A pragmatic randomised controlled trial of tailored pulmonary rehabilitation in participants with difficult-to-control asthma and elevated body mass index.

BACKGROUND: Difficult-to-control asthma associated with elevated body mass index (BMI) is challenging with limited treatment options. The effects of pulmonary rehabilitation (PR) in this population are uncertain. METHODS: This is a randomised controlled trial of an eight-week asthma-tailored PR programme versus usual care (UC) in participants with difficult-to-control asthma and BMI ≥ 25 kg/m2. PR comprised two hours of education and supervised exercise per week, with encouragement for two individual exercise sessions. Primary outcome was difference in change in Asthma Quality of Life Questionnaire (AQLQ) in PR versus UC groups between visits. Secondary outcomes included difference in change in Asthma Control Questionnaire-6 (ACQ6), and a responder analysis comparing proportion reaching minimum clinically important difference for AQLQ and ACQ6. RESULTS: 95 participants were randomised 1:1 to PR or UC. Median age was 54 years, 60% were female and median BMI was 33.8 kg/m2. Mean  (SD) AQLQ was 3.9 (+/-1.2) and median (IQR) ACQ6 2.8(1.8-3.6). 77 participants attended a second visit and had results analysed. Median (IQR) change in AQLQ was not significantly different: 0.3 (- 0.2 to 0.6) in PR and - 0.1 (- 0.5 to 0.4) in UC, p = 0.139. Mean change in ACQ6 was significantly different: - 0.4 (95% CI - 0.6 to - 0.2) in PR and 0 (- 0.3 to + 0.3) in UC, p = 0.015, but below minimum clinically important difference. In ACQ6 responder analysis, minimum clinically important difference was reached by 18 PR participants (54.5%) versus 10 UC (22.7%), p = 0.009. Dropout rate was 31% between visits in PR group, and time to completion was significantly prolonged in PR group at 94 (70-107) days versus 63 (56-73) in UC, p < 0.001. CONCLUSIONS: PR improved asthma control and reduced perceived breathlessness in participants with difficult-to-control asthma and elevated BMI. However, this format appears to be suboptimal for this population with high drop-out rates and prolonged time to completion. Trial registration Clinicaltrials.gov. ID NCT03630432. Retrospectively registered, submitted May 26th 2017, posted August 14th 2018.

Primary care chaplaincy: an intervention for complex presentation.

AIM: To determine the responsiveness of primary care chaplaincy (PCC) to the current variety of presenting symptoms seen in primary care. This was done with a focus on complex and undifferentiated illness. BACKGROUND: Current presentations to primary care are often complex, undifferentiated and display risk factors for social isolation and loneliness. These are frequently associated with loss of well-being and spiritual issues. PCC provides holistic care for such patients but its efficacy is unknown in presentations representative of such issues. There is therefore a need to assess the characteristics of those attending PCC. The effectiveness of PCC relative to the type and number of presenting symptoms should also be analysed whilst evaluating impact on GP workload. METHODS: This was a retrospective observational study based on routinely collected data. In total, 164 patients attended PCC; 75 were co-prescribed antidepressants (AD) and 89 were not (No-AD). Pre- and post-PCC well-being was assessed by the Warwick-Edinburgh mental well-being score. Presenting issue(s) data were collected on a separate questionnaire. GP appointment utilisation was measured for three months pre- and post-PCC. FINDINGS: Those displaying undifferentiated illness and risk factors for social isolation and loneliness accessed PCC. PCC (No-AD) was associated with a clinically meaningful and statistically significant improvement in well-being in all presenting issues. This effect was maintained in those with multiple presenting issues. PCC was associated with a reduction in GP appointment utilisation in those not co-prescribed AD.

Abnormal liver function tests in inflammatory arthritis: think beyond the DMARDs.

Abnormal liver function tests are often seen in patients with inflammatory arthritis. These are commonly associated with disease-modifying anti-rheumatic drugs, however, clinicians must hold a high index of suspicion for less common causes. This article details two of such cases where hereditary haemochromatosis and acute hepatitis E infection were actually responsible for deranged serum liver enzymes. Correct identification of these conditions leads to disease specific management and improved patient outcomes.

Determination of the True Lateral Grain Size in Organic-Inorganic Halide Perovskite Thin Films.

In this letter, methylammonium lead iodide (MAPbI3) thin films were examined via piezoresponse force microscopy (PFM) and nanoindentation (NI) to determine if long-range atomic order existed across the full width and depth of the apparent grains. From the PFM, the piezoelectric response of the films was strongly correlated with low-index planes of the crystal structure and ferroelastic domains in macroscale solution-grown MAPbI3 crystals, which implied long-range order near the top surface. From the NI, it was found that the induced cracks were straight and extended across the full width of the apparent grains, which indicated that the long-range order was not limited to the near-surface region, but extended through the film thickness. Interestingly, the two MAPbI3 processes examined resulted in subtle differences in the extracted electro-mechanical and fracture properties, but exhibited similar power conversion efficiencies of >17% in completed devices.

