Baseline Spirometry as a Predictor of Positive Methacholine Challenge Testing for Exertional Dyspnea.

BACKGROUND: There are several tests recommended by the American Thoracic Society (ATS) to evaluate for airway hyper-responsiveness (AHR), one of which is methacholine challenge testing (MCT). Few studies have examined the correlation of baseline spirometry to predict AHR in MCT, especially in the younger, relatively healthy military population under clinical evaluation for symptoms of exertional dyspnea. The study aim was to retrospectively correlate baseline spirometry values with MCT responsiveness. METHODS: This study is a retrospective review of all MCT performed at Brooke Army Medical Center/Wilford Hall Medical Center over a 12-y period; all completed studies were obtained from electronic databases. The following parameters were analyzed from the studies: baseline FEV1, FVC, FEV1/FVC, mid-expiratory flow (FEV25-75%), FEV25-75%/FVC. Studies were categorized based on baseline obstruction, restriction, FEF25-75% lower limit of normal, and response to bronchodilator testing (if completed); these values were compared based on methacholine reactivity and severity. RESULTS: Methacholine challenge studies (n = 1,933) were reviewed and categorized into reactive (n = 577) and nonreactive (n = 1,356) as determined by ATS guidelines. The mean baseline FEV1 (% predicted) with MCT reactivity was 88.0 ± 13.0% versus no MCT reactivity was 92.7 ± 13.0% (P < .001). The mean baseline FVC (% predicted) was 93.1 ± 13.7% versus 95.3 ± 13.5% (P < .001). The mean baseline FEV25-75% (% predicted) was 80.0 ± 22.1% versus 89.0 ± 23.4% (P < .001). Based on partition analysis, methacholine reactivity was most prevalent with baseline obstruction, n = 115 (43%), and in the absence of obstruction, when the FEF25-75% (% predicted) was below 0.70, n = 111 (40%). The negative predictive value with normal spirometry was 73%. CONCLUSIONS: The analysis of baseline spirometry prior to MCT proved useful in the evaluation of exertional dyspnea in a military population. The presence of airways obstruction (FEV1/FVC < lower limit of the normal range) followed by a reduction in FEV25-75% < 70% predicted showed a positive correlation with underlying AHR. In patients with exertional dyspnea and normal baseline spirometry, the use of the FEF25-75% may be a useful surrogate measurement to predict reactivity during MCT and consideration for additional testing or treatment.

Effects of Auditory Training and Remote Microphone Technology on the Behavioral Performance of Children and Young Adults Who Have Autism Spectrum Disorder.

BACKGROUND: Individuals who have a normal pure-tone audiogram but are diagnosed with autism spectrum disorder (ASD) often exhibit poorer speech recognition and auditory processing when compared with neurotypical peers with normal pure-tone audiograms. PURPOSE: The purpose of this study was to determine the efficacy and effectiveness of a 12-week auditory processing training (APT) program that was designed to address the deleterious effects of background noise and auditory processing deficits that are common among individuals diagnosed with ASD. RESEARCH DESIGN: A repeated measures design was used. STUDY SAMPLE: The sample consisted of 15 high-functioning children and young adults who had a formal diagnosis of ASD and who were recruited from local clinics and school districts. INTERVENTION: Participants completed the 12-week APT program consisting of computerized dichotic training, one-on-one therapist-directed auditory training, and the use of remote microphone (RM) technology at home and in the classroom. DATA COLLECTION AND ANALYSIS: Participants completed a comprehensive test battery to assess general auditory processing skills, speech recognition in noise, acceptance of background noise, spatial processing, binaural integration abilities, self-perceived difficulties, and observed behaviors. Testing was conducted before (n = 15), immediately after (n = 15), and 12 weeks after (n = 7) the completion of the APT program. Paired t-tests, repeated measures analysis of variance, or nonparametric tests were used to analyze the data. RESULTS: On average, the APT program significantly enhanced general auditory processing abilities, including binaural integration and subjective listening abilities in the classroom. When the RM was used, significantly improved speech recognition and improved acceptance of background noise was measured relative to a condition with no technology. CONCLUSIONS: Following the APT program, the participants exhibited the greatest improvements in testing that required binaural integration and auditory working memory. The use of the RM technology was able to address the deleterious effects of noise on speech recognition in noise and acceptance of noise levels.

Always looking on the bright side of life? Exploring optimism and health in three UK post-industrial urban settings.

