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Objectives: To determine whether Opto-Electronic Plethysmography (OEP) can distinguish Exercise-Induced Bronchoconstriction (EIB) breathing patterns by comparing individuals with and without EIB, and between broncho-constriction and recovery. Breathing pattern was quantified in terms of regional contribution, breathing timing, and the phase between chest sub-compartments which indicates the synchronization in movement of the different sub-compartments. Methods: Individuals (n = 47) reporting no respiratory symptoms and no history of any respiratory disease or disorder were assumed to have a healthy breathing pattern. Of 38 participants reporting respiratory symptoms during exercise, and/or a previous diagnosis of asthma or EIB, 10 participants had a positive result to the Eucapnic Voluntary Hyperpnea test, defined as a fall of at least 10% in FEV1 from baseline at two consecutive time points and were classified into the EIB group. OEP data was obtained from 89 markers and an 11-camera motion capture system operating at 100 Hz as follows: pre- and post-EVH challenge, and post-inhaler in participants who experienced a bronchoconstriction, and 2) for the healthy group during tidal breathing. Results: RCpRCa-Phase (upper versus lower ribcage), RCaS-Phase (lower ribcage versus shoulders), and RCpS-Phase (upper ribcage versus shoulders) differed between bronchoconstriction and rest in athletes with EIB and rest in healthy participants (p < 0.05), in all cases indicating greater asynchrony post-bronchoconstriction, and later movement of the abdominal ribcage (RCa) post-bronchoconstriction. RCpS-Phase was different (p < 0.05) between all conditions (rest, post-bronchoconstriction, and post-inhaler) in EIB. Conclusions: OEP can characterize and distinguish EIB-associated breathing patterns compared to rest and individuals without EIB at rest. [ABSTRACT FROM AUTHOR]

Acute respiratory distress syndrome (ARDS) is a multifactorial, inflammatory lung disease with significant morbidity and mortality that predominantly requires supportive care in its management. Although initially described in adult patients, the diagnostic definitions for ARDS have evolved over time to accurately describe this disease process in pediatric and, more recently, neonatal patients. The management of ARDS in each age demographic has converged in the application of lung-protective ventilatory strategies to mitigate the primary disease process and prevent its exacerbation by limiting ventilator-induced lung injury. However, differences arise in the preferred ventilatory strategies or adjunctive pulmonary therapies used to mitigate each type of ARDS. In this review, we compare and contrast the epidemiology, common etiologies, pathophysiology, diagnostic criteria, and outcomes of ARDS across the lifespan. Additionally, we discuss in detail the different management strategies used for each subtype of ARDS and spotlight how these strategies were applied to mitigate poor outcomes during the COVID-19 pandemic. This review is geared toward both clinicians and clinician-scientists as it not only summarizes the latest information on disease pathogenesis and patient management in ARDS across the lifespan but also highlights knowledge gaps for further investigative efforts. We conclude by projecting how future studies can fill these gaps in research and what improvements may be envisioned in the management of NARDS and PARDS based on the current breadth of literature on adult ARDS treatment strategies. [ABSTRACT FROM AUTHOR]

Objective: Engaging in outdoor cycling, particularly within cold and arid environments, frequently precipitates dryness in the laryngeal mucosa and induces various supraglottic disorders. Such conditions hold the potential to detrimentally impact respiratory system efficiency. This study principally sought to elucidate the influence of supraglottic and upper airway disorders on the the results of spirometry flow-volume measurements of road cyclist. Methods and Materials: This investigation encompassed seventy-two professional and elite road cyclists, comprising 22 females and 50 males, with an average age of 22 years and a Body Mass Index (BMI) of 21.95(±0.02) kg/m². Utilizing stroboscopic examinations, supraglottic conditions including Sicca, Tension, Edema, and Gastroesophageal Reflux Disease were assessed. Concurrently, respiratory capacity was evaluated through spirometric tests, encompassing Forced Vital Capacity [FVC], Forced Expiratory Volume in the first second [FEV1], Tidal Volume [VT], Maximum Vital Capacity [VC MAX], Mean Mid-Expiratory Flow [MMEF (FEF25-75)], Peak Expiratory Flow [PEF], and Controlled Mechanical Volume Ventilation [cMVV]. Analysis of Variance (ANOVA) was employed to analyze the relationship between stroboscopic and spirometric findings, additionally exploring correlations between the two. A backward method in regression analysis was used, with Edema (ED), Gastroesophageal Reflux Disease (GERD), Dry Laryngeal Mucosa (Sicca), and Tension (TE) serving as predictor variables against spirometric outcomes. Results: Predominantly, participants exhibited low levels of ED, GERD, Sicca, and TE. No substantial correlation emerged between ED, GERD, TE, and any spirometric indices (p-value > 0.05). However, a notable relationship was observed between Sicca and the MMEF index (p-value < 0.05). Regression analysis revealed significant outcomes for independent variables impacting VT and MEF25, with GERD negatively influencing VT in a statistically significant manner. Likewise, GERD's effect on the MEF25 variable was both negative and significant. Conclusion: Based on the findings, it seems that supraglottic disorders negatively affect the efficiency of the respiratory system in cyclists. Therefore, it is recommended that cyclists consider the necessary evaluations to check the supraglottis in order to improve their performance during training and competitions. [ABSTRACT FROM AUTHOR]

