Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults

Background The measurement of severity and control of asthma in both children and adults can be based on subjective or objective measures. It has been advocated that fractional exhaled nitric oxide (FeNO) can be used to monitor airway inflammation as it correlates with some markers of asthma. Interventions for asthma therapies have been traditionally based on symptoms and/or spirometry. Objectives To 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. Search methods We searched the Cochrane Airways Group Specialised Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and reference lists of articles. The last search was completed in February 2009. Selection criteria All randomised controlled comparisons of adjustment of asthma therapy based on exhaled nitric oxide compared to traditional methods (primarily clinical symptoms and spirometry/peak flow). Data collection and analysis Results of searches were reviewed against pre-determined criteria for inclusion. Relevant studies were independently selected in duplicate. Two authors independently assessed trial quality and extracted data. Authors were contacted for further information with response from one. Main results Two studies have been added for this update, which now includes six (2 adults and 4 children/adolescent) studies; these studies differed in a variety of ways including definition of asthma exacerbations, FeNO cut off levels, the way in which FeNO was used to adjust therapy and duration of study. Of 1053 participants randomised, 1010 completed the trials. In the meta-analysis, there was no significant difference between groups for the primary outcome of asthma exacerbations or for other outcomes (clinical symptoms, FeNO level and spirometry). In post-hoc analysis, a significant reduction in mean final daily dose inhaled corticosteroid per adult was found in the group where treatment was based on FeNO in comparison to clinical symptoms, (mean difference -450 mcg; 95% CI -677 to -223 mcg budesonide equivalent/day). However, the total amount of inhaled corticosteroid used in one of the adult studies was 11% greater in the FeNO arm. In contrast, in the paediatric studies, there was a significant increase in inhaled corticosteroid dose in the FeNO strategy arm (mean difference of 140 mcg; 95% CI 29 to 251, mcg budesonide equivalent/day). Authors' conclusions Tailoring the dose of inhaled corticosteroids based on exhaled nitric oxide in comparison to clinical symptoms was carried out in different ways in the six studies and found only modest benefit at best and potentially higher doses of inhaled corticosteroids in children. The role of utilising exhaled nitric oxide to tailor the dose of inhaled corticosteroids cannot be routinely recommended for clinical practice at this stage and remains uncertain.

Formation of blood clot on biomaterial implants influences bone healing

The first step in bone healing is forming a blood clot at injured bones. During bone implantation, biomaterials unavoidably come into direct contact with blood, leading to a blood clot formation on its surface prior to bone regeneration. Despite both situations being similar in forming a blood clot at the defect site, most research in bone tissue engineering virtually ignores the important role of a blood clot in supporting healing. Dental implantology has long demonstrated that the fibrin structure and cellular content of a peri-implant clot can greatly affect osteoconduction and de novo bone formation on implant surfaces. This paper reviews the formation of a blood clot during bone healing in related to the use of platelet-rich plasma (PRP) gels. It is implicated that PRP gels are dramatically altered from a normal clot in healing, resulting conflicting effect on bone regeneration. These results indicate that the effect of clots on bone regeneration depends on how the clots are formed. Factors that influence blood clot structure and properties in related to bone healing are also highlighted. Such knowledge is essential for developing strategies to optimally control blood clot formation, which ultimately alter the healing microenvironment of bone. Of particular interest are modification of surface chemistry of biomaterials, which displays functional groups at varied composition for the purpose of tailoring blood coagulation activation, resultant clot fibrin architecture, rigidity, susceptibility to lysis, and growth factor release. This opens new scope of in situ blood clot modification as a promising approach in accelerating and controlling bone regeneration.

Should we tailor standardize exercise interventions to suit differing menopausal status?