The efficacy of primary care chaplaincy compared with antidepressants: a retrospective study comparing chaplaincy with antidepressants.

Aim To determine the effectiveness of primary care chaplaincy (PCC) when used as the sole intervention, with outcomes being compared directly with those of antidepressants. This was to be carried out in a homogenous study population reflective of certain demographics in the United Kingdom. BACKGROUND: Increasing numbers of patients are living with long-term conditions and 'modern maladies' and are experiencing loss of well-being and depression. There is an increasing move to utilise non-pharmacological interventions such as 'talking therapies' within this context. Chaplaincy is one such 'talking therapy' but within primary care its evidence base is sparse with only one quantitative study to date. There is therefore a need to evaluate PCC excluding those co-prescribed antidepressants, as this is not evidenced in the literature as yet. PCC also needs to be directly compared with the use of antidepressants to justify its use as a valid alternative treatment for loss of well-being and depression. METHODS: This was a retrospective observational study based on routinely collected data. There were 107 patients in the PCC group and 106 in the antidepressant group. Socio-demographic data were collected. Their pre- and post-intervention (either chaplaincy or antidepressant) well-being was assessed, by the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) which is a validated Likert scale. Findings The majority of both groups were female with both groups showing marked ethnic homogeneity. PCC was associated with a significant and clinically meaningful improvement in well-being at a mean follow-up of 80 days. This treatment effect was maintained after those co-prescribed antidepressants were removed. PCC was associated with an improvement in well-being similar to that of antidepressants with no significant difference between the two groups.

Electronic and Morphological Inhomogeneities in Pristine and Deteriorated Perovskite Photovoltaic Films.

We perform scanning microwave microscopy (SMM) to study the spatially varying electronic properties and related morphology of pristine and degraded methylammonium lead-halide (MAPI) perovskite films fabricated under different ambient humidity. We find that higher processing humidity leads to the emergence of increased conductivity at the grain boundaries but also correlates with the appearance of resistive grains that contain PbI2. Deteriorated films show larger and increasingly insulating grain boundaries as well as spatially localized regions of reduced conductivity within grains. These results suggest that while humidity during film fabrication primarily benefits device properties due to the passivation of traps at the grain boundaries and self-doping, it also results in the emergence of PbI2-containing grains. We further establish that MAPI film deterioration under ambient conditions proceeds via the spatially localized breakdown of film conductivity, both at grain boundaries and within grains, due to local variations in susceptibility to deterioration. These results confirm that PbI2 has both beneficial and adverse effects on device performance and provide new means for device optimization by revealing spatial variations in sample conductivity as well as morphological differences in resistance to sample deterioration.

Characterization of ZnO Interlayers for Organic Solar Cells: Correlation of Electrochemical Properties with Thin-Film Morphology and Device Performance.

This report focuses on the evaluation of the electrochemical properties of both solution-deposited sol-gel (sg-ZnO) and sputtered (sp-ZnO) zinc oxide thin films, intended for use as electron-collecting interlayers in organic solar cells (OPVs). In the electrochemical studies (voltammetric and impedance studies), we used indium-tin oxide (ITO) over coated with either sg-ZnO or sp-ZnO interlayers, in contact with either plain electrolyte solutions, or solutions with probe redox couples. The electroactive area of exposed ITO under the ZnO interlayer was estimated by characterizing the electrochemical response of just the oxide interlayer and the charge transfer resistance from solutions with the probe redox couples. Compared to bare ITO, the effective electroactive area of ITO under sg-ZnO films was ca. 70%, 10%, and 0.3% for 40, 80, and 120 nm sg-ZnO films. More compact sp-ZnO films required only 30 nm thicknesses to achieve an effective electroactive ITO area of ca. 0.02%. We also examined the electrochemical responses of these same ITO/ZnO heterojunctions overcoated with device thickness pure poly(3-hexylthiophehe) (P3HT), and donor/acceptor blended active layers (P3HT:PCBM). Voltammetric oxidation/reduction of pure P3HT thin films on ZnO/ITO contacts showed that pinhole pathways exist in ZnO films that permit dark oxidation (ITO hole injection into P3HT). In P3HT:PCBM active layers, however, the electrochemical activity for P3HT oxidation is greatly attenuated, suggesting PCBM enrichment near the ZnO interface, effectively blocking P3HT interaction with the ITO contact. The shunt resistance, obtained from dark current-voltage behavior in full P3HT/PCBM OPVs, was dependent on both (i) the porosity of the sg-ZnO or sp-ZnO films (as revealed by probe molecule electrochemistry) and (ii) the apparent enrichment of PCBM at ZnO/P3HT:PCBM interfaces, both effects conveniently revealed by electrochemical characterization. We anticipate that these approaches will be applicable to a wider array of solution-processed interlayers for "printable" solar cells.

