Clinical utility of exhaled nitric oxide

Lower airway inflammation is generally classified as eosinophilic or neutrophilic. In conditions where eosinophilic inflammation predominates such as asthma in children, corticosteroids are usually beneficial. Traditionally, lower airway eosinophilia is measured using cellular count (through bronchoalveolar lavage or induced sputum). Both methods have limited applicability in children. When instruments to measure fractional exhaled nitric oxide (FeNO) became available, it presented an attractive option as it provided a non-invasive method of measuring eosinophilic inflammation suitable for children and adult. Not surprisingly, proposals have been made that FeNO measurement can be clinically used in many scenarios including monitoring the response to anti-inflammatory medications, to verify the adherence to treatment, and to predict upcoming asthma exacerbations. This thesis addresses the utility of FeNO levels in various scenarios, specifically in relation to asthma control and cough, a contentious aspect of the diagnosis of asthma. The thesis consists of a series of systematic reviews (related to the main question) and original studies in children. The over-arching aim of the thesis is to determine if FeNO is a clinically useful tool in the management of asthma and common asthma symptoms. The specific aims of the thesis were, to: 1. Determine if children with asthma have more severe acute respiratory symptoms at presentation with an asthma exacerbation and at days 7, 10 and 14 using validated scales. We also examined if children with asthma were more likely to have a persistent cough on day 14 than children with protracted bronchitis and/or controls. 2. Evaluate the efficacy of tailoring asthma interventions based on sputum analysis in comparison to clinical symptoms (with or without spirometry/peak flow) for asthma related outcomes in children and adults. 3. Evaluate the efficacy of tailoring asthma interventions based on exhaled nitric oxide in comparison to clinical symptoms (with or without spirometry/peak flow) for asthma related outcomes in children and adults. 4. Determine if adjustment of asthma medications based on FeNO levels (compared to management based on clinical symptoms) reduces severe exacerbations in children with asthma. 5. Examine the relationship between FeNO and exercise induced broncho-constriction and cough in children The aims above are addressed in respective chapters and all but one has been published/submitted. A synopsis of the findings are: In study-1 (Aim 1), we found that children with protracted bronchitis had the most severe acute respiratory infection symptoms and higher percentage of respiratory morbidity at day 14 in comparison to children with asthma and healthy controls. The systematic review of study-2 (Aim 2) included 246 randomised adult participants (no children) with 221 completing the trials. In the meta-analysis, a significant reduction in number of participants who had one or more asthma exacerbations occurred when treatment was based on sputum eosinophils in comparison to clinical symptoms. In the systematic review of study-3 (Aim 3), we found no significant difference between the intervention group (treatment adjusted based on FeNO) and control group (treatment adjusted based on clinical symptoms) for the primary outcome of asthma exacerbations or for the other outcomes (clinical symptoms, FeNO level and spirometry). In post-hoc analysis, a significant reduction in mean final daily dose ICS per adult was found in the group where treatment was based on FeNO in comparison to clinical symptoms. In contrast, in the paediatric studies, there was a significant increase in ICS dose in the FeNO strategy arm. Thus, controversy remains of the benefit or otherwise of utilising exhaled nitric oxide (FeNO) in routine clinical practice. FeNO levels are dependent on atopy and none of the 7 published trials have considered atopic status in FeNO levels when medications were adjusted. In study-4 (Aim 4), 64 children with asthma were recruited. Their asthma medications were adjusted according to either FeNO levels or usual clinical care utilising a management hierarchy taking into account atopy. It was concluded that tailoring of asthma medications in accordance to FeNO levels (compared to usual management), taking into account atopy status, reduced the number of children with severe exacerbations. However, a FeNO-based strategy resulted in higher daily ICS doses and had no benefit on asthma control. In study-5 (Aim 5), 33 children with cough and 17 controls were recruited. They were randomised to undertake an exercise challenge on day 1, or dry powder mannitol challenge on day 1 (with alternative challenge being done on day 2). In addition, a 24 hour cough meter, skin prick test, capsaicin cough sensitivity test and cough diary were undertaken. The change in cough frequency post exercise was significantly increased in the children with cough. FeNO decreases post exercise regardless of whether EIB is present or not. Limitations in the studies were addressed in the respective chapters. In summary, the studies from this thesis have provided new information on: • The severity of respiratory symptoms was increased in the early phase of the asthma exacerbation but not in the later recovery phase when compared with controls. • The utility of FeNO in the management of children with asthma. • The relationship of FeNO, cough and EIB in children. • Systematic reviews on the efficacy of tailoring asthma interventions based on eosinophilic inflammatory markers (sputum analysis and FeNO) in comparison to clinical symptoms.