The Toll-like receptor (TLR) adaptor protein MyD88 is integral to airway inflammatory response to microbial- enriched organic dust extract (ODE) exposures. ODE-induced airway neutrophil influx and release of pro-inflammatory cytokines was essentially abrogated in global MyD88-deficient mice, yet these mice demonstrate an increase in airway epithelial cell mucin expression. To further elucidate the role of MyD88-dependent responses specific to lung airway epithelial cells in response to ODE in vivo, the surfactant protein C protein (SPC) Cre+ embryologic expressing airway epithelial cells floxed for MyD88 to disrupt MyD88 signaling were utilized. The inducible club cell secretory protein (CCSP) Cre+, MyD88 floxed, were also developed. Using an established protocol, mice were intranasally instilled with ODE or saline once or daily up to 3weeks. Mice with MyD88-deficient SPC+ lung epithelial cells exhibited decreased neutrophil influx following ODE exposure once and repetitively for 1week without modulation of classic pro-inflammatory mediators including tumor necrosis factor (TNF)-a, interleukin (IL)-6, and neutrophil chemoattractants. This protective response was lost after 3weeks of repetitive exposure. ODE-induced Muc5ac mucin expression at 1 week was also reduced in MyD88-deficient SPC+ cells. Acute ODE-induced IL-33 was reduced in MyD88-deficient SPC+ cells whereas serum IgE levels were increased at one week. In contrast, mice with inducible MyD88-deficient CCSP+ airway epithelial cells demonstrated no significant difference in experimental indices following ODE exposure. Collectively, these findings suggest that MyD88-dependent signaling targeted to all airway epithelial cells plays an important role in mediating neutrophil influx and mucin production in response to acute organic dust exposures. [ABSTRACT FROM AUTHOR]

