Background. Self-monitoring of symptoms or peak flow monitoring (PFM) is recommended for all asthma patients and is commonly included in asthma management plans. Limited data are available ...documenting PFM outcomes in school settings. Method. Three hundred twenty-three urban children with persistent asthma were enrolled in a school-based study that implemented an internet-based asthma monitoring and data collection system. The mean age of the children was 10.0 (SD 2.1) years; 57% were male and 91% were African American. Children logged in daily to an internet-based program to record their asthma symptoms and PFM reading. Teachers logged in daily to confirm the PFM readings. School staff responsible for student health reported actions taken for low PFM readings. Results. A total of 12,245 child reports were completed; 98% (n = 11,974) had corresponding teacher reports, confirming the peak flow meter readings reported by the children. The prevalence of reported asthma symptoms varied across PFM readings; the highest prevalence occurred in the setting of red zone readings, with intermediate prevalence in the setting of yellow zone readings, and lowest prevalence in the setting of green zone readings. The actions reported in response to children's symptoms and peak flow results similarly varied; however, instances of no action were reported in the setting of yellow and red zone readings. When comparing the "worst days" of children who had ever had a red or yellow PFM reading with those of children who only had exhibited green, there was a nonsignificant trend toward fewer symptoms in the green-only group. Additionally, there was a nonsignificant trend toward a greater likelihood of being sent to the office or school nurse with greater symptoms in the setting of a yellow or red zone reading. Conclusions. On the whole, peak flow readings tended to correspond to asthma disease activity. However, the data indicate that school staff may be more inclined to take action based on their own perceptions of a child's asthma or respond to children's subjective reports of asthma symptoms rather than using a more objective measure of disease activity provided by a peak flow meter.
Forests cover 59% of Taiwan island where disastrous floods, landslides and debris flows occur often due to heavy typhoon-season rainstorms, steep terrain, fragile geologic formations and frequent ...earthquakes. This study evaluated the hydrologic influences of forests on Taiwan’s headwaters watersheds and supports the century-old policy of designating protection forests for streamflow regulation and soil conservation. Despite rainfall intensity that often exceeds 100
mm/h overland flow rarely occurs on Taiwan’s permeable forest soils. High evapotranspiration totaling 800–1200
mm annually contributes to reduced streamflows. In Taiwan forests reduce stream sedimentation from landslides by enhancing slope stability with roots and protect water quality by minimizing stream temperature fluctuation, regulating nutrient concentration and filtering contaminants. Floods in Taiwan are mainly caused by heavy rainstorms exceeding 250
mm and are not significantly affected by the currently low level of annual forest removal. Rapid urbanization of some forested watersheds may cause increased peak flows and decreased low flows due to significantly reduced soil infiltration capacities. Forests’ influences are minimal on landslides, debris flows or floods caused by extreme natural events such as the 7.3 Richter-scale earthquake in September 1999 or the rainstorms exceeding 1000
mm during Typhoon Herb in August 1996.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
DISCUSSION Previous studies have demonstrated that transverse arch and descending aorta are independent variables, therefore a ratio of their diameter better signifies transverse arch hypoplasia than ...that of transverse arch/ascending aorta. 3 We found an empiric cut off point between normal and hypoplastic arch groups at 0.5 with equal distribution of anomalies, excepting uniform association of atrial septal defect to hypoplastic group. An arch incision extended beyond the origin of the left carotid artery was proposed as mandatory optimal reconstruction of the hypoplastic aortic arch. 2 It is generally acknowledged that the transverse aortic arch grows after coarctation repair so most centres now perform it with limited extensity. 3, 4 Postoperative remodelling is also recorded. 5 The purpose of this study was to investigate the time frame within which it occurs.
To determine the effect of a symptom-based and a peak flow-based action plan in preventing acute exacerbations in subjects with poorly controlled asthma.
A randomized controlled trial in which ...subjects who had required urgent treatment for their asthma were allocated to receive no action plan, a symptom-based plan, or a peak flow-based action plan.
A university hospital asthma clinic.
One hundred fifty subjects were recruited after attending an emergency department or a clinic for urgent treatment of asthma.
All subjects received evaluation and education for asthma before being randomly allocated to receive no action plan, a symptom-based action plan, or a peak flowmeter and a peak flow-based action plan.
Subjects were assessed by questionnaire at 3 and 6 months after enrollment with questions relating to their asthma control and their need for urgent treatment or hospital admission for asthma.
At 6 months after enrollment, although all three intervention groups experienced improvement in their asthma control, there was a striking reduction in emergency department visits for asthma only in the peak flow-based action plan group (p=0.006). No significant difference in emergency visits was apparent between the symptom-based action plan and no action plan groups.
We conclude that a peak flow-based action plan is effective, at least in the short term, in protecting patients with asthma against severe exacerbations of their disease.
