HIGH-FREQUENCY CHEST WALL OSCILLATION: AIRWAY CLEARANCE MANAGEMENT FOR OBSTRUCTIVE PULMONARY DISEASE PATIENTS

<p>Ineffective mucous airway clearance is identified as the main concern in obstructive pulmonary disease. An impaired mucociliary mechanism and hyper secretive are leading to mucous retention. High-frequency chest wall oscillation (HFCWO) offers a great practical advantage for obstructive pulmonary disease treatment. A literature review was conducted to summarize the existing research evidence assessing the effectiveness and benefits of HFCWO as an airway clearance management among people with obstructive pulmonary disease. Literature was limited to accessible articles in the English language and sourced from electronic databases, PubMed and EBSCO, from their published date through 2010. Seven studies that fulfilled the inclusion criteria were included in the analysis. Two themes were identified from the summary of included studies, namely respiratory function improvement and quality of life outcomes. The overall results of the studies indicate that HFCWO positively affects health status and wellbeing in patients with excessive mucous production and impaired airway clearance mechanism. It also can be performed independently and enhances self-satisfaction. Thus, it will be advantageous to include the HFCWO in pulmonary rehabilitation. Further studies are needed to validate the effectiveness of HFCWO in obstructive pulmonary disease patients and develop better treatments in this field.</p>

Introduction to the Theory of Imprecise Probability

The theory of imprecise probability is a generalization of classical ‘precise’ probability theory that allows modeling imprecision and indecision. This is a practical advantage in situations where a unique precise uncertainty model cannot be justified. This arises, for example, when there is a relatively small amount of data available to learn the uncertainty model or when the model’s structure cannot be defined uniquely. The tools the theory provides make it possible to draw conclusions and make decisions that correctly reflect the limited information or knowledge available for the uncertainty modeling task. This extra expressivity however often implies a higher computational burden. The goal of this chapter is to primarily give you the necessary knowledge to be able to read literature that makes use of the theory of imprecise probability. A secondary goal is to provide the insight needed to use imprecise probabilities in your own research. To achieve the goals, we present the essential concepts and techniques from the theory, as well as give a less in-depth overview of the various specific uncertainty models used. Throughout, examples are used to make things concrete. We build on the assumed basic knowledge of classical probability theory.

A Discriminative Ontology for Future Selves

The article presents a critique of the commonly held assumption about the practical advantage of endurantism over perdurantism regarding the problem of future-directed self-concern of a person. The future-directed self-concern of a person crucially depends on the possibility of the right differentiation of diverging futures of distinct persons, therefore any theory of persistence that does not entail a special nonbranching relation of a person to only their future self seems to be counterintuitive or unrealistic for practical purposes of personal persistence. I argue that this pragmatic rationale about future-directed self-concern is equally challenging for both theories of persistence. Moreover, I indicate, that both of these theories fall and stand on the practical feasibility of hidden ontological presuppositions about specific second-order notions of concerns of persons for their future.

Visible-light-mediated catalyst-free synthesis of unnatural α-amino acids and peptide macrocycles

The visible light induced, photocatalysts or photoabsorbing EDA complexes mediated cleavage of pyridinium C-N bond were reported in the past years. Here, we report an ionic compound promote homolytic cleavage of pyridinium C-N bond by exploiting the photonic energy from visible light. This finding is successfully applied in deaminative hydroalkylation of a series of alkenes including naturally occurring dehydroalanine, which provides an efficient way to prepare β-alkyl substituted unnatural amino acids under mild and photocatalyst-free conditions. Importantly, by using this protocol, the deaminative cyclization of peptide backbone N-terminals is realized. Furthermore, the use of Et3N or PPh3 as reductants and H2O as hydrogen atom source is a practical advantage. We anticipate that our protocol will be useful in peptide synthesis and modern peptide drug discovery.

