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Background There is some evidence that singing lessons may be of benefit to patients with chronic obstructive pulmonary disease (COPD). It is not clear how much of this benefit is specific to singing and how much relates to the classes being a group activity that addresses social isolation. Methods Patients were randomised to either singing classes or a film club for eight weeks. Response was assessed quantitatively through health status questionnaires, measures of breathing control, exercise capacity and physical activity and qualitatively, through structured interviews with a clinical psychologist. Results The singing group (n=13 mean(SD) FEV 1 44.4(14.4)% predicted) and film group (n=11 FEV 1 63.5(25.5)%predicted) did not differ significantly at baseline. There was a significant difference between the response of the physical component score of the SF-36, favouring the singing group +12.9(19.0) vs -0.25(11.9) (p=0.02), but no difference in response of the mental component score of the SF-36, breathing control measures, exercise capacity or daily physical activity. In the qualitative element, positive effects on physical well-being were reported in the singing group but not the film group. Conclusion Singing classes have an impact on health status distinct from that achieved simply by taking part in a group activity. Trials registration Registration Current Controlled Trials - ISRCTN17544114

Background: The chronic obstructive pulmonary disease (COPD) assessment test (CAT) is a simple, self-completion questionnaire developed to measure health status in patients with COPD, which is potentially suitable for routine clinical use. Objectives: The purpose of this study was to establish the determinants of the CAT score in routine clinical practice. Methods: Patients attending the clinic completed the CAT score before being seen. Clinical data, including, where available, plethysmographic lung volumes, transfer factor and arterial blood gas analysis, were recorded on a pro forma in the clinic. Results: In 224 patients (36% female), mean forced expiratory volume in 1 s (FEV 1 ) was 40.1% (17.9) of predicted (%pred); CAT score was associated with exacerbation frequency [0–1/year 20.1 (7.6); 2–4/year 23.5 (7.8); >4/year 28.5 (7.3), p < 0.0001; 41/40/19% in each category] and with Medical Research Council (MRC) dyspnoea score (r 2 = 0.26, p < 0.0001) rising approximately 4 points with each grade. FEV 1 %pred had only a weak influence. Using stepwise regression, CAT score = 2.48 + 4.12 [MRC (1–5) dyspnoea score] + 0.08 (FEV 1 %pred) + 1.06 (exacerbation rate/year)] (r 2 = 0.36, p < 0.0001). The CAT score was higher in patients (n = 54) with daily sputum production [25.9 (7.5) vs. 22.2 (8.2); p = 0.004]. Detailed lung function (plethysmography and gas transfer) was available in 151 patients but had little influence on the CAT score. Conclusion: The CAT score is associated with clinically important variables in patients with COPD and enables health status measurement to be performed in routine clinical practice.

Doc number: 181

All those interested in the solution of American railroad problems who read Judge Robert S. Lovett's statement in THE NEW YORK TIMES of April 17 will no doubt feel greatly encouraged as to the future of railway consolidation and regulation. His words, \"Many States have corporate limitations which retard or prevent consolidations and a Federal law superseding these is needed,\" might easily convey the idea that State laws hinder not only railway consolidation but effective railway regulation as well.

The railroads have been so great a factor in the prosperity of the past few years that none but the willfully unfair can fail to admit it. To cite that the heavy volume of business was handled without congestion or car shortage and that ten new performance records were made in 1925 tells only half the story.

The railroads have been so great a factor in the prosperity of the past few years that none but the willfully unfair can fail to admit it. To cite that the heavy volume of business was handled without congestion or car shortage and that ten new performance records were made in 1925 tells only half the story.

Background On January 31st, 2023, the province of British Columbia (BC), Canada, was granted a federal exemption allowing adults (aged 18 +) to possess up to 2.5 g of select illicit drugs. The exemption will be in place for three years (2023–2026), marking the first formal decriminalization of illicit drug policy reform in Canada. BC’s decriminalization initiative is premised on several goals. This project seeks to evaluate each of these goals and their individual and combined contributions to determine the overall success of this policy. Methods The following protocol paper provides a detailed outline of a five-year (2022-2027) national evaluation of BC’s decriminalization initiative, as well as the specific objectives, methodologies, and planned analyses for eight interrelated sub-studies that comprise the evaluation. These sub-studies fall under the following five topical areas of research: 1) people who use drugs (PWUD), 2) the police and the criminal justice system, 3) the general public, 4) the health services system, and 5) an economic analysis. Additional research activities may also be explored. Results The overall evaluation and specific sub-study designs were informed by intensive stakeholder engagement. The evaluation was developed in collaboration with an international expert committee who came together to undertake a nominal group technique to decide on the final evaluation design and corresponding logic model. The evaluation will also employ an advisory board and individual sub-study working groups comprised of experts and PWUD who will oversee the development and implementation of the overall evaluation as well as each sub-study. Discussion This evaluation will draw on implementation science research practices to evaluate and understand the full impacts of this novel drug policy experiment. Results will be widely disseminated through manuscripts, reports, presentations, and infographics, which will be adapted and tailored for specific audiences. The protocol identifies several anticipated challenges and limitations. This evaluation’s evidence-based findings will be poised to offer pivotal insights that can shape and refine the discourse on drug policy and will serve as a critical resource for understanding the multifaceted impacts of decriminalization.

Objectives. To estimate children’s exposure to family overdose in the United States. Methods. We used recent demographic kinship modeling advances and the Centers for Disease Control and Prevention’s most recent underlying cause of death estimates to model how many children aged younger than 18 years in 2019 had lost 1 or more parents, siblings, grandparents, aunts or uncles, or cousins to overdose mortality since birth. We calculated the number and proportion of children with such exposures and considered age, cohort, and gender patterning. Results. More than 1.4 million children in the United States, mostly adolescents, experienced a family overdose death, often losing central figures like parents or grandparents. Cohort analyses suggest dramatic increases in these exposures, portending mounting prevalence. Conclusions. Attention to the large population with lives disrupted by overdose deaths should include affected children. The long-arm consequences of the overdose crisis will continue to define the public health landscape for decades. ( Am J Public Health. 2024;114(12):1394–1397. https://doi.org/10.2105/AJPH.2024.307847 )