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Wave surfing is a multi-billion dollar industry involving both maneuverability and speed, yet little research has been performed regarding the highest lift-to-drag-ratio fin shape for these competing qualities. Numerical modeling and laboratory experiments were performed here to identify a bio-inspired fin shape that maximized lateral stability and minimized drag forces, in order to increase surfing maneuverability. Nine fins based on dorsal fins of real fish were tested. Both the CFD and laboratory experiments confirmed that the fin of the same shape as that of the Short-Finned Pilot Whale at an angle of attack of 10° had the greatest lift-to-drag ratios. Flow patterns around fins at a low angle of attack were smooth with negligible flow separation, while at any angle of attack greater than 25°, flow-separation-induced drag forces became excessive.

Background Women with stress urinary incontinence (SUI) experience urine leakage with physical activity. Currently, the interventional treatments for SUI are surgical, or endoscopic bulking injection(s). However, these procedures are not always successful, and symptoms can persist or come back after treatment, categorised as recurrent SUI. There are longstanding symptoms and distress associated with a failed primary treatment, and currently, there is no consensus on how best to treat women with recurrent, or persistent, SUI. Methods A two-arm trial, set in at least 20 National Health Service (NHS) urology and urogynaecology referral units in the UK, randomising 250 adult women with recurrent or persistent SUI 1:1 to receive either an endoscopic intervention (endoscopic bulking injections) or a standard NHS surgical intervention, currently colposuspension, autologous fascial sling or artificial urinary sphincter. The aim of the trial is to determine whether surgical treatment is superior to endoscopic bulking injections in terms of symptom severity at 1 year after randomisation. This primary outcome will be measured using the patient-reported International Consultation on Incontinence Questionnaire - Urinary Incontinence - Short Form (ICIQ-UI-SF). Secondary outcomes include assessment of longer-term clinical impact, improvement of symptoms, safety, operative assessments, sexual function, cost-effectiveness and an evaluation of patients’ and clinicians’ views and experiences of the interventions. Discussion There is a lack of high-quality, randomised, scientific evidence for which treatment is best for women presenting with recurrent SUI. The PURSUIT study will benefit healthcare professionals and patients and provide robust evidence to guide further treatment and improve symptoms and quality of life for women with this condition . Trial registration International Standard Randomised Controlled Trials Number (ISRCTN) registry ISRCTN12201059. Registered on 09 January 2020

Background: For many years it has been assumed that the risk of childhood respiratory allergies is related to allergen exposures in early life. There are, however, few prospective data in support. We aimed to examine this relationship in a representative cohort of children born in Ashford, Kent (UK). Methods: 625 children (94% of those eligible) were followed from birth to the age of 5.5 years at which time 552 underwent skin prick testing to extracts of house dust mite and cat fur allergens. Maternal reports of wheeze in the last year were collected by interview. These outcomes were related to individual domestic concentrations of Der p 1 and Fel d I allergens estimated from dust collection at the age of 8 weeks. Results: 10% of children were sensitised to house dust mite or cat at age 5.5 years; 7% had atopic wheeze. No significant relationships between allergen exposure and either sensitisation or wheeze were found but, on examination, the exposure-response relationships for both allergens and for each outcome rose steeply at low levels of exposure and were attenuated at high levels of exposure. These patterns were modified by paternal atopy and by birth order. Conclusions: There are no linear relationships between early allergen exposure and the induction of childhood respiratory allergy; rather, the risks of IgE sensitisation and asthma rise at very low levels of exposure and are attenuated thereafter. These patterns are influenced by parental atopy and birth order. These findings suggest important gene-environment interactions in the development of atopy and asthma and imply that reductions in domestic allergen exposure alone are unlikely to have a major impact in decreasing the incidence of these diseases in childhood.

Lung-volume–reduction surgery has been performed in thousands of people with emphysema in recent years. 1 More than 30 separate reports of over 2000 operations have found substantial and clinically relevant improvements in lung function, walking distance, and quality of life. 2 – 8 Nevertheless, the clinical benefits of the procedure have been questioned; private insurers and governmental organizations have refused to pay for the operation. The American Thoracic Society, together with others, has emphasized the need for randomized, controlled trials. 9 – 12 Such trials are needed for several reasons. First, patient selection and methods of rehabilitation may affect the apparent improvements associated with surgery. . . .

