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To investigate possible changes in cells and molecular mediators of airway inflammation following inhaled steroid treatment of stable COPD patients. Six-week open preliminary prospective study. A university respiratory disease clinic. : Stable COPD patients with mild disease. Six-week treatment with inhaled beclomethasone (1.5 mg die). The levels of interleukin (IL)-8, myeloperoxidase, eosinophilic cationic protein and tryptase, and cell numbers in bronchial lavage specimens were determined, and the symptom score, the endoscopic bronchitis index, and functional parameters were recorded. After treatment there were significant reductions in the lavage levels of IL-8 ([mean +/- SEM] 1,603.4 +/- 331.2 vs 1,119.2 +/- 265.3 pg/mL, respectively; p = 0. 01) and myeloperoxidase (1,614.5 +/- 682.3 vs 511.2 +/- 144.2 microg/L, respectively; p = 0.05), in cell numbers (250.6 +/- 27.7 vs 186.3 +/- 11.5 cells x 10(3)/mL, respectively; p = 0.04), neutrophil proportion (59.7 +/- 14.3% vs 31.5 +/- 10.1%; p = 0.01), symptom score (4.5 +/- 0.6 vs 1.4 +/- 0.5; p = 0.01), and bronchitis index (8.5 +/- 0.8 vs 5.5 +/- 0.7; p = 0.007). In stable patients with COPD, inhaled steroid treatment may induce changes on some cellular and molecular parameters of airway inflammation.

Since 2013, the Centers for Disease Control and Prevention (CDC) has hosted an annual influenza season forecasting challenge. The 2015–2016 challenge consisted of weekly probabilistic forecasts of multiple targets, including fourteen models submitted by eleven teams. Forecast skill was evaluated using a modified logarithmic score. We averaged submitted forecasts into a mean ensemble model and compared them against predictions based on historical trends. Forecast skill was highest for seasonal peak intensity and short-term forecasts, while forecast skill for timing of season onset and peak week was generally low. Higher forecast skill was associated with team participation in previous influenza forecasting challenges and utilization of ensemble forecasting techniques. The mean ensemble consistently performed well and outperformed historical trend predictions. CDC and contributing teams will continue to advance influenza forecasting and work to improve the accuracy and reliability of forecasts to facilitate increased incorporation into public health response efforts.

Vital signs historically served as the primary method to triage patients and resources for trauma and emergency care, but have failed to provide clinically-meaningful predictive information about patient clinical status. In this review, a framework is presented that focuses on potential wearable sensor technologies that can harness necessary electronic physiological signal integration with a current state-of-the-art predictive machine-learning algorithm that provides early clinical assessment of hypovolemia status to impact patient outcome. The ability to study the physiology of hemorrhage using a human model of progressive central hypovolemia led to the development of a novel machine-learning algorithm known as the compensatory reserve measurement (CRM). Greater sensitivity, specificity, and diagnostic accuracy to detect hemorrhage and onset of decompensated shock has been demonstrated by the CRM when compared to all standard vital signs and hemodynamic variables. The development of CRM revealed that continuous measurements of changes in arterial waveform features represented the most integrated signal of physiological compensation for conditions of reduced systemic oxygen delivery. In this review, detailed analysis of sensor technologies that include photoplethysmography, tonometry, ultrasound-based blood pressure, and cardiogenic vibration are identified as potential candidates for harnessing arterial waveform analog features required for real-time calculation of CRM. The integration of wearable sensors with the CRM algorithm provides a potentially powerful medical monitoring advancement to save civilian and military lives in emergency medical settings.