Experimental Demonstration of a Stacked Hybrid Optoacoustic-Piezoelectric Transducer for Localized Heating and Enhanced Cavitation

Laser-generated focused ultrasound (LGFU) is an emerging modality for cavitation-based therapy. However, focal pressure amplitudes by LGFU alone to achieve pulsed cavitation are often lacking as a treatment depth increases. This requires a higher pressure from a transmitter surface and more laser energies that even approach to a damage threshold of transmitter. To mitigate the requirement for LGFU-induced cavitation, we propose LGFU configurations with a locally heated focal zone using an additional high-intensity focused ultrasound (HIFU) transmitter. After confirming heat-induced cavitation enhancement using two separate transmitters, we then developed a stacked hybrid optoacoustic-piezoelectric transmitter, which is a unique configuration made by coating an optoacoustic layer directly onto a piezoelectric substrate. This shared curvature design has great practical advantage without requiring the complex alignment of two focal zones. Moreover, this enabled the amplification of cavitation bubble density by 18.5-fold compared to the LGFU operation alone. Finally, the feasibility of tissue fragmentation was confirmed through a tissue-mimicking gel, using the combination of LGFU and HIFU (not via a stacked structure). We expect that the stacked transmitter can be effectively used for stronger and faster tissue fragmentation than the LGFU transmitter alone.

Rotated twisted-mass: a convenient regularization scheme for isospin breaking QCD and QED lattice calculations

We propose a scheme of lattice twisted-mass fermion regularization which is particularly convenient for application to isospin breaking (IB) QCD and QED calculations, based in particular on the so called RM123 approach, in which the IB terms of the action are treated as a perturbation. The main, practical advantage of this scheme is that it allows the calculation of IB effects on some mesonic observables, like e.g. the $$\pi ^+ - \pi ^0$$ π + - π 0 mass splitting, using lattice correlation functions in which the quark and antiquark fields in the meson are regularized with opposite values of the Wilson parameter r. These correlation functions are found to be affected by much smaller statistical fluctuations, with respect to the analogous functions in which quark and antiquark fields are regularized with the same value of r. Two numerical application of this scheme, that we call rotated twisted-mass, within pure QCD and QCD + QED respectively, are also provided for illustration.

Tenecteplase Thrombolysis in Posterior Circulation Stroke

One in five ischaemic strokes affects the posterior circulation. Basilar artery occlusion is a type of posterior circulation stroke associated with a high risk of disability and mortality. Despite its proven efficacy in ischaemic stroke more generally, alteplase only achieves rapid reperfusion in ~4% of basilar artery occlusion patients. Tenecteplase is a genetically modified variant of alteplase with greater fibrin specificity and longer half-life than alteplase, which can be administered by intravenous bolus. The single-bolus administration of tenecteplase vs. an hour-long alteplase infusion is a major practical advantage, particularly in “drip and ship” patients with basilar artery occlusion who are being transported between hospitals. Other practical advantages include its reduced cost compared to alteplase. The EXTEND-IA TNK trial demonstrated that tenecteplase led to higher reperfusion rates prior to endovascular therapy (22 vs. 10%, non-inferiority p = 0.002, superiority p = 0.03) and improved functional outcomes (ordinal analysis of the modified Rankin Scale, common odds ratio 1.7, 95% CI 1.0–2.8, p = 0.04) compared with alteplase in large-vessel occlusion ischaemic strokes. We recently demonstrated in observational data that tenecteplase was associated with increased reperfusion rates compared to alteplase prior to endovascular therapy in basilar artery occlusion [26% (n = 5/19) of patients thrombolysed with TNK vs. 7% (n = 6/91) thrombolysed with alteplase (RR 4.0 95% CI 1.3–12; p = 0.02)]. Although randomized controlled trials are needed to confirm these results, tenecteplase can be considered as an alternative to alteplase in patients with basilar artery occlusion, particularly in “drip and ship” patients.

