Physiotherapists’ use of airway clearance techniques during an acute exacerbation of bronchiectasis: a survey study

Abstract Background Airway clearance techniques are recommended for individuals with bronchiectasis both in stable state and during an acute exacerbation, however the current use of airway clearance techniques in the management of individuals during an acute exacerbation is unclear. The aims of this study were to establish what current physiotherapy clinical practice comprises for adults and paediatrics during an acute exacerbation of bronchiectasis; identify physiotherapist’s perceptions of the effectiveness of airway clearance techniques and identify what factors influence their treatment decisions in this population. Methods An anonymous online survey was distributed to the members of the Australian Physiotherapy Association and Physiotherapy New Zealand between August 2016 and April 2017. Results The survey was accessed by 130 physiotherapists and 121 of those deemed themselves eligible and consented to participate. Most participants (89%) reported prescribing airway clearance techniques for 81–100% of individuals during an acute exacerbation of bronchiectasis. The most commonly used airway clearance techniques with adults were huffing (92%), exercise (89%) and the active cycle of breathing technique (89%). The techniques perceived most effective for adults were physical exercise (100%), oscillating positive expiratory pressure devices (97%), directed huffing (95%) the active cycle of breathing technique (90%) and positive expiratory pressure (90%). The most commonly used airway clearance techniques for paediatric patients were: newborn-3 years - percussion (85%) and modified postural drainage (85%); 4–10 years - huffing (100%) and exercise (85%); 11–18 years - huffing (92%) and exercise (77%), active cycle of breathing technique (77%) and positive expiratory pressure therapy (77%). The techniques perceived most effective for paediatric patients were directed huffing (100%), percussion (100%) and positive expiratory pressure via a mask or mouthpiece (93%). The most commonly reported factors influencing choice of technique were patient clinical presentation (72%) and the presence/absence of contra-indications (72%). Conclusion This survey demonstrates that airway clearance techniques are routinely used as part of physiotherapy management of individuals experiencing an acute exacerbation of bronchiectasis, and that choice of technique and perceived effectiveness varies depending on the age of the patient

Flexibility in foraging strategies of Brown Skuas in response to local and seasonal dietary constraints

The Brown Skua Stercorarius antarcticus lonnbergi is an opportunistic species that displays a high degree of flexibility in foraging tactics. We deployed global positioning system (GPS) and immersion (activity) loggers on breeding Brown Skuas of known sex, body size and condition at Admiralty Bay, King George Island with the aim to examine the impacts of spatial and seasonal fluctuations in prey availability on movement and foraging behavior. We also investigated whether reversed sexual size dimorphism (females larger than males) in this species leads to differences between sexes in foraging behavior and whether this or other factors contribute to variation in breeding success. Analysis of the GPS data highlighted the high degree of plasticity in foraging behavior among individuals. Although most Brown Skuas were flexible in their feeding tactics, this was not enough to ensure a successful breeding season, as few pairs fledged chicks. During early chick rearing, Brown Skuas spent most of their time on land, feeding almost exclusively on penguin chicks. By late chick rearing, when the availability of penguins had diminished, Brown Skuas supplemented the food obtained on land by traveling to the ocean. All foraging trips to sea occurred during daylight, mostly during the early morning. Despite marked sexual size dimorphism, we failed to find any difference in foraging tactics between males and females. Furthermore, although laying date affected the number of chicks hatched (earlier pairs were more successful), no relationship was found between breeding success and male or female body size, condition or degree of dimorphism within pair

Microfabricated thermoelectric power-generation devices

A device for generating power to run an electronic component. The device includes a heat-conducting substrate (composed, e.g., of diamond or another high thermal conductivity material) disposed in thermal contact with a high temperature region. During operation, heat flows from the high temperature region into the heat-conducting substrate, from which the heat flows into the electrical power generator. A thermoelectric material (e.g., a BiTe alloy-based film or other thermoelectric material) is placed in thermal contact with the heat-conducting substrate. A low temperature region is located on the side of the thermoelectric material opposite that of the high temperature region. The thermal gradient generates electrical power and drives an electrical component

