Blood eosinophils and inhaled corticosteroid/long-acting β-2 agonist efficacy in COPD

Objective We performed a review of studies of fluticasone propionate (FP)/salmeterol (SAL) (combination inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA)) in patients with COPD, which measured baseline (pretreatment) blood eosinophil levels, to test whether blood eosinophil levels ≥2% were associated with a greater reduction in exacerbation rates with ICS therapy. Methods Three studies of ≥1-year duration met the inclusion criteria. Moderate and severe exacerbation rates were analysed according to baseline blood eosinophil levels (<2% vs ≥2%). At baseline, 57–75% of patients had ≥2% blood eosinophils. Changes in FEV1 and St George’s Respiratory Questionnaire (SGRQ) scores were compared by eosinophil level. Results For patients with ≥2% eosinophils, FP/SAL was associated with significant reductions in exacerbation rates versus tiotropium (INSPIRE: n=719, rate ratio (RR)=0.75, 95% CI 0.60 to 0.92, p=0.006) and versus placebo (TRISTAN: n=1049, RR=0.63, 95% CI 0.50 to 0.79, p<0.001). No significant difference was seen in the <2% eosinophil subgroup in either study (INSPIRE: n=550, RR=1.18, 95% CI 0.92 to 1.51, p=0.186; TRISTAN: n=354, RR=0.99, 95% CI 0.67 to 1.47, p=0.957, respectively). In SCO30002 (n=373), no significant effects were observed (FP or FP/SAL vs placebo). No relationship was observed in any study between eosinophil subgroup and treatment effect on FEV1 and SGRQ. Discussion Baseline blood eosinophil levels may represent an informative marker for exacerbation reduction with ICS/LABA in patients with COPD and a history of moderate/severe exacerbations

Assessment and design of small-scale hydro-electric power plants

Appraisal and design of small-scale hydro power plants requires a knowledge of hydraulics, hydrology, civil, mechanical, and electrical engineering, and basic economics. Further, small hydro is site specific in nature and marginal from an economic view point. Methods of appraisal and design are required therefore that will keep engineering fees to a minimum and yet still achieve a reliable evaluation of scheme potential and economics.In this context it should be appreciated that small hydro is not large hydro scaled down, and that small hydro needs its own experts (Ref. 1).This thesis considers techniques for appraisal of small hydropower schemes, the selection and specification of scheme components, their costing and economic evaluation. These appraisal techniques are subsequently applied to regional assessment of small-scale hydro-electric potential in the U. K, and to the development and application of a new type of ultra low-head hydropower generator called the Salford Transverse oscillator (STO).Although this work is predominately concerned with assessment of scheme potential in the U.K., it also draws on experience gained by the writer during short visits to India and Nepal, and during a six month design appraisal for rehabilitation of mini-hydro schemes in Sri Lanka (Ref. 2)

Informal education pedagogy transcendance from the ‘academy’ to society in the current and post COVID environment

The purpose of this paper is to consider the following two notions; (1) that the use of ‘informal education pedagogies’ within teaching and learning in the ‘academy’ can both support the learning process within the ‘classroom’ but also transcend to society via students; and (2) that synergies exist between informal education and social pedagogical concepts. The discussions are situated from the perspective of an experienced practitioner and academic who is currently teaching youth related degree courses within a Higher Education Institution. This experiential learning has informed knowledge acquisition, understanding and skills application from professional practice to the teaching environment. An experiential learning perspective will be the primary method adopted; the value of this paper lies in its potential to re-affirm that degree courses which embed a ‘practice the practice’ approach in their teaching methodology support the embedding of core values of the said discipline. The paper argues that the ethically value-based principles and practice of informal education pedagogy, and social pedagogy, are relevant for the current and post COVID-19 pandemic environment

Congenital cardiac surgery and parental perception of risk: a qualitative study

Introduction: The way risk is interpreted by parents of children undergoing congenital cardiac surgery is poorly documented. Literature suggests clinicians have concerns that parents may not understand the complexity of procedures. Conversely, some parents perceive an unnecessary over-emphasise of risks. Aim: To explore how risk is encountered by parents of children who are undergoing cardiac surgery, in order to deliver effective and compassionate care. Methods: A qualitative approach was adopted. Interviews were undertaken with eighteen parents (mothers n=10 fathers n=8). Recordings were transcribed verbatim and analyzed using a constant comparative based approach. Findings: Three themes emerged from the data: the nature of risk, reflecting the complexity of parental perception of risk and the influence of the doctor-parent relationship; presenting risk, highlighting the way in which risk is presented to and interpreted by parents; and risk and responsibility, examining the way in which parents engaged with risk and the impact of this on their relationship. Conclusions: The way in which risk is perceived by parents is complex and multifactorial. The doctor-parent relationship is key to parental engagement. However, parents manage risk and uncertainty through a number of mechanisms, including those perceived as being not rational. This can cause tension, particularly when required to engage in informed decision-making

What we can learn from elite academic staff publication portfolios: a social network analysis

Purpose: To construct an understanding of professional academic writing network structures to inform organisational strategic investment in academic staff development. Design: Longitudinal social network analysis is used to examine the personal-networks evident in the publication portfolios of a purposive sample of four international academics across each quartile of the SCOPUS defined area of General Nursing’s Top 100 authors. Findings: Trends in the publication portfolios of elite academics across gender, sector and geographic location are presented. In the first years of successful writing for publication authors collaborate within a single highly connected co-author network. This network will typically expand to include new co-authors, before additional separate co-author collaborations emerge (three- to four- years). Authors experience steady growth in co-author numbers four- to seven- years from first co-authored publication. After a period of rapid expansion, these collaborations coalesce into a smaller number of highly connected groups (eight- to ten- years). Most collaborations occur within the higher education sector and across multiple disciplines including medicine, social sciences and psychology. Male co-authors are disproportionately represented in what is a predominantly female profession. Practical implications: The development of extended co-author networks, locally, internationally, and across the higher education sector, enable authors to attain the marker of achievement required by universities and government funding bodies, namely sustained output of academic publications. Identified trends support the inclusion of investment in academic time and resources in higher education institutions’ strategic and operational plans to enable academic staff to develop interdisciplinary professional networks. In focusing this investment on gender equality, female academics will experience parity of opportunity in achieving their organisational and personal goals relating to professional academic writing. Medium term investment may be required before the impact of that investment becomes apparent. Originality/value: This is the first example of social network analysis used to determine characteristics of professional academic writing portfolios over time. Findings inform the type and range of investment required to facilitate academic staff writing activities, specifically those publishing in the area of General Nursing

Optimizing adherence and persistence to non-vitamin K antagonist oral anticoagulant therapy in atrial fibrillation

Atrial fibrillation (AF) is associated with an increased risk of stroke, which can be prevented by the use of oral anticoagulation. Although non-vitamin K antagonist oral anticoagulants (NOACs) have become the first choice for stroke prevention in the majority of patients with non-valvular AF, adherence and persistence to these medications remain suboptimal, which may translate into poor health outcomes and increased healthcare costs. Factors influencing adherence and persistence have been suggested to be patient-related, physician-related, and healthcare system-related. In this review, we discuss factors influencing patient adherence and persistence to NOACs and possible problem solving strategies, especially involving an integrated care management, aiming for the improvement in patient outcomes and treatment satisfaction