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Sample records for spirometry methacholine challenge

  1. [Interpretation and use of routine pulmonary function tests: Spirometry, static lung volumes, lung diffusion, arterial blood gas, methacholine challenge test and 6-minute walk test].

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    Bokov, P; Delclaux, C

    2016-02-01

    Resting pulmonary function tests (PFT) include the assessment of ventilatory capacity: spirometry (forced expiratory flows and mobilisable volumes) and static volume assessment, notably using body plethysmography. Spirometry allows the potential definition of obstructive defect, while static volume assessment allows the potential definition of restrictive defect (decrease in total lung capacity) and thoracic hyperinflation (increase in static volumes). It must be kept in mind that this evaluation is incomplete and that an assessment of ventilatory demand is often warranted, especially when facing dyspnoea: evaluation of arterial blood gas (searching for respiratory insufficiency) and measurement of the transfer coefficient of the lung, allowing with the measurement of alveolar volume to calculate the diffusing capacity of the lung for CO (DLCO: assessment of alveolar-capillary wall and capillary blood volume). All these pulmonary function tests have been the subject of an Americano-European Task force (standardisation of lung function testing) published in 2005, and translated in French in 2007. Interpretative strategies for lung function tests have been recommended, which define abnormal lung function tests using the 5th and 95th percentiles of predicted values (lower and upper limits of normal values). Thus, these recommendations need to be implemented in all pulmonary function test units. A methacholine challenge test will only be performed in the presence of an intermediate pre-test probability for asthma (diagnostic uncertainty), which is an infrequent setting. The most convenient exertional test is the 6-minute walk test that allows the assessment of walking performance, the search for arterial desaturation and the quantification of dyspnoea complaint. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  2. Methacholine bronchial provocation measured by spirometry versus wheeze detection in preschool children

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    Yahav Yaacov

    2005-06-01

    Full Text Available Abstract Background Determination of PC20-FEV1 during Methacholine bronchial provocation test (MCT is considered to be impossible in preschool children, as it requires repetitive spirometry sets. The aim of this study was to assess the feasibility of determining PC20-FEV1 in preschool age children and compares the results to the wheeze detection (PCW method. Methods 55 preschool children (ages 2.8–6.4 years with recurrent respiratory symptoms were recruited. Baseline spirometry and MCT were performed according to ATS/ERS guidelines and the following parameters were determined at baseline and after each inhalation: spirometry-indices, lung auscultation at tidal breathing, oxygen saturation, respiratory and heart rate. Comparison between PCW and PC20-FEV1 and clinical parameters at these end-points was done by paired Student's t-tests. Results and discussion Thirty-six of 55 children (65.4% successfully performed spirometry-sets up to the point of PCW. PC20-FEV1 occurred at a mean concentration of 1.70+/-2.01 while PCW occurred at a mean concentration of 4.37+/-3.40 mg/ml (p 1 by 44.7+/-14.5%; PEFR by 40.5+/-14.5 and FEF25–75 by 54.7+/-14.4% (P Conclusion Determination of PC20-FEV1 by spirometry is feasible in many preschool children. PC20-FEV1 often appears at lower provocation dose than PCW. The lower dose may shorten the test and encourage participation. Significant decrease in spirometry indices at PCW suggests that PC20-FEV1 determination may be safer.

  3. Exertional-induced bronchoconstriction: Comparison between cardiopulmonary exercise test and methacholine challenging test

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    Mostafa Ghanei

    2015-01-01

    Full Text Available Introduction: Exertional-induced bronchoconstriction is a condition in which the physical activity causes constriction of airways in patients with airway hyper- responsiveness. In this study, we tried to study and evaluate any relationship between the findings of cardiopulmonary exercise testing (CPET and the response to methacholine challenge test (MCT in patients with dyspnea after activity. Materials and Methods: Thirty patients with complaints of dyspnea following activity referred to "Lung Clinic" of Baqiyatallah Hospital but not suffering from asthma were entered into the study. The subjects were excluded from the study if: Suffering from any other pulmonary diseases, smoking more than 1 cigarette a week in the last year, having a history of smoking more than 10 packets of cigarettes/year, having respiratory infection in the past 4 weeks, having abnormal chest X-ray or electrocardiogram, and cannot discontinue the use of medicines interfering with bronchial provocation. Baseline spirometry was performed for all the patients, and the values of forced expiratory volume in 1 second (FEV1, forced vital capacity (FVC, and FEV/FVC were recorded. The MCT and then the CPET were performed on all patients. Results: The mean VO 2 (volume oxygen in patients with positive methacholine test (20.45 mL/kg/min was significantly lower than patients with negative MCT (28.69 mL/kg/min (P = 0.000. Respiratory rates per minute (RR and minute ventilation in the group with positive MCT (38.85 and 1.636 L were significantly lower than the group with negative methacholine test (46.78 and 2.114 L (P < 0.05. Also, the O 2 pulse rate in the group with negative methacholine test (116.27 mL/beat was significantly higher than the group with positive methacholine test (84.26 mL/beat (P < 0.001. Conclusion: Pulmonary response to exercise in patients with positive methacholine test is insufficient. The dead space ventilation in these patients has increased. Also, dynamic

  4. The association between methacholine challenge test and respiratory symptoms: a study on 146 patients

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    Paknejad O

    2011-02-01

    Full Text Available "nBackground: Asthma is a life-threatening disease that can cause death due to bronchospasm. In addition to clinical symptoms such as wheezing, acute paroxysmal dyspnea, chronic cough after exposure to cold air or cough after exercise, spirometry is also necessary for the diagnosis of asthma. The association between respiratory symptoms and a positive methacholine challenge test (MCT is still controversial. The aim of this study was to determine the association between methacholine test results and respiratory symptoms and allergy."n "nMethods: One hundred and forty-six patients with respiratory symptoms and normal baseline pulmonary function tests were enrolled in this cross-sectional study. The participants were divided into two groups according to their positive or negative response to MCT. The association between MCT and the clinical symptoms and allergy was later evaluated statistically."n "nResults: Out of 146 participants of the study 59 (40.4% were female and 87 (59.6% were male. The mean age of the participants was 33.8±13.8 years. Sixty-one patients (41.8% had positive results for the test. There was an association between a history of allergy, wheezing and age with positive MCT results. The other clinical signs had no association with the test."n "nConclusion: Methacholine challenge test is the best diagnostic test for ruling out asthma in patients with normal pulmonary function tests in whom we cannot definitely rule out asthma based solely on clinical symptoms. Nevertheless, in adults with a history of allergy, wheezing and also in patients below 30, the probability for a positive MCT is high.

  5. Spirometry

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    Spirometry Overview Spirometry (spy-ROM-uh-tree) is a common office test used to assess how well your lungs work by ... much you exhale and how quickly you exhale. Spirometry is used to diagnose asthma, chronic obstructive pulmonary ...

  6. Methacholine challenge test: Comparison of tidal breathing and dosimeter methods in children.

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    Mazi, Ahlam; Lands, Larry C; Zielinski, David

    2018-02-01

    Methacholine Challenge Test (MCT) is used to confirm, assess the severity and/or rule out asthma. Two MCT methods are described as equivalent by the American Thoracic Society (ATS), the tidal breathing and the dosimeter methods. However, the majority of adult studies suggest that individuals with asthma do not react at the same PC 20 between the two methods. Additionally, the nebulizers used are no longer available and studies suggest current nebulizers are not equivalent to these. Our study investigates the difference in positive MCT tests between three methods in a pediatric population. A retrospective, chart review of all MCT performed with spirometry at the Montreal Children's Hospital from January 2006 to March 2016. A comparison of the percentage positive MCT tests with three methods, tidal breathing, APS dosimeter and dose adjusted DA-dosimeter, was performed at different cutoff points up to 8 mg/mL. A total of 747 subjects performed the tidal breathing method, 920 subjects the APS dosimeter method, and 200 subjects the DA-dosimeter method. At a PC 20 cutoff ≤4 mg/mL, the percentage positive MCT was significantly higher using the tidal breathing method (76.3%) compared to the APS dosimeter (45.1%) and DA-dosimeter (65%) methods (P < 0.0001). The choice of nebulizer and technique significantly impacts the rate of positivity when using MCT to diagnose and assess asthma. Lack of direct comparison of techniques within the same individuals and clinical assessment should be addressed in future studies to standardize MCT methodology in children. © 2017 Wiley Periodicals, Inc.

  7. Evaluation of Methacholine Challenge Test Results in Chronic Cough Patients Referring to Clinic of Pulmonary Disease

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    Derakhshan Deilami Gholamreza

    2009-10-01

    Full Text Available Chronic cough is a common problem in patients visiting physicians and its prevalence in different populations range from 3 to 40%. Postnasal drip, asthma and gastroesophageal reflux are the known cause of chronic cough. Although diagnosis of asthma is usually made by clinical signs and spirometeric results, methacholine challenge test is a good diagnostic test in patients who show normal physical examination and spirometeric results. In this study, the results of methacholine challenge test in chronic cough patients are investigated. This is a cross sectional study performed on patients suffering from chronic cough (over 8 weeks, who went to Pulmonary Disease Clinic of Imam Khomeini Hospital in 2006. Postnasal drip, gastroesophageal reflux was evaluated and ruled out in all patients. Then they were tested by methacholine inhalation using low to high doses of methacholine. The results of test was defined as 20% fall in FEV1 and its relationship with age, sex, history of allergic disease, family history of asthma and smoking status was investigated. 81 patients (36 female and 45 male entered this study who had mean age of 32.5 ± 13.06 years. 81.5% of patients had never smoked or closed contact with smokers, 6.2% were passive smokers, 8.6% were smokers and 3.7% had quit smoking. 37% had suffered from chronic cough less than 6 months, 11% for 6-11 months and 52% for more than 12 months. In 26% of patients, family history of asthma was present and 34.5% had a history of one type of allergy. In 29.5% the results of methacholine challenge test was positive, among them 45.8% showed an intense response and 54.2% a moderate response. The test results and its intensity had no statistically significant relationship with age, sex, smoking status, the duration of cough and family history of asthma, but the relationship between methacholine challenge test and the history of allergic disease was significant. Methacholine challenge test can be used as a

  8. Bronchodilator responses after methacholine and adenosine 5'-monophosphate (AMP) challenges in children with asthma: their relationships with eosinophil markers.

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    Yoo, Young; Seo, Sung Chul; Kim, Young Il; Chung, Bo Hyun; Song, Dae Jin; Choung, Ji Tae

    2012-09-01

    Bronchodilator responsiveness (BDR) and eosinophilic inflammation are characteristic features of asthma. Objective. The aim of this study was to compare the relationships of BDR after methacholine challenge or adenosine 5'-monophosphate (AMP) challenge to blood eosinophil markers in children with asthma. Methacholine and AMP challenges were performed on 69 children with mild intermittent to moderate persistent asthma. BDR was calculated as the change in forced expiratory volume in 1 second, expressed as percentage change of the value immediately after the each challenge and the value after inhalation of salbutamol. Serum total IgE levels, blood eosinophil counts, and serum eosinophil cationic protein (ECP) levels were determined for each subject. A positive relationship between serum total IgE levels and BDR was found only after the AMP challenge (R(2) = 0.345, p = .001) rather than after the methacholine challenge (R(2) = 0.007, p = .495). Peripheral blood eosinophil counts correlated more significantly with BDR after AMP challenge (R(2) = 0.212, p = .001) than BDR after methacholine challenge (R(2) = 0.002, p = .724). Both BDR after methacholine challenge (R(2) = 0.063, p = .038) and BDR after AMP challenge (R(2) = 0.192, p = .001) were significantly correlated with serum ECP levels. BDR after AMP challenge may be more closely related to eosinophilic inflammation, compared with that after methacholine challenge.

  9. Comparison of two standardized methods of methacholine inhalation challenge in young adults

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    Siersted, H C; Walker, C M; O'Shaughnessy, A D

    2000-01-01

    In the European Community Respiratory Health Study (ECRHS), airway responsiveness to methacholine was determined using the Mefar dosimeter protocol. Elsewhere, the 2-min tidal breathing method has become the preferred standardized method. The relationship between measurements of responsiveness by...

  10. Feasibility of repetitive lung function measurements by raised volume rapid thoracoabdominal compression during methacholine challenge in young infants

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    Loland, L.; Bisgaard, H.

    2008-01-01

    BACKGROUND: The aim of the study was to evaluate the feasibility of lung function measurements by the raised volume rapid thoracoabdominal compression (RVRTC) technique during bronchial methacholine challenge in young infants. METHOD: Four hundred two healthy infants were tested at 1 month of age....... The mean acceptability rating among parents was 8 on a scale from 1 to 10, with 13% rating test, with the actual lung function testing accounting for half the time. CONCLUSION: This very comprehensive experience with standardized measurements of lung...... was successfully measured in 87% by transcutaneous oxygen pressure. No serious adverse events were observed during testing or after discharge from the clinic. The methacholine dose range was appropriate as PD could be determined in the majority of infants. FEV(0.5) values in 21% of infants dropped > 40% during...

  11. Interpretation of positive results of a methacholine inhalation challenge and 1 week of inhaled bronchodilator use in diagnosing and treating cough-variant asthma.

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    Irwin, R S; French, C T; Smyrnios, N A; Curley, F J

    1997-09-22

    In diagnosing cough due to asthma, methacholine chloride inhalation challenge (MIC) interpreted in a traditional fashion has been shown to have positive predictive values from 60% to 82%. To determine whether any features of positive results of an MIC or the results of a 1-week trial of inhaled beta-agonist therapy were helpful in predicting when the cough was due to asthma. The study design was a prospective, randomized, double-blind, placebo-controlled, crossover format performed in adult, nonsmoking subjects, who were referred for diagnosis and treatment of chronic cough. The subjects had no other respiratory complaints or medical conditions for which they were taking medications, the results of baseline spirometry and chest roentgenograms were normal, and the results of MIC were positive. After obtaining baseline data, including MICs on 2 separate days, objective cough counting, and self-assessment of cough severity using a visual analog scale, subjects were randomized to receive 2 inhalations (1.3 mg) of metaproterenol sulfate or placebo by metered dose inhaler attached to a spacer device every 4 hours while awake. At 1 week, data identical to baseline were collected, and subjects received the other metered dose inhaler for 7 days. At 1 week, data identical to baseline were collected. After completion of the protocol, subjects were followed up in the clinic to observe the final response of the cough to specific therapy. Based on the disappearance of the cough with specific therapy, the cough was due to asthma in 9 of 15 subjects and nonasthma in 6 of 15 subjects. Baseline data were similar between groups. With respect to MICs, there were no significant differences between groups in the cumulative dose of methacholine that provoked a 20% decrease in forced expiratory volume in 1 second from the postsaline baseline value (PD20 values), slopes of dose-response curves, and maximal-response plateaus. Cough severity significantly improved after 1 week of

  12. Spirometry in Asthma Care: A Review of the Trends and Challenges in Pediatric Practice

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    Ayuk, Adaeze C; Uwaezuoke, Samuel N; Ndukwu, Chizalu I; Ndu, Ikenna K; Iloh, Kenechukwu K; Okoli, Chinyere V

    2017-01-01

    Background: Given the rising incidence of noncommunicable diseases (NCDs) globally, especially bronchial asthma, there is the need to reduce the associated morbidity and mortality by adopting an objective means of diagnosis and monitoring. Aim: This article aims to review the trends and challenges in the use of spirometry for managing childhood bronchial asthma especially in developing countries. Methods: We conducted a literature search of published data on the use of spirometry for the diagnosis of childhood bronchial asthma with special emphasis resource-poor countries. Results: Guidelines for the diagnosis and treatment of childhood asthma recommend the use of spirometry, but this is currently underused in both tertiary and primary care settings especially in developing countries. Lack of spirometers and proper training in their use and interpretation of findings as well as a dearth of asthma guidelines remains core to the underuse of spirometry in managing children with asthma. Targeting education of health care staff was, however, observed to improve its utility, and practical implementable strategies are highlighted. Conclusions: Spirometry is not frequently used for asthma diagnosis in pediatric practice especially in resource-poor countries where the NCD burden is higher. Strategies to overcome the obstacles are implementable and can make a difference in reducing the burden of NCD. PMID:28781518

  13. The value of spirometry and exercise challenge test to diagnose and monitor children with asthma.

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    van den Wijngaart, Lara S; Roukema, Jolt; Merkus, Peter Jfm

    2015-03-01

    Asthma is defined as a chronic inflammatory disease of the airways with characteristic symptoms including recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. It may result in abnormalities of ventilator function, which can be assessed by different pulmonary function tests. In this case report, we present a 15-year-old boy with asthma and illustrate the value and limitations of spirometry and exercise challenge test in daily practice.

  14. Methacholine and adenosine 5'-monophosphate (AMP) responsiveness, and the presence and degree of atopy in children with asthma.

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    Suh, Dong I; Lee, Ju K; Kim, Chang K; Koh, Young Y

    2011-02-01

    The relationship between atopy and bronchial hyperresponsiveness (BHR), both key features of asthma, remains to be clarified. BHR is commonly evaluated by bronchial challenges using direct and indirect stimuli. The aim of this study was to investigate the degree of BHR to methacholine (direct stimulus) and adenosine 5'-monophosphate (AMP) (indirect stimulus) according to the presence and degree of atopy in children with asthma. We performed a retrospective analysis of data from 120 children presenting with a diagnosis of asthma. These children were characterized by skin-prick tests (SPTs), spirometry and bronchial challenges with methacholine and AMP. Atopy was defined by at least one positive reaction to SPTs, and its degree was measured using serum total IgE levels, number of positive SPTs and atopic scores (sum of graded wheal size). A provocative concentration causing a 20% decline in FEV(1) (PC(20) ) was determined for each challenge. Patients with atopy(n=94) had a significantly lower AMP PC(20) than non-atopic patients (n=26), whereas methacholine PC(20) was not different between the two groups. Among the patients with atopy, there was no association between methacholine PC(20) and any atopy parameter. In contrast, a significant association was found between AMP PC(20) and the degree of atopy reflected in serum total IgE, number of positive SPTs and atopic scores (anova trend test, p=0.002, 0.001, 0.003, respectively). AMP responsiveness was associated with the presence and degree of atopy, whereas such a relationship was not observed for methacholine responsiveness. These findings suggest that atopic status may be better reflected by bronchial responsiveness assessed by AMP than by methacholine. © 2011 John Wiley & Sons A/S.

  15. Relationships of methacholine and adenosine 5'-monophosphate (AMP) responsiveness to the postbronchodilator FEV₁/FVC ratio in children with asthma.

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    Suh, Dong In; Choi, Sun Hee; Lee, Ju Kyung; Kim, Jin-Tack; Koh, Young Yull

    2011-05-01

    Airway remodeling has been assumed to cause bronchial hyperresponsiveness (BHR). A low postbronchodilator FEV₁/FVC ratio has been suggested to be a functional surrogate marker of airway remodeling in asthma. BHR is commonly assessed by bronchial challenges using direct or indirect stimuli. The aim of this study was to compare BHR to methacholine and adenosine 5'-monophosphate (AMP) with regard to their relationship with a marker of airway remodeling in children with asthma. Methacholine and AMP challenge tests were performed in 129 children with asthma, aged 12 years, and a provocative concentration causing a 20% fall in FEV₁ (PC₂₀) was calculated for each challenge. All subjects also underwent pre- and postbronchodilator spirometry. A postbronchodilator FEV₁/FVC ratio below the lower limits of normal was used as a marker of airway remodeling. A low postbronchodilator FEV₁/FVC ratio was found in 17 subjects (13.2%). These subjects had a significantly lower methacholine PC₂₀ (geometric mean: 0.63 mg/mL, range of 1 SD: 0.17-2.29) than those (n = 112) with a normal postbronchodilator FEV₁/FVC ratio (2.42 mg/mL, 0.57-10.32, p = .000), whereas AMP PC₂₀ was similar between the two groups (22.1 mg/mL, 3.9-125.9 vs. 27.7 mg/mL, 4.2-183.5, p = .231). In the whole group of subjects, methacholine PC₂₀, but not AMP PC₂₀, correlated significantly with the postbronchodilator FEV₁/FVC ratio (r = 0.340, p = .000, and r = 0.056, p = .526, respectively). Our results provide evidence, though indirect, that BHR to methacholine is related to airway remodeling in children with asthma and suggest that BHR to methacholine may be a better marker of airway remodeling than BHR to AMP.

  16. Accuracy of spirometry for detection of asthma: a cross-sectional study.

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    Meneghini, Andréa Cristina; Paulino, Ana Carolina Botto; Pereira, Luciano Penha; Vianna, Elcio Oliveira

    2017-01-01

    Asthma is a chronic inflammatory disease with airway hyperresponsiveness. Spirometry is the most commonly used test among asthmatic patients. Another functional test used for diagnosing asthma is the bronchial challenge test. The aim of this study was to analyze the accuracy of spirometry for detecting asthma in the general population. Cross-sectional study with data analysis to evaluate the accuracy of spirometry through calculating sensitivity, specificity and predictive values and through the kappa agreement test. Subjects who constituted a birth cohort were enrolled at the age of 23 to 25 years. Spirometric abnormality was defined as reduced forced expiratory volume in one second, i.e. lower than 80% of the predicted value. Measurement of bronchial responsiveness was performed by means of the bronchial challenge test with methacholine. The gold-standard diagnosis of asthma was defined as the presence of bronchial hyperresponsiveness in association with respiratory symptoms. Asthma was detected in 200 subjects (10.4%) out of the sample of 1922 individuals. Spirometric abnormality was detected in 208 subjects (10.9%) of the sample. The specificity of spirometric abnormality for detecting asthma was 90%, sensitivity was 23%, positive predictive value was 22%, and negative predictive value was 91%. The kappa test revealed weak agreement of 0.13 (95% confidence interval, CI: 0.07-0.19) between spirometry and the diagnosis of asthma. Spirometry, as a single test, has limitations for detecting asthma in the general population.

  17. Useful marker of oscillatory lung function in methacholine challenge test-comparison of reactance and resistance with dose-response slope.

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    Yoon, Jung Won; Shin, Youn Ho; Jee, Hye Mi; Chang, Sun Jung; Baek, Ji Hyeon; Choi, Sun Hee; Kim, Hyeong Yun; Han, Man Yong

    2014-06-01

    There are few studies focusing on the comparison of resistance (Rrs) and reactance (Xrs) in impulse oscillometry system (IOS) in the bronchial challenge test using dose-response slope (DRS), a quantitative index of bronchial hyperresponsiveness. We conducted a case-control study of 144 asthmatic and 218 non-asthmatic children to compare the diagnostic accuracy of two-point linear DRS for FEV1 , Rrs5 , and Xrs5 (DRS_FEV1 , DRS_Rrs5 , and DRS_Xrs5 ) and assessed various diagnostic cut-off points of provocation concentrations (PC) using receiver operating characteristic (ROC) curves. DRS_FEV1 had a stronger correlation with DRS_Xrs5 (r = 0.739, P  percent change of FEV1 (Pch_FEV1 ) (0.735) > Pch_Xrs5 (0.727) > Abs_Rrs5 (0.690) > Pch_Rrs5 (0.630). PC78 _Xrs5 and PC0.17 _Xrs5 of IOS showed considerably good sensitivity and specificity comparable to those of PC20 _FEV1 by spirometry. Additional 18 (13%) children who showed normal spirometric measures were identified as asthmatics with the use of IOS. The utility of the DRS_Xrs5 to differentiate asthmatics from controls was comparable to that of the DRS_FEV1 and better than that of the DRS_Rrs5 . In addition, IOS could detect additional asthmatic patients who did not show positive responses in spirometry. © 2013 Wiley Periodicals, Inc.

  18. Reference values for methacholine reactivity (SAPALDIA study

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    Perruchoud André

    2005-11-01

    Full Text Available Abstract Background The distribution of airway responsiveness in a general population of non-smokers without respiratory symptoms has not been established, limiting its use in clinical and epidemiological practice. We derived reference equations depending on individual characteristics (i.e., sex, age, baseline lung function for relevant percentiles of the methacholine two-point dose-response slope. Methods In a reference sample of 1567 adults of the SAPALDIA cross-sectional survey (1991, defined by excluding subjects with respiratory conditions, responsiveness during methacholine challenge was quantified by calculating the two-point dose-response slope (O'Connor. Weighted L1-regression was used to estimate reference equations for the 95th , 90th , 75th and 50th percentiles of the two-point slope. Results Reference equations for the 95th , 90th , 75th and 50th percentiles of the two-point slope were estimated using a model of the form a + b* Age + c* FEV1 + d* (FEV12 , where FEV1 corresponds to the pre-test (or baseline level of FEV1. For the central half of the FEV1 distribution, we used a quadratic model to describe the dependence of methacholine slope on baseline FEV1. For the first and last quartiles of FEV1, a linear relation with FEV1 was assumed (i.e., d was set to 0. Sex was not a predictor term in this model. A negative linear association with slope was found for age. We provide an Excel file allowing calculation of the percentile of methacholine slope of a subject after introducing age – pre-test FEV1 – and results of methacholine challenge of the subject. Conclusion The present study provides equations for four relevant percentiles of methacholine two-point slope depending on age and baseline FEV1 as basic predictors in an adult reference population of non-obstructive and non-atopic persons. These equations may help clinicians and epidemiologists to better characterize individual or population airway responsiveness.

  19. Challenges in Collating Spirometry Reference Data for South-Asian Children: An Observational Study

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    Lum, Sooky; Bountziouka, Vassiliki; Quanjer, Philip; Sonnappa, Samatha; Wade, Angela; Beardsmore, Caroline; Chhabra, Sunil K.; Chudasama, Rajesh K.; Cook, Derek G.; Harding, Seeromanie; Kuehni, Claudia E.; Prasad, K. V. V.; Whincup, Peter H.; Lee, Simon; Stocks, Janet

    2016-01-01

    Availability of sophisticated statistical modelling for developing robust reference equations has improved interpretation of lung function results. In 2012, the Global Lung function Initiative(GLI) published the first global all-age, multi-ethnic reference equations for spirometry but these lacked equations for those originating from the Indian subcontinent (South-Asians). The aims of this study were to assess the extent to which existing GLI-ethnic adjustments might fit South-Asian paediatric spirometry data, assess any similarities and discrepancies between South-Asian datasets and explore the feasibility of deriving a suitable South-Asian GLI-adjustment. Methods Spirometry datasets from South-Asian children were collated from four centres in India and five within the UK. Records with transcription errors, missing values for height or spirometry, and implausible values were excluded(n = 110). Results Following exclusions, cross-sectional data were available from 8,124 children (56.3% male; 5–17 years). When compared with GLI-predicted values from White Europeans, forced expired volume in 1s (FEV1) and forced vital capacity (FVC) in South-Asian children were on average 15% lower, ranging from 4–19% between centres. By contrast, proportional reductions in FEV1 and FVC within all but two datasets meant that the FEV1/FVC ratio remained independent of ethnicity. The ‘GLI-Other’ equation fitted data from North India reasonably well while ‘GLI-Black’ equations provided a better approximation for South-Asian data than the ‘GLI-White’ equation. However, marked discrepancies in the mean lung function z-scores between centres especially when examined according to socio-economic conditions precluded derivation of a single South-Asian GLI-adjustment. Conclusion Until improved and more robust prediction equations can be derived, we recommend the use of ‘GLI-Black’ equations for interpreting most South-Asian data, although ‘GLI-Other’ may be more

  20. Challenges in Collating Spirometry Reference Data for South-Asian Children: An Observational Study.

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    Sooky Lum

    Full Text Available Spirometry datasets from South-Asian children were collated from four centres in India and five within the UK. Records with transcription errors, missing values for height or spirometry, and implausible values were excluded(n = 110.Following exclusions, cross-sectional data were available from 8,124 children (56.3% male; 5-17 years. When compared with GLI-predicted values from White Europeans, forced expired volume in 1s (FEV1 and forced vital capacity (FVC in South-Asian children were on average 15% lower, ranging from 4-19% between centres. By contrast, proportional reductions in FEV1 and FVC within all but two datasets meant that the FEV1/FVC ratio remained independent of ethnicity. The 'GLI-Other' equation fitted data from North India reasonably well while 'GLI-Black' equations provided a better approximation for South-Asian data than the 'GLI-White' equation. However, marked discrepancies in the mean lung function z-scores between centres especially when examined according to socio-economic conditions precluded derivation of a single South-Asian GLI-adjustment.Until improved and more robust prediction equations can be derived, we recommend the use of 'GLI-Black' equations for interpreting most South-Asian data, although 'GLI-Other' may be more appropriate for North Indian data. Prospective data collection using standardised protocols to explore potential sources of variation due to socio-economic circumstances, secular changes in growth/predictors of lung function and ethnicities within the South-Asian classification are urgently required.

  1. Spirometry in children.

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    Jat, Kana Ram

    2013-06-01

    Respiratory disorders are responsible for considerable morbidity and mortality in children. Spirometry is a useful investigation for diagnosing and monitoring a variety of paediatric respiratory diseases, but it is underused by primary care physicians and paediatricians treating children with respiratory disease. We now have a better understanding of respiratory physiology in children, and newer computerised spirometry equipment is available with updated regional reference values for the paediatric age group. This review evaluates the current literature for indications, test procedures, quality assessment, and interpretation of spirometry results in children. Spirometry may be useful for asthma, cystic fibrosis, congenital or acquired airway malformations and many other respiratory diseases in children. The technique for performing spirometry in children is crucial and is discussed in detail. Most children, including preschool children, can perform acceptable spirometry. Steps for interpreting spirometry results include identification of common errors during the test by applying acceptability and repeatability criteria and then comparing test parameters with reference standards. Spirometry results depict only the pattern of ventilation, which may be normal, obstructive, restrictive, or mixed. The diagnosis should be based on both clinical features and spirometry results. There is a need to encourage primary care physicians and paediatricians treating respiratory diseases in children to use spirometry after adequate training.

  2. Spirometry in Greenland

    DEFF Research Database (Denmark)

    Nielsen, Lasse Overballe; Olsen, Sequssuna; Jarbøl, D. E.

    2016-01-01

    be common. International guidelines recommend the usage of spirometry as a golden standard for diagnosing COPD. The current number of spirometries performed among patients treated with medication targeting obstructive pulmonary disease in Greenland remains unexplored. Objective. To estimate the prevalence...... of patients aged 50 years or above treated with medication targeting obstructive pulmonary disease and the extent to which spirometry was performed among them within 2 years. Design. An observational, cross-sectional study based on the review of data obtained from electronic medical records in Greenland...... of the identified users of medication targeting obstructive pulmonary disease. Information on age, gender, town and spirometry was registered for each patient within the period from October 2013 to October 2015. Results. The prevalence of patients treated with medication targeting obstructive pulmonary disease aged...

  3. Spirometry in primary care

    Science.gov (United States)

    Coates, Allan L; Graham, Brian L; McFadden, Robin G; McParland, Colm; Moosa, Dilshad; Provencher, Steeve; Road, Jeremy

    2013-01-01

    Canadian Thoracic Society (CTS) clinical guidelines for asthma and chronic obstructive pulmonary disease (COPD) specify that spirometry should be used to diagnose these diseases. Given the burden of asthma and COPD, most people with these diseases will be diagnosed in the primary care setting. The present CTS position statement was developed to provide guidance on key factors affecting the quality of spirometry testing in the primary care setting. The present statement may also be used to inform and guide the accreditation process for spirometry in each province. Although many of the principles discussed are equally applicable to pulmonary function laboratories and interpretation of tests by respirologists, they are held to a higher standard and are outside the scope of the present statement. PMID:23457669

  4. Computer assisted spirometry.

    Science.gov (United States)

    Hansen, D J; Toy, V M; Deininger, R A; Collopy, T K

    1983-06-01

    Three of the most popular microcomputers, the TRS-80 Model I, the APPLE II+, and the IBM Personal Computer were connected to a spirometer for data acquisition and analysis. Simple programs were written which allow the collection, analysis and storage of the data produced during spirometry. Three examples demonstrate the relative ease for automating spirometers.

  5. Family and twin studies on methacholine hypersensitivity

    Directory of Open Access Journals (Sweden)

    Robert G Townley

    1998-01-01

    Full Text Available Essentially all asthmatics demonstrate a marked sensitivity to inhaled methacholine and histamine, termed non-specific bronchial (airway hyperresponsiveness (BHR. Airway hyperresponsiveness is a characteristic not only of asthmatics, but can be found in many persons with allergic rhinitis as well as in members of asthmatics' families. The presence of BHR usually precedes the development of clinically identifiable asthma. In recent years there has been an emphasis on inflammation, inducing hyperresponsiveness. However, these factors increase airway hyperresponsiveness by a magnitude of only three-fold compared with normal subjects. The important question is not why asthmatics respond, but why normal subjects do not. The normal subjects are quite able to maintain normal airway function in the presence of high concentrations of methacholine or histamine in vivo but not in vitro, suggesting the presence of protective mechanisms in vivo that are either lacking in, or are less effective in, the asthmatic subjects. There is a strong correlation between the degree of airway hyperresponsiveness and the severity of asthma. In order to determine whether methacholine sensitivity could be used as a potential genetic marker, we studied 750 subjects from 53 asthma families and 26 control families. The best sensitivity and specificity is at 200 breath units. Only 6% of the allergic rhinitis subjects showed a high positive response, but 30% overlapped with asthmatics in that they reacted with 200 breath units or less. There was a group of non-atopic subjects from asthma families who responded by 200 breath units, but there was a significantly lower percentage from normal families. Being from an asthma family is a risk factor in terms of subsequent development of asthma and increased airway reactivity. The parent data suggest that airway reactivity is transmitted to succeeding generations. Studies of twins have revealed that the concordance of asthma is higher in

  6. Noncontact spirometry with a webcam

    Science.gov (United States)

    Liu, Chenbin; Yang, Yuting; Tsow, Francis; Shao, Dangdang; Tao, Nongjian

    2017-05-01

    We present an imaging-based method for noncontact spirometry. The method tracks the subtle respiratory-induced shoulder movement of a subject, builds a calibration curve, and determines the flow-volume spirometry curve and vital respiratory parameters, including forced expiratory volume in the first second, forced vital capacity, and peak expiratory flow rate. We validate the accuracy of the method by comparing the data with those simultaneously recorded with a gold standard reference method and examine the reliability of the noncontact spirometry with a pilot study including 16 subjects. This work demonstrates that the noncontact method can provide accurate and reliable spirometry tests with a webcam. Compared to the traditional spirometers, the present noncontact spirometry does not require using a spirometer, breathing into a mouthpiece, or wearing a nose clip, thus making spirometry test more easily accessible for the growing population of asthma and chronic obstructive pulmonary diseases.

  7. Testes de broncoprovocação com metacolina e com exercício em bicicleta e corrida livre em crianças com asma intermitente Bronchial provocation tests using methacholine, cycle ergometer exercise and free running in children with intermittent asthma

    Directory of Open Access Journals (Sweden)

    Ana C. T. G. Souza

    2005-02-01

    Full Text Available OBJETIVO: Comparar a responsividade de vias aéreas à metacolina e ao teste de exercício na bicicleta ergométrica e corrida livre em crianças com asma intermitente. MÉTODOS: Estudo randomizado. Trinta crianças de ambos os sexos com asma intermitente participaram do estudo. Cada teste foi realizado em 3 dias diferentes, através de randomização: a broncoprovocação com metacolina, método do dosímetro; b teste de exercício: corrida livre em um corredor de 50 m; c teste de exercício: bicicleta ergométrica com ar seco. A freqüência cardíaca atingida foi 80 a 90% da freqüência cardíaca máxima. A espirometria foi realizada aos 3, 6, 10, 15, 20 e 30 minutos após o exercício. Broncoespasmo induzido por exercício foi definido como a queda de volume expiratório forçado no primeiro segundo (VEF1 > 10% em relação aos valores pré-teste. RESULTADOS: A média de idade foi 11±3 anos. O VEF1 e VEF1/CVF (capacidade vital forçada foram normais e similares antes dos três testes de broncoprovocação. A freqüência cardíaca máxima foi de 178±7 bpm durante o exercício na bicicleta e 181±6 bpm na corrida livre (p > 0,05. Broncoespasmo significante foi visto em 23 crianças após o teste com metacolina, em 19 após a corrida livre e em 14 crianças após exercício em bicicleta (p OBJECTIVE: To compare airway responsiveness to methacholine, cycle ergometer exercise and free running in children with intermittent asthma. METHODS: A randomized study was conducted with 30 children of both genders with intermittent asthma. Each child was submitted to challenge testing on three separate days, in random order: a Methacholine challenge using a dosimeter; b Exercise challenge testing - free running along a 50-meter-long corridor; c Dry-air exercise challenge on a cycle ergometer. Target heart rate during exercise was 80 to 90% of the maximum predicted value. Spirometry was performed 3, 6,10,15,20 and 30 minutes after exercise. Exercise

  8. More Relaxation by Deep Breath on Methacholine- Than on Exercise-Induced bronchoconstriction during the Routine Testing of Asthmatic Children

    Directory of Open Access Journals (Sweden)

    Iulia Ioan

    2017-10-01

    Full Text Available Deep inspiration (DI dilates normal airway precontracted with methacholine. The fact that this effect is diminished or absent in asthma could be explained by the presence of bronchial inflammation. The hypothesis was tested that DI induces more relaxation in methacholine induced bronchoconstriction—solely determined by the smooth muscle contraction—than in exercise induced bronchoconstriction, which is contributed to by both smooth muscle contraction and airway wall inflammation. The respiratory conductance (Grs response to DI was monitored in asthmatic children presenting a moderately positive airway response to challenge by methacholine (n = 36 or exercise (n = 37, and expressed as the post- to pre-DI Grs ratio (GrsDI. Both groups showed similar change in FEV1 after challenge and performed a DI of similar amplitude. GrsDI however was significantly larger in methacholine than in exercise induced bronchoconstriction (p < 0.02. The bronchodilatory effect of DI is thus less during exercise- than methacholine-induced bronchoconstriction. The observation is consistent with airway wall inflammation—that characterizes exercise induced bronchoconstriction—rendering the airways less responsive to DI. More generally, it is surmised that less relief of bronchoconstriction by DI is to be expected during indirect than direct airway challenge. The current suggestion that airway smooth muscle constriction and airway wall inflammation may result in opposing effects on the bronchomotor action of DI opens important perspective to the routine testing of asthmatic children. New crossover research protocols comparing the mechanical consequences of the DI maneuver are warranted during direct and indirect bronchial challenges.

  9. Quality assurance of spirometry in a population-based study -predictors of good outcome in spirometry testing.

    Science.gov (United States)

    Tan, Wan C; Bourbeau, Jean; O'Donnell, Denis; Aaron, Shawn; Maltais, Francois; Marciniuk, Darcy; Hernandez, Paul; Cowie, Robert; Chapman, Kenneth; Sonia Buist, A; Sin, Don; Mark Fitzgerald, J

    2014-04-01

    The assurance of high-quality spirometry testing remains a challenge. Spirometry training consisted of standardized coaching followed by certification for 35 spirometry-naïve and 9 spirometry-experienced research assistants. Spirometry was performed before and after bronchodilator (BD) in random population samples of 5176 people aged 40 years and older from 9 sites in Canada. using the hand-held EasyOne spirometer (ndd Medical Technologies Inc., Andover, MA, USA). Pulmonary function quality assurance with over reading was conducted centrally in Vancouver: spirograms were reviewed and graded according to ATS/ERS standards with prompt feedback to the technician at each site. Descriptive statistics were calculated for manoeuvre acceptability and repeatability variables. A logistic regression model was constructed for the predictors of spirometry quality success. 95% of test sessions achieved pre-determined quality standards for back extrapolated volume (BEV), time to peak flow (PEFT) and end of test volume (EOTV). The mean forced expiratory time (FET) was 11.2 seconds. Then, 90% and 95% of all manoeuvres had FEV1 and FVC that were repeatable within 150 ml and 200 ml respectively. Test quality was slightly better for post-BD test sessions compared with pre-BD for both groups of research assistants. Independent predictors of acceptable test quality included participant characteristics: female sex, younger age, greater BD responsiveness; but not study site or prior experience in completing spirometry by the technologist. Good quality spirometry tests are attainable in large multicenter epidemiological studies by trained research assistants, irrespective of their prior experience in spirometry.

  10. Clinical Implications of Oscillatory Lung Function during Methacholine Bronchoprovocation Testing of Preschool Children

    Science.gov (United States)

    Choi, Sun Hee; Sheen, Youn Ho; Kim, Mi Ae; Baek, Ji Hyeon; Baek, Hey Sung; Lee, Seung Jin; Yoon, Jung Won; Rha, Yeong Ho

    2017-01-01

    Objective To investigate the repeatability and safety of measuring impulse oscillation system (IOS) parameters and the point of wheezing during bronchoprovocation testing of preschool children. Methods Two sets of methacholine challenge were conducted in 36 asthma children. The test was discontinued if there was a significant change in reactance (Xrs5) and resistance (Rrs5) at 5 Hz (Condition 1) or respiratory distress due to airway obstruction (Condition 2). The repeatability of PC80_Xrs5, PC30_Rrs5, and wheezing (PCw) was assessed. The changes in Z-scores and SD-indexes from prebaseline (before testing) to postbaseline (after bronchodilator) were determined. Results For PC30_Rrs5, PC80_Xrs5, and PCw for subjects, PC80_Xrs5 showed the highest repeatability. Fifteen of 70 tests met Condition 2. The changes from pre- and postbaseline values varied significantly for Rrs5 and Xrs5. Excluding subjects with Z-scores higher than 2SD, we were able to detect 97.1% of bronchial hyperresponsiveness during methacholine challenge based on the change in Rrs5 or Xrs5. A change in IOS parameters was associated with wheezing at all frequencies. Conclusion Xrs5 and Rrs5 have repeatability comparable with FEV1, and Xrs5 is more reliable than Rrs5. Clinicians can safely perform a challenge test by measuring the changes in Rrs5, Xrs5, and Z-scores from the prebaseline values. PMID:28740854

  11. Telemedical Education: Teaching Spirometry on the Internet.

    Science.gov (United States)

    Lum, Esther H.; Gross, Thomas J.

    1999-01-01

    Describes the development and evaluation of an Internet-based tutorial for teaching spirometry interpretation to nonpulmonologists. Concludes that computer-based tutorials can effectively train off-site practitioners in spirometry interpretation. Contains 23 references. (Author/WRM)

  12. Evaluation of impulse oscillometry during bronchial challenge testing in children.

    Science.gov (United States)

    Bailly, Carole; Crenesse, Dominique; Albertini, Marc

    2011-12-01

    The impulse oscillation system (IOS) allows easy measurement of respiratory system impedance (Zrs). The aim of this retrospective study was to evaluate the accuracy of IOS parameters obtained during methacholine challenge by comparison with "the gold standard" forced expiratory volume in the first second (FEV1). Measurements of FEV1 and resistances at 5 and 20 Hz, reactance at 5 Hz, impedance at 5 Hz and resonant frequency were performed in 227 children with suspected asthma, before and during methacholine challenge. Data were analyzed in the overall population and in three subgroups according to the final diagnosis: asthma (n = 72), chronic cough and nonspecific respiratory symptoms (n = 122), allergic rhinitis (n = 33). All IOS parameters changed significantly during the tests but only changes in X5 were significantly different between responders and nonresponders. Moreover, changes in IOS parameters were not correlated with changes in FEV1 apart from a weak correlation for X5. The receiver operating characteristic (ROC) curve for changes in X5 (to predict a 20% decrease in FEV1 showed a best decision level for a 50% decrease in X5 with a sensitivity of 36% and a specificity of 85%. Results were not different in the asthma group. The accuracy of measurements by IOS during methacholine bronchial challenge in children was not suitable when compared with FEV1 . It could be assumed that spirometry and IOS, while both providing indirect indices of airway patency, are exploring different mechanisms, each with its own methodological potentials and limitations. Copyright © 2011 Wiley Periodicals, Inc.

  13. Agreement between spirometry and tracheal auscultation in assessing bronchial responsiveness in asthmatic children

    NARCIS (Netherlands)

    Sprikkelman, AB; Schouten, JP; Lourens, MS; Heymans, HSA; van Aalderen, WMC

    We have recently found that changes in lung sounds correspond well with a 20% fall in the forced expiratory volume in 1 s (FEV1) after methacholine challenge in asthmatic children. Up to now, little was known about the agreement between a 20% fall in FEV1 and a change in lung sounds after repeated

  14. Agreement between spirometry and tracheal auscultation in assessing bronchial responsiveness in asthmatic children

    NARCIS (Netherlands)

    Sprikkelman, A. B.; Schouten, J. P.; Lourens, M. S.; Heymans, H. S.; van Aalderen, W. M.

    1999-01-01

    We have recently found that changes in lung sounds correspond well with a 20% fall in the forced expiratory volume in 1 s (FEV1) after methacholine challenge in asthmatic children. Up to now, little was known about the agreement between a 20% fall in FEV1 and a change in lung sounds after repeated

  15. Seasons can influence the results of the methacholine challenge test

    Directory of Open Access Journals (Sweden)

    Bruno Sposato

    2012-01-01

    Conclusion: There was a higher probability of finding BHR in outpatients with suspected asthma in autumn and spring compared with summer. Spring is the season where BHR may be more severe. Females and overweight/obese subjects were those mainly involved in this seasonal variability of BHR.

  16. [Spirometry in the GP-Office].

    Science.gov (United States)

    Gonzalez, Leander; Stolz, Daiana

    2016-02-17

    Spirometry is an important diagnostic tool, which, with correct implementation, detects possible obstructive or restrictive lung diseases. However, it is important to note that only part of the lung function is measured by spirometry. For instance, total lung volume and residual volume, both useful in detecting pulmonary emphysema, are not measured. Therefore, in case of pathological spirometry or suspected restrictive lung disease, further tests such as body plethysmography with diffusion measurement should be carried out.

  17. Effects of methacholine infusion on desflurane pharmacokinetics in piglets

    Directory of Open Access Journals (Sweden)

    Alf Kozian

    2015-12-01

    We measured airway pressures, pulmonary resistance, and mean paO2 as well as hemodynamic variables in all pigs before desflurane application and at plateau in both healthy state and during methacholine administration by infusion. By MIGET, fractional alveolar ventilation and pulmonary perfusion in relation to the V.A/Q. compartments, data of logSDQ̇ and logSDV̇ (the second moments describing global dispersion, i.e. heterogeneity of distribution were estimated prior to and after MCh infusion. The uptake and elimination of desflurane was determined by MMIMS.

  18. Five tips for good office spirometry

    African Journals Online (AJOL)

    Spirometry is critical for the correct diagnosis of chronic obstructive pulmonary disease (COPD) and is part of the severity classification. It ultimately guides treatment choices. When per forming spirometry on a COPD patient, one expects a flow volume loop to have some degree of obstruction. To obtain and confirm this result ...

  19. Effects of methacholine infusion on desflurane pharmacokinetics in piglets☆

    Science.gov (United States)

    Kozian, Alf; Kretzschmar, Moritz; Baumgardner, James E.; Schreiber, Jens; Hedenstierna, Göran; Larsson, Anders; Hachenberg, Thomas; Schilling, Thomas

    2015-01-01

    The data of a corresponding animal experiment demonstrates that nebulized methacholine (MCh) induced severe bronchoconstriction and significant inhomogeneous ventilation and pulmonary perfusion (V̇A/Q̇) distribution in pigs, which is similar to findings in human asthma. The inhalation of MCh induced bronchoconstriction and delayed both uptake and elimination of desflurane (Kretzschmar et al., 2015) [1]. The objective of the present data is to determine V̇A/Q̇ matching by Multiple Inert Gas Elimination Technique (MIGET) in piglets before and during methacholine- (MCh-) induced bronchoconstriction, induced by MCh infusion, and to assess the blood concentration profiles for desflurane (DES) by Micropore Membrane Inlet Mass Spectrometry (MMIMS). Healthy piglets (n=4) under general anesthesia were instrumented with arterial, central venous, and pulmonary artery lines. The airway was secured via median tracheostomy with an endotracheal tube, and animals were mechanically ventilated with intermittent positive pressure ventilation (IPPV) with a FiO2 of 0.4, tidal volume (VT)=10 ml/kg and PEEP of 5cmH2O using an open system. The determination of V.A/Q. was done by MIGET: before desflurane application and at plateau in both healthy state and during MCh infusion. Arterial blood was sampled at 0, 1, 2, 5, 10, 20, and 30 min during wash-in and washout, respectively. Bronchoconstriction was established by MCH infusion aiming at doubling the peak airway pressure, after which wash-in and washout of the anesthetic gas was repeated. Anesthesia gas concentrations were measured by MMIMS. Data were analyzed by ANOVA, paired t-test, and by nonparametric Friedman׳s test and Wilcoxon׳s matched pairs test. We measured airway pressures, pulmonary resistance, and mean paO2 as well as hemodynamic variables in all pigs before desflurane application and at plateau in both healthy state and during methacholine administration by infusion. By MIGET, fractional alveolar ventilation and

  20. [Spirometry - basic examination of the lung function].

    Science.gov (United States)

    Kociánová, Jana

    Spirometry is one of the basic internal examination methods, similarly as e.g. blood pressure measurement or ECG recording. It is used to detect or assess the extent of ventilatory disorders. Indications include respiratory symptoms or laboratory anomalies, smoking, inhalation risks and more. Its performance and evaluation should be among the basic skills of pulmonologists, internists, alergologists, pediatricians and sports physicians. The results essentially influence the correct diagnosing and treatment method. Therefore spirometry must be performed under standardized conditions and accurately and clearly assessed to enable answering clinical questions.Key words: acceptability - calibration - contraindication - evaluation - indication - parameters - spirometry - standardization.

  1. Asthma, chronic obstructive pulmonary disease, or both? Diagnostic labeling and spirometry in primary care patients aged 40 years or more

    Science.gov (United States)

    Melbye, Hasse; Drivenes, Elin; Dalbak, Lene G; Leinan, Tone; Høegh-Henrichsen, Svein; Østrem, Anders

    2011-01-01

    Aims To describe symptoms and lung function in patients registered with asthma or chronic obstructive pulmonary disease (COPD) in primary care and to examine how spirometry findings fit with general practitioners’ (GPs) diagnoses. Methods Patients aged ≥40 years with a diagnosis of asthma or COPD registered in the electronic medical record during the previous 5 years were recruited at seven GP offices in Norway in 2009–2010. Registered diagnosis, spirometry results, comorbidity, and reported symptoms were compared. Results Among 376 patients, 62% were women. Based on Global Initiative for Chronic Obstructive Lung Diseases criteria, a spirometry diagnosis of COPD could be made in 68.1% of the patients with a previous COPD diagnosis and in 17.1% of those diagnosed with asthma only (P spirometry was 0.50. A restrictive spirometry pattern was found in 19.4% and more frequently in patients diagnosed with both asthma and COPD (23.9%) than in patients diagnosed with COPD only (6.8%, P = 0.003). Conclusion The ability of GPs to differentiate between asthma and COPD seems to have considerably improved during the last decade, probably due to the dissemination of spirometry and guidelines for COPD diagnosis. A diagnosis of COPD that cannot be confirmed by spirometry represents a challenge in clinical practice, in particular when a restrictive pattern on spirometry is found. PMID:22135492

  2. Reversion of methacholine induced bronchoconstriction with inhaled diazepam in patients with asthma

    OpenAIRE

    Miric, Mirjana; Ristic, Sinisa; Joksimovic, Bojan N; Medenica, Snezana; Racic, Maja; Ristic, Slavica; Joksimovic, Vedrana R; Skipina, Mirjana

    2016-01-01

    Background: Benzodiazepines have a direct bronchodilatory effect. Methacholine is a non-selective muscarinic receptor agonist causing bronchoconstriction. Aim: To examine the effects of inhaled benzodiazepines, modulating bronchoconstriction induced by methacholine in patients with asthma. Patients and Methods: Twelve patients with well controlled asthma were studied. On the first day, after determining the initial values of pulmonary function, a dose response curve was carried out with progr...

  3. Effects of oxytocin and methacholine on cyclic nucleotide levels of rabbit myometrium.

    Science.gov (United States)

    Schlageter, N; Janis, R A; Gualtieri, R T; Hechter, O

    1980-03-01

    The effects of oxytocin and methacholine on cyclic nucleotide levels in estrogen-primed rabbit myometrium were studied in the presence and absence of 1-methyl-3-isobutyl xanthine (MIX), a phosphodiesterase inhibitor. In the absence of MIX, methacholine increased guanosine 3',5'-cyclic monophosphate (cGMP) levels at a time when contraction was decreasing, but had no influence on adenosine 3',5'-cyclic monophosphate (cAMP) levels. In contrast, oxytocin did not elevate cGMP, but rapidly decreased cAMP levels. MIX (1 mM) increased both cAMP and cGMP levels. Oxytocin or methacholine further increased cGMP, indicating activation of guanylate cyclase. Oxytocin- but not methacholine-induced stimulation of guanylate cyclase was abolished in Ca2+-free solution. Oxytocin increased cAMP over the levels produced by MIX alone, whereas methacholine decreased cAMP below the MIX control values; these effects were insensitive to indomethacin. Tissue levels of cGMP and cAMP did not directly correlate with isometric tension. The results also indicate that both oxytocin and methacholine stimulate guanylate cyclase but have opposing effects on adenylate cyclase of rabbit myometrium.

  4. Feasibility of spirometry testing in preschool children.

    Science.gov (United States)

    Kampschmidt, Jordan C; Brooks, Edward G; Cherry, Debra C; Guajardo, Jesus R; Wood, Pamela R

    2016-03-01

    The primary purpose of this study was to evaluate the feasibility of obtaining acceptable and reproducible spirometry data in preschool aged children (3-5 years) by technicians without prior experience with spirometry. Two technicians were trained to perform spirometry testing (ndd Easy on-PC) and to administer standardized questionnaires. Preschool aged children were enrolled from two Head Start centers and a local primary care clinic. Subjects were trained in proper spirometry technique and tested until at least two acceptable efforts were obtained or the subject no longer produced acceptable efforts. 200 subjects were enrolled: mean age 4.0 years (± 0.7 SD); age distribution: 51 (25.5%) 3 years old, 103 (51.5%) 4 years old, and 46 (23%) 5 years old. Fifty-six percent male and 75% Hispanic. One hundred thirty (65%) subjects produced at least one acceptable effort on their first visit: 23 (45%) for 3 years old, 67 (65%) for 4 years old, and 40 (87%) for 5 years old. The number of acceptable efforts correlated with age (r = 0.29, P spirometry results from the preschool aged children; the number of acceptable efforts correlated significantly with age. © 2015 Wiley Periodicals, Inc.

  5. Regional bronchoconstriction in asthma. 133Xenon washout scans following parenteral methacholine

    International Nuclear Information System (INIS)

    Riley, D.J.; Fisher, A.B.; Hansell, J.R.; Brody, J.S.

    1976-01-01

    To determine the influence of bronchoconstriction on the distribution of ventilation during an asthma attack, pulmonary clearance of 133 xenon was evaluated in four normal and eight asthmatic subjects within three to five minutes after intramuscular injection of methacholine. In asthmatics, administration of 4-10 mg methacholine resulted in a decrease of forced vital capacity of 28.5 +- 5.1 (SE) percent and a decrease in expiratory flow at 60 percent vital capacity of 44.2 +- 6.9 percent (P less than 0.001). The cumulative ventilation required to reach 50 percent of the pre-washout radioactivity increased from 3.6 +- 0.8 to 9.9 +- 1.6 L after administration of the drug (P less than 0.05). The normal subjects showed no ventilatory effects after receiving 10 mg methacholine. Comparison of clearance of 133 xenon from ten areas of lung (each representing approximately 6 percent of the surface area of one lung) showed that all areas were affected to approximately the same extent during drug-induced asthma. These findings suggest that parenteral methacholine is an effective way to demonstrate airway hyperreactivity and that the airway response to methacholine in asthmatics is relatively generalized throughout the lung

  6. [Quality scale for preschool spirometry interpretation].

    Science.gov (United States)

    Gatto, Francisca; Bedregal, Paula; Ubilla, Carlos; Barrientos, Hortensia; Caussade, Solange

    2017-02-01

    Since 2007, there are international guidelines for implementation and interpretation of spirometry in preschool children. A percentage of these patients cannot obtain maneuvers that meet all eligibility criteria. The objective of this study was to develop a quality scale for interpreting these partially acceptable spirometry. Delphi methodology was used, which allows to reach consensus among experts analyzing a defined problem. We invited to participate pediatric pneumologists dedicated to lung function and who participated actively in scientific specialty societies in Chile. Successive rounds were conducted with questionnaires about criteria used to assess spirometry in preschool children. These criteria define the acceptability of spirometric maneuvers according to international guidelines. Proposed quality grades were “very good”, “good”, “fair” and “bad”. Thirteen of the 15 invited experts accepted our invitation. In the first round 9 disagreed with the degree of “regular” quality. In the second round this was removed and 11 experts answered, 9 of them agreed with the use of this new version. The most contentious criterion was the end of expiration. Most experts agreed with the final scale, using “very good”, “good” and “bad” judgments. This would help to improve the performance of spirometry in children between 2 and 5 years.

  7. Spirometry reference values in the Brazilian population.

    Science.gov (United States)

    Rufino, R; Costa, C H; Lopes, A J; Maiworm, A I; Maynard, K; Silva, L M R A; Dias, R M

    2017-03-02

    The aim of the present study was to provide new spirometry reference equations in a sample of the Brazilian population for the following parameters: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, peak of expiratory flow (PEF), forced expiratory flow at 50% (FEF50%), 75% average vital capacity (FEF25-75%), and average forced expiratory flow time (FEFT). This was a prospective study using results from chest radiographs, electrocardiograms, and questionnaires to investigate the participants' respiratory symptoms, sedentarism, and comorbidities (Charlson comorbidity index). From December 2010 to July 2014, individuals were randomly selected from various locations in the state of Rio de Janeiro. All individuals were examined by a single technician in the morning at the laboratory, and performed the spirometry with the same spirometer. Spirometry values were tabulated for the creation of three equation models: linear regression, logarithmic regression, and logarithms through a method that incorporates the lambda, median, and coefficient of variation (LMS method). Initially, 7003 individuals from both genders were contacted, and 454 were recruited. The data from the new equations were compared with one Brazilian and eight international equations, resulting in a high correlation (r>0.9). The values derived from the LMS method and linear regression were very similar (P>0.5), and both could be used to acquire the reference values for Brazilian spirometry. Data derived from the equations of this study were different from the current Brazilian equation, which could be justified by the different method used.

  8. The European Respiratory Society spirometry tent

    DEFF Research Database (Denmark)

    Maio, Sara; Sherrill, Duane L; MacNee, William

    2012-01-01

    In order to raise public awareness of the importance of early detection of airway obstruction and to enable many people who had not been tested previously to have their lung function measured, the European Lung Foundation and the European Respiratory Society (ERS) organised a spirometry testing...

  9. Spirometry quality in adults with very severe lung function impairment.

    Science.gov (United States)

    Torre-Bouscoulet, Luis; Velázquez-Uncal, Mónica; García-Torrentera, Rogelio; Gochicoa-Rangel, Laura; Fernández-Plata, Rosario; Enright, Paul; Pérez-Padilla, Rogelio

    2015-05-01

    Some technologists worry that patients with very severe lung disease are unable to complete several spirometry maneuvers, which require considerable effort. We retrospectively selected all spirometry tests with an FEV1 30,000 subjects tested during the 3-y period) had adequate quality spirometry. Subjects with airway obstruction were less likely to meet FVC repeatability goals. A poor spirometry quality grade was associated with a very low FVC and a low body mass index, but not older age. Severe lung disease should not be used as an excuse for not meeting spirometry quality goals. Copyright © 2015 by Daedalus Enterprises.

  10. Spirometry use in children hospitalized with asthma.

    Science.gov (United States)

    Tan, Chee Chun; McDowell, Karen M; Fenchel, Matthew; Szczesniak, Rhonda; Kercsmar, Carolyn M

    2014-05-01

    Asthma is the most common chronic disorder of childhood and continues to be a leading cause of pediatric hospital admission. The National Asthma Education and Prevention Program (NAEPP) recommends that spirometry be obtained for asthma patients upon hospital admission, after bronchodilation during the acute phase of asthma symptoms, and at least one additional time before discharge from the hospital. The objectives of this study were to describe the use of spirometry in children hospitalized with asthma and to determine association of pulmonary function with future exacerbations. A retrospective cohort study design was utilized involving review of medical records of children ≥5 years old admitted with asthma to Cincinnati Children's Hospital Medical Center from September 1, 2009 to March 31, 2011. Hospitalization or emergency department (ED) visits were identified by the ICD-9-CM codes of having either a primary diagnosis of asthma (493) or a respiratory illness (460-496) plus a secondary diagnosis of asthma. Asthma re-exacerbation was defined as either having an ED visit or hospitalization for asthma that occurred within 3 months after the index hospitalization. All spirometries were performed in a pediatric pulmonary function laboratory. Among 1,037 admissions included in this study, 89 (8.6%) had spirometry that was recommended by a consulting asthma specialist and usually performed on the day of discharge. Spirometries for forty-five of these patients (54.9%) met all acceptability and repeatability criteria of the American Thoracic Society. Patients who performed acceptable spirometry were significantly older (12.4 ± 3.8 vs. 10.7 ± 3.0 years; P = 0.041). The average forced expiratory volume in the first second (FEV1 ) was 84.4 ± 19.7% predicted; forced vital capacity (FVC) was 98.1 ± 16.0% predicted; FEV1 /FVC was 74.6 ± 9.6%; forced expiratory flow at 25-75% (FEF25-75 ) was 61.2 ± 30.1% predicted. Ten patients (22%) who

  11. Reference values of spirometry for Finnish adults.

    Science.gov (United States)

    Kainu, A; Timonen, K L; Toikka, J; Qaiser, B; Pitkäniemi, J; Kotaniemi, J T; Lindqvist, A; Vanninen, E; Länsimies, E; Sovijärvi, A R A

    2016-09-01

    Diagnostic assessment of lung function necessitates up-to-date reference values. The aim of this study was to estimate reference values for spirometry for the Finnish population between 18 and 80 years and to compare them with the existing Finnish, European and the recently published global GLI2012 reference values. Spirometry was performed for 1380 adults in the population-based FinEsS studies and for 662 healthy non-smoking volunteer adults. Detailed predefined questionnaire screening of diseases and symptoms, and quality control of spirometry yielded a sample of 1000 native Finns (387 men) healthy non-smokers aged 18-83 years. Sex-specific reference values, which are estimated using the GAMLSS method and adjusted for age and height, are provided. The predicted values for lung volumes are larger than those obtained by GLI2012 prediction for the Caucasian subgroup for forced vital capacity (FVC) by an average 6·2% and 5·1% and forced expiratory volume in 1 s (FEV1) by an average 4·2% and 3·0% in men and women, respectively. GLI2012 slightly overestimated the ratio FEV1/FVC with an age-dependent trend. Most reference equations from other European countries, with the exception of the Swiss SAPALDIA study, showed an underestimation of FVC and FEV1 to varying degrees, and a slight overestimation of FEV1/FVC. This study offers up-to-date reference values of spirometry for native Finns with a wide age range. The GLI2012 predictions seem not to be suitable for clinical use for native Finns due to underestimation of lung volumes. © 2015 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.

  12. Spirometry reference values in the Brazilian population

    Directory of Open Access Journals (Sweden)

    R. Rufino

    Full Text Available The aim of the present study was to provide new spirometry reference equations in a sample of the Brazilian population for the following parameters: forced vital capacity (FVC, forced expiratory volume in 1 second (FEV1, FEV1/FVC ratio, peak of expiratory flow (PEF, forced expiratory flow at 50% (FEF50%, 75% average vital capacity (FEF25-75%, and average forced expiratory flow time (FEFT. This was a prospective study using results from chest radiographs, electrocardiograms, and questionnaires to investigate the participants' respiratory symptoms, sedentarism, and comorbidities (Charlson comorbidity index. From December 2010 to July 2014, individuals were randomly selected from various locations in the state of Rio de Janeiro. All individuals were examined by a single technician in the morning at the laboratory, and performed the spirometry with the same spirometer. Spirometry values were tabulated for the creation of three equation models: linear regression, logarithmic regression, and logarithms through a method that incorporates the lambda, median, and coefficient of variation (LMS method. Initially, 7003 individuals from both genders were contacted, and 454 were recruited. The data from the new equations were compared with one Brazilian and eight international equations, resulting in a high correlation (r>0.9. The values derived from the LMS method and linear regression were very similar (P>0.5, and both could be used to acquire the reference values for Brazilian spirometry. Data derived from the equations of this study were different from the current Brazilian equation, which could be justified by the different method used.

  13. The relationship between bronchial hyperresponsiveness to methacholine and airway smooth muscle structure and reactivity.

    Science.gov (United States)

    Armour, C L; Black, J L; Berend, N; Woolcock, A J

    1984-11-01

    The airway responsiveness of a group of 25 patients scheduled for lung resection was studied. 10 of 25 patients had a greater than or equal to 20% fall in FEV1 in response to inhaled methacholine (responders), with PD20 FEV1 values ranging from 0.6 to 7.3 mumol. Methacholine did not induce a 20% fall in FEV1 in 15 patients (non-responders). The sensitivity to carbachol and histamine of the bronchial smooth muscle resected from these patients was similar in tissue from responders and non-responders. There was no correlation between in vivo responsiveness to methacholine and in vitro sensitivity to carbachol or histamine. The volume of smooth muscle in some of these airway preparations was quantitated. There was a significant correlation between the maximum tension change in response to histamine and the volume of smooth muscle in each airway. There was no similar correlation for carbachol. The in vivo responsiveness to methacholine and in vitro sensitivity to histamine or carbachol was not related to the degree of inflammation in the airways studied. It is concluded that in vivo responsiveness cannot be explained in terms of smooth muscle sensitivity and that there may be differences between histamine and carbachol in the mechanism of contraction of airway smooth muscle.

  14. Asthma, chronic obstructive pulmonary disease, or both? Diagnostic labeling and spirometry in primary care patients aged 40 years or more

    Directory of Open Access Journals (Sweden)

    Melbye H

    2011-11-01

    Full Text Available Hasse Melbye1, Elin Drivenes1, Lene G Dalbak2, Tone Leinan1, Svein Høegh-Henrichsen2, Anders Østrem21General Practice Research Unit, Department of Community Medicine, University of Tromsø, 2General Practice Research Unit, Department of Health and Society, University of Oslo, NorwayAims: To describe symptoms and lung function in patients registered with asthma or chronic obstructive pulmonary disease (COPD in primary care and to examine how spirometry findings fit with general practitioners’ (GPs diagnoses.Methods: Patients aged ≥40 years with a diagnosis of asthma or COPD registered in the electronic medical record during the previous 5 years were recruited at seven GP offices in Norway in 2009–2010. Registered diagnosis, spirometry results, comorbidity, and reported symptoms were compared.Results: Among 376 patients, 62% were women. Based on Global Initiative for Chronic Obstructive Lung Diseases criteria, a spirometry diagnosis of COPD could be made in 68.1% of the patients with a previous COPD diagnosis and in 17.1% of those diagnosed with asthma only (P < 0.001. The κ agreement between last clinical diagnosis of COPD and COPD based on spirometry was 0.50. A restrictive spirometry pattern was found in 19.4% and more frequently in patients diagnosed with both asthma and COPD (23.9% than in patients diagnosed with COPD only (6.8%, P = 0.003.Conclusion: The ability of GPs to differentiate between asthma and COPD seems to have considerably improved during the last decade, probably due to the dissemination of spirometry and guidelines for COPD diagnosis. A diagnosis of COPD that cannot be confirmed by spirometry represents a challenge in clinical practice, in particular when a restrictive pattern on spirometry is found.Keywords: asthma, COPD, diagnosis, primary care

  15. Spirometry in elderly laryngectomized patients: A feasibility study.

    Science.gov (United States)

    Izzo, Alessandro; Perrotta, Fabio; Cennamo, Antonio; Cerqua, Francesco Saverio; Rinaldi, Luca; Mazzella, Antonio; Grella, Edoardo; Tranfa, Carmelindo; Bianco, Andrea; Stefanelli, Francesco; Mazzarella, Gennaro

    2016-09-01

    Laryngeal cancer is the second most common respiratory neoplasm after lung cancer. Laryngectomy is a well established treatment for larynx cancers which involve relevant anatomic alterations. Spirometry is an essential investigation tool for diagnosis and severity of respiratory diseases, difficult to perform in laryngectomees. 43 consecutive laryngectomized patients were enrolled from July 2014 to March 2015. Patients fulfilling inclusion criteria underwent spirometry at baseline assessment and after two days. During the examination, the spirometer was placed directly on the stoma of the patient, through mouthpiece "Spirometry Filter 74". At baseline, 26 eligible laryngectomees correctly performed the spirometry test with mouthpiece adhering to the stoma; 4 patients refused to perform the second spirometry after 2 days. The feasibility of spirometry examination in these patients was 100% despite difficulties in the execution of the test. The Pearson coefficient of reproducibility for FEV1, FVC and Tiffeneau Index was, respectively, 0.98, 0.94 and 0.77. Spirometry in laryngectomee patients is a feasible procedure for assessment of respiratory function; despite technical difficulties in the execution of the test, our results underline the reproducibility and repeatability of the spirometry. In conclusion, when performed within dedicated respiratory pathophysiology unit, spirometry is a reliable tool in the assessment and follow up of laryngectomees. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  16. The use of spirometry in a primary care setting

    OpenAIRE

    Blain, Elizabeth A; Craig, Timothy J

    2009-01-01

    Elizabeth A Blain, Timothy J CraigPenn State Hershey Medical Center, Hershey, PA, USAObjective: To determine the use of spirometry in family practice, internal medicine, and pediatric outpatient settings.Methods: Data were collected from 45 outpatient offices in the central Pennsylvania area via phone survey that asked a set of four questions: 1) Do you have spirometry in your office? 2) Do you use spirometry for asthma patients? 3) In what situation do you use spirometry for? 4) Do you use s...

  17. Spirometry, Static Lung Volumes, and Diffusing Capacity.

    Science.gov (United States)

    Vaz Fragoso, Carlos A; Cain, Hilary C; Casaburi, Richard; Lee, Patty J; Iannone, Lynne; Leo-Summers, Linda S; Van Ness, Peter H

    2017-09-01

    Spirometric Z-scores from the Global Lung Initiative (GLI) rigorously account for age-related changes in lung function and are thus age-appropriate when establishing spirometric impairments, including a restrictive pattern and air-flow obstruction. However, GLI-defined spirometric impairments have not yet been evaluated regarding associations with static lung volumes (total lung capacity [TLC], functional residual capacity [FRC], and residual volume [RV]) and gas exchange (diffusing capacity). We performed a retrospective review of pulmonary function tests in subjects ≥40 y old (mean age 64.6 y), including pre-bronchodilator measures for: spirometry ( n = 2,586), static lung volumes by helium dilution with inspiratory capacity maneuver ( n = 2,586), and hemoglobin-adjusted single-breath diffusing capacity ( n = 2,508). Using multivariable linear regression, adjusted least-squares means (adj LS Means) were calculated for TLC, FRC, RV, and hemoglobin-adjusted single-breath diffusing capacity. The adj LS Means were expressed with and without height-cubed standardization and stratified by GLI-defined spirometry, including normal ( n = 1,251), restrictive pattern ( n = 663), and air-flow obstruction (mild, [ n = 128]; moderate, [ n = 150]; and severe, [ n = 394]). Relative to normal spirometry, restrictive-pattern had lower adj LS Means for TLC, FRC, RV, and hemoglobin-adjusted single-breath diffusing capacity ( P ≤ .001). Conversely, relative to normal spirometry, mild, moderate, and severe air-flow obstruction had higher adj LS Means for FRC and RV ( P < .001). However, only mild and moderate air-flow obstruction had higher adj LS Means for TLC ( P < .001), while only moderate and severe air-flow obstruction had higher adj LS Means for RV/TLC ( P < .001) and lower adj LS Means for hemoglobin-adjusted single-breath diffusing capacity ( P < .001). Notably, TLC (calculated as FRC + inspiratory capacity) was not increased in severe air-flow obstruction ( P ≥ .11

  18. Correlation and Agreement of Handheld Spirometry with Laboratory Spirometry in Allogeneic Hematopoietic Cell Transplant Recipients.