Effects of dietary folate intake on migraine disability and frequency

Objective Migraine is a highly disabling disease affecting a significant proportion of the Australian population. The Methylenetetrahydrofolate Reductase (MTHFR) C677T variant has been associated with increased levels of homocysteine and risk of migraine with aura (MA). Folic acid, Vitamin B6 and B12 supplementation has been previously shown to reduce increased levels of homocysteine and decrease migraine symptoms. However the influence of dietary folate intake on migraine has been unclear. The aim of the current study was to analyse the association of dietary folate intake in the form of dietary folate equivalent (DFE), folic acid (FA) and total food folate (TFF) on migraine frequency, severity and disability. Methods A cohort of 141 adult females of Caucasian descent with MA was genotyped for the MTHFRC677T variant using restriction enzyme digestion. Dietary folate information was collected from all participants and analysed using the “FoodWorks” 2009 package. Folate consumption was compared to migraine frequency, severity and disability using linear regression. Results A significant inverse relation was observed between DFE [R2= 0.201, P= 0.045, CI (-0.004, -0.001)] and FA [R2= 0.255, P= 0.036, 95% CI (-0.009, -0.002)] consumption and migraine frequency. It was also observed that in individuals with the CC genotype for the MTHFR C677T variant, migraine frequency was significantly linked to FA consumption [R2= 0.077, P= 0.029, CI (-0.009, -0.005)]. Conclusions The results from this study indicate that folate intake in the form of folic acid may influence migraine frequency in female MA sufferers.

Frequency-motivated observer design for the prediction of parametric roll resonance control applications in marine systems

This work deals with estimators for predicting when parametric roll resonance is going to occur in surface vessels. The roll angle of the vessel is modeled as a second-order linear oscillatory system with unknown parameters. Several algorithms are used to estimate the parameters and eigenvalues of the system based on data gathered experimentally on a 1:45 scale model of a tanker. Based on the estimated eigenvalues, the system predicts whether or not parametric roll occurred. A prediction accuracy of 100% is achieved for regular waves, and up to 87.5% for irregular waves.

Causal factors of hot air ballooning incidents : identification, frequency, and potential impact

Background: Hot air ballooning incidents are relatively rare, however, when they do occur they are likely to result in a fatality or serious injury. Human error is commonly attributed as the cause of hot air ballooning incidents; however, error in itself is not an explanation for safety failures. This research aims to identify, and establish the relative importance of factors contributing towards hot air ballooning incidents. Methods: Twenty-two Australian Ballooning Federation (ABF) incident reports were thematically coded using a bottom up approach to identify causal factors. Subsequently, 69 balloonists (mean 19.51 years’ experience) participated in a survey to identify additional causal factors and rate (out of seven) the perceived frequency and potential impact to ballooning operations of each of the previously identified causal factors. Perceived associated risk was calculated by multiplying mean perceived frequency and impact ratings. Results: Incident report coding identified 54 causal factors within nine higher level areas: Attributes, Crew resource management, Equipment, Errors, Instructors, Organisational, Physical Environment, Regulatory body and Violations. Overall, ‘weather’, ‘inexperience’ and ‘poor/inappropriate decisions’ were rated as having greatest perceived associated risk. Discussion: Although errors were nominated as a prominent cause of hot air ballooning incidents, physical environment and personal attributes are also particularly important for safe hot air ballooning operations. In identifying a range of causal factors the areas of weakness surrounding ballooning operations have been defined; it is hoped that targeted safety and training strategies can now be put into place removing these contributing factors and reducing the chance of pilot error.

