“Trying, But Failing” : The Role of Inhaler Technique and Mode of Delivery in Respiratory Medication Adherence

Peer reviewed

Growth rates and possible age of a North Pacific manganese nodule

The rate of accumulation of a ferromanganese coating on a fragment of pillow basalt was estimated using a variety of techniques. Unsupported 230 Th activity decrease in the oxide layer, K/A dating of the basalt, fission tracks dating of the glassy layer around the basalt, thickness of the palagonitization rind, and integrated 230 Th activity give ages from approximately 3 x 10-6 years to 5 x 10-3 years. Data suggest that the ferromanganese material formed rapidly (33 mm/10-6 years) and by hydrothermal or volcanic processes.

Learning to manage complexity through simulation: students' challenges and possible strategies

Many have called for medical students to learn how to manage complexity in healthcare. This study examines the nuances of students' challenges in coping with a complex simulation learning activity, using concepts from complexity theory, and suggests strategies to help them better understand and manage complexity.Wearing video glasses, participants took part in a simulation ward-based exercise that incorporated characteristics of complexity. Video footage was used to elicit interviews, which were transcribed. Using complexity theory as a theoretical lens, an iterative approach was taken to identify the challenges that participants faced and possible coping strategies using both interview transcripts and video footage.Students' challenges in coping with clinical complexity included being: a) unprepared for 'diving in', b) caught in an escalating system, c) captured by the patient, and d) unable to assert boundaries of acceptable practice.Many characteristics of complexity can be recreated in a ward-based simulation learning activity, affording learners an embodied and immersive experience of these complexity challenges. Possible strategies for managing complexity themes include: a) taking time to size up the system, b) attuning to what emerges, c) reducing complexity, d) boundary practices, and e) working with uncertainty. This study signals pedagogical opportunities for recognizing and dealing with complexity.

Presence and possible cause of periodicities in 20th-century extreme coastal surge: Belfast Harbour, Northern Ireland.

Identifying 20th-century periodic coastal surge variation is strategic for the 21st-century coastal surge estimates, as surge periodicities may amplify/reduce future MSL enhanced surge forecasts. Extreme coastal surge data from Belfast Harbour (UK) tide gauges are available for 1901–2010 and provide the potential for decadal-plus periodic coastal surge analysis. Annual extreme surge-elevation distributions (sampled every 10-min) are analysed using PCA and cluster analysis to decompose variation within- and between-years to assess similarity of years in terms of Surge Climate Types, and to establish significance of any transitions in Type occurrence over time using non-parametric Markov analysis. Annual extreme surge variation is shown to be periodically organised across the 20th century. Extreme surge magnitude and distribution show a number of significant cyclonic induced multi-annual (2, 3, 5 & 6 years) cycles, as well as dominant multi-decadal (15–25 years) cycles of variation superimposed on an 80 year fluctuation in atmospheric–oceanic variation across the North Atlantic (relative to NAO/AMO interaction). The top 30 extreme surge events show some relationship with NAO per se, given that 80% are associated with westerly dominant atmospheric flows (+ NAO), but there are 20% of the events associated with blocking air massess (− NAO). Although 20% of the top 30 ranked positive surges occurred within the last twenty years, there is no unequivocal evidence of recent acceleration in extreme surge magnitude related to other than the scale of natural periodic variation.

Surgical results and survival of older patients with unsuspected N2 (stage IIIA) non-small cell lung cancer

Purposes. The optimal treatment of N2 non-small cell lung cancer (NSCLC) in older patients is still debate and represent an important treatment and ethical problem. Patients and methods. Between January 2000 to December 2010, 273 older patients underwent lung resection for (NSCLC). Results. The overall-operative mortality was 9.5%. Risk factors for in-hospital mortality were pneumonectomy and poli-vasculopathy. One, 3 and 5-year survival were 73%, 23% and 16% respectively. Conclusions. In potentially operable older patients with NSCLC we need to make every effort to exclude N2 involvement because very poor long-term survival. Pneumonectomy in older patients gains prohibitive in-hospital mortality.