Electrical property heterogeneity at transparent conductive oxide/organic semiconductor interfaces: mapping contact ohmicity using conducting-tip atomic force microscopy.

We demonstrate mapping of electrical properties of heterojunctions of a molecular semiconductor (copper phthalocyanine, CuPc) and a transparent conducting oxide (indium-tin oxide, ITO), on 20-500 nm length scales, using a conductive-probe atomic force microscopy technique, scanning current spectroscopy (SCS). SCS maps are generated for CuPc/ITO heterojunctions as a function of ITO activation procedures and modification with variable chain length alkyl-phosphonic acids (PAs). We correlate differences in small length scale electrical properties with the performance of organic photovoltaic cells (OPVs) based on CuPc/C(60) heterojunctions, built on these same ITO substrates. SCS maps the "ohmicity" of ITO/CuPc heterojunctions, creating arrays of spatially resolved current-voltage (J-V) curves. Each J-V curve is fit with modified Mott-Gurney expressions, mapping a fitted exponent (γ), where deviations from γ = 2.0 suggest nonohmic behavior. ITO/CuPc/C(60)/BCP/Al OPVs built on nonactivated ITO show mainly nonohmic SCS maps and dark J-V curves with increased series resistance (R(S)), lowered fill-factors (FF), and diminished device performance, especially near the open-circuit voltage. Nearly optimal behavior is seen for OPVs built on oxygen-plasma-treated ITO contacts, which showed SCS maps comparable to heterojunctions of CuPc on clean Au. For ITO electrodes modified with PAs there is a strong correlation between PA chain length and the degree of ohmicity and uniformity of electrical response in ITO/CuPc heterojunctions. ITO electrodes modified with 6-8 carbon alkyl-PAs show uniform and nearly ohmic SCS maps, coupled with acceptable CuPc/C(60)OPV performance. ITO modified with C14 and C18 alkyl-PAs shows dramatic decreases in FF, increases in R(S), and greatly enhanced recombination losses.

Surface-initiated synthesis of poly(3-methylthiophene) from indium tin oxide and its electrochemical properties.

Poly(3-methylthiophene) (P3MT) was synthesized directly from indium tin oxide (ITO) electrodes modified with a phosphonic acid initiator, using Kumada catalyst transfer polymerization (KCTP). This work represents the first time that polymer thickness has been controlled in a surface initiated KCTP reaction, highlighting the utility of KCTP in achieving controlled polymerizations. Polymer film thicknesses were regulated by the variation of the solution monomer concentration and ranged from 30 to 265 nm. Electrochemical oxidative doping of these films was used to manipulate their near surface composition and effective work function. Doped states of the P3MT film are maintained even after the sample is removed from solution and potential control confirming the robustness of the films. Such materials with controllable thicknesses and electronic properties have the potential to be useful as interlayer materials for organic electronic applications.

Ameloblastoma: a surgeon's dilemma.

PURPOSE: To investigate whether there were any significant differences in the mode of presentation, treatment, and outcome of patients presenting with a primary diagnosis of ameloblastoma in Glasgow, Scotland and San Francisco, CA. MATERIALS AND METHODS: All cases of ameloblastoma seen in both institutions between January 1, 1980 and December 31, 1999 were included in this study. Mode of presentation, radiographic appearance, histologic appearance, treatment, and follow-up were recorded. RESULTS: There were no significant differences in the clinical features on presentation (swelling, followed by pain, and altered sensation), the radiographic appearance (unilocular approximately 30% and multilocular 70%), or management with either local treatment (enucleation and/or curettage in just over 50% of cases) or radical treatment (a form of resection in under 50%) in the 50 cases included in this study. Primary care by conservative treatment led to a recurrence in approximately 80% of cases and this included cases of unicystic ameloblastoma. CONCLUSION: The mode of presentation, diagnosis, and management of the ameloblastoma was remarkably similar in Glasgow and San Francisco. The recurrence rate following local enucleation and curettage was unacceptably high, and this included the cases of unicystic ameloblastoma, which should be treated more aggressively than has been recommended in the past.

New horizons for public health in Kazakhstan.

This paper, the first ever to review and critique public health developments in Kazakhstan, suggests ways in which public health can be improved strategically. The paper outlines the main threats to health in a dynamic economically developing country, but argues that with a health care reform agenda in place, and the Governments apparent support of public health policy initiatives, the time is right for new opportunities in the promotion of health. The paper utilises the Ottawa Charter, but suggests novel, more appropriate headings for Kazakhstan, to galvanise policy makers and professionals into tackling the growing burden of disease. It concludes by calling for greater transparency in relation to Government policy initiatives, and the need for greater national and international collaboration.