Cluster analysis with MOODS‐SR illustrates a potential bipolar disorder risk phenotype in young adults with remitted major depressive disorder

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147140/1/bdi12693_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147140/2/bdi12693.pd

TP53 is not a prognostic markerâ clinical consequences of a generally disregarded fact

Technological progress within the last 15â 20 years has significantly increased our knowledge about the molecular basis of cancer development, tumor progression, and treatment response. As a consequence, a vast number of biomarkers have been proposed, but only a small fraction of them have found their way into clinical use. The aim of this paper is to describe the specific demands a clinically relevant biomarker should meet and how biomarkers can be tested stepwise. We name this procedure the â tripleâ R principleâ : robustness, reproducibility, and relevance. The usefulness of this principle is illustrated with the marker TP53. Since it is mutated in a broad spectrum of cancer entities, TP53 can be considered a very promising marker. Thus, TP53 has been studied in detail but there is still no explicit consensus about its clinical value. By considering our own experience and reviewing the literature, we demonstrate that a major problem of current biomarker research is disregard of whether the biomarker is prognostic or predictive. As an example, it is demonstrated that TP53 is not a prognostic marker, but rather a purely predictive marker, and that disregard of this fact has made this otherwise strong biomarker appear as not being clinically useful so far.Many biomarkers have been proposed for cancer, but only a small fraction of them are clinically useful. This paper describes the specific demands a clinically relevant biomarker should meet and how biomarkers can be tested stepwise. This is illustrated with the marker TP53, which has been studied in detail but for which there is still no explicit consensus about its clinical value.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146810/1/nyas13947.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146810/2/nyas13947_am.pd

SPIRITS 15c and SPIRITS 14buu: Two Obscured Supernovae in the Nearby Star-Forming Galaxy IC 2163

SPIRITS---SPitzer InfraRed Intensive Transients Survey---is an ongoing survey of nearby galaxies searching for infrared (IR) transients with Spitzer/IRAC. We present the discovery and follow-up observations of one of our most luminous ($M_{[4.5]} = -17.1\pm0.4$ mag, Vega) and red ($[3.6] - [4.5] = 3.0 \pm 0.2$ mag) transients, SPIRITS 15c. The transient was detected in a dusty spiral arm of IC 2163 ($D\approx35.5$ Mpc). Pre-discovery ground-based imaging revealed an associated, shorter-duration transient in the optical and near-IR (NIR). NIR spectroscopy showed a broad ($\approx 8400$ km s$^{-1}$), double-peaked emission line of He I at $1.083 \mu$m, indicating an explosive origin. The NIR spectrum of SPIRITS 15c is similar to that of the Type IIb SN 2011dh at a phase of $\approx 200$ days. Assuming $A_V = 2.2$ mag of extinction in SPIRITS 15c provides a good match between their optical light curves. The IR light curves and the extreme $[3.6]-[4.5]$ color cannot be explained using only a standard extinction law. Another luminous ($M_{4.5} = -16.1\pm0.4$ mag) event, SPIRITS 14buu, was serendipitously discovered in the same galaxy. The source displays an optical plateau lasting $\gtrsim 80$ days, and we suggest a scenario similar to the low-luminosity Type IIP SN 2005cs obscured by $A_V \approx 1.5$ mag. Other classes of IR-luminous transients can likely be ruled out in both cases. If both events are indeed SNe, this may suggest $\gtrsim 18\%$ of nearby core-collapse SNe are missed by currently operating optical surveys.Comment: 19 pages, 7 Figures, 4 Table

Copper as a target for prostate cancer therapeutics: copper-ionophore pharmacology and altering systemic copper distribution