The article by Kretzschmar et al in this issue of Menopause details a study investigating the effect of a mild-intensity aerobic exercise training program on markers of mortality risk in both pre- and post-menopausal African American women. The findings of this study showed that aerobic exercise training was successful in improving some markers of cardiovascular disease and mortality in post-menopausal women. The premise of this study, however, does suggest that increased exercise intensity may be required in post-menopausal women as opposed to pre menopausal women to achieve the same decreased changes in CVD markers. The outcome of the study is thus of interest to the readers of Menopause and to all those who provide health care to postmenopausal women, as they suggest that higher levels of exercise intensity or perhaps additional interventions may need to be considered in this population to further decrease mortality risk. The study therefore, has greater implications than simply the suggesting of tailoring exercise interventions generally, rather, the publication highlights the importance of prescribing exercise as medicine in a tailored fashion for women depending on their menopausal status.

From short pulses to short breaks : exotic plasma bullets via residual electron control

Plasma plumes with exotically segmented channel structure and plasma bullet propagation are produced in atmospheric plasma jets. This is achieved by tailoring interruptions of a continuous DC power supply over the time scales of lifetimes of residual electrons produced by the preceding discharge phase. These phenomena are explained by studying the plasma dynamics using nanosecond-precision imaging. One of the plumes is produced using 2-10μs interruptions in the 8kV DC voltage and features a still bright channel from which a propagating bullet detaches. A shorter interruption of 900ns produces a plume with the additional long conducting dark channel between the jet nozzle and the bright area. The bullet size, formation dynamics, and propagation speed and distance can be effectively controlled. This may lead to micrometer-and nanosecond-precision delivery of quantized plasma bits, warranted for next-generation health, materials, and device technologies.

Feather-like He plasma plumes in surrounding N2 gas

Effects of surrounding gases on the propagation of room-temperature atmospheric-pressure plasma jets are reported. A highly unusual feather-like plasma plume is observed only when N2 is used as surrounding gas. The He concentration on the axis at the starting point of the feather-like plume is ∼0.85 of the maximum value and is independent on the He flow rates. High-speed optical imaging reveals that dim diffuse plasmas emerge just behind the bright head of the plasma bullet at the starting point of the feather-like plume. These results help tailoring surface exposure in emerging applications of plasma jets in medicine and nanotechnology.

Uniform, dense arrays of vertically aligned, large-diameter single-walled carbon nanotubes

Precisely controlled reactive chemical vapor synthesis of highly uniform, dense arrays of vertically aligned single-walled carbon nanotubes (SWCNTs) using tailored trilayered Fe/Al2O3/SiO2 catalyst is demonstrated. More than 90% population of thick nanotubes (>3 nm in diameter) can be produced by tailoring the thickness and microstructure of the secondary catalyst supporting SiO2 layer, which is commonly overlooked. The proposed model based on the atomic force microanalysis suggests that this tailoring leads to uniform and dense arrays of relatively large Fe catalyst nanoparticles on which the thick SWCNTs nucleate, while small nanotubes and amorphous carbon are effectively etched away. Our results resolve a persistent issue of selective (while avoiding multiwalled nanotubes and other carbon nanostructures) synthesis of thick vertically aligned SWCNTs whose easily switchable thickness-dependent electronic properties enable advanced applications in nanoelectronic, energy, drug delivery, and membrane technologies.

Control of morphology and electrical properties of self-organized graphenes in a plasma

The possibility of effective control of morphology and electrical properties of self-organized graphene structures on plasma-exposed Si surfaces is demonstrated. The structures are vertically standing nanosheets and can be grown without any catalyst and any external heating upon direct contact with high-density inductively coupled plasmas at surface temperatures not exceeding 673–723 K. Study of nucleation and growth dynamics revealed the possibility to switch-over between the two most common (turnstile- and maze-like) morphologies on the same substrates by a simple change of the plasma parameters. This change leads to the continuous or discontinuous native oxide layer that supports self-organized patterns of small carbon nanoparticles on which the structures nucleate. It is shown that by tailoring the nanoparticle arrangement one can create various three-dimensional architectures and networks of graphene nanosheet structures. We also demonstrate effective control of the degree of graphitization of the graphene nanosheet structures from the initial through the final growth stages. This makes it possible to tune the electrical resistivity properties of the produced three-dimensional patterns/networks from strongly dielectric to semiconducting. Our results contribute to enabling direct integration of graphene structures into presently dominant Si-based nanofabrication platform for next-generation nanoelectronic, sensor, biomedical, and optoelectronic components and nanodevices.