    Science.gov (United States)

    Cheng, Guang-Shing; Campbell, Angela P; Xie, Hu; Stednick, Zach; Callais, Cheryl; Leisenring, Wendy M; Englund, Janet A; Chien, Jason W; Boeckh, Michael

    2016-05-01

    Early detection of subclinical lung function decline may help identify allogeneic hematopoietic cell transplant (HCT) recipients who are at increased risk for late noninfectious pulmonary complications, including bronchiolitis obliterans syndrome. We evaluated the use of handheld spirometry in this population. Allogeneic HCT recipients enrolled in a single-center observational trial performed weekly spirometry with a handheld spirometer for 1 year after transplantation. Participants performed pulmonary function tests in an outpatient laboratory setting at 3 time points: before transplantation, at day 80 after transplantation, and at 1 year after transplantation. Correlation between the 2 methods was assessed by Pearson and Spearman correlations; agreement was assessed using Bland-Altman plots. A total of 437 subjects had evaluable pulmonary function tests. Correlation for forced expiratory volume in 1 second (FEV1) was r = .954 (P spirometry correlated well with laboratory spirometry after allogeneic HCT and may be useful for self-monitoring of patients for early identification of airflow obstruction. Copyright © 2016 American Society for Blood and Marrow Transplantation. All rights reserved.

  19. Factors associated with abnormal spirometry among HIV-infected individuals.

    Science.gov (United States)

    Drummond, M Bradley; Huang, Laurence; Diaz, Philip T; Kirk, Gregory D; Kleerup, Eric C; Morris, Alison; Rom, William; Weiden, Michael D; Zhao, Enxu; Thompson, Bruce; Crothers, Kristina

    2015-08-24

    HIV-infected individuals are susceptible to development of chronic lung diseases, but little is known regarding the prevalence and risk factors associated with different spirometric abnormalities in this population. We sought to determine the prevalence, risk factors and performance characteristics of risk factors for spirometric abnormalities among HIV-infected individuals. Cross-sectional cohort study. We analyzed cross-sectional US data from the NHLBI-funded Lung-HIV consortium - a multicenter observational study of heterogeneous groups of HIV-infected participants in diverse geographic sites. Logistic regression analysis was performed to determine factors statistically significantly associated with spirometry patterns. A total of 908 HIV-infected individuals were included. The median age of the cohort was 50 years, 78% were men and 68% current smokers. An abnormal spirometry pattern was present in 37% of the cohort: 27% had obstructed and 10% had restricted spirometry patterns. Overall, age, smoking status and intensity, history of Pneumocystis infection, asthma diagnosis and presence of respiratory symptoms were independently associated with an abnormal spirometry pattern. Regardless of the presence of respiratory symptoms, five HIV-infected participants would need to be screened with spirometry to diagnose two individuals with any abnormal spirometry pattern. Nearly 40% of a diverse US cohort of HIV-infected individuals had an abnormal spirometry pattern. Specific characteristics including age, smoking status, respiratory infection history and respiratory symptoms can identify those at risk for abnormal spirometry. The high prevalence of abnormal spirometry and the poor predictive capability of respiratory symptoms to identify abnormal spirometry should prompt clinicians to consider screening spirometry in HIV-infected populations.

  20. Bronchial hyperresponsiveness to methacholine in patients with primary Sjögren's syndrome.

    OpenAIRE

    Gudbjörnsson, B; Hedenström, H; Stålenheim, G; Hällgren, R

    1991-01-01

    The prevalence of bronchial hyperresponsiveness (BHR) to methacholine inhalation in a consecutive series of 21 patients with primary Sjögren's syndrome was studied prospectively. Slight to severe BHR was seen in 12/20 (60%) of the patients. Ten of 12 patients with BHR (83%) had a non-productive cough, wheezing, or intermittent breathlessness. Bronchial hyperresponsiveness was more common in patients with extraglandular symptoms (10/14, 71%) than in those with only glandular symptoms (29%). Sp...

  1. Non-invasive measurements of exhaled NO and CO associated with methacholine responses in mice

    Directory of Open Access Journals (Sweden)

    Ameredes Bill T

    2008-05-01

    Full Text Available Abstract Background Nitric oxide (NO and carbon monoxide (CO in exhaled breath are considered obtainable biomarkers of physiologic mechanisms. Therefore, obtaining their measures simply, non-invasively, and repeatedly, is of interest, and was the purpose of the current study. Methods Expired NO (ENO and CO (ECO were measured non-invasively using a gas micro-analyzer on several strains of mice (C57Bl6, IL-10-/-, A/J, MKK3-/-, JNK1-/-, NOS-2-/- and NOS-3-/- with and without allergic airway inflammation (AI induced by ovalbumin systemic sensitization and aerosol challenge, compared using independent-sample t-tests between groups, and repeated measures analysis of variance (ANOVA within groups over time of inflammation induction. ENO and ECO were also measured in C57Bl6 and IL-10-/- mice, ages 8–58 weeks old, the relationship of which was determined by regression analysis. S-methionyl-L-thiocitrulline (SMTC, and tin protoporphyrin (SnPP were used to inhibit neuronal/constitutive NOS-1 and heme-oxygenase, respectively, and alter NO and CO production, respectively, as assessed by paired t-tests. Methacholine-associated airway responses (AR were measured by the enhanced pause method, with comparisons by repeated measures ANOVA and post-hoc testing. Results ENO was significantly elevated in naïve IL-10-/- (9–14 ppb and NOS-2-/- (16 ppb mice as compared to others (average: 5–8 ppb, whereas ECO was significantly higher in naïve A/J, NOS-3-/- (3–4 ppm, and MKK3-/- (4–5 ppm mice, as compared to others (average: 2.5 ppm. As compared to C57Bl6 mice, AR of IL-10-/-, JNK1-/-, NOS-2-/-, and NOS-3-/- mice were decreased, whereas they were greater for A/J and MKK3-/- mice. SMTC significantly decreased ENO by ~30%, but did not change AR in NOS-2-/- mice. SnPP reduced ECO in C57Bl6 and IL-10-/- mice, and increased AR in NOS-2-/- mice. ENO decreased as a function of age in IL-10-/- mice, remaining unchanged in C57Bl6 mice. Conclusion These results are

  2. Quantitative analysis of dynamic airway changes after methacholine and salbutamol inhalation on xenon-enhanced chest CT

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sang Joon; Goo, Jin Mo; Kim, Jong Hyo; Park, Eun-Ah [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Medical Research Center, Seoul (Korea, Republic of); Lee, Chang Hyun [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Medical Research Center, Seoul (Korea, Republic of); Seoul National University Hospital, Healthcare Gangnam Center, Seoul (Korea, Republic of); Jung, Jae-Woo; Park, Heung-Woo [Seoul National University College of Medicine, Department of Internal Medicine, Seoul (Korea, Republic of); Seoul National University College of Medicine, Institute of Allergy and Clinical Immunology, Seoul (Korea, Republic of); Cho, Sang-Heon [Seoul National University Hospital, Healthcare Gangnam Center, Seoul (Korea, Republic of); Seoul National University College of Medicine, Department of Internal Medicine, Seoul (Korea, Republic of); Seoul National University College of Medicine, Institute of Allergy and Clinical Immunology, Seoul (Korea, Republic of)

    2012-11-15

    To investigate the dynamic changes in airways in response to methacholine and salbutamol inhalation and to correlate the xenon ventilation index on xenon-enhanced chest CTs in asthmatics. Thirty-one non-smokers (6 normal, 25 asthmatics) underwent xenon-enhanced chest CT and pulmonary function tests. Images were obtained at three stages (basal state, after methacholine inhalation and after salbutamol inhalation), and the total xenon ventilation index (TXVI) as well as airway values were measured and calculated. The repeated measures ANOVA and Spearman's correlation coefficient were used for statistical analysis. TXVI in the normal group did not significantly change (P > 0.05) with methacholine and salbutamol. For asthmatics, however, the TXVI significantly decreased after methacholine inhalation and increased after salbutamol inhalation (P < 0.05). Of the airway parameters, the airway inner area (IA) significantly increased after salbutamol inhalation in all airways (P < 0.01) in asthmatics. Airway IA, wall thickness and wall area percentage did not significantly decrease after methacholine inhalation (P > 0.05). IA of the large airways was well correlated with basal TXVI, FEV{sub 1} and FVC (P < 0.05). Airway IA is the most reliable parameter for reflecting the dynamic changes after methacholine and salbutamol inhalation, and correlates well with TXVI in asthmatics on xenon-enhanced CT. (orig.)

  3. The standard of spirometry in the RSA | Basson | South African ...

    African Journals Online (AJOL)

    Standards for high-quality lung function testing have not yet been formally adopted in the RSA, despite the increase in the performance of spirometry. A study was undertaken to determine the standard of spirometry in clinical practice in this country. Forty-five spirometer users agreed to participate. Responses to a ...

  4. Quality of routine spirometry tests in Dutch general practices.

    NARCIS (Netherlands)

    Schermer, T.R.J.; Crockett, A.J.; Poels, P.J.P.; Dijke, J.J. van; Akkermans, R.P.; Vlek, H.F.; Pieters, W.R.

    2009-01-01

    BACKGROUND: Spirometry is an indispensable tool for diagnosis and monitoring of chronic airways disease in primary care. AIM: To establish the quality of routine spirometry tests in general practice, and explore associations between test quality and patient characteristics. DESIGN OF STUDY: Analysis

  5. Quality of routine spirometry tests in Dutch general practices

    Science.gov (United States)

    Schermer, Tjard RJ; Crockett, Alan J; Poels, Patrick JP; van Dijke, Jacob J; Akkermans, Reinier P; Vlek, Hans F; Pieters, Willem R

    2009-01-01

    Background Spirometry is an indispensable tool for diagnosis and monitoring of chronic airways disease in primary care. Aim To establish the quality of routine spirometry tests in general practice, and explore associations between test quality and patient characteristics. Design of study Analysis of routine spirometry test records. Setting Fifteen general practices which had a working agreement with a local hospital pulmonary function laboratory for spirometry assessment regarding test quality and interpretation. Method Spirometry tests were judged by a pulmonary function technician and a chest physician. Proportions of test adequacy were analysed using markers for manoeuvre acceptability and test reproducibility derived from the 1994 American Thoracic Society spirometry guideline. Associations between quality markers and age, sex, and severity of obstruction were examined using logistic regression. Results Practices performed a mean of four (standard deviation = 2) spirometry tests per week; 1271 tests from 1091 adult patients were analysed; 96.4% (95% confidence interval [CI] = 95.6 to 97.2) of all tests consisted of ≥3 blows. With 60.6% of tests, forced expiratory time was the marker with the lowest acceptability rate. An overall 38.8% (95% CI = 36.0 to 41.6) of the tests met the acceptability as well as reproducibility criteria. Age, sex, and severity of obstruction were associated with test quality markers. Conclusion The quality of routine spirometry tests was better than in previous reports from primary care research settings, but there is still substantial room for improvement. Sufficient duration of forced expiratory time is the quality marker with the highest rate of inadequacy. Primary care professionals should be aware of patient characteristics that may diminish the quality of their spirometry tests. Further research is needed to establish to what extent spirometry tests that are inadequate, according to stringent international expert criteria

  6. Methacholine PC20 In African Americans And Whites With Asthma With Homozygous Genotypes at ADRB2 Codon 16

    Science.gov (United States)

    Blake, Kathryn; Cury, James D.; Hossain, Jobayer; Tantisira, Kelan; Wang, Jianwei; Mougey, Edward; Lima, John

    2013-01-01

    BACKGROUND African Americans have worse asthma outcomes compared to whites. Adrenoceptor beta 2, surface gene (ADRB2) Gly16Arg genotypes have been associated with β2-agonist bronchodilator response, asthma exacerbation rate, response to methacholine, and lung function decline but not specifically in African Americans. OBJECTIVE We sought to compare the provocative concentration of methacholine that causes a 20% fall in FEV1 (PC20) in African Americans and whites with asthma who were ADRB2 homozygous at codon16 (Arg16Arg or Gly16Gly). METHODS African Americans and whites whose parents and grandparents were of the same race, aged ≥ 10 years, with baseline FEV1 of ≥60% predicted, and no upper or lower respiratory tract infection within the previous 2 weeks meeting genotype criteria were enrolled. PC20 was measured after withholding short-acting and long-acting β2-agonists for 8 and 12 hours respectively, montelukast for 24 hours, ipratropium bromide and inhaled corticosteroids for 12 hours, and antihistamines for 72 hours. RESULTS 423 participants were screened and 88 had a positive challenge. Participants were 32yrs ± 19yrs (mean ± SD), 70% female, 51% White (vs. African American), 6% Hispanic. Similar numbers of participants were using inhaled corticosteroids by race and genotype. There were significant differences in log PC20 between race/genotype groups (p=0.012). African American Arg16Arg participants had a lower log PC20 than White Gly16Gly (p=0.009) and African American Gly16Gly (p=0.041) participants. Both race and genotype contributed significantly to the model (p=0.037 and p=0.014, respectively) but there was no interaction between race and genotype on log PC20. CONCLUSIONS AND CLINICAL RELEVANCE Airway hyperresponsiveness is influenced by race and the ADRB2 codon 16 polymorphism. African Americans with the Arg16Arg genotype have increased airway reactivity and may be at risk for worse asthma outcomes. Inclusion of genetic information as an

  7. Spirometry in primary care for children with asthma.

    Science.gov (United States)

    Banasiak, Nancy Cantey

    2014-01-01

    Spirometry is an essential part of diagnosing a child with asthma. The National Asthma Education and Prevention Program (NAEPP) and the Global Initiative for Asthma (GINA) expert panels recommend spirometry to be performed on children five years of age and older as an objective assessment of lung function, to diagnosis asthma, and for ongoing yearly management of asthma (GINA, 2012; NAEPP, 2007). According to the NAEPP expert panel, history and physical examination alone are not reliable to accurately diagnose asthma, exclude alternative diagnosis, or determine lung impairment (NAEPP, 2007 Dombkowski, Hassan, Wasilevich, and Clark (2010) found 52% of physicians who provide primary care to children used spirometry, but only 21% used spirometry according to the national guidelines, and only 35% of physicians surveyed were comfortable interpreting the test results. Zanconato, Meneghelli, Braga, Zacchello, and Baraldi (2005) found that 21% of spirometry readings were interpreted incorrectly, concluding that proper training and quality control were important to provide if spirometry in the primary care office setting is to be used. The purpose of this article is to review the appropriate use of spirometry in pediatric primary care.

  8. Spirometry reference values in Indigenous Australians: a systematic review.

    Science.gov (United States)

    Blake, Tamara L; Chang, Anne B; Petsky, Helen L; Rodwell, Leanne T; Brown, Michael G; Hill, Debra C; Thompson, Bruce; McElrea, Margaret S

    2016-07-04

    To evaluate published spirometry data for Australian Aboriginal and Torres Strait Islander (Indigenous) peoples to determine (i) whether their ethnicity influenced spirometry results; and (ii) if any reliable spirometry reference values exist for Indigenous Australians. Systematic review of published and grey literature. PubMed and Cochrane Library databases, references of included articles and appropriate grey literature. Last searches were conducted in April 2016. We included any study that performed spirometry on healthy Indigenous Australians and compared their results with those from people of European ancestry. Two authors independently screened titles and abstracts and then reviewed potentially relevant full-text articles for possible inclusion. We used PRISMA systematic review reporting methods to collate data. Of a possible 125 studies, 18 full-text articles were reviewed, but only nine fulfilled the inclusion criteria. None specified Torres Strait Islander inclusion. All studies reported lower spirometry values (as much as 30% lower) for Aboriginal people compared with non-Indigenous people. Five studies developed spirometry reference values for Indigenous Australians; however, none adhered to all participant inclusion and exclusion criteria outlined by the American Thoracic Society and European Respiratory Society. Hence, reported results and subsequent reference values may not be a true representation of spirometry values in healthy Indigenous people. The lower spirometry values reported for Indigenous Australians may be due to study limitations. Furthermore, there are currently no reliable spirometry reference values for Indigenous Australians that adhere to current guidelines. Developing a set of Indigenous Australian reference values will improve the accuracy of test interpretation and aid in the diagnosis of respiratory disease in this population.

  9. Effects of cigarette smoke on methacholine- and AMP-induced air trapping in asthmatics.

    Science.gov (United States)

    Prieto, Luis; Palop, Julio; Llusar, Ruth; Herrera, Susana; Perez-Frances, Carmen; Lanuza, Amparo; Aguilar, Daniela

    2015-02-01

    Abstract Objective: No information is available on the effect of cigarette smoke on bronchoconstrictor-induced air trapping in asthma. The aim of this study was to evaluate the additional influence of smoking on methacholine- and adenosine 5'-monophosphate (AMP)-induced air trapping in subjects with asthma. Airway responsiveness to methacholine and AMP, bronchial (J'awNO) and alveolar (CANO) nitric oxide (NO) and exhaled breath condensate pH were measured in 68 adults (23 current smokers with asthma, 23 non-smokers with asthma and 22 current or former smokers with chronic obstructive pulmonary disease; COPD). The degree of air trapping induced by each bronchoconstrictor agent was expressed by the percent fall in forced vital capacity (FVC) at a 20% fall in forced expiratory volume in 1 s relative to FVC after saline inhalation (ΔFVC%). The ΔFVC% for AMP was higher in both smokers with asthma and patients with COPD than in non-smokers with asthma (p<0.001). By contrast, ΔFVC% for methacholine was similar in the three groups of subjects (p=0.69). In smokers with asthma, but not in the other two groups, there was a correlation between the residual volume/total lung capacity at baseline and the ΔFVC% induced by each bronchoconstrictor agent. Mean values for J'awNO were higher in non-smokers with asthma than in the other two groups (p<0.05). The results of this study suggest that factors underlying bronchoconstriction induced by indirect agonists are different in smokers and non-smokers with asthma. These observations might be clinically relevant, because triggers that frequently induce bronchial obstruction in the real world act by an indirect mechanism.

  10. Face mask spirometry and respiratory pressures in normal subjects.

    NARCIS (Netherlands)

    Wohlgemuth, M.; Kooi, E.L. van der; Hendriks, J.C.M.; Padberg, G.W.A.M.; Folgering, H.T.M.

    2003-01-01

    Spirometry and maximal respiratory pressures are pulmonary function parameters commonly used to evaluate respiratory function. Prediction values are available for conventional lung function devices using a standard tube or flanged type of mouthpiece connection. This equipment is not suitable for

  11. Spirometry in a population of coal miners in Paipa, Colombia

    Directory of Open Access Journals (Sweden)

    Nubia González

    2017-12-01

    Conclusions: Spirometry is a useful test for detecting the presence of respiratory disorders in the population of coal miners. The time of exposure was significantly associated with the respiratory disease exhibited by these miners.

  12. Pharmacists performing quality spirometry testing: an evidence based review.

    Science.gov (United States)

    Cawley, Michael J; Warning, William J

    2015-10-01

    The scope of pharmacist services for patients with pulmonary disease has primarily focused on drug related outcomes; however pharmacists have the ability to broaden the scope of clinical services by performing diagnostic testing including quality spirometry testing. Studies have demonstrated that pharmacists can perform quality spirometry testing based upon international guidelines. The primary aim of this review was to assess the published evidence of pharmacists performing quality spirometry testing based upon American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. In order to accomplish this, the description of evidence and type of outcome from these services were reviewed. A literature search was conducted using five databases [PubMed (1946-January 2015), International Pharmaceutical Abstracts (1970 to January 2015), Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews] with search terms including pharmacy, spirometry, pulmonary function, asthma or COPD was conducted. Searches were limited to publications in English and reported in humans. In addition, Uniform Resource Locators and Google Scholar searches were implemented to include any additional supplemental information. Eight studies (six prospective multi-center trials, two retrospective single center studies) were included. Pharmacists in all studies received specialized training in performing spirometry testing. Of the eight studies meeting inclusion and exclusion criteria, 8 (100%) demonstrated acceptable repeatability of spirometry testing based upon standards set by the ATS/ERS guidelines. Acceptable repeatability of seven studies ranged from 70 to 99% consistent with published data. Available evidence suggests that quality spirometry testing can be performed by pharmacists. More prospective studies are needed to add to the current evidence of quality spirometry testing performed by

  13. Reference values for spirometry in preschool children.

    Science.gov (United States)

    Burity, Edjane F; Pereira, Carlos A C; Rizzo, José A; Brito, Murilo C A; Sarinho, Emanuel S C

    2013-01-01

    Reference values for lung function tests differ in samples from different countries, including values for preschoolers. The main objective of this study was to derive reference values in this population. A prospective study was conducted through a questionnaire applied to 425 preschool children aged 3 to 6 years, from schools and day-care centers in a metropolitan city in Brazil. Children were selected by simple random sampling from the aforementioned schools. Peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volumes (FEV1, FEV0.50), forced expiratory flow (FEF25-75) and FEV1/FVC, FEV0.5/FVC and FEF25-75/FVC ratios were evaluated. Of the 425 children enrolled, 321 (75.6%) underwent the tests. Of these, 135 (42.0%) showed acceptable results with full expiratory curves and thus were included in the regression analysis to define the reference values. Height and gender significantly influenced FVC values through linear and logarithmic regression analysis. In males, R(2) increased with the logarithmic model for FVC and FEV1, but the linear model was retained for its simplicity. The lower limits were calculated by measuring the fifth percentile residues. Full expiratory curves are more difficult to obtain in preschoolers. In addition to height, gender also influences the measures of FVC and FEV1. Reference values were defined for spirometry in preschool children in this population, which are applicable to similar populations. Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  14. A smart spirometry device for asthma diagnosis.

    Science.gov (United States)

    Kassem, A; Hamad, M; El Moucary, C

    2015-08-01

    In this paper an innovative prototype for smart asthma spirometry device to be used by doctors and asthma patients is presented. The novelty in this prototype relies in the fact that it is destined to subtend not only adults but offers an efficient and attractive manner to accommodate children patients as well thus, making it efficient for doctors, patients and parents to detect and monitor such intricate cases at stages as early as six years old. Moreover, the apparatus used enables us to integrate a vital parameter representing the Forced Expiratory Volume to the final diagnosis. Besides, the presented device will automatically diagnose those patients, assess their asthma condition, and schedule their medication process without excessive visits to medical centers whilst providing doctors with accurate and pertinent and comprehensive medical data in a chronological fashion. Zooming into under the hood of the device, a fully reliable hardware digital system lies along with a flowmeter detector and a Bluetooth emitter to interface with a user-friendly GUI-based application installed on smartphones which incorporates appealing animated graphics to encourage children to take the test. Furthermore, the device offers the capability of storing chronological data and a relevant resourceful display for accurate tracking of patients' medical record, the evolvement of their asthma condition, and the administered medication. Finally, the entire device is aligned with the medical requirements as per doctors' and telemedicine specialists' recommendations; the experiments carried out demonstrated the effectiveness and sustainable use of such device.

  15. Prevalence of Respiratory Diseases According to Spirometry Findings Among Patients Attending the Spirometry Department of Dhulikhel Hospital.

    Science.gov (United States)

    Prajapati, B K; Pradhan, S

    2016-01-01

    Background Spirometry is a standard test for screening and evaluation of patients with symptoms of cough and shortness of breath. Despite its easy availability, low cost and ease of performance it has not been widely used in clinical practice in Nepal. Objective To assess the prevalence of respiratory diseases in a regional referral centre in patients referred for spirometry. Method This is a descriptive cross-sectional study including patients referred for spirometry to the spirometry unit of Dhulikhel Hospital, Kathmandu University Hospital from 2014 July to 2015 October. The spirometry findings of the patients fulfilling the criteria of American Thoracic Society/European Respitatory Society (ATS/ERS) guidelines were analyzed and categorized as normal, having obstructive lung diseases including chronic obstructive pulmonary disease (COPD) and bronchial asthma or restrictive lung disease. Data were analyzed using SPSS 20.0 software. Result Out of 821 patients, 755 patients (92%) fulfilled ATS/ERS criteria for satisfactory spirometry. The prevalence of COPD was 31.4%, bronchial asthma 24.2% and restrictive lung disease 8.1%. The mean age of patients diagnosed with COPD was 57.8±10.8 years; bronchial asthma 44.3±16.2 years; and restrictive lung disease 44.6±21.5 years. Both COPD and bronchial asthma were common in females. About twenty two percent of the COPD patients were non-smokers and 86.3% of these were females. The most common symptoms for referral was cough and shortness of breath: these symptoms were more likely to be associated with abnormal spirometry findings. Conclusion Spirometry is a crucial preliminary test for evaluation of patients with respiratory symptoms. It should be used more frequently to help stratify patients for appropriate treatment.

  16. Reference values of inspiratory spirometry for Finnish adults.

    Science.gov (United States)

    Kainu, Annette; Timonen, Kirsi L; Vanninen, Esko; Sovijärvi, Anssi R

    2018-03-07

    Inspiratory spirometry is used in evaluation of upper airway disorders e.g. fixed or variable obstruction. There are, however, very few published data on normal values for inspiratory spirometry. The main aim of this study was to produce reference values for inspiratory spirometry for healthy Finnish adults. Inspiratory spirometry was preplanned to a sample of the Finnish spirometry reference values sample. Data was successfully retrieved from 368 healthy nonsmoking adults (132 males) between 19 and 83 years of age. Reference equations were produced for forced inspiratory vital capacity (FIVC), forced inspiratory volume in one second (FIV1), FIV1/FIVC, peak inspiratory flow (PIF) and the ratios of FIV1/forced expiratory volume in one second and PIF/peak expiratory flow. The present values were compared to PIF values from previously used Finnish study of Viljanen et al. (1982) reference values and Norwegian values for FIV1, FIVC and FIV1/FIVC presented by Gulsvik et al. (2001). The predicted values from the Gulsvik et al. (2001), provided a good fit for FIVC, but smaller values for FIV1 with mean 108.3 and 109.1% of predicted values for males and females, respectively. PIF values were 87.4 and 91.2% of Viljanen et al. (1982) predicted values in males and females, respectively. Differences in measurement methods and selection of results may contribute to the observed differences. Inspiratory spirometry is technically more demanding and needs repeatability criteria to improve validity. New reference values are suggested to clinical use in Finland when assessing inspiratory spirometry. Utility of inspiratory to expiratory values indices in assessment of airway collapse need further study.

  17. Effects of tidal volume and methacholine on low-frequency total respiratory impedance in dogs.

    Science.gov (United States)

    Lutchen, K R; Jackson, A C

    1990-05-01

    The frequency dependence of respiratory impedance (Zrs) from 0.125 to 4 Hz (Hantos et al., J. Appl. Physiol. 60: 123-132, 1986) may reflect inhomogeneous parallel time constants or the inherent viscoelastic properties of the respiratory tissues. However, studies on the lung alone or chest wall alone indicate that their impedance features are also dependent on the tidal volumes (VT) of the forced oscillations. The goals of this study were 1) to identify how total Zrs at lower frequencies measured with random noise (RN) compared with that measure with larger VT, 2) to identify how Zrs measured with RN is affected by bronchoconstriction, and 3) to identify the impact of using linear models for analyzing such data. We measured Zrs in six healthy dogs by use of a RN technique from 0.125 to 4 Hz or with a ventilator from 0.125 to 0.75 Hz with VT from 50 to 250 ml. Then methacholine was administered and the RN was repeated. Two linear models were fit to each separate set of data. Both models assume uniform airways leading to viscoelastic tissues. For healthy dogs, the respiratory resistance (Rrs) decreased with frequency, with most of the decrease occurring from 0.125 to 0.375 Hz. Significant VT dependence of Rrs was seen only at these lower frequencies, with Rrs higher as VT decreased. The respiratory compliance (Crs) was dependent on VT in a similar fashion at all frequencies, with Crs decreasing as VT decreased. Both linear models fit the data well at all VT, but the viscoelastic parameters of each model were very sensitive to VT. After methacholine, the minimum Rrs increased as did the total drop with frequency. Nevertheless the same models fit the data well, and both the airways and tissue parameters were altered after methacholine. We conclude that inferences based only on low-frequency Zrs data are problematic because of the effects of VT on such data (and subsequent linear modeling of it) and the apparent inability of such data to differentiate parallel

  18. Pathway to Best Practice in Spirometry in the Ambulatory Setting.

    Science.gov (United States)

    Peracchio, Carol

    2016-01-01

    Spirometry performed in the ambulatory setting is an invaluable tool for diagnosis, monitoring, and evaluation of respiratory health in patients with chronic lung disease. If spirometry is not performed according to American Thoracic Society (ATS) guidelines, unnecessary repeated testing, increased expenditure of time and money, and increased patient and family anxiety may result. Two respiratory therapists at Mission Health System in Asheville, NC, identified an increase in patients arriving at the pulmonary function testing (PFT) laboratories with abnormal spirometry results obtained in the ambulatory setting. These abnormal results were due to incorrect testing procedure, not chronic lung disease. Three training methods were developed to increase knowledge of correct spirometry testing procedure in the ambulatory setting. The therapists also created a plan to educate offices that do not perform spirometry on the importance and availability of PFT services at our hospital for the population of patients with chronic lung disease. Notable improvements in posttraining test results were demonstrated. The education process was evaluated by a leading respiratory expert, with improvements suggested and implemented. Next steps are listed.

  19. Automated Spirometry Quality Assurance: Supervised Learning From Multiple Experts.

    Science.gov (United States)

    Velickovski, Filip; Ceccaroni, Luigi; Marti, Robert; Burgos, Felip; Gistau, Concepcion; Alsina-Restoy, Xavier; Roca, Josep

    2018-01-01

    Forced spirometry testing is gradually becoming available across different healthcare tiers including primary care. It has been demonstrated in earlier work that commercially available spirometers are not fully able to assure the quality of individual spirometry manoeuvres. Thus, a need to expand the availability of high-quality spirometry assessment beyond specialist pulmonary centres has arisen. In this paper, we propose a method to select and optimise a classifier using supervised learning techniques by learning from previously classified forced spirometry tests from a group of experts. Such a method is able to take into account the shape of the curve as an expert would during visual inspection. We evaluated the final classifier on a dataset put aside for evaluation yielding an area under the receiver operating characteristic curve of 0.88 and specificities of 0.91 and 0.86 for sensitivities of 0.60 and 0.82. Furthermore, other specificities and sensitivities along the receiver operating characteristic curve were close to the level of the experts when compared against each-other, and better than an earlier rules-based method assessed on the same dataset. We foresee key benefits in raising diagnostic quality, saving time, reducing cost, and also improving remote care and monitoring services for patients with chronic respiratory diseases in the future if a clinical decision support system with the encapsulated classifier is to be integrated into the work-flow of forced spirometry testing.

  20. Interpretation of Spirometry: Selection of Predicted Values and Defining Abnormality.

    Science.gov (United States)

    Chhabra, S K

    2015-01-01

    Spirometry is the most frequently performed investigation to evaluate pulmonary function. It provides clinically useful information on the mechanical properties of the lung and the thoracic cage and aids in taking management-related decisions in a wide spectrum of diseases and disorders. Few measurements in medicine are so dependent on factors related to equipment, operator and the patient. Good spirometry requires quality assured measurements and a systematic approach to interpretation. Standard guidelines on the technical aspects of equipment and their calibration as well as the test procedure have been developed and revised from time-to-time. Strict compliance with standardisation guidelines ensures quality control. Interpretation of spirometry data is based only on two basic measurements--the forced vital capacity (FVC) and the forced expiratory volume in 1 second (FEV1) and their ratio, FEV1/FVC. A meaningful and clinically useful interpretation of the measured data requires a systematic approach and consideration of several important issues. Central to interpretation is the understanding of the development and application of prediction equations. Selection of prediction equations that are appropriate for the ethnic origin of the patient is vital to avoid erroneous interpretation. Defining abnormal values is a debatable but critical aspect of spirometry. A statistically valid definition of the lower limits of normal has been advocated as the better method over the more commonly used approach of defining abnormality as a fixed percentage of the predicted value. Spirometry rarely provides a specific diagnosis. Examination of the flow-volume curve and the measured data provides information to define patterns of ventilatory impairment. Spirometry must be interpreted in conjunction with clinical information including results of other investigations.

  1. Oscillometry complements spirometry in evaluation of subjects following toxic inhalation

    Directory of Open Access Journals (Sweden)

    Kenneth I. Berger

    2015-12-01

    Full Text Available The World Trade Center (WTC destruction released dust and fumes into the environment. Although many community members developed respiratory symptoms, screening spirometry was usually normal. We hypothesised that forced oscillation testing would identify functional abnormalities undetected by spirometry and that symptom severity would relate to magnitude of abnormalities measured by oscillometry. A symptomatic cohort (n=848 from the Bellevue Hospital WTC Environmental Health Center was evaluated and compared to an asymptomatic cohort (n=475 from the New York City Department of Health WTC Health Registry. Spirometry and oscillometry were performed. Oscillometry measurements included resistance (R5 and frequency dependence of resistance (R5−20. Spirometry was normal for the majority of subjects (73.2% symptomatic versus 87.6% asymptomatic, p<0.0001. In subjects with normal spirometry, R5 and R5−20 were higher in symptomatic versus asymptomatic subjects (median (interquartile range R5 0.436 (0.206 versus 0.314 (0.129 kPa·L−1·s−1, p<0.001; R5−20 0.075 (0.085 versus 0.004 (0.042 kPa·L−1·s−1, p<0.0001. In symptomatic subjects, R5 and R5−20 increased with increasing severity and frequency of wheeze (p<0.05. Measurement of R5–20 correlated with the presence and severity of symptoms even when spirometry was within normal limits. These findings are in accord with small airway abnormalities as a potential explanation of the respiratory symptoms.

  2. Oscillometry complements spirometry in evaluation of subjects following toxic inhalation

    Science.gov (United States)

    Berger, Kenneth I.; Turetz, Meredith; Liu, Mengling; Shao, Yongzhao; Kazeros, Angeliki; Parsia, Sam; Caplan-Shaw, Caralee; Friedman, Stephen M.; Maslow, Carey B.; Marmor, Michael; Goldring, Roberta M.

    2015-01-01

    The World Trade Center (WTC) destruction released dust and fumes into the environment. Although many community members developed respiratory symptoms, screening spirometry was usually normal. We hypothesised that forced oscillation testing would identify functional abnormalities undetected by spirometry and that symptom severity would relate to magnitude of abnormalities measured by oscillometry. A symptomatic cohort (n=848) from the Bellevue Hospital WTC Environmental Health Center was evaluated and compared to an asymptomatic cohort (n=475) from the New York City Department of Health WTC Health Registry. Spirometry and oscillometry were performed. Oscillometry measurements included resistance (R5) and frequency dependence of resistance (R5−20). Spirometry was normal for the majority of subjects (73.2% symptomatic versus 87.6% asymptomatic, p<0.0001). In subjects with normal spirometry, R5 and R5−20 were higher in symptomatic versus asymptomatic subjects (median (interquartile range) R5 0.436 (0.206) versus 0.314 (0.129) kPa·L−1·s−1, p<0.001; R5−20 0.075 (0.085) versus 0.004 (0.042) kPa·L−1·s−1, p<0.0001). In symptomatic subjects, R5 and R5−20 increased with increasing severity and frequency of wheeze (p<0.05). Measurement of R5–20 correlated with the presence and severity of symptoms even when spirometry was within normal limits. These findings are in accord with small airway abnormalities as a potential explanation of the respiratory symptoms. PMID:27730155

  3. Phenotype of normal spirometry in an aging population.

    Science.gov (United States)

    Vaz Fragoso, Carlos A; McAvay, Gail; Van Ness, Peter H; Casaburi, Richard; Jensen, Robert L; MacIntyre, Neil; Gill, Thomas M; Yaggi, H Klar; Concato, John

    2015-10-01

    In aging populations, the commonly used Global Initiative for Chronic Obstructive Lung Disease (GOLD) may misclassify normal spirometry as respiratory impairment (airflow obstruction and restrictive pattern), including the presumption of respiratory disease (chronic obstructive pulmonary disease [COPD]). To evaluate the phenotype of normal spirometry as defined by a new approach from the Global Lung Initiative (GLI), overall and across GOLD spirometric categories. Using data from COPDGene (n = 10,131; ages 45-81; smoking history, ≥10 pack-years), we evaluated spirometry and multiple phenotypes, including dyspnea severity (Modified Medical Research Council grade 0-4), health-related quality of life (St. George's Respiratory Questionnaire total score), 6-minute-walk distance, bronchodilator reversibility (FEV1 % change), computed tomography-measured percentage of lung with emphysema (% emphysema) and gas trapping (% gas trapping), and small airway dimensions (square root of the wall area for a standardized airway with an internal perimeter of 10 mm). Among 5,100 participants with GLI-defined normal spirometry, GOLD identified respiratory impairment in 1,146 (22.5%), including a restrictive pattern in 464 (9.1%), mild COPD in 380 (7.5%), moderate COPD in 302 (5.9%), and severe COPD in none. Overall, the phenotype of GLI-defined normal spirometry included normal adjusted mean values for dyspnea grade (0.8), St. George's Respiratory Questionnaire (15.9), 6-minute-walk distance (1,424 ft [434 m]), bronchodilator reversibility (2.7%), % emphysema (0.9%), % gas trapping (10.7%), and square root of the wall area for a standardized airway with an internal perimeter of 10 mm (3.65 mm); corresponding 95% confidence intervals were similarly normal. These phenotypes remained normal for GLI-defined normal spirometry across GOLD spirometric categories. GLI-defined normal spirometry, even when classified as respiratory impairment by GOLD, included adjusted mean values in the

  4. Effect on attendance by including focused information on spirometry in preventive health checks: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Ørts, Lene Maria; Løkke, Anders; Bjerregaard, Anne-Louise; Maindal, Helle Terkildsen; Sandbæk, Annelli

    2016-12-01

    Early detection of lung diseases can help to reduce their severity. Lung diseases are among the most frequently occurring and serious diseases worldwide; nonetheless, many patients remain undiagnosed. Preventive health checks including spirometry can detect lung diseases at early stages; however, recruitment for health checks remains a challenge, and little is known about what motivates the attendance. The aim of the study is to examine whether focused information on spirometry in the invitation compared to general information will impact the attendance rate in preventive health checks. This randomized, controlled trial tests the effect of information on spirometry embedded in the Check your Health Preventive Program (CHPP). The CHPP is an open-label, household cluster-randomized, controlled trial offering a preventive health check to 30- to -49-year-olds in a Danish municipality from 2012 to 2017 (n = 26,216). During 2015-2016, 4356 citizens aged 30-49 years will be randomized into two groups. The intervention group receives an invitation which highlights the value and contents of spirometry as part of a health check and information about lung diseases. The comparison group receives a standard invitation containing practical information and specifies the contents of the general health check. Outcomes are (1) differences in attendance rates measured by the proportion of citizens attending each of the two study groups and (2) proportion of persons at risk defined by smoking status and self-reported lung symptoms in the study groups. The proportion of participants with abnormal spirometry assessed at the preventive health check will be compared between the two study groups. The results from the present study will inform future recruitment strategies to health checks. The developed material on content, value, and information about lung disease is feasible and transferable to other populations, making it easy to implement if effective. ClinicalTrials.gov: NCT

  5. Variation in spirometry utilization between trained general practitioners in practices equipped with a spirometer.

    NARCIS (Netherlands)

    Poels, P.J.E.; Schermer, T.R.J.; Jacobs, A.; Akkermans, R.P.; Hartman, J.; Bottema, B.J.A.M.; Weel, C. van

    2006-01-01

    OBJECTIVE: To explore spirometry utilization among general practitioners and identify practitioner and practice-related factors associated with spirometry utilization. DESIGN: Multivariate multilevel cross-sectional analysis of a questionnaire survey. SETTING: Some 61 general practices involved in a

  6. Influence of the diving wetsuit on standard spirometry

    NARCIS (Netherlands)

    Schellart, Nico A. M.; Sterk, Wouter

    2016-01-01

    INTRODUCTION A well-fitting wetsuit exerts a pressure on the body that may influence spirometry. This pressure is expected to reduce the forced vital capacity (FVC) due to hampered inspiration. Since the shape of the spirometric flow curve should not be changed by the pressure effects of the

  7. Prediction Equations for Spirometry for Children from Northern India.

    Science.gov (United States)

    Chhabra, Sunil K; Kumar, Rajeev; Mittal, Vikas

    2016-09-08

    To develop prediction equations for spirometry for children from northern India using current international guidelines for standardization. Re-analysis of cross-sectional data from a single school. 670 normal children (age 6-17 y; 365 boys) of northern Indian parentage. After screening for normal health, we carried out spirometry with recommended quality assurance according to current guidelines. We developed linear and nonlinear prediction equations using multiple regression analysis. We selected the final models on the basis of the highest coefficient of multiple determination (R2) and statistical validity. Spirometry parameters: FVC, FEV1, PEFR, FEF50, FEF75 and FEF25-75. The equations for the main parameters were as follows: Boys, Ln FVC = -1.687+0.016*height +0.022*age; Ln FEV1 = -1.748+0.015*height+0.031*age. Girls, Ln FVC = -9.989 +(2.018*Ln(height)) + (0.324*Ln(age)); Ln FEV1 = -10.055 +(1.990*Ln(height))+(0.358*Ln(age)). Nonlinear regression yielded substantially greater R2 values compared to linear models except for FEF50 for girls. Height and age were found to be the significant explanatory variables for all parameters on multiple regression with weight making no significant contribution. We developed prediction equations for spirometry for children from northern India. Nonlinear equations were superior to linear equations.

  8. Spirometry: a predictor of lung cancer among asbestos workers.

    Science.gov (United States)

    Świątkowska, Beata; Szeszenia-Dąbrowska, Neonila

    2017-01-01

    The significance of lung function as an independent risk factor for lung cancer remains unclear. The objective of the study is to answer the question if spirometry can identify patients at risk for lung cancer among people occupationally exposed to asbestos dust in the past. In order to identify a group of individuals with the highest risk of lung cancer incidence based on lung function levels of FEV 1 % predicted value, we examined 6882 subjects enrolled in the health surveillance program for asbestos related diseases over the years 2000-2014. We found a total of 110 cases confirmed as primary lung cancer. Using Cox's proportional hazards model after adjustment for age, gender, number of cigarettes, duration of smoking and cumulative asbestos exposure, we estimated that compared with the subjects with FEV 1 ≥90% pred, the HR of lung cancer was 1.40 (95%CI: 0.94-2.08) for the subjects with FEV 1 less than 90% and 1.95 (HR = 1.86; 95%CI: 1.12-3.08) for those with FEV 1 less than 70%. In addition, probability of the occurrence of lung cancer for FEV 1 spirometry and cancer diagnosis was three years or less. The results strongly support the hypothesis that spirometry can identify patients at a risk of lung cancer development. Regular spirometry should be offered to all patients with a history of asbestos exposure, at least once every three years.

  9. A Rwandan spirometry and resting ventilation study | Gahutu ...

    African Journals Online (AJOL)

    To illustrate spirometric population variation and ventilatory adaptation to moderate altitude, we report the spirometric and resting ventilation values observed in a student population in Butare, Rwanda (altitude: 1 768 m; barometric pressure: 629 mm Hg). Spirometry was carried out with a Mijnhardt Volutest VT-3 ...

  10. A guide to spirometry as applied to occupational health | White ...

    African Journals Online (AJOL)

    In the context of occupational health, spirometric testing of respiratory function has a number of important applications. These applications can be expected to become more widespread in view of extensive changes to occupational health and compensation legislation in South Africa. Spirometry is an essential component of ...

  11. Accuracy and Quality of Spirometry in Primary Care Offices.

    Science.gov (United States)

    Hegewald, Matthew J; Gallo, Heather M; Wilson, Emily L

    2016-12-01

    Spirometry is necessary for the optimal management of patients with respiratory disease. The quality of spirometry performed in the primary care setting has been inconsistent. We aimed to evaluate spirometer accuracy, determine the clinical significance of inaccurate spirometers, and assess the quality of spirograms obtained in primary care offices. We tested 17 spirometers used in primary care offices with a waveform generator; accuracy and precision were assessed using American Thoracic Society criteria. The clinical significance of inaccurate instruments was determined by applying the FEV 1 /FVC error from an obstructed waveform to a clinical data set. Spirogram quality was determined by grading spirograms using acceptability and repeatability criteria. The relationship between the number of tests performed by a clinic and test quality was assessed. Only 1 of 17 spirometers met accuracy criteria, with mean errors for FVC, FEV 1 , and FEV 1 /FVC ranging from 1.7 to 3.1%. Applying the percentage error to a clinical data set resulted in 28% of tests being recategorized from obstructed to nonobstructed. Of the spirograms reviewed, 60% were considered acceptable for clinical use. There was no association between the number of tests performed by a clinic and spirometry quality. Most spirometers tested were not accurate. The magnitude of the errors resulted in significant changes in the categorization of patients with obstruction. Acceptable-quality tests were produced for only 60% of patients. Our results raise concerns regarding the utility of spirometry obtained in primary care offices without greater attention to quality assurance and training.

  12. Spirometry of healthy adult South African men | Louw | South African ...

    African Journals Online (AJOL)

    An exhaustive questionnaire and radiographic screening process was used to identify a healthy population. Spirometry was performed using two calibrated instruments, a sleeve sealed piston spirometer (Autolink) and a bellows spirometer (Vitalograph). The methodological guidelines of the American Thoracic Society were ...

  13. 21 CFR 868.1860 - Peak-flow meter for spirometry.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Peak-flow meter for spirometry. 868.1860 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1860 Peak-flow meter for spirometry. (a) Identification. A peak-flow meter for spirometry is a device used to measure a patient's...

  14. Spirometry filters can be used to detect exhaled respiratory viruses.

    Science.gov (United States)

    Mitchell, Alicia B; Mourad, Bassel; Tovey, Euan; Buddle, Lachlan; Peters, Matthew; Morgan, Lucy; Oliver, Brian G

    2016-09-26

    Respiratory viruses are very common in the community and contribute to the burden of illness for patients with chronic respiratory diseases, including acute exacerbations. Traditional sampling methods are invasive and problematic to repeat. Accordingly, we explored whether respiratory viruses could be isolated from disposable spirometry filters and whether detection of viruses in this context represented presence in the upper or lower respiratory tract. Discovery (n  =  53) and validation (n  =  49) cohorts were recruited from a hospital outpatient department during two different time periods. Spirometry mouthpiece filters were collected from all participants. Respiratory secretions were sampled from the upper and lower respiratory tract by nasal washing (NW), sputum, and bronchoalveolar lavage (BAL). All samples were examined using RT-PCR to identify a panel of respiratory viruses (rhinovirus, respiratory syncytial virus, influenza A, influenza B, parainfluenza virus 1, 2 & 3, and human metapneumovirus). Rhinovirus was quantified using qPCR. Paired filter-NW samples (n  =  29), filter-sputum samples (n  =  24), filter-BAL samples (n  =  39) and filter-NW-BAL samples (n  =  10) provided a range of comparisons. At least one virus was detected in any sample in 85% of participants in the discovery cohort versus 45% in the validation cohort. Overall, 72% of viruses identified in the paired comparator method matched those detected in spirometry filters. There was a high correlation between viruses identified in spirometry filters compared with viruses identified in both the upper and lower respiratory tract using traditional sampling methods. Our results suggest that examination of spirometry filters may be a novel and inexpensive sampling method for the presence of respiratory viruses in exhaled breath.

  15. Prediction equations for spirometry in adults from northern India.

    Science.gov (United States)

    Chhabra, S K; Kumar, R; Gupta, U; Rahman, M; Dash, D J

    2014-01-01

    Most of the Indian studies on prediction equations for spirometry in adults are several decades old and may have lost their utility as these were carried out with equipment and standardisation protocols that have since changed. Their validity is further questionable as the lung health of the population is likely to have changed over time. To develop prediction equations for spirometry in adults of north Indian origin using the 2005 American Thoracic Society/European Respiratory Society (ATS/ERS) recommendations on standardisation. Normal healthy non-smoker subjects, both males and females, aged 18 years and above underwent spirometry using a non-heated Fleisch Pneumotach spirometer calibrated daily. The dataset was randomly divided into training (70%) and test (30%) sets and the former was used to develop the equations. These were validated on the test data set. Prediction equations were developed separately for males and females for forced vital capacity (FVC), forced expiratory volume in first second (FEV1), FEV1/FVC ratio, and instantaneous expiratory flow rates using multiple linear regression procedure with different transformations of dependent and/or independent variables to achieve the best-fitting models for the data. The equations were compared with the previous ones developed in the same population in the 1960s. In all, 685 (489 males, 196 females) subjects performed spirometry that was technically acceptable and repeatable. All the spirometry parameters were significantly higher among males except the FEV1/FVC ratio that was significantly higher in females. Overall, age had a negative relationship with the spirometry parameters while height was positively correlated with each, except for the FEV1/FVC ratio that was related only to age. Weight was included in the models for FVC, forced expiratory flow (FEF75) and FEV1/FVC ratio in males, but its contribution was very small. Standard errors of estimate were provided to enable calculation of the lower

  16. Pilot program on distance training in spirometry testing - the technology feasibility study.

    Science.gov (United States)

    Nowiński, Adam; Romański, Emil; Bieleń, Przemysław; Bednarek, Michał; Puścińska, Elżbieta; Goljan-Geremek, Anna; Pływaczewski, Robert; Śliwinski, Paweł

    2015-01-01

    Office spirometry has been widely used in recent years by general practitioners in primary care setting, thus the need for stricter monitoring of the quality of spirometry has been recognized. A spirometry counseling network of outpatients clinics was created in Poland using portable spirometer Spirotel. The spirometry data were transferred to counseling centre once a week. The tests sent to the counseling centre were analyzed by doctors experienced in the analysis of spirometric data. In justified cases they sent their remarks concerning performed tests to the centres via e-mail. We received 878 records of spirometry tests in total. Data transmission via the telephone was 100% effective. The quality of spirometry tests performed by outpatients clinics was variable. The use of spirometers with data transfer for training purposes seems to be advisable. There is a need to proper face-to-face training of spirometry operators before an implementation of any telemedicine technology.

  17. Criteria for inhalation exposure systems utilizing concurrent flow spirometry

    International Nuclear Information System (INIS)

    Raabe, O.G.; Yeh, H.C.

    1974-01-01

    Principles are given for the design and operation of a new class of inhalation exposure systems utilizing concurrent flow spirometry (CFS), a simple method for providing realtime measurement of respiratory volumes and rates during inhalation exposure by mouth or nose of individual experimental animals or man to aerosols or gases. This technique is especially useful for inhalation exposure of larger experimental animals, such as horses, where whole-body plethysmography is usually impractical. Difficulties encountered with conventional exposure systems in maintenance of uniform aerosol or gas concentrations and prevention of large pressure excursions in the exposure chamber during breathing are obviated by systems utilizing the principles of concurrent flow spirometry. For illustration, two exposure units with CFS are described, one for exposure of Beagle dogs and one for ponies. (U.S.)

  18. The Use of Home Spirometry in Pediatric Cystic Fibrosis Patients

    Directory of Open Access Journals (Sweden)

    Aarti Shakkottai MD

    2017-02-01

    Full Text Available Medication adherence is poor among pediatric cystic fibrosis (CF patients, with adolescents having one of the lowest adherence rates. We wanted to identify an adherence intervention that would be acceptable to CF adolescents and assess its feasibility. We surveyed 40 adolescents with CF and asked about barriers to and motivators for their own adherence and to generate ideas for potential adherence interventions. Since most of the respondents chose frequent spirometry at home and medication reminders for interventions, we selected 5 subjects, 10 to 14 years of age, with CF to test the feasibility of home spirometry and medication reminders in pediatric CF patients. This article summarizes the results of both the survey and the feasibility pilot study.

  19. Spirometry improvement after muscular exercise in elite swimmers.

    Science.gov (United States)

    Rubini, Alessandro; Rizzato, Alex; Fava, Simone; Olivato, Nicola; Mangar, Devanand; Camporesi, Enrico M; Bosco, Gerardo

    2017-12-01

    An increased sympathetic activity during muscular effort is a well established physiological response, whose intensity is known to increase with the muscular load. Spirometry was described to improve as an effect of swimming training in healthy and asthmatic subjects, suggesting a decrease in airway resistance The aim was to investigate the possible effect of muscular exercise (swimming) on spirometry, in particular searching for possible differences because of different swimming times. The measurements were performed on 9 highly trained male competitive swimmers (age: 41±12.79 years, height: 1.69±0.06 meters, weight: 66.14±14.28 kg, BMI: 22.8±3.61 kg/m2) during an official competition. The data were collected at the border of the swimming-pool before (control, C) and few minutes after the swimming sessions (exercise, E), which consisted either of 800 meter (7 subjects) or 1500 meter (5 subjects) free style. A general trend indicating a postexercise increase in spirometry was observed. We found post-exercise significant increments in FEV1 and in MEF75 for both the 800 and 1500 meter swimming sessions, and in FEF25-75 and in MEF25 for the shorter distance. We conclude that, as it may be expected, muscular exercise induces an improvement of spirometry both because of a smooth muscle relaxation-induced modulation of airway diameter and resistance to airflow, and because of an enhanced expiratory muscle contraction strength. Both of these mechanisms are related to an increased sympathetic activity which is well known to accompany muscular exercise.

  20. Pulmonary involvement in rheumatoid arthritis: evaluation by radiography and spirometry *

    Science.gov (United States)

    Kawassaki, Alexandre Melo; Pereira, Daniel Antunes Silva; Uliana Kay, Fernando; Laurindo, Ieda Maria Magalhães; Carvalho, Carlos Roberto Ribeiro; Kairalla, Ronaldo Adib

    2015-01-01

    Abstract Objective: To determine whether simple diagnostic methods can yield relevant disease information in patients with rheumatoid arthritis (RA). Methods: Patients with RA were randomly selected for inclusion in a cross-sectional study involving clinical evaluation of pulmonary function, including pulse oximetry (determination of SpO2, at rest), chest X-ray, and spirometry. Results: A total of 246 RA patients underwent complete assessments. Half of the patients in our sample reported a history of smoking. Spirometry was abnormal in 30% of the patients; the chest X-ray was abnormal in 45%; and the SpO2 was abnormal in 13%. Normal chest X-ray, spirometry, and SpO2 were observed simultaneously in only 41% of the RA patients. A history of smoking was associated with abnormal spirometry findings, including evidence of obstructive or restrictive lung disease, and with abnormal chest X-ray findings, as well as with an interstitial pattern on the chest X-ray. Comparing the patients in whom all test results were normal (n = 101) with those in whom abnormal test results were obtained (n = 145), we found a statistically significant difference between the two groups, in terms of age and smoking status. Notably, there were signs of airway disease in nearly half of the patients with minimal or no history of tobacco smoke exposure. Conclusions: Pulmonary involvement in RA can be identified through the use of a combination of diagnostic methods that are simple, safe, and inexpensive. Our results lead us to suggest that RA patients with signs of lung involvement should be screened for lung abnormalities, even if presenting with no respiratory symptoms. PMID:26398753

  1. PIKO-6® vs. forced spirometry in asthmatic children.

    Science.gov (United States)

    Gochicoa-Rangel, Laura; Larios-Castañeda, Pablo José; Miguel-Reyes, José Luis; Briseño, David Martínez; Flores-Campos, Roberto; Sáenz-López, Juan Arturo; Torre-Bouscoulet, Luis

    2014-12-01

    The PIKO-6® is an electronic device that measures forced expiratory volume at seconds 1 (FEV1) and 6 (FEV6) of a forced vital capacity (FVC) maneuver. This device could aid in diagnosing obstructive respiratory diseases. To determine the concordance of FEV1, FEV6, and the FEV1/FEV6 quotient achieved with PIKO-6® versus spirometric values from asthmatic patients, and compare results with measures from healthy children. A cross-sectional study with asthmatic and healthy 6-to-14-year-old children, all of whom performed a forced spirometry as well as a PIKO-6® test. The study included 82 subjects (58 asthmatics, 24 healthy children). Except for the functional parameters, the basal characteristics of the two groups were similar. The concordance correlation coefficient (CCC) for FEV1 was 0.938 (P spirometry was lower in patients with partially controlled or uncontrolled asthma compared to controlled or healthy children. The broad limits of agreement show that the FEV1, FEV6, and FEV1/FEV6 obtained with the PIKO-6® are not interchangeable with spirometry results. Longitudinal evaluations of asthma patients are necessary to assess the utility of PIKO-6®. © 2014 Wiley Periodicals, Inc.

  2. Spirometry. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR).

    Science.gov (United States)

    García-Río, Francisco; Calle, Myriam; Burgos, Felip; Casan, Pere; Del Campo, Félix; Galdiz, Juan B; Giner, Jordi; González-Mangado, Nicolás; Ortega, Francisco; Puente Maestu, Luis

    2013-09-01

    Spirometry is the main pulmonary function test and is essential for the evaluation and monitoring of respiratory diseases. Its utility transcends the field of Respiratory Medicine, is becoming increasingly important in primary care and applications have even been described outside the field of respiratory diseases. This document is therefore intended to serve as support for all health professionals who use spirometry, providing recommendations based on the best scientific evidence available. An update of the indications and contraindications of the test is proposed. The document sets out recommendations on the requirements necessary for conventional spirometers and portable office equipment, as well as on spirometer hygiene and quality control measures. Spirometric parameters that must be considered, performance of manoeuvres, criteria for acceptability and repeatability of measurements and their quality control are defined. A proposal is also established for presentation of the results and an evaluation and interpretation is proposed according to information generated in recent years. Finally, lines of adaptation and integration of spirometry in the field of new technologies are considered. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  3. The Role of Incentive Spirometry in Primary Spontaneous Pneumothorax.

    Science.gov (United States)

    Pribadi, Rabbinu R; Singh, Gurmeet; Rumende, Cleopas M

    2016-01-01

    Pneumothorax is the presence of air in the pleural space. Its management consists of noninvasive and invasive therapies and it is determined based on clinical manifestations, type and size of pneumothorax. We present a case of a patient with diagnosis of primary spontaneous pneumothorax treated with incentive spirometry (noninvasive therapy). A 20 year old man came to respirology clinic with chief complaint of shortness of breath. He was recently diagnosed with left pneumothorax based on previous chest X-ray in another health care facilities and was advised to undergo tube thoracostomy but he refused the procedure. On physical examination, vital signs were normal. Chest X-ray showed 33% of pneumothorax or 1.2 cm. He was asked to perform incentive spirometry therapy at home. During 12 days of therapy, shortness of breath slowly disappeared and on repeated chest X-ray, it showed minimal pneumothorax in the left upper hemithorax. Noninvasive treatment such as incentive spirometry can be considered in patient with minimal symptoms and no signs of life-threatening respiratory distress.

  4. Spirometry use: detection of chronic obstructive pulmonary disease in the primary care setting

    Science.gov (United States)

    Barnes, Thomas A; Fromer, Len

    2011-01-01

    Objective: To describe a practical method for family practitioners to stage chronic obstructive pulmonary disease (COPD) by the use of office spirometry. Methods: This is a review of the lessons learned from evaluations of the use of office spirometry in the primary care setting to identify best practices using the most recent published evaluations of office spirometry and the analysis of preliminary data from a recent spirometry mass screening project. A mass screening study by the American Association for Respiratory Care and the COPD Foundation was used to identify the most effective way for general practitioners to implement office spirometry in order to stage COPD. Results: A simple three-step method is described to identify people with a high pre-test probability in an attempt to detect moderate to severe COPD: COPD questionnaire, measurement of peak expiratory flow, and office spirometry. Clinical practice guidelines exist for office spirometry basics for safety, use of electronic peak flow devices, and portable spirometers. Conclusion: Spirometry can be undertaken in primary care offices with acceptable levels of technical expertise. Using office spirometry, primary care physicians can diagnose the presence and severity of COPD. Spirometry can guide therapies for COPD and predict outcomes when used in general practice. PMID:21472091

  5. Spirometry reference equations for central European populations from school age to old age.

    Science.gov (United States)

    Rochat, Mascha K; Laubender, Ruediger P; Kuster, Daniela; Braendli, Otto; Moeller, Alexander; Mansmann, Ulrich; von Mutius, Erika; Wildhaber, Johannes

    2013-01-01

    Spirometry reference values are important for the interpretation of spirometry results. Reference values should be updated regularly, derived from a population as similar to the population for which they are to be used and span across all ages. Such spirometry reference equations are currently lacking for central European populations. To develop spirometry reference equations for central European populations between 8 and 90 years of age. We used data collected between January 1993 and December 2010 from a central European population. The data was modelled using "Generalized Additive Models for Location, Scale and Shape" (GAMLSS). The spirometry reference equations were derived from 118'891 individuals consisting of 60'624 (51%) females and 58'267 (49%) males. Altogether, there were 18'211 (15.3%) children under the age of 18 years. We developed spirometry reference equations for a central European population between 8 and 90 years of age that can be implemented in a wide range of clinical settings.

  6. Risk for COPD with Obstruction of Active Smokers with Normal Spirometry and Reduced Diffusion Capacity

    Science.gov (United States)

    Kaner, Robert J.; Sanders, Abraham; Vincent, Thomas L.; Mezey, Jason G.; Crystal, Ronald G.

    2016-01-01

    Background Smokers are assessed for COPD using spirometry, with COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as airflow limitation not fully reversible with bronchodilators. There is a subset of smokers with normal spirometry (by GOLD criteria), who have a low diffusion capacity (DLCO), a parameter linked to emphysema and small airway disease. The natural history of these “normal spirometry/low DLCO” smokers is unknown. Methods From a cohort of 1570 smokers in the New York City metropolitian area, all of whom had normal spirometry, two groups were randomly selected for lung function follow-up: smokers with normal spirometry/normal DLCO (n=59) and smokers with normal spirometry/low DLCO (n=46). All had normal history, physical examination, CBC, urinalysis, HIV status, α1-antitrypsin level, chest X-ray, FEV1, FVC, FEV1/FVC ratio and total lung capacity (TLC). Throughout the study, all continued to be active smokers. Findings In the normal spirometry/normal DLCO group assessed over 45 ± 20 months, 3% developed GOLD-defined COPD. In contrast, in the normal spirometry/low DLCO group, followed over 41 ± 31 months, 22% developed GOLD-defined COPD. Interpretation Despite appearing “normal” by GOLD, smokers with normal spirometry but low DLCO are at significant risk for developing COPD with obstruction to airflow. PMID:26541521

  7. Spirometry Use among Older Adults with Chronic Obstructive Pulmonary Disease: 1999–2008

    Science.gov (United States)

    Wang, Yue; Kuo, Yong-Fang; Goodwin, James S.; Sharma, Gulshan

    2013-01-01

    Rationale: Clinical practice guidelines recommend spirometry to diagnose chronic obstructive pulmonary disease (COPD) and facilitate management. National trends in spirometry use in older adults with newly diagnosed COPD are not known. Objectives: To examine the rate and beneficiary characteristics associated with spirometry use in subjects with newly diagnosed COPD between 1999 and 2008. Methods: We examined newly diagnosed beneficiaries with COPD using a 5% Medicare population from 1999 to 2008. A new COPD diagnosis required two outpatient visits or one hospitalization with primary International Classification of Diseases, 9th edition code 491.xx, 492.xx, or 496 occurring at least 30 days apart with none in the prior 12 months. The primary measurement was spirometry performed within 365 days (±) of the first claim with a COPD diagnosis. Measurements and Main Results: Between 1999 and 2008, 64,985 subjects were newly diagnosed with COPD. Of these, 35,739 (55%) had spirometry performed within 1 year before or after the initial diagnosis of COPD. Spirometry use increased from 51.3% in 1999 to 58.3% in 2008 (P spirometry. In a multivariable analysis, compared with 1999, subjects diagnosed in 2008 had 10% higher odds (odds ratio, 1.10; 95% confidence interval, 1.06–1.13) of having spirometry performed. Conclusions: Despite an increase in the use of spirometry over time in newly diagnosed older adults with COPD, spirometry use remains low. Clinical practice guidelines and educational efforts should focus on increasing the use of spirometry to diagnose and manage COPD. PMID:24053440

  8. Confirmatory spirometry for adults hospitalized with a diagnosis of asthma or chronic obstructive pulmonary disease exacerbation

    Science.gov (United States)

    2012-01-01

    Background Objective measurement of airflow obstruction by spirometry is an essential part of the diagnosis of asthma or COPD. During exacerbations, the feasibility and utility of spirometry to confirm the diagnosis of asthma or chronic obstructive pulmonary disease (COPD) are unclear. Addressing these gaps in knowledge may help define the need for confirmatory testing in clinical care and quality improvement efforts. This study was designed to determine the feasibility of spirometry and to determine its utility to confirm the diagnosis in patients hospitalized with a physician diagnosis of asthma or COPD exacerbation. Methods Multi-center study of four academic healthcare institutions. Spirometry was performed in 113 adults admitted to general medicine wards with a physician diagnosis of asthma or COPD exacerbation. Two board-certified pulmonologists evaluated the spirometry tracings to determine the proportion of patients able to produce adequate quality spirometry data. Findings were interpreted to evaluate the utility of spirometry to confirm the presence of obstructive lung disease, according to the 2005 European Respiratory Society/American Thoracic Society recommendations. Results There was an almost perfect agreement for acceptability (κ = 0.92) and reproducibility (κ =0.93) of spirometry tracings. Three-quarters (73%) of the tests were interpreted by both pulmonologists as being of adequate quality. Of these adequate quality tests, 22% did not present objective evidence of obstructive lung disease. Obese patients (BMI ≥30 kg/m2) were more likely to produce spirometry tracings with no evidence of obstructive lung disease, compared to non-obese patients (33% vs. 8%, p = 0.007). Conclusions Adequate quality spirometry can be obtained in most hospitalized adults with a physician diagnosis of asthma or COPD exacerbation. Confirmatory spirometry could be a useful tool to help reduce overdiagnosis of obstructive lung disease, especially among obese

  9. Virtual respiratory system for interactive e-learning of spirometry

    Directory of Open Access Journals (Sweden)

    W. Tomalak

    2008-04-01

    Full Text Available Progress in computer simulation technology offers new possibilities for modern medicine. On one hand – virtual organs can help to create animal or human models for research, on the other hand – e-learning or distant learning through Internet is now possible. The aim of our work was to create a system for interactive learning of spirometry (SILS, enabling students or physicians to observe spirometric measurements (flow-volume modified by setting level and kind of abnormalities within the respiratory system. SILS is based on a virtual respiratory system presented previously in several papers. Its main features are: separation of the lungs and chest; anatomical division of the lungs; division of airway resistance into transmural pressure dependent (Rp and lung volume dependent (Rv parts. The one mathematical formula that represents Rp describes both flow limitation (forced expiration and dependence of Raw on lungs volume (small airflows. The output of system are spirometric parameters (as FEV1, FVC, FEV1%FVC and a flow–volume loop constructed according to results of simulation of forced expiration for the chosen abnormality kind and level. As a result – this system may be used in teaching process in medical schools and postgraduate education. We offer access to a basic version of SILS for students and physicians at: www.spirometry.ibib.waw.pl and www.zpigichp.edu.pl. As we expect feedback from users, it is possible to modify user interface or model features to comply with users' requests.

  10. Spirometry Changes in Cold Climatic Conditions of Antarctica.

    Science.gov (United States)

    Udaya, Iyamanda B; Laxmi, Chettangada C; Abhishekh, Hulegar A; Raju, Trichur R; Sathyaprabha, Talakad N

    2015-01-01

    Pulmonary function is one of the important physiological measures that is known to be affected during the changes in the altitude. There is dearth of literature on changes in the pulmonary function variables in the cold climate conditions of Antarctica. We carried out spirometry before, during and after one year stay at Antarctica in members of the Indian expedition. Spirometry was carried out on 23 members of the XXVI Indian Scientific Expedition to Antarctica at baseline, after six months of expedition and at the end of one year, using standard guidelines. The tests were carried out indoor in temperature controlled laboratory. The pulmonary function test parameters did not vary across the period. Although, both forced vital capacity (FVC) and forced expiratory volume in first second (FEV1) showed a decreasing trend but did not attain any statistical significance. However, peak expiratory flow (PEFR) rate was reduced significantly. Our study did not show consistently significant change in the pulmonary function parameters in the members of the Indian Antarctic expedition.

  11. Introduction of spirometry into clinical practice in Georgetown, Guyana: quality and diagnostic outcomes.

    Science.gov (United States)

    Johnston, J C; Rempel, C; Sanders, C; Piggott, E; Maxwell, Y; Jaipersaud, K; Luknauth, R; Persaud, D; Rambaran, M; Levy, R D

    2016-09-01

    Georgetown Public Hospital Corporation (GPHC), a 600-bed publicly funded referral hospital in Georgetown, Guyana. To assess spirometry quality and diagnostic outcomes 2 years after the introduction of spirometry into routine clinical practice at GPHC. We performed a retrospective review of 476 consecutive spirometry assessments performed from November 2013 to November 2015. We assessed the proportion and trend of spirometry tests meeting acceptability criteria, along with diagnostic interpretations and spirometry laboratory referral patterns. Overall, 80.4% of the 454 initial spirometry measurements on unique patients met the acceptability criteria, with no significant change in the proportion of acceptable spirometry over the study period (P = 0.450). Of the 369 (81.3%) first tests considered interpretable, 139 (30.6%) were normal, 151 (33.3%) were obstructive, 54 (11.9%) were suggestive of a restrictive pattern, 25 (5.5%) were suggestive of a mixed disorder and 119 (26.2%) tests met the definition of reversibility. Over a 2-year period, high-quality spirometry was performed in GPHC, a publicly funded hospital in a middle-income country with no pre-existing specialised respiratory service.

  12. Lack of spirometry use in Danish patients initiating medication targeting obstructive lung disease

    DEFF Research Database (Denmark)

    Koefoed, Mette; Christensen, René Depont; Søndergaard, Jens

    2012-01-01

    Research indicates that a large proportion of patients using medication targeting obstructive lung disease have no history of spirometry testing.......Research indicates that a large proportion of patients using medication targeting obstructive lung disease have no history of spirometry testing....

  13. Mismatch between asthma symptoms and spirometry: implications for managing asthma in children.

    Science.gov (United States)

    Schifano, Elizabeth D; Hollenbach, Jessica P; Cloutier, Michelle M

    2014-11-01

    To examine the concordance between spirometry and asthma symptoms in assessing asthma severity and beginning therapy by the general pediatrician. Between 2008 and 2012, spirometry testing was satisfactorily performed in 894 children (ages 5-19 years) whose asthma severity had been determined by their pediatrician using asthma guideline-based clinical criteria. Spirometry-determined asthma severity using national asthma guidelines and clinician-determined asthma severity were compared for concordance using weighted Kappa coefficients. Thirty percent of participants had clinically determined intermittent asthma; 32%, 33%, and 5% had mild, moderate, and severe, persistent asthma, respectively. Increasing disease severity was associated with decreases in the forced expiratory volume in 1 second/forced vital capacity (FVC) ratio (P spirometry-determined severity. Concordance was 0.16 (95% CI 0.10, 0.23), and when adjusted for bias and prevalence, was 0.20 (95% CI 0.17, 0.23). When accounting for age, sex, exposure to smoke, and insurance type, only spirometry-determined asthma severity was a significant predictor of agreement (P spirometry-determined severity increased. Concordance between spirometry and asthma symptoms in determining asthma severity is low even when guideline-based clinical assessment tools are used. Because appropriate therapy reduces asthma morbidity and is guided by disease severity, results from spirometry testing could better guide pediatricians in determining appropriate therapy for their patients with asthma. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Disease Severity Prediction by Spirometry in Adults with Visceral Leishmaniasis from Minas Gerais, Brazil.