Introduction: Exercise‐induced bronchoconstriction (EIB) is not only highly prevalent in people with asthma, but can also occur independently, particularly in athletes. Fractional exhaled nitric oxide (FeNO) is an indirect biomarker of type 2 airway inflammation that has an established role in the assessment and management of asthma. The aim was to evaluate the value of FeNO in the assessment of EIB in athletes. Method: Multicenter retrospective analysis. In total, 488 athletes (male: 76%) performed baseline FeNO, and spirometry pre‐ and post‐indirect bronchial provocation via eucapnic voluntary hyperpnea (EVH). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for established FeNO thresholds—that is, intermediate (≥25 ppb) and high FeNO (≥40 ppb and ≥ 50 ppb)—and were evaluated against objective evidence of EIB (≥10% fall in FEV1). The diagnostic accuracy of FeNO was calculated using receiver operating characteristics area under the curve (ROC‐AUC). Results: Thirty‐nine percent of the athletes had a post‐EVH fall in FEV1 consistent with EIB. FeNO values ≥25 ppb, ≥40 ppb, and ≥ 50 ppb were observed in 42%, 23%, and 17% of the cohort, respectively. The sensitivity of FeNO ≥25 ppb was 55%, which decreased to 37% and 27% at ≥40 ppb and ≥ 50 ppb, respectively. The specificity of FeNO ≥25 ppb, ≥40 ppb, and ≥ 50 ppb was 66%, 86%, and 89%, respectively. The ROC‐AUC for FeNO was 0.656. Conclusions: FeNO ≥40 ppb provides good specificity, that is, the ability to rule‐in a diagnosis of EIB. However, due to the poor sensitivity and predictive values, FeNO should not be employed as a replacement for indirect bronchial provocation in athletes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of twice-daily inhalation of 100 µg of salmeterol (SAL) or 12 µg of formoterol (FOR) in addition to a strength- and power-training program over a 5-wk period on a 30-m sprint, strength, power, mood, stress, and skinfold thickness. Methods: In a randomized, single-blind study, 23 male and 15 female nonasthmatic, recreationally active individuals were recruited (mean [SD] age 26.3 [5.4] y, weight 76.2 [11.5] kg, height 176.9 [8.5] cm). Participants completed 3 standardized whole-body strength- and power-training sessions per week for 5 wk during which they were assigned to an SAL, FOR, or placebo group. Participants used their inhaler twice per day as instructed and completed assessments of sprint, strength, and power at baseline and 1 wk after cessation of the training program. The assessments included a 30-m sprint, vertical jump, 1-repetition-maximum (1RM) bench press, 1RM leg press, peak torque flexion and extension, anthropometric evaluation, and Rest-Q questionnaires. Results: After 5 wk of strength and power training, 30-m sprint time reduced in the FOR (0.29 [0.11] s, P = .049) and SAL (0.35 [0.05] s, P = .040) groups compared with placebo (+0.01 [0.11] s). No significant change was found in other assessments of strength, mood, or skinfold thickness. Conclusions: When strength and power training are combined with the inhalation of FOR or SAL over a 5-wk period, moderately trained individuals experience an improvement in 30-m sprint performance. [ABSTRACT FROM AUTHOR]

Terbutaline is a prohibited drug except for athletes with a therapeutic use exemption certificate; terbutaline's effects on endurance performance are relatively unknown. Purpose: To investigate the effects of 2 therapeutic (2 and 4 mg) inhaled doses of terbutaline on 3-km running time-trial performance. Methods: A total of 8 men (age 24.3 [2.4] y; weight 77.6 [8] kg; and height 179.5 [4.3] cm) and 8 women (age 22.4 [3] y; weight 58.6 [6] kg; and height 163 [9.2] cm) free from respiratory disease and illness provided written informed consent. Participants completed 3-km running time trials on a nonmotorized treadmill on 3 separate occasions following placebo and 2- and 4-mg inhaled terbutaline in a single-blind, repeated-measures design. Urine samples (15 min postexercise) were analyzed for terbutaline concentration. Data were analyzed using 1-way repeated-measures analysis of variance, and significance was set at P < .05 for all analyses. Results: No differences were observed for completion times (1103 [201] s, 1106 [195] s, 1098 [165] s; P = .913) for the placebo or 2- and 4-mg inhaled trials, respectively. Lactate values were higher (P = .02) after 4 mg terbutaline (10.7 [2.3] mmol⋅L-1) vs placebo (8.9 [1.8] mmol⋅L-1). Values of forced expiratory volume in the first second of expiration (FEV1) were greater after inhalation of 2 mg (5.08 [0.2]; P = .01) and 4 mg terbutaline (5.07 [0.2]; P = .02) compared with placebo (4.83 [0.5] L) postinhalalion. Urinary terbutaline concentrations were mean 306 (288) ng⋅mL-1 and 435 (410) ng⋅mL-1 (P = .2) and peak 956 ng⋅mL-1 and 1244 ng⋅mL-1 after 2 and 4 mg inhaled terbutaline, respectively. No differences were observed between the male and female participants. Conclusions: Therapeutic dosing of terbutaline does not lead to an improvement in 3-km running performance despite significantly increased FEV1. The findings suggest that athletes using inhaled terbutaline at high therapeutic doses to treat asthma will not gain an ergogenic advantage during 3-km running performance. [ABSTRACT FROM AUTHOR]