3-Orders-of-magnitude density control of single-walled carbon nanotube networks by maximizing catalyst activation and dosing carbon supply

Tailoring the density of random single-walled carbon nanotube (SWCNT) networks is of paramount importance for various applications, yet it remains a major challenge due to the insufficient catalyst activation in most growth processes. Here we report on a simple and effective method to maximise the number of active catalyst nanoparticles using catalytic chemical vapor deposition (CCVD). By modulating short pulses of acetylene into a methane-based CCVD growth process, the density of SWCNTs is dramatically increased by up to three orders of magnitude without increasing the catalyst density and degrading the nanotube quality. In the framework of a vapor-liquid-solid model, we attribute the enhanced growth to the high dissociation rate of acetylene at high temperatures at the nucleation stage, which can be effective in both supersaturating the larger catalyst nanoparticles and overcoming the nanotube nucleation energy barrier of the smaller catalyst nanoparticles. These results are highly relevant to numerous applications of random SWCNT networks in next-generation energy, sensing and biomedical devices. © 2011 The Royal Society of Chemistry.

Deterministic surface growth of single-crystalline iron oxide nanostructures in nonequilibrium plasma

An innovative approach to precise tailoring of surface density, shapes, and sizes of single-crystalline α-Fe 2O 3 nanowires and nanobelts by controlling interactions of reactive oxygen plasma-generated species with the Fe surface is proposed. This strongly nonequilibrium, rapid, almost incubation-free, high-rate growth directly from the solid-solid interface can also be applied to other oxide materials and is based on deterministic control of the density of oxygen species and the surface conditions, which determine the nanostructure nucleation and growth.

Nanofabrication of single-crystalline flat-panel display microemitters : a plasma-building unit approach

This contribution is focused on plasma-enhanced chemical vapor deposition systems and their unique features that make them particularly attractive for nanofabrication of flat panel display microemitter arrays based on ordered patterns of single-crystalline carbon nanotip structures. The fundamentals of the plasma-based nanofabrication of carbon nanotips and some other important nanofilms and nanostructures are examined. Specific features, challenges, and potential benefits of using the plasma-based systems for relevant nanofabrication processes are analyzed within the framework of the "plasma-building unit" approach that builds up on extensive experimental data on plasma diagnostics and nanofilm/nanostructure characterization, and numerical simulation of the species composition in the ionized gas phase (multicomponent fluid models), ion dynamics and interaction with ordered carbon nanotip patterns, and ab initio computations of chemical structure of single crystalline carbon nanotips. This generic approach is also applicable for nanoscale assembly of various carbon nanostructures, semiconductor quantum dot structures, and nano-crystalline bioceramics. Special attention is paid to most efficient control strategies of the main plasma-generated building units both in the ionized gas phase and on nanostructured deposition surfaces. The issues of tailoring the reactive plasma environments and development of versatile plasma nanofabrication facilities are also discussed.

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.

1950s made in Brisbane : Italian tailors and the continental suit

During the 1950s and 1960s, when the French couturiers Dior, Balenciaga, Givenchy and Chanel dominated the fashion industry, the Italian community in Brisbane, Australia, was very active in the local industry through retail, dress-making and tailoring. Australia is geographically at the margins of the developed countries and has been dependent on European trends and taste. In the 1950s, communication was based on magazines and especially newsreels and film; each ethnic group dressed as they liked and according to their custom. Moreover, ‘Made in Italy’ was not yet the prestigious concept that revolutionized ready-to-wear design from the 1970s. However, Italian tailors and demi-couturiers brought to Brisbane their trans-national sense of elegance (the Italian style) and the taste in fashion that influenced new generations in England and elsewhere in Europe from the 1950s. They brought quality and workmanship, offering excellence through the use of quality fabrics from prestigious English and Italian brands. These tailors and dress-makers also contributed towards the local industry through passing on the skills that they brought from Italy. This article is based on a project that seeks to understand the connection between fashion, history and place. The area under examination is the Valley, short for Fortitude Valley, an area adjacent to the Brisbane CBD. Fundamental to this connection between place and fashion was the presence of many Italian migrants in the area. Through archival research and oral history, the aim of this ethnographic project is to bring to the fore an untold story about the economic and aesthetic contribution of Italian migrants to Queensland. Central to the understanding of this aesthetic change is the Italian suit. This research is innovative in that it opens a new area of study in Australian fashion history, connected to the history of migrants and their identity.