    Science.gov (United States)

    Maia, Isabel A; Bezerra, Frank S; Albuquerque, André Luis Pereira de; Andrade, Heitor F; Nicodemo, Antonio C; Amato, Valdir S

    2017-02-08

    Visceral leishmaniasis (VL) is associated with interstitial pneumonitis according to histology and radiology reports. However, studies to address the functional impact on respiratory function in patients are lacking. We assessed pulmonary function using noninvasive spirometry in a cross-sectional study of hospitalized adult VL patients from Minas Gerais, Brazil, without unrelated lung conditions or acute infections. Lung conditions were graded as normal, restrictive, obstructive, or mixed patterns, according to Brazilian consensus standards for spirometry. To control for regional patterns of lung function, we compared spirometry of patients with regional paired controls. Spirometry detected abnormal lung function in most VL patients (70%, 14/20), usually showing a restrictive pattern, in contrast to regional controls and the standards for normal tests. Alterations in spirometry measurements correlated with hypoalbuminemia, the only laboratory value indicative of severity of parasitic disease. Abnormalities did not correlate with unrelated factors such as smoking or occupation. Clinical data including pulmonary symptoms and duration of therapy were also unrelated to abnormal spirometry findings. We conclude that the severity of VL is correlated with a restrictive pattern of lung function according to spirometry, suggesting that there may be interstitial lung involvement in VL. Further studies should address whether spirometry could serve as an index of disease severity in the management of VL. © The American Society of Tropical Medicine and Hygiene.

  15. Spirometry for patients in hospital and one month after admission with an acute exacerbation of COPD

    Science.gov (United States)

    Rea, Harry; Kenealy, Timothy; Adair, Jacqui; Robinson, Elizabeth; Sheridan, Nicolette

    2011-01-01

    Aim To assess whether spirometry done in hospital during an admission for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is clinically useful for long-term management. Methods Patients admitted to hospital with a clinical diagnosis of AECOPD had spirometry post-bronchodilator at discharge and approximately 4 weeks later. Results Spirometry was achieved in less than half of those considered to have AECOPD. Of 49 patients who had spirometry on both occasions, 41 met the GOLD criteria for COPD at discharge and 39 of these met the criteria at 1 month. For the 41, spirometry was not statistically different between discharge and 1 month but often crossed arbitrary boundaries for classification of severity based on FEV1. The eight who did not meet GOLD criteria at discharge were either misclassified due to comorbidities that reduce FVC, or they did not have COPD as a cause of their hospital admission. Conclusion Spirometry done in hospital at the time of AECOP is useful in patients with a high pre-test probability of moderate-to-severe COPD. Small changes in spirometry at 1 month could place them up or down one grade of severity. Spirometry at discharge may be useful to detect those who warrant further investigation. PMID:22069364

  16. Implications of the Transition From Zapletal to GLI Reference Values for Spirometry

    NARCIS (Netherlands)

    Raaijmakers, Lena; Zwitserloot, Annelies; Merkus, Peter; Gappa, Monika

    The current standard for monitoring lung function in children with asthma is spirometry. In Europe, results of these lung function tests have been related to Zapletal reference values published in 1977. Recently, the Global Lung Function Initiative (GLI) published predicted values of spirometry for

  17. Differences in the use of spirometry between rural and urban primary care centers in Spain.

    Science.gov (United States)

    Márquez-Martín, Eduardo; Soriano, Joan B; Rubio, Myriam Calle; Lopez-Campos, Jose Luis

    2015-01-01

    The aim of this study is to evaluate the ability and practice of spirometry, training of technicians, and spirometry features in primary care centers in Spain, evaluating those located in a rural environment against those in urban areas. An observational cross-sectional study was conducted in 2012 by a telephone survey in 970 primary health care centers in Spain. The centers were divided into rural or urban depending on the catchment population. The survey contacted technicians in charge of spirometry and consisted of 36 questions related to the test that included the following topics: center resources, training doctors and technicians, using the spirometer, bronchodilator test, and the availability of spirometry and maintenance. Although the sample size was achieved in both settings, rural centers (RCs) gave a lower response rate than urban centers (UCs). The number of centers without spirometry in rural areas doubled those in the urban areas. Most centers had between one and two spirometers. However, the number of spirometry tests per week was significantly lower in RCs than in UCs (4 [4.1%] vs 6.9 [5.7%], Pspirometries was higher in RCs than in UCs (209 [73.0%] vs 207 [64.2%], P=0.003). RCs were more satisfied with the spirometries (7.8 vs 7.6, P=0.019) and received more training course for interpreting spirometry (41.0% vs 33.2%, P=0.004). The performance of the bronchodilator test showed a homogeneous measure in different ways. The spirometer type and the reference values were unknown to the majority of respondents. This study shows the differences between primary care RCs and UCs in Spain in terms of performing spirometry. The findings in the present study can be used to improve the performance of spirometry in these areas.

  18. Spirometry effects on conventional and multiple flow exhaled nitric oxide in children.

    Science.gov (United States)

    Eckel, Sandrah P; Linn, William S; Salam, Muhammad T; Bastain, Theresa M; Zhang, Yue; Rappaport, Edward B; Liu, Meng; Berhane, Kiros

    2015-03-01

    Clinical and research settings often require sequencing multiple respiratory tests in a brief visit. Guidelines recommend measuring the concentration of exhaled nitric oxide (FeNO) before spirometry, but evidence for a spirometry carryover effect on FeNO is mixed. Only one study has investigated spirometry carryover effects on multiple flow FeNO analysis. The objective of this study was to evaluate evidence for carryover effects of recent spirometry on three exhaled NO summary measures: FeNO at 50 ml/s, airway wall NO flux [J'awNO] and alveolar NO concentration [CANO] in a population-based sample of schoolchildren. Participants were 1146 children (191 with asthma), ages 12-15, from the Southern California Children's Health Study who performed spirometry and multiple flow FeNO on the same day. Approximately, half the children performed spirometry first. Multiple linear regression was used to estimate differences in exhaled NO summary measures associated with recent spirometry testing, adjusting for potential confounders. In the population-based sample, we found no evidence of spirometry carryover effects. However, for children with asthma, there was a suggestion that exhaled NO summary measures assessed ≤6 min after spirometry were lower (FeNO: 25.8% lower, 95% CI: -6.2%, 48.2%; J'awNO: 15.1% lower 95% CI: -26.5%, 43.0%; and CANO 0.43 parts per billion lower, 95% CI: -0.12, 0.98). In clinical settings, it is prudent to assess multiple flow FeNO before spirometry. In studies of healthy subjects, it may not be necessary to assess FeNO first.

  19. Use of telehealth technology for home spirometry after lung transplantation: a randomized controlled trial.

    Science.gov (United States)

    Sengpiel, Juliane; Fuehner, Thomas; Kugler, Christiane; Avsar, Murat; Bodmann, Isabelle; Boemke, Annelies; Simon, Andre; Welte, Tobias; Gottlieb, Jens

    2010-12-01

    Complications often occur during the early phase after lung transplantation, and rapid diagnosis is vital. Home spirometry is used to detect early changes in graft function. Bluetooth-equipped cell phones are easy to use and facilitate data transfer from home spirometry. To explore use of home spirometry with Bluetooth data transfer in outpatient lung transplant recipients. Single-center prospective randomized controlled trial. Intervention-Fifty-six patients were randomized either to home spirometry with data transfer via Bluetooth-equipped cell phones or to home spirometry alone before discharge after lung transplantation. In the Bluetooth group, results were transferred to a database capable of generating alarm messages. Time from onset of symptoms to physician consultation during the first 6 months after lung transplantation was the primary end point. Adherence to home spirometry was 97.2% in the Bluetooth group and 95.3% in the home spirometry alone group (P = .73). Median time to first consultation (P = .60) and frequency of consultation (P = .06) did not differ significantly in the 2 groups. Mean scores on the Hospital Anxiety and Depression Scale were lower in patients in the Bluetooth group (1.5; range, 0.0-4.0) than in the home spirometry alone group (4.0; range, 2.0-6.0; P = .04). Home spirometry with data transfer is feasible and safe in lung transplant recipients. Compared with home spirometry alone, additional data transfer was equally effective regarding the time interval from symptom onset to consultation. Patients in the Bluetooth group reported less anxiety, which may improve emotional well-being.

  20. [The spirometry figures of bronchoobstructive syndrome in concomitant intestinal parasitosis].

    Science.gov (United States)

    Aliyev, K; Aliyeva, G; Gadjiyeva, N

    2010-02-01

    The aim of research is to study of the spirometry figures of bronchoobstructive syndrome in concomitant intestinal parasitosis. There are 81 patients aged from 5 to 61 years (male 43, female 38) were examined. The patients were divided into 2 groups: 1 group - patients treated only with bronchodilator therapy (14 patients with protozoa, 14 - with helminth, 12 - with combination of parasitosis); 2 group - patients treated with bronchodilator therapy in common with anti-parasitic therapy (14 patients with protozoa, 17 - with helminth, 10 - with combination of parasitosis). There are 22 patients with bronchoobstructive syndrome without parasites were included in control group. Functional disorders at the initial examination are not significantly distinguished between patients with protozoa, helminth, with combined parasitosis and patients without parasites. Considerable differences manifested in dynamics after treatment: only bronchodilator therapy of patients infected with parasites is not lead to sufficient increase of the indices of external respiration function, even the decreasing of the most parameters were observed in patients with helminth. The least growth of spirometric indices were observed in patients from group 1 - 2,17/ 5,09% predicted volumes (-6,81min; 10,54max), the highest growth were observed in patients from group 2 - 20,26/ 12,45% p.v. (2,77min; 43,85max). The spirographic indicators increase after treatment in the control group was more moderate in comparison with 1 and 2 groups - 5,96/ 2,97% p.v. (0,39min; 9,59max). Thus, using antiparasitic therapy in common with bronchodilator therapy in treatment of patients with intestinal parasitosis (group 2) is lead to the reliably significant positive dynamic of spirometry parameters in comparison not only to 1 group (<0,05 for many parameters) but also to control group (<0,01 for many parameters).

  1. Effect of montelukast on excessive airway narrowing response to methacholine in adult asthmatic patients not on controller therapy

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Diamant, Zuzana

    2009-01-01

    -response plateau to Mtc in adult asthmatic patients not on controller therapy, and, hence, protects against excessive airway narrowing. Thirty-one asthmatic patients (13 male patients, 18-50 years old; forced expiratory volume in 1 second [FEV(1)], >70% predicted; PD(20), ...Excessive airway narrowing is an important determinant of fatal asthma. This pathophysiological feature is characterized by the absence of a dose-response plateau to methacholine (Mtc). We investigated if the leukotriene receptor antagonist (LTRA) montelukast (Mont) can induce a dose...... of treatment with Mont neither induced a plateau response nor affected maximum FEV(1) response or PD(20). Our findings, therefore, suggest that monotherapy with a LTRA does not protect against excessive airway narrowing in adult asthmatic patients not on inhaled corticosteroids....

  2. Measurement of lung function in awake 2-4-year-old asthmatic children during methacholine challenge and acute asthma

    DEFF Research Database (Denmark)

    Klug, B; Bisgaard, H

    1996-01-01

    This study evaluated three techniques for testing of lung function in young awake children. We compared measurements by the forced or impulse oscillation technique (IOS), the interrupter technique (IT), and transcutaneous measurements of oxygen (tcPo2) with concomitant measurements of specific ai...

  3. Use of spirometry among chest physicians and primary care physicians in India.

    Science.gov (United States)

    Vanjare, Nitin; Chhowala, Sushmeeta; Madas, Sapna; Kodgule, Rahul; Gogtay, Jaideep; Salvi, Sundeep

    2016-07-07

    Although spirometry is the gold-standard diagnostic test for obstructive airways diseases, it remains poorly utilised in clinical practice. We aimed to investigate the use of spirometry across India, the change in its usage over a period of time and to understand the reasons for its under-utilisation. Two nationwide surveys were conducted in the years 2005 and 2013, among four groups of doctors: chest physicians (CPs), general physicians (GenPs), general practitioners (GPs) and paediatricians (Ps). A total of 1,000 physicians from each of the four groups were randomly selected from our database in the years 2005 and 2013. These surveys were conducted in 52 cities and towns across 15 states in India. A questionnaire was administered to the physicians, which captured information about their demographic details, type of practice and use of spirometry. The overall response rates of the physicians in 2005 and 2013 were 42.8% and 54.9%, respectively. Spirometry was reported to be used by 55% CPs, 20% GenPs, 10% GPs and 5% Ps in 2005, and this increased by 30.9% among CPs (P value spirometry varied between 2005 and 2013. In all, 32.2% of physicians were unaware of which predicted equation they were using. The use of spirometry in India is low, although it seems to have improved over the years. The reasons identified in this study for under-utilisation should be used to address initiatives to improve the use of spirometry in clinical practice.

  4. The association between incentive spirometry performance and pain in postoperative thoracic epidural analgesia.

    Science.gov (United States)

    Harris, David J; Hilliard, Paul E; Jewell, Elizabeth S; Brummett, Chad M

    2015-01-01

    Effective use of postoperative incentive spirometry improves patient outcomes but is limited by pain after thoracic and upper abdominal surgery. Thoracic epidurals are frequently used to provide analgesia and attenuate postoperative pulmonary dysfunction. We hypothesized that, in patients with thoracic epidurals for thoracic and abdominal surgery, high pain scores would be associated with poorer incentive spirometry performance, even when accounting for other variables. Retrospective study of 468 patients who underwent upper abdominal or thoracic surgery using postoperative thoracic epidural analgesia between June 1, 2009, and August 31, 2013, at a single tertiary academic center. The association between incentive spirometry performance and pain was assessed as the primary outcome. Other independent predictors of incentive spirometry performance were also identified. Postoperative incentive spirometry performance was found to be inversely proportional to pain score, which correlated significantly stronger with deep breathing pain compared with pain at rest (-0.33 vs -0.14 on postoperative day 1; -0.23 vs -0.12 on postoperative day 2). Pain with deep breathing was independently associated with poorer incentive spirometry performance in the multivariable linear regression model (P spirometry performance could be used as another indicator of thoracic epidural efficacy. This may be particularly useful in patients reporting high pain scores postoperatively.

  5. Telemedicine spirometry training and quality assurance program in primary care centers of a public health system.

    Science.gov (United States)

    Marina Malanda, Nuria; López de Santa María, Elena; Gutiérrez, Asunción; Bayón, Juan Carlos; Garcia, Larraitz; Gáldiz, Juan B

    2014-04-01

    Forced spirometry is essential for diagnosing respiratory diseases and is widely used across levels of care. However, several studies have shown that spirometry quality in primary care is not ideal, with risks of misdiagnosis. Our objective was to assess the feasibility and performance of a telemedicine-based training and quality assurance program for forced spirometry in primary care. The two phases included (1) a 9-month pilot study involving 15 centers, in which spirometry tests were assessed by the Basque Office for Health Technology Assessment, and (2) the introduction of the program to all centers in the Public Basque Health Service. Technicians first received 4 h of training, and, subsequently, they sent all tests to the reference laboratory using the program. Quality assessment was performed in accordance with clinical guidelines (A and B, good; C-F, poor). In the first phase, 1,894 spirometry tests were assessed, showing an improvement in quality: acceptable quality tests increased from 57% at the beginning to 78% after 6 months and 83% after 9 months (passessed after the inclusion of 36 additional centers, maintaining the positive trend (61%, 87%, and 84% at the same time points; pquality of spirometry tests improved in all centers. (2) The program provides a tool for transferring data that allows monitoring of its quality and training of technicians who perform the tests. (3) This approach is useful for improving spirometry quality in the routine practice of a public health system.

  6. Risk of COPD with obstruction in active smokers with normal spirometry and reduced diffusion capacity.

    Science.gov (United States)

    Harvey, Ben-Gary; Strulovici-Barel, Yael; Kaner, Robert J; Sanders, Abraham; Vincent, Thomas L; Mezey, Jason G; Crystal, Ronald G

    2015-12-01

    Smokers are assessed for chronic obstructive pulmonary disease (COPD) using spirometry, with COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as airflow limitation that is not fully reversible with bronchodilators. There is a subset of smokers with normal spirometry (by GOLD criteria), who have a low diffusing capacity of the lung for carbon monoxide (DLCO), a parameter linked to emphysema and small airway disease. The natural history of these "normal spirometry/low DLCO" smokers is unknown.From a cohort of 1570 smokers in the New York City metropolitian area, all of whom had normal spirometry, two groups were randomly selected for lung function follow-up: smokers with normal spirometry/normal DLCO (n=59) and smokers with normal spirometry/low DLCO (n=46). All had normal history, physical examination, complete blood count, urinalysis, HIV status, α1-antitrypsin level, chest radiography, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio and total lung capacity. Throughout the study, all continued to be active smokers.In the normal spirometry/normal DLCO group assessed over 45±20 months, 3% developed GOLD-defined COPD. In contrast, in the normal spirometry/low DLCO group, followed over 41±31 months, 22% developed GOLD-defined COPD.Despite appearing "normal" according to GOLD, smokers with normal spirometry but low DLCO are at significant risk of developing COPD with obstruction to airflow. Copyright ©ERS 2015.

  7. Differential effects of allergen challenge on large and small airway reactivity in mice.

    Directory of Open Access Journals (Sweden)

    Chantal Donovan

    Full Text Available The relative contributions of large and small airways to hyperresponsiveness in asthma have yet to be fully assessed. This study used a mouse model of chronic allergic airways disease to induce inflammation and remodelling and determine whether in vivo hyperresponsiveness to methacholine is consistent with in vitro reactivity of trachea and small airways. Balb/C mice were sensitised (days 0, 14 and challenged (3 times/week, 6 weeks with ovalbumin. Airway reactivity was compared with saline-challenged controls in vivo assessing whole lung resistance, and in vitro measuring the force of tracheal contraction and the magnitude/rate of small airway narrowing within lung slices. Increased airway inflammation, epithelial remodelling and fibrosis were evident following allergen challenge. In vivo hyperresponsiveness to methacholine was maintained in isolated trachea. In contrast, methacholine induced slower narrowing, with reduced potency in small airways compared to controls. In vitro incubation with IL-1/TNFα did not alter reactivity. The hyporesponsiveness to methacholine in small airways within lung slices following chronic ovalbumin challenge was unexpected, given hyperresponsiveness to the same agonist both in vivo and in vitro in tracheal preparations. This finding may reflect the altered interactions of small airways with surrounding parenchymal tissue after allergen challenge to oppose airway narrowing and closure.

  8. Spirometry utilisation among Danish adults initiating medication targeting obstructive lung disease.

    Science.gov (United States)

    Koefoed, Mette Marie

    2015-02-01

    This PhD thesis was written during my employment at the Research Unit of General Practice in Odense, University of Southern Denmark. It comprises an overview and three papers, all published or submitted for publication in international peer-reviewed scientific journals.   Non-infectious dyspnoea, chronic cough and wheezing are common symptoms in the population. Patients often present with these symptoms in general practice and have a high probability of having obstructive lung diseases. However, there is an indication that the majority of these patients are treated empirically with pharmacotherapy targeting obstructive lung disease and only few have additional tests conducted, although the predictive value of respiratory symptoms for diagnosing obstructive lung disease has proven to be low. Spirometry is recommended as the gold standard for confirming obstructive lung disease, and testing can also rule out airway obstruction in patients with respiratory symptoms caused by other illnesses, such as heart failure or lung cancer. Initiating medication for obstructive lung disease without spirometry entails the risk of these patients experiencing unnecessary delay in the diagnostic process and being exposed to unnecessary economic costs and medication risks. The literature has indicated that many users of medication targeting obstructive lung medication have not had spirometry performed and do not actually have obstructive lung disease. This potential quality gap needs to be assessed. Also, in order to target interventions enhancing earlier spirometry utilisation among patients initiating medication targeting obstructive lung disease, improved knowledge on patient and practice factors associated with spirometry testing is needed.   Among first time users of obstructive lung medication we aimed: - To assess to what extent spirometry was performed within the first year of medication use (Study I) - To assess if patient characteristics like socioeconomic and demographic

  9. The reliability and utility of spirometry performed on people with asthma in community pharmacies.

    Science.gov (United States)

    Lei Burton, Deborah; LeMay, Kate S; Saini, Bandana; Smith, Lorraine; Bosnic-Anticevich, Sinthia; Southwell, Phillipa; Cooke, Julie; Emmerton, Lynne; Stewart, Kay; Krass, Ines; Reddel, Helen; Armour, Carol

    2015-01-01

    To investigate the reliability and the utility of spirometry generated by community pharmacists participating in two large asthma intervention trials of 892 people. The Pharmacy Asthma Care Program (PACP) and the Pharmacy Asthma Management Service (PAMS) involved up to four visits to the pharmacy over 6 months for counseling and goal setting. Pharmacists performed spirometry according to ATS/ERS guidelines to inform management. The proportion of A-E, F quality tests, as per EasyOne QC grades, were recorded. Lung function results between visits and for participants referred/not referred to their general practitioner on the basis of spirometry were compared. Complete data from 2593 spirometry sessions were recorded, 68.5% of spirometry sessions achieved three acceptable tests with between-test repeatability of 150 ml or less (A or B quality), 96% of spirometry sessions included at least one test that met ATS/ERS acceptability criteria. About 39.1% of participants had FEV1/FVC values below the lower limit of normal (LNN), indicating a respiratory obstruction. As a result of the service, there was a significant increase in FEV1 and FEV1/FVC and asthma control. Lung function values were significantly poorer for participants referred to their general practitioner, compared with those not referred, on the basis of spirometry. Community pharmacists are able to reliably achieve spirometry results meeting ATS/ERS guidelines in people with asthma. Significant improvements in airway obstruction were demonstrated with the pharmacy services. Pharmacists interpreted lung function results to identify airway obstruction for referral, making this a useful technique for review of people with asthma in the community.

  10. Official American Thoracic Society technical standards: spirometry in the occupational setting.

    Science.gov (United States)

    Redlich, Carrie A; Tarlo, Susan M; Hankinson, John L; Townsend, Mary C; Eschenbacher, William L; Von Essen, Susanna G; Sigsgaard, Torben; Weissman, David N

    2014-04-15

    This document addresses aspects of the performance and interpretation of spirometry that are particularly important in the workplace, where inhalation exposures can affect lung function and cause or exacerbate lung diseases, such as asthma, chronic obstructive pulmonary disease, or fibrosis. Issues that previous American Thoracic Society spirometry statements did not adequately address with respect to the workplace were identified for systematic review. Medline 1950-2012 and Embase 1980-2012 were searched for evidence related to the following: training for spirometry technicians; testing posture; appropriate reference values to use for Asians in North America; and interpretative strategies for analyzing longitudinal change in lung function. The evidence was reviewed and technical recommendations were developed. Spirometry performed in the work setting should be part of a comprehensive workplace respiratory health program. Effective technician training and feedback can improve the quality of spirometry testing. Posture-related changes in FEV1 and FVC, although small, may impact interpretation, so testing posture should be kept consistent and documented on repeat testing. Until North American Asian-specific equations are developed, applying a correction factor of 0.88 to white reference values is considered reasonable when testing Asian American individuals in North America. Current spirometry should be compared with previous tests. Excessive loss in FEV1 over time should be evaluated using either a percentage decline (15% plus loss expected due to aging) or one of the other approaches discussed, taking into consideration testing variability, worker exposures, symptoms, and other clinical information. Important aspects of workplace spirometry are discussed and recommendations are provided for the performance and interpretation of workplace spirometry.

  11. Use of spirometry in detecting airway obstruction in asymptomatic smokers

    International Nuclear Information System (INIS)

    Bangash, M.H.; Zaidi, S.B.H.; Zaidi, S.M.A.; Khan, I.

    2010-01-01

    Objectives: To detect spirometric abnormalities in asymptomatic smokers in relation to duration of smoking. Study Design: Cross sectional study. Place and Duration of Study: The study was carried out at PNS Shifa from Oct 2006 to June 2007. Subjects and Methods: Hundred individuals were included in this study who fulfilled the required criteria. Spirometry was done after briefing the patient about the procedure. Smokers were divided into two groups. Group I (5 to 9 pack years) and group II (= 10 pack years). All relevant information were recorded on Performa (Annex-A). The data was analyzed through SPSS-10, in terms of Mean +- SD (Standard Deviation) for numeric response variables and independent sample T test was applied to compare significance of proportion for numeric response variables at p < 0.05. Categorical variables were compared by applying Chi-square test at p < 0.05 level of significance. Results: Significant statistical difference was found between the mean age in the two groups with p-value of 0.011. This may be due to the longer duration of smoking history in Group II. Strong association was found between number of cigarette smoked and the pattern of airway obstruction as significant statistical difference of airway obstruction and early airflow limitation was found between the two groups of smokers at p value of 0.004. Conclusion: There is strong association between duration of smoking and development of airway obstruction even before the smoker become symptomatic. (author)

  12. Correlation between spirometry values and pulmonary artery pressure in young healthy subjects.

    Science.gov (United States)

    Grossman, Alon; Benderly, Michal; Prokupetz, Alex; Gordon, Barak; Kalter-Leibovici, Ofra

    2014-03-01

    Pulmonary hypertension is frequently associated with parenchymal lung disease. We evaluated the association between spirometry values and pulmonary artery systolic pressure (PASP) in young subjects without lung disease : We studied applicants to the Israeli Air Force, who undergo routine evaluation that includes resting spirometry and echocardiography. Applicants with overt lung disease were excluded. All echocardiographic studies performed in the years 1994 through 2010 (n = 6,598) were screened, and files that included PASP and spirometry values were analyzed for the association between PASP and FVC, FEV1, FEV1/FVC, peak expiratory flow, and forced expiratory flow during the middle half of the FVC maneuver. Of the 647 air force applicants who underwent echocardiography in which PASP was measurable and had spirometry data, 607 (94%) were male, and their average age was 18.16 ± 0.73 years. Mean PASP was 26.4 ± 5.2 mm Hg (range 10-41 mm Hg). None of the spirometry values significantly correlated with PASP. PASP in young healthy subjects is not significantly associated with spirometry values. Lung mechanics probably do not contribute significantly to PASP in this population.

  13. Impulse Oscillometry and Spirometry Small-Airway Parameters in Mild to Moderate Bronchiectasis.

    Science.gov (United States)

    Guan, Wei-Jie; Yuan, Jing-Jing; Gao, Yong-Hua; Li, Hui-Min; Zheng, Jin-Ping; Chen, Rong-Chang; Zhong, Nan-Shan

    2016-11-01

    Both impulse oscillometry and spirometry can reflect small-airway disorders. The objective of this work was to investigate the diagnostic value of impulse oscillometry and spirometry small-airway parameters and their correlation with radiology, disease severity, and sputum bacteriology in mild to moderate bronchiectasis (bronchiectasis severity index spirometry, and sputum culture were performed. Correlation between small-airway parameters and clinical indices was determined, adjusting for age, sex, body mass index, and smoking history. Sensitivity analyses were repeated when excluding subjects with bronchiectasis severity index ≥9 or HRCT score ≥13. Impulse oscillometry and spirometry small-airway parameters could discriminate mild to moderate bronchiectasis from healthy subjects and correlated significantly with HRCT score and the number of bronchiectatic lobes and the bronchiectasis severity index (all P Spirometry, but not impulse oscillometry, small-airway parameters differed statistically between subjects with isolated peripheral-airway bronchiectasis and those with peripheral plus central-airway bronchiectasis (all P spirometry small-airway parameters have similar diagnostic value in reflecting peripheral-airway disorders and correlate with the HRCT scores, the bronchiectasis severity index, and the number of bronchiectatic lobes in mild to moderate bronchiectasis. Assessment of small-airway parameters should be incorporated in future lung function investigations in bronchiectasis. Copyright © 2016 by Daedalus Enterprises.

  14. Spirometry reference equations for central European populations from school age to old age.

    Directory of Open Access Journals (Sweden)

    Mascha K Rochat

    Full Text Available BACKGROUND: Spirometry reference values are important for the interpretation of spirometry results. Reference values should be updated regularly, derived from a population as similar to the population for which they are to be used and span across all ages. Such spirometry reference equations are currently lacking for central European populations. OBJECTIVE: To develop spirometry reference equations for central European populations between 8 and 90 years of age. MATERIALS: We used data collected between January 1993 and December 2010 from a central European population. The data was modelled using "Generalized Additive Models for Location, Scale and Shape" (GAMLSS. RESULTS: The spirometry reference equations were derived from 118'891 individuals consisting of 60'624 (51% females and 58'267 (49% males. Altogether, there were 18'211 (15.3% children under the age of 18 years. CONCLUSION: We developed spirometry reference equations for a central European population between 8 and 90 years of age that can be implemented in a wide range of clinical settings.

  15. Airway reactivity in chronic obstructive pulmonary disease. Failure of in vivo methacholine responsiveness to correlate with cholinergic, adrenergic, or nonadrenergic responses in vitro.

    Science.gov (United States)

    Taylor, S M; Paré, P D; Armour, C L; Hogg, J C; Schellenberg, R R

    1985-07-01

    This study aimed to determine whether in vivo airways hyperreactivity was manifested by either enhanced bronchial smooth muscle responses to contractile stimuli or by deficient responses to relaxant stimuli in vitro. Quantitative responses to nebulized methacholine were obtained in 12 human subjects prior to pulmonary resection. The provocative concentration of methacholine producing a 20% reduction in FEV1 (PC20) was calculated, and these values were compared with in vitro responses of bronchial smooth muscle strips from the surgical specimens. Both contractile cholinergic responses and relaxant nonadrenergic noncholinergic dose-response data were obtained for the in vitro bronchial specimens by electrical field stimulation. In addition, cumulative dose responses were obtained to exogenously added methacholine, the beta-adrenergic agonist salbutamol, and the adenylate cyclase activator forskolin. Despite a wide range of PC20 values, the in vivo airway responsiveness did not correlate with any of the in vitro responses examined, suggesting that airway reactivity is not due solely to the responsiveness of smooth muscle to contractile agonists nor to a localized deficiency in the nonadrenergic inhibitory system, beta-adrenergic inhibition, or abnormal cyclic-AMP-mediated pathways of relaxation.

  16. Longitudinal spirometry among patients in a treatment program for community members with World Trade Center (WTC)-related illness

    Science.gov (United States)

    Liu, Mengling; Qian, Meng; Cheng, Qinyi; Berger, Kenneth I.; Shao, Yongzhao; Turetz, Meredith; Kazeros, Angeliki; Parsia, Sam; Goldring, Roberta M.; Fernandez-Beros, Maria Elena; Marmor, Michael; Reibman, Joan

    2013-01-01

    Objective The course of lung function in community members exposed to World Trade Center (WTC) dust and fumes remains undefined. We studied longitudinal spirometry among patients in the WTC Environmental Health Center (WTCEHC) treatment program. Methods Observational study of 946 WTCEHC patients with repeated spirometry measures analyzed on the population as a whole and stratified by smoking status, initial spirometry pattern and WTC-related exposure category. Results Improvement in forced expiratory volume (FVC; 54.4 ml/year; 95% CI: 45.0-63.8) and forced expiratory volume in one second (FEV1; 36.8 ml/year; 95% CI: 29.3-44.3) was noted for the population as a whole. Heavy smokers did not improve. Spirometry changes differed depending on initial spirometry pattern and exposure category. Conclusions These data demonstrate spirometry improvement in select populations suggesting reversibility in airway injury and reinforcing the importance of continued treatment. PMID:22995806

  17. Influence of socioeconomic and demographic status on spirometry testing in patients initiating medication targeting obstructive lung disease

    DEFF Research Database (Denmark)

    Koefoed, Mette M; Søndergaard, Jens; Christensen, René Depont

    2013-01-01

    a possible association between education, income, labour market affiliation, cohabitation status and having spirometry performed when initiating medication targeting obstructive pulmonary disease. METHODS: We conducted a population-based cohort study. Danish national registers were linked, retrieving data...... on prescriptions, spirometry testing, socioeconomic and demographic variables in all first time users of medication targeting obstructive lung disease in 2008. RESULTS: A total of 37,734 persons were included and approximately half of the cohort had spirometry performed. Among medication users under 65 years...... spirometry performed among men (OR = 0.78, CI = 0.69-0.88). CONCLUSION: Social inequity in spirometry testing among patients initiating medication targeting obstructive lung disease was confirmed in this study. Increased focus on spirometry testing among elderly men living alone, among the unemployed...

  18. Effectiveness of the Spirometry 360 Quality Improvement Program for Improving Asthma Care: A Cluster Randomized Trial.

    Science.gov (United States)

    Mangione-Smith, Rita; Zhou, Chuan; Corwin, Michael J; Taylor, James A; Rice, Fiona; Stout, James W

    To determine the effectiveness of the Spirometry 360 distance learning quality improvement (QI) program for enhancing the processes and outcomes of care for children with asthma. Cluster randomized controlled trial involving 25 matched pairs of pediatric primary care practices. Practices were recruited from 2 practice-based research networks: the Slone Center Office-based Research Network at Boston University, Boston, Mass, and the Puget Sound Pediatric Research Network, Seattle, Wash. Study participants included providers from one of the 50 enrolled pediatric practices and 626 of their patients with asthma. Process measures assessed included spirometry test quality and appropriate prescription of asthma controller medications. Outcome measures included asthma-specific health-related quality of life, and outpatient, emergency department, and inpatient utilization for asthma. At baseline, 25.4% of spirometry tests performed in control practices and 50.4% of tests performed in intervention practices were of high quality. During the 6-month postintervention period, 28.7% of spirometry tests performed in control practices and 49.9% of tests performed in intervention practices were of high quality. The adjusted difference-of-differences analysis revealed no intervention effect on spirometry test quality. Adjusted differences-of-differences analysis also revealed no intervention effect on appropriate use of controller medications or any of the parent- or patient-reported outcomes examined. In this study, the Spirometry 360 distance learning QI program was ineffective in improving spirometry test quality or parent- or patient-reported outcomes. QI programs like the one assessed here may need to focus on practices with lower baseline performance levels or may need to be tailored for those with higher baseline performance. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  19. Spirometry is underused in the diagnosis and monitoring of patients with chronic obstructive pulmonary disease (COPD)

    Science.gov (United States)

    Yu, Wai Cho; Fu, Sau Nga; Tai, Emily Lai-bun; Yeung, Yiu Cheong; Kwong, Kwok Chu; Chang, Yui; Tam, Cheuk Ming; Yiu, Yuk Kwan

    2013-01-01

    Spirometry is important in the diagnosis and management of chronic obstructive pulmonary disease (COPD), yet it is a common clinical observation that it is underused though the extent is unclear. This survey aims to examine the use of spirometry in the diagnosis and management of COPD patients in a district in Hong Kong. It is a cross-sectional survey involving four clinic settings: hospital-based respiratory specialist clinic, hospital-based mixed medical specialist clinic, general outpatient clinic (primary care), and tuberculosis and chest clinic. Thirty physician-diagnosed COPD patients were randomly selected from each of the four clinic groups. All of them had a forced expiratory volume in 1 second (FEV1) to forced vital capacity ratio less than 0.70 and had been followed up at the participating clinic for at least 6 months for COPD treatment. Of 126 patients who underwent spirometry, six (4.8%) did not have COPD. Of the 120 COPD patients, there were 111 males and mean post-bronchodilator FEV1 was 46.2% predicted. Only 22 patients (18.3%) had spirometry done during diagnostic workup, and 64 patients (53.3%) had spirometry done ever. The only independent factor predicting spirometry done ever was absence of old pulmonary tuberculosis and follow-up at respiratory specialist clinic. Age, sex, smoking status, comorbidities, duration of COPD, percentage predicted FEV1, body mass index, 6-minute walking distance, and Medical Research Council dyspnea score were not predictive. We conclude that spirometry is underused in general but especially by nonrespiratory physicians and family physicians in the management of COPD patients. More effort at educating the medical community is urgently needed. PMID:24009418

  20. Feasibility of spirometry in primary care to screen for COPD: a pilot study.

    Science.gov (United States)

    Giraud, Violaine; Beauchet, Alain; Gomis, Thierry; Chinet, Thierry

    2016-01-01

    COPD is a frequent but underdiagnosed disease whose diagnosis relies on the spirometric demonstration of bronchial obstruction. Spirometry use by general practitioners could represent the first line in COPD diagnosis. Because duration of spirometry is retarding its development in primary care, we decided to measure the time it requires in the primary-care context in France. Ten volunteer general practitioners were trained during two 3-hour theoretical and practical continuing education sessions. Then, from October 2013 to May 2014, they included patients without any known respiratory disease but at risk of developing COPD (age: ≥40 years, smoker: ≥20 pack-years). The duration of spirometry and its quality were evaluated according to the following acceptability criteria: 1) expiration ≥6 seconds or reaching a plateau; 2) good start with an early peak flow, curve peaked on top and not flat; 3) no artifacts; and 4) reproducibility criteria, ie, forced expiratory volume in 1 second and forced vital capacity differences between the two best spirometry curves ≤0.15 L. Quality of the spirograms was defined as optimal when all the criteria were met and acceptable when all the criteria were satisfied except the reproducibility criterion, otherwise, it was unacceptable. For the 152 patients included, the 142 assessable spirometries lasted for 15.2±5.9 minutes. Acceptability criteria 1-3, respectively, were satisfied for 90.1%, 89.4%, and 91.5% of patients and reproducibility criterion 4 for 56.3%. Quality was considered optimal for 58.5% of the curves and acceptable for 30.2%. The duration of spirometry renders it poorly compatible with the current primary-care practice in France other than for dedicated consultations. Moreover, the quality of spirometry needs to be improved.

  1. Spirometry-related pain and distress in adolescents and young adults with cystic fibrosis: the role of acceptance.

    Science.gov (United States)

    Casier, Annabelle; Goubert, Liesbet; Vervoort, Tine; Theunis, Marleen; Huse, Danielle; De Baets, Frans; Matthys, Dirk; Crombez, Geert

    2013-01-01

    To investigate the occurrence of spirometry-related pain and distress in adolescents and young adults with cystic fibrosis (CF), and to investigate the role of acceptance of illness in spirometry-related pain and distress. A total of 36 adolescents and young adults with CF (12 to 22 years of age) completed a questionnaire assessing acceptance of illness. Spirometry-related distress was assessed using self-report (ie, anxiety⁄worry about the procedure) and physiological outcomes (ie, heart rate and heart rate variability) before spirometry. Spirometry-related pain was assessed using self-report (ie, expected pain and pain-related thoughts). Self-reported distress and pain during spirometry were also assessed. Eighty-nine per cent of subjects reported distress before spirometry, 67% experienced distress during spirometry, 28% expected pain during spirometry and 22% actually experienced pain. Interestingly, partial correlations revealed that more acceptance was related to less expected pain and pain-related thoughts. Acceptance, however, was unrelated to distress, anxiety and pain during spirometry. The present study suggests that a non-negligible number of adolescents and young adults with CF experience pain and distress during spirometry. Furthermore, results indicate that acceptance may play a protective role in the more indirect consequences of CF such as expected pain and pain-related thoughts during medical procedures. Acceptance, however, was not related to distress before and during spirometry, nor to experienced pain. These findings contribute to the increasing evidence that acceptance may play a protective role in managing the consequences of living with CF.

  2. A clinical study of COPD severity assessment by primary care physicians and their patients compared with spirometry.

    Science.gov (United States)

    Mapel, Douglas W; Dalal, Anand A; Johnson, Phaedra; Becker, Laura; Hunter, Alyssa Goolsby

    2015-06-01

    Primary care physicians often do not use spirometry to confirm the diagnosis of chronic obstructive pulmonary disease. This project was designed to see how well physicians' impressions about their patients' chronic obstructive pulmonary disease severity correlate with the severity of airflow obstruction measured by spirometry and to assess whether spirometry results subsequently changed the physicians' opinions about chronic obstructive pulmonary disease severity and treatment. We performed a multicenter, cross-sectional, observational study conducted in 83 primary care clinics from across the United States. A total of 899 patients with a clinical diagnosis of chronic obstructive pulmonary disease completed a questionnaire and spirometry testing. Physicians completed a questionnaire and case report forms. Concordance among physician ratings, patient ratings, and spirometry results was evaluated. Physicians' chronic obstructive pulmonary disease severity ratings before spirometry were accurate for only 30% of patients with evaluable spirometry results, and disease severity in 41% of patients was underestimated. Physicians also underestimated severity compared with patients' self-assessment among 42% of those with evaluable results. After spirometry, physicians changed their opinions on the severity for 30% of patients and recommended treatment changes for 37%. Only 75% of patients performed at least 1 high-quality spirometry test; however, the physicians' opinions and treatment decisions were similar regardless of suboptimal test results. Without performing spirometry, physicians are likely to underestimate their patients' chronic obstructive pulmonary disease severity or inadequately characterize their patients' lung disease. Spirometry changed the physicians' clinical impressions and treatments for approximately one third of these patients; thus, spirometry is a valuable tool for chronic obstructive pulmonary disease management in primary care. Copyright © 2015

  3. Choosing wisely: adherence by physicians to recommended use of spirometry in the diagnosis and management of adult asthma.

    Science.gov (United States)

    Sokol, Kristin C; Sharma, Gulshan; Lin, Yu-Li; Goldblum, Randall M

    2015-05-01

    The National Asthma Education and Prevention Program (NAEPP) and the American Thoracic Society provide guidelines stating that physicians should use spirometry in the diagnosis and management of asthma. The aim of this study was to evaluate the trends, over a 10-year period, in the utilization of spirometry in patients newly diagnosed with asthma. We hypothesized that spirometry use would increase in physicians who care for asthma patients, especially since 2007, when the revised NAEPP guidelines were published. This retrospective cohort analysis of spirometry use in subjects newly diagnosed with asthma used a privately insured adult population for the years 2002-2011. Our primary outcome of interest was spirometry performed within a year (± 365 days) of the initial date of asthma diagnosis. We also examined the type of asthma medications prescribed. In all, 134,208 patients were found to have a diagnosis of asthma. Only 47.6% had spirometry performed within 1 year of diagnosis. Younger patients, males, and those residing in the Northeast were more likely to receive spirometry. Spirometry use began to decline in 2007. Patients cared for by specialists were more likely to receive spirometry than those cared for by primary care physicians; 80.1% vs 23.3%, respectively. Lastly, even without spirometry, a significant portion of patients (78.3%) was prescribed asthma drugs. Our study suggests that spirometry is underutilized in newly diagnosed asthma patients. Moreover, the use of controller medications in those diagnosed with asthma without spirometry remains high. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. The effect of medical clowns on performance of spirometry among preschool aged children.

    Science.gov (United States)

    Nir, Vered; Schichter-Konfino, Vered; Kassem, Eias; Klein, Adi

    2018-04-02

    Medical clowns (MCs) are known to assist in reducing pain and alleviating anxiety. The objective of this study is to evaluate the ability of MCs to assist preschoolers in performing spirometry. A prospective, randomized controlled trial. Children aged 3-6 years participated. After a first spirometry, children were divided into two groups: the first performed a second spirometry with an MC. The second repeated spirometry with the technician. Primary outcome was second spirometry values compared between the groups. Secondary outcome were change in spirometry values within groups, and difference between the groups. A total of 140 children participated. The groups did not differ in age, sex, mother tongue, or weight. Nor in mean FVC (MC 89.2% ± 16.7, control 89.5% ± 16.3) mean FEV1 (MC 91.3% ± 15.6, control 94.2% ± 16.8), and expiratory time (MC 1.58 ± 0.43, control 1.7 ± 0.44) in first spirometry. In second spirometry the control group had a similar FVC, FEV1, and expiratory time. The MC group had a significant improvement in all parameters: FVC: MC 95.3% ± 15.5, control 89.3% ± 19.1, FEV1: MC 98.0% ± 15.6, control 91.8% ± 19.3, and expiratory time MC 1.96 ± 0.55, control 1.84 ± 0.52. The differences between the groups between first and second attempt were significant (P-value FVC 0.000, FEV1 0.000, expiratory time 0.003). MCs improved performance of spirometry among preschoolers. It is possible that laughter and relief of stress had a physiological effect. Further studies are required to better establish the ability of MCs to improve active participation and to better understand whether the mechanism of the improvement is better cooperation or true physiological change. © 2018 Wiley Periodicals, Inc.

  5. The majority of participants with abnormal spirometry at walk-in consult their general practitioner as recommended.

    Science.gov (United States)

    Kølner-Augustson, Line; Thøgersen, Niels; Faaborg, Thea Heide; Weinreich, Ulla Møller

    2015-11-01

    A number of studies inviting citizens to perform spirometry without need for a previous appointment have been performed to determine the need for general screening of the population for chronic obstructive pulmonary disease (COPD). Yet, no studies have examined how many of the participants follow the advice given to consult their general practitioner (GP) afterwards. A walk-in spirometry was carried out on the island of Laesoe. All habitants above the age of 18 years were invited. In total, 142 were eligible for the study. Participants with an abnormal spirometry were recommended to consult their GP immediately, whereas smokers with symptoms, but with a normal spirometry, were recommended to consult their GP within a year for another spirometry. A follow-up was performed to investigate whether the participants had followed this advice. In total, 52% (74/142) of the participants were advised to contact their GP: 34 due to an abnormal spirometry and 40 due to smoking and respiratory symptoms. Among the participants with an abnormal spirometry, 79% saw their GP within three months, whereas 30% of the current smokers saw their GP within 9-15 months. Lung disease was diagnosed in 56% (19/34) of the participants who initially had an abnormal spirometry. Among the participants who had an abnormal spirometry at screening, 79% consulted their GP as recommended. Furthermore, 52% of the participants who had an abnormal spirometry were subsequently diagnosed with pulmonary disease by their GP. We conclude that walk-in spirometry is a useful tool for early diagnosis of COPD. none. not relevant.

  6. Accuracy of near-patient vs. inbuilt spirometry for monitoring tidal volumes in an in-vitro paediatric lung model.

    Science.gov (United States)

    Morgenroth, S; Thomas, J; Cannizzaro, V; Weiss, M; Schmidt, A R

    2018-03-01

    Spirometric monitoring provides precise measurement and delivery of tidal volumes within a narrow range, which is essential for lung-protective strategies that aim to reduce morbidity and mortality in mechanically-ventilated patients. Conventional anaesthesia ventilators include inbuilt spirometry to monitor inspiratory and expiratory tidal volumes. The GE Aisys CS 2 anaesthesia ventilator allows additional near-patient spirometry via a sensor interposed between the proximal end of the tracheal tube and the respiratory tubing. Near-patient and inbuilt spirometry of two different GE Aisys CS 2 anaesthesia ventilators were compared in an in-vitro study. Assessments were made of accuracy and variability in inspiratory and expiratory tidal volume measurements during ventilation of six simulated paediatric lung models using the ASL 5000 test lung. A total of 9240 breaths were recorded and analysed. Differences between inspiratory tidal volumes measured with near-patient and inbuilt spirometry were most significant in the newborn setting (p tidal volume measurements with near-patient spirometry were consistently more accurate than with inbuilt spirometry for all lung models (p tidal volumes decreased with increasing tidal volumes, and was smaller with near-patient than with inbuilt spirometry. The variability in measured tidal volumes was higher during expiration, especially with inbuilt spirometry. In conclusion, the present in-vitro study shows that measurements with near-patient spirometry are more accurate and less variable than with inbuilt spirometry. Differences between measurement methods were most significant in the smallest patients. We therefore recommend near-patient spirometry, especially for neonatal and paediatric patients. © 2018 The Association of Anaesthetists of Great Britain and Ireland.

  7. The impact of spirometry in the Ebeltoft Health Promotion Study (EHPS)

    DEFF Research Database (Denmark)

    Ørts, Lene Maria; Ottesen, Anders Løkke; Bjerregaard, Anne-Louise

    Background: It has been stressed that early detection of impaired lung function can be useful in prevention of lung diseases. It is unknown whether spirometry as an integrated part of preventive health checks including a questionnaire regarding risk factors and exposure, can be used for early...... detection of lung diseases.The aim of the study is to describe exposure characteristics and spirometry parameters 15 years ahead of a diagnosis of Chronic Obstructive Pulmonary Disease (COPD*)*Defined by FEV1/FVC ... (n=573), aged 30-49 years at baseline, attended in 1991 and 2006 a health check and a follow-up consultation at their own general practitioner. The characteristics of the citizens are described according to sex, age, smoking history, exposure, lung symptoms and spirometry values. Register information...

  8. The value of including spirometry in health checks - a randomized controlled study in primary health care

    DEFF Research Database (Denmark)

    Ørts, Lene Maria; Ottesen, Anders Løkke; Bjerregaard, Anne-Louise

    Background Lung diseases are among the most frequent and most serious ailments in Denmark. Preventive health checks including spirometry can be used to detect lung diseases earlier. Over time the attendance at preventive health checks has decreased and at present the response rate is approximately...... 50%. Little is known about initiatives that can influence the attendance rate. Objectives To examine whether focused information on spirometry in the invitation material will influence the attendance in preventive health checks. Materiel/Methods Design: A randomized controlled study on information...... on spirometry embedded in “Check your health Prevention Program, CHPP” from 2015-16. CHPP is a house-hold cluster randomized controlled trial offering a preventive health check to 30-49 year olds in a Danish municipality during the years 2012 through to 2017 (n= 26,216), carried out in collaboration between...

  9. Is preoperative spirometry a predictive marker for postoperative complications after colorectal cancer surgery?

    Science.gov (United States)

    Tajima, Yuki; Tsuruta, Masashi; Yahagi, Masashi; Hasegawa, Hirotoshi; Okabayashi, Koji; Shigeta, Kohei; Ishida, Takashi; Kitagawa, Yuko

    2017-09-01

    Spirometry is a basic test that provides much information about pulmonary function; it is performed preoperatively in almost all patients undergoing colorectal cancer (CRC) surgery in our hospital. However, the value of spirometry as a preoperative test for CRC surgery remains unknown. The aim of this study was to determine whether spirometry is useful to predict postoperative complications (PCs) after CRC surgery. The medical records of 1236 patients who had preoperative spirometry tests and underwent CRC surgery between 2005 and 2014 were reviewed. Preoperative spirometry results, such as forced vital capacity (FVC), one-second forced expiratory volume (FEV1), %VC (FVC/predicted VC) and FEV1/FVC (%FEV1), were analyzed with regard to PCs, including pneumonia. PCs were found in 383 (30.9%) patients, including 218 (56%) with surgical site infections, 67 (17%) with bowel obstruction, 62 (16%) with leakage and 20 (5.2%) with pneumonia. Of the spirometry results, %VC was correlated with PC according to logistic regression analysis (odds ratio, OR = 0.99, 95% confidence interval, CI = 0.98-0.99; P = 0.034). Multivariate analysis after adjusting for male sex, age, laparoscopic surgery, tumor location, operation time and blood loss showed that a lower %VC tends to be a risk factor for PC (OR = 0.99, 95% CI = 0.98-1.002; P = 0.159) and %VC was an independent risk factor for postoperative pneumonia in PCs (OR = 0.97, 95% CI = 0.94-0.99; P = 0.049). In CRC surgery, %VC may be a predictor of postoperative complications, especially pneumonia. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  10. Evaluation of the Global Lung Initiative 2012 Reference Values for Spirometry in African Children.

    Science.gov (United States)

    Arigliani, Michele; Canciani, Mario C; Mottini, Giovanni; Altomare, Michele; Magnolato, Andrea; Loa Clemente, Sofia Vanda; Tshilolo, Leon; Cogo, Paola; Quanjer, Philip H

    2017-01-15

    Despite the high burden of respiratory disease, no spirometry reference values for African children are available. Investigate whether the Global Lung Initiative (GLI-2012) reference values for spirometry are appropriate for children in sub-Saharan Africa and assess the impact of malnutrition on lung function. Anthropometry and spirometry were obtained in children aged 6 to 12 years from urban and semiurban schools in three African countries. Spirometry z-scores were derived using the GLI-2012 prediction equations for African Americans. Thinness (body mass index z-score Spirometry outcomes were compared with those of African American children from the third National Health and Nutrition Survey. Spirometry data were analyzed from 1,082 schoolchildren (51% boys) aged 6.0 to 12.8 years in Angola (n = 306), Democratic Republic of the Congo (n = 377), and Madagascar (n = 399). GLI-2012 provided a good fit with mean (SD) z-scores of -0.11 (0.83) for FEV 1 , -0.08 (0.86) for FVC, and -0.07 (0.83) for FEV 1 /FVC. Because of low scatter, the fifth centile corresponded to -1.3 z-scores in boys and -1.5 z-scores in girls. Malnourished African children had a normal FEV 1 /FVC ratio but significant reductions of ∼0.5 z-scores (∼5%) in FEV 1 and FVC compared with African American peers from the third National Health and Nutrition Survey. Children in Angola had the lowest, and those in Madagascar had the highest, zFEV 1 and zFVC. The results of this study support the use of GLI-2012 reference values for schoolchildren in sub-Saharan Africa. Malnutrition affects body growth, leading to a proportionately smaller FEV 1 and FVC without respiratory impairment, as shown by the normal FEV 1 /FVC ratio.

  11. Daily Home Spirometry: An Effective Tool for Detecting Progression in Idiopathic Pulmonary Fibrosis.

    Science.gov (United States)

    Russell, Anne-Marie; Adamali, Huzaifa; Molyneaux, Philip L; Lukey, Pauline T; Marshall, Richard P; Renzoni, Elisabetta A; Wells, Athol U; Maher, Toby M

    2016-10-15

    Recent clinical trial successes have created an urgent need for earlier and more sensitive endpoints of disease progression in idiopathic pulmonary fibrosis (IPF). Domiciliary spirometry permits more frequent measurement of FVC than does hospital-based assessment, which therefore affords the opportunity for a more granular insight into changes in IPF progression. To determine the feasibility and reliability of measuring daily FVC in individuals with IPF. Subjects with IPF were given handheld spirometers and instruction on how to self-administer spirometry. Subjects recorded daily FEV 1 and FVC for up to 490 days. Clinical assessment and hospital-based spirometry was undertaken at 6 and 12 months, and outcome data were collected for 3 years. Daily spirometry was recorded by 50 subjects for a median period of 279 days (range, 13-490 d). There were 18 deaths during the active study period. Home spirometry showed excellent correlation with hospital-obtained readings. The rate of decline in FVC was highly predictive of outcome and subsequent mortality when measured at 3 months (hazard ratio [HR], 1.040; 95% confidence interval [CI], 1.021-1.062; P ≤ 0.001), 6 months (HR, 1.024; 95% CI, 1.014-1.033; P spirometry in patients with IPF is highly clinically informative and is feasible to perform for most of these patients. The relationship between mortality and rate of change of FVC at 3 months suggests that daily FVC may be of value as a primary endpoint in short proof-of-concept IPF studies.

  12. Spirometry and Impulse Oscillometry in Preschool Children: Acceptability and Relationship to Maternal Smoking in Pregnancy.

    Science.gov (United States)

    Kattan, Meyer; Bacharier, Leonard B; O'Connor, George T; Cohen, Robyn; Sorkness, Ronald L; Morgan, Wayne; Gergen, Peter J; Jaffee, Katy F; Visness, Cynthia M; Wood, Robert A; Bloomberg, Gordon R; Doyle, Susan; Burton, Ryan; Gern, James E

    2018-02-13

    Comparisons of the technical acceptability of spirometry and impulse oscillometry (IOS) and clinical correlations of the measurements have not been well studied in young children. There are no large studies focused on African American and Hispanic children. We sought to (1) compare the acceptability of spirometry and IOS in 3- to 5-year-old children and (2) examine the relationship of maternal smoking during pregnancy to later lung function. Spirometry and IOS were attempted at 4 sites from the Urban Environmental and Childhood Asthma Study birth cohort at ages 3, 4, and 5 years (472, 471, and 479 children, respectively). We measured forced expiratory flow in 0.5 s (forced expiratory volume in 0.5 seconds [FEV 0.5 ]) with spirometry and area of reactance (A X ), resistance and reactance at 5 Hz (R 5 and X 5 , respectively) using IOS. Children were more likely to achieve acceptable maneuvers with spirometry than with IOS at age 3 (60% vs 46%, P < .001) and 5 years (89% vs 84%, P = .02). Performance was consistent among the 4 study sites. In children without recurrent wheeze, there were strong trends for higher FEV 0.5 and lower R 5 and A X over time. Maternal smoking during pregnancy was associated with higher A X at ages 4 and 5 years (P < .01 for both years). There was no significant difference in FEV 0.5 between children with and without in utero exposure to smoking. There is a higher rate of acceptable maneuvers with spirometry compared with IOS, but IOS may be a better indicator of peripheral airway function in preschool children. Copyright © 2018 American Academy of Allergy, Asthma & Immunology. All rights reserved.

  13. Active case finding strategy for chronic obstructive pulmonary disease with handheld spirometry.

    Science.gov (United States)

    Kim, Joo Kyung; Lee, Chang Min; Park, Ji Young; Kim, Joo Hee; Park, Sung-Hoon; Jang, Seung Hun; Jung, Ki-Suck; Yoo, Kwang Ha; Park, Yong Bum; Rhee, Chin Kook; Kim, Deog Kyeom; Hwang, Yong Il

    2016-12-01

    The early detection and diagnosis of chronic obstructive pulmonary disease (COPD) is critical to providing appropriate and timely treatment. We explored a new active case-finding strategy for COPD using handheld spirometry.We recruited subjects over 40 years of age with a smoking history of more than 10 pack-years who visited a primary clinic complaining of respiratory symptoms. A total of 190 of subjects were enrolled. Medical information was obtained from historical records and physical examination by general practitioners. All subjects had their pulmonary function evaluated using handheld spirometry with a COPD-6 device. Because forced expiratory volume in 6 seconds (FEV6) has been suggested as an alternative to FVC, we measured forced expiratory volume in 1 second (FEV1)/FEV6 for diagnosis of airflow limitation. All subjects were then referred to tertiary referral hospitals to complete a "Could it be COPD?" questionnaire, handheld spiromtery, and conventional spirometry. The results of each instrument were compared to evaluate the efficacy of both handheld spirometry and the questionnaire.COPD was newly diagnosed in 45 (23.7%) patients. According to our receiver-operating characteristic (ROC) curve analysis, sensitivity and specificity were maximal when the FEV1/FEV6 ratio was less than 77%. The area under the ROC curve was 0.759. The sensitivity, specificity, positive predictive value, and negative predictive value were 72.7%, 77.1%, 50%, and 90%, respectively. The area under the ROC curve of respiratory symptoms listed on the questionnaire ranged from 0.5 to 0.65, which indicates that there is almost no difference compared with the results of handheld spirometry.The present study demonstrated the efficacy of handheld spirometry as an active case-finding tool for COPD in a primary clinical setting. This study suggested that physicians should recommend handheld spirometry for people over the age of 40, who have a smoking history of more than 10 pack

  14. The objective evaluation of obstructive pulmonary diseases with spirometry

    Directory of Open Access Journals (Sweden)

    Özkaya S

    2016-08-01

    was defined as the undifferentiated obstruction (UNDO group. Number and percentage distribution of patients by groups were 58 (24.7% in the asthma group, 70 (29.8% in the ACOS group, 61 (26% in the chronic bronchitis group, 32 (13.6% in the emphysema group, and 14 (6% in the UNDO group. In conclusion, in our study, the types of obstructive airway diseases could be classified based on clinical, radiological, and pulmonary function test findings into five groups, including asthma, ACOS, chronic bronchitis, emphysema, and both asthma and chronic bronchitis in association with underlying emphysema (emphysema with chronic bronchitis and emphysema with asthma or the so-called undifferentiated obstruction. We suggest that these patient groups can be determined more accurately by studies that evaluate the association between spirometric FEV1, FEV1/FVC values, and reversibility ratios. Keywords: asthma, COPD, asthma–COPD overlap syndrome, reversibility, spirometry

  15. Differences in the use of spirometry between rural and urban primary care centers in Spain

    Directory of Open Access Journals (Sweden)

    Márquez-Martín E

    2015-08-01

    Full Text Available Eduardo Márquez-Martín,1 Joan B Soriano,2 Myriam Calle Rubio,3 Jose Luis Lopez-Campos1,4 On behalf of the 3E project 1Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, 2Instituto de Investigación Hospital Universitario de la Princesa (IISP, Universidad Autónoma de Madrid, Cátedra UAM-Linde, 3Servicio de Neumología, Hospital Universitario Clínico San Carlos, 4Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES, Instituto de Salud Carlos III, Madrid, Spain Objectives: The aim of this study is to evaluate the ability and practice of spirometry, training of technicians, and spirometry features in primary care centers in Spain, evaluating those located in a rural environment against those in urban areas.Methods: An observational cross-sectional study was conducted in 2012 by a telephone survey in 970 primary health care centers in Spain. The centers were divided into rural or urban depending on the catchment population. The survey contacted technicians in charge of spirometry and consisted of 36 questions related to the test that included the following topics: center resources, training doctors and technicians, using the spirometer, bronchodilator test, and the availability of spirometry and maintenance.Results: Although the sample size was achieved in both settings, rural centers (RCs gave a lower response rate than urban centers (UCs. The number of centers without spirometry in rural areas doubled those in the urban areas. Most centers had between one and two spirometers. However, the number of spirometry tests per week was significantly lower in RCs than in UCs (4 [4.1%] vs 6.9 [5.7%], P<0.01. The availability of a specific schedule for conducting spirometries was higher in RCs than in UCs (209 [73.0%] vs 207 [64.2%], P=0.003. RCs were more satisfied with the spirometries (7.8 vs 7.6, P

  16. Acute effects of volume-oriented incentive spirometry on chest wall volumes in patients after a stroke.

    Science.gov (United States)

    Lima, Illia Ndf; Fregonezi, Guilherme Af; Melo, Rodrigo; Cabral, Elis Ea; Aliverti, Andrea; Campos, Tânia F; Ferreira, Gardênia Mh

    2014-07-01

    The aim of the present study was to assess how volume-oriented incentive spirometry applied to patients after a stroke modifies the total and compartmental chest wall volume variations, including both the right and left hemithoraces, compared with controls. Twenty poststroke patients and 20 age-matched healthy subjects were studied by optoelectronic plethysmography during spontaneous quiet breathing (QB), during incentive spirometry, and during the recovery period after incentive spirometry. Incentive spirometry was associated with an increased chest wall volume measured at the pulmonary rib cage, abdominal rib cage and abdominal compartment (P = .001) and under 3 conditions (P spirometry, and postincentive spirometry, respectively. Under all 3 conditions, the contribution of the abdominal compartment to VT was greater in the stroke subjects (54.1, 43.2, and 48.9%) than in the control subjects (43.7, 40.8, and 46.1%, P = .039). In the vast majority of subjects (13/20 and 18/20 during QB and incentive spirometry, respectively), abdominal expansion precedes rib cage expansion during inspiration. Greater asymmetry between the right and left hemithoracic expansions occurred in stroke subjects compared with control subjects, but it decreased during QB (62.5%, P = .002), during incentive spirometry (19.7%), and postincentive spirometry (67.6%, P = .14). Incentive spirometry promotes increased expansion in all compartments of the chest wall and reduces asymmetric expansion between the right and left parts of the pulmonary rib cage; therefore, it should be considered as a tool for rehabilitation. Copyright © 2014 by Daedalus Enterprises.

  17. Semiautomatic assessment of respiratory motion in dynamic MRI. Comparison with simultaneously acquired spirometry

    Energy Technology Data Exchange (ETDEWEB)

    Tetzlaff, R.; Eichinger, M.; Puderbach, M. [Radiologie, Deutsches Krebsforschungszentrum, Heidelberg (Germany); Schoebinger, M.; Meinzer, H.P. [Medizinische und Biologische Informatik, Deutsches Krebsforschungszentrum, Heidelberg (Germany); Kauczor, H.U. [Diagnostische Radiologie, Radiologische Universitaetsklinik, Heidelberg (Germany)

    2008-11-15

    Purpose: supplementing global spirometry with regional information could allow for earlier and more specific diagnosis of lung disease. Dynamic magnetic resonance imaging (dMRI) makes it possible to derive functional parameters from the visualization of the pulmonary motion of single lungs. The aim of this study was to compare high temporal resolution measurements of left and right thoracic diameters to simultaneously acquired spirometry. Materials and methods: 10 healthy volunteers underwent 2-dimensional dMRI of both lungs at 1.5 T. Spirometry was performed simultaneously with an MRI-compatible spirometer. Thoracic diameters were measured semiautomatically and compared to simultaneously measured spirometric volumes. A dMRI surrogate for the Tiffeneau Index was compared to the spirometric Tiffeneau. Results: The volume-time and flow-volume curves from dMRI were very similar to the spirometric curves. The semiautomatically measured diameters correlated well with the spirometric volumes (r > = 0.8, p < 10-15). Agreement between the methods at full temporal resolution was not as convincing (width of 95% limits of agreement interval up to 56%). Good agreement was found between the Tiffenau surrogate and spirometry (width of 95% limits of agreement interval of 14.5%). (orig.)

  18. The Vital Capacity Is Vital: Epidemiology and Clinical Significance of the Restrictive Spirometry Pattern.

    Science.gov (United States)

    Godfrey, Mark S; Jankowich, Matthew D

    2016-01-01

    Epidemiologic research has revealed a substantial portion of the general population with abnormal spirometry results that are characterized by decreased FEV1 and FVC but a preserved FEV1/FVC ratio. This restrictive spirometry pattern (RSP) is inconsistently defined in the literature and not well addressed by current guidelines; there is an accumulating body of evidence, however, that RSP is prevalent to a similar degree as airflow obstruction. Genetic and other risk factors for RSP, such as inhalational injuries and early life exposures, continue to be actively described. Although it seems that RSP is closely associated with the metabolic syndrome, diabetes, and systemic inflammation, it is not a simple marker of obesity. RSP is associated with adverse cardiovascular outcomes, as well as mortality, and it may be an underappreciated cause of functional impairments and respiratory symptoms. Improvement in outcomes in this population will require that clinicians have an appreciation for the significance of this spirometry pattern; additional research into the clinical and radiologic phenotype of these subjects is also needed. This article provides an overview of the recent developments in our understanding of this prevalent and highly morbid spirometry pattern. Published by Elsevier Inc.

  19. General practitioners' needs for ongoing support for the interpretation of spirometry tests.

    NARCIS (Netherlands)

    Poels, P.J.P.; Schermer, T.R.J.; Akkermans, R.P.; Jacobs, A.; Bogart-Jansen, M.; Bottema, B.J.A.M.; Weel, C. van

    2007-01-01

    BACKGROUND: Although one out of three general practitioners (GPs) carries out spirometry, the diagnostic interpretation of spirometric test results appears to be a common barrier for GPs towards its routine application. METHODS: Multivariate cross-sectional analysis of a questionnaire survey among

  20. Integration of electronic nose technology with spirometry: validation of a new approach for exhaled breath analysis

    NARCIS (Netherlands)

    de Vries, R.; Brinkman, P.; van der Schee, M. P.; Fens, N.; Dijkers, E.; Bootsma, S. K.; de Jongh, F. H. C.; Sterk, P. J.

    2015-01-01

    New 'omics'-technologies have the potential to better define airway disease in terms of pathophysiological and clinical phenotyping. The integration of electronic nose (eNose) technology with existing diagnostic tests, such as routine spirometry, can bring this technology to 'point-of-care'. We

  1. Should the diagnosis of COPD be based on a single spirometry test?

    NARCIS (Netherlands)

    Schermer, T.R.; Robberts, B.; Crockett, A.J.; Thoonen, B.P.; Lucas, A.; Grootens, J.; Smeele, I.J.; Thamrin, C.; Reddel, H.K.

    2016-01-01

    Clinical guidelines indicate that a chronic obstructive pulmonary disease (COPD) diagnosis is made from a single spirometry test. However, long-term stability of diagnosis based on forced expiratory volume in 1 s over forced vital capacity (FEV1/FVC) ratio has not been reported. In primary care

  2. Spirometry utilization among Danish adults initiating medication targeting obstructive lung disease

    DEFF Research Database (Denmark)

    Koefoed, Mette

    2013-01-01

    litteraturen, at mange af disse patienter får medicinsk behandling for deres symptomer uden yderligere undersøgelser, selvom symptomer og klinisk undersøgelse ikke med tilstrækkelig sikkerhed kan prædiktere, hvem der har astma og eller KOL. Spirometri er anbefalet som Gold Standard for at bekræfte eller...... den diagnostiske proces og at blive udsat for unødig medicinsk behandling. Litteraturen tyder på, at mange medicinbrugere ikke bliver undersøgt med spirometri og muligvis ikke har obstruktive lungelidelser. Dette kvalitetsproblem bør afdækkes, og associationer med manglende spirometri i denne gruppe...... bør klarlægges, så interventioner kan målrettes. Formål: Blandt nye brugere af obstruktiv lungemedicin var formålet at: • Afdække i hvor høj grad spirometri var udført indenfor det første år, efter at medicineringen var påbegyndt • Afdække om patientkarakteristika såsom socioøkonomisk og demografisk...

  3. Semiautomatic assessment of respiratory motion in dynamic MRI. Comparison with simultaneously acquired spirometry

    International Nuclear Information System (INIS)

    Tetzlaff, R.; Eichinger, M.; Puderbach, M.; Schoebinger, M.; Meinzer, H.P.; Kauczor, H.U.

    2008-01-01

    Purpose: supplementing global spirometry with regional information could allow for earlier and more specific diagnosis of lung disease. Dynamic magnetic resonance imaging (dMRI) makes it possible to derive functional parameters from the visualization of the pulmonary motion of single lungs. The aim of this study was to compare high temporal resolution measurements of left and right thoracic diameters to simultaneously acquired spirometry. Materials and methods: 10 healthy volunteers underwent 2-dimensional dMRI of both lungs at 1.5 T. Spirometry was performed simultaneously with an MRI-compatible spirometer. Thoracic diameters were measured semiautomatically and compared to simultaneously measured spirometric volumes. A dMRI surrogate for the Tiffeneau Index was compared to the spirometric Tiffeneau. Results: The volume-time and flow-volume curves from dMRI were very similar to the spirometric curves. The semiautomatically measured diameters correlated well with the spirometric volumes (r > = 0.8, p < 10-15). Agreement between the methods at full temporal resolution was not as convincing (width of 95% limits of agreement interval up to 56%). Good agreement was found between the Tiffenau surrogate and spirometry (width of 95% limits of agreement interval of 14.5%). (orig.)

  4. A new spirometry-based algorithm to predict occupational pulmonary restrictive impairment.

    Science.gov (United States)

    De Matteis, S; Iridoy-Zulet, A A; Aaron, S; Swann, A; Cullinan, P

    2016-01-01

    Spirometry is often included in workplace-based respiratory surveillance programmes but its performance in the identification of restrictive lung disease is poor, especially when the prevalence of this condition is low in the tested population. To improve the specificity (Sp) and positive predictive value (PPV) of current spirometry-based algorithms in the diagnosis of restrictive pulmonary impairment in the workplace and to reduce the proportion of false positives findings and, as a result, unnecessary referrals for lung volume measurements. We re-analysed two studies of hospital patients, respectively used to derive and validate a recommended spirometry-based algorithm [forced vital capacity (FVC) 55%] for the recognition of restrictive pulmonary impairment. We used true lung restrictive cases as a reference standard in 2×2 contingency tables to estimate sensitivity (Sn), Sp and PPV and negative predictive values for each diagnostic cut-off. We simulated a working population aged spirometry-based algorithm may be adopted to accurately exclude pulmonary restriction and to possibly reduce unnecessary lung volume testing in an occupational health setting. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Is Home Spirometry Useful in Diagnosing Asthma in Children With Nonspecific Respiratory Symptoms?