Introduction: The purpose was to compare two flexible regimens of intravitreal aflibercept (IVT-AFL) with fixed dosing every 8 weeks, beyond the first year of treatment, in patients with diabetic macular edema (DME). VIOLET was a 100-week, randomized, Phase IIIb, non-inferiority study in patients with center-involving DME previously treated with IVT-AFL for ≥ 1 year according to the European label. Methods: Patients received an initial dose of IVT-AFL at study baseline and were randomly assigned (1:1:1) to treat-and-extend (T&E), pro re nata (PRN), or fixed regimens. The primary endpoint was mean change in best-corrected visual acuity (BCVA) from baseline (randomization) to Week 52. Results: Full analysis set comprised 458 patients (baseline mean BCVA: 72.5, 71.0, and 72.7 letters in the T&E, PRN, and fixed-dose groups, respectively). Patients received a mean (min–max) of 10.0 (2–14; T&E), 11.5 (1–25; PRN), and 12.3 (3–13; fixed) injections over 100 weeks, with 13.3 (4–23), 25.0 (3–29), and 16.1 (5–25) clinic visits, respectively. At Week 52, mean (± standard deviation) BCVA changes from baseline were + 0.5 ± 6.7 (T&E), + 1.7 ± 6.8 (PRN), and + 0.4 ± 6.7 (fixed-dosing) letters (least squares mean difference [95% confidence interval]: T&E 0.01 [− 1.46, 1.47] and PRN 0.95 (− 0.52, 2.42) letters versus fixed dosing; p < 0.0001 for both non-inferiority tests [4-letter margin]). The IVT-AFL safety profile was consistent with previous studies. Conclusion: The treatment burden associated with intravitreal injections for DME is lowest with T&E regimens, but there are a range of flexible IVT-AFL dosing regimens, allowing physicians to adopt an individualized treatment plan. Trial Registration: ClinicalTrials.gov identifier: NCT02818998. [ABSTRACT FROM AUTHOR]

Background: Respiratory viral infections are one of the leading causes of need for emergency care and hospitalizations in asthmatic individuals, and airway-secreted cytokines are released within hours of viral infection to initiate these exacerbations. IL-33, specifically, contributes to these allergic exacerbations by amplifying type 2 inflammation. We hypothesized that blocking IL-33 in RSV-induced exacerbation would significantly reduce allergic inflammation.Methods: Sensitized BALB/c mice were challenged with aerosolized ovalbumin (OVA) to establish allergic inflammation, followed by RSV-A2 infection to yield four treatment groups: saline only (Saline), RSV-infected alone (RSV), OVA alone (OVA), and OVA-treated with RSV infection (OVA-RSV). Lung outcomes included lung mRNA and protein markers of allergic inflammation, histology for mucus cell metaplasia and lung immune cell influx by cytospin and flow cytometry.Results: While thymic stromal lymphopoietin (TSLP) and IL-33 were detected 6 h after RSV infection in the OVA-RSV mice, IL-23 protein was uniquely upregulated in RSV-infected mice alone. OVA-RSV animals varied from RSV- or OVA-treated mice as they had increased lung eosinophils, neutrophils, group 2 innate lymphoid cells (ILC2) and group 3 innate lymphoid cells (ILC3) detectable as early as 6 h after RSV infection. Neutralized IL-33 significantly reduced ILC2 and eosinophils, and the prototypical allergic proteins, IL-5, IL-13, CCL17 and CCL22 in OVA-RSV mice. Numbers of neutrophils and ILC3 were also reduced with anti-IL-33 treatment in both RSV and OVA-RSV treated animals as well.Conclusions: Taken together, our findings indicate a broad reduction in allergic-proinflammatory events mediated by IL-33 neutralization in RSV-induced asthma exacerbation. [ABSTRACT FROM AUTHOR]

