How do patients conceptualize chronic obstructive pulmonary disease?

Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States, yet even at risk or diagnosed patients misunderstand COPD and its consequences for their quality of life and mortality. This study explored how patients conceptualize the causes, symptoms, consequences, treatment, and risk for developing COPD. The study consisted of six focus groups: 39 participants who were adults > 40 and current smoker or have COPD symptoms, family history, or exposures. Although many participants had some familiarity with the breathing, lung function, physical, emotional, and social consequences of COPD, confusion and misunderstanding prevailed. Few knew that COPD, chronic bronchitis, and emphysema are synonymous. Some participants claimed that they "only" had bronchitis and/or emphysema and not COPD. Some participants described behavioral adaptations to decrease symptom impact and others expressed strong interest in learning how to increase daily functioning. Insufficient knowledge and persisting misconceptions about COPD can prevent patients from accessing life-enhancing strategies. Patients can benefit from (1) providers clarifying COPD's connection to chronic bronchitis and emphysema to aid them in recognizing the need for mitigating action; (2) encouraging smoking cessation, specifically to stem worsening of disease; and (3) explaining lifestyle adaptations for easing daily life despite decreased lung function.

Absence of strong magnetic fluctuations in FeP-based systems LaFePO and Sr2ScO3FeP.

We report neutron inelastic scattering measurements on polycrystalline LaFePO and Sr2ScO3FeP, two members of the iron phosphide families of superconductors. No evidence is found for any magnetic fluctuations in the spectrum of either material in the energy and wavevector ranges probed. Special attention is paid to the wavevector at which spin-density-wave-like fluctuations are seen in other iron-based superconductors. We estimate that the magnetic signal, if present, is at least a factor of four (Sr2ScO3FeP) or seven (LaFePO) smaller than in the related iron arsenide and chalcogenide superconductors. These results suggest that magnetic fluctuations are not as influential on the electronic properties of the iron phosphide systems as they are in other iron-based superconductors.

Neutron scattering and µSR investigations of the low temperature state of LuCuGaO4.

LuCuGaO4 has magnetic Cu(2+) and diamagnetic Ga(3+) ions distributed on a triangular bilayer and is suggested to undergo a spin glass transition at Tg ∼ 0.4 K. Using µSR (muon spin rotation) and neutron scattering measurements, we show that at low temperature the spins form a short range correlated state with spin fluctuations detectable over a wide range of timescales: at 0.05 K magnetic fluctuations can be detected in both the µSR time window and also extending beyond 7 meV in the inelastic neutron scattering response, indicating magnetic fluctuations spanning timescales between ∼10(-5) and ∼10(-10) s. The dynamical susceptibility scales according to the form χ″(ω)T(α), with α = 1, throughout the measured temperature range (0.05-50 K). These effects are associated with quantum fluctuations and some degree of structural disorder in ostensibly quite different materials, including certain heavy fermion alloys, kagome spin liquids, quantum spin glasses, and valence bond glasses. We therefore suggest that LuCuGaO4 is an interesting model compound for the further examination of disorder and quantum magnetism.

Probing the effects of light and temperature on diurnal rhythms of phytosiderophore release in wheat.

* The existing literature is ambiguous as to whether the diurnal pulse in phytosiderophore (PS) release in the Poaceae is mediated by light or temperature, or both. * Here, wheat (Triticum aestivum cv. Yecora Rojo) seedlings were grown in Fe-sufficient (pFe = 16.5) and Fe-deficient (pFe = 17.8) chelator-buffered nutrient solutions. Six different light/temperature regimes were tested over 8 d in paired growth chambers. * Phytosiderophore release patterns under a square-wave light regime were similar, irrespective of whether temperature was varied diurnally or held constant, but PS release was negligible when the light was removed. Release patterns of PS for Fe-deficient and Fe-sufficient plants grown under the square-wave vs ramped light and temperature regimes were similar in the corresponding Fe treatments. * Our results strongly support the notion that the diurnal pulse in PS release in the Poaceae is mainly mediated by changes in light rather than temperature. Our comparison of square-wave with more natural ramped light/temperature regimes suggests that the diurnal response patterns of PS release in wheat can be confidently studied using traditional square-wave regimes, and this is likely to be the case with other Poaceae as well.