    NARCIS (Netherlands)

    Brouwer, Alwin F. J.; Visser, Chantal A. N.; Duiverman, Eric J.; Roorda, Ruurd Jan; Brand, Paul L. P.

    Background: Variation of lung function is considered to be a hallmark of asthma. Although guidelines recommend measuring it as a diagnostic tool for asthma, the usefulness of this approach has not been studied in children. Aim: To assess the usefulness of home spirometry in children with nonspecific

  6. [Accesibility and use of spirometry in primary care centers in Catalonia].

    Science.gov (United States)

    Llauger, M Antònia; Rosas, Alba; Burgos, Felip; Torrente, Elena; Tresserras, Ricard; Escarrabill, Joan

    2014-01-01

    Examine the accessibility and use of forced spirometry (FS) in public primary care facilities centers in Catalonia. Cross-sectional study using a survey. Three hundred sixty-six Primary Care Teams (PCT) in Catalonia. Third quarter of 2010. Survey with information on spirometers, training, interpretation and quality control, and the priority that the quality of spirometry had for the team. Indicators FS/100 inhabitants/year, FS/month/PCT; FS/month/10,000 inhabitants. Response rate: 75%. 97.5% of PCT had spirometer and made an average of 2.01 spirometries/100 inhabitants (34.68 spirometry/PCT/month). 83% have trained professionals.>50% centers perform formal training but no information is available on the quality. 70% performed some sort of calibration. Interpretation was made by the family physician in 87.3% of cases. In 68% of cases not performed any quality control of exploration. 2/3 typed data manually into the computerized medical record.>50% recognized a high priority strategies for improving the quality. Despite the accessibility of EF efforts should be made to standardize training, increasing the number of scans test and promote systematic quality control. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  7. THE EFFECT OF SUBMAXIMAL INHALATION ON MEASURES DERIVED FROM FORCED EXPIRATORY SPIROMETRY

    Science.gov (United States)

    THE EFFECT OF SUBMAXIMAL INHALATION ON MEASURES DERIVED FROM FORCED EXPIRATORY SPIROMETRY. William F. McDonnell Human Studies Division, NHEERL, U.S. Environmental Protection Agency, RTP, NC 27711. Short-term exposure to ozone results in a neurally-mediated decrease in the ab...

  8. Respiratory symptoms necessitating spirometry among soldiers with Iraq/Afghanistan war lung injury.

    Science.gov (United States)

    Szema, Anthony M; Salihi, Walid; Savary, Khalil; Chen, John J

    2011-09-01

    New-onset asthma rates are higher among US soldiers deployed to Iraq/Afghanistan than stateside, but overall respiratory symptom and spirometry rates among soldiers returning from Iraq/Afghanistan have not yet been addressed. We determined these rates in soldiers deployed to Iraq/Afghanistan versus troops stationed elsewhere. Retrospective review of active-duty soldiers (2004 to 2010) registered at Veterans Affairs Medical Center, Northport, New York, with Long Island/New York City zip codes. Subjects were examined by physicians or physicians' assistants. We counted number of spirometries, which required respiratory symptoms, and the provider was required to submit a diagnosis as part of the request process. Twenty-five percent of 7151 troops went to Iraq/Afghanistan (n = 1816) and 75% went elsewhere (n = 5335), with more smokers in the Iraq/Afghanistan group (16.1% vs 3.3%). Rates of symptoms and spirometry were 14.5% and 1.8%, for Iraq/Afghanistan, versus troops deployed elsewhere, respectively (P Afghanistan war lung injury is common and rates of symptoms leading to a diagnosis requiring spirometry are high. (C)2011The American College of Occupational and Environmental Medicine

  9. Popcorn worker's lung: In vitro exposure to diacetyl, an ingredient in microwave popcorn butter flavoring, increases reactivity to methacholine

    International Nuclear Information System (INIS)

    Fedan, J.S.; Dowdy, J.A.; Fedan, K.B.; Hubbs, A.F.

    2006-01-01

    Workers who inhale microwave popcorn butter flavorings experience decrements in lung function and can develop clinical bronchiolitis obliterans, i.e., 'popcorn worker's lung' (Kreiss, K., Gomaa, A., Kullman, G., Fedan, K., Simoes, E.J., Enright, P.L., 2002. Clinical bronchiolitis obliterans in workers at a microwave-popcorn plant. N. Engl. J. Med. 347, 330-338.). In a rat inhalation model, vapors of an artificial butter flavoring damaged the epithelium of the upper and lower airways (Hubbs, A.F., Battelli, L.A., Goldsmith, W.T., Porter, D.W., Frazer, D., Friend, S., Schwegler-Berry, D., Mercer, R.R., Reynolds, J.S., Grote, A., Castranova, V., Kullman, G., Fedan, J.S., Dowdy, J., Jones, W.G., 2002. Necrosis of nasal and airway epithelium in rats inhaling vapors of artificial butter flavoring. Toxicol. Appl. Pharmacol. 185, 128-135.). Diacetyl, a butter flavoring component, is a major volatile ketone in the popcorn-processing workplace. We investigated the effects of diacetyl on epithelium of guinea pig isolated airway preparations and the effects of diacetyl in vitro on reactivity to bronchoactive agents. In the isolated, perfused trachea preparation, diacetyl added to the intraluminal (mucosal) bath elicited responses that began with contraction (threshold ca. 3 mM) and ended with relaxation. After a 4-h incubation with intraluminal diacetyl (3 mM), contractions to extraluminal (serosal) methacholine (MCh) were slightly increased; however, sensitivity to intraluminally (mucosally) applied MCh was increased by 10-fold. Relaxation responses of MCh (3 x 10 -7 M)-contracted tracheas to extraluminally applied terbutaline and intraluminally applied 120 mM KCl, to evoke epithelium-derived relaxing factor release, were unaffected by diacetyl. Exposure of the tracheal epithelium in Ussing chambers to diacetyl decreased transepithelial potential difference and resistance. These findings suggest that diacetyl exposure compromised epithelial barrier function, leading to

  10. A retrospective study of two populations to test a simple rule for spirometry.

    Science.gov (United States)

    Ohar, Jill A; Yawn, Barbara P; Ruppel, Gregg L; Donohue, James F

    2016-06-04

    Chronic lung disease is common and often under-diagnosed. To test a simple rule for conducting spirometry we reviewed spirograms from two populations, occupational medicine evaluations (OME) conducted by Saint Louis and Wake Forest Universities at 3 sites (n = 3260, mean age 64.14 years, 95 % CI 58.94-69.34, 97 % men) and conducted by Wake Forest University preop clinic (POC) at one site (n = 845, mean age 62.10 years, 95 % CI 50.46-73.74, 57 % men). This retrospective review of database information that the first author collected prospectively identified rates, types, sensitivity, specificity and positive and negative predictive value for lung function abnormalities and associated mortality rate found when conducting spirometry based on the 20/40 rule (≥20 years of smoking in those aged ≥ 40 years) in the OME population. To determine the reproducibility of the 20/40 rule for conducting spirometry, the rule was applied to the POC population. A lung function abnormality was found in 74 % of the OME population and 67 % of the POC population. Sensitivity of the rule was 85 % for an obstructive pattern and 77 % for any abnormality on spirometry. Positive and negative predictive values of the rule for a spirometric abnormality were 74 and 55 %, respectively. Patients with an obstructive pattern were at greater risk of coronary heart disease (odds ratio (OR) 1.39 [confidence interval (CI) 1.00-1.93] vs. normal) and death (hazard ratio (HR) 1.53, 95 % CI 1.20-1.84) than subjects with normal spirometry. Restricted spirometry patterns were also associated with greater risk of coronary disease (odds ratio (OR) 1.7 [CI 1.23-2.35]) and death (Hazard ratio 1.40, 95 % CI 1.08-1.72). Smokers (≥ 20 pack years) age ≥ 40 years are at an increased risk for lung function abnormalities and those abnormalities are associated with greater presence of coronary heart disease and increased all-cause mortality. Use of the 20/40 rule could provide a

  11. Impulse oscillometry in acute and stable asthmatic children: a comparison with spirometry.

    Science.gov (United States)

    Batmaz, Sehra Birgul; Kuyucu, Semanur; Arıkoglu, Tugba; Tezol, Ozlem; Aydogdu, Ayse

    2016-01-01

    Lung function tests have attracted interest for the diagnosis and follow-up of childhood asthma in recent years. For patients who cannot perform forced expiratory maneuvers, impulse oscillometry (IOS), performed during spontaneous breathing, may be an alternative tool. Thirty-five acute, 107 stable asthmatic and 103 healthy children who presented to our clinic performed IOS followed by spirometry before and after salbutamol inhalation. The mean baseline and reversibility of IOS and spirometry parameters were compared between the groups. Correlation analyses were undertaken within the asthmatics, and the healthy controls separately. To distinguish the three groups, the sensitivity and specificity of baseline and reversibility values of IOS and spirometry were computed. When spirometry was taken as the gold standard, the discriminating performance of IOS to detect the airway obstruction and reversibility was investigated. The mean absolute values of Zrs, R5, R5-R20, X5, X10, X15, Fres, AX, and all spirometric parameters, and the mean reversibility values of R5, R10, Fres, AX and forced expiratory volume in one second were different between the groups and the highest area under curve values to discriminate the groups was obtained from area of reactance (AX) and ΔAX. Zrs, all resistance (including R5-R20) and reactance parameters, Fres and AX were correlated with at least one spirometric parameter. Spirometric reversibility was detected by ≤-22.34 and ≤-39.05 cut-off values of ΔR5 and ΔAX, respectively. IOS has shown a highly significant association with spirometric indices and reversibility testing. It may be a substitute for spirometry in children who fail to perform forced expiratory maneuvers.

  12. Inter-regional changes in the performance and interpretation of spirometry in Spain: 3E study.

    Science.gov (United States)

    López-Campos, José Luis; Soriano, Joan B; Calle, Myriam

    2014-11-01

    This report shows the results of a nation-wide survey on spirometry to assess regional differences. Observational cross-sectional study conducted by means of a telephone survey in 805 primary care (PC) and specialized centers (SC) in all regions. The survey contacted technicians in charge of spirometry and consisted of 36 questions related to the test. The results showed major differences between regions. Most centers had 1-2 spirometers. The number of spirometry tests per week ranged from 2 to 8.9 in PC and between 34.3 and 98.3 in SC. Some training had been given in most centers (63.6-100% in PC and 60.0-100% in SC) but not on a regular basis. Most centers used several short-acting bronchodilators for the bronchodilation test, but with insufficient inhalations (2.0-3.8 in PC and 2.0-3.3 in SC) and frequently incorrect waiting time (29.4-83.3% PC and 33.3-87.5% in SC). Daily calibration was not performed in all centers (0-100% in PC and 66.7-100% in SC). Significant inter-regional differences in spirometry quality criteria were observed, with 6 or more criteria met in 9.1-84.6% of PC centers and 37.5-100% in SC. Our results show the current situation of spirometry in primary and specialized care in Spain, highlighting considerable variability and areas for improvement. This information should be considered by health officials to improve the quality and accessibility of such tests. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  13. Restrictive pattern on spirometry: association with cardiovascular risk and level of physical activity in asymptomatic adults

    Directory of Open Access Journals (Sweden)

    Evandro Fornias Sperandio

    2016-02-01

    Full Text Available Objective : To determine whether a restrictive pattern on spirometry is associated with the level of physical activity in daily life (PADL, as well as with cardiovascular disease (CVD risk factors, in asymptomatic adults. Methods : A total of 374 participants (mean age, 41 ± 14 years underwent spirometry, which included the determination of FVC and FEV1. A restrictive pattern on spirometry was defined as an FEV1/FVC ratio > 0.7 and an FVC < 80% of the predicted value. After conducting demographic, anthropometric, and CVD risk assessments, we evaluated body composition, muscle function, and postural balance, as well as performing cardiopulmonary exercise testing and administering the six-minute walk test. The PADL was quantified with a triaxial accelerometer. Results : A restrictive pattern on spirometry was found in 10% of the subjects. After multivariate logistic regression, adjusted for confounders (PADL and cardiorespiratory fitness, the following variables retained significance (OR; 95% CI as predictors of a restrictive pattern: systemic arterial hypertension (17.5; 1.65-184.8, smoking (11.6; 1.56-87.5, physical inactivity (8.1; 1.43-46.4, larger center-of-pressure area while standing on a force platform (1.34; 1.05-1.71; and dyslipidemia (1.89; 1.12-1.98. Conclusions : A restrictive pattern on spirometry appears to be common in asymptomatic adults. We found that CVD risk factors, especially systemic arterial hypertension, smoking, and physical inactivity, were directly associated with a restrictive pattern, even when the analysis was adjusted for PADL and cardiorespiratory fitness. Longitudinal studies are needed in order to improve understanding of the etiology of a restrictive pattern as well as to aid in the design of preventive strategies.

  14. The value of spirometry and exercise challenge test to diagnose and monitor children with asthma

    NARCIS (Netherlands)

    Wijngaart, L.S. van den; Roukema, J.; Merkus, P.J.F.M.

    2015-01-01

    Asthma is defined as a chronic inflammatory disease of the airways with characteristic symptoms including recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. It may result in abnormalities of ventilator function, which can be assessed by different pulmonary function tests.

  15. Spirometry training courses: Content, delivery and assessment - a position statement from the Australian and New Zealand Society of Respiratory Science.

    Science.gov (United States)

    Swanney, Maureen P; O'Dea, Christopher A; Ingram, Emily R; Rodwell, Leanne T; Borg, Brigitte M

    2017-10-01

    Spirometry training courses are provided by health services and training organizations to enable widespread use of spirometry testing for patient care or for monitoring health. The primary outcome of spirometry training courses should be to enable participants to perform spirometry to international best practice, including testing of subjects, quality assurance and interpretation of results. Where valid results are not achieved or quality assurance programmes identify errors in devices, participants need to be able to adequately manage these issues in accordance with best practice. It is important that potential participants are confident in the integrity of the course they attend and that the course meets their expectations in terms of training. This position statement lists the content that the Australian and New Zealand Society of Respiratory Science (ANZSRS) has identified as required in a spirometry training course to adequately meet the primary outcomes mentioned above. The content requirements outlined in this position statement are based on the current international spirometry standards set out by the American Thoracic Society and European Respiratory Society. Furthermore, recommendations around course delivery for theoretical and practical elements of spirometry testing and post-course assessment are outlined in this statement. © 2017 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

  16. Assessment of spirometry and impulse oscillometry in relation to asthma control.

    Science.gov (United States)

    Manoharan, Arvind; Anderson, William J; Lipworth, Joseph; Lipworth, Brian J

    2015-02-01

    Guidelines advocate the use of spirometry to assess pulmonary function in asthmatic patients. Commonly used measures include forced expiratory volume in 1 s (FEV1), forced expiratory ratio (FEV1/FVC), and forced mid-expiratory flow between 25 and 75 % of forced vital capacity (FEF25-75). Impulse oscillometry (IOS) is an effort-independent test performed during tidal breathing. IOS may be used to assess the total and central airway resistance at 5 Hz (R5) and 20 Hz (R20), respectively, and hence derive the peripheral airway resistance from the difference (R5-R20). We compared spirometry and IOS as tests of global airway function (i.e., FEV1, FEV1/FVC, R5) and putative measures of small airways function (i.e., FEF25-75, R5-R20) and their relationship to oral steroid and short-acting beta-agonist (SABA) use as surrogates for long-term asthma control. Spirometry and IOS measurements from physician-diagnosed asthmatics were linked to a health informatics database for oral steroid and SABA use 1 year prior to the index measurements. Four hundred forty-two patients had both spirometry and IOS, mean FEV1 = 86 % predicted, 94 % on ICS, median dose 800 µg/day. IOS and spirometry measures were equally predictive of impaired asthma control for both oral steroid and SABA use. For oral steroid use, the adjusted odds ratio, OR (95 % CI) is as follows: FEV1 150 %: 1.91(1.25-2.95), p = 0.003; and R5-R20 > 0.1 kPa L(-1) s 1.73(1.12-2.66), p = 0.013. For SABA use, the adjusted OR (95 % CI) is as follows: FEV1 150 %: 1.76(1.18-2.63), p = 0.006; and R5-R20 > 0.1 kPa L(-1) s: 2.94(1.94-4.46), p Spirometry or IOS measurements were equally useful as potential markers of asthma control in persistent asthmatic patients.

  17. Comparison of spirometry and abdominal height as four-dimensional computed tomography metrics in lung

    International Nuclear Information System (INIS)

    Lu Wei; Low, Daniel A.; Parikh, Parag J.; Nystrom, Michelle M.; El Naqa, Issam M.; Wahab, Sasha H.; Handoko, Maureen; Fooshee, David; Bradley, Jeffrey D.

    2005-01-01

    An important consideration in four-dimensional CT scanning is the selection of a breathing metric for sorting the CT data and modeling internal motion. This study compared two noninvasive breathing metrics, spirometry and abdominal height, against internal air content, used as a surrogate for internal motion. Both metrics were shown to be accurate, but the spirometry showed a stronger and more reproducible relationship than the abdominal height in the lung. The abdominal height was known to be affected by sensor placement and patient positioning while the spirometer exhibited signal drift. By combining these two, a normalization of the drift-free metric to tidal volume may be generated and the overall metric precision may be improved

  18. Spirometry utilisation among Danish adults initiating medication targeting obstructive lung disease

    DEFF Research Database (Denmark)

    Koefoed, Mette

    2015-01-01

    performed. RESULTS: A total of 40,969 adults initiated medication targeting obstructive lung medication in 2008 in Denmark. The mean age of the cohort was 55.6 years (SD18.7) and approximately half of the mediations users had spirometry test performed. Initiating several types of medication targeting......UNLABELLED: This PhD thesis was written during my employment at the Research Unit of General Practice in Odense, University of Southern Denmark. It comprises an overview and three papers, all published or submitted for publication in international peer-reviewed scientific journals. BACKGROUND: Non...... with pharmacotherapy targeting obstructive lung disease and only few have additional tests conducted, although the predictive value of respiratory symptoms for diagnosing obstructive lung disease has proven to be low. Spirometry is recommended as the gold standard for confirming obstructive lung disease, and testing...

  19. [Further examination of COPD using spirometry, respiratory function test, and impulse oscillometry].

    Science.gov (United States)

    Tanaka, Hiroshi; Fujii, Masaru; Kitada, Junya

    2011-10-01

    Spirometry is essential for diagnosis and staging of chronic obstructive pulmonary disease (COPD). Characteristic of physiological change of small airways in COPD is heterogeneous distribution of small airway narrowing, resulting in air-trapping and nonhomogeneous ventilation. FEF25-75, residual volume/total lung capacity, delta N2 in phase III slope of single breath N2 washout test, closing volume, static and dynamic compliance, and carbon monoxide diffusing capacity (transfer factor) are measured for detecting small airways disease. Impulse oscillometry is also useful for assessment of small airways disease, especially indices of frequent resonance (Fres) and frequent dependent of resistance change of R5-R20; resistance at 5 Hz minus resistance at 20 Hz. Impulse oscillometry seems to have a complemental role of spirometry in managing COPD.

  20. Spirometry Reference Equations from the HCHS/SOL (Hispanic Community Health Study/Study of Latinos).

    Science.gov (United States)

    LaVange, Lisa; Davis, Sonia M; Hankinson, John; Enright, Paul; Wilson, Rebbecca; Barr, R Graham; Aldrich, Thomas K; Kalhan, Ravi; Lemus, Hector; Ni, Ai; Smith, Lewis J; Talavera, Gregory A

    2017-10-15

    Accurate reference values for spirometry are important because the results are used for diagnosing common chronic lung diseases such as asthma and chronic obstructive pulmonary disease, estimating physiologic impairment, and predicting all-cause mortality. Reference equations have been established for Mexican Americans but not for others with Hispanic/Latino backgrounds. To develop spirometry reference equations for adult Hispanic/Latino background groups in the United States. The HCHS/SOL (Hispanic Community Health Study/Study of Latinos) recruited a population-based probability sample of 16,415 Hispanics/Latinos aged 18-74 years living in the Bronx, Chicago, Miami, and San Diego. Participants self-identified as being of Puerto Rican, Cuban, Dominican, Mexican, or Central or South American background. Spirometry was performed using standardized methods with central quality control monitoring. Spirometric measures from a subset of 6,425 never-smoking participants without respiratory symptoms or disease were modeled as a function of sex, age, height, and Hispanic/Latino background to produce background-specific reference equations for the predicted value and lower limit of normal. Dominican and Puerto Rican Americans had substantially lower predicted and lower limit of normal values for FVC and FEV 1 than those in other Hispanic/Latino background groups and also than Mexican American values from NHANES III (Third National Health and Nutrition Examination Survey). For patients of Dominican and Puerto Rican background who present with pulmonary symptoms in clinical practice, use of background-specific spirometry reference equations may provide more appropriate predicted and lower limit of normal values, enabling more accurate diagnoses of abnormality and physiologic impairment.

  1. Bronchial responsiveness to adenosine-5 '-monophosphate and methacholine as predictors for nasal symptoms due to newly introduced allergens. A follow-up study among laboratory animal workers and bakery apprentices

    NARCIS (Netherlands)

    de Meer, G; Postma, DS; Heederik, D

    Background In asthma patients, bronchial hyper-responsiveness (BHR) to adenosine-5'-monophosphate (AMP) reflects bronchial inflammation more closely than BHR to methacholine. In this follow-up study we studied bronchial responsiveness to both stimuli as predictors of new-onset airway symptoms.

  2. Spirometry in Greenland: a cross-sectional study on patients treated with medication targeting obstructive pulmonary disease.

    Science.gov (United States)

    Nielsen, Lasse Overballe; Olsen, Sequssuna; Jarbøl, Dorte Ejg; Pedersen, Michael Lynge

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) is globally increasing in frequency and is expected to be the third largest cause of death by 2020. Smoking is the main risk factor of developing COPD. In Greenland, more than half of the adult population are daily smokers, and COPD may be common. International guidelines recommend the usage of spirometry as a golden standard for diagnosing COPD. The current number of spirometries performed among patients treated with medication targeting obstructive pulmonary disease in Greenland remains unexplored. To estimate the prevalence of patients aged 50 years or above treated with medication targeting obstructive pulmonary disease and the extent to which spirometry was performed among them within 2 years. An observational, cross-sectional study based on the review of data obtained from electronic medical records in Greenland was performed. The inclusion criterion was that patients must have been permanent residents aged 50 years or above who had medication targeting obstructive pulmonary disease prescribed within a period of 15 months prior to data extraction. A full review of electronic patient records was done on each of the identified users of medication targeting obstructive pulmonary disease. Information on age, gender, town and spirometry was registered for each patient within the period from October 2013 to October 2015. The prevalence of patients treated with medication targeting obstructive pulmonary disease aged 50 years or above was 7.9%. Of those, 34.8% had spirometry performed within 2 years and 50% had a forced expiratory volume (1 sec)/ forced vital capacity (FEV1/FVC) under 70% indicating obstructive pulmonary disease. The use of medication targeting obstructive pulmonary disease among patients over 50 years old is common in Greenland. About one third of the patients had a spirometry performed within 2 years. To further increase spirometry performance, it is recommended to explore possible barriers in health

  3. Modern Spirometry Supports Anesthetic Management in Small Animal Clinical Practice: A Case Series.

    Science.gov (United States)

    Calice, Ivana; Moens, Yves

    2016-01-01

    Modern spirometry, like no other monitoring technique, allows insight into breath-to-breath respiratory mechanics. Spirometers continuously measure volume, airway pressure, and flow while calculating and continuously displaying respiratory system compliance and resistance in the form of loops. The aim of this case series is to show how observation of spirometric loops, similar to electrocardiogram or CO2 curve monitoring, can improve safety of anesthetic management in small animals. Spirometric monitoring cases described in this case series are based on use of the anaesthesia monitor Capnomac Ultima with a side stream spirometry sensor. The cases illustrate how recognition and understanding of spirometric loops allows for easy diagnosis of iatrogenic pneumothorax, incorrect ventilator settings, leaks in the system, kinked or partially obstructed endotracheal tube, and spontaneous breathing interfering with intermittent positive-pressure ventilation. The case series demonstrates the potential of spirometry to improve the quality and safety of anesthetic management, and, hence, its use can be recommended during intermittent positive-pressure ventilation and procedures in which interference with ventilation can be expected.

  4. Measurement of total lung capacity : a comparison of spiral CT and spirometry

    International Nuclear Information System (INIS)

    Chung, Kyung Il; Park, Kyung Ju; Lee, Eh Hyung; Yune, Heun Young; Suh, Jung Ho; Choe, Kyu Ok; Lim, Tae Hwan; Chung, In Hyuk

    1996-01-01

    To determine the potential of spiral CT as a functional imaging modality of the lung aside from its proven value in morphological depiction. Spiral CT scan was performed in ten normal female and nine normal male adults (mean age: 39, height: 163 cm, weight: 62 kg ) after single full breath-holding. Three dimensional lung images were reconstructed(minimal threshold value: -1,000HU, maximal threshold values: -150, 250, -350, -450 HU) to obtain total lung volume(TLV) on a histogram. Total lung volume measured by spiral CT was compared with TLV obtained by spirometry. Mean TLV measured by spirometry was 5.62L and TLV measured by CT at maximal threshold values of -150, -250, -350, and -450 HU was 5.53, 5.33, 5.15, and 4.98L, respectively. Mean absolute differences between the modalities of 0.17L(3%), 0.32L(5.6%), 0.48L(8.5%), 0.65L(11.5%) were statistically significant(p<0.001). Linear regression coefficients between the modalities were 0.99, 0.97, 095, and 0.94 and no statistically significant differences in accuracy of threshold levels in the estimation of lung volume(r=0.99, standard error=0.034L in all) were seen. TLV measured by spiral CT closely approximated that measured by spirometry. Spiral CT may be useful as a means of evaluating lung function

  5. A Study of the Usability of Ergonomic Camera Vest Based on Spirometry Parameters

    Directory of Open Access Journals (Sweden)

    Shirazeh Arghami

    2017-12-01

    Full Text Available Background: Being a cameraman is one of those occupations that expose people to musculoskeletal disorders (MSDs. Therefore, control measures should be taken to protect cameramen’s health. To solve the given problem, a vest was designed for cameramen to prevent MSDs by reducing the pressure and contact stress while carrying the camera on their shoulder. However, the usability of vest had to be considered. The aim of this study was to determine the usability of the proposed vest using the spirometry parameters indicator. Methods: In this experimental study, 120 spirometry experiments were conducted with 40 male volunteer subjects with and without designed vest. Data were analyzed using SPSS- 16 with dependent t-test, at 0.05 significance level. Results: Based on the spirometry results, there is a significant difference between Forced Vital Capacity (FVC, Forced Expiratory Volume (FEV1 and heart rate in activity with and without vest (p<0.001. Conclusion: The results suggest that the promising impact of this invention on the health of cameramen makes this domestically designed camera vest a good option for mass production.

  6. Practical surrogate marker of pulmonary dysanapsis by simple spirometry: an observational case-control study in primary care.

    Science.gov (United States)

    Shiota, Satomi; Ichikawa, Masako; Suzuki, Kazuhiro; Fukuchi, Yoshinosuke; Takahashi, Kazuhisa

    2015-03-26

    We see patients who present with spirometry airflow limitation despite their forced expiratory volume in one second (FEV1) as well as forced vital capacity (FVC) to be supernormal (FEV1/FVC spirometry conditions (results measured with spirometry) could be suitably used as a practical surrogate marker of pulmonary dysanapsis: the condition of disproportionate but physiologically normal growth between airways and lung parenchyma. We compared the conventional surrogate marker of dysanapsis, maximum mid-expiratory flow to FVC (MMF/FVC), in SUBJECTS (FEV1/FVC spirometry results with SUBJECTS) (n = 55), and in CONTROLS (age- and height- matched, normal spirometry results) (n = 25). Next we added imaging analysis to evaluate the relationship between the cross sectional airway luminal area (X-Ai) and the lung volume results among the three groups. The MMF/FVC was significantly lower in SUBJECTS and in EMPHYSEMA compared to CONTROLS. However, percent predicted peak expiratory flow (%PEFR) was significantly lower only in SUBJECTS and not in EMPHYSEMA compared to CONTROLS. The ratio of the X-Ai of the trachea and right apical bronchus to lung volume was significantly lower in SUBJECTS compared to CONTROLS. The simple spirometry conditions in SUBJECTS are highly suggestive of practical surrogate marker of pulmonary dysanapsis. Awareness of this concept would help to attenuate the risk of overdiagnosis of obstructive pulmonary disease.

  7. Effects of a 12-month multi-faceted mentoring intervention on knowledge, quality, and usage of spirometry in primary care: a before-and-after study.

    Science.gov (United States)

    Gupta, Samir; Moosa, Dilshad; MacPherson, Ana; Allen, Christopher; Tamari, Itamar E

    2016-04-21

    Asthma is among the most common chronic diseases in adults. International guidelines have emphasized the importance of regular spirometry for asthma control evaluation. However, spirometry use in primary care remains low across jurisdictions. We sought to design and evaluate a knowledge translation intervention to address both the poor quality of spirometry and the underuse of spirometry in primary care. We designed a 1-year intervention consisting of initial interactive education and hands-on training followed by unstructured peer expert mentoring (through an online portal, email, telephone, videoconference, fax, and/or in-person). We recruited physician and allied health mentees from across primary care sites in Ontario, Canada. We compared spirometry-related knowledge immediately before and after the 1-year intervention period and the quality of spirometry testing and the usage of spirometry in patients with asthma in the year before and the year of the intervention. Seven of 10 (70 %) invited sites participated, including 25/90 (28 %) invited allied health mentees and 23/68 (34 %) invited physician mentees. We recruited 7 physician mentors and 4 allied health mentors to form 3 mentor-mentee pods. Spirometry knowledge scores increased from 21.4 +/- 3.1 pre- to 27.3 +/- 3.5 (out of 35) (p Spirometry acceptability and repeatability criteria were met by 59/191 (30.9 %) spirometries and 86/193 (44.6 %) spirometries [odds ratio 1.7 (1.0, 3.0)], in the pre-intervention and intervention periods, respectively. Spirometry was ordered in 75/512 (14.6 %) and 129/336 (38.4 %) respiratory visits (p spirometry in real world primary care settings. A future controlled study should assess the impact of this intervention on patient outcomes, its cost-effectiveness, and its sustainability.

  8. Spirometry-Assisted High Resolution Chest Computed Tomography in Children: Is it Worth the Effort?

    Science.gov (United States)

    Otjen, Jeffrey Parke; Swanson, Jonathan Ogden; Oron, Assaf; DiBlasi, Robert M; Swortzel, Tim; van Well, Jade Adriana Marie; Gommers, Eva Anna Elisabeth; Rosenfeld, Margaret

    Image quality of high resolution chest computed tomographies (HRCTs) depends on adequate breath holds at end inspiration and end expiration. We hypothesized that implementation of spirometry-assisted breath holds in children undergoing HRCTs would improve image quality over that obtained with voluntary breath holds by decreasing motion artifact and atelectasis. This is a retrospective case-control study of HRCTs obtained at a tertiary care children's hospital before and after implementation of a spirometry-assisted CT protocol, in which children ≥8 years of age are first trained in supine slow vital capacity maneuvers and then repeat the maneuvers in the CT scanner, coached by a respiratory therapist. Spirometry-assisted CT scans (cases) were matched by age, gender and diagnosis (cystic fibrosis vs other) to CT scans obtained with voluntary breath holds in the 6 years before implementation of the spirometry assistance protocol (controls), and evaluated by 2 blinded pediatric radiologists. Among both cases and controls (N = 50 each), 10 carried the diagnosis of cystic fibrosis and 40 had other diagnoses. Mean age was 12.9 years (range: 7.5-20.1) among cases and 13.0 (7.1-19.7) among controls. Mean (SD) inspiratory image density among cases was -852 (37) Hounsfield units (HU) and -828 (43) among controls (p = 0.006). Mean (SD) expiratory image density was -629 (95) HU among cases and -688 (83) HU among controls (p = 0.002). Mean (SD) change in image density between inspiratory and expiratory images was +222 (85) HU among cases and +140 (76) HU among controls (p 0.80). Atelectasis was present on inspiratory images in 8 cases and 9 controls and on expiratory images in 9 cases and 10 controls (p > 0.80). Spirometry-assisted CTs had a significantly greater difference in lung density between inspiratory and expiratory scans than those performed with voluntary breath holds, likely improving the ability to detect air trapping. No appreciable difference in image quality

  9. The effect of incentive spirometry on postoperative pulmonary function following laparotomy: a randomized clinical trial.

    Science.gov (United States)

    Tyson, Anna F; Kendig, Claire E; Mabedi, Charles; Cairns, Bruce A; Charles, Anthony G

    2015-03-01

    Changes in pulmonary dynamics following laparotomy are well documented. Deep breathing exercises, with or without incentive spirometry, may help counteract postoperative decreased vital capacity; however, the evidence for the role of incentive spirometry in the prevention of postoperative atelectasis is inconclusive. Furthermore, data are scarce regarding the prevention of postoperative atelectasis in sub-Saharan Africa. To determine the effect of the use of incentive spirometry on pulmonary function following exploratory laparotomy as measured by forced vital capacity (FVC). This was a single-center, randomized clinical trial performed at Kamuzu Central Hospital, Lilongwe, Malawi. Study participants were adult patients who underwent exploratory laparotomy and were randomized into the intervention or control groups (standard of care) from February 1 to November 30, 2013. All patients received routine postoperative care, including instructions for deep breathing and early ambulation. We used bivariate analysis to compare outcomes between the intervention and control groups. Adult patients who underwent exploratory laparotomy participated in postoperative deep breathing exercises. Patients in the intervention group received incentive spirometers. We assessed pulmonary function using a peak flow meter to measure FVC in both groups of patients. Secondary outcomes, such as hospital length of stay and mortality, were obtained from the medical records. A total of 150 patients were randomized (75 in each arm). The median age in the intervention and control groups was 35 years (interquartile range, 28-53 years) and 33 years (interquartile range, 23-46 years), respectively. Men predominated in both groups, and most patients underwent emergency procedures (78.7% in the intervention group and 84.0% in the control group). Mean initial FVC did not differ significantly between the intervention and control groups (0.92 and 0.90 L, respectively; P=.82 [95% CI, 0.52-2.29]). Although

  10. Effectiveness of spirometry as a motivational tool for smoking cessation: a clinical trial, the ESPIMOAT study.

    Science.gov (United States)

    Irizar-Aramburu, María Isabel; Martínez-Eizaguirre, Jose Manuel; Pacheco-Bravo, Petra; Diaz-Atienza, Maria; Aguirre-Arratibel, Iñigo; Peña-Peña, Maria Isabel; Alba-Latorre, Mercedes; Galparsoro-Goikoetxea, Mikel

    2013-12-05

    Smoking is the main preventable cause of morbidity and mortality in our region, it being the main causative agent of chronic obstructive pulmonary disease. There still is no consensus on the use of spirometry as a strategy for smoking cessation, given that there is insufficient scientific evidence from high quality studies to recommend the use of this technique. This is to be a randomized, multicentre, open-label clinical trial. A total of 444 smokers over 40 years of age will be recruited by 39 general practitioners from 22 health centers. Primary objective of this study is to assess the effectiveness of spirometry together with information regarding the test for smoking cessation after 1 year in smokers over 40 years of age with a more than 10 pack-year history and no previous diagnosis of chronic obstructive pulmonary disease. Groups of 45 patients who smoke will be randomly selected from the lists of the participating doctors. The names will be sent to the corresponding doctors who will contact candidate patients and assess whether they meet the selection criteria. Patients who meet these criteria will be randomly allocated to an intervention or control group. For patients in both groups, a nurse will conduct an interview and perform a spirometry test to measure forced vital capacity. Then, all patients will be referred for an appointment with their doctor for brief anti-smoking intervention, patients from the intervention group additionally being informed about the result of the spirometry test. After 1 year, smoking status will be assessed and, in those who report that they have quit smoking, abstinence will be confirmed by co-oximetry. Data will be analyzed on an intention-to-treat basis using the chi-squared test for outcomes and binary logistic regression if it is considered to be necessary to adjust for confounding variables. Performing a spirometry test and providing information on pulmonary function may increase awareness of the effect of smoking among

  11. A home monitoring program including real-time wireless home spirometry in idiopathic pulmonary fibrosis: a pilot study on experiences and barriers.

    Science.gov (United States)

    Moor, C C; Wapenaar, M; Miedema, J R; Geelhoed, J J M; Chandoesing, P P; Wijsenbeek, M S

    2018-05-29

    In idiopathic pulmonary fibrosis (IPF), home monitoring experiences are limited, not yet real-time available nor implemented in daily care. We evaluated feasibility and potential barriers of a new home monitoring program with real-time wireless home spirometry in IPF. Ten patients with IPF were asked to test this home monitoring program, including daily home spirometry, for four weeks. Measurements of home and hospital spirometry showed good agreement. All patients considered real-time wireless spirometry useful and highly feasible. Both patients and researchers suggested relatively easy solutions for the identified potential barriers regarding real-time home monitoring in IPF.

  12. Inflammatory Responses, Spirometry, and Quality of Life in Subjects With Bronchiectasis Exacerbations.

    Science.gov (United States)

    Guan, Wei-Jie; Gao, Yong-Hua; Xu, Gang; Lin, Zhi-Ya; Tang, Yan; Li, Hui-Min; Lin, Zhi-Min; Jiang, Mei; Zheng, Jin-Ping; Chen, Rong-Chang; Zhong, Nan-Shan

    2015-08-01

    Bronchiectasis exacerbations are critical events characterized by worsened symptoms and signs (ie, cough frequency, sputum volume, malaise). Our goal was to examine variations in airway and systemic inflammation, spirometry, and quality of life during steady state, bronchiectasis exacerbations, and convalescence (1 week following a 2-week antibiotic treatment) to determine whether potentially pathogenic microorganisms, including Pseudomonas aeruginosa, were associated with poorer conditions during bronchiectasis exacerbations. Peripheral blood and sputum were sampled to detect inflammatory mediators and bacterial densities. Spirometry and quality of life (St George Respiratory Questionnaire [SGRQ]) were assessed during the 3 stages. Forty-eight subjects with bronchiectasis (43.2 ± 14.2 y of age) were analyzed. No notable differences in species and density of potentially pathogenic microorganisms were found during bronchiectasis exacerbations. Except for CXCL8 and tumor necrosis factor alpha (TNF-α), serum inflammation was heightened during bronchiectasis exacerbations and recovered during convalescence. Even though sputum TNF-α was markedly higher during bronchiectasis exacerbations and remained heightened during convalescence, the variations in miscellaneous sputum markers were unremarkable. Bronchiectasis exacerbations were associated with notably higher SGRQ symptom and total scores, which recovered during convalescence. FVC, FEV1, and maximum mid-expiratory flow worsened during bronchiectasis exacerbations (median change from baseline of -2.2%, -0.8%, and -1.3%) and recovered during convalescence (median change from baseline of 0.6%, 0.7%, and -0.7%). Compared with no bacterial isolation, potentially pathogenic microorganism or P. aeruginosa isolation at baseline did not result in poorer clinical condition during bronchiectasis exacerbations. Bronchiectasis exacerbations are characterized by heightened inflammatory responses and poorer quality of life and

  13. The diagnosis of COPD in primary care; gender differences and the role of spirometry.

    Science.gov (United States)

    Roberts, N J; Patel, I S; Partridge, M R

    2016-02-01

    Females with exacerbations of Chronic Obstructive Pulmonary Disease now account for one half of all hospital admissions for that condition and rates have been increasing over the last few decades. Differences in presentations of disease between genders have been shown in several conditions and this study explores whether there are inter gender biases in probable diagnoses in those suspected to have COPD. 445 individuals with a provisional diagnosis by their General Practitioner of "suspected COPD" or "definite COPD" were referred to a community Respiratory Assessment unit (CRAU) for tests including spirometry. Gender, demographics, respiratory symptoms and respiratory medical history were recorded. The provisional diagnoses were compared with the final diagnosis made after spirometry and respiratory specialist nurse review and the provisional diagnosis was either confirmed as correct or refuted as unlikely. Significantly more men (87.5%) had their diagnosis of "definite COPD" confirmed compared to 73.9% of women (p = 0.021). When the GP suggested a provisional diagnosis of "suspected COPD" (n = 265) at referral, this was confirmed in 60.9% of men and only 43.2% of women (p = 0.004). There was a different symptom pattern between genders with women being more likely to report allergies, symptoms starting earlier in life, and being less likely than men to report breathlessness as the main symptom. These results may suggest a difference between genders in some of the clinical features of COPD and a difference in likelihood of a GPs provisional diagnosis of COPD being correct. The study reiterates the absolute importance of spirometry in the diagnosis of COPD. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Spirometry as a motivational tool to improve smoking cessation rates: a systematic review of the literature.

    Science.gov (United States)

    Wilt, Timothy J; Niewoehner, Dennis; Kane, Robert L; MacDonald, Roderick; Joseph, Anne M

    2007-01-01

    Obtaining spirometric testing and providing those results to individuals who smoke has been advocated as a motivational tool to improve smoking cessation. However, its effectiveness is not known. We conducted a systematic review to determine if this approach improves rates of smoking cessation. Data sources included MEDLINE (1966 to October 2005), the Cochrane Library, and experts in the field. Eligible randomized controlled trials (RCTs) enrolled at least 25 smokers per arm, evaluated spirometry with associated counseling or in combination with other treatments, followed subjects at least 6 months, and provided smoking abstinence rates. Results from nonrandomized studies also were summarized. The primary outcome was patient-reported long-term (at least 6 months) sustained abstinence with biological validation. Additional outcomes included self-reported abstinence and point-prevalence abstinence. Seven RCTs (N = 6,052 subjects) met eligibility criteria. Follow-up duration ranged from 9 to 36 months. In six trials, the intervention group received concomitant treatments previously demonstrated to increase cessation independently. The range of abstinence was 3%-14% for control subjects and 7%-39% among intervention groups, statistically significantly in favor of intervention in four studies. The only RCT that assessed the independent contribution of spirometry in combination with counseling demonstrated a nonsignificant 1% improvement in patient-reported point-prevalence abstinence at 12 months in the group that received spirometry plus counseling versus counseling alone (6.5% versus 5.5%). Findings from observational studies were mixed, and the lack of controls makes interpretation problematic. Available evidence is insufficient to determine whether obtaining spirometric values and providing that information to patients improves smoking cessation compared with other smoking cessation methods. Spirometric values are of limited benefit as a predictor of smoking

  15. A Multiphase Non-Linear Mixed Effects Model: An Application to Spirometry after Lung Transplantation

    Science.gov (United States)

    Rajeswaran, Jeevanantham; Blackstone, Eugene H.

    2014-01-01

    In medical sciences, we often encounter longitudinal temporal relationships that are non-linear in nature. The influence of risk factors may also change across longitudinal follow-up. A system of multiphase non-linear mixed effects model is presented to model temporal patterns of longitudinal continuous measurements, with temporal decomposition to identify the phases and risk factors within each phase. Application of this model is illustrated using spirometry data after lung transplantation using readily available statistical software. This application illustrates the usefulness of our flexible model when dealing with complex non-linear patterns and time varying coefficients. PMID:24919830

  16. Hyperpolarized 3helium magnetic resonance ventilation imaging of the lung in cystic fibrosis: comparison with high resolution CT and spirometry

    International Nuclear Information System (INIS)

    McMahon, Colm J.; Dodd, Jonathan D.; Skehan, Stephen J.; Masterson, James B.; Hill, Catherine; Woodhouse, Neil; Wild, Jim M.; Fichele, Stan; Gallagher, Charles G.; Beek, Edwin J.R. van

    2006-01-01

    The purpose of this study was to compare hyperpolarized 3 helium magnetic resonance imaging ( 3 He MRI) of the lungs in adults with cystic fibrosis (CF) with high-resolution computed tomography (HRCT) and spirometry. Eight patients with stable CF prospectively underwent 3 He MRI, HRCT, and spirometry within 1 week. Three-dimensional (3D) gradient-echo sequence was used during an 18-s breath-hold following inhalation of hyperpolarized 3 He. Each lung was divided into six zones; 3 He MRI was scored as percentage ventilation per lung zone. HRCT was scored using a modified Bhalla scoring system. Univariate (Spearman rank) and multivariate correlations were performed between 3 He MRI, HRCT, and spirometry. Results are expressed as mean±SD (range). Spirometry is expressed as percent predicted. There were four men and four women, mean age=31.9±9 (20-46). Mean forced expiratory volume in 1 s (FEV) 1 =52%±29 (27-93). Mean 3 He MRI score=74%±25 (55-100). Mean HRCT score=48.8±24 (13.5-83). The correlation between 3 He MRI and HRCT was strong (R=±0.89, p 3 He MRI; 3 He MRI correlated better with FEV 1 and forced vital capacity (FVC) (R=0.86 and 0.93, p 3 He MRI correlates strongly with structural HRCT abnormalities and is a stronger correlate of spirometry than HRCT in CF. (orig.)

  17. Influence of socioeconomic and demographic status on spirometry testing in patients initiating medication targeting obstructive lung disease: a population-based cohort study

    Science.gov (United States)

    2013-01-01

    Background Socioeconomic status is known to influence the prevalence, severity and mortality of obstructive lung diseases, but it is uncertain whether it affects the use of diagnostic spirometry in patients initiating treatment for these conditions. The objective of this paper was to examine a possible association between education, income, labour market affiliation, cohabitation status and having spirometry performed when initiating medication targeting obstructive pulmonary disease. Methods We conducted a population-based cohort study. Danish national registers were linked, retrieving data on prescriptions, spirometry testing, socioeconomic and demographic variables in all first time users of medication targeting obstructive lung disease in 2008. Results A total of 37,734 persons were included and approximately half of the cohort had spirometry performed. Among medication users under 65 years of age, being unemployed was significantly associated with reduced odds of having spirometry performed, the strongest association was seen in men (OR = 0.82, CI = 0.73-0.91). Medium income was associated with increased odds of having spirometry performed in men (OR = 1.18, CI = 1.06-1.30) and high educational level (>12 years) was associated with reduced odds of having spirometry performed in women (OR = 0.86, CI = 0.78-0.94). Cohabitation status was not associated with having spirometry performed. Among medication users over 65 years of age, living alone was associated with reduced odds of having spirometry performed among men (OR = 0.78, CI = 0.69-0.88). Conclusion Social inequity in spirometry testing among patients initiating medication targeting obstructive lung disease was confirmed in this study. Increased focus on spirometry testing among elderly men living alone, among the unemployed and among women with higher education is required when initiating medication. PMID:23768408

  18. General practice variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease in Denmark: a population-based observational study.

    Science.gov (United States)

    Koefoed, Mette M; Søndergaard, Jens; Christensen, René dePont; Jarbøl, Dorte E

    2013-08-07

    Spirometry testing is essential to confirm an obstructive lung disease, but studies have reported that a large proportion of patients diagnosed with COPD or asthma have no history of spirometry testing. Also, it has been shown that many patients are prescribed medication for obstructive lung disease without a relevant diagnosis or spirometry test registered. General practice characteristics have been reported to influence diagnosis and management of several chronic diseases. However, these findings are inconsistent, and it is uncertain whether practice characteristics influence spirometry testing among patients receiving medication for obstructive lung disease. The aim of this study was therefore to examine if practice characteristics are associated with spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease. A national register-based cohort study was performed. All patients over 18 years receiving first-time prescriptions for medication targeting obstructive lung disease in 2008 were identified and detailed patient-specific data on sociodemographic status and spirometry tests were extracted. Information on practice characteristics like number of doctors, number of patients per doctor, training practice status, as well as age and gender of the general practitioners was linked to each medication user. Partnership practices had a higher odds ratio (OR) of performing spirometry compared with single-handed practices (OR 1.24, CI 1.09-1.40). We found a significant association between increasing general practitioner age and decreasing spirometry testing. This tendency was most pronounced among partnership practices, where doctors over 65 years had the lowest odds of spirometry testing (OR 0.25, CI 0.10-0.61). Training practice status was significantly associated with spirometry testing among single-handed practices (OR 1.40, CI 1.10-1.79). Some of the variation in spirometry testing among patients receiving

  19. The UK Quality and Outcomes Framework pay-for-performance scheme and spirometry: rewarding quality or just quantity? A cross-sectional study in Rotherham, UK

    Directory of Open Access Journals (Sweden)

    South Gail

    2009-06-01

    Full Text Available Abstract Background Accurate spirometry is important in the management of COPD. The UK Quality and Outcomes Framework pay-for-performance scheme for general practitioners includes spirometry related indicators within its COPD domain. It is not known whether high achievement against QOF spirometry indicators is associated with spirometry to BTS standards. Methods Data were obtained from the records of 3,217 patients randomly sampled from 5,649 patients with COPD in 38 general practices in Rotherham, UK. Severity of airflow obstruction was categorised by FEV1 (% predicted according to NICE guidelines. This was compared with clinician recorded COPD severity. The proportion of patients whose spirometry met BTS standards was calculated in each practice using a random sub-sample of 761 patients. The Spearman rank correlation between practice level QOF spirometry achievement and performance against BTS spirometry standards was calculated. Results Spirometry as assessed by clinical records was to BTS standards in 31% of cases (range at practice level 0% to 74%. The categorisation of airflow obstruction according to the most recent spirometry results did not agree well with the clinical categorisation of COPD recorded in the notes (Cohen's kappa = 0.34, 0.30 – 0.38. 12% of patients on COPD registers had FEV1 (% predicted results recorded that did not support the diagnosis of COPD. There was no association between quality, as measured by adherence to BTS spirometry standards, and either QOF COPD9 achievement (Spearman's rho = -0.11, or QOF COPD10 achievement (rho = 0.01. Conclusion The UK Quality and Outcomes Framework currently assesses the quantity, but not the quality of spirometry.

  20. Sensitivity of bronchial responsiveness measurements in young infants

    DEFF Research Database (Denmark)

    Loland, Lotte; Buchvald, Frederik F; Halkjaer, Liselotte Brydensholt

    2006-01-01

    of 402 infants (median age, 6 weeks). Forced flow-volume measurements were obtained by the raised volume rapid thoracoabdominal compression technique and were compared with indexes of tidal breathing, measurements of transcutaneous oxygen (Ptco(2)), and auscultation during methacholine challenge testing....... RESULTS: Ptco(2) was the most sensitive parameter to detect increasing airway obstruction during methacholine challenge, followed by forced expiratory volume at 0.5 s (FEV(0.5)). Both were superior to other indexes of forced spirometry as well as tidal breathing indexes and auscultation. Coefficients...

  1. Development of a spirometry T-score in the general population.

    Science.gov (United States)

    Lee, Sei Won; Kim, Hyun Kuk; Baek, Seunghee; Jung, Ji-Ye; Kim, Young Sam; Lee, Jae Seung; Lee, Sang-Do; Mannino, David M; Oh, Yeon-Mok

    2016-01-01

    Spirometry values may be expressed as T-scores in standard deviation units relative to a reference in a young, normal population as an analogy to the T-score for bone mineral density. This study was performed to develop the spirometry T-score. T-scores were calculated from lambda-mu-sigma-derived Z-scores using a young, normal age reference. Three outcomes of all-cause death, respiratory death, and COPD death were evaluated in 9,101 US subjects followed for 10 years; an outcome of COPD-related health care utilization (COPD utilization) was evaluated in 1,894 Korean subjects followed for 4 years. The probability of all-cause death appeared to remain nearly zero until -1 of forced expiratory volume in 1 second (FEV1) T-score but increased steeply where FEV1 T-score reached below -2.5. Survival curves for all-cause death, respiratory death, COPD death, and COPD utilization differed significantly among the groups when stratified by FEV1 T-score (Pspirometry T-score could predict all-cause death, respiratory death, COPD death, and COPD utilization.

  2. Lung volumes and airway resistance in patients with a possible restrictive pattern on spirometry.

    Science.gov (United States)

    Schultz, Kenia; D'Aquino, Luiz Carlos; Soares, Maria Raquel; Gimenez, Andrea; Pereira, Carlos Alberto de Castro

    2016-01-01

    Many patients with proportional reductions in FVC and FEV1 on spirometry show no reduction in TLC. The aim of this study was to evaluate the role that measuring lung volumes and airway resistance plays in the correct classification of patients with a possible restrictive pattern on spirometry. This was a prospective study involving adults with reduced FVC and FEV1, as well as an FEV1/FV(C) ratio within the predicted range. Restrictive lung disease (RLD) was characterized by TLC below the 5th percentile, as determined by plethysmography. Obstructive lung disease (OLD) was characterized by high specific airway resistance, significant changes in post-bronchodilator FEV1, or an FEF25-75% espirometria não têm CPT reduzida. O objetivo deste estudo foi avaliar o papel da medida dos volumes pulmonares e da resistência das vias aéreas para a classificação correta de pacientes com possível restrição à espirometria. Estudo prospectivo de adultos com CVF e VEF1 reduzidos e relação VEF1/CV(F) na faixa prevista. Distúrbio ventilatório restritivo (DVR) foi definido por CPT espirometria. A obstrução ao fluxo aéreo é comum nesses casos.

  3. Effect of e-Learning and Repeated Performance Feedback on Spirometry Test Quality in Family Practice: A Cluster Trial

    Science.gov (United States)

    Schermer, Tjard R.; Akkermans, Reinier P.; Crockett, Alan J.; van Montfort, Marian; Grootens-Stekelenburg, Joke; Stout, Jim W.; Pieters, Willem

    2011-01-01

    PURPOSE Spirometry has become an indispensable tool in primary care to exclude, diagnose, and monitor chronic respiratory conditions, but the quality of spirometry tests in family practices is a reason for concern. Aim of this study was to investigate whether a combination of e-learning and bimonthly performance feedback would improve spirometry test quality in family practices in the course of 1 year. METHODS Our study was a cluster trial with 19 family practices allocated to intervention or control conditions through minimization. Intervention consisted of e-learning and bimonthly feedback reports to practice nurses. Control practices received only the joint baseline workshop. Spirometry quality was assessed by independent lung function technicians. Two outcomes were defined, with the difference between rates of tests with 2 acceptable and repeatable blows being the primary outcome and the difference between rates of tests with 2 acceptable blows being the secondary outcome. We used multilevel logistic regression analysis to calculate odds ratios (ORs) for an adequate test in intervention group practices. RESULTS We analyzed 1,135 tests. Rate of adequate tests was 33% in intervention and 30% in control group practices (OR = 1.3; P=.605). Adequacy of tests did not differ between groups but tended to increase with time: OR = 2.2 (P = .057) after 3 and OR = 2.0 (P = .086) in intervention group practices after 4 feedback reports. When ignoring test repeatability, these differences between the groups were slightly more pronounced: OR = 2.4 (P = .033) after 3 and OR=2.2 (P = .051) after 4 feedback reports. CONCLUSIONS In the course of 1 year, we observed a small and late effect of e-learning and repeated feedback on the quality of spirometry as performed by family practice nurses. This intervention does not seem to compensate the lack of rigorous training and experience in performing spirometry tests in most practices. PMID:21747104

  4. Effect of e-learning and repeated performance feedback on spirometry test quality in family practice: a cluster trial.

    Science.gov (United States)

    Schermer, Tjard R; Akkermans, Reinier P; Crockett, Alan J; van Montfort, Marian; Grootens-Stekelenburg, Joke; Stout, Jim W; Pieters, Willem

    2011-01-01

    Spirometry has become an indispensable tool in primary care to exclude, diagnose, and monitor chronic respiratory conditions, but the quality of spirometry tests in family practices is a reason for concern. Aim of this study was to investigate whether a combination of e-learning and bimonthly performance feedback would improve spirometry test quality in family practices in the course of 1 year. Our study was a cluster trial with 19 family practices allocated to intervention or control conditions through minimization. Intervention consisted of e-learning and bimonthly feedback reports to practice nurses. Control practices received only the joint baseline workshop. Spirometry quality was assessed by independent lung function technicians. Two outcomes were defined, with the difference between rates of tests with 2 acceptable and repeatable blows being the primary outcome and the difference between rates of tests with 2 acceptable blows being the secondary outcome. We used multilevel logistic regression analysis to calculate odds ratios (ORs) for an adequate test in intervention group practices. We analyzed 1,135 tests. Rate of adequate tests was 33% in intervention and 30% in control group practices (OR = 1.3; P=.605). Adequacy of tests did not differ between groups but tended to increase with time: OR = 2.2 (P = .057) after 3 and OR = 2.0 (P = .086) in intervention group practices after 4 feedback reports. When ignoring test repeatability, these differences between the groups were slightly more pronounced: OR = 2.4 (P = .033) after 3 and OR=2.2 (P = .051) after 4 feedback reports. In the course of 1 year, we observed a small and late effect of e-learning and repeated feedback on the quality of spirometry as performed by family practice nurses. This intervention does not seem to compensate the lack of rigorous training and experience in performing spirometry tests in most practices.

  5. Spirometry, questionnaire and electronic medical record based COPD in a population survey: comparing prevalence, level of agreement and associations with potential risk factors.

    NARCIS (Netherlands)

    Borlée, F.; Yzermans, C.J.; Krop, E.; Rooijackers, J.; Aalders, B.; Zock, J.P.; Dijk, C.E. van; Maassen, C.B.M.; Schellevis, F.; Heederik, D.; Smit, L.A.M.

    2017-01-01

    Background: COPD-diagnosis is confirmed by post-bronchodilator (BD) spirometry. However, epidemiological studies often rely on pre-BD spirometry, self-reports, or medical records. This population-based study aims to determine COPD-prevalence based on four different operational definitions and their

  6. General practice variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease in Denmark

    DEFF Research Database (Denmark)

    Koefoed, Mette M; Søndergaard, Jens; Christensen, René dePont

    2013-01-01

    Spirometry testing is essential to confirm an obstructive lung disease, but studies have reported that a large proportion of patients diagnosed with COPD or asthma have no history of spirometry testing. Also, it has been shown that many patients are prescribed medication for obstructive lung...... disease without a relevant diagnosis or spirometry test registered. General practice characteristics have been reported to influence diagnosis and management of several chronic diseases. However, these findings are inconsistent, and it is uncertain whether practice characteristics influence spirometry...... testing among patients receiving medication for obstructive lung disease. The aim of this study was therefore to examine if practice characteristics are associated with spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease....

  7. Analysis of spirometry results in hospitalized patients aged over 65 years

    Directory of Open Access Journals (Sweden)

    Wróblewska I

    2015-06-01

    Full Text Available Izabela Wróblewska,1 Piotr Oleśniewicz,2 Donata Kurpas,3 Mariusz Sołtysik,2 Jerzy Błaszczuk41Faculty of Health Science, Wroclaw Medical University, 2Institute of Tourism and Recreation, University School of Physical Education in Wroclaw, 3Department of Family Medicine, 4Faculty of Postgraduate Medical Training, Wroclaw Medical University, Wroclaw, Lower Silesia, PolandIntroduction and objective: The growing population of the elderly, as well as the occurrence of coexisting diseases and polypharmacy, is the reason why diseases of patients aged ≥65 years belong to the major issues of the contemporary medicine. Among the most frequent diseases of the elderly, there are respiratory system diseases. They are difficult to diagnose because of the patient group specificity, which is the reason for increased mortality among seniors, caused by underdiagnosis. The study objective was to assess the factors influencing spirometry results in hospitalized patients aged ≥65 years with respiratory system disorders.Material and methods: In the research, 217 (100% patients aged ≥65 years who underwent spirometry at the Regional Medical Center of the Jelenia Góra Valley Hospital in Poland were analyzed. In the statistical analysis, the STATISTICA 9.1 program, the t-test, the Shapiro–Wilk test, the ANOVA test, and the Scheffé’s test were applied.Results: The majority of the patients (59.4% were treated in the hospital. The most frequent diagnosis was malignant neoplasm (18%. The study showed a statistically significant dependence between the forced vital capacity (FVC, forced expiratory volume in 1 second (FEV1, and FEV1/FVC parameters and the time of hospitalization, as well as between the FVC and FEV1 parameters and the age of patients. The FVC parameter values turned out to be dependent on the main diagnosis. Highest results were noted in patients with the diagnosis of sleep apnea or benign neoplasm. A low FVC index can reflect restrictive

  8. Integration of electronic nose technology with spirometry: validation of a new approach for exhaled breath analysis.

    Science.gov (United States)

    de Vries, R; Brinkman, P; van der Schee, M P; Fens, N; Dijkers, E; Bootsma, S K; de Jongh, F H C; Sterk, P J

    2015-10-15

    New 'omics'-technologies have the potential to better define airway disease in terms of pathophysiological and clinical phenotyping. The integration of electronic nose (eNose) technology with existing diagnostic tests, such as routine spirometry, can bring this technology to 'point-of-care'. We aimed to determine and optimize the technical performance and diagnostic accuracy of exhaled breath analysis linked to routine spirometry. Exhaled breath was collected in triplicate in healthy subjects by an eNose (SpiroNose) based on five identical metal oxide semiconductor sensor arrays (three arrays monitoring exhaled breath and two reference arrays monitoring ambient air) at the rear end of a pneumotachograph. First, the influence of flow, volume, humidity, temperature, environment, etc, was assessed. Secondly, a two-centre case-control study was performed using diagnostic and monitoring visits in day-to-day clinical care in patients with a (differential) diagnosis of asthma, chronic obstructive pulmonary disease (COPD) or lung cancer. Breathprint analysis involved signal processing, environment correction based on alveolar gradients and statistics based on principal component (PC) analysis, followed by discriminant analysis (Matlab2014/SPSS20). Expiratory flow showed a significant linear correlation with raw sensor deflections (R(2)  =  0.84) in 60 healthy subjects (age 43  ±  11 years). No correlation was found between sensor readings and exhaled volume, humidity and temperature. Exhaled data after environment correction were highly reproducible for each sensor array (Cohen's Kappa 0.81-0.94). Thirty-seven asthmatics (41  ±  14.2 years), 31 COPD patients (66  ±  8.4 years), 31 lung cancer patients (63  ±  10.8 years) and 45 healthy controls (41  ±  12.5 years) entered the cross-sectional study. SpiroNose could adequately distinguish between controls, asthma, COPD and lung cancer patients with cross-validation values

  9. Assessment of Air Pollution Effects on the Respiratory System Based on Pulmonary Function Tests Performed During Spirometry Days.

    Science.gov (United States)

    Dąbrowiecki, Piotr; Mucha, Dominika; Gayer, Anna; Adamkiewicz, Łukasz; Badyda, Artur J

    2015-01-01

    The Polish Spirometry Day is an initiative aimed at increasing awareness of the causes, symptoms, course, and effects that accompany respiratory diseases, especially asthma and chronic obstructive pulmonary disease (COPD). In 2013, the second edition of the Spirometry Day was held. It gathered 180 medical centers and other institution. The final analysis encompassed a total of 1187 persons from 26 different locations, including rural areas, and smaller and larger city agglomerations. Of this total, 755 persons (63.6 %) completed their spirometry tests for the first time in life. Each person fulfilled a questionnaire regarding the personal information, respiratory diseases, symptoms, lifestyle, and a place of residence. In the total group, 234 (19.7 %) cases of bronchial obstruction were diagnosed. A hundred and thirty four persons with obstruction, among those tested for the first time in life (17.8 %), were unaware of their disease. The lowest values of FEV1 and FEF(1)/FVC, corresponding to the highest percentage of persons with obstruction (27.9 %) were observed in small and medium cities (100,000-500,000 inhabitants). There were differences in the prevalence of obstruction depending on the distance of the place of residence from a busy traffic road. A significant decrease of both spirometric variables was observed among people living in cities above 100,000 inhabitants within a distance lower than 50 m from roads. In general, better spirometry results were observed among inhabitants living more than 150 m from main roads.

  10. [Spirometry interpretation feasibility among pre-school children according to the European Respiratory Society and American Thoracic Society Guidelines].

    Science.gov (United States)

    Donaire, Roberto M; González, Scarlett A; Moya, Ana I; Fierro, Laura T; Brockmann, Pablo V; Caussade, Solange L

    2015-01-01

    Spirometry is the most used test to evaluate pulmonary function. Guidelines that defined acceptability and repeatability criteria for its implementation and interpretation among preschoolers were published in 2007. Our objective was to quantify the actual compliance with these criteria among pre-school patients. A review was performed on the baseline spirometry measured in patients aged 2 to 5 years in the Pediatric Respiratory Laboratory of the Pontificia Universidad Católica de Chile, who were admitted due to recurrent or persistent coughing or wheezing. Only those results obtained in patients who took the test for the first time were considered. They were analyzed by international standards. A total of 93 spirometry results (mean age 57.4 ± 8.6 months, 48 males) were obtained, of which 44 (47%) met all acceptable criteria, 87 (93%) obtained expiratory time of ≥ 0.5seconds, and 67 (72%) of the patients had an end-expiratory flow of ≤10% from peak flow. The variation in the measurement of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) was very low (intraclass correlation coefficient > 0.9). It was possible to meet the acceptability and repeatability criteria for spirometry among pre-school children in our Center, which was similar to previous reports. As in older children, this test is fully recommended for pre-school children who require lung function studies. Copyright © 2015. Publicado por Elsevier España, S.L.U.

  11. COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.

    Science.gov (United States)

    Castillo, D; Guayta, R; Giner, J; Burgos, F; Capdevila, C; Soriano, J B; Barau, M; Casan, P

    2009-06-01

    COPD case finding is currently recommended at primary and tertiary care levels only. To evaluate the feasibility of a community pharmacy program for COPD case finding in high-risk customers by means of spirometry. Pilot cross-sectional descriptive study in 13 urban community pharmacies in Barcelona, Spain, from April to May 2007. Customers >40 years old with respiratory symptoms and/or a history of smoking were invited to participate in the study during pharmacists' routine work shifts. High-risk customers were identified by means of a 5-item COPD screening questionnaire based on criteria of the Global Initiative for Chronic Obstructive Lung Disease, and were invited to perform spirometry accordingly. Those with an FEV(1)/FVC ratio less than 0.70 were referred to the hospital for a repeat spirometry. Of the 161 pharmacy customers studied, 100 (62%) scored 3 or more items in the COPD screening questionnaire, and after spirometry, 21 (24%) had an FEV(1)/FVC ratiocustomers of urban community pharmacies is feasible. Similarly to primary care practitioners, pharmacists have access to high-risk, middle-aged subjects who have never been tested for COPD. Pharmacists can help with early detection of COPD if they are correctly trained.

  12. Tracking lung tissue motion and expansion/compression with inverse consistent image registration and spirometry.

    Science.gov (United States)

    Christensen, Gary E; Song, Joo Hyun; Lu, Wei; El Naqa, Issam; Low, Daniel A

    2007-06-01

    Breathing motion is one of the major limiting factors for reducing dose and irradiation of normal tissue for conventional conformal radiotherapy. This paper describes a relationship between tracking lung motion using spirometry data and image registration of consecutive CT image volumes collected from a multislice CT scanner over multiple breathing periods. Temporal CT sequences from 5 individuals were analyzed in this study. The couch was moved from 11 to 14 different positions to image the entire lung. At each couch position, 15 image volumes were collected over approximately 3 breathing periods. It is assumed that the expansion and contraction of lung tissue can be modeled as an elastic material. Furthermore, it is assumed that the deformation of the lung is small over one-fifth of a breathing period and therefore the motion of the lung can be adequately modeled using a small deformation linear elastic model. The small deformation inverse consistent linear elastic image registration algorithm is therefore well suited for this problem and was used to register consecutive image scans. The pointwise expansion and compression of lung tissue was measured by computing the Jacobian of the transformations used to register the images. The logarithm of the Jacobian was computed so that expansion and compression of the lung were scaled equally. The log-Jacobian was computed at each voxel in the volume to produce a map of the local expansion and compression of the lung during the breathing period. These log-Jacobian images demonstrate that the lung does not expand uniformly during the breathing period, but rather expands and contracts locally at different rates during inhalation and exhalation. The log-Jacobian numbers were averaged over a cross section of the lung to produce an estimate of the average expansion or compression from one time point to the next and compared to the air flow rate measured by spirometry. In four out of five individuals, the average log

  13. Tracking lung tissue motion and expansion/compression with inverse consistent image registration and spirometry

    International Nuclear Information System (INIS)

    Christensen, Gary E.; Song, Joo Hyun; Lu, Wei; Naqa, Issam El; Low, Daniel A.

    2007-01-01

    Breathing motion is one of the major limiting factors for reducing dose and irradiation of normal tissue for conventional conformal radiotherapy. This paper describes a relationship between tracking lung motion using spirometry data and image registration of consecutive CT image volumes collected from a multislice CT scanner over multiple breathing periods. Temporal CT sequences from 5 individuals were analyzed in this study. The couch was moved from 11 to 14 different positions to image the entire lung. At each couch position, 15 image volumes were collected over approximately 3 breathing periods. It is assumed that the expansion and contraction of lung tissue can be modeled as an elastic material. Furthermore, it is assumed that the deformation of the lung is small over one-fifth of a breathing period and therefore the motion of the lung can be adequately modeled using a small deformation linear elastic model. The small deformation inverse consistent linear elastic image registration algorithm is therefore well suited for this problem and was used to register consecutive image scans. The pointwise expansion and compression of lung tissue was measured by computing the Jacobian of the transformations used to register the images. The logarithm of the Jacobian was computed so that expansion and compression of the lung were scaled equally. The log-Jacobian was computed at each voxel in the volume to produce a map of the local expansion and compression of the lung during the breathing period. These log-Jacobian images demonstrate that the lung does not expand uniformly during the breathing period, but rather expands and contracts locally at different rates during inhalation and exhalation. The log-Jacobian numbers were averaged over a cross section of the lung to produce an estimate of the average expansion or compression from one time point to the next and compared to the air flow rate measured by spirometry. In four out of five individuals, the average log

  14. Age group classification and gender detection based on forced expiratory spirometry.

    Science.gov (United States)

    Cosgun, Sema; Ozbek, I Yucel

    2015-08-01

    This paper investigates the utility of forced expiratory spirometry (FES) test with efficient machine learning algorithms for the purpose of gender detection and age group classification. The proposed method has three main stages: feature extraction, training of the models and detection. In the first stage, some features are extracted from volume-time curve and expiratory flow-volume loop obtained from FES test. In the second stage, the probabilistic models for each gender and age group are constructed by training Gaussian mixture models (GMMs) and Support vector machine (SVM) algorithm. In the final stage, the gender (or age group) of test subject is estimated by using the trained GMM (or SVM) model. Experiments have been evaluated on a large database from 4571 subjects. The experimental results show that average correct classification rate performance of both GMM and SVM methods based on the FES test is more than 99.3 % and 96.8 % for gender and age group classification, respectively.

  15. Gated CT imaging using a free-breathing respiration signal from flow-volume spirometry

    International Nuclear Information System (INIS)

    D'Souza, Warren D.; Kwok, Young; Deyoung, Chad; Zacharapoulos, Nicholas; Pepelea, Mark; Klahr, Paul; Yu, Cedric X.