Deaf learners frequently demonstrate significantly less vocabulary knowledge than hearing age-mates. Studies involving other domains of knowledge, and perhaps deaf learners' academic performance, indicate similar lags with regard to world knowledge. Such gaps often are attributed to limitations on deaf children's incidental learning by virtue of not having access to the conversations of others. Cochlear implants (CIs) have been described as providing such access, and rapid growth in vocabularies following pediatrie cochlear implantation has suggested that, over time, children with implants might close the gap relative to hearing peers. Two experiments evaluated this possibility through the assessment of word and world knowledge among deaf college students with and without CIs and a hearing comparison group. Results across essentially all tasks indicated hearing students to outperform deaf students both with and without CIs with no significant differences between the latter two groups. Separate analyses of a subset of implant users who received their implants at a young age did not reveal any long-term advantages, nor was age of implantation related to enhanced performance on any of the tasks. Results are discussed in terms of incidental learning and the accessibility of word and world knowledge to deaf learners with and without CIs.

Background Bond strength of orthodontic composite is strongly influenced by molecular and structural mechanisms. Aim of this in vitro study was to compare bond strength of light-cure orthodontic composites by measuring debonding forces and evaluating locations of bond failure. Investigations on chemical compositions clarified adhesive behaviors and abilities, exploring effects of ageing processes in this junction materials. Methods Twelve enamel discs, from human premolars, were randomly coupled to one orthodontic adhesive system (Transbond XT™ 3 M UNITEK, USA, Light-Cure Orthodontic Paste, LEONE, Italy and Bisco Ortho Bracket Paste LC, BISCO, Illinois) and underwent to Shear Bond Strength test. Metallic brackets were bonded to twenty-seven human premolar, with one of the adhesive systems, to quantify, at FE-SEM magnifications, after debonding, the residual material on enamel and bracket base surfaces. Raman Spectroscopy analysis was performed on eight discs of each composites to investigate on chemical compositions, before and after accelerated aging procedures in human saliva and sugary drink. Results Orthodontic adhesive systems showed similar strength of adhesion to enamel. The breakage of adhesive-adherent bond occurs in TXT at enamel-adhesive interface while in Bisco and Leone at adhesive-bracket interface. Accelerated in vitro aging demonstrated good physical–chemical stability for all composites, Bisco only, was weakly contaminated with respect to the other materials. Conclusion A similar, clinically adequate and acceptable bond strength to enamel for debonding maneuvers was recorded in all orthodontic adhesive systems under examination. No significant chemical alterations are recorded, even in highly critical situations, not altering the initial mechanical properties of materials.

To study central hypovolemia in humans, lower body negative pressure (LBNP) is a recognized alternative to blood removal (HEM). While LBNP mimics the cardiovascular responses of HEM in baboons, similarities in hemostatic responses to LBNP and HEM remain unknown in this species. Thirteen anesthetized baboons were exposed to progressive hypovolemia by HEM and, four weeks later, by LBNP. Hemostatic activity was evaluated by plasma markers, thromboelastography (TEG), flow cytometry, and platelet aggregometry at baseline (BL), during and after hypovolemia. BL values were indistinguishable for most parameters although platelet count, maximal clot strength (MA), protein C, thrombin anti-thrombin complex (TAT), thrombin activatable fibrinolysis inhibitor (TAFI) activity significantly differed between HEM and LBNP. Central hypovolemia induced by either method activated coagulation; TEG R-time decreased and MA increased during and after hypovolemia compared to BL. Platelets displayed activation by flow cytometry; platelet count and functional aggregometry were unchanged. TAFI activity and protein, Factors V and VIII, vWF, Proteins C and S all demonstrated hemodilution during HEM and hemoconcentration during LBNP, whereas tissue plasminogen activator (tPA), plasmin/anti-plasmin complex, and plasminogen activator inhibitor-1 did not. Fibrinolysis (TEG LY30) was unchanged by either method; however, at BL, fibrinolysis varied greatly. Post-hoc analysis separated baboons into low-lysis (LY30 2%) whose fibrinolytic state matched at both HEM and LBNP BL. In high-lysis, BL tPA and LY30 correlated strongly (r = 0.95; P<0.001), but this was absent in low-lysis. In low-lysis, BL TAFI activity and tPA correlated (r = 0.88; P<0.050), but this was absent in high-lysis. Central hypovolemia induced by either LBNP or HEM resulted in activation of coagulation; thus, LBNP is an adjunct to study hemorrhage-induced pro-coagulation in baboons. Furthermore, this study revealed a subset of baboons with baseline hyperfibrinolysis, which was strongly coupled to tPA and uncoupled from TAFI activity.