Nutrient status and plant growth effects of forest soils in the Basin of Mexico.

The nutrient status of forest soils in the Mexico City Air Basin was evaluated by observing plant growth responses to fertilization with N, P or both nutrients combined. P deficiency was the most frequent condition for soil from two high pollution sites and N deficiency was greatest at a low N deposition site. Concentrations of Pb and Ni, and to a lesser extent Zn and Co, were higher at the high pollution sites. However, positive plant growth responses to P and sometimes to N, and results of wheat root elongation bioassays, suggest that heavy metal concentrations were not directly phytotoxic. Further studies are needed to determine if heavy metal toxicity to mycorrhizal symbionts of eucalyptus (Eucalyptus camaldulensis Dehnh.) from high pollution sites may explain the P deficiency and stunted growth. P deficiency is expected to limit the capacity for biotic N retention in N saturated forested watersheds in the Basin of Mexico dominated by Andisols.

Water source utilization by Pinus jeffreyi and Arctostaphylos patula on thin soils over bedrock.

Stable isotopes were used to evaluate water sources for co-occurring Jeffrey pine (Pinus jeffreyi Grev & Balf.) and greenleaf manzanita (Arctostaphylos patula Greene) in the southern Sierra Nevada, California, where soils averaged only 75 cm thick but were underlain by up to 5 m of weathered granitic bedrock. Soils and underlying weathered bedrock were sampled three times during both the 1997 and 1998 growing seasons, in 25 cm increments, from 0 to 400 cm or until hard bedrock was reached, and plant stem tissue was sampled simultaneously. Extracted water from the soil/bedrock substrate and plant tissue was analyzed for delta(18)O and/or deltaD, and depth of water source was determined by inference in conjunction with moisture status of the substrate. Water source utilization over the growing seasons for both plants generally followed a pattern similar to that observed for water depletion. Predominant water use was initially from the surface soils. Progressively deeper water sources, including weathered bedrock to a depth of several meters, were exploited as the season progressed and the overlying substrate was depleted of moisture. Early in the growing season, stable isotope values were slightly lower for pine than for manzanita (e.g., average deltaD in June 1997 was -81 per thousand for pine and -77 per thousand for manzanita), and suggest that the functional rooting depth for pine may have been slightly greater than for manzanita. In September 1997, manzanita deltaD values averaged -57 per thousand while pine values averaged -85 per thousand, indicating that manzanita opportunistically utilized summer precipitation while pine used more dependable bedrock water. In 1998, soils remained moist through July due to a late snowfall. Unlike the previous year, pine and manzanita deltaD values were not significantly different in mid- and late-growing season, and both plants exploited bedrock-derived water as soil water was depleted. Water held within bedrock was essential for meeting plant transpirational requirements over the summer drought.

A dental hygienist's role in tobacco cessation.

Dental professionals are uniquely poised to contribute to the battle against tobacco use. When tobacco users receive a consistent anti-tobacco message from a variety of health care providers, the likelihood of success in the battle to quit is increased. Most people receive many warnings in the media about the negative health effects of tobacco, especially those regarding cancer and heart disease. Smokers and smokeless tobacco users may not be as knowledgeable about the negative oral manifestations of tobacco use, and dental hygienists can be instrumental in educating their patients on these effects. Including questions about tobacco use in the health history is a vital first step to identifying patients who may benefit from tobacco intervention counselling in the dental office. Once identified, the hygienist can proceed to discover the patient's motivation to quit, and assist in providing information that may be of help to the patient in ceasing tobacco dependency. Helping and encouraging patients in their battle against tobacco use is an important way that dental hygienists can contribute to their patients' improved health.

Reevaluating the free-ion activity model of trace metal toxicity toward higher plants: experimental evidence with copper and zinc.

