Baffles contained in conventional actuators may be a convenient alternative to some of the extension devices used presently with metered-dose inhalers (MDIs). Actuators were modified to determine ...whether baffles could be used to decrease the output of large "nonrespirable" droplets. These actuators were tested using a series of nonaqueous suspension aerosols containing 0.1 to 2.0% micronized disodium fluorescein (DF) as the model drug, stabilized by sorbitan trioleate in a constant blend of fluorocarbons 11, 12, and 114. A 25-microliter metering volume was used throughout. Aerosol output was characterized by cascade impaction. Baffle size and position had pronounced effects on actuator retention and aerosol output. Increasing baffle size resulted in increased retention in the actuator. The total output of the MDI in the "respirable" range (aerodynamic diameter, Dae, less than 5.5 microns) was greater in the unbaffled actuator than in all baffled actuators. However, all baffles increased the respirable fraction (DF with Dae less than 5.5 microns: total DF leaving the actuator), R, when compared to their unbaffled controls. For example, for a 0.1% DF, 0.14% surfactant formulation, R was increased from 0.40 (unbaffled) to 0.71 by incorporation of a 0.6-cm-diameter sphere 1.3 cm from the jet of the actuator. In these cases, aerosol segregation occurred due to droplet inertia in the high velocity gas flows. Increasing the respirable fraction at the expense of the total respirable output may obviate undesirable clinical effects.
Primary percutaneous coronary intervention (PPCI) is the preferred strategy for acute ST-segment elevation myocardial infarction (STEMI), with evidence of improved clinical outcomes compared to ...fibrinolytic therapy. However, there is no consensus on how best to manage multivessel coronary disease detected at the time of PPCI, with little robust data on best management of angiographically significant stenoses detected in non-infarct-related (N-IRA) coronary arteries. CVLPRIT will determine the optimal management of N-IRA lesions detected during PPCI.
CVLPRIT (Complete Versus culprit-Lesion only PRimary PCI Trial) is an open-label, prospective, randomised, multicentre trial. STEMI patients undergo verbal "assent" on presentation. Patients are included when angiographic MVD has been detected, and randomised to culprit (IRA)-only PCI (n=150) or in-patient complete multivessel PCI (n=150). Cumulative major adverse cardiac events (MACE) - all-cause mortality, recurrent MI, heart failure, need for revascularisation (PCI or CABG) will be recorded at 12 months. Secondary endpoints include safety endpoints of confirmed ischaemic stroke, intracranial haemorrhage, major non-intracranial bleeding, and repair of vascular complications. A cardiac magnetic resonance (CMR) substudy will provide mechanistic data on infarct size, myocardial salvage index and microvascular obstruction. A cost efficacy analysis will be undertaken.
The management of multivessel coronary artery disease in the setting of PPCI for STEMI, including the timing of when to perform non-culprit-artery revascularisation if undertaken, remains unresolved. CVLPRIT will yield mechanistic insights into the myocardial consequence of N-IRA intervention undertaken during the peri-infarct period.
Dabbling ducks (Anas spp.) are importantmigratory quarry species, protected as a shared resource under international legislation. However, there is a lack of sufficient high-quality data on vital ...demographic rates and long-term trends in numbers to judge the conservation status of many duck populations at the flyway level. In response to reported declines in the North-West European flyway population of theMallard, we compiled available data on this species in the Nordic countries up to 2010. Generally, national breeding numbers showed increasing trends, wintering abundance showed variable trends, and productivitymeasures indicated stable or increasing trends.Major knowledge gaps were identified, namely the size of hunting bags, the influence of the released Mallards and the role of short-stopping in explaining changing patterns of wintering abundance across the North-West European flyway. Numerically the Nordic breeding population appears in “good condition”, and the wintering numbers have been either stable or increasing in the last two decades. The annual number of releases needs to be determined in order to judge the sustainability of the current levels of exploitation. Overall, none of the indicators showed alarming signs for the Mallard population in the Nordic countries when considered in isolation. However, the widespread decline in wintering numbers elsewhere across North-western Europe requires urgent pan-European action.