Study of infectious haematopoietic necrosis disease in some hatcheries and farmed rainbow trout in Iran using immunohistochemical technique and to comparing the obtained results with the PCR works

To detect rainbow trout hatcheries for infectious hematopoietic necrosis virus, samples of kidney, liver, spleen, muscle, intestine, heart and gills of trout larvae were obtained from a number of trout hatcheries from different provinces. Also tissue samples were obtained for molecular works using RT- PCR procedure. Tissue samples were processed using standard histotechnique and the obtained sections were stained using immunohistochemical procedure. From 100 examined samples 35 were positive for IHN by immunohistochemical test. Also, from 100 samples examined, 43 were positive in RT- PCR studies. The obtained results show that some rainbow trout hatcheries are contaminated in different regions of country. Therefore, a definition of prevention and eradication criteria are now critical to protect the unaffected areas within the country.

Some causes of unreliability of fishery statistics on the African great lakes and possible ways of bettering the statistics

This paper is based on a two year's intensive statistical data collection survey on Lake Kyoga, observations made on Lake Victoria over the last decade occasional visits on Lake Albert (Mobutu) and Lake Malawi. World over, scientists have kept doubting the fisheries statistical figures presented by various African countries. Some countries fail to present any figures. This paper, therefore, narrates most of the causes and possible solutions to those problems.

Manganese toxicity in Portuguese Cambisols derived from granite: causes, limitations of soil analyses and possible solutions

Cambisols are the major soil type in Portugal. The yield of annual crops in these soils is generally poor, and the situation is aggravated in wet winters. In the south of Portugal, manganese toxicity has been identified as the major cause of poor growth and leaching as the main reason for the negative effect of rainfall observed in Cambisols derived from granite Manganese toxicity also appears to be present in the Cambisols in other regions of Portugal. Manganese toxicity is cross-related to the magnesium concentration, either in the soil solution or in plant shoots. Therefore soil amendment using dolomitic limestone is needed to overcome the problem. Current soil test methods are unable to predict the level of Mn toxicity. However, new approach using the extraction of soil solution is proposed, although further work is needed to fully implement the method.

Padrões de captação de constraste do útero TC e RM

Ao contrário da ecografia e da ressonância magnética (RM), a tomografia computadorizada (TC) não é uma técnica de primeira linha no estudo da patologia pélvica feminina. Contudo, a TC é frequentemente utilizada na avaliação de patologia pélvica não ginecológica, nomeadamente em contexto de urgência ou de seguimento, na qual os órgãos ginecológicos são englobados. Nestas situações, o padrão de captação de contraste endovenoso pelo corpo e colo do útero na TC pode ser de difícil interpretação e por vezes simular patologia, dado o amplo espectro de padrões de captação de contraste endovenoso, de variantes anatómicas e/ou de patologia subjacente. Neste artigo as autoras revêm e ilustram os padrões de captação de contraste endovenoso pelo útero em TC e RM e possíveis pitfalls, permitindo diferenciar os aspectos normais e patológicos do útero em TC.

Surgical infection and malnutrition

Background: Malnutrition in surgical patients is associated with delayed recovery, higher rates of morbidity and mortality, prolonged hospital stay, increased healthcare costs and a higher early re-admission rate. Methods: Data synthesis after review of pertinent literature. Results: The aetiology of malnutrition is multifactorial. In cancer patients, there is an abnormal peripheral glucose disposal, gluconeogenesis, and whole-body glucose turnover. Malnourished cancer patients undergoing major operations are at significant risk from perioperative complications such as infectious complications. Surgical aggression generates an inflammatory response which worsens intermediary metabolism. Conclusions: Nutritional evaluation and nutritional support must be performed in all surgical patients, in order to minimize infectious complications. Enteral nutrition early in the postoperative period is effective and well tolerated reducing infectious complications, improving wound healing and reducing length of hospital stay. Pharmaconutrition is indicated in those patients, who benefit from enteral administration of arginine, omega 3 and RNA, as well as parenteral glutamine supplementation. When proximal sutures are used, tubes allowing early jejunal feeding should be used.

Semantic relations: Modelling issues, proposals and possible applications

Semantic relations are an important element in the construction of ontology-based linguistic resources and models of problem domains. Nevertheless, they remain under-specified. This is a pervasive problem in both Software Engineering and Artificial Intelligence. Thus, we find semantic links that can have multiple interpretations, abstractions that are not enough to represent the relation richness of problem domains, and even poorly structured taxonomies. However, if provided with precise semantics, some of these problems can be avoided, and meaningful operations can be performed on them that can be an aid in the ontology construction process. In this paper we present some insightful issues about the representation of relations. Moreover, the initiatives aiming to provide relations with clear semantics are explained and the inclusion of their core ideas as part of a methodology for the development of ontology-based linguistic resources is proposed.