Across a diverse spectrum of organisms, the absorption and toxicity of trace elements are usually correlated with the activity of the free metal ion, but reported exceptions to this generalization are increasing. For the first time, we tested the validity of the free-ion activity model (FIAM) in the case of terrestrial plants and organic acids that may be abundant in the soil solution and rhizosphere. Short-term (48-h) root elongation of wheat (Triticum aestitvum L.) in a simple medium (2 mM CaCl2, pH 6.0) was used to probe the toxicity of Cu and Zn in the presence of malonate, malate, and citrate. Precautions were taken to prevent biodegradation of the organic acids, and its absence was confirmed by ion chromatography. Copper speciation was verified using a Cu-selective ion electrode, and published stability constants were modified to improve agreement between measured and calculated Cu2+ activities. With additions of both malonate and malate, Cu toxicity was alleviated but not to the extent predicted by the FIAM; the Cu-ligand complexes seemingly contributed to the toxicity. No such departures were observed with citrate and Cu nor with any of the three ligands in combination with Zn. Thus, exceptions to the FIAM occur with higher plants as well as with aquatic biota but do not seem to occur in a predictable or systematic fashion with respect to metal or organic acid under investigation. Several possible explanations for the observed departures from the FIAM are discussed, including the possibility of accidental cotransport of metal and ligand into the cytoplasm.

Cadmium reactivity in metal-contaminated soils using a coupled stable isotope dilution-sequential extraction procedure.

To better understand the intrinsic reactivity of Cd, four soils having diverse sources of Cd contamination (total Cd: 22-34 mg kg(-1)) were investigated using a stable isotope dilution-sequential extraction procedure (SID-SEP) during a 59-week incubation. Samples were spiked with carrier-free 111Cd and periodically extracted into five operationally defined fractions; the 111Cd:10Cd ratios were measured by inductively coupled plasma-mass spectrometry. The total labile pool of Cd (E value) was calculated as well as the labile Cd within each extracted fraction. Results for three of the soils (Cd sources: natural, sewage sludge, smelter emissions) were quite similar. The overall %E after 2-week equilibration was 35-49% of total soil Cd. Within fraction 2 (sorbed/carbonate), 70-75% of the Cd was isotopically labile, while within fraction 3 (oxidizable) only 35-41% of the Cd was labile within 2 weeks. The fourth (reducible) and fifth (residual) fractions were dominated by nonlabile Cd. Although all E values increased somewhat from 2 to 59 weeks, none of the extracted fractions reached isotopic equilibrium with the soluble/exchangeable Cd extracted during step 1. Because fractions 2 and 3 dominated the native Cd in all three soils, the total labile pool was contributed primarily (85-98%) by these two fractions. A fourth soil (mine spoil-contaminated) was demonstrably different: after 2 weeks, the overall %E was just 13 and, although 82% of the total Cd was present in the oxidizable fraction, just 2% of that was isotopically labile. The nonlability of Cd in this soil could be ascribed to the predominance of inorganic forms, most likely occluded Cd in sphalerite. No single Cd fraction from the SEP nor any combination of fractions showed a good correspondence with the size of the isotopically labile pool. Our results suggest that conventional SEPs may be of limited utility for predicting bioavailability, for example, during ecological risk assessment.

Passive sampler for measurements of atmospheric nitric acid vapor (HNO3) concentrations.

Nitric acid (HNO3) vapor is an important nitrogenous air pollutant responsible for increasing saturation of forests with nitrogen and direct injury to plants. The USDA Forest Service and University of California researchers have developed a simple and inexpensive passive sampler for monitoring air concentrations of HNO3. Nitric acid is selectively absorbed on 47-mm Nylasorb nylon filters with no interference from particulate NO3-. Concentrations determined with the passive samplers closely corresponded with those measured with the co-located honeycomb annular denuder systems. The PVC protective caps of standardized dimensions protect nylon filters from rain and wind and allow for reliable measurements of ambient HNO3 concentrations. The described samplers have been successfully used in Sequoia National Park, the San Bernardino Mountains, and on Mammoth Mountain in California.

Zinc deficiency-induced phytosiderophore release by the Triticaceae is not consistently expressed in solution culture.