Objective: A randomised controlled trial (RCT) to assess the effectiveness of nurse-initiated use of albuterol metered-dose inhaler (MDI) to patients for relieving the signs and symptoms of acute ...exacerbations of chronic obstructive pulmonary disease (COPD) prior to consultation in an emergency department (ED). Design: A single-centre unblinded RCT. Methods: Known COPD Chinese patients who aged at least 18 years old, previous use of albuterol MDI, competent to blow the peak flow meter and complained of dyspnoea. The anticipated time between nurse-initiated use of albuterol MDI and consultation was over five minutes. The subjects were recruited from the ED of a hospital in Hong Kong and were allocated to the albuterol or control group by block randomisation. Six albuterol puffs were administered via a MDI to the albuterol group but not the control group. Peak flow rate, blood oxygen saturation, respiratory rate, adverse effects, ED length of stay and admission rate were assessed before nursed-initiated use of albuterol MDI and prior to consultation. Results: 110 subjects were recruited and randomly allocated into the albuterol (n=55) or control (n=55) group. The PFR increased 2.4 L/minute (p<0.001) in the albuterol group but not in the control group. The oxygen saturation and symptom of dyspnoea also improved in the albuterol group but not in the control group. Conclusions: Nurse-initiated use of albuterol MDI can improve PFR prior to consultation so that it should be recommended as a standard practice in EDs to reduce the suffering of patients with acute exacerbations of COPD.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background: Exposure to cat and dog allergens is very common in the Western World and is a serious cause of asthma in sensitized subjects.
Objective: We sought to study the clinical effects of air ...cleaners in living rooms and bedrooms of asthmatic children sensitized to cat or dog allergens.
Methods: Twenty asthmatic children sensitized to pet allergens (cat/dog) and with an animal at home participated in a double-blind, placebo-controlled, cross-over study in which the effects of air cleaners placed in the living room and bedroom for 3 months were compared with the effects of sham air cleaners. Before and after each study period, lung function, airway hyperresponsiveness (adenosine monophosphate), and peak flow variation were recorded. Cat and dog allergen levels were assessed in the filters of the air cleaners.
Results: After a 3-month intervention with active air cleaners, airway hyperresponsiveness decreased significantly, showing a 1.2 doubling dose increase of PC
20 adenosine (
P = .003). Peak flow amplitude also decreased (
P = .045). Substantial amounts of airborne cat and dog allergen were captured by the air cleaners in living rooms and bedrooms as well. Allergen levels in floor dust were not changed.
Conclusion: In young asthmatic patients sensitized and exposed to pets in the home, application of air cleaners in living rooms and bedrooms was accompanied by a significant improvement in airway hyperresponsiveness and a decrease in peak flow amplitude. (J Allergy Clin Immunol 1999;104:447-51.)
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IJS, IMTLJ, KILJ, KISLJ, NUK, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
A randomized, placebo-controlled, double-blind study involving 60 subjects, aged 6-18 years old, was conducted over a period of 3 months to determine the effect of Pycnogenol® (a proprietary mixture ...of water-soluble bioflavonoids extracted from French maritime pine) on mild-to-moderate asthma. After baseline evaluation, subjects were randomized into two groups to receive either Pycnogenol® or placebo. Subjects were instructed to record their peak expiratory flow with an Assess® Peak Flow Meter each evening. At the same time, symptoms, daily use of rescue inhalers (albuterol), and any changes in oral medications were also recorded. Urine samples were obtained from the subjects at the end of the run-in period, and at 1-, 2-, and 3-month visits. Urinary leukotriene C4 D4 E4 was measured by an enzyme immunoassay. Compared with subjects taking placebo, the group who took Pycnogenol® had significantly more improvement in pulmonary functions and asthma symptoms. The Pycnogenol® group was able to reduce or discontinue their use of rescue inhalers more often than the placebo group. There was also a significant reduction of urinary leukotrienes in the Pycnogenol® group. The results of this study demonstrate the efficacy of Pycnogenol® as an adjunct in the management of mild-to-moderate childhood asthma.
A particularly useful generalized numerical solution for detention basin design is presented and sets the stage for practical applications for roof detention and the rationale and use of such a ...solution for detention basin design more generally. The generalized numerical solution provides results that can be applied to practical problems in certain cases and demonstrates the general importance of storm duration. The method utilizes a trapezoidal inflow hydrograph, which includes the important effect of storm duration based on the modified rational method. Convenient charts are presented to display the relationship between the variables. The derivation provides the basis for specializing the method to provide generalized curves applicable to storage detention on roofs. Although the results presented herein are more generalized than those presented by other writers, certain other methods are shown to compare favorably for special cases. An added perspective is provided on some of those other methods. Soil Conservation Service TR-55 curves are included in the comparisons, which demonstrates their limitations. An example demonstrates application of the generalized curves.
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DOBA, FGGLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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