Background: Environmental organic dust exposures enriched in Toll-like receptor (TLR) agonists can reduce allergic asthma development but are associated with occupational asthma and chronic bronchitis. The TLR adaptor protein myeloid differentiation factor88 (MyD88) is fundamental in regulating acute inflammatory responses to organic dust extract (ODE), yet its role in repetitive exposures is unknown and could inform future strategies.Methods: Wild-type (WT) and MyD88 knockout (KO) mice were exposed intranasally to ODE or saline daily for 3 weeks (repetitive exposure). Repetitively exposed animals were also subsequently rested with no treatments for 4 weeks followed by single rechallenge with saline/ODE.Results: Repetitive ODE exposure induced neutrophil influx and release of pro-inflammatory cytokines and chemokines were profoundly reduced in MyD88 KO mice. In comparison, ODE-induced cellular aggregates, B cells, mast cell infiltrates and serum IgE levels remained elevated in KO mice and mucous cell metaplasia was increased. Expression of ODE-induced tight junction protein(s) was also MyD88-dependent. Following recovery and then rechallenge with ODE, inflammatory mediators, but not neutrophil influx, was reduced in WT mice pretreated with ODE coincident with increased expression of IL-33 and IL-10, suggesting an adaptation response. Repetitively exposed MyD88 KO mice lacked inflammatory responsiveness upon ODE rechallenge.Conclusions: MyD88 is essential in mediating the classic airway inflammatory response to repetitive ODE, but targeting MyD88 does not reduce mucous cell metaplasia, lymphocyte influx, or IgE responsiveness. TLR-enriched dust exposures induce a prolonged adaptation response that is largely MyD88-independent. These findings demonstrate the complex role of MyD88-dependent signaling during acute vs. chronic organic dust exposures. [ABSTRACT FROM AUTHOR]

Building information modeling (BIM) can be considered a collaborative design process that allows all project stakeholders in different disciplines to contribute during the design phase of a construction project. However, interoperability issues between wind, structural engineering tools, and BIM design authoring software platforms have acted as a barrier to such collaborative design processes. This research pursued an evaluation-based approach to propose and develop a workflow for resolving the interoperability issues as well as automating significant parts of the collaborative design process. In this paper, the development of an automated modelling system to facilitate integrated structural design and wind engineering analysis using BIM is presented. The research was focused on pre-engineered building (PEB) as a case study. This research introduces some novel BIM concepts to facilitate the implementation of automation in the model development processes. These concepts facilitate engineering analysis integration and overcome challenges associated with creating and working with different level of development (LOD) models. The proposed system uses a central element level database and outputs a 3D model of the building and the computational domain for use by the computational fluid dynamics software. A BIM-based application program interface (API) and stand-alone software was developed to evaluate the proposed concepts and process and their feasibility. The results suggest a successful integration that could significantly improve the building design quality and further facilitate wind, or other, engineering design collaborations. It is also observed that the resulting process could be applied (extended) to the general architecture, engineering, and construction (AEC) industry. [ABSTRACT FROM AUTHOR]

Patients with cystic fibrosis (CF) experience multiple pulmonary exacerbations throughout their lifetime, resulting in repeated antibiotic exposure and hospital admissions. Reliable diagnostic markers to guide antibiotic treatment in patients with CF, however, are lacking. Given that the CF airway is characterized by persistent and frequent bacterial infection, our goal was to determine if procalcitonin (PCT) could be used as a severity and prognostic marker of CF exacerbation. We enrolled 40 participants at the time of diagnosis of CF pulmonary exacerbation. Inclusion criteria: age ≥19 years with exacerbation requiring antibiotics as determined by the treating physician. Exclusion criteria: antibiotics initiated more than 48 hours prior to enrollment, and pregnancy. Blood samples were collected on enrollment day and after 7-10 days of treatment. Of the 40 patients enrolled, 23 (57.5%) had detectable levels of PCT (≥0.05 ng/mL). PCT levels were significantly associated with pulmonary exacerbation scores (p=0.01) and per cent decrease in forced expiratory volume in 1 second (FEV1) (p=0.01) compared with the best in the last 12 months. Those who had worsening PCT during treatment had less improvement in FEV1 (p=0.001) and were more likely to be readmitted to the hospital sooner (p<0.0001). Likewise, those who had a detectable PCT at the time of admission were more likely to be readmitted sooner (p=0.03). PCT elevation during antibiotic treatment is associated with less improvement in FEV1 and earlier readmission. A detectable PCT level occurs only in more severe CF exacerbations. Multicenter trials are needed to confirm whether PCT may play a role in the clinical care of patients with CF. [ABSTRACT FROM AUTHOR]