Background: Patients with occupational asthma, and their medical advisers, need valid information about the prognosis of their disease. Methods: A systematic review of the published literature on the symptomatic and functional outcomes of occupational asthma was carried out after avoidance of exposure to the causative agent. Through a full search of electronic and bibliographic sources, original studies documenting complete recovery from asthma (n = 39,1681 patients) or improvement in non-specific bronchial hyper-responsiveness (NSBHR; n = 28,695 patients) were identified. The median duration of follow-up was 31 (range 6–240) months for studies of symptomatic recovery and 37 (6–240) months for studies of NSBHR. Most studies were of patients recruited from special clinics. Results: Reported rates of symptomatic recovery varied from 0% to 100%, with a pooled estimate of 32% (95% CI 26% to 38%). These rates were lower with increasing age (p = 0.019) and among clinic based populations (p = 0.053). Patients with the shortest durations of exposure (⩽76 months) had the highest rate of recovery (36%; 95% CI 25% to 50%), but the effect was not linear. The pooled prevalence of persistent NSBHR at follow-up was 73% (95% CI 66% to 79%). This figure was higher among patients whose disease was due to high-molecular-weight agents (p = 0.006) and, less clearly, those from clinic-based populations (p = 0.561). In between-study comparisons, no clear patterns of improvement relating to total duration of exposure or follow-up were found. From within-study comparisons there was some evidence that a shorter duration of symptoms was associated with a higher rate of symptomatic recovery. Conclusion: The available data on the prognosis of occupational asthma are insufficiently consistent to allow confident advice to be given to patients with the disease. Clinicians and epidemiologists with an interest in this disease should consider a collaborative and carefully standardised study of the prognosis of occupational asthma.

Background:Studies of the health effects of traffic interventions are rare. The Oxford Transport Strategy (OTS), implemented in June 1999, involved a wide range of permanent changes designed to reduce congestion in the city centre of Oxford, UK. The impact of the OTS on peak expiratory flow (PEF) and respiratory symptoms among schoolchildren in the city is reported.Methods:A dynamic cohort of 1389 children aged 6–10 years attending first schools in Oxford was studied. Schools were visited 2–3 times a year for 5-day periods between 1998 and 2000. On each day of each visit children had their PEF measured and were asked about their respiratory symptoms.Results:Changes in traffic varied across the city. In the whole population, regression analysis of daily PEF adjusting for potential confounders showed statistically significant improvements post-OTS (β = 5.52 l/min, 95% CI 3.08 to 7.97), but there was no consistent evidence that these improvements varied by changes in traffic exposure. In post-hoc analyses, children currently receiving treatment for asthma tended to experience a greater increase in PEF post-OTS as did children from less affluent homes, although these differences did not reach statistical significance. In each of these groups, greater benefits were observed among those living near roads where traffic levels fell post-OTS.Conclusions:These findings suggest that traffic management may lead to small localised improvements in childhood respiratory health and that such benefits are limited to children with pre-existing respiratory problems and those from less affluent backgrounds.

BackgroundStudies in the late ‘80s and early ‘90s suggested that survival in UK CF patients was better in those from non-manual social classes and that adults attending specialist clinics (66% of the total) received more intensive care. Twenty years on, we assessed whether treatments and outcomes varied by specialist care and the socio-economic status (SES) of patients.MethodsThe CF Trust provided 2008 annual review data for patients attending UK adult clinics (n=3182). Three models of care were identified: “centre”, “shared” between specialist and non-specialist clinics and non-specialist “stand-alone”. SES was estimated by Townsend scores at CAS ward level. Distance to clinic was calculated as the distance between the patients’ home postcode and that of their clinic.ResultsIn 2008 most patients received “centre care” (94%) and few received “stand-alone care” (4%). There were no differences in rates of dornase alfa, pancreatic enzyme or IV antibiotic treatment between models. The highest rates of chronic Pseudomonas aeruginosa (PA) infections were in patients attending “centre care” (“centre” 62%: “shared” 56%: “stand-alone” 49%; p=0.01) but there were no differences in FEV1%predicted. Most patients (91%) lived <50 miles of their clinic; the distribution of clinics broadly reflected that of patients. Although those living near their clinic were less likely to be using dornase alfa (<50 miles 43%: ≥50 miles 52%, p=0.003), there were no differences in chronic Pa infection or FEV1% predicted. There were more patients than expected in the least deprived quintile of SES (30%) and fewer in the most deprived (10%). There was a decreasing trend in dornase α treatment with increasing deprivation (least deprived 48%: 43%: 41%: 41%: most deprived 42%, p=0.004) although when stratified by disease severity this was only significant among patients with mild disease (70% ≤FEV1% predicted <90%). There were no differences in chronic Pa infections or FEV1% predicted.ConclusionIn the last 20 years, the proportion of adults attending specialist clinics has increased and the majority live near their clinics. Despite these improvements, there exist disparities in treatment by distance and SES and chronic Pa infections by model of care.