    2005-01-01

    Respiration-induced tumor motion is known to cause artifacts on free-breathing spiral CT images used in treatment planning. This leads to inaccurate delineation of target volumes on planning CT images. Flow-volume spirometry has been used previously for breath-holds during CT scans and radiation treatments using the active breathing control (ABC) system. We have developed a prototype by extending the flow-volume spirometer device to obtain gated CT scans using a PQ 5000 single-slice CT scanner. To test our prototype, we designed motion phantoms to compare image quality obtained with and without gated CT scan acquisition. Spiral and axial (nongated and gated) CT scans were obtained of phantoms with motion periods of 3-5 s and amplitudes of 0.5-2 cm. Errors observed in the volume estimate of these structures were as much as 30% with moving phantoms during CT simulation. Application of motion-gated CT with active breathing control reduced these errors to within 5%. Motion-gated CT was then implemented in patients and the results are presented for two clinical cases: lung and abdomen. In each case, gated scans were acquired at end-inhalation, end-exhalation in addition to a conventional free-breathing (nongated) scan. The gated CT scans revealed reduced artifacts compared with the conventional free-breathing scan. Differences of up to 20% in the volume of the structures were observed between gated and free-breathing scans. A comparison of the overlap of structures between the gated and free-breathing scans revealed misalignment of the structures. These results demonstrate the ability of flow-volume spirometry to reduce errors in target volumes via gating during CT imaging

  16. CT-derived Biomechanical Metrics Improve Agreement Between Spirometry and Emphysema.

    Science.gov (United States)

    Bhatt, Surya P; Bodduluri, Sandeep; Newell, John D; Hoffman, Eric A; Sieren, Jessica C; Han, Meilan K; Dransfield, Mark T; Reinhardt, Joseph M

    2016-10-01

    Many patients with chronic obstructive pulmonary disease (COPD) have marked discordance between forced expiratory volume in 1 second (FEV1) and degree of emphysema on computed tomography (CT). Biomechanical differences between these patients have not been studied. We aimed to identify reasons for the discordance between CT and spirometry in some patients with COPD. Subjects with Global initiative for chronic Obstructive Lung Disease stages I-IV from a large multicenter study (The Genetic Epidemiology of COPD) were arranged by percentiles of %predicted FEV1 and emphysema on CT. Three categories were created using differences in percentiles: Catspir with predominant airflow obstruction/minimal emphysema, CatCT with predominant emphysema/minimal airflow obstruction, and Catmatched with matched FEV1 and emphysema. Image registration was used to derive Jacobian determinants, a measure of lung elasticity, anisotropy, and strain tensors, to assess biomechanical differences between groups. Regression models were created with the previously mentioned categories as outcome variable, adjusting for demographics, scanner type, quantitative CT-derived emphysema, gas trapping, and airway thickness (model 1), and after adding biomechanical CT metrics (model 2). Jacobian determinants, anisotropy, and strain tensors were strongly associated with FEV1. With Catmatched as control, model 2 predicted Catspir and CatCT better than model 1 (Akaike information criterion 255.8 vs. 320.8). In addition to demographics, the strongest independent predictors of FEV1 were Jacobian mean (β = 1.60,95%confidence intervals [CI] = 1.16 to 1.98; P spirometry, offering the potential for new insights into the linkage between regional parenchymal destruction and global decrement in lung function in patients with COPD. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  17. CT-derived Biomechanical Metrics Improve Agreement Between Spirometry and Emphysema

    Science.gov (United States)

    Bhatt, Surya P.; Bodduluri, Sandeep; Newell, John D.; Hoffman, Eric A.; Sieren, Jessica C.; Han, Meilan K.; Dransfield, Mark T.; Reinhardt, Joseph M.

    2016-01-01

    Rationale and Objectives Many COPD patients have marked discordance between FEV1 and degree of emphysema on CT. Biomechanical differences between these patients have not been studied. We aimed to identify reasons for the discordance between CT and spirometry in some patients with COPD. Materials and Methods Subjects with GOLD stage I–IV from a large multicenter study (COPDGene) were arranged by percentiles of %predicted FEV1 and emphysema on CT. Three categories were created using differences in percentiles: Catspir with predominant airflow obstruction/minimal emphysema, CatCT with predominant emphysema/minimal airflow obstruction, and Catmatched with matched FEV1 and emphysema. Image registration was used to derive Jacobian determinants, a measure of lung elasticity, anisotropy and strain tensors, to assess biomechanical differences between groups. Regression models were created with the above categories as outcome variable, adjusting for demographics, scanner type, quantitative CT-derived emphysema, gas trapping, and airway thickness (Model 1), and after adding biomechanical CT metrics (Model 2). Results Jacobian determinants, anisotropy and strain tensors were strongly associated with FEV1. With Catmatched as control, Model 2 predicted Catspir and CatCT better than Model 1 (Akaike Information Criterion, AIC 255.8 vs. 320.8). In addition to demographics, the strongest independent predictors of FEV1 were Jacobian mean (β= 1.60,95%CI = 1.16 to 1.98; p<0.001), coefficient of variation (CV) of Jacobian (β= 1.45,95%CI = 0.86 to 2.03; p<0.001) and CV strain (β= 1.82,95%CI = 0.68 to 2.95; p = 0.001). CVs of Jacobian and strain are both potential markers of biomechanical lung heterogeneity. Conclusions CT-derived measures of lung mechanics improve the link between quantitative CT and spirometry, offering the potential for new insights into the linkage between regional parenchymal destruction and global decrement in lung function in COPD patients. PMID:27055745

  18. Polynomial estimation of the smoothing splines for the new Finnish reference values for spirometry.

    Science.gov (United States)

    Kainu, Annette; Timonen, Kirsi

    2016-07-01

    Background Discontinuity of spirometry reference values from childhood into adulthood has been a problem with traditional reference values, thus modern modelling approaches using smoothing spline functions to better depict the transition during growth and ageing have been recently introduced. Following the publication of the new international Global Lung Initiative (GLI2012) reference values also new national Finnish reference values have been calculated using similar GAMLSS-modelling, with spline estimates for mean (Mspline) and standard deviation (Sspline) provided in tables. The aim of this study was to produce polynomial estimates for these spline functions to use in lieu of lookup tables and to assess their validity in the reference population of healthy non-smokers. Methods Linear regression modelling was used to approximate the estimated values for Mspline and Sspline using similar polynomial functions as in the international GLI2012 reference values. Estimated values were compared to original calculations in absolute values, the derived predicted mean and individually calculated z-scores using both values. Results Polynomial functions were estimated for all 10 spirometry variables. The agreement between original lookup table-produced values and polynomial estimates was very good, with no significant differences found. The variation slightly increased in larger predicted volumes, but a range of -0.018 to +0.022 litres of FEV1 representing ± 0.4% of maximum difference in predicted mean. Conclusions Polynomial approximations were very close to the original lookup tables and are recommended for use in clinical practice to facilitate the use of new reference values.

  19. Quantitative computed tomography versus spirometry in predicting air leak duration after major lung resection for cancer.

    Science.gov (United States)

    Ueda, Kazuhiro; Kaneda, Yoshikazu; Sudo, Manabu; Mitsutaka, Jinbo; Li, Tao-Sheng; Suga, Kazuyoshi; Tanaka, Nobuyuki; Hamano, Kimikazu

    2005-11-01

    Emphysema is a well-known risk factor for developing air leak or persistent air leak after pulmonary resection. Although quantitative computed tomography (CT) and spirometry are used to diagnose emphysema, it remains controversial whether these tests are predictive of the duration of postoperative air leak. Sixty-two consecutive patients who were scheduled to undergo major lung resection for cancer were enrolled in this prospective study to define the best predictor of postoperative air leak duration. Preoperative factors analyzed included spirometric variables and area of emphysema (proportion of the low-attenuation area) that was quantified in a three-dimensional CT lung model. Chest tubes were removed the day after disappearance of the air leak, regardless of pleural drainage. Univariate and multivariate proportional hazards analyses were used to determine the influence of preoperative factors on chest tube time (air leak duration). By univariate analysis, site of resection (upper, lower), forced expiratory volume in 1 second, predicted postoperative forced expiratory volume in 1 second, and area of emphysema ( 10%) were significant predictors of air leak duration. By multivariate analysis, site of resection and area of emphysema were the best independent determinants of air leak duration. The results were similar for patients with a smoking history (n = 40), but neither forced expiratory volume in 1 second nor predicted postoperative forced expiratory volume in 1 second were predictive of air leak duration. Quantitative CT is superior to spirometry in predicting air leak duration after major lung resection for cancer. Quantitative CT may aid in the identification of patients, particularly among those with a smoking history, requiring additional preventive procedures against air leak.

  20. Short- and long-term effectiveness of a supervised training program in spirometry use for primary care professionals.

    Science.gov (United States)

    Represas-Represas, Cristina; Botana-Rial, Maribel; Leiro-Fernández, Virginia; González-Silva, Ana Isabel; García-Martínez, Ana; Fernández-Villar, Alberto

    2013-09-01

    Despite the importance of spirometry, its use and quality are limited in the Primary Care setting. There are few accredited training programs that have demonstrated improvement in the quality of spirometric studies. In this paper, we analyze the short- and long-term effectiveness of a supervised training program for performing and interpreting spirometries. Ours is an intervention study with before and after measurements. The target population included teams of physicians and nursing staff at 26 health-care centers in the area of Vigo (Galicia, Spain). The structured training program involved 2 theoretical and practical training sessions (that were 2months apart), an intermediate period of 30 supervised spirometries performed in the respective centers and weekly e-mail exercises. Effectiveness was evaluated using exercises at the beginning (test 1) and the end (test 2) of the 1st day, 2nd day (test 3) and one year later (test 4), as well as the analysis of spirometries done in month1, month2 and one year later. Participants also completed a survey about their satisfaction. 74 participants initiated the program; 72 completed the program, but only 45 participated in the one-year evaluation. Mean test scores were: 4.1±1.9 on test 1; 7.5±1.6 on test 2; 8.9±1.3 on test 3, and 8.8±1.4 on test 4. During month1, the percentage of correctly done/interpreted tests was 71%, in month two it was 91% and after one year it was 83% (Ptraining program based on theoretical and practical workshops and a supervised follow-up of spirometries significantly improved the ability of Primary Care professionals to carry out and interpret spirometric testing, although the quality of the tests diminished over time. Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.

  1. Onset of relief of dyspnoea with budesonide/formoterol or salbutamol following methacholine-induced severe bronchoconstriction in adults with asthma: a double-blind, placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Bantje Theo A

    2006-12-01

    Full Text Available Abstract Background The long-acting β2-agonist (LABA formoterol has an onset of effect comparable to that of salbutamol. Consequently, the combination of formoterol and budesonide in one inhaler, approved for maintenance use, can potentially be used for reliever therapy. This study compared the onset of relief from induced bronchospasm with a single dose of budesonide/formoterol versus standard salbutamol therapy in patients with asthma. Methods In this randomised, double-blind, placebo-controlled, cross-over study, 32 patients with asthma underwent a methacholine provocation test leading to a fall in forced expiratory volume in 1 second (FEV1 of ≥30% at enrolment (Visit 1 and three subsequent study visits (Visits 2–4. Immediately after each provocation at Visits 2–4, patients received one of three test treatments: one inhalation of budesonide/formoterol 160/4.5 μg (via Turbuhaler®, two inhalations of salbutamol 100 μg (via a pressurised metered-dose inhaler [pMDI] or placebo. All patients received each of the test treatments in a randomised order, after separate methacholine provocations. The effect of treatment on FEV1 and breathlessness (using the Borg scale was measured at 1, 3, 5, 10, 15, 20, 25 and 30 minutes after test treatment. Results Following methacholine provocation, Borg score increased from a baseline value of below 0.5 to 3.03, 3.31 and 3.50 before treatment with budesonide/formoterol, salbutamol and placebo, respectively. Budesonide/formoterol and salbutamol reversed methacholine-induced dyspnoea (breathlessness rapidly. At 1 minute after inhalation, statistically significant decreases in Borg score were observed for budesonide/formoterol and salbutamol (p = 0.0233 and p 1 (both active treatments p Conclusion Single doses of budesonide/formoterol and salbutamol both provided rapid relief of dyspnoea and reversal of severe airway obstruction in patients with asthma with experimentally induced bronchoconstriction. The

  2. Studies on the correlation between pre-and post-operative perfusion scintigraphy and differential spirometry in operated lungs

    International Nuclear Information System (INIS)

    Kaseda, Shizuka; Ikeda, Takaaki; Sakai, Tadaaki; Tomaru, Hiroko; Ishihara, Tsuneo; Kikuchi, Keiichi.

    1982-01-01

    For the purpose of clarifying the relationship between the percentage of perfusion and that of vital capacity or oxygen uptake on the affected lung, perfusion scintigraphy using sup(99m)Tc-MAA and differential spirometry were performed in twenty patients including sixteen patients with lung cancer. Both examinations were performed before and after the operation. The results are as follows: (1) There is a significant correlation between the percentage of perfusion and that of vital capacity or oxygen uptake of the affected lung before and after the operation. (2) The estimation of the percentage of vital capacity or oxygen uptake of the affected lung is possible by combining the spirometry and sup(99m)Tc-MAA pulmonary scintigraphy. (author)

  3. Correlation of single-breath count test and neck flexor muscle strength with spirometry in myasthenia gravis.

    Science.gov (United States)

    Elsheikh, Bakri; Arnold, W David; Gharibshahi, Shahram; Reynolds, Jerold; Freimer, Miriam; Kissel, John T

    2016-01-01

    Although formal spirometry is the gold standard for monitoring respiratory function in patients with myasthenia gravis (MG), such testing is often delayed or unavailable. There is a need for a simple bedside test that can accurately measure respiratory function. We conducted a prospective, cross-sectional, single-blind study in adults with acetylcholine receptor antibody positive MG. Participants performed the single breath count test (SBCT) and underwent manual muscle strength testing, and a respiratory therapist performed spirometry blinded to SBCT and strength results. Thirty-one patients, aged 57 ± 19 years participated. SBCT showed significant correlations with forced vital capacity (FVC), negative inspiratory force, and neck flexor strength (P strength (P = 0.02) but no correlation with shoulder abductor strength. These data suggest that the SBCT and neck flexor strength testing are valuable tools for bedside assessment of respiratory function in MG patients. © 2015 Wiley Periodicals, Inc.

  4. In vitro and in vivo evaluation of a new large animal spirometry device using mainstream CO2 flow sensors.

    Science.gov (United States)

    Ambrisko, T D; Lammer, V; Schramel, J P; Moens, Y P S

    2014-07-01

    A spirometry device equipped with mainstream CO2 flow sensor is not available for large animal anaesthesia. To measure the resistance of a new large animal spirometry device and assess its agreement with reference methods for volume measurements. In vitro experiment and crossover study using anaesthetised horses. A flow partitioning device (FPD) equipped with 4 human CO2 flow sensors was tested. Pressure differences were measured across the whole FPD and across each sensor separately using air flows (range: 90-720 l/min). One sensor was connected to a spirometry monitor for in vitro volume (3, 5 and 7 l) measurements. These measurements were compared with a reference method. Five anaesthetised horses were used for tidal volume (VT) measurements using the FPD and a horse-lite sensor (reference method). Bland-Altman analysis, ANOVA and linear regression analysis were used for data analysis. Pressure differences across each sensor were similar suggesting equal flow partitioning. The resistance of the device increased with flow (range: 0.3-1.5 cmH2 O s/l) and was higher than that of the horse-lite. The limits of agreement for volume measurements were within -1 and 2% in vitro and -12 and 0% in vivo. Nine of 147 VT measurements in horses were outside of the ± 10% limits of acceptance but most of these erroneous measurements occurred with VTs lower than 4 l. The determined correction factor for volume measurements was 3.97 ± 0.03. The limits of agreement for volume measurements by the new device were within ± 10% using clinically relevant range of volumes. The new spirometry device can be recommended for measurement of VT in adult Warmblood horses. © 2013 EVJ Ltd.

  5. Daily home-based spirometry during withdrawal of inhaled corticosteroid in severe to very severe chronic obstructive pulmonary disease.

    Science.gov (United States)

    Rodriguez-Roisin, Roberto; Tetzlaff, Kay; Watz, Henrik; Wouters, Emiel Fm; Disse, Bernd; Finnigan, Helen; Magnussen, Helgo; Calverley, Peter Ma

    2016-01-01

    The WISDOM study (NCT00975195) reported a change in lung function following withdrawal of fluticasone propionate in patients with severe to very severe COPD treated with tiotropium and salmeterol. However, little is known about the validity of home-based spirometry measurements of lung function in COPD. Therefore, as part of this study, following suitable training, patients recorded daily home-based spirometry measurements in addition to undergoing periodic in-clinic spirometric testing throughout the study duration. We subsequently determined the validity of home-based spirometry for detecting changes in lung function by comparing in-clinic and home-based forced expiratory volume in 1 second in patients who underwent stepwise fluticasone propionate withdrawal over 12 weeks versus patients remaining on fluticasone propionate for 52 weeks. Bland-Altman analysis of these data confirmed good agreement between in-clinic and home-based measurements, both across all visits and at the individual visits at study weeks 6, 12, 18, and 52. There was a measurable difference between the forced expiratory volume in 1 second values recorded at home and in the clinic (mean difference of -0.05 L), which may be due to suboptimal patient effort in performing unsupervised recordings. However, this difference remained consistent over time. Overall, these data demonstrate that home-based and in-clinic spirometric measurements were equally valid and reliable for assessing lung function in patients with COPD, and suggest that home-based spirometry may be a useful tool to facilitate analysis of changes in lung function on a day-to-day basis.

  6. INCENTIVE SPIROMETRY AND BREATHING EXERCISES WERE NOT ABLE TO IMPROVE RESTRICTIVE PULMONARY CHARACTERISTICS INDUCED BY WATER IMMERSION IN HEALTHY SUBJECTS

    OpenAIRE

    Aline A. Vepo,; Caroline S. Martinez; Giulia A. Wiggers; Franck M. Peçanha

    2016-01-01

    pulmonary volumes and capacities which could be at least in part similar to that happen in healthy individuals during water immersion. Objectives: To investigate if respiratory effects of water immersion are partially due to enhanced return venous from legs and arms and if physiotherapeutic techniques incentive spirometry (IS) and breathing exercises (BE) are able to improve pulmonary volumes and capacities in healthy subjects during water immersion. Design: Randomised, within-partici...

  7. Reference Values for Spirometry Derived Using Lambda, Mu, Sigma (LMS) Method in Korean Adults: in Comparison with Previous References.

    Science.gov (United States)

    Jo, Bum Seak; Myong, Jun Pyo; Rhee, Chin Kook; Yoon, Hyoung Kyu; Koo, Jung Wan; Kim, Hyoung Ryoul

    2018-01-15

    The present study aimed to update the prediction equations for spirometry and their lower limits of normal (LLN) by using the lambda, mu, sigma (LMS) method and to compare the outcomes with the values of previous spirometric reference equations. Spirometric data of 10,249 healthy non-smokers (8,776 females) were extracted from the fourth and fifth versions of the Korea National Health and Nutrition Examination Survey (KNHANES IV, 2007-2009; V, 2010-2012). Reference equations were derived using the LMS method which allows modeling skewness (lambda [L]), mean (mu [M]), and coefficient of variation (sigma [S]). The outcome equations were compared with previous reference values. Prediction equations were presented in the following form: predicted value = e{a + b × ln(height) + c × ln(age) + M - spline}. The new predicted values for spirometry and their LLN derived using the LMS method were shown to more accurately reflect transitions in pulmonary function in young adults than previous prediction equations derived using conventional regression analysis in 2013. There were partial discrepancies between the new reference values and the reference values from the Global Lung Function Initiative in 2012. The results should be interpreted with caution for young adults and elderly males, particularly in terms of the LLN for forced expiratory volume in one second/forced vital capacity in elderly males. Serial spirometry follow-up, together with correlations with other clinical findings, should be emphasized in evaluating the pulmonary function of individuals. Future studies are needed to improve the accuracy of reference data and to develop continuous reference values for spirometry across all ages. © 2018 The Korean Academy of Medical Sciences.

  8. Overall and peripheral lung function assessment by spirometry and forced oscillation technique in relation to asthma diagnosis and control.

    Science.gov (United States)

    Heijkenskjöld Rentzhog, C; Janson, C; Berglund, L; Borres, M P; Nordvall, L; Alving, K; Malinovschi, A

    2017-12-01

    Classic spirometry is effort dependent and of limited value in assessing small airways. Peripheral airway involvement, and relation to poor control, in asthma, has been highlighted recently. Forced oscillation technique (FOT) offers an effort-independent assessment of overall and peripheral lung mechanics. We studied the association between lung function variables, obtained either by spirometry or multifrequency (5, 11 and 19 Hz) FOT, and asthma diagnosis and control. Spirometry measures, resistance at 5 (R5) and 19 Hz (R19), reactance at 5 Hz (X5), resonant frequency (f res ), resistance difference between 5-19 Hz (R5-R19) and Asthma Control Test scores were determined in 234 asthmatic and 60 healthy subjects (aged 13-39 years). We used standardized lung function variables in logistic regression analyses, unadjusted and adjusted for age, height, gender and weight. Lower FEV 1 /FVC (OR [95% CI] 0.47 [0.32, 0.69]) and FEF 50 (0.62 [0.46, 0.85]) per standard deviation increase, and higher R5 (3.31 [1.95, 5.62]) and R19 (2.54 [1.65, 3.91]) were associated with asthma diagnosis. Independent predictive effects of FEV 1 /FVC and R5 or R19, respectively, were found for asthma diagnosis. Lower FEV 1 /FVC and altered peripheral FOT measures (X5, f res and R5-R19) were associated with uncontrolled asthma (P-values < .05). Resistance FOT measures were equally informative as spirometry, related to asthma diagnosis, and, furthermore, offered additive information to FEV 1 /FVC, supporting a complementary role for FOT. Asthma control was related to FOT measures of peripheral airways, suggesting a potential use in identifying such involvement. Further studies are needed to determine a clinical value and relevant reference values in children, for the multifrequency FOT measurements. © 2017 John Wiley & Sons Ltd.

  9. Predictors of poor-quality spirometry in two cohorts of older adults in Russia and Belgium: a cross-sectional study.

    Science.gov (United States)

    Turkeshi, Eralda; Zelenukha, Dmitry; Vaes, Bert; Andreeva, Elena; Frolova, Elena; Degryse, Jean-Marie

    2015-07-23

    Spirometry is an important test for the diagnosis of respiratory diseases, yet it is underused especially in older adults. Several predictors of good-quality spirometry in this age group have been reported, based mainly on in/outpatients of geriatric and/or respiratory units. This study aims to assess predictors of poor-quality spirometry in community-dwelling older adults from two primary care cohorts in Russia and Belgium. Spirograms from two population-based cohort studies in Russia (CRYSTAL) and Belgium (BELFRAIL) were assessed in accordance with the American Thoracic Society/European Respiratory Society (ATS/ERS) acceptability and repeatability criteria and grouped into good and poor quality. Multivariable analysis assessed the association of poor-quality spirometry with socio-demographics, functional dependency, physical and mental functioning and co-morbidities. In all, 43.3% of the 522 BELFRAIL participants (84.71 ± 3.67 years old) and 57.7% of the 605 CRYSTAL participants (75.11 ± 5.97 years old) achieved all ATS/ERS acceptability and repeatability criteria. In both cohorts, those with poor-quality spirometry had lower cognitive function (mini-mental state examination (MMSE) ⩽ 24). After adjustment in multivariable analysis, MMSE ⩽ 24 had an odds ratio for poor-quality spirometry of 1.33 (95% CI = 0.78-2.28) in the BELFRAIL and 1.30 (95% CI = 0.88-1.91) in the CRYSTAL cohort. In community-dwelling older adults, including those over 80 years old, impaired cognition measured by the MMSE may not be an independent predictor of poor-quality spirometry. Further research is needed in this area, and spirometry should be used more often in older adults in primary care.

  10. Differences in spirometry values between U.S. children 6-11 years and adolescents 12-19 years with current asthma, 2007-2010.

    Science.gov (United States)

    Kit, Brian K; Simon, Alan E; Tilert, Timothy; Okelo, Sande; Akinbami, Lara J

    2016-03-01

    National Asthma Education and Prevention Program (NAEPP) guidelines recommend that periodic spirometry be performed in youth with asthma. NAEPP uses different spirometry criteria to define uncontrolled asthma for children (6-11 years) and adolescents (12+ years). To describe differences in spirometry between U.S. children and adolescents with current asthma. We examined cross-sectional spirometry data from 453 U.S. youth with current asthma age 6-19 years from the 2007-2010 National Health and Nutrition Examination Surveys. The main outcomes were percentage predicted forced expiratory volume at 1 sec (FEV1%) ≤80 and the ratio of FEV1 to forced vital capacity (FEV1/FVC) ≤0.80. We also examined the prevalence of youth with spirometry values consistent with uncontrolled asthma, using NAEPP age-specific criteria, defined for children aged 6-11 years as FEV1% ≤80 or FEV1/FVC ≤0.80, and for adolescents aged 12-19 years as FEV1% ≤80. Children 6-11 years and adolescents 12-19 years did not differ in prevalence of FEV1% ≤80 (10.1% vs. 9.0%) or FEV1/FVC ≤0.80 (30.6% vs. 29.8%). However, based on the NAEPP age-specific criteria, 33.0% of children 6-11 years and 9.0% of adolescents 12-19 years had spirometry values consistent with uncontrolled asthma (P spirometry values consistent with uncontrolled asthma did differ. The difference appears to stem mainly from the different spirometry criteria for the two age groups. © 2015 Wiley Periodicals, Inc.

  11. Assessment of five different guideline indication criteria for spirometry, including modified GOLD criteria, in order to detect COPD: data from 5,315 subjects in the PLATINO study.

    Science.gov (United States)

    Luize, Ana P; Menezes, Ana Maria B; Perez-Padilla, Rogelio; Muiño, Adriana; López, Maria Victorina; Valdivia, Gonzalo; Lisboa, Carmem; Montes de Oca, Maria; Tálamo, Carlos; Celli, Bartolomé; Nascimento, Oliver A; Gazzotti, Mariana R; Jardim, José R

    2014-10-30

    Spirometry is the gold standard for diagnosing chronic obstructive pulmonary disease (COPD). Although there are a number of different guideline criteria for deciding who should be selected for spirometric screening, to date it is not known which criteria are the best based on sensitivity and specificity. Firstly, to evaluate the proportion of subjects in the PLATINO Study that would be recommended for spirometry testing according to Global initiative for Obstructive Lung Disease (GOLD)-modified, American College of Chest Physicians (ACCP), National Lung Health Education Program (NLHEP), GOLD and American Thoracic Society/European Respiratory Society (ATS/ERS) criteria. Secondly, we aimed to compare the sensitivity, specificity, and positive predictive and negative predictive values, of these five different criteria. Data from the PLATINO study included information on respiratory symptoms, smoking and previous spirometry testing. The GOLD-modified spirometry indication criteria are based on three positive answers out of five questions: the presence of cough, phlegm in the morning, dyspnoea, age over 40 years and smoking status. Data from 5,315 subjects were reviewed. Fewer people had an indication for spirometry (41.3%) according to the GOLD-modified criteria, and more people had an indication for spirometry (80.4%) by the GOLD and ATS/ERS criteria. A low percentage had previously had spirometry performed: GOLD-modified (14.5%); ACCP (13.2%); NLHEP (12.6%); and GOLD and ATS/ERS (12.3%). The GOLD-modified criteria showed the least sensitivity (54.9) and the highest specificity (61.0) for detecting COPD, whereas GOLD and ATS/ERS criteria showed the highest sensitivity (87.9) and the least specificity (20.8). There is a considerable difference in the indication for spirometry according to the five different guideline criteria. The GOLD-modified criteria recruit less people with the greatest sum of sensitivity and specificity.

  12. Prediction equations for spirometry in four- to six-year-old children.

    Science.gov (United States)

    França, Danielle Corrêa; Camargos, Paulo Augusto Moreira; Jones, Marcus Herbert; Martins, Jocimar Avelar; Vieira, Bruna da Silva Pinto Pinheiro; Colosimo, Enrico Antônio; de Mendonça, Karla Morganna Pereira Pinto; Borja, Raíssa de Oliveira; Britto, Raquel Rodrigues; Parreira, Verônica Franco

    2016-01-01

    To generate prediction equations for spirometry in 4- to 6-year-old children. Forced vital capacity, forced expiratory volume in 0.5s, forced expiratory volume in one second, peak expiratory flow, and forced expiratory flow at 25-75% of the forced vital capacity were assessed in 195 healthy children residing in the town of Sete Lagoas, state of Minas Gerais, Southeastern Brazil. The least mean squares method was used to derive the prediction equations. The level of significance was established as p<0.05. Overall, 85% of the children succeeded in performing the spirometric maneuvers. In the prediction equation, height was the single predictor of the spirometric variables as follows: forced vital capacity=exponential [(-2.255)+(0.022×height)], forced expiratory volume in 0.5s=exponential [(-2.288)+(0.019×height)], forced expiratory volume in one second=exponential [(-2.767)+(0.026×height)], peak expiratory flow=exponential [(-2.908)+(0.019×height)], and forced expiratory flow at 25-75% of the forced vital capacity=exponential [(-1.404)+(0.016×height)]. Neither age nor weight influenced the regression equations. No significant differences in the predicted values for boys and girls were observed. The predicted values obtained in the present study are comparable to those reported for preschoolers from both Brazil and other countries. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  13. Spirometry and volumetric capnography in lung function assessment of obese and normal-weight individuals without asthma.

    Science.gov (United States)

    Ferreira, Mariana S; Mendes, Roberto T; Marson, Fernando A L; Zambon, Mariana P; Antonio, Maria A R G M; Paschoal, Ilma A; Toro, Adyléia A D C; Severino, Silvana D; Ribeiro, Maria A G O; Ribeiro, José D

    To analyze and compare lung function of obese and healthy, normal-weight children and adolescents, without asthma, through spirometry and volumetric capnography. Cross-sectional study including 77 subjects (38 obese) aged 5-17 years. All subjects underwent spirometry and volumetric capnography. The evaluations were repeated in obese subjects after the use of a bronchodilator. At the spirometry assessment, obese individuals, when compared with the control group, showed lower values of forced expiratory volume in the first second by forced vital capacity (FEV 1 /FVC) and expiratory flows at 75% and between 25 and 75% of the FVC (p11 years (p<0.05). Even without the diagnosis of asthma by clinical criteria and without response to bronchodilator use, obese individuals showed lower FEV 1 /FVC values and forced expiratory flow, indicating the presence of an obstructive process. Volumetric capnography showed that obese individuals had higher alveolar tidal volume, with no alterations in ventilation homogeneity, suggesting flow alterations, without affecting lung volumes. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  14. The development of a community-based spirometry service in the Canterbury region of New Zealand: observations on new service delivery.

    Science.gov (United States)

    Epton, Michael J; Stanton, Josh D; McGeoch, Graham R B; Shand, Brett I; Swanney, Maureen P

    2015-03-05

    In 2008, as part of the changes to develop integrated health care services in the Canterbury region of New Zealand, the local health board in collaboration with general practitioners, respiratory specialists and scientists introduced a programme for general practices to provide laboratory-quality spirometry in the community. The service adhered to the 2005 ATS/ERS international spirometry standards. The spirometry service was provided by trained practice nurses and community respiratory nurses, and was monitored and quality assured by certified respiratory scientists in the Respiratory Physiology Laboratory, Christchurch Hospital and CISO (Canterbury Initiative Services Organisation). These two organisations were responsible for organising training seminars and refresher courses on spirometry technique and interpretation of results. A total of 10 practices have now become approved spirometry providers, with the number of tests carried out in the primary care setting increasing gradually. Consistently high-quality spirometry tests have been obtained and are now presented on a centrally available results database for all hospital and community clinicians to review. Although the service has proved to be more convenient for patients, the tests have not been delivered as quickly as those carried out by the Respiratory Physiology Laboratory. However, the time scales for testing achieved by the community service is considered suitable for investigation of chronic disease. The success of the service has been dependent on several key factors including hospital and clinical support and a centralised quality assurance programme, a comprehensive training schedule and online clinical guidance and close integration between primary and secondary care clinicians.

  15. Assessment of serology and spirometry and the combination of both to complement microbiological isolation for earlier detection of Pseudomonas aeruginosa infection in children with cystic fibrosis.

    Science.gov (United States)

    Kotnik Pirš, Ana; Krivec, Uroš; Simčič, Saša; Seme, Katja

    2016-11-25

    The aim of this study was to assess whether serology and spirometry and the combination of both can complement culture-based detection for earlier recognition of Pseudomonas aeruginosa infection in children with cystic fibrosis. A 4 year longitudinal prospective study that included 67 Slovenian children with cystic fibrosis with a mean age of 10.5 years was conducted. Serology, spirometry and a scoring system combining serology and spirometry were assessed and compared. Infection was confirmed with isolation of Pseudomonas aeruginosa from respiratory samples. There was a significantly positive correlation between serology and the combination of serology and spirometry and Pseudomonas aeruginosa isolation (P spirometry and Pseudomonas aeruginosa isolation (P spirometry the highest sensitivity (0.90). Both had a high negative predictive value (0.93 and 0.79 respectively). Using serology and the combination of serology and lung function measurement can be beneficial for earlier detection of infection with Pseudomonas aeruginosa in children with cystic fibrosis when done simultaneously with standard culture-based detection from respiratory samples.

  16. Reference values for spirometry and their use in test interpretation: A Position Statement from the Australian and New Zealand Society of Respiratory Science.

    Science.gov (United States)

    Brazzale, Danny; Hall, Graham; Swanney, Maureen P

    2016-10-01

    Traditionally, spirometry testing tended to be confined to the realm of hospital-based laboratories but is now performed in a variety of health care settings. Regardless of the setting in which the test is conducted, the fundamental basis of spirometry is that the test is both performed and interpreted according to the international standards. The purpose of this Australian and New Zealand Society of Respiratory Science (ANZSRS) statement is to provide the background and recommendations for the interpretation of spirometry results in clinical practice. This includes the benchmarking of an individual's results to population reference data, as well as providing the platform for a statistically and conceptually based approach to the interpretation of spirometry results. Given the many limitations of older reference equations, it is imperative that the most up-to-date and relevant reference equations are used for test interpretation. Given this, the ANZSRS recommends the adoption of the Global Lung Function Initiative (GLI) 2012 spirometry reference values throughout Australia and New Zealand. The ANZSRS also recommends that interpretation of spirometry results is based on the lower limit of normal from the reference values and the use of Z-scores where available. © 2016 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

  17. Analysis of the influence of respiratory disorders observed in preoperative spirometry on the dynamics of early inflammatory response in patients undergoing isolated coronary artery bypass grafting.

    Science.gov (United States)

    Szylińska, Aleksandra; Listewnik, Mariusz J; Rotter, Iwona; Rył, Aleksandra; Biskupski, Andrzej; Brykczyński, Mirosław

    2017-01-01

    Preoperative spirometry provides measurable information about the occurrence of respiratory disorders. The aim of this study was to assess the association between preoperative spirometry abnormalities and the intensification of early inflammatory responses in patients following coronary artery bypass graft in extracorporeal circulation. The study involved 810 patients (625 men and 185 women) aged 65.4±7.9 years who were awaiting isolated coronary artery bypass surgery. On the basis of spirometry performed on the day of admittance to the hospital, the patients were divided into three groups. Patients without respiratory problems constituted 78.8% of the entire group. Restricted breathing was revealed by spirometry in 14.9% and obstructive breathing in 6.3% of patients. Inter-group analysis showed statistically significant differences in C-reactive protein (CRP) between patients with restrictive spirometry abnormalities and patients without any pulmonary dysfunction. CRP concentrations differed before surgery ( P =0.006) and on the second ( P spirometry results from restrictive respiratory disorders have an elevated level of generalized inflammatory response both before and after the isolated coronary artery bypass surgery. Therefore, this group of patients should be given special postoperative monitoring and, in particular, intensive respiratory rehabilitation immediately after reconstitution.

  18. Daily home-based spirometry during withdrawal of inhaled corticosteroid in severe to very severe chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Rodriguez-Roisin R

    2016-08-01

    Full Text Available Roberto Rodriguez-Roisin,1 Kay Tetzlaff,2,3 Henrik Watz,4 Emiel FM Wouters,5 Bernd Disse,2 Helen Finnigan,6 Helgo Magnussen,4 Peter MA Calverley7 1Respiratory Institute, Servei de Pneumologia, Hospital Clínic IDIBAPS-CIBERES, Universitat de Barcelona, Barcelona, Spain; 2Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany; 3Department of Sports Medicine, University of Tübingen, Tübingen, Germany; 4Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany; 5Department of Respiratory Medicine, University Hospital Maastricht, Maastricht University, Maastricht, the Netherlands; 6Department of Biostatistics and Data Sciences, Boehringer Ingelheim, Bracknell, UK; 7Institute of Ageing and Chronic Disease, Aintree University Hospital, Liverpool, UK Abstract: The WISDOM study (NCT00975195 reported a change in lung function following withdrawal of fluticasone propionate in patients with severe to very severe COPD treated with tiotropium and salmeterol. However, little is known about the validity of home-based spirometry measurements of lung function in COPD. Therefore, as part of this study, following suitable training, patients recorded daily home-based spirometry measurements in addition to undergoing periodic in-clinic spirometric testing throughout the study duration. We subsequently determined the validity of home-based spirometry for detecting changes in lung function by comparing in-clinic and home-based forced expiratory volume in 1 second in patients who underwent stepwise fluticasone propionate withdrawal over 12 weeks versus patients remaining on fluticasone propionate for 52 weeks. Bland–Altman analysis of these data confirmed good agreement between in-clinic and home-based measurements, both across all visits and at the individual visits at study weeks 6, 12, 18, and 52. There was a measurable difference between the forced expiratory volume

  19. Prediction of lung tumour position based on spirometry and on abdominal displacement: Accuracy and reproducibility

    International Nuclear Information System (INIS)

    Hoisak, Jeremy D.P.; Sixel, Katharina E.; Tirona, Romeo; Cheung, Patrick C.F.; Pignol, Jean-Philippe

    2006-01-01

    Background and purpose: A simulation investigating the accuracy and reproducibility of a tumour motion prediction model over clinical time frames is presented. The model is formed from surrogate and tumour motion measurements, and used to predict the future position of the tumour from surrogate measurements alone. Patients and methods: Data were acquired from five non-small cell lung cancer patients, on 3 days. Measurements of respiratory volume by spirometry and abdominal displacement by a real-time position tracking system were acquired simultaneously with X-ray fluoroscopy measurements of superior-inferior tumour displacement. A model of tumour motion was established and used to predict future tumour position, based on surrogate input data. The calculated position was compared against true tumour motion as seen on fluoroscopy. Three different imaging strategies, pre-treatment, pre-fraction and intrafractional imaging, were employed in establishing the fitting parameters of the prediction model. The impact of each imaging strategy upon accuracy and reproducibility was quantified. Results: When establishing the predictive model using pre-treatment imaging, four of five patients exhibited poor interfractional reproducibility for either surrogate in subsequent sessions. Simulating the formulation of the predictive model prior to each fraction resulted in improved interfractional reproducibility. The accuracy of the prediction model was only improved in one of five patients when intrafractional imaging was used. Conclusions: Employing a prediction model established from measurements acquired at planning resulted in localization errors. Pre-fractional imaging improved the accuracy and reproducibility of the prediction model. Intrafractional imaging was of less value, suggesting that the accuracy limit of a surrogate-based prediction model is reached with once-daily imaging

  20. Age- and size-related reference ranges: a case study of spirometry through childhood and adulthood.

    Science.gov (United States)

    Cole, T J; Stanojevic, S; Stocks, J; Coates, A L; Hankinson, J L; Wade, A M

    2009-02-28

    Age-related reference ranges are useful for assessing growth in children. The LMS method is a popular technique for constructing growth charts that model the age-changing distribution of the measurement in terms of the median, coefficient of variation and skewness. Here the methodology is extended to references that depend on body size as well as age, by exploiting the flexibility of the generalised additive models for location, scale and shape (GAMLSS) technique. GAMLSS offers general linear predictors for each moment parameter and a choice of error distributions, which can handle kurtosis as well as skewness. A key question with such references is the nature of the age-size adjustment, additive or multiplicative, which is explored by comparing the identity link and log link for the median predictor.There are several measurements whose reference ranges depend on both body size and age. As an example, models are developed here for the first four moments of the lung function variables forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC) and FEV(1)/FVC in terms of height and age, in a data set of 3598 children and adults aged 4 to 80 years. The results show a strong multiplicative association between spirometry, height and age, with a large and nonlinear age effect across the age range. Variability also depends nonlinearly on age and to a lesser extent on height. FEV(1) and FVC are close to normally distributed, while FEV(1)/FVC is appreciably skew to the left. GAMLSS is a powerful technique for the construction of such references, which should be useful in clinical medicine. Copyright (c) 2008 John Wiley & Sons, Ltd.

  1. Spirometry, questionnaire and electronic medical record based COPD in a population survey: Comparing prevalence, level of agreement and associations with potential risk factors.

    Science.gov (United States)

    Borlée, Floor; Yzermans, C Joris; Krop, Esmeralda; Aalders, Bernadette; Rooijackers, Jos; Zock, Jan-Paul; van Dijk, Christel E; Maassen, Catharina B M; Schellevis, François; Heederik, Dick; Smit, Lidwien A M

    2017-01-01

    COPD-diagnosis is confirmed by post-bronchodilator (BD) spirometry. However, epidemiological studies often rely on pre-BD spirometry, self-reports, or medical records. This population-based study aims to determine COPD-prevalence based on four different operational definitions and their level of agreement, and to compare associations between COPD-definitions and risk factors. COPD-prevalence in 1,793 adults from the general Dutch population (aged 18-70 years) was assessed based on self-reported data, Electronic Medical Records (EMR), and post-BD spirometry: using the FEV1/FVC below the lower limit of normal (LLN) and GOLD fixed cut-off (FEV1/FVC spirometry as a reference, sensitivity was calculated for self-reported and EMR-based COPD. Associations between COPD and known risk factors were assessed with logistic regression. Data were collected as part of the cross-sectional VGO study (Livestock Farming and Neighboring Residents' Health Study). The highest prevalence was found based on spirometry (GOLD: 10.9%, LLN: 5.9%), followed by self-report (4.6%) and EMR (2.9%). Self-reported or EMR-based COPD identified less than 30% of all COPD-cases based on spirometry. The direction of association between known risk factors and COPD was similar across the four definitions, however, magnitude and significance varied. Especially indicators of allergy were more strongly associated with self-reported COPD compared to the other definitions. COPD-prevalence varied depending on the used definition. A substantial number of subjects with spirometry-based COPD cannot be identified with questionnaires or medical records which can cause underestimation of COPD-prevalence. The influence of the different COPD-definitions on associations with known risk factors was limited.

  2. Effects of one-hour training course and spirometry on the ability of physicians to diagnose and treat chronic obstructive pulmonary disease.

    Science.gov (United States)

    Cai, Shan; Qin, Li; Tanoue, Lynn; Hu, Anmei; Jia, Xiujie; Luo, Hong; Chen, Yan; Chen, Ping; Peng, Hong

    2015-01-01

    In China, the prevalence of chronic obstructive pulmonary disease (COPD) in persons 40 years of age or older is estimated at 8.2%, but this is likely a substantial underestimate. Eight secondary hospitals which didn't have spirometries were chosen randomly in Hunan province of central south China. Physician subjects at these hospitals underwent a one-hour training course on the Chinese COPD guidelines. Physicians answered questionnaires assessing their knowledge of the guidelines before and after the training session. The mean correct scores of questionnaires were compared before and after training. Four out of the eight hospitals were given access to spirometry. Eligible patient subjects underwent spirometry testing prior to the physician visit. After seeing the patient, physicians were asked to answer a questionnaire relating to the diagnosis and severity of COPD. Physicians were then given the results of the spirometry, and asked to answer the same questionnaire. Physicians' responses before and after receiving the spirometry results were compared. 225 physicians participated in the training session. 207 questionnaires were completed. Mean scores (out of 100) before and after the training were 53.1 ± 21.7 and 93.3 ± 9.8, respectively. 18 physicians and 307 patient subjects participated in the spirometry intervention. Based on spirometric results, the prevalence of COPD was 38.8%. Physicians correctly identified the presence of COPD without spirometric data in 85 cases (76.6%); this increased to 117 cases (97.4%) once spirometric data were available. Without spirometric data, physicians incorrectly diagnosed COPD in 38 patients; this decreased to 6 patients once spirometric data were available. Spirometric data also improved the ability of physicians to correctly grade COPD severity. Simple educational training can substantially improve physicians' knowledge relating to COPD. Spirometry combined with education improves the ability of physicians to diagnose COPD

  3. Asthma in pregnancy: association between the Asthma Control Test and the Global Initiative for Asthma classification and comparisons with spirometry.

    Science.gov (United States)

    de Araujo, Georgia Véras; Leite, Débora F B; Rizzo, José A; Sarinho, Emanuel S C

    2016-08-01

    The aim of this study was to identify a possible association between the assessment of clinical asthma control using the Asthma Control Test (ACT) and the Global Initiative for Asthma (GINA) classification and to perform comparisons with values of spirometry. Through this cross-sectional study, 103 pregnant women with asthma were assessed in the period from October 2010 to October 2013 in the asthma pregnancy clinic at the Clinical Hospital of the Federal University of Pernambuco. Questionnaires concerning the level of asthma control were administered using the Global Initiative for Asthma classification, the Asthma Control Test validated for asthmatic expectant mothers and spirometry; all three methods of assessing asthma control were performed during the same visit between the twenty-first and twenty-seventh weeks of pregnancy. There was a significant association between clinical asthma control assessment using the Asthma Control Test and the Global Initiative for Asthma classification (pspirometry. This study shows that both the Global Initiative for Asthma classification and the Asthma Control Test can be used for asthmatic expectant mothers to assess the clinical control of asthma, especially at the end of the second trimester, which is assumed to be the period of worsening asthma exacerbations during pregnancy. We highlight the importance of the Asthma Control Test as a subjective instrument with easy application, easy interpretation and good reproducibility that does not require spirometry to assess the level of asthma control and can be used in the primary care of asthmatic expectant mothers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure

    DEFF Research Database (Denmark)

    Møller, Tom; Moser, Claus; Adamsen, Lis

    2016-01-01

    Long-lasting neutropenia associated with acute myeloid leukemia (AML) and its treatment gives rise to a high risk of pneumonia. The use of broad-spectrum antibiotic prophylaxis during outpatient management has not completely protected patients against admission due to infections and neutropenic...... in their continuous daily measurement of FEV1 and use of PEP. Daily measures of FEV1 may be an important early warning tool for assessment of pulmonary deterioration during critical phases of neutropenia. We suggest that strategic patient education in the use of spirometry and PEP should be part of standard of care...

  5. The recent multi-ethnic global lung initiative 2012 (GLI2012) reference values don't reflect contemporary adult's North African spirometry.

    Science.gov (United States)

    Ben Saad, Helmi; El Attar, Mohamed Nour; Hadj Mabrouk, Khaoula; Ben Abdelaziz, Ahmed; Abdelghani, Ahmed; Bousarssar, Mohamed; Limam, Khélifa; Maatoug, Chiraz; Bouslah, Hmida; Charrada, Ameur; Rouatbi, Sonia

    2013-12-01

    The applicability of the recent multi-ethnic reference equations derived by the ERS Global Lung Initiative (ERS/GLI) in interpreting spirometry data in North African adult subjects has not been studied. To ascertain how well the recent ERS/GLI reference equations fit contemporary adult Tunisian spirometric data. Spirometric data were recorded from 1192 consecutive spirometry procedures in adults aged 18-60 years. Reference values and lower limits of normality (LLN) were calculated using the local and the ERS/GLI reference equations. Applied definitions: large airway obstructive ventilatory defect (LAOVD): FEV1/FVC contemporary Tunisian spirometry. Using Tunisian reference equations, 71.31%, 6.71% and 19.04% of spirometry records were interpreted as normal, and as having, LAOVD and TRVD, respectively. Using the ERS/GLI reference equations, these figures were respectively, 85.82%, 4.19% and 8.39%. The mean ± SD Z-scores for the contemporary healthy North African subject's data were -0.55 ± 0.87 for FEV1, -0.62 ± 0.86 for FVC and 0.10 ± 0.73 for FEV1/FVC. The present study don't recommend the use of the recent ERS/GLI reference equations to interpret spirometry in North African adult population. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. [The role of spirometry in encouraging smoking cessation in general practice. A pilot study using "lung age"].

    Science.gov (United States)

    Lorenzo, A; Noël, F; Lorenzo, M; Van Den Broucke, J

    2017-09-01

    Our aim was to investigate whether spirometry, performed in general practitioners' offices would change non-motivated smokers' attitudes toward smoking cessation. We performed an interventional, prospective, before-after single-center study, approved by a research ethics committee. We included 74 smokers older than 18years old, who reported no intention to quit smoking, whatever they were visiting general practitioners for. We performed spirometry and gave them their results, FEV 1 /FVC and lung age together with a comment on it. Nine months later, we called them for another assessment. Fifty-six percent were women with an average-age of 46.5, who smoked 26.3 pack-years. Eighty-two percent of them had normal FEV 1 /FVC but lung age was pathological among 38% of them. Nine months later, 61.1% reported an increased motivation to quit smoking. They smoked 10.9 cigarettes per day versus 13,3 at baseline (P=0.0254). Increase in motivation was not statistically related to age, gender, previous smoking cessations, daily smoking, nicotine dependence or an abnormal FEV 1 /VC ratio (P>0.75) but was significantly related to the presence of an abnormal lung age status (Pspirometry in general practice, combined with the determination of the lung age, may increase motivation towards smoking cessation in smokers who lack motivation. Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  7. Determination of functional residual capacity with 133-xenon radiospirometry. Comparison with body plethysmography and helium spirometry. Effect of body position

    International Nuclear Information System (INIS)

    Kauppinen-Walin, K.; Sovijaervi, A.R.A.; Muittari, A.; Uusitalo, A.

    1980-01-01

    The accuracy of 133-xenon radiospirometry for determination of FRC in healthy subjects was studied. Forty volunteers, both smokers and non-smokers, were examined. The FRC of each subject was concurrently determined with radiospirometric, He-dilution in closed circuit, and body plethysmographic methods. The mean FRC measured by radiospirometry (FRCsub(RS)) was 0.72 1 larger than that measured by helium spirometry (FRCsub(He)) in sitting position (P<0.01). In supine position the FRCsub(RS) was 0.65 1 larger than the FRCsub(He) (P<0.01). The body plethysmography (sitting position) gave FRC (TGV) 0.35 1 larger than the FRCsub(He) sitting (P<0.01). The FRCsub(He) and the FRCsub(RS) in the sitting position were 0.48 and 0.55 1 larger than in the supine position (P<0.01), respectively. Trapped air correlated significantly (P<0.01) with the difference FRCsub(RS) - FRCsub(He), when sitting. The results indicated that the FRC determined radiospirometrically is significantly larger than the FRC determined with He-spirometry. The difference is systematic, suggesting that it is caused by 133-xenon dissolved in blood and accumulated in tissues of the thoracic cage and by dissimilar representation of trapped air in FRCsub(RS) and FRCsub(He). After correction for systematic error, the FRC obtained as a by-product of radiospirometry may be used. (author)

  8. COPD Diagnostic Questionnaire (CDQ) for selecting at-risk patients for spirometry: a cross-sectional study in Australian general practice.

    Science.gov (United States)

    Stanley, Anthony J; Hasan, Iqbal; Crockett, Alan J; van Schayck, Onno C P; Zwar, Nicholas A

    2014-07-10

    Using the COPD Diagnostic Questionnaire (CDQ) as a selection tool for spirometry could potentially improve the efficiency and accuracy of chronic obstructive pulmonary disease (COPD) diagnosis in at-risk patients. To identify an optimal single cut point for the CDQ that divides primary care patients into low or high likelihood of COPD, with the latter group undergoing spirometry. Former or current smokers aged 40-85 years with no prior COPD diagnosis were invited to a case-finding appointment with the practice nurse at various general practices in Sydney, Australia. The CDQ was collected and pre- and post-bronchodilator spirometry was performed. Cases with complete CDQ data and spirometry meeting quality standards were analysed (1,054 out of 1,631 patients). CDQ cut points were selected from a receiver operating characteristic (ROC) curve. The area under the ROC curve was 0.713. A cut point of 19.5 had the optimal combination of sensitivity (63%) and specificity (70%) with two-thirds below this cut point. A cut point of 14.5 corresponded to a sensitivity of 91%, specificity of 35% and negative predictive value of 96%, and 31% of patients below this cut point. The CDQ can be used to select patients at risk of COPD for spirometry using one cut point. We consider two possible cut points. The 19.5 cut point excludes a higher proportion of patients from undergoing spirometry with the trade-off of more false negatives. The 14.5 cut point has a high sensitivity and negative predictive value, includes more potential COPD cases but has a higher rate of false positives.

  9. Prevalence of Airflow Limitation Defined by Pre- and Post-Bronchodilator Spirometry in a Community-Based Health Checkup: The Hisayama Study.

    Science.gov (United States)

    Fukuyama, Satoru; Matsumoto, Koichiro; Kaneko, Yasuko; Kan-o, Keiko; Noda, Naotaka; Tajiri-Asai, Yukari; Nakano, Takako; Ishii, Yumiko; Kiyohara, Yutaka; Nakanishi, Yoichi; Inoue, Hiromasa

    2016-02-01

    Spirometry in health checkup may contribute to early diagnosis of chronic obstructive pulmonary disease (COPD) and asthma. Although post-bronchodilator airflow limitation is essential for definite diagnosis of COPD and post-bronchodilator normalization of airflow is suggestive of asthma, this test has not been prevailed in health checkup. The objective of this study was to estimate the prevalence of airflow limitation defined by pre- and post-bronchodilator spirometry in health checkup. Post-bronchodilator spirometry was conducted for participants with airflow limitation in a town-wide health checkup for residents aged 40 years and older in Hisayama, a town in the western part of Japan. The prevalence of pre- and post-bronchodilator airway limitation defined by FEV1/FVC spirometry. In males, the age of current smokers was significantly younger than those of never smokers and former smokers. In females, the ages of current- and former smokers were significantly younger than never smokers. The values of %FEV1 and %FVC in current smokers were significantly lower than those in former smokers and never smokers. Two hundred sixty nine subjects, 85% of total subjects with a pre-bronchodilator FEV1/FVC spirometry. The prevalence of pre-bronchodilator airflow limitation was 14.6% in males and 13.7% in females, and the prevalence of post-bronchodilator airway limitation was 8.7% and 8.7%, respectively. Post-bronchodilator spirometry in health checkup would reduce the number of subjects with probable COPD to two-third. Recommendation for those examinees to take further evaluations may pave the way for early intervention.

  10. Viabilidade da realização de espirometria em pré-escolares Feasibility of spirometry in preschool children

    Directory of Open Access Journals (Sweden)

    Tiago Neves Veras

    2011-02-01

    Full Text Available OBJETIVO: Determinar a taxa de sucesso na obtenção de resultados adequados de espirometria em pacientes pré-escolares. MÉTODOS: Foram analisados os resultados de espirometrias de crianças menores que 6 anos. Todos os testes foram realizados no Laboratório de Função Pulmonar do Hospital Infantil Jeser Amarante Faria, em Joinville (SC entre junho de 2009 e fevereiro de 2010. O programa utilizado continha um incentivo de animação (bolhas de sabão.Os procedimentos foram realizados por um pneumologista infantil e obedeceram aos critérios de reprodutibilidade e aceitabilidade preconizados pela American Thoracic Society. Buscou-se atingir um tempo expiratório de pelo menos 1 s. Os seguintes parâmetros foram registrados: CVF, VEF0,5, VEF1 e relação VEF1/CVF. RESULTADOS: Nossa amostra consistiu de 74 crianças. A taxa de sucesso foi de 82%, com melhora no desempenho do teste em idades mais avançadas, mas sem significado estatístico (p > 0,05. Em média, foram necessárias 6,6 tentativas durante o exame para a obtenção de curvas aceitáveis e reprodutíveis. Todos os 61 testes bem sucedidos tiveram resultados de VEF0,5 e VEF1 satisfatórios. Através de escore Z, constatou-se que 21,6 % das crianças apresentavam com padrão obstrutivo. CONCLUSÕES: A taxa de sucesso da espirometria foi alta em nossa amostra, mostrando que esse é um método válido de avaliação da função pulmonar em pré-escolares. O uso de métodos de incentivo e a realização do teste por profissionais treinados no trabalho com crianças podem estar associados à elevada taxa de sucesso em nossa amostraOBJECTIVE: To determine the rate at which satisfactory spirometry results are obtained (spirometry success rate in preschool children. METHODS: We analyzed the spirometry results of children 0.05. An average of 6.6 attempts/test were needed in order to achieve acceptable, reproducible curves. All 61 successful tests produced satisfactory FEV0.5 and FEV1 values

  11. Advantage of impulse oscillometry over spirometry to diagnose chronic obstructive pulmonary disease and monitor pulmonary responses to bronchodilators: An observational study

    Directory of Open Access Journals (Sweden)

    Constantine Saadeh

    2015-04-01

    Full Text Available Objectives: This retrospective study was a comparative analysis of sensitivity of impulse oscillometry and spirometry techniques for use in a mixed chronic obstructive pulmonary disease group for assessing disease severity and inhalation therapy. Methods: A total of 30 patients with mild-to-moderate chronic obstructive pulmonary disease were monitored by impulse oscillometry, followed by spirometry. Lung function was measured at baseline after bronchodilation and at follow-up (3–18 months. The impulse oscillometry parameters were resistance in the small and large airways at 5 Hz (R5, resistance in the large airways at 15 Hz (R15, and lung reactance (area under the curve X; AX. Results: After the bronchodilator therapy, forced expiratory volume in 1 second (FEV1 readings evaluated by spirometry were unaffected at baseline and at follow-up, while impulse oscillometry detected an immediate improvement in lung function, in terms of AX (p = 0.043. All impulse oscillometry parameters significantly improved at follow-up, with a decrease in AX by 37% (p = 0.0008, R5 by 20% (p = 0.0011, and R15 by 12% (p = 0.0097. Discussion: Impulse oscillometry parameters demonstrated greater sensitivity compared with spirometry for monitoring reversibility of airway obstruction and the effect of maintenance therapy. Impulse oscillometry may facilitate early treatment dose optimization and personalized medicine for chronic obstructive pulmonary disease patients.

  12. Angle β of greater than 80° at the start of spirometry may identify high-quality flow volume curves.

    Science.gov (United States)

    Lian, Ningfang; Li, Li; Ren, Weiying; Jiang, Zhilong; Zhu, Lei

    2017-04-01

    The American Thoracic Society (ATS) and European Respiratory Society (ERS) emphasize a satisfactory start in maximal expiratory flow-volume (MEFV) curves and highlight subjective parameters: performance without hesitation and expiration with maximum force. We described a new parameter, angle β for characterization of the start to the MEFV curve. Subjects completed the MEFV curve at least three times and at least two curves met ATS/ERS quality. Subjects were divided into normal, restrictive and obstructive groups according to pulmonary function test results. The tangent line was drawn at the start of the MEFV curve's ascending limb to the x-axis and the angle β between the tangent line and x-axis was obtained. The relationships between tangent of β, pulmonary function parameters (PFPs) and anthropometric data were assessed. The MEFV curves with insufficient explosion at the start were considered as poor-quality MEFV curves. In 998 subjects with high-quality spirometry, although PFP varied in relation to the three aspects: the angle β and its tangent were similar (P > 0.05), the tangent of β did not correlate with PFP or anthropometric measurements (P > 0.05) and the lower limit of normal (LLN) of the angle β was 80° in the group with high-quality spirometry (P < 0.05). Angle β derived from poor-quality MEFV curves was smaller than that from good quality one (P < 0.05). Angle β may function as a parameter to assess the expiratory efforts, which can be used to assess the quality of the MEFV curve start. © 2016 Asian Pacific Society of Respirology.

  13. Validation of Global Lung Function Initiative and All Ages Reference Equations for Forced Spirometry in Healthy Spanish Preschoolers.

    Science.gov (United States)

    Martín de Vicente, Carlos; de Mir Messa, Inés; Rovira Amigo, Sandra; Torrent Vernetta, Alba; Gartner, Silvia; Iglesias Serrano, Ignacio; Carrascosa Lezcano, Antonio; Moreno Galdó, Antonio

    2018-01-01

    Recent publication of multi-ethnic spirometry reference equations for subjects aged from 3-95 years aim to avoid age-related discontinuities and provide a worldwide standard for interpreting spirometric test results. To assess the agreement of the Global Lung Function Initiative (GLI-2012) and All ages (FEV 0.5 ) reference equations with the Spanish preschool lung function data. To verify the appropriateness of these reference values for clinical use in Spanish preschool children. Spirometric measurements were obtained from children aged 3 to 6 years attending 10 randomly selected schools in Barcelona (Spain). Stanojevic's quality control criteria were applied. Z-scores were calculated for the spirometry outcomes based on the GLI equations. If the z-score (mean) of each parameter was close to 0, with a maximum variance of ± 0.5 from the mean and a standard deviation of 1, the GLI-2012 equations would be applicable in our population. Of 543 children recruited, 405 (74.6%) were 'healthy', and of these, 380 were Caucasians. Of these 380, 81.6% (169 females, 141 males) performed technically acceptable and reproducible maneuvers to assess FEVt, and 69.5% achieved a clear end-expiratory plateau. Z-scores for FVC, FEV 1 , FEV 1 /FVC, FEV 0.75 , FEV 0.75 /FVC, FEV 0.5 , FEF 75 and FEF 25-75 all fell within ± 0.5, except for FEV 1 /FVC (0.53 z-scores). GLI equations are appropriate for Spanish preschool children. These data provide further evidence to support widespread application of the GLI reference equations. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Echocardiography, spirometry, and systemic acute-phase inflammatory proteins in smokers with COPD or CHF: an observational study.

    Directory of Open Access Journals (Sweden)

    Bianca Beghé

    Full Text Available Chronic obstructive pulmonary disease (COPD and chronic heart failure (CHF may coexist in elderly patients with a history of smoking. Low-grade systemic inflammation induced by smoking may represent the link between these 2 conditions. In this study, we investigated left ventricular dysfunction in patients primarily diagnosed with COPD, and nonreversible airflow limitation in patients primarily diagnosed with CHF. The levels of circulating high-sensitive C-reactive protein (Hs-CRP, pentraxin 3 (PTX3, interleukin-1β (IL-1 β, and soluble type II receptor of IL-1 (sIL-1RII were also measured as markers of systemic inflammation in these 2 cohorts. Patients aged ≥ 50 years and with ≥ 10 pack years of cigarette smoking who presented with a diagnosis of stable COPD (n=70 or stable CHF (n=124 were recruited. All patients underwent echocardiography, N-terminal pro-hormone of brain natriuretic peptide measurements, and post-bronchodilator spirometry. Plasma levels of Hs-CRP, PTX3, IL-1 β, and sIL-1RII were determined by using a sandwich enzyme-linked immuno-sorbent assay in all patients and in 24 healthy smokers (control subjects. Although we were unable to find a single COPD patient with left ventricular dysfunction, we found nonreversible airflow limitation in 34% of patients with CHF. On the other hand, COPD patients had higher plasma levels of Hs-CRP, IL1 β, and sIL-1RII compared with CHF patients and control subjects (p < 0.05. None of the inflammatory biomarkers was different between CHF patients and control subjects. In conclusion, although the COPD patients had no evidence of CHF, up to one third of patients with CHF had airflow limitation, suggesting that routine spirometry is warranted in patients with CHF, whereas echocardiography is not required in well characterized patients with COPD. Only smokers with COPD seem to have evidence of systemic inflammation.

  15. Hyperpolarized {sup 3}helium magnetic resonance ventilation imaging of the lung in cystic fibrosis: comparison with high resolution CT and spirometry

    Energy Technology Data Exchange (ETDEWEB)

    McMahon, Colm J.; Dodd, Jonathan D.; Skehan, Stephen J.; Masterson, James B. [St. Vincent' s University Hospital, Department of Radiology, Dublin (Ireland); Hill, Catherine; Woodhouse, Neil; Wild, Jim M.; Fichele, Stan [Royal Hallamshire Hospital, The Unit of Academic Radiology, University of Sheffield, Sheffield (United Kingdom); Gallagher, Charles G. [St. Vincent' s University Hospital, Department of National Referral Centre for Adult Cystic Fibrosis, Dublin (Ireland); Beek, Edwin J.R. van [Royal Hallamshire Hospital, The Unit of Academic Radiology, University of Sheffield, Sheffield (United Kingdom); University of Iowa, Department of Radiology, Carver College of Medicine, Iowa City, IA (United States)

    2006-11-15

    The purpose of this study was to compare hyperpolarized {sup 3}helium magnetic resonance imaging ({sup 3}He MRI) of the lungs in adults with cystic fibrosis (CF) with high-resolution computed tomography (HRCT) and spirometry. Eight patients with stable CF prospectively underwent {sup 3}He MRI, HRCT, and spirometry within 1 week. Three-dimensional (3D) gradient-echo sequence was used during an 18-s breath-hold following inhalation of hyperpolarized {sup 3}He. Each lung was divided into six zones; {sup 3}He MRI was scored as percentage ventilation per lung zone. HRCT was scored using a modified Bhalla scoring system. Univariate (Spearman rank) and multivariate correlations were performed between {sup 3}He MRI, HRCT, and spirometry. Results are expressed as mean{+-}SD (range). Spirometry is expressed as percent predicted. There were four men and four women, mean age=31.9{+-}9 (20-46). Mean forced expiratory volume in 1 s (FEV){sub 1}=52%{+-}29 (27-93). Mean {sup 3}He MRI score=74%{+-}25 (55-100). Mean HRCT score=48.8{+-}24 (13.5-83). The correlation between {sup 3}He MRI and HRCT was strong (R={+-}0.89, p<0.001). Bronchiectasis was the only independent predictor of {sup 3}He MRI; {sup 3}He MRI correlated better with FEV{sub 1} and forced vital capacity (FVC) (R=0.86 and 0.93, p<0.01, respectively) than HRCT (R={+-}0.72 and {+-}0.81, p<0.05, respectively). This study showed that {sup 3}He MRI correlates strongly with structural HRCT abnormalities and is a stronger correlate of spirometry than HRCT in CF. (orig.)

  16. Effect of volume-oriented versus flow-oriented incentive spirometry on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly.

    Science.gov (United States)

    Lunardi, Adriana C; Porras, Desiderio C; Barbosa, Renata Cc; Paisani, Denise M; Marques da Silva, Cibele C B; Tanaka, Clarice; Carvalho, Celso R F

    2014-03-01

    Aging causes physiological and functional changes that impair pulmonary function. Incentive spirometry is widely used for lung expansion, but the effects of volume-oriented incentive spirometry (VIS) versus flow-oriented incentive spirometry (FIS) on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly are poorly understood. We compared VIS and FIS in elderly subjects and healthy adult subjects. Sixteen elderly subjects (9 women, mean ± SD age 70.6 ± 3.9 y, mean ± SD body mass index 23.8 ± 2.5 kg/m(2)) and 16 healthy adults (8 women, mean ± age 25.9 ± 4.3 y, mean ± body mass index 23.6 ± 2.4 kg/m(2)) performed quiet breathing, VIS, and FIS in randomized sequence. Chest wall kinematics (via optoelectronic plethysmography) and inspiratory muscle activity (via surface electromyography) were assessed simultaneously. Synchrony between the superior thorax and abdominal motion was calculated (phase angle). In the elderly subjects both types of incentive spirometry increased chest wall volumes similarly, whereas in the healthy adult subjects VIS increased the chest wall volume more than did FIS. FIS and VIS triggered similar lower thoracoabdominal synchrony in the elderly subjects, whereas in the healthy adults FIS induced lower synchrony than did VIS. FIS required more muscle activity in the elderly subjects to create an increase in chest wall volume. Incentive spirometry performance is influenced by age, and the differences between elderly and healthy adults response should be considered in clinical practice.

  17. Semi-Quantitative Assessment of the Health Risk of Occupational Exposure to Chemicals and Evaluation of Spirometry Indices on the Staff of Petrochemical Industry

    Directory of Open Access Journals (Sweden)

    Hajar Dazi

    2017-01-01

    Full Text Available Background & Aims of the Study: Petrochemical industry is an important industry in the economic development of the country that causes employees have exposure with several kinds of contamination. The aim of this study was Semi-quantitative assessment of the health risk of occupational exposure to chemical materials and investigation of spirometry indices between employees of petrochemical industry. Material & Methods: This cross-sectional study was conducted in one of the petrochemical industry complex in a special area of Assaluyeh in Iran in 2016. Health risk assessment of exposure to harmful chemical agents was performed in all of units and during three stages (identification of harmful material, determination of hazard rate of the chemical material, exposure rate and estimate of risk rate. Spirometry indices were measured using spirometry. Results: The results of chemical materials risk assessment showed that Raffinate in Butadiene unit has identified the highest amount of risk rank among 27 chemical materials in investigated units. In comparison with spirometry indices in Olefine unit between age with FVC parameter and history work with FVC and FEV1 parameters has observed a significant and negative correlation (P<0.05. Conclusion: The results of risk assessment in all of the petrochemical units showed that 48.14% of materials were at low risk level, 29.62% medium risk, 18.51% high risk and 3.7% had very high risk level. The variables affecting on spirometry employees such as age and work experience play an important role in reducing the pulmonary function tests in exposed subjects.

  18. Assessing the Effectiveness of "Making the Right Diagnosis: The Need for Spirometry"

    Science.gov (United States)

    Make, Barry; Friedlander, Adam; Lundstrom, Natalie

    2010-01-01

    Chronic obstructive pulmonary disease (COPD) is expected to increase in prevalence in the coming decades. The evolving nature of COPD outcome assessment and therapies, as well as the increasing societal burden of COPD, have created a significant challenge for primary-care physicians. As a result, a continuing medical education/continuing education…

  19. Valor de la espirometría para el diagnostico de restricción pulmonar Accuracy of spirometry in the diagnosis of pulmonary restriction

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    Silvia Quadrelli

    2007-12-01

    Full Text Available Un defecto ventilatorio restrictivo está caracterizado por una reducción en la capacidad pulmonar total. El objetivo de este estudio fue evaluar la utilidad de la espirometría para determinar la presencia de restricción en pacientes con y sin obstrucción bronquial. Fueron incluídos 520 pacientes. Se definieron los valores normales mediante el intervalo de confianza del 95% (IC utilizando la ecuación de Morris para la espirometría, y la de la European Respiratory Society (ERS para capacidad pulmonar. Las espirometrías fueron clasificadas como obstructivas cuando mostraban relación volumen espiratorio forzado en 1 segundo (VEF1/capacidad vital forzada (CVF A restrictive ventilatory defect is characterized by a decreased total lung capacity (TLC. The objective of this study was to determine the accuracy of spirometry to detect pulmonary restriction in patients with or without airflow obstruction in the spirometry. Five hundred and twenty patients were included. Normal values for lung function were determined by using the 95% confidence interval (CI with Morris reference equation for spirometry and European Respiratory Society equation for lung volume. Spirometries were considered obstructive when FEV1/FVC ratio was <70% and FEV1 was below 95%CI. In patients without obstruction in the spirometry (n = 357 sensitivity and specificity were 42.2% and 94.3% respectively, negative predictive value (NPP was 86.6% and positive PV (PPV was 65.2%. In patients with an obstructive spirometry (n = 66 sensitivity increased to 75.8% but specificity decreased to 65.9%. PPV was only 57.8% and NPV 81.5%. Patients showing obstruction in the spirometry and false positives of a low FVC (n = 22 had similar values of FVC (57.36 ± 13.45 vs. 58.82 ± 8.71%, p = 0.6451, FEV1 (44.73 ± 19.24 vs. 44.0 ± 13.08%, p = 0.8745 and DLCO (67.50 ±27.23 vs. 77.00 ±16.00%, p = 0.1299 than true positives. Residual volume (RV (125.72 ± 64. vs. 77.96 ± 29.98%, p = 0

  20. Efeito do salbutamol liberado através de inalador de pó seco sobre o broncoespasmo induzido por metacolina Effects of salbutamol delivered by dry-powder inhaler on methacholine-induced bronchoconstriction

    Directory of Open Access Journals (Sweden)

    Adalberto Sperb Rubin

    2004-06-01

    (MDIs are the drugs usually used for the reversal of methacholine-induced bronchoconstriction. The b2 agonists that are delivered by dry-powder inhaler (DPI can be an efficacious option. OBJECTIVE: To evaluate the effectiveness and speed of action of salbutamol delivered by DPI (Pulvinal; Butovent®, in comparison to salbutamol delivered by MDI, in reversing methacholine-induced bronchoconstriction. METHOD: Sixty successive methacholine-induced bronchoconstriction patients who presented a decrease of at least 20% in forced expiratory volume (FEV1 were evaluated prospectively. Of these 60 patients, we randomized 30 (first group to receive 200 mcg of salbutamol by MDI and 30 (second group to receive 200 mcg of salbutamol by DPI (Pulvinal. Both drugs were administered with the objective of reversing bronchoconstriction during the final phase of a bronchoprovocation test. The FEV1 values obtained at 1 and 5 minutes after bronchodilator administration were evaluated. RESULTS: The groups were comparable in gender distribution, age, weight, dose level provoking a 20% drop in FEV1 (first group: 1.3 mg; second group: 1.19 mg; p = 0.79 and post-methacholine FEV1 (first group: 2.03 l; second group: 1.99 l; p = 0.87, with no statistically significant differences between the two groups. In the first group (MDI, the mean increase in FEV1 was 16.2% (at 1 minute and 22.2% (at 5 minutes, and in the second group (DPI it was 17% (at 1 minute and 23.6% (at 5 minutes. There was no statistically significant difference between the groups (p = 0.8. CONCLUSION: The beta2-agonists delivered by DPI (Pulvinal present the same bronchodilator efficacy and speed of action as do those delivered by the more traditional MDI method.