Environmental burdens such as air pollution are inequitably distributed with groups of lower socioeconomic statuses, which tend to comprise of large proportions of racial minorities, typically bearing greater exposure. Such groups have also been shown to present more severe health outcomes which can be related to adverse pollution exposure. Air pollution exposure, especially in urban areas, is usually impacted by the built environment, such as major roadways, which can be a significant source of air pollution. This study aims to examine inequities in prevalence of cardiovascular and respiratory diseases in the Atlanta metropolitan region as they relate to exposure to air pollution and characteristics of the built environment. Census tract level data were obtained from multiple sources to model health outcomes (asthma, chronic obstructive pulmonary disease, coronary heart disease, and stroke), pollution exposure (particulate matter and nitrogen oxides), demographics (ethnicity and proportion of elderly residents), and infrastructure characteristics (tree canopy cover, access to green space, and road intersection density). Conditional autoregressive models were fit to the data to account for spatial autocorrelation among census tracts. The statistical model showed areas with majority African-American populations had significantly higher exposure to both air pollutants and higher prevalence of each disease. When considering univariate associations between pollution and health outcomes, the only significant association existed between nitrogen oxides and COPD being negatively correlated. Greater percent tree canopy cover and green space access were associated with higher prevalence of COPD, CHD, and stroke. Overall, in considering health outcomes in connection with pollution exposure infrastructure and ethnic demographics, demographics remained the most significant explanatory variable.

The use of vegetated vertical systems is a sustainable technology for improving the energy efficiency of buildings in cities in order to reduce the energy consumption for air conditioning in summer and to increase the thermal insulation in winter. increasing urban green infrastructure (UGI) in a city can contribute to improve urban climate in summer reducing buildings surface temperature and urban air especially in southern europe. The application of vertical green systems requires the knowledge of the energy performance of the applied greenery system. the choice of the green facades depends on the local climate, water availability, building shape. The presence of green facades affects the building microclimate all day, by reducing heat waves during the warm periods and heat losses from the building in the cold period. The heat and mass transfer between the external environment, the green facades and the building surface determine the building microclimate. solar radiation, long wave infrared radiation, convective heat transfer and evapotranspiration are the main mechanisms of heat transfer in a green façade. The paper describes the main parameters concerning heat flow in green facades that can be used in simulation models for predicting temperatures in buildings using the external weather conditions as model inputs. The input parameters are: external air temperature and relative humidity, solar radiation, wind velocity and direction, plants and building characteristics. The green facade was described by a schematic representation, four layers were defined: the green layer, the external surface of the building wall, the internal surface of the building wall, the air inside the building. The energy balance was defined for each layer and all the terms involved in the energy exchange between the layers were defined as a function of the plant, the weather conditions and the constructive characteristics of the wall.