IntroductionLittle information exists on the prevalence and risk factors of asthma exacerbations in the general population. We used GP records to determine whether we can predict exacerbations in adults from their medical history.MethodsUsing the Health Improvement Network database, weidentified all patients aged 16–40 years with “current asthma” (≥1 asthma prescription between 01/07/98 and 01/07/00). Three types of asthma exacerbations were studied: “hospital” defined as events resulting in attendance at A&E or admission; “GP” defined as events occurring during out-of-hours consultations; and “prednisolone” defined as non-repeat prescriptions of oral prednisolone for asthma.Results73 462 patients were identified. They were on average 28 years old and 56% were female. 36,762 (50%) were registered for at least 5 years pre-qualification and 1 year post. Of these, 0.3% had at least one hospital exacerbation in the first year post, 2.4% had at least one GP exacerbation and 8.3% had at least one prednisolone exacerbation. Women and those prescribed a reliever and preventor at qualification were more likely to have exacerbations (see Abstract P184 Table 1). The prevalence of exacerbations was associated with an increasing number and increasingly recent history of exacerbations pre-qualification.Abstract P184 Table 1Prevalences of at least one exacerbation in the first year post-qualificationHospitalGPPrednisoloneSex Male0.2%2.1%7.1% Female0.4%2.6%9.2%p=0.001p=0.001p<0.001Prescriptions at qualification Reliever and preventor0.5%3.9%14.3% Other0.3%1.7%5.8%p=0.001p<0.001p<0.001Number of exacerbations* in the 5 years pre-qualification 0 10.3%1.7%5.9% 23.3%9.0%14.9% 3+17.5%12.5%25.0%18.8%30.8%47.8%p<0.001 (trend)p<0.001 (trend)p<0.001 (trend)Time since the last pre-qualificaiton exacerbation* <1 year11.8%20.5%39.5% 1–2 years8.8%11.0%22.3% 2–3 years6.5%9.2%16.2% 3+ years1.9%5.8%13.6%p<0.001 (trend)p<0.001 (trend)p<0.001 (trend)*Of the same type.DiscussionThese results show that while few have hospital exacerbations, GP and prednisolone exacerbations are comparatively common. For all types, a previous and recent history of exacerbations increases the risk of future exacerbations.

Background People with cystic fibrosis (CF) are managed differently in the USA and UK providing an opportunity to learn from differences in practice patterns. Objectives To compare cross-sectional demographics, practice patterns and clinical outcomes between US and UK CF patients. Methods This was a cross-sectional study using 2010 data from patients in the US Cystic Fibrosis Foundation and the UK Cystic Fibrosis patient registries. The a priori outcome measures of interest were lung function and nutritional status. Descriptive statistics and two sample comparisons were performed. Stratification and multivariable linear regression were used to adjust for confounding. Results The study cohort included 13 777 children and 11 058 adults from the USA and 3968 children and 3965 adults from the UK. In children, mean body mass index centiles were similar. Lung function (FEV1 and FVC% predicted) was significantly higher in US patients ages 6–25 years of age. In a regression model adjusted for only age, FEV1% predicted was on average 3.31% of predicted (95% CI 2.65 to 3.96) higher in the USA compared with the UK. When adjusted for age, age at diagnosis, gender, pancreatic insufficiency and genotype, FEV1% predicted was on average 3.03% of predicted (95% CI 2.37 to 3.69) higher in the USA compared with the UK These differences persisted despite adjustment for possible confounders. Hypertonic saline and dornase alfa were much more commonly prescribed in US children. Conclusions Children and young adults with CF have better lung function in the USA compared with the UK despite similar nutritional status.

With the aim to expand the randomized controlled trial evidence of cinacalcet treatment to the unselected, general chronic kidney disease (CKD) population we analysed a large inception cohort of CKD patients in the region of Stockholm, Sweden 2006–2012 (both non-dialysis, dialysis and transplanted) with evidence of secondary hyperparathyroidism (SHPT). We used marginal structural models to account for both confounding by indication and time-dependent confounding. Over 37 months, 435/3,526 (12%) initiated cinacalcet de novo . Before cinacalcet initiation, parathyroid hormone (PTH) had increased progressively to a median of 636ng/L. After cinacalcet initiation, PTH declined, as did serum calcium and phosphate. In total, 42% of patients experienced a fatal/non-fatal cardiovascular event, 32% died and 9% had a new fracture. The unadjusted cardiovascular odds ratio (OR) associated with cinacalcet treatment was 1.01 (95% confidence interval: 0.83, 1.22). In the fully weighted model, the cardiovascular odds was lower in cinacalcet treated patients (OR 0.67: 0.48, 0.93). The adjusted ORs for all-cause mortality and for fractures were 0.79 (0.56, 1.11) and 1.08 (0.59, 1.98) respectively. Our study suggests cinacalcet treatment improves biochemical abnormalities in the wider CKD population, and adds real-world support that treating SHPT with cinacalcet may have beneficial effects on cardiovascular outcomes.