Inner-ear morphology of the New Zealand Kiwi (Apteryx mantelli) suggests high-frequency specialization

The sensory systems of the New Zealand kiwi appear to be uniquely adapted to occupy a nocturnal ground-dwelling niche. In addition to well-developed tactile and olfactory systems, the auditory system shows specializations of the ear, which are maintained along the central nervous system. Here, we provide a detailed description of the auditory nerve, hair cells, and stereovillar bundle orientation of the hair cells in the North Island brown kiwi. The auditory nerve of the kiwi contained about 8,000 fibers. Using the number of hair cells and innervating nerve fibers to calculate a ratio of average innervation density showed that the afferent innervation ratio in kiwi was denser than in most other birds examined. The average diameters of cochlear afferent axons in kiwi showed the typical gradient across the tonotopic axis. The kiwi basilar papilla showed a clear differentiation of tall and short hair cells. The proportion of short hair cells was higher than in the emu and likely reflects a bias towards higher frequencies represented on the kiwi basilar papilla. The orientation of the stereovillar bundles in the kiwi basilar papilla showed a pattern similar to that in most other birds but was most similar to that of the emu. Overall, many features of the auditory nerve, hair cells, and stereovilli bundle orientation in the kiwi are typical of most birds examined. Some features of the kiwi auditory system do, however, support a high-frequency specialization, specifically the innervation density and generally small size of hair-cell somata, whereas others showed the presumed ancestral condition similar to that found in the emu.

Genetic divergence and echolocation call frequency in cryptic species of Hipposideros larvatus s.l. (Chiroptera : Hipposideridae) from the Indo-Malayan region

The intermediate leaf-nosed bat (Hipposideros larvatus) is a medium-sized bat distributed throughout the Indo-Malay region. In north-east India, bats identified as H. larvatus captured at a single cave emitted echolocation calls with a bimodal distribution of peak frequencies, around either 85 kHz or 98 kHz. Individuals echolocating at 85 kHz had larger ears and longer forearms than those echolocating at 98 kHz, although no differences were detected in either wing morphology or diet, suggesting limited resource partitioning. A comparison of mitochondrial control region haplotypes of the two phonic types with individuals sampled from across the Indo-Malay range supports the hypothesis that, in India, two cryptic species are present. The Indian 98-kHz phonic bats formed a monophyletic clade with bats from all other regional populations sampled, to the exclusion of the Indian 85-kHz bats. In India, the two forms showed 12–13% sequence divergence and we propose that the name Hipposideros khasiana for bats of the 85-kHz phonic type. Bats of the 98-kHz phonic type formed a monophyletic group with bats from Myanmar, and corresponded to Hipposideros grandis, which is suggested to be a species distinct from Hipposideros larvatus. Differences in echolocation call frequency among populations did not reflect phylogenetic relationships, indicating that call frequency is a poor indicator of evolutionary history. Instead, divergence in call frequency probably occurs in allopatry, possibly augmented by character displacement on secondary contact to facilitate intraspecific communication.

The effects of flight speed on ranging performance of bats using frequency modulated echolocation pulses

Many species of bat use ultrasonic frequency modulated (FM) pulses to measure the distance to objects by timing the emission and reception of each pulse. Echolocation is mainly used in flight. Since the flight speed of bats often exceeds 1% of the speed of sound, Doppler effects will lead to compression of the time between emission and reception as well as an elevation of the echo frequencies, resulting in a distortion of the perceived range. This paper describes the consequences of these Doppler effects on the ranging performance of bats using different pulse designs. The consequences of Doppler effects on ranging performance described in this paper assume bats to have a very accurate ranging resolution, which is feasible with a filterbank receiver. By modeling two receiver types, it was first established that the effects of Doppler compression are virtually independent of the receiver type. Then, used a cross-correlation model was used to investigate the effect of flight speed on Doppler tolerance and range–Doppler coupling separately. This paper further shows how pulse duration, bandwidth, function type, and harmonics influence Doppler tolerance and range–Doppler coupling. The influence of each signal parameter is illustrated using calls of several bat species. It is argued that range–Doppler coupling is a significant source of error in bat echolocation, and various strategies bats could employ to deal with this problem, including the use of range rate information are discussed.