Introdcution: The FARO project is an Italian multiregional project of active surveillance of drug safety in emergency department (ED). [1] Aim: We analyzed all the individual case safety reports (ICSRs) collected in the FARO database in the first three years of the project for the Tuscany region. We also analyzed the contribution of the project to the Tuscany reports. Methods: A total of 9 hospitals contributed to the FARO project in Tuscany. Dedicated monitors screened everyday ED visits using key words related to possible adverse drug reactions (ADR) (e.g., drug-induced, reaction to drug). Then, all the selected ED visits were manually revised and only those caused by an ADR were reported as ICSRs first in the FARO database, and finally in the national pharmacovigilance network. Results: In the three-year period 2020-2022, in Tuscany we reported the following number of ICSRs: 5043, 9267 and 7133. In the same period, the ICSRs of the FARO which contributed to the total of yearly Tuscan reports were 1100 (22%), 474 (5%) and 1574 (22%) for 2020, 2021 and 2022, respectively. Most of the patients of the FARO project ICSRs were in the 18-65 years group. The seriousness of ICSRs were equally distributed between \"not serious\" (52%) and \"serious\" (48%). Among the \"serious\" ICSRs, 555 were classified as \"other condition medically significant\", 401 \"hospitalization\", 18 \"life-threating\", 6 \"death\" and 1 \"permanent disability\". The most reported outcome was \"recovering\" (58%). Acetylsalicylic acid was the most reported suspected active substance (50.3% \"serious\" and 49.7% \"not serious\"), followed by warfarin (63.4% \"serious\" and 36.6% \"not serious\"), and amoxicillin-clavulanate (43.9% \"serious\" and 56.2% \"not serious\"). The three most reported System Organ Classes were \"gastrointestinal disorders\" (20%), \"skin and subcutaneous tissue disorders\" (14%), and \"nervous system disorders\" (10%). The three most reported Preferred Term were \"anemia\" (160), \"epistaxis\" (147), and \"urticaria\" (116). Conclusion: The ED is a privilege observatory for pharmacovigilance, offering the possibility to intercept ADRs in an outpatient setting that may result in hospitalization. The FARO project contributed for more than 20% of the regional ICSRs, with a noticeable reduction during 2021 due to the massive reporting storm of COVID-19 vaccine ICSRs.

Introduction: Tardive dyskinesia (TD), a chronic and disabling syndrome, usually develops after at least 3 months of anti-dopaminergic treatment, but it can also appear after shorter periods or even after discontinuation of the medication1. Aim: To evaluate whether there is significant risk of reporting for early-onset TD (<60 days) for some specific drugs. Methods: We used data from the FDA's Adverse Event Reporting System (FAERS) database from 2004 to 2022. We quantified for all drugs in the database, the number of drug-event pairs with the preferred term \"Tardive Dyskinesia\" (TD). Then, we counted those with Time to onset (TTO) < 60 days (cases). All other adverse events where classified as \"non-cases\". Finally, we calculate Reporting Odds Ratio (ROR) as a measure of disproportionality, for drugs with at least 3 cases of TD with a TTO < 60 days (index), using the entire database as reference. Results: Our dataset includes 66.461.955 drug-event pairs. We found that the overall number of TD-drug pairs reported in FAERS database was 10,352. The overall TD-drug pairs with available TTO information available was 1,871 (18.1%). The overall TD cases with TTO < 60 days was 1,269 (68.8% of TD cases with TTO defined). Sixtyseven drugs with at least 3 reports with TD with TTO < 60 days were listed. Valbenazine has the highest number of case (n = 445), but it was excluded from the analysis due to its primary use in treating TD (indication bias). Among the remaining drugs, the overall number of pairs was 824. Risperidone has the highest count with 317 pairs (38.5%), Aripiprazole follows with 226 pairs (27.4%), Olanzapine with 109 pairs (13.2%), Paliperidone with 77 pairs (9.3%), and Haloperidol with 62 pairs (7.5% ). The RORs for these drugs are as follows: Risperidone - 510.9 (95% CI 443.9 - 588.0), Aripiprazole - 331.1 (95% CI 284.1 - 385.9), Olanzapine - 192.1 (95% CI 157.0 - 235.3), Paliperidone - 203 (95% CI 160.8 - 257.3), Haloperidol - 44.7 (95% CI 34.5 - 57.9). Conclusions: For many drugs, especially antipsychotics, there is a reporting risk of early onset tardive dyskinesia. It is important to underline that the TTO can be calculated for a proportion of drugevent pairs of less than 20%. It is possible that cases for which information is not known are predominantly with later onset because it is more difficult to report therapy initiation dates for events occurring after years of treatment.