  1. Comparison of Flow and Volume Incentive Spirometry on Pulmonary Function and Exercise Tolerance in Open Abdominal Surgery: A Randomized Clinical Trial

    Science.gov (United States)

    Kumar, Amaravadi Sampath; Augustine, Alfred Joseph; Pazhyaottayil, Zulfeequer Chundaanveetil; Ramakrishna, Anand; Krishnakumar, Shyam Krishnan

    2016-01-01

    Introduction Surgical procedures in abdominal area lead to changes in pulmonary function, respiratory mechanics and impaired physical capacity leading to postoperative pulmonary complications, which can affect up to 80% of upper abdominal surgery. Aim To evaluate the effects of flow and volume incentive spirometry on pulmonary function and exercise tolerance in patients undergoing open abdominal surgery. Materials and Methods A randomized clinical trial was conducted in a hospital of Mangalore city in Southern India. Thirty-seven males and thirteen females who were undergoing abdominal surgeries were included and allocated into flow and volume incentive spirometry groups by block randomization. All subjects underwent evaluations of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow (PEF). Preoperative and postoperative measurements were taken up to day 5 for both groups. Exercise tolerance measured by Six- Minute Walk Test during preoperative period and measured again at the time of discharge for both groups. Pulmonary function was analysed by post-hoc analysis and carried out using Bonferroni’s ‘t’-test. Exercise tolerance was analysed by Paired ‘T’-test. Results Pulmonary function (FVC, FEV1, and PEFR) was found to be significantly decreased in 1st, 2nd and 3rd postoperative day when compared with preoperative day. On 4th and 5th postoperative day the pulmonary function (FVC, FEV1, and PEFR) was found to be better preserved in both flow and volume incentive spirometry groups. The Six-Minute Walk Test showed a statistically significant improvement in pulmonary function on the day of discharge than in the preoperative period. In terms of distance covered, the volume- incentive spirometry group showed a greater statistically significant improvement from the preoperative period to the time of discharge than was exhibited by the flow incentive spirometry group

  2. Clinical Utility of Additional Measurement of Total Lung Capacity in Diagnosing Obstructive Lung Disease in Subjects With Restrictive Pattern of Spirometry.

    Science.gov (United States)

    Lee, Hyun; Chang, Boksoon; Kim, Kyunga; Song, Won Jun; Chon, Hae Ri; Kang, Hyung Koo; Kim, Jung Soo; Jeong, Byeong-Ho; Oh, Yeon-Mok; Koh, Won-Jung; Park, Hye Yun

    2016-04-01

    Total lung capacity (TLC), forced expiratory flow between 25 and 75% (FEF25-75%), peak expiratory flow (PEF), or post-bronchodilator volume response is recommended to detect obstructive abnormalities in the lung. The present study was performed to evaluate the usefulness of these pulmonary function test (PFT) parameters to diagnose obstructive lung disease in subjects with a restrictive pattern of spirometry. A retrospective study was conducted in 64 subjects with a restrictive pattern of spirometry (normal FEV1/FVC and low FVC) out of 3,030 patients who underwent all pre- and post-bronchodilator spirometry and lung volume measurement between April 2008 and December 2010. After subjects were clinically classified into those with obstructive lung disease, restrictive lung disease, and mixed lung disease, the agreements between the clinical diagnosis and PFT classification according to TLC, FEF(25-75%), PEF, and post-bronchodilator response criteria were compared. Of 64 subjects, 18 (28.1%) were classified with obstructive lung disease, 39 (60.9%) had restrictive lung disease, 1 (1.6%) had mixed lung disease, and 6 (9.4%) had no clinical lung disease. Among the 58 subjects with clinical lung disease, 22 (37.9%), 37 (63.8%), 33 (56.9%), and 3 (5.2%) were classified as having obstructive pattern based on TLC, FEF25-75%, PEF, and post-bronchodilator response criteria, respectively. The kappa coefficients for the agreement between the clinical classification and PFT classification using TLC, FEF25-75%, PEF, and post-bronchodilator response criteria in 58 subjects were 0.59, 0.18, 0.17, and spirometry, when obstructive lung disease is clinically suspected. Copyright © 2016 by Daedalus Enterprises.

  3. Economic Assessment and Budgetary Impact of a Telemedicine Procedure and Spirometry Quality Control in the Primary Care Setting.

    Science.gov (United States)

    Marina, Nuria; Bayón, Juan Carlos; López de Santa María, Elena; Gutiérrez, Asunción; Inchausti, Marta; Bustamante, Victor; Gáldiz, Juan B

    2016-01-01

    To evaluate the economic impact of a telemedicine procedure designed to improve the quality of lung function testing (LFT) in primary care in a public healthcare system, compared with the standard method. The economic impact of 9,039 LFTs performed in 51 health centers (2010-2013) using telespirometry (TS) compared to standard spirometry (SS) was studied. TS costs more per unit than SS (€47.80 vs. €39.70) (2013), but the quality of the TS procedure is superior (84% good quality, compared to 61% using the standard procedure). Total cost of TS was €431,974 (compared with €358,306€ for SS), generating an economic impact of €73,668 (2013). The increase in cost for good quality LFT performed using TS was €34,030 (2010) and €144,295 (2013), while the costs of poor quality tests fell by €15,525 (2010) and 70,627€ (2013). The cost-effectiveness analysis concludes that TS is 23% more expensive and 46% more effective. Healthcare costs consequently fall as the number of LFTs performed by TS rises. Avoiding poor quality, invalid LFTs generates savings that compensate for the increased costs of performing LFTs with TS, making it a cost-effective method. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  4. Spirometry Findings Following Treatment with Oral and Inhalant Corticosteroids in Mild to Moderate Asthma Exacerbation in Children

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    Nemat Bilan

    2014-12-01

    Full Text Available Introduction:  Asthma exacerbation is common in children. Treatment with oral corticosteroids (OCS and inhaled corticosteroids are suggested for asthma exacerbation. It is shown that inhaled corticosteroids has similar outcome in reducing asthma symptoms compared to OCS. But few studies have evaluated the pulmonary function changes in these two treatments. In this study, we evaluated the changes in pulmonary function tests in children with mild-to-moderate asthma exacerbation receiving oral prednisolone and inhaled Budesonide. Methods and Materials: Forty-four children with mild-to-moderate asthma exacerbation were randomly assigned to receive oral prednisolone (2 mg/kg or Budesonide spray (2 puffs every 12 hours, each puff contains 200 microgram Budesonide using a spacer for one week. The first dose of the treatment was given in the emergency department. Children were followed for seven days and spirometry findings before and after treatment were evaluated. Results: There was no significant difference between pulmonary function tests before and after treatment between groups. Children receiving oral prednisolone had significantly more improvement in PEF (p=0.01. There was significant improvement in all respiratory parameters after treatment in both groups (p

  5. Lung function in North American Indian children: reference standards for spirometry, maximal expiratory flow volume curves, and peak expiratory flow.

    Science.gov (United States)

    Wall, M A; Olson, D; Bonn, B A; Creelman, T; Buist, A S

    1982-02-01

    Reference standards of lung function was determined in 176 healthy North American Indian children (94 girls, 82 boys) 7 to 18 yr of age. Spirometry, maximal expiratory flow volume curves, and peak expiratory flow rate were measured using techniques and equipment recommended by the American Thoracic Society. Standing height was found to be an accurate predictor of lung function, and prediction equations for each lung function variable are presented using standing height as the independent variable. Lung volumes and expiratory flow rates in North American Indian children were similar to those previously reported for white and Mexican-American children but were greater than those in black children. In both boys and girls, lung function increased in a curvilinear fashion. Volume-adjusted maximal expiratory flow rates after expiring 50 or 75% of FVC tended to decrease in both sexes as age and height increased. Our maximal expiratory flow volume curve data suggest that as North American Indian children grow, lung volume increases at a slightly faster rate than airway size does.

  6. Spirometry and regular follow-up do not improve quality of life in children or adolescents with asthma: Cluster randomized controlled trials.

    Science.gov (United States)

    Abramson, Michael J; Schattner, Rosa L; Holton, Christine; Simpson, Pam; Briggs, Nancy; Beilby, Justin; Nelson, Mark R; Wood-Baker, Richard; Thien, Francis; Sulaiman, Nabil D; Colle, Eleonora Del; Wolfe, Rory; Crockett, Alan J; Massie, R John

    2015-10-01

    To determine whether spirometry and regular medical review improved quality of life or other outcomes in children and adolescents with asthma. We conducted two cluster randomized controlled trials. We recruited 238 asthma patients aged between 7 and 17 years from 56 general practices in South Eastern Australia. Participants were randomized to receive an intervention that included spirometry or usual care. The main outcome measure was asthma related quality of life. Baseline characteristics were well matched between the intervention and control groups. Neither trial found any difference in asthma related quality of life between groups. However because of measurement properties, a formal meta-analysis could not be performed. Nor were there any significant effects of the intervention upon asthma attacks, limitation to usual activities, nocturnal cough, bother during physical activity, worry about asthma, or written asthma action plans. The findings do not support more widespread use of spirometry for the management of childhood asthma in general practice, unless it is integrated into a complete management model. © 2014 Wiley Periodicals, Inc.

  7. A pilot study to monitor changes in spirometry and lung volume, following an exacerbation of Chronic Obstructive Pulmonary Disease (COPD), as part of a supported discharge program.

    Science.gov (United States)

    Cushen, Breda; McCormack, Niamh; Hennigan, Kerrie; Sulaiman, Imran; Costello, Richard W; Deering, Brenda

    2016-10-01

    One-third of patients with an exacerbation of Chronic Obstructive Pulmonary Disease(COPD) are re-hospitalised at 90 days. Exacerbation recovery is associated with reductions in lung hyperinflation and improvements in symptoms and physical activity. We assessed the feasibility of monitoring these clinical parameters in the home. We hypothesised that the degree of change in spirometry and lung volumes differs between those who had an uneventful recovery and those who experienced a further exacerbation. Hospitalised patients with an acute exacerbation of COPD referred for a supported discharge program participated in the study. Spirometry and Inspiratory Vital Capacity(IVC) were measured in the home at Days 1, 14 and 42 post-discharge. Patients also completed Medical Research Council(MRC), Borg and COPD Assessment Test(CAT) scores and were provided with a tri-axial accelerometer. Any new exacerbation events were recorded. Sixty-five patients with 72 exacerbation episodes were recruited. Fifty percent experienced a second exacerbation. Adequate IVC measurements were achieved by 90%, while only 70% completed spirometry. Uneventful recovery was accompanied by significant improvements in physiological measurements at day14, improved symptom scores and step count, p volumes, symptoms and step count following a COPD exacerbation may help to identify patients at risk of re-exacerbation. It is feasible to carry out these assessments in the home as part of a supported discharge programme. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Bronchodilator Response in Patients with Persistent Allergic Asthma Could Not Predict Airway Hyperresponsiveness

    Directory of Open Access Journals (Sweden)

    Petanjek Bojana B

    2007-12-01

    Full Text Available Anticholinergics, or specific antimuscarinic agents, by inhibition of muscarinic receptors cause bronchodilatation, which might correlate with activation of these receptors by the muscarinic agonist methacholine. The aim of this study was to determine whether a positive bronchodilator response to the anticholinergic ipratropium bromide could predict airway hyperresponsiveness in patients with persistent allergic asthma. The study comprised 40 patients with mild and moderate persistent allergic asthma. Diagnosis was established by clinical and functional follow-up (skin-prick test, spirometry, bronchodilator tests with salbutamol and ipratropium bromide, and methacholine challenge testing. The bronchodilator response was positive to both bronchodilator drugs in all patients. After salbutamol inhalation, forced expiratory volume in 1 second (FEV1 increased by 18.39 ± 6.18%, p 1 increased by 19.14 ± 6.74%, p 1 decreased by 25.75 ± 5.16%, p 20 FEV1 [provocative concentration of methacholine that results in a 20% fall in FEV1] from 0.026 to 1.914 mg/mL. Using linear regression, between methacholine challenge testing and bronchodilator response to salbutamol, a positive, weak, and stastistically significant correlation for FEV1 was found (p

  9. Effect of Mindfulness Based Stress Reduction on Quality of Life (SF-36) and Spirometry Parameters, in Chemically Pulmonary Injured Veterans.

    Science.gov (United States)

    Arefnasab, Zahra; Ghanei, Mostafa; Noorbala, Ahmad Ali; Alipour, Ahmad; Babamahmoodi, Farhang; Babamahmoodi, Abdolreza; Salehi, Maryam

    2013-09-01

    Studies have shown that Mindfulness Based Stress Reduction (MBSR) has positive effect on physical and psychological dimensions of chronic illnesses. In this study for the first time we examine the effect of this new technique on quality of life and pulmonary function in chemically pulmonary injured veterans who have chronic pulmonary problem, psychological problems and low quality of life. Forty male pulmonary injured veterans were randomly replaced in two groups with 20 participants (MBSR and control Wait List (WL)). Then MBSR group received 8-weekly sessions intervention. We evaluate quality of life (used SF-36 questionnaire) and Spirometry parameters two times; before and after intervention in two group. We used "mixed factorial analyses of variance" test for analyzing data in each dependent variables. Then if we have significant interactional effect, we used -paired- sample t-test" for comparing before and after intervention data of each group, and "Independent-Sample t-test" for comparing after intervention data of two groups. The MBSR compare to WL group improved SF-36 total score, (F (1, 38) =12.09, P=0.001), "Role limitations due to physical problems"(F(1,38)= 6.92, P=0.01), "Role limitations due to emotional problems"(F(1,38)= 7.75, P=0.008), "Social functioning"(F(1,38)= 9.89, P=0.003), "Mental health"(F(1,38)= 15.93, P=0), "Vitality"(F(1,38)= 40.03, P≤0.001), and "Pain"(F(1,38)= 27.60, P≤0.001). MBSR had no significant effect on "FEV1" (F (1, 38) = 0.03, P=0.85),"FVC" (F (1, 38) = 0.16, P=0.69) and "FEV1/FVC" (F (1, 38) = 2.21, P=0.14). MBSR can improve individual's quality of life but not lung function in chemically pulmonary injured veterans.

  10. Impulse oscillometry at preschool age is a strong predictor of lung function by flow-volume spirometry in adolescence.

    Science.gov (United States)

    Lauhkonen, Eero; Riikonen, Riikka; Törmänen, Sari; Koponen, Petri; Nuolivirta, Kirsi; Helminen, Merja; Toikka, Jyri; Korppi, Matti

    2018-05-01

    The transition from early childhood wheezing to persistent asthma is linked to lung function impairment over time. Little is known how the methods used to study lung function at different ages correlate longitudinally. Sixty-four children with a history of hospitalization for bronchiolitis before 6 months of age were prospectively studied with impulse oscillometry (IOS) at the mean age of 6.3 years and these preschool IOS results were compared with flow-volume spirometry (FVS) measurements at mean age of 11.4 years. The baseline respiratory system resistance at 5 Hz (Rrs5) showed a modest statistically significant correlation with all baseline FVS parameters except FVC. The post-bronchodilator (post-BD) Rrs5 showed a modest statistically significant correlation with post-BD FEV 1 and FEV 1 /FVC. The bronchodilator-induced decrease in Rrs5 showed a modest statistically significant correlation with the percent increase in FEV 1 . Baseline and post-BD respiratory reactance at 5 Hz (Xrs5) showed a modest statistically significant correlation with baseline and post-BD FVS parameters except post-BD FEV 1 /FVC, respectively, and post-BD Xrs5 showed a strong correlation with post-BD FVC (ρ = 0.61) and post-BD FEV 1 (ρ = 0.59). In adjusted linear regression, preschool Xrs5 remained as a statistically significant independent predictor of FVS parameters in adolescence; the one-unit decrease in the Z-score of preschool post-BD Xrs5 predicted 9.6% lower post-BD FEV 1 , 9.3% lower post-BD FVC, and 9.7% lower post-BD MEF 50 when expressed as %-predicted parameters. Persistent post-BD small airway impairment in children with a history of bronchiolitis detected with IOS at preschool age predicted FVS results measured in early adolescence. © 2018 Wiley Periodicals, Inc.

  11. Lung function measurement in awake young children

    DEFF Research Database (Denmark)

    Bisgaard, H; Klug, B

    1995-01-01

    ) and transcutaneous measurements of oxygen tension (Ptc,O2) were compared with concomitant measurements of specific airway resistance (sRaw) and forced expiratory volume in one second (FEV1) by whole body plethysmography and spirometry, respectively, during methacholine challenge in 21 young children aged 4-6 yrs...... to methacholine in young children aged 4-6 yrs. This implies that ZIOS, Rint and Ptc,O2 provide convenient indices of changes in lung function. Their combined use will be useful for monitoring airway diseases of young children.......The aim of the study was to evaluate methods applicable in a clinical setting for monitoring of changes in lung function in awake young children. Impedance measurements by the impulse oscillation technique (ZIOS), respiratory resistance measurements by the interrupter technique (Rint...

  12. Effectiveness of a structured motivational intervention including smoking cessation advice and spirometry information in the primary care setting: the ESPITAP study

    Directory of Open Access Journals (Sweden)

    Martin-Lujan Francisco

    2011-11-01

    Full Text Available Abstract Background There is current controversy about the efficacy of smoking cessation interventions that are based on information obtained by spirometry. The objective of this study is to evaluate the effectiveness in the primary care setting of structured motivational intervention to achieve smoking cessation, compared with usual clinical practice. Methods Design Multicentre randomized clinical trial with an intervention and a control group. Setting 12 primary care centres in the province of Tarragona (Spain. Subjects of study 600 current smokers aged between 35 and 70 years with a cumulative habit of more than 10 packs of cigarettes per year, attended in primary care for any reason and who did not meet any of the exclusion criteria for the study, randomly assigned to structured intervention or standard clinical attention. Intervention Usual advice to quit smoking by a general practitioner as well as a 20-minute personalized visit to provide detailed information about spirometry results, during which FEV1, FVC, FEF 25-75% and PEF measurements were discussed and interpreted in terms of theoretical values. Additional information included the lung age index (defined as the average age of a non-smoker with the same FEV1 as the study participant, comparing this with the chronological age to illustrate the pulmonary deterioration that results from smoking. Measurements Spirometry during the initial visit. Structured interview questionnaire administered at the primary care centre at the initial visit and at 12-month follow-up. Telephone follow-up interview at 6 months. At 12-month follow-up, expired CO was measured in patients who claimed to have quit smoking. Main variables Smoking cessation at 12 months. Analysis Data will be analyzed on the basis of "intention to treat" and the unit of analysis will be the individual smoker. Expected results Among active smokers treated in primary care we anticipate significantly higher smoking cessation in the

  13. Quantitative computed tomography analysis of the airways in patients with cystic fibrosis using automated software: correlation with spirometry in the evaluation of severity

    International Nuclear Information System (INIS)

    Santos, Marcel Koenigkam; Cruvinel, Danilo Lemos; Menezes, Marcelo Bezerra de; Teixeira, Sara Reis; Vianna, Elcio de Oliveira; Elias Junior, Jorge; Martinez, Jose Antonio Baddini

    2016-01-01

    Objective: To perform a quantitative analysis of the airways using automated software, in computed tomography images of patients with cystic fibrosis, correlating the results with spirometric findings. Materials and methods: Thirty-four patients with cystic fibrosis were studied-20 males and 14 females; mean age 18 ± 9 years - divided into two groups according to the spirometry findings: group I (n = 21), without severe airflow obstruction (forced expiratory volume in first second [FEV1] > 50% predicted), and group II (n = 13), with severe obstruction (FEV1 ≤ 50% predicted). The following tracheobronchial tree parameters were obtained automatically: bronchial diameter, area, thickness, and wall attenuation. Results: On average, 52 bronchi per patient were studied. The number of bronchi analyzed was higher in group II. The correlation with spirometry findings, especially between the relative wall thickness of third to eighth bronchial generation and predicted FEV1, was better in group I. Conclusion: Quantitative analysis of the airways by computed tomography can be useful for assessing disease severity in cystic fibrosis patients. In patients with severe airflow obstruction, the number of bronchi studied by the method is higher, indicating more bronchiectasis. In patients without severe obstruction, the relative bronchial wall thickness showed a good correlation with the predicted FEV1. (author)

  14. Quantitative computed tomography analysis of the airways in patients with cystic fibrosis using automated software: correlation with spirometry in the evaluation of severity

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Marcel Koenigkam; Cruvinel, Danilo Lemos; Menezes, Marcelo Bezerra de; Teixeira, Sara Reis; Vianna, Elcio de Oliveira; Elias Junior, Jorge; Martinez, Jose Antonio Baddini, E-mail: marcelk46@yahoo.com.br [Universidade de Sao Paulo (HC/FMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina

    2016-11-15

    Objective: To perform a quantitative analysis of the airways using automated software, in computed tomography images of patients with cystic fibrosis, correlating the results with spirometric findings. Materials and methods: Thirty-four patients with cystic fibrosis were studied-20 males and 14 females; mean age 18 ± 9 years - divided into two groups according to the spirometry findings: group I (n = 21), without severe airflow obstruction (forced expiratory volume in first second [FEV1] > 50% predicted), and group II (n = 13), with severe obstruction (FEV1 ≤ 50% predicted). The following tracheobronchial tree parameters were obtained automatically: bronchial diameter, area, thickness, and wall attenuation. Results: On average, 52 bronchi per patient were studied. The number of bronchi analyzed was higher in group II. The correlation with spirometry findings, especially between the relative wall thickness of third to eighth bronchial generation and predicted FEV1, was better in group I. Conclusion: Quantitative analysis of the airways by computed tomography can be useful for assessing disease severity in cystic fibrosis patients. In patients with severe airflow obstruction, the number of bronchi studied by the method is higher, indicating more bronchiectasis. In patients without severe obstruction, the relative bronchial wall thickness showed a good correlation with the predicted FEV1. (author)

  15. Bronchodilator response cut-off points and FEV 0.75 reference values for spirometry in preschoolers.

    Science.gov (United States)

    Burity, Edjane Figueiredo; Pereira, Carlos Alberto de Castro; Jones, Marcus Herbert; Sayão, Larissa Bouwman; Andrade, Armèle Dornelas de; Britto, Murilo Carlos Amorim de

    2016-01-01

    To determine the cut-off points for FEV1, FEV0.75, FEV0.5, and FEF25-75% bronchodilator responses in healthy preschool children and to generate reference values for FEV0.75. This was a cross-sectional community-based study involving children 3-5 years of age. Healthy preschool children were selected by a standardized questionnaire. Spirometry was performed before and after bronchodilator use. The cut-off point of the response was defined as the 95th percentile of the change in each parameter. We recruited 266 children, 160 (60%) of whom were able to perform acceptable, reproducible expiratory maneuvers before and after bronchodilator use. The mean age and height were 57.78 ± 7.86 months and 106.56 ± 6.43 cm, respectively. The success rate for FEV0.5 was 35%, 68%, and 70% in the 3-, 4-, and 5-year-olds, respectively. The 95th percentile of the change in the percentage of the predicted value in response to bronchodilator use was 11.6%, 16.0%, 8.5%, and 35.5% for FEV1, FEV0.75, FEV0.5, and FEF25-75%, respectively. Our results provide cut-off points for bronchodilator responsiveness for FEV1, FEV0.75, FEV0.5, and FEF25-75% in healthy preschool children. In addition, we proposed gender-specific reference equations for FEV0.75. Our findings could improve the physiological assessment of respiratory function in preschool children. Determinar os pontos de corte de resposta ao broncodilatador do VEF1, VEF0,75, VEF0,5 e FEF25-75% em crianças pré-escolares saudáveis e gerar valores de referência para o VEF0,75. Foi realizado um estudo transversal de base comunitária em crianças de 3-5 anos de idade. Pré-escolares saudáveis foram selecionados por um questionário padronizado. Foi realizada espirometria antes e depois do uso de broncodilatador. Foram definidos os pontos de corte dessa resposta como o percentil 95 de variação em cada parâmetro. Foram recrutadas 266 crianças, e 160 (60,0%) foram capazes de gerar manobras expiratórias aceitáveis e reprodut

  16. Cognitive Challenges

    Science.gov (United States)

    ... Privacy Policy Sitemap Learn Engage Donate About TSC Cognitive Challenges Approximately 45% to 60% of individuals with TSC develop cognitive challenges (intellectual disabilities), although the degree of intellectual ...

  17. Effect of changing from the National Health and Nutritional Examination Survey III spirometry reference range to that of the Global Lung Initiative 2012 at Gold Coast Hospital and Health Service.

    Science.gov (United States)

    Embling, Laura A K; Zagami, Debbie; Sriram, Krishna Bajee; Gordon, Robert J; Sivakumaran, Pathmanathan

    2016-12-01

    The categorisation of lung disease into obstructive ventilatory defect (OVD) and tendency to a restrictive ventilatory defect (TRVD) patterns using spirometry is used to guide both prognostication and treatment. The effectiveness of categorisation depends upon having reference ranges that accurately represent the population they describe. The Global Lung Initiative 2012 (GLI 2012) has spirometry reference ranges drawn from the largest sample size to date. This study aimed to determine whether using spirometry reference ranges from the new GLI 2012 dataset, compared to the previously used National Health and Nutritional Examination Survey III (NHANES III) dataset, resulted in a change in diagnosis between OVD, TRVD and normal ventilatory pattern (NVP). Spirometry data were collected from 301 patients, aged 18-80 years, undergoing investigation at the Gold Coast Hospital and Health Service (GCHHS) throughout February and March 2014. OVD was defined as a forced expiratory volume in 1 second (FEV 1 ) divided by forced vital capacity (FVC) less than lower limit of normal (LLN). TRVD was defined as FEV 1 /FVC ≥ LLN, FEV 1 reference range resulted in a change in diagnosis of lung disease in 5.9% of the individuals included in this study. This variance in diagnosis when changing reference ranges should be taken into account by clinicians as it may affect patient management.

  18. The predictive value of preoperative perfusion/ventilation scintigraphy, spirometry and x-ray of the lungs on postoperative pulmonary complications. A prospective study

    International Nuclear Information System (INIS)

    Fogh, J.; Wille-Joergensen, P.; Brynjolf, I.; Thorup, J.; Joergensen, T.; Bording, L.; Kjaergaard, J.

    1987-01-01

    Prospectively, 125 patients were examined with 99m Tc-perfusion scintigraphy, 89m Kr- or 127 Xe-ventilation scintigraphy and chest radiogram prior to major surgery. Postoperative therapy-demanding pulmonary complications occurred in 18% of the patients. A statistical association could be demonstrated between all the preoperative tests except ventilation scintigraphy and the frequency of complications. However, the predictive values of each of the tests, or even the combined results, were not significantly different from the frequency of complications among all the patients. It is concluded that the predictive values of perfusion-and ventilation scintigraphy, spirometry and radiogram of the chest are too low to be of any practical use. (author)

  19. Association between spirometry controlled chest CT scores using computer-animated biofeedback and clinical markers of lung disease in children with cystic fibrosis

    DEFF Research Database (Denmark)

    Kongstad, Thomas; Green, Kent; Buchvald, Frederik

    2017-01-01

    Background: Computed tomography (CT) of the lungs is the gold standard for assessing the extent of structural changes in the lungs. Spirometry-controlled chest CT (SCCCT) has improved the usefulness of CT by standardising inspiratory and expiratory lung volumes during imaging. This was a single...... (expressed as % of maximum score) to quantify different aspects of structural lung changes including bronchiectasis, airway wall thickening, mucus plugging, opacities, cysts, bullae and gas trapping. Clinical markers consisted of outcomes from pulmonary function tests, microbiological cultures from sputum......-centre cross-sectional study in children with cystic fibrosis (CF). Using SCCCT we wished to investigate the association between the quantity and extent of structural lung changes and pulmonary function outcomes, and prevalence of known CF lung pathogens. Methods: CT images were analysed by CF-CT scoring...

  20. Studying allergic inflammation and spirometry over menstrual cycles in well-controlled asthmatic women: Changes in progesterone and estradiol affect neither FENO levels nor lung function.

    Science.gov (United States)

    Nittner-Marszalska, Marita; Dor-Wojnarowska, Anna; Wolańczyk-Mędrala, Anna; Rosner-Tenerowicz, Anna; Zimmer, Mariusz; Dobek, Julia; Gomułka, Krzysztof; Parużyńska, Anna; Panaszek, Bernard

    2018-05-01

    It has been reported that female sex hormones influence on allergic inflammation and ventilation parameters in asthma but conclusions drawn by different researchers are divergent. The aim of our study was to assess the impact of progesterone (Pg) and estradiol (E) on the dynamics of allergic inflammation and spirometry test results in regularly menstruating women with stable allergic asthma. 13 women (28 days menstrual cycle), aged 18-45, taking no hormonal contraceptives, with mild and moderate asthma, without reported exacerbations at the near-ovulation and/or menstruation time, were monitored during two consecutive menstrual cycles. They had 4 visits per cycle (the first day of menstruation was assumed to be day 1 of the cycle; visits were carried out on days: 3-4, 10-11, 13-14 and 23-24). At each visit asthma symptoms, asthma control test (ACT) results, asthma treatment, fractioned nitric oxide (FENO) levels, spirometry test results, Pg and E, levels were analyzed. As a result of the study, no essential variability in FENO values and ventilation parameters' values in the course of menstruation cycle were observed. Negative correlation between FENO values and Pg concentrations was demonstrated (r = 0.27), but no correlation between FENO values and E levels was shown. No relationship between the ACT values and ventilation parameters and the levels of the sex hormones under investigation was detected. We conclude that changing levels of estradiol and progesterone (regardless of the negative correlation of progesterone and FENO values) affect neither the dynamics of allergic inflammation nor pulmonary function in women with stable allergic mild/moderate asthma. Copyright © 2018 Elsevier Inc. All rights reserved.

  1. Overcoming challenges

    Medline Plus

    Full Text Available ... breastfeeding Overcoming challenges Common questions about breastfeeding and pain Breastfeeding checklist: How to get a good latch Finding ... myths Overcoming challenges Common questions about breastfeeding and pain Breastfeeding checklist: How to get a good latch Finding ...

  2. Overcoming challenges

    Medline Plus

    Full Text Available ... section Back to section menu It's Only Natural Planning ahead Breastfeeding and baby basics Making breastfeeding work ... It's Only Natural Overcoming challenges It's Only Natural Planning ahead Addressing breastfeeding myths Overcoming challenges Common questions ...

  3. [Playing of wind instruments is associated with an obstructive pattern in the spirometry of adolescents with a good aerobic resistance capacity].

    Science.gov (United States)

    Granell, Javier; Granell, Jose; Ruiz, Diana; Tapias, Jose A

    2011-03-01

    There is controversy in the medical literature regarding the beneficial or detrimental effects of playing wind musical instruments on the respiratory system. The aim of this study is to analyse this relationship, taking the physical condition of the subjects into consideration. Cross-sectional observational study. Public institution with coordinated medium grade musical instruction and primary and secondary education. Young performers (between 13 and 17 years). We collected basic epidemiological parameters (gender, age, weight, size, heath status), and each subject underwent a fitness test ("course navette" cardiorespiratory fitness test) and a forced spirometry. We included 90 students, 53 females and 37 males. Thirty two were wind instrument players and 58 studied other instruments. The two groups were homogeneous with respect to gender, age and body mass index. The maximum oxygen uptake showed no significant difference (P=0.255), further demonstrating an adequate level of fitness compared to the general population. FVC was normal and similar in both groups (P=0.197). The FEV(1) percentage and the FEV(1)/FVC ratio were significantly lower (Pstudy of wind instruments was associated with an obstructive spirometric pattern in young musicians with a normal level of physical fitness. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  4. Overcoming challenges

    Medline Plus

    Full Text Available ... Disease and Stroke HIV and AIDS Mental Health Pain Pregnancy Reproductive Health Sexual Health Sexually Transmitted Infections ... breastfeeding Overcoming challenges Common questions about breastfeeding and pain Breastfeeding checklist: How to get a good latch ...

  5. Overcoming challenges

    Medline Plus

    Full Text Available ... menu It's Only Natural Planning ahead Breastfeeding and baby basics Making breastfeeding work for you Addressing breastfeeding ... in the African-American community Incredible facts about babies, breastmilk, and breastfeeding Overcoming challenges Common questions about ...

  6. Overcoming challenges

    Medline Plus

    Full Text Available ... facts about babies, breastmilk, and breastfeeding Overcoming challenges Common questions about breastfeeding and pain Breastfeeding checklist: How to get a good latch Finding support It takes a village: Building ...

  7. Cognitive Challenges

    Science.gov (United States)

    ... Alliance Our Story Our Vision Our Team Our Leadership Our Results Our Corporate Policies FAQs Careers Contact Us Media Store Privacy Policy Sitemap Learn Engage Donate About TSC Cognitive Challenges Approximately 45% to 60% of individuals with TSC ...

  8. Overcoming challenges

    Medline Plus

    Full Text Available ... breastfeeding means to them. Subscribe To receive Breastfeeding email updates Enter email Submit Overcoming challenges Breastfeeding has a long list ... breastfeeding means to them. Subscribe To receive Breastfeeding email updates Enter email Submit All material contained on ...

  9. Overcoming challenges

    Medline Plus

    Full Text Available ... into your life Breastfeeding in daily life: At home and in public Laws that support breastfeeding 10 ... and jobs View all pages in this section Home It's Only Natural Overcoming challenges It's Only Natural ...

  10. Estimating the U.S. prevalence of chronic obstructive pulmonary disease using pre- and post-bronchodilator spirometry: the National Health and Nutrition Examination Survey (NHANES) 2007–2010

    Science.gov (United States)

    2013-01-01

    Background During 2007–2010, the National Health and Nutrition Examination Survey (NHANES) conducted a spirometry component which obtained pre-bronchodilator pulmonary lung function data on a nationally representative sample of US adults aged 6–79 years and post-bronchodilator pulmonary lung function data for the subset of adults with airflow limitation. The goals of this study were to 1) compute prevalence estimates of chronic obstructive pulmonary disease (COPD) using pre-bronchodilator and post-bronchodilator spirometry measurements and fixed ratio and lower limit of normal (LLN) diagnostic criteria and 2) examine the potential impact of nonresponse on the estimates. Methods This analysis was limited to those aged 40–79 years who were eligible for NHANES pre-bronchodilator spirometry (n=7,104). Examinees with likely airflow limitation were further eligible for post-bronchodilator testing (n=1,110). Persons were classified as having COPD based on FEV1/FVC spirometry but self-reporting both daytime supplemental oxygen therapy plus emphysema and/or current chronic bronchitis were also classified as having COPD. The final analytic samples for pre-bronchodilator and post-bronchodilator analyses were 77.1% (n=5,477) and 50.8% (n=564) of those eligible, respectively. To account for non-response, NHANES examination weights were adjusted to the eligible pre-bronchodilator and post-bronchodilator subpopulations. Results In 2007–2010, using the fixed ratio criterion and pre-bronchodilator test results, COPD prevalence was 20.9% (SE 1.1) among US adults aged 40–79 years. Applying the same criterion to post-bronchodilator test results, prevalence was 14.0% (SE 1.0). Using the LLN criterion and pre-bronchodilator test results, the COPD prevalence was 15.4% (SE 0.8), while applying the same criterion to post-bronchodilator test results, prevalence was 10.2% (SE 0.8). Conclusions The overall COPD prevalence among US adults aged 40–79 years varied from 10.2% to 20

  11. Diseño de un programa de formación básico para conseguir espirometrías de calidad Design of a basic training program to get quality spirometry

    Directory of Open Access Journals (Sweden)

    Joan Escarrabill

    2012-06-01

    Full Text Available Introducción. La espirometría forzada es una manera sencilla y no invasiva de valorar la función pulmonar. La obtención de una espirometría de calidad requiere formación, condiciones técnicas adecuadas (calibración, mantenimiento y ubicación del aparato y colaboración del paciente. Diversos trabajos han constatado déficits formativos de los profesionales, relacionados en parte con la elevada rotación en un mismo puesto, la falta de sistemática en la incorporación de nuevos profesionales que realizan espirometrías y la ausencia de planes de evaluación periódica de competencias. Materiales y métodos. En el marco del Plan Director de Enfermedades del Aparato Respiratorio (PDMAR se ha diseñado un programa formativo mínimo teórico-práctico de 16 horas de duración, basado en el programa de formación del National Institute for Occupational Safety and Health y de las iniciativas que surgen en el marco de la European Respiratory Society. Durante el año 2010 se realizaron 13 cursos en los que participaron 307 profesionales. Resultados. Las diferencias observadas entre la evaluación de conocimientos previos y la evaluación final fue estadísticamente significativa (p Introduction. The spirometry is a simple and noninvasive test to assess lung function. Obtaining a spirometry of quality requires training, appropriate technical conditions (calibration, maintenance and location of the device, and patient cooperation. Several studies have found professional training deficits related to a high turnover in the same place, the lack of systematic training when new professionals performing spirometry are incorporated and the lack of competences' periodic evaluation. Materials and methods. The Master Plan for respiratory diseases (PDMAR has designed a minimum practical/theoretical training program (16 hours based on the training program of the National Institute for Occupational Safety and Health and the European Respiratory Society

  12. Environmental challenge

    International Nuclear Information System (INIS)

    Conable, B.; Warford, J.; Partow, Z.; Lutz, E.; Munasinghe, M.

    1991-09-01

    The contents include the following: Development and the Environment: A Global Balance; Evolution of the World Bank's Environmental Policy; Accounting for the Environment; Public Policy and the Environment; Managing Drylands; Environmental Action Plans in Africa; Agroforestry in Sub-Saharan Africa; Irrigation and the Environmental Challenge; Curbing Pollution in Developing Countries; Global Warming and the Developing World; and The Global Environment Facility

  13. Challenging Identities

    DEFF Research Database (Denmark)

    depends on the conceptual or ideological constellation in which it takes part. This volume on one hand demonstrates the role of notions of identity in a variety of European contexts, and on the other hand highlights how there may be reasons to challenge the use of the term and corresponding social...

  14. Overcoming challenges

    Medline Plus

    Full Text Available ... Contact Us Blog Popular topics Vision and mission Leadership Programs and activities In your community Funding opportunities Internships and jobs View all pages in this section Home It's Only Natural Overcoming challenges It's Only Natural Planning ahead Addressing breastfeeding myths ...

  15. Overcoming challenges

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    Full Text Available ... we are What we do Programs and activities Work with us Contact Us Blog Popular topics Vision and mission Leadership Programs and activities In your community Funding opportunities Internships and jobs View all pages in this section Home It's Only Natural Overcoming challenges It's Only Natural ...

  16. Eosinophils contribute to the resolution of lung-allergic responses following repeated allergen challenge.

    Science.gov (United States)

    Takeda, Katsuyuki; Shiraishi, Yoshiki; Ashino, Shigeru; Han, Junyan; Jia, Yi; Wang, Meiqin; Lee, Nancy A; Lee, James J; Gelfand, Erwin W

    2015-02-01

    Eosinophils accumulate at the site of allergic inflammation and are critical effector cells in allergic diseases. Recent studies have also suggested a role for eosinophils in the resolution of inflammation. To determine the role of eosinophils in the resolution phase of the response to repeated allergen challenge. Eosinophil-deficient (PHIL) and wild-type (WT) littermates were sensitized and challenged to ovalbumin (OVA) 7 or 11 times. Airway inflammation, airway hyperresponsiveness (AHR) to inhaled methacholine, bronchoalveolar lavage (BAL) cytokine levels, and lung histology were monitored. Intracellular cytokine levels in BAL leukocytes were analyzed by flow cytometry. Groups of OVA-sensitized PHIL mice received bone marrow from WT or IL-10(-/-) donors 30 days before the OVA challenge. PHIL and WT mice developed similar levels of AHR and numbers of leukocytes and cytokine levels in BAL fluid after OVA sensitization and 7 airway challenges; no eosinophils were detected in the PHIL mice. Unlike WT mice, sensitized PHIL mice maintained AHR, lung inflammation, and increased levels of IL-4, IL-5, and IL-13 in BAL fluid after 11 challenges whereas IL-10 and TGF-β levels were decreased. Restoration of eosinophil numbers after injection of bone marrow from WT but not IL-10-deficient mice restored levels of IL-10 and TGF-β in BAL fluid as well as suppressed AHR and inflammation. Intracellular staining of BAL leukocytes revealed the capacity of eosinophils to produce IL-10. After repeated allergen challenge, eosinophils appeared not essential for the development of AHR and lung inflammation but contributed to the resolution of AHR and inflammation by producing IL-10. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  17. Mobility Challenges

    DEFF Research Database (Denmark)

    Jensen, Ole B.; Lassen, Claus

    2011-01-01

    This article takes point of departure in the challenges to understand the importance of contemporary mobility. The approach advocated is a cross-disciplinary one drawing on sociology, geography, urban planning and design, and cultural studies. As such the perspective is to be seen as a part...... of the so-called ‘mobility turn’ within social science. The perspective is illustrative for the research efforts at the Centre for Mobility and Urban Studies (C-MUS), Aalborg University. The article presents the contours of a theoretical perspective meeting the challenges to research into contemporary urban...... mobilities. In particular the article discusses 1) the physical city, its infrastructures and technological hardware/software, 2) policies and planning strategies for urban mobility and 3) the lived everyday life in the city and the region....

  18. Global challenges

    International Nuclear Information System (INIS)

    Blix, H.

    1990-01-01

    A major challenge now facing the world is the supply of energy needed for growth and development in a manner which is not only economically viable but also environmentally acceptable and sustainable in view of the demands of and risks to future generations. The internationally most significant pollutants from energy production through fossil fuels are SO 2 and NO x which cause acid rain, and CO 2 which is the most significant contributor to the greenhouse effect. Nuclear power, now providing about 17% of the world's electricity and 5% of the primary energy already is making a notable contribution to avoiding these emissions. While the industrialized countries will need more energy and especially electricity in the future, the needs of the developing countries are naturally much larger and present a tremendous challenge to the shaping of the world's future energy supply system. The advanced countries will have to accept special responsibilities, as they can most easily use advanced technologies and they have been and remain the main contributors to the environmental problems we now face. Energy conservation and resort to new renewable energy sources, though highly desirable, appear inadequate alone to meet the challenges. The world can hardly afford to do without an increased use of nuclear power, although it is strongly contested in many countries. The objections raised against the nuclear option focus on safety, waste management and disposal problems and the risk for proliferation of nuclear weapons. These issues are not without their problems. The risk of proliferation exists but will not appreciably diminish with lesser global reliance on nuclear power. The waste issue is more of a political than a technical problem. The use of nuclear power, or any other energy source, will never be at zero risk, but the risks are constantly reduced by new techniques and practices. The IAEA sees it as one of its priority tasks to promote such techniques. (author)

  19. Data Challenges

    CERN Multimedia

    McCubbin, N A

    Some two years ago we planned a series of Data Challenges starting at the end of 2001. At the time, that seemed to be comfortingly far in the future... Well, as the saying goes, doesn't time fly when you are having fun! ATLAS Computing is now deep in the throes of getting the first Data Challenge (DC0) up and running. One of the main aims of DC0 is to have a software 'release' in which we can generate full physics events, track all particles through the detector, simulate the detector response, reconstruct the event, and study it, with appropriate data storage en route. As all software is "always 95% ready" (!), we have been able to do most of this, more or less, for some time. But DC0 forces us to have everything working, together, at the same time: a reality check. DC0 should finish early next year, and it will be followed almost immediately afterwards by DC1 (DC0 was foreseen as the 'check' for DC1). DC1 will last into the middle of 2002, and has two major goals. The first is generation, simulation, and r...

  20. Challenging makerspaces

    DEFF Research Database (Denmark)

    Sandvik, Kjetil; Thestrup, Klaus

    This paper takes its departure in the EU-project MakEY - Makerspaces in the early years – enhancing digital literacy and creativity that is part of a H2020 RISE-program and is running January 2017 - June 2019. Here digital literacy and creative skills of young children between the age of 3......-8 will be developed through participation in creative activities in specially-designed spaces termed ‘makerspaces’. This paper discusses, develops and challenges this term in relation to Danish pedagogical traditions, to expanding makerspaces onto the internet and on how to combine narratives and construction....... The Danish part of the project will be undertaken by a small network of partners: DOKK1, a public library and open urban space in Aarhus, that is experimenting with different kind of makerspaces, spaces and encounters between people, The LEGO-LAB situated at Computer Science, Aarhus University, that has...

  1. A espirometria na avaliação pré e pós-transplante de medula óssea Pre-operative and post-operative spirometry in bone marrow transplant patients

    Directory of Open Access Journals (Sweden)

    Eliane Viana Mancuzo

    2007-02-01

    Full Text Available OBJETIVO: Analisar os resultados da espirometria de pacientes submetidos a transplante de medula óssea e verificar sua importância na detecção de complicações pulmonares e sua correlação com a evolução dos pacientes. MÉTODOS:Foram analisados retrospectivamente os resultados da espirometria em 120 pacientes, maiores de doze anos, de ambos os sexos, e comparados com o tipo de transplante de medula óssea, doença de base, sorologia para citomegalovírus, fonte de células para o transplante, tabagismo, infecção pulmonar, doença pulmonar prévia, duração da doença hematológica, quimioterapia utilizada, regime de condicionamento, doença do enxerto contra o hospedeiro aguda e crônica e óbito. RESULTADOS: Dezesseis pacientes apresentaram alterações da espirometria antes do transplante, sendo 5% com obstrução pura, 5,8% com restrição pura e 2,5% com obstrução com redução da capacidade vital. Após o transplante 29 pacientes apresentaram alterações desses exames. A chance de alteração da espirometria foi maior nos pacientes com doença do enxerto contra o hospedeiro aguda (p = 0,02, idade menor que 30 anos (p = 0,02, sexo feminino (p = 0,02 e naqueles que receberam células tronco (p = 0,01. As presenças de doença pulmonar prévia e doença do enxerto contra o hospedeiro crônica associaram-se com aumento da mortalidade. Alterações prévias da espirometria não estiveram relacionadas com o óbito pós-transplante. CONCLUSÃO: As alterações detectadas na espirometria não foram capazes de predizer a ocorrência de complicações pulmonares e óbito pós-transplantes. Também não foram determinantes para a não realização do procedimento. A espirometria simples realizada na avaliação desses pacientes parece ter pouca importância prática.OBJECTIVE: To analyze the spirometry findings in patients undergoing bone marrow transplant, determining the importance of such findings in predicting postoperative pulmonary

  2. Glomar challenger

    Energy Technology Data Exchange (ETDEWEB)

    Carroll, J P

    1969-01-01

    The Glomar Challenger has a length of 400 ft, a 65-ft beam, and a depth of 27 ft 6-in. She has a draft of 20 ft with a gross displacement of 10,500 long tons. The principal specifications of the vessel are tabulated. To achieve dynamic positioning, 4 fixed thrusters and the vessel's 2 propulsion screws are utilized. The ''fix'' is obtained by placing a sonar beacon, with self contained batteries, on the ocean floor at a selected site. The vessel is provided with 4 hydrophones installed in the hull at the 4 corners of a square. The sonar beacon radiates sound waves at a fixed pulse rate. If the vessel is directly over the beacon, the sound waves will arrive at all hydrophones simultaneously. A difference in time of arrival indicates the vessel is off location. The sound signals received by the hydrophones are fed into a computer. They are changed into coordinate information, which serves as the primary function of determining corrective action by the vessel's propulsion and thruster system. The computer feeds back information into a control system, which enables the propulsion and thrusters to automatically respond, in order to keep the vessel on the predetermined location. The major drilling components are listed. The deep-sea drilling project is described. A summary of the first leg is given in tabular form.

  3. Scrapheap Challenge

    CERN Document Server

    2004-01-01

    Three British guys at CERN recently took a break from work to try their hand at Scrapheap Challenge. Shown on Channel 4 in the UK, it is a show where two teams must construct a machine for a specific task using only the junk they can scavenge from the scrap yard around them. And they have just 10 hours to build their contraption before it is put to the test. The first round, aired 19 September, pitted a team of three women, from the British Army's Royal Electrical and Mechanical Engineers, against the CERN guys - the Up 'n Atoms: Ali Day, David McFarlane and James Ridewood. Each team, with the help of an appointed expert, had the task of making a giant, 3-metre self-propelled "bowling ball", to roll down a 50 metre bowling alley at skittles 4 metres high. The Up 'n Atoms' contraption featured a small car with a huge wheel on its back. Once up to speed, slamming on the brakes caused the wheel to roll over and take the car with it. On their very last run they managed to take out seven pins. Luckily, though, ...

  4. Regulatory challenges

    International Nuclear Information System (INIS)

    Austvik, Ole Gunnar

    2003-01-01

    The problem for policy makers wanting to liberalize natural gas markets is that its concentrated structure may also be the socially most efficient one. Because of scale economies, more firms operating in the market may incur higher transportation costs unless the market grows sufficiently in each geographic segment. This argument goes for product extension through vertical (or horizontal) integration and the exploitation of economies of scope as well. Thus, the challenge for governments is to intervene in a way that preserves a market structure that has the potential to minimize cost, and at the same lime change its behavior in order to avoid possible lax cost control and exploitation of market power. The existence of scope advantages indicates that liberalization of the market should open for the possibility to bundle services in competition with provision of unbundled services. If operations are unbundled and there exist economies of scope, the gain from increased competition should be weighed against the losses of less efficient operations of each firm. Thus, with the growth in the European market, gradually more arguments support the idea of unbundling. The significant scale economy in trunk pipelines, sunk investments and capital immobility, possible economies of scope in vertical integration and companies' bundling of services influences vertical and horizontal ownership relations and contractual terms in the European gas market. In specific segments of the markets, these relationships may promote efficient investments and pricing without public interference, but the strong concentration of market power indicates that this is rather the exception than the rule. In order to design an efficient and welfare maximizing way of regulating the market one needs a closer identification of the actual goal of the regulation. Microeconomic theory is often used for this purpose. The author discusses the alternatives of laissez-faire, nationalization or regulation for the

  5. Different effects of deep inspirations on central and peripheral airways in healthy and allergen-challenged mice

    Directory of Open Access Journals (Sweden)

    Dahlén Sven-Erik

    2008-02-01

    Full Text Available Abstract Background Deep inspirations (DI have bronchodilatory and bronchoprotective effects in healthy human subjects, but these effects appear to be absent in asthmatic lungs. We have characterized the effects of DI on lung mechanics during mechanical ventilation in healthy mice and in a murine model of acute and chronic airway inflammation. Methods Balb/c mice were sensitized to ovalbumin (OVA and exposed to nebulized OVA for 1 week or 12 weeks. Control mice were challenged with PBS. Mice were randomly selected to receive DI, which were given twice during the minute before assessment of lung mechanics. Results DI protected against bronchoconstriction of central airways in healthy mice and in mice with acute airway inflammation, but not when OVA-induced chronic inflammation was present. DI reduced lung resistance induced by methacholine from 3.8 ± 0.3 to 2.8 ± 0.1 cmH2O·s·mL-1 in healthy mice and 5.1 ± 0.3 to 3.5 ± 0.3 cmH2O·s·mL-1 in acute airway inflammation (both P P P P P Conclusion We have tested a mouse model of potential value for defining mechanisms and sites of action of DI in healthy and asthmatic human subjects. Our current results point to potent protective effects of DI on peripheral parts of chronically inflamed murine lungs and that the presence of DI may blunt airway hyperreactivity.

  6. Novos valores de referência para espirometria forçada em brasileiros adultos de raça branca New reference values for forced spirometry in white adults in Brazil

    Directory of Open Access Journals (Sweden)

    Carlos Alberto de Castro Pereira

    2007-08-01

    Full Text Available OBJETIVO: Descrever novas equações de referência para a espirometria em adultos brasileiros saudáveis que nunca fumaram, e comparar os valores previstos atuais com os valores derivados em 1992. MÉTODOS: Equações e limites de referência foram derivados em 270 homens e 373 mulheres, habitantes de oito cidades brasileiras, por espirômetro. A idade variou de 20 a 85 anos nas mulheres e 26 a 86 anos nos homens. Os exames seguiram as normas recomendadas pela Sociedade Brasileira de Pneumologia e Tisiologia. Os limites inferiores foram derivados pela análise do 5º percentil dos resíduos. RESULTADOS: Os valores previstos para capacidade vital forçada (CVF, volume expiratório forçado no primeiro segundo (VEF1 e para as relações VEF1/CVF e VEF1/volume expiratório forçado nos primeiros seis segundos (VEF6 se ajustaram melhor em regressões lineares. Os fluxos ajustaram-se melhor em equações logarítmicas. Em ambos os sexos, maiores estaturas resultaram em menores valores para as relações VEF1/CVF, VEF1/VEF6 e fluxos/CVF. Os valores de referência do VEF1 e da CVF, no presente estudo, foram maiores do que aqueles derivados para adultos brasileiros em 1992. CONCLUSÃO: Novos valores previstos para a espirometria forçada foram obtidos em uma amostra da população brasileira de raça branca. Os valores são maiores do que os obtidos em 1992, provavelmente em decorrência de fatores técnicos.OBJECTIVE: To describe spirometric reference equations for healthy Brazilian adults who have never smoked and to compare the predicted values with those derived in 1992. METHODS: Reference equations for spirometry were derived in 270 men and 373 women living in eight cities in Brazil. Ages ranged from 20 to 85 years in women and from 26 to 86 years in men. Spirometry examinations followed the recommendations of the Brazilian Thoracic Society. Lower limits were derived by the analysis of the fifth percentiles of the residuals. RESULTS: Forced vital

  7. The Concave Shape of the Forced Expiratory Flow-Volume Curve in 3 Seconds Is a Practical Surrogate of FEV1/FVC for the Diagnosis of Airway Limitation in Inadequate Spirometry.

    Science.gov (United States)

    Li, Hao; Liu, Chunhong; Zhang, Yi; Xiao, Wei

    2017-03-01

    Spirometry is important for the differential diagnosis of dyspnea. However, some patients cannot exhale for ≥6 s to achieve the American Thoracic Society/European Respiratory Society criteria. The aim of this study was to demonstrate the reliability of a new parameter that quantifies the degree of concavity in the first 3 s to define airway limitation as a surrogate for the FEV 1 /FVC. Four hundred spirometry test results were selected through complete random sampling. The new parameter, termed the AUC 3 /AT 3 , was calculated as the area under the descending limb of the expiratory flow-volume curve before the end of the first 3 s (AUC 3 ) divided by the area of the triangle before the end of the first 3 s (AT 3 ). The AUC 3 /AT 3 was compared with the FEV 1 /FVC using Pearson's correlation analysis. The level of agreement between the AUC 3 /AT 3 and the FEV 1 /FVC in the detection of airway obstruction was analyzed using the kappa statistic. We also compared the diagnostic accuracy of the new index with that of the FEV 1 /forced expiratory volume in the first 3 s (FEV 3 ). There was a strong correlation (r = 0.88, P < .001) between the AUC 3 /AT 3 and the FEV 1 /FVC. There was also strong agreement between the AUC 3 /AT 3 and the FEV 1 /FVC in the detection of obstruction with kappa indices of 0.72 (Global Initiative for Chronic Obstructive Lung Disease [GOLD] criterion) and 0.67 (lower limit of normal criterion), and these values were greater than those obtained for the FEV 1 /FEV 3 . The AUC 3 /AT 3 also exhibited acceptable sensitivity, specificity, positive predictive value, and negative predictive value. The diagnostic accuracies of the AUC 3 /AT 3 were 86.3% (GOLD criterion) and 83.8% (lower limit of normal criterion), which were greater than the 76.0 and 74.0% obtained for the FEV 1 /FEV 3 , respectively. The AUC 3 /AT 3 can be utilized as a surrogate parameter for the FEV 1 /FVC when patients cannot complete a 6-s expiratory effort. Additionally, the

  8. Heightened bronchial hyperresponsiveness in the absence of heightened atopy in children with current wheezing and low income status.

    Science.gov (United States)

    Mallol, J; Castro-Rodriguez, J A; Cortez, E; Aguirre, V; Aguilar, P; Barrueto, L

    2008-02-01

    Although global studies such as the International Study of Asthma and Allergies in Childhood (ISAAC) have provided valuable data on the prevalence of asthma in children in Latin America, there is little information on the relationship between asthma symptoms, pulmonary function, bronchial hyperresponsiveness (BHR) and atopy in the region. This study examined the relationship between self-reported wheezing in the past 12 months, pulmonary function, airway responsiveness and atopy in children from a low income population in a neighbourhood of Santiago, Chile. Two random samples (100 each) of children aged 13-14 years who participated in ISAAC phase I were selected according to whether or not they reported wheezing in the past 12 months. Spirometry, the methacholine bronchial challenge test and the prick test were performed in all individuals. Children who reported current wheezing had significantly higher BHR to methacholine compared with those without wheezing (71.6% vs 52.6%; p = 0.007) and no significant difference was found in forced expiratory volume in 1 s (116.7 (12.3)% vs 120.3 (14.5%); p = 0.11). The prevalence of atopy was not significantly different between those children who reported wheezing compared with those who did not (44.2% vs 42.3%; p = 0.89). Multiple regression analysis showed that only BHR to methacholine (OR 2.72, 95% CI 1.25 to 4.13; p = 0.01) and maternal asthma (OR 3.1, 95% CI 1.2 to 8.3, p = 0.03) were significant risk factors for current wheezing. Our results support previous findings suggesting that in adolescents from underprivileged populations, self-reported current wheezing is related to BHR but not to atopy.

  9. Night Rover Challenge

    Data.gov (United States)

    National Aeronautics and Space Administration — The objective of the Night Rover Challenge was to foster innovations in energy storage technology. Specifically, this challenge asked competitors to create an energy...

  10. National Drug IQ Challenge

    Science.gov (United States)

    ... National Drug IQ Challenge 2017 Reto nacional del coeficiente intelectual (CI) sobre las drogas y el alcohol 2016 National Drug IQ Challenge 2016 Reto nacional del coeficiente intelectual (CI) sobre las drogas y el alcohol 2015 ...

  11. Fit for high altitude: are hypoxic challenge tests useful?

    Directory of Open Access Journals (Sweden)

    Matthys Heinrich

    2011-02-01

    Full Text Available Abstract Altitude travel results in acute variations of barometric pressure, which induce different degrees of hypoxia, changing the gas contents in body tissues and cavities. Non ventilated air containing cavities may induce barotraumas of the lung (pneumothorax, sinuses and middle ear, with pain, vertigo and hearing loss. Commercial air planes keep their cabin pressure at an equivalent altitude of about 2,500 m. This leads to an increased respiratory drive which may also result in symptoms of emotional hyperventilation. In patients with preexisting respiratory pathology due to lung, cardiovascular, pleural, thoracic neuromuscular or obesity-related diseases (i.e. obstructive sleep apnea an additional hypoxic stress may induce respiratory pump and/or heart failure. Clinical pre-altitude assessment must be disease-specific and it includes spirometry, pulsoximetry, ECG, pulmonary and systemic hypertension assessment. In patients with abnormal values we need, in addition, measurements of hemoglobin, pH, base excess, PaO2, and PaCO2 to evaluate whether O2- and CO2-transport is sufficient. Instead of the hypoxia altitude simulation test (HAST, which is not without danger for patients with respiratory insufficiency, we prefer primarily a hyperoxic challenge. The supplementation of normobaric O2 gives us information on the acute reversibility of the arterial hypoxemia and the reduction of ventilation and pulmonary hypertension, as well as about the efficiency of the additional O2-flow needed during altitude exposure. For difficult judgements the performance of the test in a hypobaric chamber with and without supplemental O2-breathing remains the gold standard. The increasing numbers of drugs to treat acute pulmonary hypertension due to altitude exposure (acetazolamide, dexamethasone, nifedipine, sildenafil or to other etiologies (anticoagulants, prostanoids, phosphodiesterase-5-inhibitors, endothelin receptor antagonists including mechanical aids to

  12. Fit for high altitude: are hypoxic challenge tests useful?

    Science.gov (United States)

    Matthys, Heinrich

    2011-02-28

    Altitude travel results in acute variations of barometric pressure, which induce different degrees of hypoxia, changing the gas contents in body tissues and cavities. Non ventilated air containing cavities may induce barotraumas of the lung (pneumothorax), sinuses and middle ear, with pain, vertigo and hearing loss. Commercial air planes keep their cabin pressure at an equivalent altitude of about 2,500 m. This leads to an increased respiratory drive which may also result in symptoms of emotional hyperventilation. In patients with preexisting respiratory pathology due to lung, cardiovascular, pleural, thoracic neuromuscular or obesity-related diseases (i.e. obstructive sleep apnea) an additional hypoxic stress may induce respiratory pump and/or heart failure. Clinical pre-altitude assessment must be disease-specific and it includes spirometry, pulsoximetry, ECG, pulmonary and systemic hypertension assessment. In patients with abnormal values we need, in addition, measurements of hemoglobin, pH, base excess, PaO2, and PaCO2 to evaluate whether O2- and CO2-transport is sufficient.Instead of the hypoxia altitude simulation test (HAST), which is not without danger for patients with respiratory insufficiency, we prefer primarily a hyperoxic challenge. The supplementation of normobaric O2 gives us information on the acute reversibility of the arterial hypoxemia and the reduction of ventilation and pulmonary hypertension, as well as about the efficiency of the additional O2-flow needed during altitude exposure. For difficult judgements the performance of the test in a hypobaric chamber with and without supplemental O2-breathing remains the gold standard. The increasing numbers of drugs to treat acute pulmonary hypertension due to altitude exposure (acetazolamide, dexamethasone, nifedipine, sildenafil) or to other etiologies (anticoagulants, prostanoids, phosphodiesterase-5-inhibitors, endothelin receptor antagonists) including mechanical aids to reduce periodical or

  13. The GREAT3 challenge

    International Nuclear Information System (INIS)

    Miyatake, H; Mandelbaum, R; Rowe, B

    2014-01-01

    The GRavitational lEnsing Accuracy Testing 3 (GREAT3) challenge is an image analysis competition that aims to test algorithms to measure weak gravitational lensing from astronomical images. The challenge started in October 2013 and ends 30 April 2014. The challenge focuses on testing the impact on weak lensing measurements of realistically complex galaxy morphologies, realistic point spread function, and combination of multiple different exposures. It includes simulated ground- and space-based data. The details of the challenge are described in [1], and the challenge website and its leader board can be found at http://great3challenge.info and http://great3.projects.phys.ucl.ac.uk/leaderboard/, respectively

  14. Millennium Challenge Account

    National Research Council Canada - National Science Library

    Tarnoff, Curt

    2008-01-01

    .... foreign aid initiative. The Millennium Challenge Account (MCA) provides assistance through a competitive selection process to developing nations that are pursing political and economic reforms in three areas...

  15. First Aid Challenge

    Science.gov (United States)

    Roman, Harry T.

    2011-01-01

    This article describes a challenge wherein students will be asked to design a portable first aid kit that is normally carried in a recreational vehicle (RV), but can also be hand-carried or backpacked off road for distances of approximately 1-2 miles. This can be a very practical challenge for the students because it touches everyone. Everybody…

  16. Virtual Bridge Design Challenge

    Science.gov (United States)

    Mitts, Charles R.

    2013-01-01

    This design/problem-solving activity challenges students to design a replacement bridge for one that has been designated as either structurally deficient or functionally obsolete. The Aycock MS Technology/STEM Magnet Program Virtual Bridge Design Challenge is an authentic introduction to the engineering design process. It is a socially relevant…

  17. Dewey's Challenge to Teachers

    Science.gov (United States)

    Fishman, Stephen M.; McCarthy, Lucille

    2010-01-01

    Given the serious social problems confronting Americans and others worldwide, the authors propose that Dewey's 1932 challenge to teachers is worthy of reconsideration by educators at all levels. In times similar to our own, Dewey challenged teachers to cultivate students' capacities to identify their happiness with what they can do to improve the…

  18. Challenges in fingertip replantation.

    Science.gov (United States)

    Kim, Jin-Soo; Yang, Jae-Won; Lee, Dong-Chul; Ki, Sae-Hwi; Roh, Si-Young

    2013-11-01

    Fingertip amputation is a challenging injury to manage. Among various reconstructive procedures, replantation results in superior outcome, but is seldom considered in many institutions. From the identification of vessel ends to reanastomosis of the submillimeter vessels, fingertip's highly specialized anatomy requires technical excellence. By addressing these anatomic challenges, fingertip replantation can be a routine reconstructive option for microvascular surgeons.

  19. Challenges in Fingertip Replantation

    OpenAIRE

    Kim, Jin-Soo; Yang, Jae-Won; Lee, Dong-Chul; Ki, Sae-Hwi; Roh, Si-Young

    2013-01-01

    Fingertip amputation is a challenging injury to manage. Among various reconstructive procedures, replantation results in superior outcome, but is seldom considered in many institutions. From the identification of vessel ends to reanastomosis of the submillimeter vessels, fingertip's highly specialized anatomy requires technical excellence. By addressing these anatomic challenges, fingertip replantation can be a routine reconstructive option for microvascular surgeons.

  20. Challenge and Change

    Science.gov (United States)

    Mehaffy, George L.

    2012-01-01

    In the past twenty years, various industries have been forever altered by technology: newspapers, book publishing, the photography business, and many more. Higher education too faces unprecedented challenges primarily driven by rapid changes in technology. To meet these challenges and adapt to these changes, new models are needed. Six challenges…

  1. Employment challenges in the future

    DEFF Research Database (Denmark)

    2011-01-01

    Discussion of challenges in employment challenges in Europe and a brief discription of the Danish flexicurity system......Discussion of challenges in employment challenges in Europe and a brief discription of the Danish flexicurity system...

  2. Big Data Challenges

    Directory of Open Access Journals (Sweden)

    Alexandru Adrian TOLE

    2013-10-01

    Full Text Available The amount of data that is traveling across the internet today, not only that is large, but is complex as well. Companies, institutions, healthcare system etc., all of them use piles of data which are further used for creating reports in order to ensure continuity regarding the services that they have to offer. The process behind the results that these entities requests represents a challenge for software developers and companies that provide IT infrastructure. The challenge is how to manipulate an impressive volume of data that has to be securely delivered through the internet and reach its destination intact. This paper treats the challenges that Big Data creates.

  3. The challenges of dismantling

    International Nuclear Information System (INIS)

    Sene, Monique; Lheureux, Yves; Leroyer, Veronique; Rollinger, Francois; Gauthier, Florence; Depauw, Denis; Reynal, Nathalie; Fraysse, Thierry; Burger, Eric; Bertrand, Adrien; Vallat, Christophe; Bernet, Philippe; Eimer, Michel; Boutin, Dominique; Bietrix, Philippe; Richard, Francoise; Piketty, Laurence; Mouchet, Chantal; Charre, Jean-Pierre

    2014-01-01

    This document gathers Power Point presentations which address the contexts and challenges of dismantling (legal framework, safety and radiation protection challenges, waste processing industry), and propose illustrations of dismantling challenges (example of operations to prepare EURODIF dismantling and CLIGEET work-group on EURODIF dismantling, examples of dismantling of EDF installations and CLIs' opinion on the dismantling of EDF installations, Brennilis dismantling follow-up performed by the CLI, examples of dismantling of CEA installations and opinion of a CLI on the dismantling of CEA installations)

  4. Challenges of serious games

    Directory of Open Access Journals (Sweden)

    B. Fernández-Manjón

    2015-11-01

    Full Text Available Although educational games have revealed to be a very effective focus in diverse situations, their use in education is still very limited. In this paper we analyse the main challenges concerning educational games that, from our perspective, have to be approached so that the use of this kind of games can be widespread. These challenges are classified in three main dimensions: socio-cultural, educational and technological. Once the challenges are identified, some possible measures are suggested to address or reduce these problems so that the use of educational games may be widespread.

  5. Anthropocene Age Wicked Challenges

    DEFF Research Database (Denmark)

    Edgeman, Rick; Wu, Zhaohui

    2015-01-01

    weather events, drought, and desertification; threatened food supplies; water pollution, air pollution, and soil contamination; and the connection of these to disease, violence, and terrorism. Wicked challenges are discussed in relation to enterprise excellence, sustainability, resilience and robustness...

  6. Big data challenges

    DEFF Research Database (Denmark)

    Bachlechner, Daniel; Leimbach, Timo

    2016-01-01

    Although reports on big data success stories have been accumulating in the media, most organizations dealing with high-volume, high-velocity and high-variety information assets still face challenges. Only a thorough understanding of these challenges puts organizations into a position in which...... they can make an informed decision for or against big data, and, if the decision is positive, overcome the challenges smoothly. The combination of a series of interviews with leading experts from enterprises, associations and research institutions, and focused literature reviews allowed not only...... framework are also relevant. For large enterprises and startups specialized in big data, it is typically easier to overcome the challenges than it is for other enterprises and public administration bodies....

  7. Space Robotics Challenge

    Data.gov (United States)

    National Aeronautics and Space Administration — The Space Robotics Challenge seeks to infuse robot autonomy from the best and brightest research groups in the robotics community into NASA robots for future...

  8. The Electric Car Challenge.

    Science.gov (United States)

    Diehl, Brian E.

    1997-01-01

    Describes the Electric Car Challenge during which students applied methods of construction to build lightweight, strong vehicles that were powered by electricity. The activity required problem solving, sheet metal work, electricity, design, and construction skills. (JOW)

  9. Challenges to Public Health

    Indian Academy of Sciences (India)

    First page Back Continue Last page Graphics. Challenges to Public Health. Tracing of the infection. Isolation of patients to stop spread. Laboratory diagnosis. Hospitalization &Treatment. Stock pile & supply of drugs. Planning & mitigation. Information to public. Support to SEARO countries.

  10. Community Challenge Grantees

    Data.gov (United States)

    Department of Housing and Urban Development — HUD's Community Challenge Grants aim to reform and reduce barriers to achieving affordable, economically vital and sustainable communities. The funds are awarded to...

  11. Brazil World Cup Challenges

    Directory of Open Access Journals (Sweden)

    MANSUR, R.

    2012-12-01

    Full Text Available Overcoming the productivity challenge is the main benefit of the 2014 World Cup for Brazilian people. The sustainable development of our cultural tourism industry will catapult the new middle class growing up rate.