Despite this, all participants had normal resting lung function with no evidence of airflow limitation (FEV SB 1 sb predicted >80% and FEV SB 1 sb /FVC > 70% predicted). The mean fall in FEV SB 1 sb was greater following EVH (-7.9% ± 6.9%) in comparison to EX (-1.9 ± 7.1; I P i < .01), with a reduction in FEV SB 1 sb observed following EVH in almost all participants (94%). Furthermore, in those with >=10% fall in FEV SB 1 sb , the mean reduction in lung function (ie severity of EIB) was greater following EVH (-19% ± 7%) in comparison to EX (-11% ± 9%; I P i < .01). EX + EVH negative (closed circles); EX + EVH positive (open circles); EX negative + EVH positive (split circles); EX positive + EVH negative (closed triangle). [Extracted from the article]

Background: Exogenous endophthalmitis is a potential complication of intraocular surgery and frequently results in visual impairment. Current treatment involves administration of intravitreal (IVT) antibiotics with or without vitrectomy surgery. Evidence for the use of adjunctive anti‐inflammatory agents is conflicting. We set out to determine if bevacizumab, a humanized monoclonal IgG1 antibody targeted against vascular endothelial growth factor (VEGF), has anti‐inflammatory properties in experimental models of Gram‐positive and Gram‐negative inflammation. Methods: BALB/c mice were subjected to lipopolysaccharide‐ (LPS) or peptidoglycan‐ (PGN) induced ocular inflammation and treated with IVT bevacizumab. Iris microvasculature was imaged 6 hours following irritant/treatment using intravital microscopy (IVM) before the mice were euthanized and the eyes were enucleated immediately post‐mortem. Following enucleation, levels of VEGF and 23 cytokines and chemokines (IL‐1α, IL‐1β, IL‐2, IL‐3, IL‐4, IL‐5, IL‐6, IL‐10, IL‐12 (p40), IL‐12 (p70), IL‐13, IL‐17, TNF, KC, G‐CSF, GM‐CSF, Eotaxin, INF‐γ, MCP‐1, MIP‐1α, MIP‐1β, RANTES) were quantified using a multiplex assay. Results: Levels of VEGF were significantly increased during the inflammatory response, triggered by either PGN or LPS. Both the adherence of leukocytes to the iris vascular endothelium and the levels of pro‐inflammatory cytokines and chemokines were significantly increased following administration of either irritant. Treatment with bevacizumab decreased levels of leukocyte adherence in LPS‐treated eyes, however, not in PGN‐treated eyes. Conversely, bevacizumab treatment decreased levels of cytokines and chemokines (TNF, IL‐6, MCP‐1, MIP‐1α, MIP‐1β, RANTES, KC) in PGN‐treated eyes, however, not in LPS‐treated eyes. Conclusions: Within a 6‐hour window bevacizumab had anti‐inflammatory actions that were distinct in both Gram‐positive (PIU) and Gram‐negative (EIU) models, respectively. Given our findings, this would suggest that bevacizumab may have utility as an adjunctive therapy to IVT antibiotics and vitrectomy in the management of exogenous endophthalmitis. [ABSTRACT FROM AUTHOR]

Inflammation from airborne microbes can overwhelm compensatory mucociliary clearance mechanisms, leading to mucous cell metaplasia. Toll-like receptor (TLR) activation via myeloid differentiation factor 88 (MyD88) signaling is central to pathogen responses. We have previously shown that agricultural organic dust extract (ODE), with abundant microbial component diversity, activates TLR-induced airway inflammation. With the use of an established model, C57BL/6J wild-type (WT) and global MyD88 knockout (KO) mice were treated with intranasal inhalation of ODE or saline, daily for 1 wk. ODE primarily increased mucin (Muc)5ac levels relative to Muc5b. Compared with ODE-challenged WT mice, ODE-challenged, MyD88-deficient mice demonstrated significantly increased Muc5ac immunostaining, protein levels by immunoblot, and expression by quantitative PCR. The enhanced Muc5ac levels in MyD88-deficient mice were not explained by differences in the differentiation program of airway secretory cells in naïve mice. Increased Muc5ac levels in MyD88-deficient mice were also not explained by augmented inflammation, IL-17A, or neutrophil elastase levels. Furthermore, the enhanced airway mucins in the MyD88-deficient mice were not due to defective secretion, as the mucin secretory capacity of MyD88-KO mice remained intact. Finally, ODE-induced Muc5ac levels were enhanced in MyD88-deficient airway epithelial cells in vitro. In conclusion, MyD88 deficiency enhances airway mucous cell metaplasia under environments with high TLR activation. [ABSTRACT FROM AUTHOR]