BACKGROUND: Many theories have been proposed to explain the high levels of 'excess' mortality (i.e. higher mortality over and above that explained by differences in socio-economic circumstances) shown in Scotland-and, especially, in its largest city, Glasgow-compared with elsewhere in the UK. One such proposal relates to differences in optimism, given previously reported evidence of the health benefits of an optimistic outlook. METHODS: A representative survey of Glasgow, Liverpool and Manchester was undertaken in 2011. Optimism was measured by the Life Orientation Test (Revised) (LOT-R), and compared between the cities by means of multiple linear regression models, adjusting for any differences in sample characteristics. RESULTS: Unadjusted analyses showed LOT-R scores to be similar in Glasgow and Liverpool (mean score (SD): 14.7 (4.0) for both), but lower in Manchester (13.9 (3.8)). This was consistent in analyses by age, gender and social class. Multiple regression confirmed the city results: compared with Glasgow, optimism was either similar (Liverpool: adjusted difference in mean score: -0.16 (95% CI -0.45 to 0.13)) or lower (Manchester: -0.85 (-1.14 to -0.56)). CONCLUSIONS: The reasons for high levels of Scottish 'excess' mortality remain unclear. However, differences in psychological outlook such as optimism appear to be an unlikely explanation.

Comparing Antonovsky's sense of coherence scale across three UK post-industrial cities.

OBJECTIVES: High levels of 'excess' mortality (ie, that seemingly not explained by deprivation) have been shown for Scotland compared to England and Wales and, especially, for its largest city, Glasgow, compared to the similarly deprived English cities of Liverpool and Manchester. It has been suggested that this excess may be related to differences in 'Sense of Coherence' (SoC) between the populations. The aim of this study was to ascertain whether levels of SoC differed between these cities and whether, therefore, this could be a plausible explanation for the 'excess'. SETTING: Three post-industrial UK cities: Glasgow, Liverpool and Manchester. PARTICIPANTS: A representative sample of more than 3700 adults (over 1200 in each city). PRIMARY AND SECONDARY OUTCOME MEASURES: SoC was measured using Antonovsky's 13-item scale (SOC-13). Multivariate linear regression was used to compare SoC between the cities while controlling for characteristics (age, gender, SES etc) of the samples. Additional modelling explored whether differences in SoC moderated city differences in levels of self-assessed health (SAH). RESULTS: SoC was higher, not lower, among the Glasgow sample. Fully adjusted mean SoC scores for residents of Liverpool and Manchester were, respectively, 5.1 (-5.1 (95% CI -6.0 to -4.1)) and 8.1 (-8.1 (-9.1 to -7.2)) lower than those in Glasgow. The additional modelling confirmed the relationship between SoC and SAH: a 1 unit increase in SoC predicted approximately 3% lower likelihood of reporting bad/very bad health (OR=0.97 (95% CI 0.96 to 0.98)): given the slightly worse SAH in Glasgow, this resulted in slightly lower odds of reporting bad/very bad health for the Liverpool and Manchester samples compared to Glasgow. CONCLUSIONS: The reasons for the high levels of 'excess' mortality seen in Scotland and particularly Glasgow remain unclear. However, on the basis of these analyses, it appears unlikely that a low SoC provides any explanation.

Do postfire mulching treatments affect plant community recovery in California coastal sage scrub lands?

In recent years, the use of postfire mulch treatments to stabilize slopes and reduce soil erosion in shrubland ecosystems has increased; however, the potential effects on plant recovery have not been examined. To evaluate the effects of mulching treatments on postfire plant recovery in southern California coastal sage scrub, we conducted a field experiment with three experimental treatments, consisting of two hydromulch products and an erosion control blanket, plus a control treatment. The area burned in 2007, and treatments were applied to six plot blocks before the 2008 growing season. Treatment effects on plant community recovery were analyzed with a mixed effects ANOVA analysis using a univariate repeated measures approach. Absolute plant cover increased from 13 to 90% by the end of the second growing season, and the mean relative cover of exotic species was 32%. The two hydromulch treatments had no effect on any plant community recovery response variable measured. For the erosion control blanket treatment, the amount of bare ground cover at the end of the second growing season was significantly lower (P = 0.01), and greater shrub height was observed (P < 0.01). We conclude that postfire mulch treatments did not provide either a major benefit or negative impact to coastal sage scrub recovery on the study area.

Implementing the new BCG vaccination guidelines--a maternity hospital-based clinic approach.

BACKGROUND: With the recent changes to the UK BCG vaccination programme, the emphasis on childhood immunisation changes to identification and immunisation of at risk neonates. We report our experience of improving the system for provision of early BCG immunisation to high-risk infants born in the east of Glasgow. METHODS: A maternity hospital-based BCG clinic was established, together with a programme designed to increase awareness among midwifery and junior medical staff. RESULTS: Neonatal identification of at risk infants increased by 300% and was associated with high rates of clinic attendance and a 93% uptake of BCG immunisation in early infancy. Almost all infants were immunised within the first three months of life. CONCLUSION: Targeting parents prior to discharge from the maternity unit is an effective means of implementing BCG immunisation guidelines. The clinic model described is a successful and easily implemented example of co-operation between acute and community services.