Estimating the impact of reduced inertia on frequency stability due to large-scale wind penetration in Australian electricity network

Large-scale integration of non-inertial generators such as wind farms will create frequency stability issues due to reduced system inertia. Inertia based frequency stability study is important to predict the performance of power system with increased level of renewables. This paper focuses on the impact large-scale wind penetration on frequency stability of the Australian Power Network. MATLAB simulink is used to develop a frequency based dynamic model utilizing the network data from a simplified 14-generator Australian power system. The loss of generation is modeled as the active power disturbance and minimum inertia required to maintain the frequency stability is determined for five-area power system.

Battery energy storage systems to improve power system frequency response

Battery energy storage systems (BESS) are becoming feasible to provide system frequency support due to recent developments in technologies and plummeting cost. Adequate response of these devices becomes critical as the penetration of the renewable energy sources increases in the power system. This paper proposes effective use of BESS to improve system frequency performance. The optimal capacity and the operation scheme of BESS for frequency regulation are obtained using two staged optimization process. Furthermore, the effectiveness of BESS for improving the system frequency response is verified using dynamic simulations.

Effects of magnetite on high-frequency ground-penetrating radar

Large concentrations of magnetite in sedimentary deposits and soils with igneous parent material have been reported to affect geophysical sensor performance. We have undertaken the first systematic experimental effort to understand the effects of magnetite for ground-penetrating radar (GPR) characterization of the shallow subsurface. Laboratory experiments were conducted to study how homogeneous magnetite-sand mixtures and magnetite concentrated in layers affect the propagation behavior (velocity, attenuation) of high-frequency GPR waves and the reflection characteristics of a buried target. Important observations were that magnetite had a strong effect on signal velocity and reflection, at magnitudes comparable to what has been observed in small-scale laboratory experiments that measured electromagnetic properties of magnetite-silica mixtures. Magnetite also altered signal attenuation and affected the reflection characteristics of buried targets. Our results indicated important implications for several fields, including land mine detection, Martian exploration, engineering, and moisture mapping using satellite remote sensing and radiometers.

Characterization of frequency‐dependent magnetic susceptibility in UXO electromagnetic geophysics

Soils at many locations that have their origin in volcanic parent material and have undergone extensive weathering often exhibit strong frequency-dependent magnetic susceptibilities. The presence of such susceptibility has a profound effect on electromagnetic induction data acquired in such environments. Their transient electromagnetic response is characterized by a t-1 decay that is strong enough to mask UXO responses. In a field study and associated laboratory work on characterizing the frequency-dependent magnetic susceptibility and its influence on transient electromagnetic data, we collected soil samples on the surface and in soil pits from the Island of Kaho'olawe, Hawaii, and measured their frequency dependent magnetic susceptibilities. We present the details of the field investigation, confirm previous theoretical work with field and laboratory measurements, characterize the susceptibility with a Cole-Cole model, and investigate the response specific to the measured susceptibility.

Structural damage detection method using frequency response functions

Structural damage detection using measured dynamic data for pattern recognition is a promising approach. These pattern recognition techniques utilize artificial neural networks and genetic algorithm to match pattern features. In this study, an artificial neural network–based damage detection method using frequency response functions is presented, which can effectively detect nonlinear damages for a given level of excitation. The main objective of this article is to present a feasible method for structural vibration–based health monitoring, which reduces the dimension of the initial frequency response function data and transforms it into new damage indices and employs artificial neural network method for detecting different levels of nonlinearity using recognized damage patterns from the proposed algorithm. Experimental data of the three-story bookshelf structure at Los Alamos National Laboratory are used to validate the proposed method. Results showed that the levels of nonlinear damages can be identified precisely by the developed artificial neural networks. Moreover, it is identified that artificial neural networks trained with summation frequency response functions give higher precise damage detection results compared to the accuracy of artificial neural networks trained with individual frequency response functions. The proposed method is therefore a promising tool for structural assessment in a real structure because it shows reliable results with experimental data for nonlinear damage detection which renders the frequency response function–based method convenient for structural health monitoring.