Background: Optoelectronic plethysmography (OEP) is a non-invasive motion capture method to measure chest wall movements and estimate lung volumes. Objectives: To provide an overview of the clinical findings and research applications of OEP in the assessment of breathing mechanics across populations of healthy and diseased individuals. Methods: A bibliographic research was performed with the terms "opto-electronic plethysmography," "optoelectronic plethysmography," and "optoelectronic plethysmograph" in 50 digital library and bibliographic search databases resulting in the selection of 170 studies. Results: OEP has been extensively employed in studies looking at chest wall kinematics and volume changes in chest wall compartments in healthy subjects in relation to age, gender, weight, posture, and different physiological conditions. In infants, OEP has been demonstrated to be a tool to assess disease severity and the response to pharmacological interventions. In chronic obstructive pulmonary disease patients, OEP has been used to test if patients can dynamically hyperinflate or deflate their lungs during exercise. In neuromuscular patients, respiratory muscle strength and chest kinematics have been analyzed. A widespread application of OEP is in tailoring post-operative pulmonary rehabilitation as well as in monitoring volume increases and muscle contributions during exercise. Conclusions: OEP is an accurate and validated method of measuring lung volumes and chest wall movements. OEP is an appropriate alternative method to monitor and analyze respiratory patterns in children, adults, and patients with respiratory diseases. OEP may be used in the future to contribute to improvements in the therapeutic strategies for respiratory conditions. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective Elite swimming and boxing require athletes to achieve relatively high minute ventilation. The combination of a sustained high ventilation and provocative training environment may impact the susceptibility of athletes to exercise-induced bronchoconstriction ( EIB). The purpose of this study was to evaluate the prevalence of EIB in elite Great British ( GB) boxers and swimmers. Methods Boxers ( n = 38, mean age: 22.1 ± 3.1 years) and swimmers ( n = 44, mean age: 21.1 ± 2.6 years) volunteered for the study. Athletes completed an exercise-induced respiratory symptom questionnaire, baseline assessment of fraction of exhaled nitric oxide ( FeNO), maximal spirometry manoeuvres and a eucapnic voluntary hyperpnoea ( EVH) challenge. EIB was confirmed if forced expiratory volume in 1 s ( FEV1 ) reduced by ≥10% from baseline at two time points post- EVH challenge. Results The prevalence of EIB was greater in elite swimmers (30 of 44; 68%) than in boxers (3 of 38; 8%) ( P < 0.001). Twenty-two out of the 33 (67%) EVH-positive athletes had no prior diagnosis of asthma/ EIB. Moreover, 12% (6 of 49) of the EVH-negative athletes had a previous diagnosis of asthma/ EIB. We found a correlation between FeNO and FEV1 change in lung function post- EVH challenge in swimmers (r = 0.32; P = 0.04) but not in boxers (r = 0.24; P = 0.15). Conclusion The prevalence of EIB was ninefold greater in swimmers when compared with boxers. Athletes who train and compete in provocative environments at sustained high ventilation may have an increased susceptibility to EIB. It is not entirely clear whether increased susceptibility to EIB affects elite sporting performance and long-term airway health in elite athletes. [ABSTRACT FROM AUTHOR]

In athletes, a secure diagnos is of exercise-induced bronchoconstriction (EIB) is dependent on objective testing. Evaluating spirometric indices of airflow before and following an exercise bout is intuitively the optimal means for the diagnosis; however, this approach is recognized as having several key limitations. Accordingly, alternative indirect bronchoprovocation tests have been recommended as surrogate means for obtaining a diagnosis of EIB. Of these tests, it is often argued that the eucapnic voluntary hyperpnea (EVH) challenge represents the 'gold standard'. This article provides a state-of-the-art review of EVH, including an overview of the test methodology and its interpretation. We also address the performance of EVH against the other functional and clinical approaches commonly adopted for the diagnosis of EIB. The published evidence supports a key role for EVH in the diagnostic algorithm for EIB testing in athletes. However, its wide sensitivity and specificity and poor repeatability preclude EVH from being termed a 'gold standard' test for EIB. [ABSTRACT FROM AUTHOR]