  12. The boomer challenge.

    Science.gov (United States)

    Barr, Paul

    2014-01-01

    Hospitals and the rest of health care will have to make some major adjustments to meet the needs of the aging baby boom generation. The first article in our year-long series inventories the many challenges that lie ahead.

  13. Overcoming Safeguards Challenges

    International Nuclear Information System (INIS)

    Henriques, Sasha

    2011-01-01

    The focus of the 2010 IAEA International Safeguards Symposium was how best, from a technical perspective, to prepare for future verification challenges during this time of change. By bringing together the leading experts in the field from across the world, this symposium provided an opportunity for stakeholders to explore possible solutions in support of the IAEA's nuclear verification mission, and to identify areas where the different stakeholders in the safeguards business can help address these challenges

  14. Challenges in obesity research

    OpenAIRE

    Palou, Andreu; Bonet, M. Luisa

    2013-01-01

    Obesity is the main nutritional problem and one of the most important health problems in developed societies. Central to the challenge of obesity prevention and management is a thoroughly understanding of its determinants. Multiple socio-cultural, socio-economic, behavioural and biological factors -often interrelated and many of them still unknown or poorly understood- can contribute to the establishment and perpetuation of obese phenotypes. Here, we address current research challenges regard...

  15. Novel spirometry based on optical surface imaging

    Energy Technology Data Exchange (ETDEWEB)

    Li, Guang, E-mail: lig2@mskcc.org; Huang, Hailiang; Li, Diana G.; Chen, Qing; Gaebler, Carl P.; Mechalakos, James [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York 10065 (United States); Wei, Jie [Department of Computer Science, City College of New York, New York, New York 10031 (United States); Sullivan, James [Pulmonary Laboratories, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York 10065 (United States); Zatcky, Joan; Rimner, Andreas [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York 10065 (United States)

    2015-04-15

    Purpose: To evaluate the feasibility of using optical surface imaging (OSI) to measure the dynamic tidal volume (TV) of the human torso during free breathing. Methods: We performed experiments to measure volume or volume change in geometric and deformable phantoms as well as human subjects using OSI. To assess the accuracy of OSI in volume determination, we performed experiments using five geometric phantoms and two deformable body phantoms and compared the values with those derived from geometric calculations and computed tomography (CT) measurements, respectively. To apply this technique to human subjects, an institutional review board protocol was established and three healthy volunteers were studied. In the human experiment, a high-speed image capture mode of OSI was applied to acquire torso images at 4–5 frames per second, which was synchronized with conventional spirometric measurements at 5 Hz. An in-house MATLAB program was developed to interactively define the volume of interest (VOI), separate the thorax and abdomen, and automatically calculate the thoracic and abdominal volumes within the VOIs. The torso volume change (TV C = ΔV{sub torso} = ΔV{sub thorax} + ΔV{sub abdomen}) was automatically calculated using full-exhalation phase as the reference. The volumetric breathing pattern (BP{sub v} = ΔV{sub thorax}/ΔV{sub torso}) quantifying thoracic and abdominal volume variations was also calculated. Under quiet breathing, TVC should equal the tidal volume measured concurrently by a spirometer with a conversion factor (1.08) accounting for internal and external differences of temperature and moisture. Another MATLAB program was implemented to control the conventional spirometer that was used as the standard. Results: The volumes measured from the OSI imaging of geometric phantoms agreed with the calculated volumes with a discrepancy of 0.0% ± 1.6% (range −1.9% to 2.5%). In measurements from the deformable torso/thorax phantoms, the volume differences measured using OSI imaging and CT imaging were 1.2% ± 2.1% (range −0.5% to 3.6%), with a linear regression fitting (slope = 1.02 and R{sup 2} = 0.999). In volunteers, the relative error in OSI tidal volume measurement was −2.2% ± 4.9% (range −9.2% to 4.8%) and a correlation of r = 0.98 was found with spirometric measurement. The breathing pattern values of the three volunteers were substantially different from each other (BP{sub v} = 0.15, 0.45, and 0.32). Conclusions: This study demonstrates the feasibility of using OSI to measure breathing tidal volumes and breathing patterns with adequate accuracy. This is the first time that dynamic breathing tidal volume as well as breathing patterns is measured using optical surface imaging. The OSI-observed movement of the entire torso could serve as a new respiratory surrogate in the treatment room during radiation therapy.

  16. New Danish reference values for spirometry

    DEFF Research Database (Denmark)

    Løkke, Anders; Marott, Jacob Louis; Mortensen, Jann

    2013-01-01

    years of age or older with adequate lung function. Results:  We used sex-stratified multiple linear regression analysis to find prediction formulas for forced expiratory volume in 1 s (FEV(1) ), forced vital capacity (FVC) and FEV(1) /FVC adjusted for age and height. The cutoff value of normal lung......Introduction:  International recommendations state that reference values for lung function should derive from cross-sectional studies of healthy nonsmokers and be renewed from time to time because of cohort effect and newer, more accurate, technical equipment. In 1986, the Danish Lung Society...

  17. Spirometry of healthy adult South African men

    African Journals Online (AJOL)

    1996-07-07

    Jul 7, 1996 ... radiographic screening process was used to identify a healthy population ... significantly lower values than the Autolink for FVC measurements despite .... t Medical Instrumentation. ATS '" American ... Quality control. Biological ...

  18. Novel spirometry based on optical surface imaging

    International Nuclear Information System (INIS)

    Li, Guang; Huang, Hailiang; Li, Diana G.; Chen, Qing; Gaebler, Carl P.; Mechalakos, James; Wei, Jie; Sullivan, James; Zatcky, Joan; Rimner, Andreas

    2015-01-01

    Purpose: To evaluate the feasibility of using optical surface imaging (OSI) to measure the dynamic tidal volume (TV) of the human torso during free breathing. Methods: We performed experiments to measure volume or volume change in geometric and deformable phantoms as well as human subjects using OSI. To assess the accuracy of OSI in volume determination, we performed experiments using five geometric phantoms and two deformable body phantoms and compared the values with those derived from geometric calculations and computed tomography (CT) measurements, respectively. To apply this technique to human subjects, an institutional review board protocol was established and three healthy volunteers were studied. In the human experiment, a high-speed image capture mode of OSI was applied to acquire torso images at 4–5 frames per second, which was synchronized with conventional spirometric measurements at 5 Hz. An in-house MATLAB program was developed to interactively define the volume of interest (VOI), separate the thorax and abdomen, and automatically calculate the thoracic and abdominal volumes within the VOIs. The torso volume change (TV C = ΔV torso = ΔV thorax + ΔV abdomen ) was automatically calculated using full-exhalation phase as the reference. The volumetric breathing pattern (BP v = ΔV thorax /ΔV torso ) quantifying thoracic and abdominal volume variations was also calculated. Under quiet breathing, TVC should equal the tidal volume measured concurrently by a spirometer with a conversion factor (1.08) accounting for internal and external differences of temperature and moisture. Another MATLAB program was implemented to control the conventional spirometer that was used as the standard. Results: The volumes measured from the OSI imaging of geometric phantoms agreed with the calculated volumes with a discrepancy of 0.0% ± 1.6% (range −1.9% to 2.5%). In measurements from the deformable torso/thorax phantoms, the volume differences measured using OSI imaging and CT imaging were 1.2% ± 2.1% (range −0.5% to 3.6%), with a linear regression fitting (slope = 1.02 and R 2 = 0.999). In volunteers, the relative error in OSI tidal volume measurement was −2.2% ± 4.9% (range −9.2% to 4.8%) and a correlation of r = 0.98 was found with spirometric measurement. The breathing pattern values of the three volunteers were substantially different from each other (BP v = 0.15, 0.45, and 0.32). Conclusions: This study demonstrates the feasibility of using OSI to measure breathing tidal volumes and breathing patterns with adequate accuracy. This is the first time that dynamic breathing tidal volume as well as breathing patterns is measured using optical surface imaging. The OSI-observed movement of the entire torso could serve as a new respiratory surrogate in the treatment room during radiation therapy

  19. 77 FR 70835 - Centennial Challenges 2013 Sample Return Robot Challenge

    Science.gov (United States)

    2012-11-27

    ... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION Centennial Challenges 2013 Sample Return Robot... Challenge is scheduled and teams that wish to compete may register. Centennial Challenges is a program of... Challenge, please visit: http://challenge.wpi.edu . For general information on the NASA Centennial...

  20. 76 FR 56819 - Centennial Challenges 2012 Sample Return Robot Challenge

    Science.gov (United States)

    2011-09-14

    ... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION [Notice (11-079)] Centennial Challenges 2012 Sample... Challenge is scheduled and teams that wish to compete may register. Centennial Challenges is a program of... Challenge, please visit: http://wp.wpi.edu/challenge/ . For general information on the NASA Centennial...

  1. Challenges in obesity research.

    Science.gov (United States)

    Palou, Andreu; Bonet, M Luisa

    2013-09-01

    Obesity is the main nutritional problem and one of the most important health problems in developed societies. Central to the challenge of obesity prevention and management is a thoroughly understanding of its determinants. Multiple socio-cultural, socio-economic, behavioural and biological factors--often interrelated and many of them still unknown or poorly understood--can contribute to the establishment and perpetuation of obese phenotypes. Here, we address current research challenges regarding basic aspects of obesity and emerging science for its control, including brown adipose tissue thermogenesis and browning of white fat as possible therapeutic targets for obesity, the influence of the microbioma, and genetics, epigenetics, nutrigenomics and nutrigenetics of obesity. We also highlight hot topics in relation to food and lifestyle as determinants of obesity, including the brain mechanisms underlying environmental motivation to eat, the biological control of spontaneous physical activity, the possible role of concrete foods and food components, and the importance of early life nutrition and environment. Challenges regarding the connections of obesity with other alterations and pathologies are also briefly addressed, as well as social and economical challenges in relation to healthy food production and lifestyle for the prevention of obesity, and technological challenges in obesity research and management. The objective is to give a panoramic of advances accomplished and still ahead relevant to the different stakeholders engaged in understanding and combating obesity. Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.

  2. Global challenges in energy

    International Nuclear Information System (INIS)

    Dorian, James P.; Franssen, Herman T.; Simbeck, Dale R. MD

    2006-01-01

    Environmental and security concerns are stimulating global interest in hydrogen power, renewable energy, and advanced transportation technologies, but no significant movement away from oil and a carbon-based world economy is expected soon. Over the longer-term, however, a transition from fossil fuels to a non-carbon-based economy will likely occur, affecting the type of environment future generations may encounter. Key challenges will face the world's energy industry over the next few decades to ensure a smooth transition-challenges which will require government and industry solutions beginning as early as today. This paper identifies four critical challenges in energy and the choices which will have to be made on how best to confront growing pollution caused by fossil fuels and how to facilitate an eventual revolutionary-like transition to a non-carbon-based global economy

  3. The challenge of sustainability

    International Nuclear Information System (INIS)

    Orr, D.W.

    1993-01-01

    This paper discusses sustainability in a world that has changed rapidly. The author suggests that ecological assumptions embedded in communism and capitalism are badly flawed, but the flaws were not apparent when there were fewer than a billion people on earth living at low technology levels. Sustaining the earth's vital signs is a challenge to our perception of time, and the numbers - population, environmental damage, oil consumption, waste disposal - are too large to comprehend easily. There is a global debate about what sustainability means. In fact the challenge of sustainability is 6 different challenges: overcoming the tendency to deny inconvenient realities; establishing accurate indicators of human and ecological health; questions about the kinds of technology necessary to make the transition to sustainability; education; the need for an emotional bond between man and nature; rebuilding the existing democratic institutions. 16 refs

  4. Centennial Challenges Program

    Science.gov (United States)

    Ortega, Sam; Eberly, Eric

    2015-01-01

    NASA's Centennial Challenges Program was initiated in 2005 to directly engage the public in the process of advanced technology development. The program offers incentive prizes to generate revolutionary solutions to problems of interest to NASA and the nation. The program seeks innovations from diverse and nontraditional sources. Competitors are not supported by government funding and awards are only made to successful teams when the challenges are met. In keeping with the spirit of the Wright Brothers and other American innovators, the Centennial Challenge prizes are offered to independent inventors including small businesses, student groups, and individuals. These independent inventors are sought to generate innovative solutions for technical problems of interest to NASA and the nation and to provide them with the opportunity to stimulate or create new business ventures.

  5. Small finance banks: Challenges

    Directory of Open Access Journals (Sweden)

    Jayadev M

    2017-12-01

    Full Text Available A recent innovation in the Indian banking structure has been the formation of a new banking institution—small finance banks (SFBs. These banks are expected to penetrate into financial inclusion by providing basic banking and credit services with a differentiated banking model to the larger population. In this context the new SFBs have multiple challenges in coming out with a new, differentiated business model. The challenges include building low cost liability portfolio, technology management, and balancing the regulatory compliances. This paper also presents the top of mind views of three senior executives of new small finance banks.

  6. Challenges facing production grids

    Energy Technology Data Exchange (ETDEWEB)

    Pordes, Ruth; /Fermilab

    2007-06-01

    Today's global communities of users expect quality of service from distributed Grid systems equivalent to that their local data centers. This must be coupled to ubiquitous access to the ensemble of processing and storage resources across multiple Grid infrastructures. We are still facing significant challenges in meeting these expectations, especially in the underlying security, a sustainable and successful economic model, and smoothing the boundaries between administrative and technical domains. Using the Open Science Grid as an example, I examine the status and challenges of Grids operating in production today.

  7. The challenge of conceiving

    DEFF Research Database (Denmark)

    Hansen, Claus Thorp; Jørgensen, Ulrik

    2011-01-01

    the perspective of engineering design challenges where the need for problem identification is obvious to avoid the pitfall to reproduce and piecemeal engineer already existing product or service concepts. Problem identification is not a simple desk research task as it often involves a multitude of actors having......One of the big challenges in the CDIO approach to engineering education is the first part focusing on conceiving problems to be handled and eventually solved. Traditional engineering education has been dominated by its focus on technical disciplines emphasising their individual tool box of problem...

  8. Projectile Motion Hoop Challenge

    Science.gov (United States)

    Jordan, Connor; Dunn, Amy; Armstrong, Zachary; Adams, Wendy K.

    2018-01-01

    Projectile motion is a common phenomenon that is used in introductory physics courses to help students understand motion in two dimensions. Authors have shared a range of ideas for teaching this concept and the associated kinematics in "The Physics Teacher" ("TPT"); however, the "Hoop Challenge" is a new setup not…

  9. A Challenge to Watson

    Science.gov (United States)

    Detterman, Douglas K.

    2011-01-01

    Watson's Jeopardy victory raises the question of the similarity of artificial intelligence and human intelligence. Those of us who study human intelligence issue a challenge to the artificial intelligence community. We will construct a unique battery of tests for any computer that would provide an actual IQ score for the computer. This is the same…

  10. Challenging and valuable

    NARCIS (Netherlands)

    Van Hal, J.D.M.

    2008-01-01

    Challenging and valuable Inaugural speech given on May 7th 2008 at the occasion of the acceptance of the position of Professor Sustainable Housing Transformation at the faculty of Architeeture of the Delft University of Technology by Prof. J.D.M. van Hal MSc PhD.

  11. The energy challenge

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    This chapter addresses the challenge of switching US energy dependency from fossil fuels to renewable sources of energy for economic and environmental reasons. The topics discussed include the role of fossil fuels in the US economy, the role of chlorofluorocarbons and fossil fuel combustion on the greenhouse effect, energy choices, and the role of energy efficiency and nuclear energy

  12. The diesel challenge

    International Nuclear Information System (INIS)

    Tobin, Geoff

    1997-01-01

    This article is focused on the challenges being faced by the diesel producer and these include a number of interesting developments which illustrate the highly competitive world of the European refiner. These include: The tightening quality requirements being legislated coupled with the availability of the ''city diesel'' from Scandinavia and elsewhere which is already being sold into the market. For a time there will be a clear means of product differentiation. One of the key questions is whether the consumer will value the quality difference; a growing demand for diesel which is outstripping the growth in gasoline demand and causing refiners headaches when it comes to balancing their supply/demand barrels; the emergence of alternative fuels which are challenging the traditional markets of the refiner and in particular, the niche markets for the higher quality diesel fuels. All of this at a time of poor margins and over-capacity in the industry with further major challenges ahead such as fuel oil disposal, tighter environmental standards and the likelihood of heavier, higher sulphur crude oils in the future. Clearly, in such a difficult and highly-competitive business environment it will be important to find low-cost solutions to the challenges of the diesel quality changes. An innovative approach will be required to identify the cheapest and best route to enable the manufacture of the new quality diesel. (Author)

  13. The Moon Challenge

    Science.gov (United States)

    Fitzsimmons, Pat; Leddy, Diana; Johnson, Lindy; Biggam, Sue; Locke, Suzan

    2013-01-01

    This article describes a first-grade research project that incorporates trade books and challenges misconceptions. Educators see the power of their students' wonder at work in their classrooms on a daily basis. This wonder must be nourished by students' own experiences--observing the moon on a crystal clear night--as well as by having…

  14. Rooftop Garden Design Challenge

    Science.gov (United States)

    Roman, Harry T.

    2010-01-01

    A small commercial building in a nearby industrial park has decided to install a rooftop garden for its employees to enjoy. The garden will be about 100 feet long and 75 feet wide. This article presents a design challenge for technology and engineering students wherein they will assist in the initial conceptual design of the rooftop garden. The…

  15. Hopes and Challenges

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    China tops the medal tally again at the Asian Games but still faces challenges in some events The curtain of the 16th Asian Games has fallen, but the 15 days of exciting competitions will be recorded in the history of the Games.

  16. Communication Challenge Softball

    Science.gov (United States)

    Moran, Tom; Vance, Mike

    2005-01-01

    Communication Challenge Softball is a developmentally appropriate game for middle school students. The game allows them to develop new communication skills using American Sign Language (signing). Traditional softball has been a part of physical education for years, and remains a popular sport played by children in community leagues throughout the…

  17. Electric Vehicle Battery Challenge

    Science.gov (United States)

    Roman, Harry T.

    2014-01-01

    A serious drawback to electric vehicles [batteries only] is the idle time needed to recharge their batteries. In this challenge, students can develop ideas and concepts for battery change-out at automotive service stations. Such a capability would extend the range of electric vehicles.

  18. Common Breastfeeding Challenges

    Science.gov (United States)

    ... or duplicated without permission of the Office on Women’s Health in the U.S. Department of Health and Human Services. Citation of the source is appreciated. Page last updated: March 02, 2018. Common breastfeeding challenges Breastfeeding can be ...

  19. BPI Challenge 2014

    NARCIS (Netherlands)

    Dongen, B.F. van

    2014-01-01

    BPI Challenge 2014: Similar to other ICT companies, Rabobank Group ICT has to implement an increasing number of software releases, while the time to market is decreasing. Rabobank Group ICT has implemented the ITIL-processes and therefore uses the Change-proces for implementing these so called

  20. The Challenges in Communication

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. The Challenges in Communication. The conflict between connection oriented and connectionless. The seamless integration needs of broadcast, unicast and multicast in the midst growing security concerns. Like Indian roads – need to carry voice, internet traffic, video ...

  1. Biggest challenges in bioinformatics.

    Science.gov (United States)

    Fuller, Jonathan C; Khoueiry, Pierre; Dinkel, Holger; Forslund, Kristoffer; Stamatakis, Alexandros; Barry, Joseph; Budd, Aidan; Soldatos, Theodoros G; Linssen, Katja; Rajput, Abdul Mateen

    2013-04-01

    The third Heidelberg Unseminars in Bioinformatics (HUB) was held on 18th October 2012, at Heidelberg University, Germany. HUB brought together around 40 bioinformaticians from academia and industry to discuss the 'Biggest Challenges in Bioinformatics' in a 'World Café' style event.

  2. Biggest challenges in bioinformatics

    OpenAIRE

    Fuller, Jonathan C; Khoueiry, Pierre; Dinkel, Holger; Forslund, Kristoffer; Stamatakis, Alexandros; Barry, Joseph; Budd, Aidan; Soldatos, Theodoros G; Linssen, Katja; Rajput, Abdul Mateen

    2013-01-01

    The third Heidelberg Unseminars in Bioinformatics (HUB) was held in October at Heidelberg University in Germany. HUB brought together around 40 bioinformaticians from academia and industry to discuss the ‘Biggest Challenges in Bioinformatics' in a ‘World Café' style event.

  3. Future nuclear regulatory challenges

    International Nuclear Information System (INIS)

    Royen, J.

    1998-01-01

    In December 1996, the NEA Committee on Nuclear Regulatory Activities concluded that changes resulting from economic deregulation and other recent developments affecting nuclear power programmes have consequences both for licensees and regulatory authorities. A number of potential problems and issues which will present a challenge to nuclear regulatory bodies over the next ten years have been identified in a report just released. (author)

  4. Challenge Beginning Teacher Beliefs

    Science.gov (United States)

    Lannin, John K.; Chval, Kathryn B.

    2013-01-01

    As beginning teachers start to recognize the complexity of teaching mathematics in elementary school classrooms and how their new vision for teaching mathematics creates new challenges, they experience discomfort--a healthy awareness that much is to be learned. Brousseau (1997) notes that changes in the roles that are implicitly assigned to the…

  5. Asia's new challenges

    DEFF Research Database (Denmark)

    Brach, Juliana; Vang, Jan

    2012-01-01

    Asian countries are currently undergoing significant changes with respect to their role in and interaction with the international economy. Despite their heterogeneity, Asian countries share the common aim to upgrade capacities, skills and capabilities. This paper aims at unpacking the challenges ...

  6. Seven challenges for neuroscience.

    Science.gov (United States)

    Markram, Henry

    2013-01-01

    Although twenty-first century neuroscience is a major scientific enterprise, advances in basic research have not yet translated into benefits for society. In this paper, I outline seven fundamental challenges that need to be overcome. First, neuroscience has to become "big science" - we need big teams with the resources and competences to tackle the big problems. Second, we need to create interlinked sets of data providing a complete picture of single areas of the brain at their different levels of organization with "rungs" linking the descriptions for humans and other species. Such "data ladders" will help us to meet the third challenge - the development of efficient predictive tools, enabling us to drastically increase the information we can extract from expensive experiments. The fourth challenge goes one step further: we have to develop novel hardware and software sufficiently powerful to simulate the brain. In the future, supercomputer-based brain simulation will enable us to make in silico manipulations and recordings, which are currently completely impossible in the lab. The fifth and sixth challenges are translational. On the one hand we need to develop new ways of classifying and simulating brain disease, leading to better diagnosis and more effective drug discovery. On the other, we have to exploit our knowledge to build new brain-inspired technologies, with potentially huge benefits for industry and for society. This leads to the seventh challenge. Neuroscience can indeed deliver huge benefits but we have to be aware of widespread social concern about our work. We need to recognize the fears that exist, lay them to rest, and actively build public support for neuroscience research. We have to set goals for ourselves that the public can recognize and share. And then we have to deliver on our promises. Only in this way, will we receive the support and funding we need.

  7. 76 FR 41526 - Centennial Challenges 2011 Strong Tether Challenge

    Science.gov (United States)

    2011-07-14

    ... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION [Notice (11-063)] Centennial Challenges 2011 Strong... scheduled and teams that wish to compete may register. Centennial Challenges is a program of prize... NASA Centennial Challenges Program please visit: http://www.nasa.gov/challenges . General questions and...

  8. 78 FR 19742 - Centennial Challenges: 2014 Night Rover Challenge

    Science.gov (United States)

    2013-04-02

    ... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION [Notice 13-032] Centennial Challenges: 2014 Night... Centennial Challenges 2014 Night Rover Challenge. SUMMARY: This notice is issued in accordance with 51 U.S.C.... Centennial Challenges is a program of prize competitions to stimulate innovation in technologies of interest...

  9. 78 FR 49296 - Centennial Challenges 2014 Sample Return Robot Challenge

    Science.gov (United States)

    2013-08-13

    ... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION [Notice 13-093] Centennial Challenges 2014 Sample... Centennial Challenges 2014 Sample Return Robot Challenge. SUMMARY: This notice is issued in accordance with... compete may register. Centennial Challenges is a program of prize competitions to stimulate innovation in...

  10. CE Challenges : Work to Do

    NARCIS (Netherlands)

    Stjepandic, J; Verhagen, W.J.C.; Wognum, P.M.

    2015-01-01

    CE has been used for more than two decades now. Despite many successes and advantages, there are still many challenges to be addressed. These challenges are both technical and organisational. In the paper we will address the current challenges of CE. Many challenges

  11. Challenges to Resistance Welding

    DEFF Research Database (Denmark)

    Song, Quanfeng

    This report originates from the compulsory defense during my Ph.D. study at the Technical University of Denmark. Resistance welding is an old and well-proven technology. Yet the emergence of more and more new materials, new designs, invention off new joining techniques, and more stringent...... requirement in quality have imposed challenges to the resistance welding. More some research and development have to be done to adapt the old technology to the manufacturing industry of the 21st century. In the 1st part of the report, the challenging factors to the resistance welding are reviewed. Numerical...... simulation of resistance welding has been under development for many years. Yet it is no easy to make simulation results reliable and accurate because of the complexity of resistance welding process. In the 2nd part of the report numerical modeling of resistance welding is reviewed, some critical factors...

  12. Projectile Motion Hoop Challenge

    Science.gov (United States)

    Jordan, Connor; Dunn, Amy; Armstrong, Zachary; Adams, Wendy K.

    2018-04-01

    Projectile motion is a common phenomenon that is used in introductory physics courses to help students understand motion in two dimensions. Authors have shared a range of ideas for teaching this concept and the associated kinematics in The Physics Teacher; however, the "Hoop Challenge" is a new setup not before described in TPT. In this article an experiment is illustrated to explore projectile motion in a fun and challenging manner that has been used with both high school and university students. With a few simple materials, students have a vested interest in being able to calculate the height of the projectile at a given distance from its launch site. They also have an exciting visual demonstration of projectile motion when the lab is over.

  13. Mathematical olympiad challenges

    CERN Document Server

    Andreescu, Titu

    2000-01-01

    Mathematical Olympiad Challenges is a rich collection of problems put together by two experienced and well-known professors and coaches of the U.S. International Mathematical Olympiad Team. Hundreds of beautiful, challenging, and instructive problems from algebra, geometry, trigonometry, combinatorics, and number theory were selected from numerous mathematical competitions and journals. An important feature of the work is the comprehensive background material provided with each grouping of problems. The problems are clustered by topic into self-contained sections with solutions provided separately. All sections start with an essay discussing basic facts and one or two representative examples. A list of carefully chosen problems follows and the reader is invited to take them on. Additionally, historical insights and asides are presented to stimulate further inquiry. The emphasis throughout is on encouraging readers to move away from routine exercises and memorized algorithms toward creative solutions to open-e...

  14. Challenges in sexual medicine

    DEFF Research Database (Denmark)

    Cellek, Selim; Giraldi, Annamaria

    2012-01-01

    The sexual medicine field has been in mode of revolution until recently. Like all other fields of biomedical research, the economic situation around the world has had a negative impact on the field's momentum-research funding bodies, regulatory bodies and pharmaceutical companies seem to have...... placed sexual medicine in their low-priority list. But this is not the only challenge the field is facing. The successful development of phosphodiesterase type 5 (PDE5) inhibitors for treatment of erectile dysfunction (ED) means that research in this area seems to have slowed. However, there remain...... several unmet medical needs within sexual medicine such as premature ejaculation, severe ED and hypoactive sexual desire disorder, which await novel therapeutic approaches. Despite these challenges, research into finding and developing such therapies is likely to continue in the sexual medicine field...

  15. Characterizing challenged Minnesota ballots

    Science.gov (United States)

    Nagy, George; Lopresti, Daniel; Barney Smith, Elisa H.; Wu, Ziyan

    2011-01-01

    Photocopies of the ballots challenged in the 2008 Minnesota elections, which constitute a public record, were scanned on a high-speed scanner and made available on a public radio website. The PDF files were downloaded, converted to TIF images, and posted on the PERFECT website. Based on a review of relevant image-processing aspects of paper-based election machinery and on additional statistics and observations on the posted sample data, robust tools were developed for determining the underlying grid of the targets on these ballots regardless of skew, clipping, and other degradations caused by high-speed copying and digitization. The accuracy and robustness of a method based on both index-marks and oval targets are demonstrated on 13,435 challenged ballot page images.

  16. Challenges in Request Management

    DEFF Research Database (Denmark)

    Sommer, Anita Friis

    2014-01-01

    and its customers. The study provides an insight into a new area of supply chain management, including the process activity flow and challenges involved across the process. Furthermore, the method is dyadic including the customer in the case study, which is rare in related research....... profitability. This research study seeks to investigate the challenges of RQM in practice. Existing demand chain management literature is used as a basis for developing a RQM framework. RQM is investigated through an explorative research design in a dyadic B2B case study including a global industrial company......Request management (RQM) is a new term used for managing customer requests for new products. It is the counterpart to typical product development processes, which has no direct customer involvement. It is essential to manage customer requests in a structured and efficient way to obtain...

  17. US Cyber Challenge Research

    Science.gov (United States)

    2017-02-01

    tactics to prevent future attacks. This project will develop, test, evaluate and assess alternative methods for identifying computer security talent ...RESPONSIBLE PERSON FRANCES ROSE a. REPORT U b. ABSTRACT U c. THIS PAGE U 19b. TELEPHONE NUMBER (Include area code ) N/A Standard Form 298 (Rev. 8...is ever increasing. Meeting the demand for top technical cybersecurity talent is one of the continuing challenges facing military and civilian

  18. Terabit Wireless Communication Challenges

    Science.gov (United States)

    Hwu, Shian U.

    2012-01-01

    This presentation briefly discusses a research effort on Terabit Wireless communication systems for possible space applications. Recently, terahertz (THz) technology (300-3000 GHz frequency) has attracted a great deal of interest from academia and industry. This is due to a number of interesting features of THz waves, including the nearly unlimited bandwidths available, and the non-ionizing radiation nature which does not damage human tissues and DNA with minimum health threat. Also, as millimeter-wave communication systems mature, the focus of research is, naturally, moving to the THz range. Many scientists regard THz as the last great frontier of the electromagnetic spectrum, but finding new applications outside the traditional niches of radio astronomy, Earth and planetary remote sensing, and molecular spectroscopy particularly in biomedical imaging and wireless communications has been relatively slow. Radiologists find this area of study so attractive because t-rays are non-ionizing, which suggests no harm is done to tissue or DNA. They also offer the possibility of performing spectroscopic measurements over a very wide frequency range, and can even capture signatures from liquids and solids. According to Shannon theory, the broad bandwidth of the THz frequency bands can be used for terabit-per-second (Tb/s) wireless communication systems. This enables several new applications, such as cell phones with 360 degrees autostereoscopic displays, optic-fiber replacement, and wireless Tb/s file transferring. Although THz technology could satisfy the demand for an extremely high data rate, a number of technical challenges need to be overcome before its development. This presentation provides an overview the state-of-the- art in THz wireless communication and the technical challenges for an emerging application in Terabit wireless systems. The main issue for THz wave propagation is the high atmospheric attenuation, which is dominated by water vapor absorption in the THz

  19. The Terawatt Challenge

    Science.gov (United States)

    Haegel, Nancy

    In response to concerns about accelerating climate change, the world is uniting to both envision and enable a global energy system that supports a sustainable environment and broad economic prosperity. Growth in the technology and the deployment of renewable energy has been dramatic. Evidence can be seen in the growth of photovoltaics (PV) and wind as contributors to worldwide electricity production over the last decade. PV and wind provided 1.2% and 3.7% of global electricity production in 2015, compared to 0.1% and 1.3% respectively in 2005. These numbers indicate both the rapid increase in the rate of deployment, as well as the remaining work to be done to extend this trend to transform a massive energy system and provide a significant fraction of the world's future energy demand with renewable energy. Based on recent trends, it is highly likely that global cumulative PV installation will reach terawatt scale in the next few decades. The challenges, as well as the resulting impact, vary greatly depending on whether we envision 1 TW ( 15% of 2015 global electricity capacity), 3 TW ( 50% of 2015 global electricity capacity) or 10 TW, a level that could drive electrification of transportation and industrial sectors and production of solar fuels. This presentation will draw upon the work of the 2016 GA-SERI (Global Alliance of Solar Energy Research Institutes) Terawatt Workshop to assess the feasibility and summarize the challenges for PV as a primary energy source. These challenges include the continuing demand for improved efficiency and reliability, the required magnitude of capital expenditure, the need for a sustainable industry (both financially and environmentally), as well as needs for grid modernization and consistent policies that support global climate goals. Physicists can play important roles in addressing this full range of challenges, from materials science to public policy, as well as in education of the public and its future leaders.

  20. Challenges in paediatric neurosurgery

    Directory of Open Access Journals (Sweden)

    Pragati Ganjoo

    2017-01-01

    Full Text Available Improvements in technique, knowledge and expertise have brought about rapid advances in the fields of paediatric neurosurgery and anaesthesia, and many procedures limited earlier to adults are now being increasingly attempted in neonates and small children, with good outcomes. This article highlights the challenges faced by the operating team while handling some of the technically complex procedures like awake craniotomy, interventional neuroradiology, minimally invasive neurosurgery, procedures in intraoperative magnetic resonance imaging suites, and neonatal emergencies in the paediatric population.

  1. Energy challenges in Asia

    International Nuclear Information System (INIS)

    Niquet, V.

    2007-01-01

    Energy challenges represent one of the most important security paradigms in the Asia Pacific region where you have a mixture of growing energy dependency, fuelled by high economic growth, the emergence of new major players like China and India, and a quasi-complete absence of regional regulatory mechanisms to tackle the challenges in a multilateral way. These challenges mostly concern Japan and China, where crucial energy issues are aggravated by power rivalry, historical and ideological issues, and a lack of both economic and political harmony between them. Neither countries are self sufficient in terms of energy needs. This can lead to a shared analysis and common approaches regarding Japan and China concerning this issue. Their cases are. however very different and the solutions applied are related to different world views that are not easily reconcilable. Both countries share common objectives: both want security and stable supply. But there are also big divergences and these divergences could be new sources of conflict and misunderstanding between Tokyo and Beijing. One of the main differences is history related. Both China and Japan are uneasy regarding outside energy dependency. In Japan, memories of the pre-war oil embargo have not disappeared. The oil shocks of the 70's renewed this uneasiness. However, Japan's outside dependency is not new. Tokyo has learned to live with it, finding a system to alleviate this vulnerability in cooperation with its partners, multilateral institutions like the International Energy Agency (IEA). China's outside dependency is new. The country's dependency on oil, which began in 1993, is particularly challenging since the principles of independence, non interference and military autonomy, principles at the core of Maoist foreign strategy, did not completely disappear in spite of China's new policy of reform and opening up. China's leadership, even the fourth generation, did not forget its isolation during the 60's and 70's

  2. Ireland's Competitiveness Challenge 2011

    OpenAIRE

    2012-01-01

    The NCC publishes two annual competitiveness reports. Ireland's Competitiveness Challenge focuses on the national competitiveness issues of most importance to the enterprise sector and identifies policy recommendations required to address these issues. The report focuses on pursuing policies to improve competitiveness, particularly those to reduce the cost base for enterprise, to enhance the performance of the entire education system, and to deliver meaningful public sector reform. Ireland's ...

  3. US Cyber Challenge Research

    Science.gov (United States)

    2012-02-01

    Computers (General Term), Information Systems or Information Technology 0 6 5 1 1 13 Criminal Justice 0 0 0 1 0 1 Economics 0 0 1 0 0 1 Electrical...Assurance or Computer Security 8 6 15 10 7 46 Information Technology 4 1 9 1 4 19 Nanotechnology 0 1 0 0 0 1 Networking or Network Security 7 1 2 2 4...FORCE RESEARCH LABORATORY INFORMATION DIRECTORATE US CYBER CHALLENGE RESEARCH CENTER FOR INTERNET SECURITY, INC FEBRUARY

  4. EDMS implementation challenge.

    Science.gov (United States)

    De La Torre, Marta

    2002-08-01

    The challenges faced by facilities wishing to implement an electronic medical record system are complex and overwhelming. Issues such as customer acceptance, basic computer skills, and a thorough understanding of how the new system will impact work processes must be considered and acted upon. Acceptance and active support are necessary from Senior Administration and key departments to enable this project to achieve measurable success. This article details one hospital's "journey" through design and successful implementation of an electronic medical record system.

  5. The Challenges of Leadership.

    Science.gov (United States)

    Myrtle, Robert C

    Perhaps in no other period in recent times have the challenges leaders face been so profound. In these times of uncertainty and turbulence, we look to leaders who create a sense of purpose, who generate feelings of trust and optimism, and who tap the passion, talent, and efforts of those so essential to the success of the organization and of the people it serves. Our research suggests that becoming the leader whom people look to and admire requires an active commitment to responding to 5 essential leadership challenges. These are (1) creating a sense of purpose, (2) devising means for aligning the actions of the followers with that sense of purpose, (3) establishing a context that enables others to behave in a way that is consistent with the vision and values of the organization, (4) ensuring that the work that is done provides meaning to those engaging in the work activities, and (5) adding to the sum of everyone's knowledge through learning through reflective actions. In this article, we describe these challenges and offer suggestions that you can take to become a more effective and respected leader.

  6. Patients who challenge.

    Science.gov (United States)

    Ward, Michael; Savulescu, Julian

    2006-12-01

    Individuals have different values. They seek to express their individuality even when receiving medical care. It is a part of modern medical practice and respect for patient autonomy to show respect for different values. We give an account of what it means to respect different values and challenging patients in medical practice. Challenging choices are often choices which are perceived by many to be either irrational or against a person's interests, such as engaging in harmful or excessively risky activities. When the medical profession is involved in such choices, the basic medical principle of acting in a person's best interests is challenged. Often doctors refuse to respect controversial choices on paternalistic grounds. We should all respect and facilitate the controversial choices of competent individuals, subject to resource limitations, our own and others well-being and autonomy, and the public interest. But more importantly, sometimes such choices make for a better, more autonomous life. Sometimes, such choices reflect considerations of global well-being or altruism, or idiosyncratic attitudes to risk. Sometimes, they reflect unusual values. However, in some other cases, controversial choices are irrational and are not expressions of our autonomy. Doctors should assist patients to make rational if individual choices. The patient also bears the responsibility for bringing his beliefs to the attention of the clinician.

  7. Challenges and opportunities

    International Nuclear Information System (INIS)

    Morgan, G.

    1998-01-01

    Challenges and opportunities facing the Canadian natural gas industry were discussed. The greatest opportunity is that the industry will become part of a fully functioning continental gas market for the first time in history. The challenge will be to ensure that the access to continental markets, which the Alliance project would provide, moves forward in a timely way, especially if the proposed merger between Canada's two dominant natural gas pipelines occurs. The second challenge is to find ways to deal with global warming in a more sensible and knowledgeable way. In the view of this author, the implications of the Kyoto greenhouse gas emission protocol could be potentially devastating to the competitiveness of the North American economy. According to the author, the emission stabilization policy will save the Earth only 0.05 degree C of warming in 2025 based on projected planetary temperature rise from 1990 to 2050. By 2050, the stabilization of emissions will have resulted in savings of only 0.10 degrees C, still a negligible amount. The impact of the Canadian Kyoto obligation was analyzed using federal Department of the Environment data. It was noted that in order for Canada to meet its commitment of reducing greenhouse gas emissions to 1990 levels by 6 per cent by 2008-2012, actual annual reduction in emission would have to amount to 20-25 per cent. To achieve that would require unimaginably drastic measures. 1 tab., 1 fig

  8. Caspian sea: petroleum challenges

    International Nuclear Information System (INIS)

    2005-01-01

    The Caspian sea is one of the world areas the most promising in terms of investments and petroleum development. This study presents the petroleum challenges generated by this hydrocarbons reserve. The first part discusses the juridical status (sea or lake), the petroleum and the gas reserves, the ecosystem and the today environment (fishing and caviar), the geostrategic situation and the transport of gas and oil. It provides also a chronology from 1729 to 2005, a selection of Internet sites, books and reports on the subject and identity sheets of the countries around the Caspian sea. (A.L.B.)

  9. Development Challenges in Bhutan

    DEFF Research Database (Denmark)

    This book provides essential insights into Bhutan’s developmental challenges. It analyzes and scrutinizes the sovereign state’s developmental approach, including the idea of Gross National Happiness (GNH), which has replaced Gross National Product (GNP) as a measurement of prosperity. The authors...... also explore and deconstruct ideational and cultural aspects of knowledge production and present a critical overall assessment of the political economy of education policy, health, ICT and migration in Bhutan. The book is divided into five parts all taking a critical approach towards inequality: Part...

  10. Cracking the Cipher Challenge

    CERN Document Server

    CERN. Geneva. Audiovisual Unit; Singh, Simon

    2002-01-01

    In the back of 'The Code Book', a history of cryptography, Simon Singh included a series of 10 encoded messages, each from a different period of history. The first person to crack all 10 messages would win a prize of £10,000. Now that the prize has been won, Simon can reveal the story behind the Cipher Challenge. Along the way he will show how mathematics can be used to crack codes, the role it played in World War Two and how it helps to guarantee security in the Information Age.

  11. Perishable Inventory Challenges

    DEFF Research Database (Denmark)

    Damgaard, Cecilie Maria; Nguyen, Vivi Thuy; Hvolby, Hans-Henrik

    2012-01-01

    in the retail supply chains. The goal is to find and evaluate the parameters which affect the decision making process, when finding the optimal order quantity and order time. The paper takes a starting point in the retail industry but links to other industries.......The paper investigates how inventory control of perishable items is managed and line up some possible options of improvement. This includes a review of relevant literature dealing with the challenges of determining ordering policies for perishable products and a study of how the current procedures...

  12. Safeguards by Design Challenge

    Energy Technology Data Exchange (ETDEWEB)

    Alwin, Jennifer Louise [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-09-13

    The International Atomic Energy Agency (IAEA) defines Safeguards as a system of inspection and verification of the peaceful uses of nuclear materials as part of the Nuclear Nonproliferation Treaty. IAEA oversees safeguards worldwide. Safeguards by Design (SBD) involves incorporation of safeguards technologies, techniques, and instrumentation during the design phase of a facility, rather that after the fact. Design challenge goals are the following: Design a system of safeguards technologies, techniques, and instrumentation for inspection and verification of the peaceful uses of nuclear materials. Cost should be minimized to work with the IAEA’s limited budget. Dose to workers should always be as low are reasonably achievable (ALARA). Time is of the essence in operating facilities and flow of material should not be interrupted significantly. Proprietary process information in facilities may need to be protected, thus the amount of information obtained by inspectors should be the minimum required to achieve the measurement goal. Then three different design challenges are detailed: Plutonium Waste Item Measurement System, Marine-based Modular Reactor, and Floating Nuclear Power Plant (FNPP).

  13. Biotechnology: challenges and prospects

    Energy Technology Data Exchange (ETDEWEB)

    Sasson, A.

    1985-04-01

    Rapidly occurring technological breakthroughs in the wake of numerous discoveries in different fields, such as biochemistry, genetic engineering as well as cellular and molecular biology as described in this paper have a variety of industrial applications, and forcasts covering these and various other fields have been made. The emerging bio-industry, covering diverse industries, such as chemical, food, pharmaceutical, etc., as well as the domains of health, environmental protection and abatement of pollution present challenging prospects. Several biotechnology processes relating to bioenergy, fermentation, waste transformation, vaccines, etc. are of particular interest to the developing countries. The 'functioning systems' resulting from the breakthrouth in genetic engineering, entailing extraordinary refinement of analytical techniques and technological progress, pose the challenging task of harnessing them to the advantage of mankind. Providing effective legal protection, conducive to the development of biotechnologies-their innovative process and technological change-is a matter of serious concern, involving practical and economical considerations. Several other issues and questions, such as risk prevention and management of potential dangers and hazards in genetic recombination operation by way of safety regulations and necessary guidelines, questions relating to the clinical trials of the interferons-the wonder drug-as well as questions of professional ethics are raised by biotechnologies. Industry-funded research in biotechnology, where scientific and commercial imperatives are interlocked, has for instance, its repercussions on the traditional thrust of university system, specially the sanctity of autonomy for basic research.

  14. Résultats challenge

    CERN Multimedia

    Club de pétanque

    2015-01-01

    C'est avec un temps magnifique que se disputait pour la deuxième année le Challenge de notre cher ami Patrick DURAND le jeudi 30 juillet 2015. Vingt-six personnes formées en doublettes s'affrontaient pour trois parties .Après des parties très serrées le juge arbitre Claude JOUVE épaulé par Alain PHILIPONA déclarait  vainqueur l'imbattable Claude MACARI suivi de très près par Eric DARMEDRU et à la troisième place Christian JOUVE. La première féminine était Mireille ROCHE. La soirée se clôturait par une succulente paëlla préparée par Jennifer et sa maman Sylvie JOUVE. Rendez-vous à tous pour le jeudi 27 août 2015 pour le challenge Jean-Claude FROT Nos concours sont ouverts à tous les amateurs de pétanque.

  15. [Challenges of Digital Medicine].

    Science.gov (United States)

    Blaser, Jürg

    2018-06-01

    Challenges of Digital Medicine Abstract. Digitization is increasingly covering more and more sectors, including medicine. To ensure medical operation 365 × 24 hours, progressively more human and financial resources are necessary. The transformation of patient histories from paper into electronic patient records focused initially on documentation. Today, hospital information systems are increasingly used as a platform for the communication of all professionals involved in the patient process - in Switzerland, however, so far without providing patients direct access to their data. Digititizing processes intend to increase efficiency, but also to enhance clinical and administrative decision support and quality assurance. The introduction of the electronic patient record in Switzerland in 2020 is expected to provide cross-company, more complete documentation of patient care. Multimorbid patients, often treated in different institutions and by different specialists, should benefit from this in particular. Advances in artificial intelligence offer new opportunities in medicine. Challenges include ensuring reliable data protection, and better interoperability of the systems involved. Semantically structured, machine-readable data exchange is a necessity for both networked services and internationally competitive research.

  16. Safeguards by Design Challenge

    International Nuclear Information System (INIS)

    Alwin, Jennifer Louise

    2016-01-01

    The International Atomic Energy Agency (IAEA) defines Safeguards as a system of inspection and verification of the peaceful uses of nuclear materials as part of the Nuclear Nonproliferation Treaty. IAEA oversees safeguards worldwide. Safeguards by Design (SBD) involves incorporation of safeguards technologies, techniques, and instrumentation during the design phase of a facility, rather that after the fact. Design challenge goals are the following: Design a system of safeguards technologies, techniques, and instrumentation for inspection and verification of the peaceful uses of nuclear materials. Cost should be minimized to work with the IAEA's limited budget. Dose to workers should always be as low are reasonably achievable (ALARA). Time is of the essence in operating facilities and flow of material should not be interrupted significantly. Proprietary process information in facilities may need to be protected, thus the amount of information obtained by inspectors should be the minimum required to achieve the measurement goal. Then three different design challenges are detailed: Plutonium Waste Item Measurement System, Marine-based Modular Reactor, and Floating Nuclear Power Plant (FNPP).

  17. Challenge Based Innovation gala

    CERN Multimedia

    CERN. Geneva; Utriainen, Tuuli Maria; Toivonen, Harri; Nordberg, Markus

    2014-01-01

    Challenge Based Innovation gala   There’s a new experiment starting in CERN called IdeaLab where we work together with detector R&D researchers to help them to bridge their knowledge into a more human, societally oriented context. Currently we are located in B153, but will move our activities to a new facility next to the Globe in May 2014. One of our first pilot projects is a 5 month course CBI (Challenge Based Innovation) where two multidisciplinary student teams join forces with Edusafe & TALENT projects at CERN. Their goal is to discover what kind of tools for learning could be created in collaboration with the two groups. After months of user interviews and low resolution prototyping they are ready to share the results with us in the form of an afternoon gala. We warmly welcome you to join us to see the students' results and experience the prototypes they have conceived. The event is in three parts, you are welcome to visit all of them,...

  18. Managing the Fukushima Challenge

    Science.gov (United States)

    Suzuki, Atsuyuki

    2014-01-01

    The Fukushima Daiichi accident raises a fundamental question: Can science and technology prevent the inevitability of serious accidents, especially those with low probabilities and high consequences? This question reminds us of a longstanding challenge with the trans-sciences, originally addressed by Alvin Weinberg well before the Three Mile Island and Chernobyl accidents. This article, revisiting Weinberg's issue, aims at gaining insights from the accident with a special emphasis on the sociotechnical or human behavioral aspects lying behind the accident's causes. In particular, an innovative method for managing the challenge is explored referring to behavioral science approaches to a decision-making process on risk management; such as managing human behavioral risks with information asymmetry, seeking a rational consensus with communicative action, and pursuing procedural rationality through interactions with the outer environment. In short, this article describes the emerging need for Japan to transform its national safety management institutions so that these might be based on interactive communication with parties inside and outside Japan. PMID:24954604

  19. Challenges in Infective Endocarditis.

    Science.gov (United States)

    Cahill, Thomas J; Baddour, Larry M; Habib, Gilbert; Hoen, Bruno; Salaun, Erwan; Pettersson, Gosta B; Schäfers, Hans Joachim; Prendergast, Bernard D

    2017-01-24

    Infective endocarditis is defined by a focus of infection within the heart and is a feared disease across the field of cardiology. It is frequently acquired in the health care setting, and more than one-half of cases now occur in patients without known heart disease. Despite optimal care, mortality approaches 30% at 1 year. The challenges posed by infective endocarditis are significant. It is heterogeneous in etiology, clinical manifestations, and course. Staphylococcus aureus, which has become the predominant causative organism in the developed world, leads to an aggressive form of the disease, often in vulnerable or elderly patient populations. There is a lack of research infrastructure and funding, with few randomized controlled trials to guide practice. Longstanding controversies such as the timing of surgery or the role of antibiotic prophylaxis have not been resolved. The present article reviews the challenges posed by infective endocarditis and outlines current and future strategies to limit its impact. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  20. ATLAS Data Challenge 1

    CERN Document Server

    Poulard, G

    2003-01-01

    In 2002 the ATLAS experiment started a series of Data Challenges (DC) of which the goals are the validation of the Computing Model, of the complete software suite, of the data model, and to ensure the correctness of the technical choices to be made. A major feature of the first Data Challenge (DC1) was the preparation and the deployment of the software required for the production of large event samples for the High Level Trigger (HLT) and physics communities, and the production of those samples as a world-wide distributed activity. The first phase of DC1 was run during summer 2002, and involved 39 institutes in 18 countries. More than 10 million physics events and 30 million single particle events were fully simulated. Over a period of about 40 calendar days 71000 CPU-days were used producing 30 Tbytes of data in about 35000 partitions. In the second phase the next processing step was performed with the participation of 56 institutes in 21 countries (~ 4000 processors used in parallel). The basic elements of ...

  1. The ALICE data challenges

    International Nuclear Information System (INIS)

    Baud, J.P.; Collignon, M.; Collin, F.; Durand, J.; Jarp, S.; Jouanigot, J.M.; Panzer, B.; Carena, W.; Carminati, F.; Divia, R.; Rademakers, F.; Saiz, P.; Schossmaier, K.; Vande Vyvre, P.; Vascotto, A.

    2001-01-01

    Since 1998, the ALICE experiment and the CERN/IT division have jointly executed several large-scale high throughput distributed computing exercises: the ALICE data challenges. The goals of these regular exercises are to test hardware and software components of the data acquisition and computing systems in realistic conditions and to execute an early integration of the overall ALICE computing infrastructure. The authors report on the third ALICE Data Challenge (ADC III) that has been performed at CERN from January to March 2001. The data used during the ADC III are simulated physics raw data of the ALICE TPC, produced with the ALICE simulation program AliRoot. The data acquisition was based on the ALICE online framework called the ALICE Data Acquisition Test Environment (DATE) system. The data, after event building, were then formatted with the ROOT I/O package and a data catalogue based on MySQL was established. The Mass Storage System used during ADC III is CASTOR. Different software tools have been used to monitor the performances. DATE has demonstrated performances of more than 500 MByte/s. An aggregate data throughput of 85 MByte/s was sustained in CASTOR over several days. The total collected data amounts to 100 TBytes in 100.000 files

  2. Challenges of Combining Perspectives.

    Science.gov (United States)

    Sundvall, Maria; Titelman, David; Bäärnhielm, Sofie

    2018-02-23

    Asylum seekers have increased risk of suicide and suicidal behavior, with differences related to origin, gender, and age. There are barriers to communication in clinical encounters between asylum seekers and clinicians. There is insufficient knowledge about how communication in the clinical encounter affects the suicide risk in female asylum seekers. To explore the documented communication between female asylum-seeking suicide attempters and clinicians and how it affects treatment. The medical records of 18 asylum-seeking women who had attempted suicide were analyzed with content analysis. Communication between patients and clinicians was affected by: the unbearable realities of the women; difficulties for clinicians in decoding languages of distress, and understanding trauma and subjective meanings of suicide; challenges of combining patients' and clinicians' perspectives; and a sense of shared powerlessness. The medical records did not give direct access to the patient's experience, only to the patient as documented by the clinician. The results suggest that clinicians working with asylum seekers who have attempted suicide need to develop an understanding of social and cultural factors and of trauma issues. A question for further study is how an enhanced integration of context and subjectivity in psychiatric practice would equip clinicians for the specific challenges encountered.

  3. 75 FR 47316 - Centennial Challenges 2010 Strong Tether Challenge

    Science.gov (United States)

    2010-08-05

    ... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION Centennial Challenges 2010 Strong Tether Challenge... teams that wish to compete may register. Centennial Challenges is a program of prize competitions to..., please visit: http://www.spaceward.org/elevator2010-ts . For general information on the NASA Centennial...

  4. Efecto del tabaquismo, los síntomas respiratorios y el asma sobre la espirometría de adultos de la Ciudad de México Effect of tobacco smoking, respiratory symptoms and asthma on spirometry among adults attending a check-up clinic in Mexico City

    Directory of Open Access Journals (Sweden)

    Justino Regalado-Pineda

    2005-10-01

    Full Text Available OBJETIVO: Evaluar el efecto del tabaquismo, los síntomas respiratorios y el asma sobre la función pulmonar espirométrica en población adulta mexicana. MATERIAL Y MÉTODOS: Se generaron ecuaciones de predicción basadas en modelos de regresión lineal múltiple para la capacidad vital forzada (FVC, el vollumen espiratorio forzado al primer segundo (FEV1 y FEV1/FVC de espirometrías obtenidas de adultos que acuden a evaluación de salud y se determinó el efecto del tabaquismo, los síntomas respiratorios y el asma sobre los modelos de estos parámetros. RESULTADOS: Se estudiaron 919 sujetos de entre 14 y 86 años de edad. El asma disminuye la FVC y el FEV1 en hombres con un cambio en la R² OBJECTIVE: To evaluate the effect of tobacco smoking, respiratory symptoms, and asthma on lung function among Mexican adults who were evaluated during a medical exam in a private health clinic. MATERIAL AND METHODS: Reference prediction equations were generated for spirometry parameters [forced vital capacity (FVC, forced expired volume in one second (FEV1 and FEV1/FVC] based on multiple linear regression models. The effect of tobacco smoking, respiratory symptoms and asthma on these equations were explored. RESULTS: Spirometry tests were performed on 919 subjects from 14 to 86 years of age. Asthma decreased FVC and FEV1 in men with a R² change <1%. Respiratory symptoms decreased the FEV1/FVC ratio in both sexes. Tobacco smoking was associated with a significant reduction in FEV1 in women. CONCLUSIONS: Asthma lightly reduced lung function in males while tobacco smoking decreased FEV1, particularly in females.

  5. The competitive challenge in banking

    NARCIS (Netherlands)

    Boot, A.W.A.; Schmeits, A.

    2005-01-01

    The increasingly competitive environment poses challenges to bankers. This paper emphasizes relationship banking as a prime source of the banks' comparative advantage. The proliferation of transaction-oriented banking (trading and financial market activities) does however seriously challenge

  6. Offshore northern Europe, the challenges

    International Nuclear Information System (INIS)

    Bergseth, S.

    1996-01-01

    This paper relates to challenges of the offshore activity in the North Sea. It is appropriate to address these challenges in the context of generating values through efficient management of resources, markets, safety and technology, as the challenges lie therein. The petroleum industry is built to turn natural resources into market value, assuring broad benefits to stake holders and shareholders. In the following, the challenges facing the industry the industry offshore Northern Europe is examined on this background

  7. Lithium niobate packaging challenges

    International Nuclear Information System (INIS)

    Murphy, E.J.; Holmes, R.J.; Jander, R.B.; Schelling, A.W.

    1988-01-01

    The use of lithium niobate integrated optic devices outside of the research laboratory is predicated on the development of a sound packaging method. The authors present a discussion of the many issues that face the development of a viable, robust packaging technology. The authors emphasize the interaction of lithium niobate's physical properties with available packaging materials and technologies. The broad range of properties (i.e. electro-optic, piezo-electric, pyro-electric, photorefractive...) that make lithium niobate an interesting material in many device applications also make it a packaging challenge. The package design, materials and packaging technologies must isolate the device from the environment so that lithium niobate's properties do not adversely affect the device performance

  8. Challenging the Boundaries

    DEFF Research Database (Denmark)

    Nørgaard, Nina

    2004-01-01

    To many people, challenging the boundaries between the traditional disciplines in foreign language studies means doing cultural studies. The aim of this article is to pull in a different direction by suggesting how the interface between linguistics and literature may be another fertile field...... to explore in the study and teaching of foreign languages. Not only may linguistics and literature be employed to shed light on each other, the insights gained may furthermore prove useful in a broader context in our foreign language studies. The article begins with a brief introduction to literary...... linguistics in general and to Hallidayan linguistics in particular. The theoretical framework thus laid out, it is exemplified how Halliday's theory of language may be employed in the analysis of literature. The article concludes by considering the possible status of literary linguistics in a broader...

  9. Optics fabrication technical challenges

    International Nuclear Information System (INIS)

    Chabassier, G.; Ferriou, N.; Lavastre, E.; Maunier, C.; Neauport, J.; Taroux, D.; Balla, D.; Fornerod, J.C.

    2004-01-01

    Before the production of all the LMJ (MEGAJOULE laser) optics, the CEA had to proceed with the fabrication of about 300 large optics for the LIL (laser integration line) laser. Thanks to a fruitful collaboration with high-tech optics companies in Europe, this challenge has been successfully hit. In order to achieve the very tight requirements for cleanliness, laser damage threshold and all the other high demanding fabrication specifications, it has been necessary to develop and to set completely new fabrication process going and to build special outsize fabrication equipment. Through a couple of examples, this paper gives an overview of the work which has been done and shows some of the results which have been obtained: continuous laser glass melting, fabrication of the laser slabs, rapid-growth KDP (potassium dihydrogen phosphate) technology, large diffractive transmission gratings engraving and characterization. (authors)

  10. Challenge Measurements For Authentication

    International Nuclear Information System (INIS)

    Pitts, W. Karl

    2009-01-01

    Authentication of systems with an information barrier that protects sensitive information is difficult; in particular, the information barrier can allow a hidden switch to be implemented by the system fabricator and operator. The hidden switch is the operator's ability to subvert the measurement system and force it to produce a desired and false result. It is usually discussed in the context of an attribute measurement in which a faked item is presented in place of a real item regulated by an agreement, with the driving motivation being the ability to preserve a stock of valuable items. In simple terms, the hidden switch enables a shell game with assets, and the information barrier protects the switch. This presentation outlines challenge measurements that could be used to detect the implementation of a hidden switch and assist the authentication process.

  11. Challenges of ecological restoration

    DEFF Research Database (Denmark)

    Halme, Panu; Allen, Katherine A.; Aunins, Ainars

    2013-01-01

    we introduce northern forests as an ecosystem, discuss the historical and recent human impact and provide a brief status report on the ecological restoration projects and research already conducted there. Based on this discussion, we argue that before any restoration actions commence, the ecology......The alarming rate of ecosystem degradation has raised the need for ecological restoration throughout different biomes and continents. North European forests may appear as one of the least vulnerable ecosystems from a global perspective, since forest cover is not rapidly decreasing and many...... on Biological Diversity. Several northern countries are now taking up this challenge by restoring forest biodiversity with increasing intensity. The ecology and biodiversity of boreal forests are relatively well understood making them a good model for restoration activities in many other forest ecosystems. Here...

  12. Sustainable Consumption: Research Challenges

    DEFF Research Database (Denmark)

    Reisch, Lucia A.; Cohen, Maurie J.; Thøgersen, John

    The Board of the Swedish Foundation for Strategic Environmental Research (Mistra) decided in October 2015 that a proposal for a funding application call in the research area of “sustainable consumption” should be drawn up. According to the statutes of Mistra, research funded by the foundation...... international senior researchers in the eld — Lucia A. Reisch, Maurie J. Cohen, John B. Thøgersen and Arnold Tukker (see Appendix 3) — to draft a background report to prepare the call. The group’s tasks were outlined as follows: ► to describe the challenges facing society in this area, and the political (and...... the orientation of a new research program to be used as draft text for the call for funding applications. The aim of this background report is hence to shed light on future research topics within sustainable consumption from a Swedish perspective. The research pro- moted should help to develop Sweden...

  13. The Global Energy Challenge

    DEFF Research Database (Denmark)

    Connolly, David

    2011-01-01

    This report gives a brief overview of the global energy challenge and subsequently outlines how and where renewable energy could be developed to solve these issues. The report does not go into a lot of detail on these issues and hence, it is meant as an overview only. The report begins by outlining...... the causes of global climate change, concluding that energy-related emissions are the primary contributors to the problem. As a result, global energy production is analysed in more detail, discussing how it has evolved over the last 30 years and also, how it is expected to evolve in the coming 30 years....... Afterwards, the security of the world’s energy supply is investigated and it becomes clear that there is both an inevitable shortage of fossil fuels and a dangerous separation of supply and demand. The final topic discussed is renewable energy, since it is one sustainable solution to the global energy...

  14. Energy a planetary challenge

    International Nuclear Information System (INIS)

    Dessus, B.; Souviron, J.P

    1996-01-01

    After explaining that nuclear energy as well fossil fuel energy are a problem for environment, in radioactive wastes for the first one and for the greenhouse effect for the second one, a new energy policy for France and for the whole countries in the world is described here. Technological and financial arguments in support of this demonstration, it is possible to live better on making the right choices; The energy future is built on the exploitation of two richnesses the energy economies and the renewable energies, as solar energy or wind energy. Technologies exist, they have to be improved and to be applied with judgment according to areas. This challenge is, above all, a question of policy will. (N.C.)

  15. The challenge of implementation

    DEFF Research Database (Denmark)

    Andersen, Karen Heide Hauge

    2016-01-01

    of the paper: which factors influence the degree of implementation of innovation and entrepreneurship in the individual lecturers’ daily teaching? The paper questions the common approach taken by higher educational institutions whereby lecturers are urged to teach innovation and entrepreneurship with minor...... these concepts in daily teaching, as it is strongly encouraged by policy makers and educations. This paper aims to discuss how lecturers experience the challenge of teaching their own discipline while being imposed to embrace and promote innovation and entrepreneurship teaching. Through a single study case...... of the BATCoM education at VIA University College, Denmark, the paper shows that the knowledge, use and implementation of the concepts is far from anchored in the lecturers’ daily practices. Through qualitative interviews the paper highlights different aspects considered, to determine the research question...

  16. Technology Empowerment: Security Challenges.

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Drake Edward [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Backus, George A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jones, Wendell [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Nelson, Thomas R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Skocypec, Russell D. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-03-01

    “Technology empowerment” means that innovation is increasingly accessible to ordinary people of limited means. As powerful technologies become more affordable and accessible, and as people are increasingly connected around the world, ordinary people are empowered to participate in the process of innovation and share the fruits of collaborative innovation. This annotated briefing describes technology empowerment and focuses on how empowerment may create challenges to U.S. national security. U.S. defense research as a share of global innovation has dwindled in recent years. With technology empowerment, the role of U.S. defense research is likely to shrink even further while technology empowerment will continue to increase the speed of innovation. To avoid falling too far behind potential technology threats to U.S. national security, U.S. national security institutions will need to adopt many of the tools of technology empowerment.

  17. Challenges of Ensuring Equity

    DEFF Research Database (Denmark)

    Pasgaard, Maya

    and on a conceptual framework to examine equity in REDD+. Qualitative research with a case study in Cambodia provides the empirical foundation for the thesis, supplemented with a quantitative analysis of climate change research to address the fourth research question. Together, these articles and approaches...... these challenges, specific recomm ndations are summarized in the thesis, namely: better integration of qualitative methods in social assessments, greater emphasis on local inclusion and representativeness in relation to resource access and decision-making, more field research and cross...... social assessments in REDD+ are inadequate due to a dominant positivistic approach to methods and indicators for social assessment, which contrasts the complexities and context of REDD+ projects; 2) The distribution of costs and benefits within communities in Oddar Meanchey is uneven, as the costs...

  18. Challenges in plastics recycling

    DEFF Research Database (Denmark)

    Pivnenko, Kostyantyn; Jakobsen, L. G.; Eriksen, Marie Kampmann

    2015-01-01

    Recycling of waste plastics still remains a challenging area in the waste management sector. The current and potential goals proposed on EU or regional levels are difficult to achieve, and even to partially fullfil them the improvements in collection and sorting should be considerable. A study...... was undertaken to investigate the factors affecting quality in plastics recycling. The preliminary results showed factors primarily influencing quality of plastics recycling to be polymer cross contamination, presence of additives, non-polymer impurities, and polymer degradation. Deprivation of plastics quality......, with respect to recycling, has been shown to happen throughout the plastics value chain, but steps where improvements may happen have been preliminary identified. Example of Cr in plastic samples analysed showed potential spreading and accumulation of chemicals ending up in the waste plastics. In order...

  19. Multicore Programming Challenges

    Science.gov (United States)

    Perrone, Michael

    The computer industry is facing fundamental challenges that are driving a major change in the design of computer processors. Due to restrictions imposed by quantum physics, one historical path to higher computer processor performance - by increased clock frequency - has come to an end. Increasing clock frequency now leads to power consumption costs that are too high to justify. As a result, we have seen in recent years that the processor frequencies have peaked and are receding from their high point. At the same time, competitive market conditions are giving business advantage to those companies that can field new streaming applications, handle larger data sets, and update their models to market conditions faster. The desire for newer, faster and larger is driving continued demand for higher computer performance.

  20. Changing times, similar challenges.

    Science.gov (United States)

    Baillie, Jonathan

    2013-11-01

    With IHEEM celebrating its 70th Anniversary this month, HEJ editor, Jonathan Baillie, recently met the Institute's oldest surviving Past-President, Lawrence Turner OBE, who, having in 1964 established a small engineering business producing some of the NHS's earliest nurse call systems from the basement of his three-storey West Midlands home, has since seen the company, Static Systems Group, grow to become one of the U.K. market-leaders in its field. The Institute's President from 1979-1981, he looked back, during a fascinating two-hour discussion, at his time in the role, talked through some of the key technological and other changes he has seen in the past five decades, reflected on an interesting and varied career, and considered some of the very different current-day challenges that today's IHEEM President, and the Institute as a whole, face.

  1. [Ambulatory pediatrics: a challenge].

    Science.gov (United States)

    Ransy, V; Gevers, B; Landsberg, M

    2006-01-01

    Ambulatory paediatrics in University hospitals has remarkably evolved during the past decade, along with technological progress and the current need for undelayed information and attention; demand for hospital medical advice increases consequently, either directly in outpatients wards or indirectly by phone or e-mails. Specific medico-social aspects linked essentially to populations' migration, poverty, chronic stress and family splitting are regularly encountered. Hospital architecture and adequacy of medical and nursing staff must both be adjusted to these changing medical demands including medical teaching. We now face the ever-growing challenge of providing an adequate management of actual medico-psycho-social aspects and integrating up-to-date paediatrics in our daily practices.

  2. Challenges in data science

    DEFF Research Database (Denmark)

    Carbone, Anna; Jensen, M.; Sato, Aki-Hiro

    2016-01-01

    of global properties from locally interacting data entities and clustering phenomena demand suitable approaches and methodologies recently developed in the foundational area of Data Science by taking a Complex Systems standpoint. Here, we deal with challenges that can be summarized by the question: "What...... can Complex Systems Science contribute to Big Data? ". Such question can be reversed and brought to a superior level of abstraction by asking "What Knowledge can be drawn from Big Data?" These aspects constitute the main motivation behind this article to introduce a volume containing a collection...... of papers presenting interdisciplinary advances in the Big Data area by methodologies and approaches typical of the Complex Systems Science, Nonlinear Systems Science and Statistical Physics. (C) 2016 Elsevier Ltd. All rights reserved....

  3. Hydropower Modeling Challenges

    Energy Technology Data Exchange (ETDEWEB)

    Stoll, Brady [National Renewable Energy Lab. (NREL), Golden, CO (United States); Andrade, Juan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cohen, Stuart [National Renewable Energy Lab. (NREL), Golden, CO (United States); Brinkman, Greg [National Renewable Energy Lab. (NREL), Golden, CO (United States); Brancucci Martinez-Anido, Carlo [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2017-04-19

    Hydropower facilities are important assets for the electric power sector and represent a key source of flexibility for electric grids with large amounts of variable generation. As variable renewable generation sources expand, understanding the capabilities and limitations of the flexibility from hydropower resources is important for grid planning. Appropriately modeling these resources, however, is difficult because of the wide variety of constraints these plants face that other generators do not. These constraints can be broadly categorized as environmental, operational, and regulatory. This report highlights several key issues involving incorporating these constraints when modeling hydropower operations in terms of production cost and capacity expansion. Many of these challenges involve a lack of data to adequately represent the constraints or issues of model complexity and run time. We present several potential methods for improving the accuracy of hydropower representation in these models to allow for a better understanding of hydropower's capabilities.

  4. Media Challenging Status Quo

    DEFF Research Database (Denmark)

    Sandvik, Kjetil

    and Libya creating headlines like “the Facebook revolution”. On the other hand, several scholars argue that it is naive to believe that social media in themselves create change: they may at the best facilitate already existing social and political movements (Downing 2008, Christakis & Fowler 2010...... and communication research is currently engaging in a longer and deeper process of examining and assessing the cultural consequences of networked communication. One present challenge is to understand digital media and networked communication at the intersection of established and countercultural, utopian......Digital media and especially so-called ‘social media’ have on the one hand been ascribed the power to change societies and empower democratic movements following the thoughts of e.g. Rheingold (2004), recently fueled by the democratic uprising in Arabic countries such as Egypt, Tunisia, Iran...

  5. Challenges for nuclear regulators

    International Nuclear Information System (INIS)

    Allen, M.R.

    1994-01-01

    The paper discusses issues that will present particular challenges to the nuclear industry, during the next decade, that should be addressed in order to achieve increased public acceptance of the industry. The issues of safety culture, peer review of safety, severe accidents, transport accidents and public communication are suggest as meriting special consideration. The need for nuclear regulatory agencies to establish credibility and for operating organisations to demonstrate accountability is emphasised, and the Australian experiences are reviewed. Increased collaboration by nuclear regulatory agencies in the Asian-pacific region is suggested, in order to encourage consistency of regulatory safety standards for the nuclear safety issues identified. Methods whereby this could be achieved within the framework of existing agreements and arrangements are suggested. 2 refs

  6. Some Challenges to Sustainability

    Directory of Open Access Journals (Sweden)

    Bruce R. Conard

    2013-08-01

    Full Text Available The word “sustainability” is often used in business in the belief that the current ways of doing things will be able to be continued with only minor changes to balance economic development with related environmental and social issues. There are, however, immense challenges that threaten the very sustainability of our global society, let alone individual businesses or developments. A few of the most important of these challenges—population growth, clean energy supply, fresh water availability, and global climate change—are discussed. As humanity forms its collective response to these threats, it is concluded that all intelligent people, but especially scientists, have important roles to play, not only in technical innovation, but also in catalyzing political action.

