Are early life factors considered when managing respiratory disease?:A British Thoracic Society survey of current practice

We hypothesised that early life events are not routinely considered by most respiratory specialists.

Integrated care pathways for airway diseases (AIRWAYS-ICPs)

The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. In the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers).

Lung consequences in adults born prematurely

Although survival has improved significantly in recent years, prematurity remains a major cause of infant and childhood mortality and morbidity. Preterm births (<37 weeks of gestation) account for 8% of live births representing >50 000 live births each year in the UK. Preterm birth, irrespective of whether babies require neonatal intensive care, is associated with increased respiratory symptoms, partially reversible airflow obstruction and abnormal thoracic imaging in childhood and in young adulthood compared with those born at term. Having failed to reach their optimal peak lung function in early adulthood, there are as yet unsubstantiated concerns of accelerated lung function decline especially if exposed to noxious substances leading to chronic respiratory illness; even if the rate of decline in lung function is normal, the threshold for respiratory symptoms will be crossed early. Few adult respiratory physicians enquire about the neonatal period in their clinical practice. The management of these subjects in adulthood is largely evidence free. They are often labelled as asthmatic although the underlying mechanisms are likely to be very different. Smoking cessation, maintaining physical fitness, annual influenza immunisation and a general healthy lifestyle should be endorsed irrespective of any symptoms. There are a number of clinical and research priorities to maximise the quality of life and lung health in the longer term not least understanding the underlying mechanisms and optimising treatment, rather than extrapolating from other airway diseases.

Swift and Conversational Culture

Swift often noted his aversion to coffee-house conversation and to tavern talk, to gossip and company, and to being buried in Dublin in the years of his Deanship. Yet the popular myth of a morose, unsociable Swift belies both his engagement with various literary and political clubs in his early career and his participation in collaborative and experimental poetic games in his Dublin circles. This essay considers Swift’s involvement with three clubs in London (the Saturday Club, the Brothers’ Club, and the Scriblerians) and his writings on a number of fictional clubs (the Athenian Society, the Calves-Head Club, and a putative Society for the correction of the English language). While Swift wrote very little of his experience of actual clubs, the latter three, in addition to the Scriblerian Club as an imagined, rather than actual clubs, resulted in a number of defining poems and works in his career. When Swift settled in Dublin, poetry written and exchanged in a number of sociable circles characterised much of his published verse and gave glimpses of the circles and informal clubs which he formed among friends there. Although these poems are often dismissed as ‘trifles’, the essay argues that the poems are crucial for our understandings of ‘conversational culture’ or sociability in Swift’s Dublin.

Assessing the effect of reducing agents on the selective catalytic reduction of NOx over Ag/Al2O3 catalysts

The selective catalytic reduction (SCR) of NOx in the presence of different reducing agents over Ag/Al2O3 prepared by wet impregnation was investigated by probing catalyst activity and using NMR relaxation time analysis to probe the strength of surface interaction of the various reducing agent species and water. The results reveal that the strength of surface interaction of the reducing agent relative to water, the latter present in engine exhausts as a fuel combustion product and, in addition, produced during the SCR reaction, plays an important role in determining catalyst performance. Reducing agents with weak strength of interaction with the catalyst surface, such as hydrocarbons, show poorer catalytic performance than reducing agents with a higher strength of interaction, such as alcohols. This is attributed to the greater ability of oxygenated species to compete with water in terms of surface interaction with the catalyst surface, hence reducing the inhibiting effect of water molecules blocking catalyst sites. The results support the observations of earlier work in that the light off-temperature and maximum NOx conversion and temperature at which that occurs are sensitive to the reducing agent present during reaction, and the proposal that improved catalyst performance is caused by increased adsorption strength of the reducing agent, relative to water, at the catalyst surface. Importantly, the NMR relaxation time analysis approach to characterising the strength of adsorption more readily describes the trends in catalytic behaviour than does a straightforward consideration of the polarity (i.e., relative permittivity) of the reducing agents studied here. In summary, this paper describes a simple approach to characterising the interaction energy of water and reducing agent so as to aid the selection of reducing agent and catalyst to be used in SCR conversions.