Over the past decade, there has been an increased exploration of ePortfolios in higher education across disciplines at both the undergraduate and graduate level. ePortfolios have been significantly under-explored, however, in the context of non-traditional continuing education environments within higher education. This paper explores students' perceptions of ePortfolios in a non-credit continuing education environment in three programs--Fine Arts, Writing and Editing, and Residential Interiors--unpacking some of the opportunities, challenges, and barriers associated with ePortfolio use. It concludes that continuing education students, at least in programs where traditional (hard copy) portfolios are commonplace, are positively inclined towards the introduction and use of ePortfolios, though the study still identifies two major concerns that need to be addressed--the level of computer literacy in the student body due to their variability in age and previous educational backgrounds, and the support for and portability of the ePortfolios for students and instructors. [ABSTRACT FROM AUTHOR]

The article discusses the assessment on the validity of simulation game numeric outcome values through Benford's Law. The mathematical law is applied to income statement items from a business game competition. The first and second digits of numeric outcome values are noted to conform closely to Benford's Law. The appropriateness of such law for the assessment of simulation game numeric outcome values is mentioned.

International postgraduate students are important to the higher education sectors of many countries. They arrive from all over the world with diverse cultures and prior experiences. Such students present additional challenges in terms of programme-based learning and teaching support. This action research was undertaken at a large university business school in the North East of England over a three-year period (2007–2009), in order to better understand the characteristics of postgraduate business and management students. It was found student cohort prior learning experiences and needs covered a wide spectrum. The data collected were used to inform the design and implementation of an induction and learning support programme that would accommodate geographically diverse postgraduate students and improve their engagement in learning. This led to the development of the ‘PG Learning Model’. [ABSTRACT FROM AUTHOR]

Background There is increasing evidence to suggest many elite athletes fail to recognise and report symptoms of exercise-induced bronchoconstriction (EIB), supporting the contention that athletes should be screened routinely for EIB. Purpose To screen elite British athletes for EIB using eucapnic voluntary hyperpnoea (EVH). Methods 228 elite athletes provided written informed consent and completed an EVH challenge with maximal flow volume loops measured at baseline and 3, 5, 10 and 15 min following EVH. A fall of 10% in forced expiratory volume in 1 s (FEV1) from baseline was deemed positive. Two-way analysis of variance was conducted to compare FEV1 at baseline and maximal change following EVH between EVH-positive and EVH-negative athletes who did and did not report a previous diagnosis of EIB. Signifi cance was assumed if p≤0.05. Results Following the EVH challenge 78 athletes (34%) demonstrated EVH positive. 57 out of the 78 (73%) athletes who demonstrated EVH positive did not have a previous diagnosis of EIB. 30 athletes reported a previous diagnosis of asthma, nine (30%) of whom demonstrated EVH negative. There was no significant difference between the magnitude of the fall in FEV1 between athletes who reported a previous diagnosis of EIB and demonstrated EVH positive, and those with no previous diagnosis of EIB who demonstrated EVH positive (mean±SD; -21.6±16.1% vs -17.1±9.7%; p=0.07). Conclusion The high proportion of previously undiagnosed athletes who demonstrated EVH positive suggests that elite athletes should be screened routinely for EIB using a suitable bronchoprovocation challenge. [ABSTRACT FROM AUTHOR]

Severe sepsis and septic shock are conditions that pose difficult challenges to physicians and the health care system. In the past 10 years, a number of retrospective and prospective observational studies have shed light on the importance of a rapid and systematic approach to treatment of these conditions. A key component is early and appropriate use of antibiotics. Delay of even 6 h can dramatically increase hospital mortality. In addition, multivariate analyses have demonstrated that inappropriate initial antibiotics lead to worse outcomes. The treating physician can rapidly identify risk factors for initial inappropriate antibiotics at the bedside, such as recent antibiotic therapy or recent hospitalization. Organized antibiotic order sets have been shown to significantly improve timely appropriate antibiotic administration in septic patients. Finally, emerging laboratory data suggest that early in the course of septic shock, the pharmacokinetics of common broad spectrum antibiotics may be significantly altered due to increased volumes of distribution having dosing implications for antibiotics in septic shock. [ABSTRACT FROM AUTHOR]