Practical advantage of SPECT/CT image co-registration for accurate bleeding Meckel’s diverticulum localization in pediatrics: A case report

Planar scintigraphy with 99mTc-pertechnetate or Meckel scan is the gold standard in the diagnosis of a bleeding Meckel’s diverticulum (MD) for pediatrics. However, several setbacks may occur during the interpretation of a scintigram, especially in cases of an atypical MD presentation. In this report, we highlight the importance of functional and anatomical image co-registration using a hybrid SPECT/CT scanner to precisely localize a MD lesion. An 18-month-old boy presented with severe hematochezia over 4 days with declining hemoglobin levels. He underwent a conventional 60-min dynamic planar imaging of the Meckel scan. Upon review of the Meckel scan, a suspicious increase in the 99mTc-pertechnetate uptake was observed at the right upper quadrant of the abdomen. Due to its atypical location at the right kidney, we could not differentiate between a physiological uptake of the right kidney or an ectopic gastric mucosa. The patient was imaged again using single-photon emission computed tomography (SPECT) and low-dose CT protocol with a hybrid SPECT/CT scanner, and the co-registration of both SPECT and CT images was able to confirm the MD, which was located anterior to the right kidney at the right hepatic flexure region. An exploratory laparotomy was then ensued to remove the bleeding MD. The patient was discharged after 3 days with no complications. In summary, this case illustrates that hybrid imaging modality and co-registration allow for a more definitive diagnosis, as well as a more precise localization of MD.

Comparing methods for determining landslide early warning thresholds: potential use of non-triggering rainfall for locations with scarce landslide data availability

Rainfall intensity-duration landslide-triggering thresholds have become widespread for the development of landslide early warning systems. Thresholds can be in principle determined using rainfall event datasets of three types: (a) rainfall events associated with landslides (triggering rainfall) only, (b) rainfall events not associated with landslides (non-triggering rainfall) only, (c) both triggering and non-triggering rainfall. In this paper, through Monte Carlo simulation, we compare these three possible approaches based on the following statistical properties: robustness, sampling variation, and performance. It is found that methods based only on triggering rainfall can be the worst with respect to those three investigated properties. Methods based on both triggering and non-triggering rainfall perform the best, as they could be built to provide the best trade-off between correct and wrong predictions; they are also robust, but still require a quite large sample to sufficiently limit the sampling variation of the threshold parameters. On the other side, methods based on non-triggering rainfall only, which are mostly overlooked in the literature, imply good robustness and low sampling variation, and performances that can often be acceptable and better than thresholds derived from only triggering events. To use solely triggering rainfall—which is the most common practice in the literature—yields to thresholds with the worse statistical properties, except when there is a clear separation between triggering and non-triggering events. Based on these results, it can be stated that methods based only on non-triggering rainfall deserve wider attention. Methods for threshold identification based on only non-triggering rainfall may have the practical advantage that can be in principle used where limited information on landslide occurrence is available (newly instrumented areas). The fact that relatively large samples (about 200 landslides events) are needed for a sufficiently precise estimation of threshold parameters when using triggering rainfall suggests that threshold determination in future applications may start from identifying thresholds from non-triggering events only, and then move to methods considering also the triggering events as landslide information starts to become more available.

Versatile Super-Sensitive Metrology Using Induced Coherence

We theoretically analyze the phase sensitivity of the Induced-Coherence (Mandel-Type) Interferometer, including the case where the sensitivity is "boosted" into the bright input regime with coherent-light seeding. We find scaling which reaches below the shot noise limit, even when seeding the spatial mode which does not interact with the sample – or when seeding the undetected mode. It is a hybrid of a linear and a non-linear (Yurke-Type) interferometer, and aside from the supersensitivity, is distinguished from other systems by "preferring" an imbalance in the gains of the two non-linearities (with the second gain being optimal at low values), and non-monotonic behavior of the sensitivity as a function of the gain of the second non-linearity. Furthermore, the setup allows use of subtracted intensity measurements, instead of direct (additive) or homodyne measurements – a significant practical advantage. Bright, super-sensitive phase estimation of an object with different light fields for interaction and detection is possible, with various potential applications, especially in cases where the sample may be sensitive to light, or is most interesting in frequency domains outside what is easily detected, or when desiring bright-light phase estimation with sensitive/delicate detectors. We use an analysis in terms of general squeezing and discover that super-sensitivity occurs only in this case – that is, the effect is not present with the spontaneous-parametric-down-conversion approximation, which many previous analyses and experiments have focused on.