Palliative care for people with non-malignant lung disease: summary of current evidence and future direction

Background: The physical and psychosocial needs of patients with chronic non-malignant lung disease are comparable to those with lung cancer. This article will focus on chronic obstructive pulmonary disease, interstitial lung disease and cystic fibrosis as examples of life-limiting, non-curable and non-malignant lung diseases. The need for supportive and palliative care: Recent national guidance has demanded that palliative care is inclusive of all patients with life-limiting disease, irrespective of diagnosis, and that specialist palliative care teams are involved in the management of patients on a basis of need rather than prognosis. What is known: Despite medical therapy, most patients with moderate to severe chronic obstructive pulmonary disease, interstitial lung disease and cystic fibrosis experience pain, fatigue and dyspnoea, with the majority not getting relief from dyspnoea towards the end of life. Furthermore, dyspnoea causes social isolation and difficulty performing activities of daily living and impairs quality of life. There is an increasing evidence base for the assessment of supportive and palliative care needs, symptom interventions, prognostication, models of service delivery and implications of these for clinical practice and research in non-malignant lung diseases. What is unknown: Despite advances, much still remains unknown regarding assessment, management and prognostication in individual chronic non-malignant lung diseases. Although different service models are being used in clinical practice, the optimal model(s) of service delivery remain unknown. Implication for future research, policy and practice: We describe key areas for further research, which include the need for large, high-quality trials of pharmacological and non-pharmacological interventions and their combinations as well as evaluation of the efficacy and cost-effectiveness of models of care. As access to palliative care is poor for these patients, the barriers to referral need to be understood and reduced, which along with effective working between palliative care teams, with respiratory services backup, should optimise delivery of care in patients with life-limiting non-malignant lung disease

The Fundamental Aspects of Iron Ore Reduction

Iron ore reduction is the conversion of iron oxide minerals to metallic iron. The chemical reactions inv-olved take place in the blast furnace during the prod-uction of hot metal or in the several proposed solid- state processes that produce sponge iron. Because there are three oxides of iron, hematite magnetite and wustite and because both carbon and hydrogen are used as reducing agents, the fundamental aspects of the reduction process are rather complex. It is therefore important that these fundamentals be throughly understood in the development of a new process if sucess is to be achieved

A numerical simulation of the NFAC (National Full-scale Aerodynamics Complex) open-return wind tunnel inlet flow

The flow into an open return wind tunnel inlet was simulated using Euler equations. An explicit predictor-corrector method was employed to solve the system. The calculation is time-accurate and was performed to achieve a steady-state solution. The predictions are in reasonable agreement with the experimental data. Wall pressures are accurately predicted except in a region of recirculating flow. Flow-field surveys agree qualitatively with laser velocimeter measurements. The method can be used in the design process for open return wind tunnels

Development and screening of selective catalysts for the synthesis of clean liquid fuels

This article is a compilation of the research carried out under EEC contract EN3V-0400-D at the Institut für Energieverfahrenstechnik in Jülich and at the Faculty of Chemical Technology and Materials Science, Delft, concerning the development and screening of copper/cobalt-based catalysts for the synthesis of alcohol mixtures from syngas. Analogous work, based on copper/zinc oxide/alumina catalysts, has been performed at the Faculty of Chemical Technology in Twente University at Enschede. This work is described in a companion paper. Comparative tests of several catalysts in a pressure micropulse reactor and in a plug flow tubular reactor, carried out at the Institut für Technische Chemie, TU Braunschweig, are presented in a second companion paper. \ud In the discussion section of the present article the results obtained by the joint groups are compared with the initial objectives of the programme

Adaptable buildings for sustainable built environment

Purpose – The purpose of this paper is to explore the ability of “adaptable buildings” to respond to future potential built environment changes in sustainable way. Design/methodology/approach – A detailed literature review and a case study were undertaken to identify the life cycle changes of typical buildings over a period of more than 100 years. In total, 12 semi-structured interviews were conducted among construction industry professionals to identify how adaptable buildings enhance sustainability within the built environment. Case study data were analysed through a Morphological Analysis, and the interview data were analysed through discourse analysis. Findings – Out of the many adaptable features, the results revealed “change of use” as the dominant trend within the buildings of the selected urban cluster. More than 60 per cent of buildings have changed their original use during their life cycle. Around 10 per cent of them have changed their use frequently (every six year) during the last 20 years thereby signalling an increase in the rate of change. The positive contribution of adaptable buildings in achieving sustainability in terms of economic, social and environmental considerations, were confirmed through the analysis of semi-structured interviews. Originality/value – This paper reports a longitudinal study spanning over 100 years, exploring the extent of building adaptation within a selected cluster of Liverpool city centre, UK. The study further confirms the need to incorporate adaptability as a key criterion when designing buildings. The increased rate at which “change of use” has occurred further reinforces the need. Lack of a track record of designing for reuse makes this an interesting challenge for the construction industry, hence likely to have significant implications for policy/strategy formulation