The effects of zinc (Zn) and iron (Fe) deficiencies on phytosiderophore (PS) exudation by three barley (Hordeum vulgare L.) cultivars differing in Zn efficiency were assessed using chelator-buffered nutrient solutions. A similar study was carried out with four wheat (Triticum aestivum L. and T. durum Desf.) cultivars, including the Zn-efficient Aroona and Zn-inefficient Durati. Despite severe Zn deficiency, none of the barley or wheat cultivars studied exhibited significantly elevated PS release rates, although there was significantly enhanced PS exudation under Fe deficiency. Aroona and Durati wheats were grown in a further study of the effects of phosphate (P) supply on PS release, using 100 microM KH2PO4 as high P, or solid hydroxyapatite as a supply of low-release P. Phytosiderophore exudation was not increased due to P treatment under control or Zn-deficient conditions, but was increased by Fe deficiency. Accumulation of P in shoots of Zn- and Fe-deficient plants was seen in both P treatments, somewhat more so under the KH2PO4 treatment. Zinc-efficient wheats and grasses have been previously shown to exude more PS under Zn deficiency than Zn-inefficient genotypes. We did not observe Zn-deficiency-induced PS release and were unable to replicate the results of previous researchers. The tendency for Zn deficiency to induce PS release seems to be method dependent, and we suggest that all reported instances may be explained by an induced physiological deficiency of Fe.

Measurement of the albumin content of urinary protein using dipsticks.

An albumin selective urine strip based on bis (3',3''-diiodo-4', 4''-dihydroxy-5',5''-dinitrophenyl)-3,4,5,6-tetrabromo sulfonphthalein dye (DIDNTB) dye was examined in populations with clinical proteinuria. The relationship of albumin to the sum concentration of all protein in urine was found to vary widely even though the albumin concentration generally increased with the total protein concentration. The albumin reagent strips correlated well with immuno-nephrometric assays for albumin on specimens from hypertensives, diabetics, and renal disease which tended to have albumin contents of >/= 50.0%. High proteinuria concentrations of > 250 mg/l, with low albumin contents of

Physiological control of splanchnic blood flow by adrenaline: studies during acute hypoglycaemia in man.

Superior mesenteric artery blood flow (SMABF) increases significantly during and after the hypoglycaemia reaction in healthy humans. To investigate the mechanisms controlling this phenomenon, SMABF and plasma catecholamines were measured in healthy human volunteers. In 10 controls, hypoglycaemia was induced by insulin infusion (2.5 m-units.min-1.kg-1). In six subjects, beta-blockade by propranolol infusion (0.7 microgram.min-1.kg-1) preceded insulin infusion and was continued throughout the study. Following the hypoglycaemia reaction, the glucose nadir was similar in both groups. In controls, increases in SMABF [42.4+/-6.1% (mean+/-S.E.M.); P<0. 001], cardiac output (34.3+/-2.3%; P<0.001) and pulse rate (from 63. 9+/-2.7 to 82.5+/-3.1 beats/min; P<0.001) occurred. Superior mesenteric artery resistance fell by 32.4+/-3.3% (P<0.001). Under beta-blockade, decreases in SMABF (34.8+/-2.9%; P<0.001) and pulse rate (from 59.5+/-0.2 to 51.8+/-2.2 beats/min; P<0.001) occurred. Superior mesenteric artery resistance increased (peak +30.8+/-12.3%; not significant). Subjects showed greater increases in adrenaline (P<0.006) and noradrenaline (P<0.022) concentrations than controls. Mesenteric hyperaemia associated with hypoglycaemia in man appears to be mediated by a beta-adrenergic mechanism that is activated by increased circulating levels of adrenaline.

Increased splanchnic blood flow after hypoglycaemia in diabetic and normal man: evidence against glucagon as a mediator.