Access to climate justice: the main procedural hurdles, and possible solutions, within the italian legal framework and the IBA Model Statute

The thesis deals with standing and justiciability in climate litigation against governments and the private sector. The first part addresses the impacts of climate change on human rights, the major developments in international climate law, and the historical reasons for climate litigation. The second part analyses several cases, divided into categories. It then draws to a comparative conclusion with regard to each category. The third part deals with the Italian legal tradition on standing and justiciability – starting from the historical roots of such rules. The fourth part introduces the ‘Model Statute’ drafted by the International Bar Association, arguing that the 'ratio legis' of this proposal could be implemented in Italy or the EU. The thesis develops arguments, based on the existing legal framework, to help plaintiffs establish standing and justiciability in proceedings pending before Italian courts. It further proposes the idea that 'citizen suits' are consistent with the Italian and EU legal tradition and that the EU could rely on citizen suits to privately enforce its climate law and policies under the ‘European Green Deal.’

Contaminants of emerging concern in drinking water: assessment of the effectiveness of removal by drinking water treatments and possible risks to human health

Contaminants of emerging concern are increasingly detected in the water cycle, with endocrine-disrupting chemicals (EDCs) receiving attention due to their potential to cause adverse health effects even at low concentrations. Although the EU has recently introduced some EDCs into drinking water legislation, most drinking water treatment plants (DWTPs) are not designed to remove EDCs, making their detection and removal in DWTPs an important challenge. The aim of this doctoral project was to investigate hormones and phenolic compounds as suspected EDCs in drinking waters across the Romagna area (Italy). The main objectives were to assess the occurrence of considered contaminants in source and drinking water from three DWTPs, characterize the effectiveness of removal by different water treatment processes, and evaluate the potential biological impact on drinking water and human health. Specifically, a complementary approach of target chemical analysis and effect-based methods was adopted to explore drinking water quality, treatment efficacy, and biological potential. This study found that nonylphenol (NP) was prevalent in all samples, followed by BPA. Sporadic contamination of hormones was found only in source waters. Although the measured EDC concentrations in drinking water did not exceed threshold guideline values, the potential role of DWTPs as an additional source of EDC contamination should be considered. Significant increases in BPA and NP levels were observed during water treatment steps, which were also reflected in estrogenic and mutagenic responses in water samples after the ultrafiltration. This highlights the need to monitor water quality during various treatment processes to improve the efficiency of DWTPs. Biological assessments on finished water did not reveal any bioactivity, except for few treated water samples that exhibited estrogenic responses. Overall, the data emphasize the high quality of produced drinking water and the value of applying integrated chemical analysis and in vitro bioassays for water quality assessment.

Caracterização da fala de indivíduos submetidos à palatoplastia primária

OBJETIVOS: Descrever as características de fala de indivíduos submetidos à palatoplastia primária; relacioná-las com tipo de fissura, técnica cirúrgica e idade na ocasião da cirurgia; e descrever as condutas fonoaudiológicas após a cirurgia. MÉTODOS: Estudo retrospectivo de 167 casos, de ambos os gêneros, com fissura labiopalatina, submetidos à palatoplastia primária. Foram coletadas informações relativas ao tipo de fissura, idade na palatoplastia, técnica cirúrgica, e as análises subjetivas sobre as características da fala, realizadas por fonoaudiólogas. RESULTADOS: Na avaliação perceptiva da fala após a cirurgia, encontrou-se inteligibilidade de fala alterada (46%), ressonância hipernasal (33%), articulações compensatórias (26%), emissão de ar nasal (14%), mímica facial (11%) e fraca pressão aérea intra-oral (8%). Na associação entre a ressonância e as articulações compensatórias com tipo de fissura, técnica cirúrgica e faixa etária, não houve diferença significativa. A conduta mais frequentemente tomada foi a de terapia fonoaudiológica (38%), para correção das articulações compensatórias e/ou outras alterações. CONCLUSÃO: A maioria dos indivíduos apresentou ressonância equilibrada ou hipernasalidade aceitável e ausência de articulações compensatória, independente do tipo de fissura, da técnica cirúrgica e da faixa etária, embora não tenha ocorrido diferença significativa. Dentre as condutas adotadas após a primeira avaliação pós-palatoplastia primária, a terapia fonoaudiológica foi a mais frequente.