The Influence of pH on the Combustion Properties of Bio-Coal Following Hydrothermal Treatment of Swine Manure

The application of excessive amounts of manure to soil prompted interest in using alternative approaches for treating slurry. One promising technology is hydrothermal carbonisation (HTC) which can recover nutrients such as phosphorus and nitrogen while simultaneously making a solid fuel. Processing manure under acidic conditions can facilitate nutrient recovery; however, very few studies considered the implications of operating at low pH on the combustion properties of the resulting bio-coal. In this work, swine manure was hydrothermally treated at temperatures ranging from 120 to 250 °C in either water alone or reagents including 0.1 M NaOH, 0.1 M H2SO4, and finally 0.1 M organic acid (CH3COOH and HCOOH). The influence of pH on the HTC process and the combustion properties of the resulting bio-coals was assessed. The results indicate that pH has a strong influence on ash chemistry, with decreasing pH resulting in an increased removal of ash. The reduction in mineral matter influences the volatile content of the bio-coal and its energy content. As the ash content in the final bio-coal reduces, the energy density increases. Treatment at 250 °C results in a more “coal like” bio-coal with fuel properties similar to that of lignite coal and a higher heating value (HHV) ranging between 21 and 23 MJ/kg depending on pH. Processing at low pH results in favourable ash chemistry in terms of slagging and fouling. Operating at low pH also appears to influence the level of dehydration during HTC. The level of dehydration increases with decreasing pH, although this effect is reduced at higher temperatures. At higher-temperature processing (250 °C), operating at lower pH increases the yield of bio-coal; however, at lower temperatures (below 200 °C), the reverse is true. The lower yields obtained below 200 °C in the presence of acid may be due to acid hydrolysis of carbohydrate in the manure, whereas, at the higher temperatures, it may be due to the acid promoting polymerisation

Entanglement Sharing and Decoherence in the Spin-Bath

The monogamous nature of entanglement has been illustrated by the derivation of entanglement sharing inequalities - bounds on the amount of entanglement that can be shared amongst the various parts of a multipartite system. Motivated by recent studies of decoherence, we demonstrate an interesting manifestation of this phenomena that arises in system-environment models where there exists interactions between the modes or subsystems of the environment. We investigate this phenomena in the spin-bath environment, constructing an entanglement sharing inequality bounding the entanglement between a central spin and the environment in terms of the pairwise entanglement between individual bath spins. The relation of this result to decoherence will be illustrated using simplified system-bath models of decoherence.Comment: 5 pages, 1 figure v2: 6 pages 2 figures, additional example and reference

Clinical laboratory testing for smoking toxicity: implications for early identification of respiratory diseases

Smoking toxicity has short and long term clinical effects and also leads to organ damage. However, clinical assessment in the context of early identification of smoke toxicity by evidence-base pathology is yet to be practiced. The present study was aimed to assess the knowledge and practice of health practitioners regarding clinical laboratory testing of smoking toxicity, with a view to generate a debate on why and how to test. In this pilot study, various health practitioners and students were asked via interviews about laboratory testing of smoking toxicity. There is considerable dismissal of ‘why’ to test and up 57% responded that it was unnecessary. However, there is general opinion that laboratory routine tests can be used to identify toxicity. It appears that there is a gap between knowledge and practice of clinical laboratory testing of cigarette toxicity. Students and health practitioners have the knowledge on smoke toxicity but this requires articulation into evidence-base pathology for early identification and intervention of subclinical pathology in smoking toxicity, especially before noticeable organ damage

Evaluation of oxidative stress and whole blood viscosity for clinical laboratory testing of smoking toxicity

Background: There are no clearly established clinical biochemical markers for cigarette smoking despite the knowledge that cigarette smoking is a risk factor for various diseases, especially cardiovascular complications of respiratory pathologies. However, there are reports of significant increases in blood viscosity and oxidative stress among smokers. The main objective of the study was to ascertain the association of toxicity from cigarette smoking on whole blood viscosity in our data.Methods: This study analysed the archived clinical data of 20 cigarette smokers and 20 apparently healthy individuals.Results: The data show that on average, oxidative stress levels are relatively the same between groups, while whole blood viscosity is statistically significantly lower in non-smokers compared to smokers.Conclusions: This report suggests that oxidative stress induced whole blood hyper-viscosity could be a valid biomarker for laboratory testing of smoking toxicity among cigarette smokers

Endurance Training Attenuates Chemoreflex Sensitivity to Intermittent Hypoxia

Please refer to the pdf version of the abstract located adjacent to the title