Superior mesenteric artery blood flow increases significantly after hypoglycaemia in healthy humans. Glucagon has vasoactive properties but its role in hypoglycaemic hyperaemia is unclear. To assess this role, we studied the superior mesenteric artery blood flow response to hypoglycaemia of patients with uncomplicated Type 1 (insulin-dependent) diabetes mellitus of at least 10 years duration; a group known to have defective glucagon response to hypoglycaemia. Hypoglycaemia was induced using an intravenous infusion of soluble human insulin (2.5 m-units.min-1.kg-1) discontinued at a plasma glucose of 2.5 mmol/l. Superior mesenteric artery blood flow was measured using transcutaneous duplex Doppler ultrasound. Plasma samples were assayed for glucose, insulin, glucagon, catecholamines, growth hormone and cortisol. Plasma glucose concentration fell to a nadir of 1.8 (0.3) mmol/l in patients and 1.4 (0.1) mmol/l in controls. Plasma glucagon concentration was unchanged in patients from a baseline level of 111.7 (13.1) ng/l but rose in controls from 105 (8.5) to a peak of 239 (3.1) ng/l (P<0.001). Superior mesenteric artery blood flow increased in both groups: from 385 (29) to 921 (100) ml/min (140% increase; P<0.05) in patients and from 517 (50) to 790 (67) (53% increase; P<0.001) in controls. This study shows that patients with Type 1 diabetes have a normal splanchnic vascular hyperaemic response to hypoglycaemia despite defective glucagon counter-regulation. These results support our previous work suggesting that glucagon is not a major mediator of this response; it seems likely that circulating adrenaline is the major regulatory mechanism.

HDL cholesterol: trends in two southeastern New England communities, 1981-1993.

PURPOSE: Although public health interventions have not specifically targeted high density lipoprotein (HDL) cholesterol, observed changes in the prevalence of other cardiovascular risk factors would be expected to have differential effects on HDL. This study examined secular trends in HDL in relation to changes in other cardiovascular risk factors for the years 1981 through 1993 in the Pawtucket Heart Health Program (PHHP) study communities. METHODS: Nonfasting HDL levels were assessed in 12,223 respondents to six biennial population random sample surveys. RESULTS: Between 1981 and 1993, mean HDL cholesterol declined by 0.08 mmol/L in both men and women after adjustment for age, city, education, hormone use, medications, recent alcohol use, smoking, regular exercise, body mass index (BMI), and total cholesterol, (p for trend < 0.001). There was no apparent laboratory explanation for the trend which occurred concurrent with decreased smoking prevalence, increasing BMI and decreased prevalence of recent alcohol use. Decreasing HDL cholesterol was observed consistently across subgroups defined by smoking, alcohol use and BMI. CONCLUSIONS: Although several favorable cardiovascular risk factor trends have been observed in recent decades, declining HDL cholesterol is also of interest, particularly in conjunction with population increases in BMI.

The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences.

BACKGROUND: Coexistent primary biliary cirrhosis (PBC) and coeliac disease has been recorded but the association has not been systematically studied. AIMS: To determine relative prevalences of PBC and coeliac disease in a defined population over a 12 year period. PATIENTS AND METHODS: All patients with PBC or coeliac disease in a stable population of 250,000 in South Wales were identified from a clinical register and laboratory records. RESULTS: Sixty seven patients with PBC and 143 patients with coeliac disease have been diagnosed and followed over a median of 86 (4-135) months; point prevalences in 1996 were 20 per 100,000 for PBC and 54 per 100,000 for coeliac disease. PBC in patients with coeliac disease was sought by investigating abnormal liver function tests. Ten (7%) had persistent abnormalities and three had PBC. Coeliac disease in patients with PBC was sought by investigating malabsorption, haematinic deficiency, positive antigliadin antibody, or coeliac disease family history. Eleven patients underwent duodenal biopsy revealing one further coeliac disease case. Four patients (three women have both conditions giving a point prevalence for patients with both conditions of 1.6 per 100,000 (95% confidence limits 0.44 to 4.1 per 100,000). Prevalence of PBC in patients with coeliac disease was 3% and of coeliac disease in patients with PBC was 6%. CONCLUSION: A 12 year study of a stable 250,000 population revealed a relative prevalence of PBC in 3% of 143 patients with coeliac disease and of coeliac disease in 6% of 67 patients with PBC. PBC and coeliac disease are therefore associated. Screening for PBC in patients with coeliac disease using antimitochondrial antibody testing and screening for coeliac disease in patients with PBC with antigliadin antibody testing or duodenal biopsy are recommended.