Understanding Pathophysiology - ANZ adaptation [1st edition.]

Pathophysiology is a complex, though essential, component of all undergraduate nursing courses and there is an identified need for a text tailored specifically for the Australian and New Zealand student. The entrenched bio-medical terminology can often be difficult to relate to nursing practice. To overcome this, the authors have presented pathophysiology in an accessible manner appropriate to undergraduate students, providing a balance between science, clinical case material and pharmacology. This adaptation prioritises the diseases relevant to nursing students and presents them according to their prevalence and rate of incidence in Australia and New Zealand. This focused approach prepares students for the presentations they will experience in a clinical setting. Each body system is explored first by structure and function, then by alteration.This establishes the physiology prior to addressing the diseases relative to the system and allows the student to analyse and compare the normal versus altered state. A lifespan approach is incorporated in the Alterations chapters, as each chapter addresses childhood diseases through to the aged with respect to each body system. A new section on Contemporary Health Issues examines the effects of an aging population and lifestyle choices on the overall health of our society. These are explored through specific chapters on Stress; Genes and the Environment; Obesity and Diabetes; Cancer; Mental Illness and Indigenous health issues. Concept maps are used to assist students to understand the basic concepts of each chapter and are used as a foundation for more complex discussions. Clinical case studies are also included in each chapter to bring pathophysiology into practice. Each patient case study will highlight relevant symptoms of a given disease within a clinical setting. This is analysed with respect to the relevancy of each given symptom, their respective affect on body systems and the best course of pharmacological treatment. This forthcoming textbook is an adaptation of Understanding Pathophysiology 4e by Huether & McCance. It builds on the strengths of the US edition while tailoring it to the specific needs of Australia and New Zealand undergraduate nursing students. As such it is an invaluable text which will compliment your suite of Elsevier nursing titles.

Indigenous health issues in Australia

This adaptation of Understanding Pathophysiology by Huether and McCance builds on the strengths of the US edition while tailoring it to the specific needs of Australia and New Zealand undergraduate nursing students.

Catching drink drivers in Queensland through Random Breath Testing : what does the last decade of data tell us

Background Random Breath Testing (RBT) has proven to be a cornerstone of enforcement attempts to deter (as well as apprehend) motorists from drink driving in Queensland (Australia) for decades. However, scant published research has examined the relationship between the frequency of implementing RBT activities and subsequent drink driving apprehension rates across time. Aim This study aimed to examine the prevalence of apprehending drink drivers in Queensland over a 12 year period. It was hypothesised that an increase in breath testing rates would result in a corresponding decrease in the frequency of drink driving apprehension rates over time, which would reflect general deterrent effects. Method The Queensland Police Service provided RBT data that was analysed. Results Between the 1st of January 2000 and 31st of December 2011, 35,082,386 random breath tests (both mobile and stationary) were conducted in Queensland, resulting in 248,173 individuals being apprehended for drink driving offences. A total of 342,801 offences were recorded during this period, representing an intercept rate of .96. Of these offences, 276,711 (80.72%) were recorded against males and 66,024 (19.28%) offences committed by females. The most common drink driving offence was between 0.05 and 0.08 BAC limit. The largest proportion of offences was detected on the weekends, with Saturdays (27.60%) proving to be the most common drink driving night followed by Sundays (21.41%). The prevalence of drink driving detection rates rose steadily across time, peaking in 2008 and 2009, before slightly declining. This decline was observed across all Queensland regions and any increase in annual figures was due to new offence types being developed. Discussion This paper will further outline the major findings of the study in regards to tailoring RBT operations to increase detection rates as well as improve the general deterrent effect of the initiative.