Copper-ionophores that elevate intracellular bioavailable copper display significant therapeutic utility against prostate cancer cells in vitro and in TRAMP (Transgenic Adenocarcinoma of Mouse Prostate) mice. However, the pharmacological basis for their anticancer activity remains unclear, despite impending clinical trails. Herein we show that intracellular copper levels in prostate cancer, evaluated in vitro and across disease progression in TRAMP mice, were not correlative with copper-ionophore activity and mirrored the normal levels observed in patient prostatectomy tissues (Gleason Score 7 & 9). TRAMP adenocarcinoma cells harbored markedly elevated oxidative stress and diminished glutathione (GSH)-mediated antioxidant capacity, which together conferred selective sensitivity to prooxidant ionophoric copper. Copper-ionophore treatments [CuII(gtsm), disulfiram & clioquinol] generated toxic levels of reactive oxygen species (ROS) in TRAMP adenocarcinoma cells, but not in normal mouse prostate epithelial cells (PrECs). Our results provide a basis for the pharmacological activity of copper-ionophores and suggest they are amendable for treatment of patients with prostate cancer. Additionally, recent in vitro and mouse xenograft studies have suggested an increased copper requirement by prostate cancer cells. We demonstrated that prostate adenocarcinoma development in TRAMP mice requires a functional supply of copper and is significantly impeded by altered systemic copper distribution. The presence of a mutant copper-transporting Atp7b protein (tx mutation: A4066G/Met1356Val) in TRAMP mice changed copper-integration into serum and caused a remarkable reduction in prostate cancer burden (64% reduction) and disease severity (grade), abrogating adenocarcinoma development. Implications for current clinical trials are discussed

The Angular Trispectra of CMB Temperature and Polarization

We develop the formalism necessary to study four-point functions of the cosmic microwave background (CMB) temperature and polarization fields. We determine the general form of CMB trispectra, with the constraints imposed by the assumption of statistical isotropy of the CMB fields, and derive expressions for their estimators, as well as their Gaussian noise properties. We apply these techniques to initial non-Gaussianity of a form motivated by inflationary models. Due to the large number of four-point configurations, the sensitivity of the trispectra to initial non-Gaussianity approaches that of the temperature bispectrum at high multipole moment. These trispectra techniques will also be useful in the study of secondary anisotropies induced for example by the gravitational lensing of the CMB by the large scale structure of the universe.Comment: 16 pages, 4 figures; typographical errors correcte

Measurements of Aperture Averaging on Bit-Error-Rate

We report on measurements made at the Shuttle Landing Facility (SLF) runway at Kennedy Space Center of receiver aperture averaging effects on a propagating optical Gaussian beam wave over a propagation path of 1,000 in. A commercially available instrument with both transmit and receive apertures was used to transmit a modulated laser beam operating at 1550 nm through a transmit aperture of 2.54 cm. An identical model of the same instrument was used as a receiver with a single aperture that was varied in size up to 20 cm to measure the effect of receiver aperture averaging on Bit Error Rate. Simultaneous measurements were also made with a scintillometer instrument and local weather station instruments to characterize atmospheric conditions along the propagation path during the experiments

An Unbiased Survey of 500 Nearby Stars for Debris Disks: A JCMT Legacy Program

We present the scientific motivation and observing plan for an upcoming detection survey for debris disks using the James Clerk Maxwell Telescope. The SCUBA-2 Unbiased Nearby Stars (SUNS) Survey will observe 500 nearby main sequence and sub-giant stars (100 of each of the A, F, G, K and M spectral classes) to the 850 micron extragalactic confusion limit to search for evidence of submillimeter excess, an indication of circumstellar material. The survey distance boundaries are 8.6, 16.5, 22, 25 and 45 pc for M, K, G, F and A stars, respectively, and all targets lie between the declinations of -40 deg to 80 deg. In this survey, no star will be rejected based on its inherent properties: binarity, presence of planetary companions, spectral type or age. This will be the first unbiased survey for debris disks since IRAS. We expect to detect ~125 debris disks, including ~50 cold disks not detectable in current shorter wavelength surveys. A substantial amount of complementary data will be required to constrain the temperatures and masses of discovered disks. High resolution studies will likely be required to resolve many of the disks. Therefore, these systems will be the focus of future observational studies using a variety of observatories to characterize their physical properties. For non-detected systems, this survey will set constraints (upper limits) on the amount of circumstellar dust, of typically 200 times the Kuiper Belt mass, but as low as 10 times the Kuiper Belt mass for the nearest stars in the sample (approximately 2 pc).Comment: 11 pages, 7 figures (3 color), accepted by the Publications of the Astronomical Society of the Pacifi