Short stature and cardiovascular disease among men and women from two southeastern New England communities.

BACKGROUND: Short stature has been associated with an increased risk of coronary heart disease (CHD), although the reason for the association remains unclear. Data on the relation between stature and stroke is more limited. We examined the association between stature and CHD as well as between stature and stroke in men and women from two communities in southeastern New England. METHODS: Coronary heart disease and stroke events were abstracted from medical records between January 1980 and December 1991. An epidemiological diagnostic algorithm developed to measure CHD was used in the present analysis. Unadjusted relative risks (RR) and RR adjusted for age, smoking status, obesity, high-density lipoprotein (HDL) cholesterol <0.91 mmol/l, total cholesterol >6.21 mmol/l, hypertension, diabetes, education, and being foreign born were computed by gender-specific height categories separately for men (n = 2826) and women (n = 3741). RESULTS: A graded inverse association between stature and risk of CHD was observed among men which persisted after adjustment for confounders. Men >69.75 inches had an 83% lower risk of CHD compared with men < or = 65 inches. In addition, the tallest men had a 67% decreased risk of stroke compared with the shortest men. No significant relation between stature and CHD or stroke was observed among women. CONCLUSIONS: These data support the hypothesis that stature is inversely related to both risk of CHD and stroke at least among men. Factors which might explain this association remain to be determined.

Comparison of urine dipsticks with quantitative methods for microalbuminuria.

We describe a new dip- and read dipstick that detects urine albumin at concentrations of 10 mg/l and above and urine creatinine at concentrations of 300 mg/l and above. The albumin assay is based on a high-affinity, dye-binding technique while the creatinine assay is based on the peroxidase-like activity of copper creatinine complexes. With these two-test dipsticks, urines from normal adults supplemented with albumin and creatinine were correctly identified to within +/- 15% of the expected value for both analytes; the between-day coefficients of variation ranged from 7.1% to 16.1%. We tested 275 patients' unmodified urines by the Bayer and Boehringer Mannheim Micral-Test albumin dipsticks and for albumin with the Beckman Array on the same specimens. We also analyzed 42 selected urines from the group of 275 for albumin by another quantitative immunochemical method and by electrophoresis plus a total protein method to estimate the albumin concentration. The quantitative immunochemical methods appear to underestimate the urine albumin concentrations; in these 42 urines measured as negative, i.e., < ca. 16-20 mg/l, by one of the quantitative method but positive by the Bayer dipstick, 33 of these were positive by the electrophoresis/total protein assay combination. The Bayer albumin dipstick correctly identified urines as having < 16 mg/l or > or = 16 mg/l at an 80% rate. At a cutoff of 20 mg/l, the rate increased to 87%. We also determined the urinary albumin/creatinine ratios on the 275 patients using the Bayer two-pad dipstick and found agreement 84% of the time with the same ratio obtained from a quantitative immunochemical method for albumin and a rate-Jaffe method for creatinine; an albumin/creatinine ratio (mg/g) of 30 was used as the discrimination point. Albumin stability studies performed on the Beckman Array patients with six fresh urines showed small but consistent decreases at -20 degrees C but not at 4 degrees C after one month of storage. The albumin in contrived urines, as estimated by electrophoreses/total protein and by the dipsticks did not change at these storage conditions. Boric acid at 1 g/l as a urine preservative had no effect on the measurement of albumin by any of the methods described here nor of the assay of creatinine. Other urinary proteins present at abnormal excretion rates did not interfere with the Bayer albumin dipstick. Abnormal concentrations of bilirubin, citrate, creatine, ascorbic acid, albumin, hemoglobin and myoglobin in urine did not interfere with the creatinine dipstick measurements. The first four of the above did not affect the Bayer dipstick results for albumin.