Absorbing-State Transitions in Granular Materials Close to Jamming.

We consider a model for driven particulate matter in which absorbing states can be reached both by particle isolation and by particle caging. The model predicts a nonequilibrium phase diagram in which analogs of hydrodynamic and elastic reversibility emerge at low and high volume fractions respectively, partially separated by a diffusive, nonabsorbing region. We thus find a single phase boundary that spans the onset of chaos in sheared suspensions to the onset of yielding in jammed packings. This boundary has the properties of a nonequilibrium second order phase transition, leading us to write a Manna-like mean field description that captures the model predictions. Dependent on contact details, jamming marks either a direct transition between the two absorbing states, or occurs within the diffusive region.ERC, Royal Society, Pembroke Colleg

Shaken and stirred: Random organization reduces viscosity and dissipation in granular suspensions.

The viscosity of suspensions of large (≥10 μm) particles diverges at high solid fractions due to proliferation of frictional particle contacts. Reducing friction, to allow or improve flowability, is usually achieved by tuning the composition, either by changing particle sizes and shapes or by adding lubricating molecules. We present numerical simulations that demonstrate a complementary approach whereby the viscosity divergence is shifted by driven flow tuning, using superimposed shear oscillations in various configurations to facilitate a primary flow. The oscillations drive the suspension toward an out-of-equilibrium, absorbing state phase transition, where frictional particle contacts that dominate the viscosity are reduced in a self-organizing manner. The method can allow otherwise jammed states to flow; even for unjammed states, it can substantially decrease the energy dissipated per unit strain. This creates a practicable route to flow enhancement across a broad range of suspensions where compositional tuning is undesirable or problematic

Combination formoterol and budesonide as maintenance and reliever therapy versus inhaled steroid maintenance for chronic asthma in adults and children (Review)

Background Traditionally inhaled treatment for asthma has been considered as preventer and reliever therapy. The combination of formoterol and budesonide in a single inhaler introduces the possibility of using a single inhaler for both prevention and relief of symptoms (single inhaler therapy). Objectives The aim of this review is to compare formoterol and corticosteroid in single inhaler for maintenance and relief of symptoms with inhaled corticosteroids for maintenance and a separate reliever inhaler. Search methods We last searched the Cochrane Airways Group trials register in September 2008. Selection criteria Randomised controlled trials in adults and children with chronic asthma. Data collection and analysis Two review authors independently assessed studies for inclusion and extracted the characteristics and results of each study. Authors or manufacturers were asked to supply unpublished data in relation to primary outcomes. Main results Five studies on 5,378 adults compared single inhaler therapy with current best practice, and did not show a significant reduction in participants with exacerbations causing hospitalisation (Peto OR 0.59; 95% CI 0.24 to 1.45) or treated with oral steroids (OR 0.83; 95% CI 0.66 to 1.03). Three of these studies on 4281 adults did not show a significant reduction in time to first severe exacerbation needing medical intervention (HR 0.96; 95% CI 0.85 to 1.07). These trials demonstrated a reduction in the mean total daily dose of inhaled corticosteroids with single inhaler therapy (mean reduction ranged from 107 to 267 micrograms/day, but the trial results were not combined due to heterogeneity). The full results from four further studies on 4,600 adults comparing single inhaler therapy with current best practice are awaited. Three studies including 4,209 adults compared single inhaler therapy with higher dose budesonide maintenance and terbutaline for symptom relief. No significant reduction was found with single inhaler therapy in the risk of patients suffering an asthma exacerbation leading to hospitalisation (Peto OR 0.56; 95% CI 0.28 to 1.09), but fewer patients on single inhaler therapy needed a course of oral corticosteroids (OR 0.54; 95% CI 0.45 to 0.64). These results translate into an eleven month number needed to treat of 14 (95% CI 12 to 18), to prevent one patient being treated with oral corticosteroids for an exacerbation. The run-in for these studies involved withdrawal of long-acting beta2-agonists, and patients were recruited who were symptomatic during run-in. One study included children (N = 224), in which single inhaler therapy was compared to higher dose budesonide. There was a significant reduction in participants who needed an increase in their inhaled steroids with single inhaler therapy, but there were only two hospitalisations for asthma and no separate data on courses of oral corticosteroids. Less inhaled and oral corticosteroids were used in the single inhaler therapy group and the annual height gain was also 1 cm greater in the single inhaler therapy group, [95% CI 0.3 to 1.7 cm]. There was no significant difference found in fatal or non-fatal serious adverse events for any of the comparisons. Authors’ conclusions Single inhaler therapy can reduce the risk of asthma exacerbations needing oral corticosteroids in comparison with fixed dose maintenance inhaled corticosteroids. Guidelines and common best practice suggest the addition of regular long-acting beta2-agonist to inhaled corticosteroids for uncontrolled asthma, and single inhaler therapy has not been demonstrated to significantly reduce exacerbations in comparison with current best practice, although results of five large trials are awaiting full publication. Single inhaler therapy is not currently licensed for children under 18 years of age in the United Kingdom

The Ethical Frontier: Ethical Considerations for Frontier Counselors

Counselors working in frontier communities may encounter unique challenges and experiences not regularly found in larger contexts. This paper explores the aspects of counseling significant to rural and frontier settings. It discusses the traditional attitudes of rural and frontier populations, the counselor's place in these communities, boundaries of competence, and ethical concerns that are significant to these areas of counseling, such as confidentiality. It also offers potential ways to address related ethical issues. The cultural milieu in small communities, subcultural selfidentification, frontier attitudes and beliefs, and multiple relationships are explored