  7. The WCET Tool Challenge 2011

    DEFF Research Database (Denmark)

    Hanxleden, Reinhard von; Holsti, Niklas; Lisper, Björn

    Following the successful WCET Tool Challenges in 2006 and 2008, the third event in this series was organized in 2011, again with support from the ARTIST DESIGN Network of Excellence. Following the practice established in the previous Challenges, the WCET Tool Challenge 2011 (WCC'11) dened two kin...

  8. WCET Tool Challenge 2011: Report

    DEFF Research Database (Denmark)

    Bonenfant, Armelle; Cassé, Hugues; Bünte, Sven

    2011-01-01

    Following the successful WCET Tool Challenges in 2006 and 2008, the third event in this series was organized in 2011, again with support from the ARTIST DESIGN Network of Excellence. Following the practice established in the previous Challenges, the WCET Tool Challenge 2011 (WCC’11) defined two k...

  9. Challenges of Virtual School Leadership

    Science.gov (United States)

    Richardson, Jayson W.; LaFrance, Jason; Beck, Dennis

    2015-01-01

    The purpose of this case study was to examine challenges faced by virtual school leaders in the United States. Through semistructured interviews, the researchers explored challenges faced by eighteen leaders of fully online or blended online programs. Analysis revealed six main challenges: funding, staff, accountability, time, parents, and…

  10. New challenges in gas

    Energy Technology Data Exchange (ETDEWEB)

    Mandil, C. [Institut Francais du Petrole (IFP), 92 - Rueil-Malmaison (France); Chabrelie, M.F. [Cedigaz, 92 - Rueil Malmaison (France); Streicher, C. [Prosernat, 92 - Paris la Defense (France)] [and others

    2003-07-01

    New developments in the area of gas treatment will be to a large extent driven by the need to find appropriate solutions to the fundamental need of sustainable development. New gas treatment processes are developed with the aim to minimise contaminant emissions and meet most stringent environmental specifications. A new major challenge for the industry will be to implement new cost effective technologies for reducing CO{sub 2} emissions. Industry has also to minimise its costs, and therefore, in order to ensure at the same time a better protection of the environment and a better safety, it is necessary to innovate. The purpose of this seminar is precisely to identify better the innovations which are required in the area of gas treatment. These proceedings comprise 8 papers and a summary of the contributions to a round-table discussion dealing with the options for CO{sub 2} capture and sequestration. The presentations treat of: the future prospects for the gas industry (M.F. Chabrelie, Cedigaz); the solutions for offshore gas treatment (C. Streicher, Prosernat); gas treatment with membranes (H. Meyer, GTI); the Axens Multibed{sub TM} technology for natural gas treatment (G. Jochem, Axens); the potentials and applications for the Propure co-current contactors (F.P. Nilsen, ProPure); the production of very-sour and super-sour large gas reserves: the new challenges (F. Lallemand, TotalFinaElf); Hybrisol, a new gas treatment process for sour natural gases (F. Lecomte, IFP); and the conception and building of large acid-gas removal units (J. Castel, Technip-Coflexip). (J.S.)

  11. High levels of physical activity are associated with poorer asthma control in young females but not in males.

    Science.gov (United States)

    Lövström, Ludvig; Emtner, Margareta; Alving, Kjell; Nordvall, Lennart; Borres, Magnus P; Janson, Christer; Malinovschi, Andrei

    2016-01-01

    Earlier studies on the levels of physical activity in asthma patients compared with controls have yielded varying results. We have previously reported that high versus moderate levels of physical activity were associated with higher prevalence of wheezing, especially in females. Here we studied the levels of physical activity in young patients with asthma and healthy subjects and their effect on asthma control. Four hundred eight physician-diagnosed patients with asthma and 118 controls (10-34 years) answered questions concerning frequency and/or duration of physical activity and undertook the Asthma Control Test (ACT), spirometry, methacholine challenges and exhaled nitric oxide measurements. Asthma patients were more frequently physically active (P = 0.01) and for longer durations (P = 0.002) than controls. Highly versus moderately physically active patients with asthma had a higher prevalence of not well-controlled asthma (ACT < 20) when physical activity was assessed by frequency (40.6% vs 24.1%, P = 0.001) or duration (39.0% vs 21.7%, P < 0.001). This was only seen in females who had reduced ACT items (P < 0.05). Frequently versus moderately active females had an odds ratio of 4.81 (2.43, 9.51) to have ACT < 20, while no such effect was found in males (OR 1.18 (0.61, 2.30)) and this interaction was statistically significantly associated with gender (P = 0.003). No differences in fraction of exhaled nitric oxide or methacholine reactivity were found between moderately and highly physically active females with asthma. Young asthma patients were more active than controls. High levels of physical activity were associated with poor asthma control as judged by the ACT in females, but not in males, and this appears unrelated to airway inflammation or responsiveness. © 2015 Asian Pacific Society of Respirology.

  12. Cough-variant asthma: a diagnostic dilemma in the occupational setting.

    Science.gov (United States)

    Lipińska-Ojrzanowska, A; Wiszniewska, M; Walusiak-Skorupa, J

    2015-03-01

    Cough-variant asthma (Corrao's syndrome) is defined as the presence of chronic non-productive cough in patients with bronchial hyperresponsiveness (BHR) and response to bronchodilator therapy. This variant of asthma may present a diagnostic problem in occupational medicine. To describe additional evaluation of cough-variant asthma in a cyanoacrylate-exposed worker in whom standard diagnostic testing was negative. A female beautician was evaluated for suspected occupational allergic rhinitis and asthma. A specific inhalation challenge test (SICT) was performed with cyanoacrylate glues used for applying artificial eyelashes and nails. Spirometry and peak expiratory flow (PEF) measurements were recorded hourly for 24h; methacholine challenge testing was performed and nasal lavage (NL) samples were analysed for eosinophilia. After SICT, the patient developed sneezing, nasal airflow obstruction and cough. Declines in forced expiratory volume in 1 s and PEF were not observed. Eosinophil proportions in NL fluid increased markedly at 4 and 24h after SICT. A significant increase in BHR also occurred 24h after SICT. Clinical symptoms, post-challenge BHR and increased NL eosinophil counts confirmed a positive response to SICT and validated the diagnosis of cough-variant occupational asthma. SICT may be useful in cases where history and clinical data suggest cough-variant asthma and spirometric indices are negative. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. VISIR: Experiences and Challenges

    Directory of Open Access Journals (Sweden)

    Mohamed Tawfik

    2012-02-01

    Full Text Available It is of crucial importance the integration of practical sessions in engineering curricula owing to their significant role in understanding engineering concepts and scientific phenomena. However, the lack of practical sessions due to the high costs of the equipment and the unavailability of instructors has caused a significant declination in experimentation in engineering education. Remote laboratories have tackled this issues providing online reusable and shared workbenches unconstrained by neither geographical nor time considerations. Thereby, they have extremely proliferated among universities and integrated into engineering curricula over the last decade. This contribution compiles diverse experiences based on the deployment of the remote laboratory, Virtual Instrument Systems in Reality (VISIR, on the practices of undergraduate engineering grades at various universities within the VISIR community. It aims to show the impact of its usage on engineering education concerning the assessments of students and teachers as well. In addition, the paper address the next challenges and future works carried out at several universities within the VISIR community.

  14. Challenges for decommissioning policies

    International Nuclear Information System (INIS)

    Riotte, H.

    2007-01-01

    In the coming years, OECD member countries will be increasingly faced with the need to make appropriate provisions, in terms of policy, finance and management, for all aspects of decommissioning. Decommissioning requires regulatory approval and oversight, the directions of which are guided by national policy. In several instances, governments have only recently begun to address their approaches to decommissioning policy and regulation in national legislation, and international overviews of such approaches, which may eventually lead to international harmonization, are only now beginning to emerge. In parallel, policy and regulation have been evolving and a broadened competence has developed in relevant regulatory authorities. The challenge lying ahead is to establish a framework that will allow for the growth of nuclear industrial activities in competitive, globalized markets, while maintaining and assuring the safety of decommissioning for the public and for workers. Within this context, institutional arrangements, stakeholder issues, costs and funding, waste management and policies for release from regulatory control, as well as the availability of technologies and skills, need to be reviewed. (author)

  15. Whiplash Continues Its Challenge.

    Science.gov (United States)

    Jull, Gwendolen

    2016-10-01

    There have been many advances in the management of neck pain disorders, but a personal frustration as a clinician and researcher in the field is that the incidence of full recovery following a whiplash injury as a result of a motor vehicle crash has not increased and, subsequently, the rate of transition to chronic neck pain has not lessened. The commentaries in this special issue reflect the multifaceted nature of whiplash-associated disorders and the wide-ranging research in the field. While management of whiplash, especially the challenge of lessening the rate of transition to chronicity, has yet to be achieved, the picture is becoming clearer. This should give great confidence and some hope to individuals with whiplash-associated disorders who have long-term pain and functional disability that after the next decade of research and clinical development, the outcomes following whiplash are likely to be vastly improved. J Orthop Sports Phys Ther 2016;46(10):815-817. doi:10.2519/jospt.2016.0112.

  16. Challenges in Piaget's legacy.

    Science.gov (United States)

    Bibace, Roger

    2013-03-01

    The publication of After Piaget (Martí and Rodríguez 2012) hopefully triggers a new effort to understand the richness of the efforts of that major psychologist of the 20th century. Piaget was consistently concerned with part/whole relationships throughout his life. He addressed this issue philosophically, epistemologically, and psychologically. Conceptually Piaget struggled with the issue of continuity/discontinuity in development and changed his mind about how to reconcile the discontinuities of stages with his concept of development. I also attribute his variability to the implications of his important work on perception, and to his willingness to get involved in widespread concrete applications of his approach to education including the education of children with special needs; his center for genetic epistemology, and his interest in psychoanalysis. Benefiting from all the authors of After Piaget, I want to point out that Piaget has identified many major issues that will continue to constitute challenges to psychology in this century. These include specifying terms such as 'development;' methodological issues such as sampling both quantitatively in one culture and across cultures; comprehensive inclusion of the psychological processes covered by introductory textbooks in psychology; and conceptual issues such as the relationships among all these parts within a whole. I make a distinction between an 'issue' and a 'problem'--problems have solutions; while issues refer to controversies in science generally as well as in psychology that have persisted for centuries.

  17. Ribosomal Antibiotics: Contemporary Challenges

    Directory of Open Access Journals (Sweden)

    Tamar Auerbach-Nevo

    2016-06-01

    Full Text Available Most ribosomal antibiotics obstruct distinct ribosomal functions. In selected cases, in addition to paralyzing vital ribosomal tasks, some ribosomal antibiotics are involved in cellular regulation. Owing to the global rapid increase in the appearance of multi-drug resistance in pathogenic bacterial strains, and to the extremely slow progress in developing new antibiotics worldwide, it seems that, in addition to the traditional attempts at improving current antibiotics and the intensive screening for additional natural compounds, this field should undergo substantial conceptual revision. Here, we highlight several contemporary issues, including challenging the common preference of broad-range antibiotics; the marginal attention to alterations in the microbiome population resulting from antibiotics usage, and the insufficient awareness of ecological and environmental aspects of antibiotics usage. We also highlight recent advances in the identification of species-specific structural motifs that may be exploited for the design and the creation of novel, environmental friendly, degradable, antibiotic types, with a better distinction between pathogens and useful bacterial species in the microbiome. Thus, these studies are leading towards the design of “pathogen-specific antibiotics,” in contrast to the current preference of broad range antibiotics, partially because it requires significant efforts in speeding up the discovery of the unique species motifs as well as the clinical pathogen identification.

  18. Challenges in Regulating Ageing

    International Nuclear Information System (INIS)

    Tiippana, P.

    2016-01-01

    Finland has recent experience in regulating design, construction, commissioning and operation of nuclear facilities. Also decommissioning is topical as the research reactor will enter a decommissioning phase in the near future. From regulator’s point of view, the paper discusses potential challenges related to ageing management at the Finnish nuclear facilities throughout their lifetime. Based on the experience the most important decisions to ensure adequate provisions against adverse effects of various ageing phenomena and mechanisms are made much earlier than operation starts, namely during design, construction and manufacturing of systems, structures and components (SSC). Early consideration of ageing management resulting in good engineering including ageing-proof manufacturing and construction practices is of particular importance for new reactors. Elongated design lifetime of new reactors underlines the need of all available means to minimize progress of ageing beforehand and to create prerequisites for well-established condition monitoring and maintenance up to decommissioning. Furthermore, continuous research and development in order to understand various types of ageing and to detect degradation before SSC’s failure is expected as soon as a facility has been put in service. All these activities have to be supported by proper information and knowledge management in each phase of the facility’s life span. (author)

  19. Challenges of nuclear fusion

    International Nuclear Information System (INIS)

    Kunkel, W.B.

    1987-01-01

    After 30 years of research and development in many countries, the magnetic confinement fusion experiments finally seem to be getting close to the original first goal: the point of ''scientific break-even''. Plans are being made for a generation of experiments and tests with actual controlled thermonuclear fusion conditions. Therefore engineers and material scientists are hard at work to develop the required technology. In this paper the principal elements of a generic fusion reactor are described briefly to introduce the reader to the nature of the problems at hand. The main portion of the presentation summarises the recent advances made in this field and discusses the major issues that still need to be addressed in regard to materials and technology for fusion power. Specific examples are the problems of the first wall and other components that come into direct contact with the plasma, where both lifetime and plasma contamination are matters of concern. Equally challenging are the demands on structural materials and on the magnetic-field coils, particularly in connection with the neutron-radiation environment of fusion reactors. Finally, the role of ceramics must be considered, both for insulators and for fuel breeding purposes. It is evident that we still have a formidable task before us, but at this point none of the problems seem to be insoluble. (author)

  20. Osteomyelitis: a current challenge

    Directory of Open Access Journals (Sweden)

    Luciana Souza Jorge

    Full Text Available Over the last 30 years, the pathogenesis of osteomyelitis has almost been totally elucidated, and many factors responsible for the persistence of this infection have been identified. Numerous antimicrobial agents with distinct spectrums of action, pharmacokinetics, and pharmacodynamics have been used in its treatment. Surgical techniques, including muscle grafts, the Ilizarov technique, and antibiotic bone cements, have been applied. However, bone infections are still a challenge. Despite the importance of isolation and identification of microorganisms to determine the antimicrobial treatment of bone infections, there are few systematic national studies about the etiological profile of these diseases. This article describes the current knowledge of osteomyelitis and summarizes published national data based on the experience of different Orthopedic and Traumatology Services. In general, S. aureus was described as an important etiological agent; however, the difference in design of national studies makes a comparison between the prevalence of bone infection, the associated risk factors, and the different therapeutic approaches difficult. In conclusion, effort is necessary in order to stimulate systematic national studies in different Orthopedics and Traumatology Services to obtain a better consensus on preventive measures and therapies of bone infections.

  1. 'Scrap yard challenge'

    International Nuclear Information System (INIS)

    Hollick, A.

    2000-01-01

    'Plutonium'. The word evokes deep reactions outside of the nuclear industry. Although the majority of Plutonium currently in existence is man-made and therefore perceived as being unnatural, plutonium has been found as a product of the Oklo natural reactor in Gabon. This paper seeks to challenge two concepts, that of the Nuclear Control Institute that Plutonium is unnatural, 'fiendishly toxic' and one of the 'substances most hazardous to man' and the second image that a high security Plutonium store is merely a 'scrapyard' containing a material which has little use. The nuclear industry has often been accused of treating Plutonium and its accumulation casually in proportion to the risks perceived by those outside the industry. As a result this paper seeks to demonstrate that the industry is aware of the concerns of the public and is actively seeking viable solutions. The paper looks at Plutonium itself and explores the issues surrounding military and civil Plutonium in adding to the current stockpiles. It also suggests three possible alternatives for dealing with these Plutonium stockpiles and arrives at a conclusion as to which solutions currently appear most viable. (authors)

  2. Challenges in Astronomy Education

    Science.gov (United States)

    De Greve, Jean-Pierre

    2010-11-01

    Astronomy is an attractive subject for education. It deals with fascination of the unknown and the unreachable, yet is uses tools, concepts and insights from various fundamental sciences such as mathematics, physics, chemistry, biology. Because of this it can be well used for introducing sciences to young people and to raise their interest in further studies in that direction. It is also an interesting subject for teaching as its different aspects (observation techniques, theory, data sampling and analysis, modelling,?) offer various didactical approaches towards different levels of pupils, students and different backgrounds. And it gives great opportunities to teach and demonstrate the essence of scientific research, through tutorials and projects. In this paper we discuss some of the challenges education in general, and astronomy in particular, faces in the coming decades, given the major geophysical and technological changes that can be deducted from our present knowledge. This defines a general, but very important background in terms of educational needs at various levels, and in geographical distribution of future efforts of the astronomical community. Special emphasis will be given to creative approaches to teaching, to strategies that are successful (such as the use of tutorials with element from computer games), and to initiatives complementary to the regular educational system. The programs developed by the IAU will be briefly highlighted.

  3. The stem factor challenge

    International Nuclear Information System (INIS)

    Russell, M.J.; Steele, R. Jr.; DeWall, K.G.; Watkins, J.C.; Bramwell, D.

    1994-01-01

    One of the most important challenges that still needs to be met in the effort to understand the operation of motor-operated, rising-stem valves is the ability to determine stem factor throughout the valve's load range. The stem factor represents the conversion of operator torque to stem thrust. Determining the stem factor is important because some motor-operated valves (MOVs) cannot be tested in the plant at design basis conditions. The ability of these valves to perform their design basis function (typically, to operate against specified flow and pressure loads) must be ensured by analytical methods or by extrapolating from the results of tests conducted at lower loads. Because the stem factor tends to vary in response to friction and lubrication phenomena that occur during loading and wedging, analytical methods and extrapolation methods have been difficult to develop and implement. Early investigations into variability in the stem factor tended to look only at the tip of the iceberg; they focused on what was happening at torque switch trip, which usually occurs at full wedging. In most stems, the stem factor is better (lower) in the wedging transient than before wedging, so working with torque switch trip data alone led many early researchers to false conclusions about the relationship between stem factor and load. However, research at the Idaho National Engineering Laboratory (INEL) has taken a closer look at what happens during the running portion of the closing stroke along with the wedging portion. This shift in focus is important, because functional failure of a valve typically consists of a failure to isolate flow, not a failure to achieve full wedging. Thus, the stem factor that must be determined for a valve's design basis closing requirements is the one that corresponds with the running load before wedging

  4. DIGITAL PAKISTAN: OPPORTUNITIES & CHALLENGES

    Directory of Open Access Journals (Sweden)

    Ghulam Muhammad Kundi

    2008-10-01

    Full Text Available IT has revolutionized the social and organizational life around the globe. Given the newness of IT as a technology, there is a lot of potential that needs to be explored. It is however, argued that as IT can revolutionize the economic development, by the same coin, although its mismanagement in adoption process can end up in problems or even straight failure of the technology at the business-end. This study was conducted with reference to opportunities and challenges in the IT adoption process in Pakistan. The aim of the study was to point out the barriers that are impeding the country’s computerization process in order to provide facts to the policy makers for smooth computerization. The primary data collected through structured questionnaires was analyzed and tested through correlation, regressions analysis and t-test. Out of 10 hypotheses, 3 were accepted while in the rest null hypotheses were not substantiated. Based on primary and secondary data analysis this study has found that all independent bureaucratic, political, education and social and cultural variables are mutually correlated and have significant impact on shaping and reshaping of IT in Pakistan, while the Pakistan IT policy is inconsistent, administrative machinery attitude is negative and non cooperative, procedures are cumbersome and implementation is weak and ineffective, not to mention the lack of IT knowledge on the bureaucratic side. The political environment is instable and law and order is worse which is discouraging the investment. Moreover, physical and legal infrastructure is insufficient and the country is lacking good quality IT professionals. IT organization alignment is another serious issue in Pakistan. However, government incentives and growing interest from the private sector indicate positive attitude towards computerization of the country.

  5. Decommissioning - The worldwide challenge

    International Nuclear Information System (INIS)

    McKeown, John

    2002-01-01

    Full text: Whatever the future may hold for nuclear power, there are closed or ageing nuclear facilities in many countries around the world. While these may be in safe care and maintenance at present, a sustainable long term solution is required. Facilities need to be decommissioned, contaminated land remediated, and wastes conditioned for safe storage or disposal. Practical nuclear site restoration has been demonstrated internationally. This experience has revealed generic challenges in dealing with old, often experimental, facilities. These include: Facilities not designed for ease of decommissioning; Records of plant construction and operation, and of the materials utilised and wastes produced, not to modern standards; Fuels and wastes stored for long periods in less than optimal conditions, leading to deterioration and handling problems; The historic use of experimental fuels and materials, giving rise to unique waste streams requiring unique waste management solutions; The application of modern safety and environmental standards to plant which dates from the 1940s, 50s and 60s, requiring investment before decommissioning can even commence. These problems can be tackled, as examples from UKAEA's own programme will illustrate. But two fundamental issues must be recognised and considered. First, the costs of decommissioning older facilities are very high, and may place a heavy burden on national budgets, despite using best efforts to control them. We can limit these costs by learning from one another's experience and sharing the development of new techniques and technologies. UKAEA has already initiated a programme of international collaboration, and hopes that other IAEA countries will be encouraged to follow suit. But whilst the costs of decommissioning may be high, the process normally meets with public acceptance. This is seldom the case for long term waste storage or disposal. Until waste management routes are available - either nationally or internationally

  6. HEPEX - achievements and challenges!

    Science.gov (United States)

    Pappenberger, Florian; Ramos, Maria-Helena; Thielen, Jutta; Wood, Andy; Wang, Qj; Duan, Qingyun; Collischonn, Walter; Verkade, Jan; Voisin, Nathalie; Wetterhall, Fredrik; Vuillaume, Jean-Francois Emmanuel; Lucatero Villasenor, Diana; Cloke, Hannah L.; Schaake, John; van Andel, Schalk-Jan

    2014-05-01

    HEPEX is an international initiative bringing together hydrologists, meteorologists, researchers and end-users to develop advanced probabilistic hydrological forecast techniques for improved flood, drought and water management. HEPEX was launched in 2004 as an independent, cooperative international scientific activity. During the first meeting, the overarching goal was defined as: "to develop and test procedures to produce reliable hydrological ensemble forecasts, and to demonstrate their utility in decision making related to the water, environmental and emergency management sectors." The applications of hydrological ensemble predictions span across large spatio-temporal scales, ranging from short-term and localized predictions to global climate change and regional modeling. Within the HEPEX community, information is shared through its blog (www.hepex.org), meetings, testbeds and intercompaison experiments, as well as project reportings. Key questions of HEPEX are: * What adaptations are required for meteorological ensemble systems to be coupled with hydrological ensemble systems? * How should the existing hydrological ensemble prediction systems be modified to account for all sources of uncertainty within a forecast? * What is the best way for the user community to take advantage of ensemble forecasts and to make better decisions based on them? This year HEPEX celebrates its 10th year anniversary and this poster will present a review of the main operational and research achievements and challenges prepared by Hepex contributors on data assimilation, post-processing of hydrologic predictions, forecast verification, communication and use of probabilistic forecasts in decision-making. Additionally, we will present the most recent activities implemented by Hepex and illustrate how everyone can join the community and participate to the development of new approaches in hydrologic ensemble prediction.

  7. WANO. Development, programs, challenges

    International Nuclear Information System (INIS)

    Haferburg, Manfred

    2011-01-01

    In the wake of the accident at the Soviet RBMK reactor unit 4 in Chernobyl the nuclear industry founded the World Association of Nuclear Operators (WANO). To this day, the purpose of the organization has been to enhance worldwide cooperation of nuclear industry and, in this way, strengthen the safety and availability of nuclear power plants. Following some first steps after 1986, the charter of the organization was signed at the WANO constituent assembly in Moscow on May 15 and 16, 1989. The member companies thus committed themselves to support WANO's mission. WANO was established for these purposes: ''The mission of WANO is to maximize the safety and reliability of nuclear power plants worldwide by working together to assess, benchmark and improve performance through mutual support, exchange of information, and emulation of best practices.'' The WANO programs developed speedily thereafter. The focus was on peer reviews. In 2000, the first interim objective had been reached: Fifty percent of all member nuclear power plants had undergone peer reviews. In addition, plant-related peer reviews were extended throughout all operator organizations, and corporate peer reviews were developed. The other WANO programs as well, i.e. exchanges of experience, technical support, and performance indicators, exerted more and more influence on industry. Peer reviews covered entire operator organizations, and corporate peer reviews were developed. The worldwide paradigm shift in evaluating the use of nuclear power, and the associated construction programs for new nuclear power plants already in their implementation phase, assigned a new quality to the work of WANO. The organization is preparing a long-term strategy in the face of the challenges to be expected. The ultimate objective of these efforts is to support member organizations from the first preparations of a nuclear power plant project to the end of commercial operation. (orig.)

  8. DIGITAL PAKISTAN: OPPORTUNITIES & CHALLENGES

    Directory of Open Access Journals (Sweden)

    Ghulam Muhammad Kundi

    2008-12-01

    Full Text Available ABSTRACT IT has revolutionized the social and organizational life around the globe. Given the newness of IT as a technology, there is a lot of potential that needs to be explored. It is however, argued that as IT can revolutionize the economic development, by the same coin, although its mismanagement in adoption process can end up in problems or even straight failure of the technology at the business-end. This study was conducted with reference to opportunities and challenges in the IT adoption process in Pakistan. The aim of the study was to point out the barriers that are impeding the country’s computerization process in order to provide facts to the policy makers for smooth computerization. The primary data collected through structured questionnaires was analyzed and tested through correlation, regressions analysis and t-test. Out of 10 hypotheses, 3 were accepted while in the rest null hypotheses were not substantiated. Based on primary and secondary data analysis this study has found that all independent bureaucratic, political, education and social and cultural variables are mutually correlated and have significant impact on shaping and reshaping of IT in Pakistan, while the Pakistan IT policy is inconsistent, administrative machinery attitude is negative and non cooperative, procedures are cumbersome and implementation is weak and ineffective, not to mention the lack of IT knowledge on the bureaucratic side. The political environment is instable and law and order is worse which is discouraging the investment. Moreover, physical and legal infrastructure is insufficient and the country is lacking good quality IT professionals. IT organization alignment is another serious issue in Pakistan. However, government incentives and growing interest from the private sector indicate positive attitude towards computerization of the country.

  9. The Repack Challenge

    Science.gov (United States)

    Kruse, Daniele Francesco

    2014-06-01

    Physics data stored in CERN tapes is quickly reaching the 100 PB milestone. Tape is an ever-changing technology that is still following Moore's law in terms of capacity. This means we can store every year more and more data in the same amount of tapes. However this doesn't come for free: the first obvious cost is the new higher capacity media. The second less known cost is related to moving the data from the old tapes to the new ones. This activity is what we call repack. Repack is vital for any large tape user: without it, one would have to buy more tape libraries and more floor space and, eventually, data on old non supported tapes would become unreadable and be lost forever. In this paper we describe the challenge of repacking 115 PB before LHC data taking starts in the beginning of 2015. This process will have to run concurrently with the existing experiment tape activities, and therefore needs to be as transparent as possible for users. Making sure that this works out seamlessly implies careful planning of the resources and the various policies for sharing them fairly and conveniently. To tackle this problem we need to fully exploit the speed and throughput of our modern tape drives. This involves proper dimensioning and configuration of the disk arrays and all the links between them and the tape servers, i.e the machines responsible for managing the tape drives. It is also equally important to provide tools to improve the efficiency with which we use our tape libraries. The new repack setup we deployed has on average increased tape drive throughput by 80%, allowing them to perform closer to their design specifications. This improvement in turn means a 48% decrease in the number of drives needed to achieve the required throughput to complete the full repack on time.

  10. The Cosmonauts challenge

    Directory of Open Access Journals (Sweden)

    Ian Blatchford

    2015-11-01

    Full Text Available Focusing on the experience of working with Russia’s cultural, industrial and political sectors, this paper investigates how the development of new contacts and partnerships has contributed not only to the loan of material of historic significance to the Science Museum’s exhibition, but more broadly changes perceptions about Russia and its space programme in the western world. Addressing the multiple challenges involved – legal, political and security, among others – it reveals the importance of many of the space objects themselves as well as demonstrating how the Science Museum has helped to maintain a dialogue with Russia even during the most testing times. In September 2015 the Science Museum opened the most ambitious special exhibition it had ever undertaken: Cosmonauts: birth of the space age. Whilst the creation of a ‘blockbuster’ exhibition might be the normal expectation of a great art museum, the fact that a science museum should undertake such an endeavour is equally worthy of comment, and this article seeks to illustrate the exceptional curatorial, museological, logistical, legal and political hurdles that this project had to overcome. Indeed, they would astonish even the grandest and most experienced of the international art museums. Art museums are delighted when they can display the acclaimed works of Monet, but even the most valuable paintings cannot be said to be have been official state secrets in the way that so much Russian space technology has been. The curatorial team kept its nerve because of a compelling sense that while the project delivery was high stress, the intellectual rewards would be considerable, and especially the opportunity to present a story of human endeavour in which cultural and scientific excellence are so intertwined. When the project team started out they could never have anticipated that they would be seeking to deliver an audacious exhibition set against a background of very serious strains

  11. Our biggest challenge.

    Science.gov (United States)

    Mcfadden, P; Ray, S

    1994-06-01

    womanhood without children. Women do not believe they have child-bearing choices. Differential AIDS mortality for women will decrease the young female population, which will increase pressure on women to bear children. The greatest challenge is to make women feel valued and believe in themselves.

  12. Inspirometria de incentivo e breath stacking: repercussões sobre a capacidade inspiratória em indivíduos submetidos à cirurgia abdominal Incentive spirometry and breath stacking: effects on the inspiratory capacity of individuals submitted to abdominal surgery

    Directory of Open Access Journals (Sweden)

    CM Dias

    2008-04-01

    it is necessary to know which therapeutic approaches are the best ones to implement. OBJECTIVE: To compare the inspiratory volume during the breath stacking maneuver with the volume during incentive spirometry, in abdominal surgery patients. METHODS: Twelve patients, on their first postoperative day, were instructed to take a deep breath through the VoldyneTM incentive spirometer and to make successive inspiratory efforts using a facemask that had been adapted for performing the breath stacking maneuver. Each technique was performed five times according to the randomization. Before the operation, the patients performed a spirometric test. They were also assessed and instructed about the procedures. A WrightTM ventilometer allowed inspiratory capacity to be recorded. RESULTS: The inspiratory capacity during breath stacking was significantly higher than during incentive spirometry, both before and after the operation. There was a significant reduction in volumes after the surgical procedure, independent of the technique performed. CONCLUSIONS: The breath stacking technique was shown to be effective. This technique was better than incentive spirometry for generating and sustaining inspiratory volumes. Since no adverse effects have been described, this technique can probably be used safely and effectively, particularly in uncooperative patients.

  13. Comparação entre inspirometria de incentivo e pressão positiva expiratória na função pulmonar após cirurgia bariátrica Comparison between incentive spirometry and expiratory positive airway pressure on pulmonary function after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Marcela C. Barbalho-Moulim

    2009-06-01

    Full Text Available O objetivo deste estudo foi comparar o efeito da pressão positiva expiratória (EPAP, na sigla em inglês e da inspirometria de incentivo a fluxo sobre a função pulmonar após o bypass gástrico em Y de Roux por videolaparoscopia. Participaram 28 mulheres, não-tabagistas e não-pneumopatas, com índice de massa corporal entre 35 e 50 kg/m², submetidas à cirurgia bariátrica. Todas foram avaliadas por espirometria, cirtometria toracoabdominal e quanto à mobilidade diafragmática no pré e segundo dia de pós-operatório (o tempo de internação foi de 2 dias. Foram divididas em dois grupos, GI - grupo inspirômetro (n=13 e GE, grupo EPAP (n=15. A fisioterapia foi iniciada no dia da cirurgia, cada técnica, inspirometria ou EPAP, com duração de 15 minutos; a fisioterapia motora foi padronizada para ambos os grupos. No pós-operatório, houve redução similar nos dois grupos das variáveis: capacidade vital, volume de reserva inspiratório, capacidade vital forçada e ventilação voluntária máxima. Não houve alteração nos valores do volume corrente no GI e volume de reserva expiratório no GE. A mobilidade diafragmática e a mobilidade toracoabdominal foram menos prejudicadas no GI. No pós-operatório da cirurgia bariátrica por videolaparoscopia, a inspirometria de incentivo a fluxo exerceu melhores efeitos na manutenção do volume corente, na mobilidade diafragmática e toracoabdominal, enquanto a EPAP foi mais eficaz no restabelecimento do volume de reserva expiratório.The aim of this study was to compare the effect of expiratory positive airway pressure (EPAP and flow-oriented incentive spirometry on pulmonary function after laparoscopic Roux-en-Y gastric bypass surgery. Twenty-eight non-smoking women, with no lung disease and body mass index of 35 to 50 kg/m², undergoing laparoscopic gastric bypass surgery (hospitalized for two days were assessed by spirometry, thoracoabdominal cirtometry and as to diaphragmatic motion

  14. Radioecological challenges for mining

    Energy Technology Data Exchange (ETDEWEB)

    Vesterbacka, P.; Ikaeheimonen, T.K.; Solatie, D. [Radiation and Nuclear Safety Authority (Finland)

    2014-07-01

    In Finland, mining became popular in the mid-1990's when the mining amendments to the law made the mining activities easier for foreign companies. Also the price of the minerals rose and mining in Finland became economically profitable. Expanding mining industry brought new challenges to radiation safety aspect since radioactive substances occur in nearly all minerals. In Finnish soil and bedrock the average crystal abundance of uranium and thorium are 2.8 ppm and 10 ppm, respectively. It cannot be predicted beforehand how radionuclides behave in the mining processes which why they need to be taken into account in mining activities. Radiation and Nuclear Safety Authority (STUK) has given a national guide ST 12.1 based on the Finnish Radiation Act. The guide sets the limits for radiation doses to the public also from mining activities. In general, no measures to limit the radiation exposure are needed, if the dose from the operation liable to cause exposure to natural radiation is no greater than 0.1 mSv per year above the natural background radiation dose. If the exposure of the public may be higher than 0.1 mSv per year, the responsible party must provide STUK a plan describing the measures by which the radiation exposure is to be kept as low as is reasonably achievable. In that case the mining company responsible company has to make a radiological baseline study. The baseline study must focus on the environment that the mining activities may impact. The study describes the occurrence of natural radioactivity in the environment before any mining activities are started. The baseline study lasts usually for two to three years in natural circumstances. Based on the baseline study measurements, detailed information of the existing levels of radioactivity in the environment can be attained. Once the mining activities begin, it is important that the limits are set for the wastewater discharges to the environment and environmental surveillance in the vicinity of

  15. Challenges Facing Group Work Online

    Science.gov (United States)

    Chang, Bo; Kang, Haijun

    2016-01-01

    Online group work can be complicated because of its asynchronous characteristics and lack of physical presence, and its requirements for skills in handling technology, human relationships, and content-related tasks. This study focuses on the administrative, logistical and relationship-related challenges in online group work. Challenges in areas…

  16. The Challenge of the Deanship.

    Science.gov (United States)

    Montez, Joni; Wolverton, Mimi

    This paper addresses the evolution of the kinds of challenges that deans have met over time and examines perceptions of today's deans concerning their ability to deal effectively with current challenges. A sample of deans (n=695) in the colleges of education, business, liberal arts, and nursing at 360 public and private institutions was surveyed…

  17. IT Challenges for Space Medicine

    Science.gov (United States)

    Johnson-Throop, Kathy

    2010-01-01

    This viewgraph presentation reviews the various Information Technology challenges for aerospace medicine. The contents include: 1) Space Medicine Activities; 2) Private Medical Information; 3) Lifetime Surveillance of Astronaut Health; 4) Mission Medical Support; 5) Data Repositories for Research; 6) Data Input and Output; 7) Finding Data/Information; 8) Summary of Challenges; and 9) Solutions and questions.

  18. Statistics Poster Challenge for Schools

    Science.gov (United States)

    Payne, Brad; Freeman, Jenny; Stillman, Eleanor

    2013-01-01

    The analysis and interpretation of data are important life skills. A poster challenge for schoolchildren provides an innovative outlet for these skills and demonstrates their relevance to daily life. We discuss our Statistics Poster Challenge and the lessons we have learned.

  19. Oral food challenges in children

    Directory of Open Access Journals (Sweden)

    Hye Yung Yum

    2011-01-01

    Full Text Available Many patients assume that allergic reactions against foods are responsible for triggering or worsening their allergic symptoms. Therefore, it is important to identify patients who would benefit from an elimination diet, while avoiding unnecessary dietary restrictions. The diagnosis of food allergy depends on the thorough review of the patients's medical history, results of supplemented trials of dietary elimination, and in vivo and in vitro tests for measuring specific IgE levels. However, in some cases the reliability of such procedures is suboptimal. Oral food challenges are procedures employed for making an accurate diagnosis of immediate and occasionally delayed adverse reactions to foods. The timing and type of the challenge, preparation of patients, foods to be tested, and dosing schedule should be determined on the basis of the patient's history, age, and experience. Although double-blind, placebo-controlled food challenges(DBPCFC are used to establish definitively if a food is the cause of adverse reactions, they are time-consuming, expensive and troublesome for physician and patients. In practice, An open challenge controlled by trained personnel is sufficient especially in infants and young children. The interpretation of the results and follow-up after a challenge are also important. Since theses challenges are relatively safe and informative, controlled oral food challenges could become the measure of choice in children.

  20. Grand Challenges facing Storage Systems

    CERN Multimedia

    CERN. Geneva

    2004-01-01

    In this talk, we will discuss the future of storage systems. In particular, we will focus on several big challenges which we are facing in storage, such as being able to build, manage and backup really massive storage systems, being able to find information of interest, being able to do long-term archival of data, and so on. We also present ideas and research being done to address these challenges, and provide a perspective on how we expect these challenges to be resolved as we go forward.

  1. Eight challenges in phylodynamic inference

    Directory of Open Access Journals (Sweden)

    Simon D.W. Frost

    2015-03-01

    Full Text Available The field of phylodynamics, which attempts to enhance our understanding of infectious disease dynamics using pathogen phylogenies, has made great strides in the past decade. Basic epidemiological and evolutionary models are now well characterized with inferential frameworks in place. However, significant challenges remain in extending phylodynamic inference to more complex systems. These challenges include accounting for evolutionary complexities such as changing mutation rates, selection, reassortment, and recombination, as well as epidemiological complexities such as stochastic population dynamics, host population structure, and different patterns at the within-host and between-host scales. An additional challenge exists in making efficient inferences from an ever increasing corpus of sequence data.

  2. Challenges in aerospace medicine education.

    Science.gov (United States)

    Grenon, S Marlene; Saary, Joan

    2011-11-01

    Aerospace medicine training and research represents a dream for many and a challenge for most. In Canada, although some opportunities exist for the pursuit of education and research in the aerospace medicine field, they are limited despite the importance of this field for enabling safe human space exploration. In this commentary, we aim to identify some of the challenges facing individuals wishing to get involved in the field as well as the causal factors for these challenges. We also explore strategies to mitigate against these.

  3. Challenges in Designing Mechatronic Systems

    DEFF Research Database (Denmark)

    Torry-Smith, Jonas; Qamar, Ahsan; Achiche, Sofiane

    2013-01-01

    Development of mechatronic products is traditionally carried out by several design experts from different design domains. Performing development of mechatronic products is thus greatly challenging. In order to tackle this, the critical challenges in mechatronics have to be well understood and well...... supported through applicable methods and tools. This paper aims at identifying the major challenges, by conducting a systematic and thorough survey of the most relevant research work in mechatronic design. Solutions proposed in literature are assessed and illustrated through a case study in order...... to investigate if the challenges can be handled appropriately by the methods, tools, and mindsets suggested by the mechatronic community. Using a real world mechatronics case, the paper identifies the areas where further research is required, by showing a clear connection between the actual problems faced during...

  4. PROSPECTS AND CHALLENGES FOR CORPORATE ...

    African Journals Online (AJOL)

    Fr. Ikenga

    Key words: Proxy contest, Corporate governance, Prospects, Challenges, Nigeria ... this advantage, cumulative voting is rare in publicly traded firms and most ..... framework needs to be put in place in Nigeria, which will highlight the gains of ...

  5. Refugee status determination: three challenges

    Directory of Open Access Journals (Sweden)

    Martin Jones

    2009-04-01

    Full Text Available Refugee status determination (RSD, which is vital to the protection of so many asylum seekers worldwide, is at best an imperfect, haphazard and challenging process. It merits greater attention and appropriate reform.

  6. Challenging environmental mythology: wrestling Zeus

    National Research Council Canada - National Science Library

    Dini, J. W; Lehr, Jay H

    2003-01-01

    .... At a time when the public can be thoroughly confused between fact and fiction regarding our environmental concerns, this book proposes to challenge our concerns in clear, jargon free language that we can...

  7. Presidential Transition. Challenges and Opportunities

    National Research Council Canada - National Science Library

    Walker, David

    2000-01-01

    .... Attention to these themes will help the new administration successfully implement its agenda and address both long-standing and newly emerging management, fiscal, and other challenges that confront...

  8. Challenge of COPD: Getting Tested

    Science.gov (United States)

    ... please turn JavaScript on. Feature: The Challenge of COPD Getting Tested Past Issues / Fall 2014 Table of Contents Getting Tested Everyone at risk for COPD who has cough, sputum production, or shortness of ...

  9. Systems Challenges for Hypersonic Vehicles

    Science.gov (United States)

    Hunt, James L.; Laruelle, Gerard; Wagner, Alain

    1997-01-01

    This paper examines the system challenges posed by fully reusable hypersonic cruise airplanes and access to space vehicles. Hydrocarbon and hydrogen fueled airplanes are considered with cruise speeds of Mach 5 and 10, respectively. The access to space matrix is examined. Airbreathing and rocket powered, single- and two-stage vehicles are considered. Reference vehicle architectures are presented. Major systems/subsystems challenges are described. Advanced, enhancing systems concepts as well as common system technologies are discussed.

  10. Challenges to Nordic Police Research

    DEFF Research Database (Denmark)

    Holmberg, Lars

    2015-01-01

    The paper will cover three main points: A short description of published police research in the Nordic countries; a somewhat longer discussion of the nature of, and challenges to, Nordic police research and, finally, a critique of the homeliness of research.......The paper will cover three main points: A short description of published police research in the Nordic countries; a somewhat longer discussion of the nature of, and challenges to, Nordic police research and, finally, a critique of the homeliness of research....

  11. The challenges of amblyopia treatment

    OpenAIRE

    Maconachie, Gail D.E.; Gottlob, Irene

    2015-01-01

    The treatment of amblyopia, particularly anisometropic (difference in refractive correction) and/or strabismic (turn of one eye) amblyopia has long been a challenge for many clinicians. Achieving optimum outcomes, where the amblyopic eye reaches a visual acuity similar to the fellow eye, is often impossible in many patients. Part of this challenge has resulted from a previous lack of scientific evidence for amblyopia treatment that was highlight by a systematic review by Snowdon et al. in 199...

  12. Protective effect of inhaled budesonide against unlimited airway narrowing to methacholine in atopic patients with asthma

    NARCIS (Netherlands)

    Booms, P.; Cheung, D.; Timmers, M. C.; Zwinderman, A. H.; Sterk, P. J.

    1997-01-01

    Patients with asthma who have moderate to severe airway hyperresponsiveness often demonstrate progressive, unlimited airway narrowing in response to inhaled bronchoconstrictor stimuli, which is likely to be due to inflammatory changes within the airway wall. It is unknown whether regular therapy

  13. Relief of dyspnoea by beta(2)-agonists after methacholine-induced bronchoconstriction

    NARCIS (Netherlands)

    van der Woude, HJ; Postma, DS; Politiek, MJ; Winter, TH; Aalbers, R

    Virtually all asthma patients use bronchodilators. Formoterol and salbutamol have a rapid onset of bronchodilating effect, whereas salmeterol acts slower. We studied the onset of improvement of dyspnoea sensation after inhalation with these bronchodilators and placebo to reverse a

  14. Exhaled Leukotrienes and Bronchial Responsiveness to Methacholine in Patients with Seasonal Allergic Rhinitis

    Czech Academy of Sciences Publication Activity Database

    Čáp, P.; Malý, Marek; Pehal, F.; Pelikán, Z.

    2009-01-01

    Roč. 102, č. 2 (2009), s. 103-109 ISSN 1081-1206 Grant - others:GA MZd(CZ) NL7024 Institutional research plan: CEZ:AV0Z10300504 Keywords : allergic rhinitis * asthma * breath condensate * leukotrienes * gas chromatography * mass spectrometry analysis Subject RIV: FN - Epidemiology, Contagious Diseases ; Clinical Immunology Impact factor: 2.457, year: 2009

  15. Airway responses to eucapnic hyperpnea, exercise, and methacholine in elite swimmers

    DEFF Research Database (Denmark)

    Pedersen, Lise; Winther, S.; Backer, V.

    2008-01-01

    Purpose: The International Olympic Committee Medical Commission (IOC-MC) requires athletes to provide the result of an objective test to support a diagnosis of asthma or exercise-induced bronchoconstriction (EIB) if they want to inhale a beta-2-agonist. The purpose of the study was to evaluate th...... of diagnosing EIB. We recommend performing the EVH test when diagnosing and evaluating EIB in elite swimmers and if EVH test negative then proceeding to a strenuous LBT Udgivelsesdato: 2008/9...

  16. The Mock LISA Data Challenges: from Challenge 1B to Challenge 3

    International Nuclear Information System (INIS)

    Babak, Stanislav; Porter, Edward K; Gair, Jonathan; Baker, John G; Arnaud, Keith; Benacquista, Matthew J; Cornish, Neil J; Crowder, Jeff; Vallisneri, Michele; Cutler, Curt; Larson, Shane L; Plagnol, Eric; Vecchio, Alberto; Barack, Leor; Blaut, Arkadiusz; Fairhurst, Stephen; Harry, Ian; Gong Xuefei; Khurana, Deepak; Krolak, Andrzej

    2008-01-01

    The Mock LISA Data Challenges are a programme to demonstrate and encourage the development of LISA data-analysis capabilities, tools and techniques. At the time of this workshop, three rounds of challenges had been completed, and the next was about to start. In this paper we provide a critical analysis of the entries to the latest completed round, Challenge 1B. The entries confirm the consolidation of a range of data-analysis techniques for galactic and massive-black-hole binaries, and they include the first convincing examples of detection and parameter estimation of extreme-mass-ratio inspiral sources. In this paper we also introduce the next round, Challenge 3. Its data sets feature more realistic waveform models (e.g., galactic binaries may now chirp, and massive-black-hole binaries may precess due to spin interactions), as well as new source classes (bursts from cosmic strings, isotropic stochastic backgrounds) and more complicated nonsymmetric instrument noise

  17. Stable isotope views on ecosystem function: challenging or challenged?

    Science.gov (United States)

    Resco, Víctor; Querejeta, José I; Ogle, Kiona; Voltas, Jordi; Sebastià, Maria-Teresa; Serrano-Ortiz, Penélope; Linares, Juan C; Moreno-Gutiérrez, Cristina; Herrero, Asier; Carreira, José A; Torres-Cañabate, Patricia; Valladares, Fernando

    2010-06-23

    Stable isotopes and their potential for detecting various and complex ecosystem processes are attracting an increasing number of scientists. Progress is challenging, particularly under global change scenarios, but some established views have been challenged. The IX meeting of the Spanish Association of Terrestrial Ecology (AAET, Ubeda, 18-22 October 2009) hosted a symposium on the ecology of stable isotopes where the linear mixing model approach of partitioning sinks and sources of carbon and water fluxes within an ecosystem was challenged, and new applications of stable isotopes for the study of plant interactions were evaluated. Discussion was also centred on the need for networks that monitor ecological processes using stable isotopes and key ideas for fostering future research with isotopes.

  18. Stable isotope views on ecosystem function: challenging or challenged?

    Science.gov (United States)

    Resco, Víctor; Querejeta, José I.; Ogle, Kiona; Voltas, Jordi; Sebastià, Maria-Teresa; Serrano-Ortiz, Penélope; Linares, Juan C.; Moreno-Gutiérrez, Cristina; Herrero, Asier; Carreira, José A.; Torres-Cañabate, Patricia; Valladares, Fernando

    2010-01-01

    Stable isotopes and their potential for detecting various and complex ecosystem processes are attracting an increasing number of scientists. Progress is challenging, particularly under global change scenarios, but some established views have been challenged. The IX meeting of the Spanish Association of Terrestrial Ecology (AAET, Úbeda, 18–22 October 2009) hosted a symposium on the ecology of stable isotopes where the linear mixing model approach of partitioning sinks and sources of carbon and water fluxes within an ecosystem was challenged, and new applications of stable isotopes for the study of plant interactions were evaluated. Discussion was also centred on the need for networks that monitor ecological processes using stable isotopes and key ideas for fostering future research with isotopes. PMID:20015858

  19. Preventing and managing challenging behaviour.

    Science.gov (United States)

    Hallett, Nutmeg

    2018-02-21

    Patients exhibiting challenging behaviour, which includes any non-verbal, verbal or physical behaviour, is a significant issue in healthcare settings. Preventing such behaviour and the harm it can cause is important for healthcare organisations and individuals, and involves following a public health model comprised of three tiers: primary, secondary and tertiary prevention. Primary prevention aims to reduce the risk of challenging behaviour occurring in the first instance; secondary prevention involves reducing the risk associated with imminent challenging behaviour and its potential escalation; and tertiary prevention focuses on minimising the physical and emotional harm caused by challenging behaviours, during and after an event. De-escalation should be the first-line response to challenging behaviour, and healthcare staff should use a range of techniques - maintaining safety, self-regulation, effective communication, and assessment and actions - to reduce the incidence of challenging behaviour. In some situations, physical interventions may be required to protect the safety of the individual, healthcare staff and other individuals involved, and healthcare staff should be aware of local policies and procedures for this. Following a serious incident, where there was potential or actual harm to patients and healthcare staff, healthcare organisations should use post-incident reviews to learn from the situation, while healthcare staff should be offered the opportunity for debriefing. Positive responses to challenging behaviour at an organisational and individual level can lead to improved work environments for healthcare staff and optimal patient care and outcomes. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  20. Vocal cord dysfunction related to water-damaged buildings.

    Science.gov (United States)

    Cummings, Kristin J; Fink, Jordan N; Vasudev, Monica; Piacitelli, Chris; Kreiss, Kathleen

    2013-01-01

    Vocal cord dysfunction (VCD) is the intermittent paradoxical adduction of the vocal cords during respiration, resulting in variable upper airway obstruction. Exposure to damp indoor environments is associated with adverse respiratory health outcomes, including asthma, but its role in the development of VCD is not well described. We describe the spectrum of respiratory illness in occupants of 2 water-damaged office buildings. The National Institute for Occupational Safety and Health conducted a health hazard evaluation that included interviews with managers, a maintenance officer, a remediation specialist who had evaluated the 2 buildings, employees, and consulting physicians. In addition, medical records and reports of building evaluations were reviewed. Diagnostic evaluations for VCD had been conducted at the Asthma and Allergy Center of the Medical College of Wisconsin. Two cases of VCD were temporally related to occupancy of water-damaged buildings. The patients experienced cough, chest tightness, dyspnea, wheezing, and hoarseness when in the buildings. Spirometry was normal. Methacholine challenge did not show bronchial hyperreactivity but did elicit symptoms of VCD and inspiratory flow-volume loop truncation. Direct laryngoscopy revealed vocal cord adduction during inspiration. Coworkers developed upper and lower respiratory symptoms; their diagnoses included sinusitis and asthma, consistent with recognized effects of exposure to indoor dampness. Building evaluations provided evidence of water damage and mold growth. VCD can occur with exposure to water-damaged buildings and should be considered in exposed patients with asthma-like symptoms. Published by Elsevier Inc.

  1. Nocturnal gastro-oesophageal reflux, asthma and symptoms of OSA: a longitudinal, general population study.

    Science.gov (United States)

    Emilsson, Össur I; Bengtsson, Anna; Franklin, Karl A; Torén, Kjell; Benediktsdóttir, Bryndís; Farkhooy, Amir; Weyler, Joost; Dom, Sandra; De Backer, Wilfried; Gislason, Thorarinn; Janson, Christer

    2013-06-01

    Nocturnal gastro-oesophageal reflux (nGOR) is associated with asthma and obstructive sleep apnoea (OSA). Our aim was to investigate whether nGOR is a risk factor for onset of asthma and onset of respiratory and OSA symptoms in a prospective population-based study. We invited 2640 subjects from Iceland, Sweden and Belgium for two evaluations over a 9-year interval. They participated in structured interviews, answered questionnaires, and underwent spirometries and methacholine challenge testing. nGOR was defined by reported symptoms. Subjects with persistent nGOR (n=123) had an independent increased risk of new asthma at follow-up (OR 2.3, 95% CI 1.1-4.9). Persistent nGOR was independently related to onset of respiratory symptoms (OR 3.0, 95% CI 1.6-5.6). The risk of developing symptoms of OSA was increased in subjects with new and persistent nGOR (OR 2.2, 95% CI 1.3-1.6, and OR 2.0, 95% CI 1.0-3.7, respectively). No significant association was found between nGOR and lung function or bronchial responsiveness. Persistent symptoms of nGOR contribute to the development of asthma and respiratory symptoms. New onset of OSA symptoms is higher among subjects with symptoms of nGOR. These findings provide evidence that nGOR may play a role in the genesis of respiratory symptoms and diseases.

  2. Severe childhood asthma and allergy to furry animals: refined assessment using molecular-based allergy diagnostics.

    Science.gov (United States)

    Konradsen, Jon R; Nordlund, Björn; Onell, Annica; Borres, Magnus P; Grönlund, Hans; Hedlin, Gunilla

    2014-03-01

    Allergy to cats and dogs and polysensitization towards these animals are associated with severe childhood asthma. Molecular-based allergy diagnostics offers new opportunities for improved characterization and has been suggested to be particularly useful in patients with polysensitization and/or severe asthma. The aim was to use extract- and molecular-based allergy diagnostics to compare patterns of IgE sensitization towards aeroallergens in children with problematic severe and controlled asthma. Children with a positive ImmunoCAP towards any furry animal (cat, dog or horse) were recruited from a Nationwide Swedish study on severe childhood asthma. Severe (n = 37, age 13 years) and controlled (n = 28, age 14 years) asthmatics underwent assessment of allergic sensitization by ImmunoCap (kUA /l) and immunosolid-phase allergen chip (ISAC). In addition, Asthma Control Test, spirometry and a methacholine challenge were performed. Children with severe asthma had lower asthma control (p Molecular-based allergy diagnostics revealed a more complex molecular spreading of allergen components in children with the most severe disease. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Ecological Challenges for Closed Systems

    Science.gov (United States)

    Nelson, Mark; Dempster, William; Allen, John P.

    2012-07-01

    Closed ecological systems are desirable for a number of purposes. In space life support systems, material closure allows precious life-supporting resources to be kept inside and recycled. Closure in small biospheric systems facilitates detailed measurement of global ecological processes and biogeochemical cycles. Closed testbeds facilitate research topics which require isolation from the outside (e.g. genetically modified organisms; radioisotopes) so their ecological interactions and fluxes can be studied separate from interactions with the outside environment. But to achieve and maintain closure entails solving complex ecological challenges. These challenges include being able to handle faster cycling rates and accentuated daily and seasonal fluxes of critical life elements such as carbon dioxide, oxygen, water, macro- and mico-nutrients. The problems of achieving sustainability in closed systems for life support include how to handle atmospheric dynamics including trace gases, producing a complete human diet and recycling nutrients and maintaining soil fertility, the sustaining of healthy air and water and preventing the loss of crucial elements from active circulation. In biospheric facilities the challenge is also to produce analogues to natural biomes and ecosystems, studying processes of self-organization and adaptation in systems that allow specification or determination of state variables and cycles which may be followed through all interactions from atmosphere to soils. Other challenges include the dynamics and genetics of small populations, the psychological challenges for small isolated human groups and measures and options which may be necessary to ensure long-term operation of closed ecological systems.

  4. ITER safety challenges and opportunities

    International Nuclear Information System (INIS)

    Piet, S.J.

    1992-01-01

    This paper reports on results of the Conceptual Design Activity (CDA) for the International Thermonuclear Experimental Reactor (ITER) suggest challenges and opportunities. ITER is capable of meeting anticipated regulatory dose limits, but proof is difficult because of large radioactive inventories needing stringent radioactivity confinement. Much research and development (R ampersand D) and design analysis is needed to establish that ITER meets regulatory requirements. There is a further oportunity to do more to prove more of fusion's potential safety and environmental advantages and maximize the amount of ITER technology on the path toward fusion power plants. To fulfill these tasks, three programmatic challenges and three technical challenges must be overcome. The first step is to fund a comprehensive safety and environmental ITER R ampersand D plan. Second is to strengthen safety and environment work and personnel in the international team. Third is to establish an external consultant group to advise the ITER Joint Team on designing ITER to meet safety requirements for siting by any of the Parties. The first of three key technical challenges is plasma engineering - burn control, plasma shutdown, disruptions, tritium burn fraction, and steady state operation. The second is the divertor, including tritium inventory, activation hazards, chemical reactions, and coolant disturbances. The third technical challenge is optimization of design requirements considering safety risk, technical risk, and cost

  5. Challenge

    International Nuclear Information System (INIS)

    Schwitters, R.F.

    1996-01-01

    The design of new and upgrades of existing high energy particle accelerators is reviewed in light of the current knowledge of the standard model determined from existing and past machines and funding factors. Current financing of science will delay determining unknowns, such as CP violation, proton decay, neutrino properties, and dark matter. Three options are given: (1) obtain more funding, (2) downsize scientific personnel as are private enterprises or (3) develop new technology which will reduce the high cost of building current designs of high energy accelerators. (AIP) copyright 1996 American Institute of Physics

  6. Respiratory challenge MRI: Practical aspects

    Directory of Open Access Journals (Sweden)

    Fiona C. Moreton

    2016-01-01

    Full Text Available Respiratory challenge MRI is the modification of arterial oxygen (PaO2 and/or carbon dioxide (PaCO2 concentration to induce a change in cerebral function or metabolism which is then measured by MRI. Alterations in arterial gas concentrations can lead to profound changes in cerebral haemodynamics which can be studied using a variety of MRI sequences. Whilst such experiments may provide a wealth of information, conducting them can be complex and challenging. In this paper we review the rationale for respiratory challenge MRI including the effects of oxygen and carbon dioxide on the cerebral circulation. We also discuss the planning, equipment, monitoring and techniques that have been used to undertake these experiments. We finally propose some recommendations in this evolving area for conducting these experiments to enhance data quality and comparison between techniques.

  7. LHC luminosity upgrade detector challenges

    CERN Multimedia

    CERN. Geneva; de Roeck, Albert; Bortoletto, Daniela; Wigmans, Richard; Riegler, Werner; Smith, Wesley H

    2006-01-01

    LHC luminosity upgrade: detector challenges The upgrade of the LHC machine towards higher luminosity (1035 cm -2s-1) has been studied over the last few years. These studies have investigated scenarios to achieve the increase in peak luminosity by an order of magnitude, as well as the physics potential of such an upgrade and the impact of a machine upgrade on the LHC DETECTORS. This series of lectures will cover the following topics: • Physics motivation and machine scenarios for an order of magnitude increase in the LHC peak luminosity (lecture 1) • Detector challenges including overview of ideas for R&D programs by the LHC experiments: tracking and calorimetry, other new detector developments (lectures 2-4) • Electronics, trigger and data acquisition challenges (lecture 5) Note: the much more ambitious LHC energy upgrade will not be covered

  8. Higgs Machine Learning Challenge 2014

    CERN Document Server

    Olivier, A-P; Bourdarios, C ; LAL / Orsay; Goldfarb, S ; University of Michigan

    2014-01-01

    High Energy Physics (HEP) has been using Machine Learning (ML) techniques such as boosted decision trees (paper) and neural nets since the 90s. These techniques are now routinely used for difficult tasks such as the Higgs boson search. Nevertheless, formal connections between the two research fields are rather scarce, with some exceptions such as the AppStat group at LAL, founded in 2006. In collaboration with INRIA, AppStat promotes interdisciplinary research on machine learning, computational statistics, and high-energy particle and astroparticle physics. We are now exploring new ways to improve the cross-fertilization of the two fields by setting up a data challenge, following the footsteps of, among others, the astrophysics community (dark matter and galaxy zoo challenges) and neurobiology (connectomics and decoding the human brain). The organization committee consists of ATLAS physicists and machine learning researchers. The Challenge will run from Monday 12th to September 2014.

  9. Success of Breast Cancer Startup Challenge Inspires Second Challenge | Poster

    Science.gov (United States)

    By Thomas Stackhouse, Joseph Conrad, and Michele Newton, Contributing Writers, and Rosemarie Truman, Guest Writer Sixty-one teams have been accepted into, and are now competing in, the Neuro Startup Challenge, a new collaboration established by the National Institutes of Health (NIH) with The Center for Advancing Innovation (CAI) and Heritage Provider Network, Inc.

  10. The medical leadership challenge in healthcare is an identity challenge.

    Science.gov (United States)

    Andersson, Thomas

    2015-01-01

    The purpose of this article is to describe and analyse the identity challenges that physicians with medical leadership positions face. Four qualitative case studies were performed to address the fact that identity is processual, relational and situational. Physicians with managerial roles were interviewed, as well as their peers, supervisors and subordinates. Furthermore, observations were made to understand how different identities are displayed in action. This study illustrates that medical leadership implies identity struggles when physicians have manager positions, because of the different characteristics of the social identities of managers and physicians. Major differences are related between physicians as autonomous individuals in a system and managers as subordinates to the organizational system. There are psychological mechanisms that evoke the physician identity more often than the managerial identity among physicians who are managers, which explains why physicians who are managers tend to remain foremost physicians. The implications of the findings, that there are major identity challenges by being both a physician and manager, suggest that managerial physicians might not be the best prerequisite for medical leadership, but instead, cooperative relationships between physicians and non-physician managers might be a less difficult way to support medical leadership. Acknowledging and addressing identity challenges can be important both in creating structures in organizations and designing the training for managers in healthcare (both physicians and non-physicians) to support medical leadership. Medical leadership is most often related to organizational structure and/or leadership skills, but this paper discusses identity requirements and challenges related to medical leadership.

  11. The Challenge of Prejudice: Counsellors' Talk about Challenging Clients' Prejudices

    Science.gov (United States)

    Spong, Sheila J.

    2012-01-01

    This paper considers the implications for training and practice of counsellors' responses to the notion of challenging clients' prejudices. It explores tensions in counselling discourse between social responsibility, responsibility to the client and responsibility for one's self as counsellor. Three focus groups of counsellors were asked whether a…

  12. ITER safety challenges and opportunities

    International Nuclear Information System (INIS)

    Piet, S.J.

    1991-01-01

    Results of the Conceptual Design Activity (CDA) for the International Thermonuclear Experimental Reactor (ITER) suggest challenges and opportunities. ''ITER is capable of meeting anticipated regulatory dose limits,'' but proof is difficult because of large radioactive inventories needing stringent radioactivity confinement. We need much research and development (R ampersand D) and design analysis to establish that ITER meets regulatory requirements. We have a further opportunity to do more to prove more of fusion's potential safety and environmental advantages and maximize the amount of ITER technology on the path toward fusion power plants. To fulfill these tasks, we need to overcome three programmatic challenges and three technical challenges. The first programmatic challenge is to fund a comprehensive safety and environmental ITER R ampersand D plan. Second is to strengthen safety and environment work and personnel in the international team. Third is to establish an external consultant group to advise the ITER Joint Team on designing ITER to meet safety requirements for siting by any of the Parties. The first of the three key technical challenges is plasma engineering -- burn control, plasma shutdown, disruptions, tritium burn fraction, and steady state operation. The second is the divertor, including tritium inventory, activation hazards, chemical reactions, and coolant disturbances. The third technical challenge is optimization of design requirements considering safety risk, technical risk, and cost. Some design requirements are now too strict; some are too lax. Fuel cycle design requirements are presently too strict, mandating inappropriate T separation from H and D. Heat sink requirements are presently too lax; they should be strengthened to ensure that maximum loss of coolant accident temperatures drop

  13. Zero Energy Schools: The Challenges

    Energy Technology Data Exchange (ETDEWEB)

    Torcellini, Paul A [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-09-29

    School buildings have a lot of potential to achieve zero energy (ZE) in new construction as well as in retrofits. There are many examples of schools operating at ZE, and many technical resources available to guide school districts and their design and construction teams through the process. When school districts embark on the path to ZE, however, they often confront challenges related to processes and a perception that ZE buildings require 'new,' unconventional, and expensive technologies, materials, or equipment. Here are some of the challenges school districts and their design and construction teams commonly encounter, and the solutions they use to overcome them.

  14. Grand Challenges of Enterprise Integration

    Energy Technology Data Exchange (ETDEWEB)

    Brosey, W.D; Neal, R.E.; Marks, D.

    2001-04-01

    Enterprise Integration connects and combines people, processes, systems, and technologies to ensure that the right people and the right processes have the right information and the right resources at the right time. A consensus roadmap for Technologies for Enterprise Integration was created as part of an industry/government/academia partnership in the Integrated Manufacturing Technology Initiative (IMTI). Two of the grand challenges identified by the roadmapping effort will be addressed here--Customer Responsive Enterprises and Totally Connected Enterprises. Each of these challenges is briefly discussed as to the current state of industry and the future vision as developed in the roadmap.

  15. Conclusion: challenges for the future.

    Science.gov (United States)

    North, D W

    1993-12-01

    The title "Challenges for the Future" implies the challenge to summarize a very complex meeting. Of necessity, I will present a personal impression. My interest is in risk assessment, which I define as a process for summarizing science in support of decision making. Risk assessment is sometimes regarded as arcane numerology, a rigid process of computing risk numbers in which much available science is unused. I am a strong advocate for the broader definition of risk assessment. It is encouraging to learn how much science is becoming available for use in risk assessment for gasoline, its components, and alternative fuels.

  16. Challenge of the oil market

    Energy Technology Data Exchange (ETDEWEB)

    Jaidah, A M

    1981-11-01

    The oil market is experiencing a different environment in 1981 as demand for OPEC oil fades while customers run down their inventories. The oil-producing countries face a new challenge, but the need of consuming countries for secure oil supplies and the need of producing countries to broaden their economies and reduce dependence on a depleting resource continue. Two episodes 1973 to 1975 and late 1978 to the present, illustrate the current market situation. The impact of these episodes is the basis for recommended long-run goals that go beyond market management to the real challenge of converting oil resources into the real assets of economic development. (DCK)

  17. Challenges and opportunities for REDD+

    DEFF Research Database (Denmark)

    Pasgaard, Maya; Sun, Zhanli; Müller, Daniel

    2016-01-01

    Reducing Emissions from Deforestation and forest Degradation (REDD+) is a promising mechanism of payments for ecosystem services with the aim to effectively reduce emissions in an efficient and equitable manner. REDD+ is part of the Paris-agreement reached at the UNFCCC COP21 in December 2015...... the opportunities and challenges of REDD+ for achieving effective, efficient and equitable outcomes and co-benefits (3E+). We substantiate our survey results with a literature review. Results suggest that the challenges in achieving the 3E+ relate to the disproportionality between deforestation drivers...

  18. The Mock LISA Data Challenges: from challenge 3 to challenge 4

    International Nuclear Information System (INIS)

    Babak, Stanislav; Petiteau, Antoine; Robinson, Emma L; Baker, John G; McWilliams, Sean T; Arnaud, Keith A; Benacquista, Matthew J; Cornish, Neil J; Adams, Matt; Larson, Shane L; Mandel, Ilya; Porter, Edward K; Vallisneri, Michele; Cutler, Curt; Vecchio, Alberto; Blaut, Arkadiusz; Bridges, Michael; Feroz, Farhan; Cohen, Michael; Gair, Jonathan R.

    2010-01-01

    The Mock LISA Data Challenges are a program to demonstrate LISA data-analysis capabilities and to encourage their development. Each round of challenges consists of one or more datasets containing simulated instrument noise and gravitational waves from sources of undisclosed parameters. Participants analyze the datasets and report best-fit solutions for the source parameters. Here we present the results of the third challenge, issued in April 2008, which demonstrated the positive recovery of signals from chirping galactic binaries, from spinning supermassive-black-hole binaries (with optimal SNRs between ∼10 and 2000), from simultaneous extreme-mass-ratio inspirals (SNRs of 10-50), from cosmic-string-cusp bursts (SNRs of 10-100), and from a relatively loud isotropic background with Ω gw (f) ∼ 10 -11 , slightly below the LISA instrument noise.

  19. The Mock LISA Data Challenges: from challenge 3 to challenge 4

    Energy Technology Data Exchange (ETDEWEB)

    Babak, Stanislav; Petiteau, Antoine; Robinson, Emma L [Max-Planck-Institut fuer Gravitationsphysik (Albert-Einstein-Institut), Am Muehlenberg 1, D-14476 Golm bei Potsdam (Germany); Baker, John G; McWilliams, Sean T; Arnaud, Keith A [Gravitational Astrophysics Laboratory, NASA Goddard Space Flight Center, 8800 Greenbelt Rd, Greenbelt, MD 20771 (United States); Benacquista, Matthew J [Center for Gravitational Wave Astronomy, University of Texas at Brownsville, Brownsville, TX 78520 (United States); Cornish, Neil J; Adams, Matt [Department of Physics, Montana State University, Bozeman, MT 59717 (United States); Larson, Shane L [Department of Physics, Utah State University, Logan, UT 84322 (United States); Mandel, Ilya [Department of Physics and Astronomy, Northwestern University, Evanston, IL (United States); Porter, Edward K [APC, UMR 7164, University Paris 7 Denis Diderot, 10, rue Alice Domon et Leonie Duquet, 75025 Paris Cedex 13 (France); Vallisneri, Michele; Cutler, Curt [Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 (United States); Vecchio, Alberto [School of Physics and Astronomy, University of Birmingham, Edgbaston, Birmingham B152TT (United Kingdom); Blaut, Arkadiusz [Institute of Theoretical Physics, University of Wroclaw, Wroclaw (Poland); Bridges, Michael; Feroz, Farhan [Astrophysics Group, Cavendish Laboratory, University of Cambridge, Cambridge CB30HE (United Kingdom); Cohen, Michael [Theoretical Astrophysics, California Institute of Technology, Pasadena, CA 91125 (United States); Gair, Jonathan R., E-mail: Michele.Vallisneri@jpl.nasa.go [Institute of Astronomy, University of Cambridge, Cambridge CB30HA (United Kingdom)

    2010-04-21

    The Mock LISA Data Challenges are a program to demonstrate LISA data-analysis capabilities and to encourage their development. Each round of challenges consists of one or more datasets containing simulated instrument noise and gravitational waves from sources of undisclosed parameters. Participants analyze the datasets and report best-fit solutions for the source parameters. Here we present the results of the third challenge, issued in April 2008, which demonstrated the positive recovery of signals from chirping galactic binaries, from spinning supermassive-black-hole binaries (with optimal SNRs between approx10 and 2000), from simultaneous extreme-mass-ratio inspirals (SNRs of 10-50), from cosmic-string-cusp bursts (SNRs of 10-100), and from a relatively loud isotropic background with OMEGA{sub gw}(f) approx 10{sup -11}, slightly below the LISA instrument noise.

  20. The Challenge of Weather Prediction

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 2; Issue 3. The Challenge of Weather Prediction Old and Modern Ways of Weather Forecasting. B N Goswami. Series Article Volume 2 Issue 3 March 1997 pp 8-15. Fulltext. Click here to view fulltext PDF. Permanent link: