Predictors of therapy resistant asthma: outcome of a systematic evaluation protocol

Background: It has been suggested that asthmatic subjects with persisting symptoms despite adequate maintenance therapy should be systematically evaluated to identify factors contributing to poor control. The aims of this study were to examine the prevalence of these factors in a cohort of sequentially referred poorly controlled asthmatics, and to determine if any factor or combination of factors predicted true therapy resistant asthma (TRA).

Methods: Patients were evaluated using a systematic evaluation protocol including induced sputum analysis, psychiatric assessment, ear, nose and throat examination, pulmonary function testing, high resolution CT scan of the thorax, and 24 hour dual probe ambulatory oesophageal pH monitoring; any identified provoking factor was treated. Asthma was managed according to BTS guidelines.

Results: Of 73 subjects who completed the assessment, 39 responded to intervention and 34 had TRA. Subjects with TRA had a greater period of instability, a higher dose of inhaled steroids at referral, more rescue steroid use, and a lower best percentage forced expiratory volume in 1 second (FEV1%). Oesophageal reflux, upper airway disease, and psychiatric morbidity were common (57%, 95%, 49%, respectively) but were not more prevalent in either group. Using multivariate logistic regression analysis, inhaled steroid dose >2000 µg BDP, previous assessment by a respiratory specialist, and initial FEV1% of <70% at referral predicted a final diagnosis of TRA.

Conclusions: In poorly controlled asthmatics there is a high prevalence of co-morbidity, identified by detailed systematic assessment, but no difference in prevalence between those who respond to intervention and those with TRA. Targeted treatment of identified co-morbidities has minimal impact on asthma related quality of life in those with therapy resistant disease.

Sorption behavior of cationic and anionic dyes from aqueous solution on different types of activated carbons

The effect of dye molecular charges on their adsorption from solution was investigated by using different types of activated carbon adsorbents. Two types of model systems were used representing cationic and anionic dyes. Screening investigations using single point tests were used throughout the study. Cationic dyes, of which Methylene Blue is an example, showed a higher adsorption tendency towards activated carbon over anionic dyes represented by an ate-type reactive compound. Of the number of activated carbons tested, only one of the adsorbents showed an exception to this behavior, and a good relation was observed between Methylene Blue capacity and activated carbon performance. The high capacity of cationic dyes in comparison to anionic dyes was also evident in the results obtained by a preliminary kinetic study carried out on the selected systems. Surface net charge of activated carbon and the nature of attractions between the molecules were suggested to be one of the reasons attributed for this behavior.

The coefficient of restitution of different representative types of granules

Gas fluidised beds have many applications in a wide range of industrial sectors and it is important to be able to predict their performance. This requires, for example, a deeper appreciation of the flow of the particles in such systems using both empirical and numerical methods. The coefficient of restitution is an important collisional parameter that is used in some granular flow models in order to predict the velocities and positions of the particles in fluidised beds. The current paper reports experimental data involving the coefficients of restitution of three different representative types of granule viz. melt, wet and binderless granules. They were measured at various impact velocities and the values were compared with those calculated from different theoretical models based on quasi-static contact mechanics. This required knowledge of the Young's moduli and yield stresses, which were measured quasi-statically using diametric compression. The results show that the current theoretical models for the coefficient of restitution explored here lead to either an over- or an under-estimation of the measured values. The melt granules exhibited the greatest values of the coefficient of restitution, Young's modulus and yield stress. The differences in these values were consistent with the nature of the interparticle bonding for each of the three granule types. A new model for the calculation of the coefficient of restitution of granular material was developed that takes account of the work hardening of the granules during impact. Generally, this model provides an improved prediction of the measured values. (c) 2006 Elsevier Ltd. All rights reserved.

Immune reactions to Bacteroides fragilis populations with three different types of capsule in a model of infection

