers. DOE-FETC requested ATS to develop new methodologies for determining the chemical species of mercury in coal flue gas, either by the modification of existing ones or by the introduction of novel methods with the final validation of acceptable methods. Candidate methods must be robust enough to perform effectively in the presence of flue gas components such as SO , NO , HCl and fly ash. Under contract to DOE-2 X FETC, ATS has performed both laboratory evaluations and pilot-scale studies of these methods