Regular treatment with salmeterol and inhaled steroids for chronic asthma: serious adverse events

Epidemiological evidence has suggested a link between beta(2)-agonists and increased asthma mortality. There has been much debate about possible causal links for this association, and whether regular (daily) long-acting beta(2)-agonists are safe.ObjectivesThe aim of this review is to assess the risk of fatal and non-fatal serious adverse events in trials that randomised patients with chronic asthma to regular salmeterol with inhaled corticosteroids versus the same dose of inhaled corticosteroids alone.Search strategyTrials were identified using the Cochrane Airways Group Specialised Register of trials. Web sites of clinical trial registers were checked for unpublished trial data and Food and Drug Administration (FDA) submissions in relation to salmeterol were also checked. The date of the most recent search was October 2008.Selection criteriaControlled parallel design clinical trials on patients of any age and severity of asthma were included if they randomised patients to treatment with regular salmeterol and inhaled corticosteroids (in separate or combined inhalers), and were of at least 12 weeks duration.Data collection and analysisTwo authors independently selected trials for inclusion in the review. Outcome data were independently extracted by two authors. Unpublished data on mortality and serious adverse events were obtained from the sponsors, and from FDA submissions.Main resultsThe review included 30 studies (10,873 participants) in adults and adolescents, and three studies (1,173 participants) in children. The overall risk of bias was low and data on serious adverse events were obtained from all studies.Six deaths occurred in 5,710 adults on regular salmeterol with inhaled corticosteroids, and five deaths in 5,163 adults on regular inhaled corticosteroids at the same dose. The difference was not statistically significant (Peto OR 1.05; 95% CI 0.32 to 3.47) and the absolute difference between groups in risk of death of any cause was 0.00005 (95% CI -0.002 to 0.002). No deaths were reported in 1,173 children, and no deaths were reported to be asthma-related.Non-fatal serious adverse events of any cause were reported in 134 adults on regular salmeterol with inhaled corticosteroids, compared to 103 adults on regular inhaled corticosteroids; again this was not a significant increase (Peto OR 1.17; 95% CI 0.90 to 1.52). The absolute difference in the risk of non-fatal serious adverse events was 0.003 (95% CI -0.002 to 0.009).There were three of 586 children with serious adverse events on regular salmeterol with inhaled corticosteroids, compared to four out of 587 on regular inhaled corticosteroids: there was no significant difference between treatments (Peto OR 0.75; 95% CI 0.17 to 3.31).Asthma-related serious adverse events were reported in 23 and 21 adults in each group respectively, a non-significant difference (Peto OR 0.95; 95% CI 0.52 to 1.73), and only one event was reported in children.Authors' conclusionsNo significant differences have been found in fatal or non-fatal serious adverse events in trials in which regular salmeterol has been randomly allocated with inhaled corticosteroids, in comparison to inhaled corticosteroids at the same dose. Although 10,873 adults and 1,173 children have been included in trials, the number of patients suffering adverse events is too small, and the results are too imprecise to confidently rule out a relative increase in all-cause mortality or non-fatal adverse events. It is therefore not possible to determine whether the increase in all-cause non-fatal serious adverse events reported in the previous meta-analysis on regular salmeterol alone is abolished by the additional use of regular inhaled corticosteroids. The absolute difference between groups in the risk of serious adverse events was small. There were no asthma-related deaths and few asthma-related serious adverse events. Clinical decisions and information for patients regarding regular use of salmeterol have to take into account the balance between known symptomatic benefits of salmeterol and the degree of uncertainty and concern associated with its potential harmful effects

Tunable shear thickening in suspensions.

Shear thickening, an increase of viscosity with shear rate, is a ubiquitous phenomenon in suspended materials that has implications for broad technological applications. Controlling this thickening behavior remains a major challenge and has led to empirical strategies ranging from altering the particle surfaces and shape to modifying the solvent properties. However, none of these methods allows for tuning of flow properties during shear itself. Here, we demonstrate that by strategic imposition of a high-frequency and low-amplitude shear perturbation orthogonal to the primary shearing flow, we can largely eradicate shear thickening. The orthogonal shear effectively becomes a regulator for controlling thickening in the suspension, allowing the viscosity to be reduced by up to 2 decades on demand. In a separate setup, we show that such effects can be induced by simply agitating the sample transversely to the primary shear direction. Overall, the ability of in situ manipulation of shear thickening paves a route toward creating materials whose mechanical properties can be controlled.I.C. and N.Y.C.L. gratefully acknowledge the Weitz Laboratory at Harvard University, School of Engineering and Applied Sciences for generous use of their rheometry facility. I.C. and N.Y.C.L. were supported by National Science Foundation (NSF) CBET-PMP Award 1232666 and continued support from NSF CBET-PMP Award 1509308. C.N. and J.S. acknowledge funding from the Engineering and Physical Sciences Research Council (EPSRC), EP/N025318/1. M.E.C. is supported by the Royal Society and EPSRC Grant EP/J007404. This work also made use of the Cornell Center for Materials Research Shared Facilities, which are supported through the NSF Materials Research Science and Engineering Centers Program (DMR-1120296).This is the author accepted manuscript. The final version is available from the National Academy of Sciences via http://dx.doi.org/10.1073/pnas.160834811