The survival and growth of populations of the obligately anaerobic pathogenic bacterium Bacteroides fragilis enriched for large capsules (LCs), small capsules (SCs) or an electron-dense layer (EDL; non-capsulate by light microscopy) were examined in a mouse model of infection over a minimum period of 20 d. Chambers which allowed the influx of leukocytes, but not the efflux of bacteria, were implanted in the mouse peritoneal cavity. The LC and EDL populations consistently attained viable cell densities of the order of 10(8)-10(9) c.f.u. ml-1 within 24 h, whereas the SC population did not. However, after 3 d, all three bacterial populations maintained total viable numbers of 10(8)-10(9) c.f.u. ml-1 within the chambers. LC expression was selected against within 24 h in the model, the populations becoming non-capsulate by light microscopy, whereas in the SC population expression of the SC was retained by approximately 90% of the population. The EDL population remained non-capsulate by light microscopy throughout. Lymphocytes infiltrated the chambers to an equal extent for all three B. fragilis populations and at approximately 1000 times higher concentration than chambers which contained only quarter-strength Ringer's solution. The presence of neutrophils within the chambers did not cause a decrease in the total viable bacterial count. Each population elicited antibodies specific for outer-membrane proteins and polysaccharide, as detected by immunoblotting, which cross-reacted with the other populations. Differences were observed in the immunogenicity of the outer-membrane proteins within the three populations. Neutrophils were initially the predominant cell type in the chambers, but as the total leukocyte count increased with incubation time, neutrophils were outnumbered by other leukocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

Agreement between clinical and ultrasound biomicroscopy findings in different types of glaucoma

Purpose. To evaluate agreement between clinical examination (slit lamp examination and gonioscopy) and ultrasound biomicroscopy (UBM) in characterizing various features of the anterior chamber angle and adjacent structures. Methods. Twenty-eight patients (51 eyes) with open angle glaucoma (14), closed angle glaucoma (4), narrow angle and/or plateau iris (10), who had undergone UBM between March 94 and September 95 were studied. Evaluated parameters included angle width, iris configuration and presence of angle closure. The UBMs were reviewed in a masked fashion. Results. In 87.8% of cases there was agreement (within 10 degrees) between gonioscopic and UBM estimates of angle width. In all cases with greater than 10 degrees difference (12.2%) the angle size estimated by UBM was less than that estimated clinically. Iris configuration was graded identically in 51% of cases; the majority of disagreements (76.1%) occurred in cases graded as "regular" by gonioscopy and as "steep" by UBM. Angle closure was judged to be present more frequently by UBM. Conclusions. UBM and gonioscopy do not necessarily yield identical values for angle width, iris configuration, and presence of angle closure.

Three different types of quasi-model networks: synthesis by group transfer polymerization and characterization

Group transfer polymerization (GTP) chemistry was employed for the preparation of polymethacrylate networks of controlled structure (quasi-model networks) of three different types: (a) regular quasi-model networks, in which all polymer chains were linked at their ends, leaving, in principle, no free chain ends, (b) crosslinked star polymer quasi-model networks, in which star polymers were interlinked via half of their chains, letting the other half free (dangling), and (c) shell-crosslinked polymer quasi-model networks, in which the outer part of the network contained polymer arms (dangling chains). Combination of hydrophilic and hydrophobic monomers led to amphiphilic networks whose aqueous swelling behavior was characterized gravimetrically.

Three Types of Temporal Perspective: Characterizing Developmental Changes in Temporal Thought

This paper provides an outline of the development of temporal thinking that is underpinned by the idea that temporal cognition shifts from being event dependent to event independent over the preschool period. I distinguish between three different ways in which it may be possible to have a perspective on time: (1) a perspective that is grounded in script-like representations of repeated events; (2) a more sophisticated perspective that brings in an fundamental categorical distinction between events that have already happened and events that are yet to come; and (3) a mature temporal perspective that involves orienting oneself in time using a linear temporal framework, with a grasp of the distinctions between past, present, and future. I propose that, with development, children possess each of these types of perspective in turn, and that only the last of these involves being able to represent time in an event-independent way.

Effect of Different Types of Processing and Storage on the Polyacetylene Profile of Carrots and Parsnips.

Polyacetylenes of the falcarinol type such as falcarinol and falcarindiol naturally occur in plants of the Apiaceae family, mainly carrots and parsnips. In extracts of newly harvested carrots and parsnips, their levels vary between 20 and 300 mg/kg fresh weight and depend on agronomic factors, in particular the cultivar type. With increasing evidence of their in vitro bioactivity, the retention of these heat-sensitive compounds is desirable during handling, processing, and storage of carrots and parsnips. Quantification of these compounds is usually performed using reverse-phase chromatography coupled with mass spectrometry or other detection methods after appropriate solvent extraction. During minimal processing most losses occur during peeling of the carrots due to the higher distribution of polyacetylenes in the vegetable skin. Heat processing results in reduction of polyacetylene levels, whereas in the case of non-thermal processing, it is mainly dependent on the method employed. The levels of polyacetylenes are rather stable during short-term storage. There are some general guidelines to ensure higher retention of polyacetylene.