Computed cardiopulmonography and the idealized lung clearance index, iLCI2.5, in early-stage cystic fibrosis.

This study explored the use of computed cardiopulmonography (CCP) to assess lung function in early-stage cystic fibrosis (CF). CCP has two components. The first is a particularly accurate technique for measuring gas exchange. The second is a computational cardiopulmonary model where patient-specific parameters can be estimated from the measurements of gas exchange. Twenty-five participants (14 healthy controls, 11 early-stage CF) were studied with CCP. They were also studied with a standard clinical protocol to measure the lung clearance index (LCI2.5). Ventilation inhomogeneity, as quantified through CCP parameter σlnCl, was significantly greater (P < 0.005) in CF than in controls, and anatomical deadspace relative to predicted functional residual capacity (DS/FRCpred) was significantly more variable (P < 0.002). Participant-specific parameters were used with the CCP model to calculate idealized values for LCI2.5 (iLCI2.5) where extrapulmonary influences on the LCI2.5, such as breathing pattern, had all been standardized. Both LCI2.5 and iLCI2.5 distinguished clearly between CF and control participants. LCI2.5 values were mostly higher than iLCI2.5 values in a manner dependent on the participant's respiratory rate (r = 0.46, P < 0.05). The within-participant reproducibility for iLCI2.5 appeared better than for LCI2.5, but this did not reach statistical significance (F ratio = 2.2, P = 0.056). Both a sensitivity analysis on iLCI2.5 and a regression analysis on LCI2.5 revealed that these depended primarily on an interactive term between CCP parameters of the form σlnCL*(DS/FRC). In conclusion, the LCI2.5 (or iLCI2.5) probably reflects an amalgam of different underlying lung changes in early-stage CF that would require a multiparameter approach, such as potentially CCP, to resolve.NEW & NOTEWORTHY Computed cardiopulmonography is a new technique comprising a highly accurate sensor for measuring respiratory gas exchange coupled with a cardiopulmonary model that is used to identify a set of patient-specific characteristics of the lung. Here, we show that this technique can improve on a standard clinical approach for lung function testing in cystic fibrosis. Most particularly, an approach incorporating multiple model parameters can potentially separate different aspects of pathological change in this disease.

An FTIR emission study of the products of NO A2Σ+ (v = 0, 1) + O2 collisions.

Collisional quenching of NO A2Σ+ (v = 0, 1) by O2 has been studied through the detection of vibrationally excited products by time-resolved Fourier transform infrared emission spectroscopy. Non-reactive quenching of NO A2Σ+ (v = 0) produces a vibrational distribution in NO X2Π which has been quantified for v = 2-22, and is found to be bimodal. The results are consistent with two quenching channels. The first forms the ground X3Σ or low-lying a 1Δg electronic state of O2 with a distribution including high vibrational levels of NO X2Π which is slightly hotter than statistical. Two possibilities are identified for the second channel. The first, with a similar quantum yield to that producing higher vibrational levels, forms a highly electronically excited state, such as O2 c1Σ, with low vibrational levels in NO X2Π which are inverted with a distribution resembling that resulting from a sudden or harpoon mechanism. The second is that ground state oxygen is formed with low vibrational energy partitioned into NO X2Π. In addition, vibrationally excited NO2 is observed, but at intensities which indicate that it is formed in low quantum yield. Quantitatively unobservable processes (defined as those which do not form ground state NO (v ≥ 2)) are found to have a branching ratio of at most 25 ± 5%. The results are compared with those of previous studies and the most consistent interpretation suggests that dissociation of O2 to form ground state O(3P) atoms and ground vibrational state NO X2Π (v = 0) is the main reactive process rather than NO2 formation. Qualitatively similar results are seen for the quenching of NO A2Σ+ (v = 1).

Effectively Communicating Colorectal Cancer Screening Information to Primary Care Providers: Application for State, Tribe or Territory Comprehensive Cancer Control Coalitions.

BACKGROUND: Patients are more likely to be screened for colorectal cancer if it is recommended by a health care provider. Therefore, it is imperative that providers have access to the latest screening guidelines. PURPOSE: This practice-based project sought to identify Kentucky primary care providers' preferred sources and methods of receiving colorectal cancer information to improve state comprehensive cancer control provider outreach initiatives. METHODS: Four focus groups were conducted with primary care physicians, nurse practitioners, and physician assistants. Discussion included preferred sources and methods of receiving updated screening guidelines, legislation, and statewide public awareness campaign materials. RESULTS: Providers (N = 17) identified their preferred methods for receiving colorectal cancer information as: routine emails from trusted sources (colleagues, professional societies and research, and advocacy agencies), scientific journals, existing conferences, and the media. DISCUSSION: When delivering colorectal cancer information to primary care providers, multiple approaches are needed. An ideal partner for dissemination of information is state comprehensive cancer control coalitions, considering their prioritization of colorectal cancer screening and existing networks of partners who were identified as trusted sources. TRANSLATION TO HEALTH EDUCATION PRACTICE: Assessment of primary care providers' preferred methods and sources of receiving colorectal cancer information informs strategies for practice among comprehensive cancer control coalitions.

Revision of comprehensive cancer control plans: experiences shared by three states.

In the early 1990 s, a new movement emerged across the country to improve the way organizations coordinate and collaborate in the fight against cancer. Central to this movement is the development and implementation of a strategic plan, called a comprehensive cancer control (CCC) plan. Currently, sixty-nine plans exist among US states, tribes or tribal organizations, territories and Pacific Island Jurisdictions. The majority of CCC plans cover a five-year timeframe; typically in the fifth year, a plan update or plan revision process begins. Although many plans have common components, different processes have been utilized by various programs to update plans. This article describes the process used by Kentucky, Michigan and Wyoming to update and revise their CCC plans. Common key factors for successful cancer plan revision and implementation will be described based on experiences shared by the three states.

"One man one job": the marriage ban and the employment of women teachers in Irish primary schools.

In 1932, the Irish government, facing an economic downturn, introduced a marriage ban which required that female primary school teachers were required to resign on marriage. This followed a series of restrictive legislative measures adopted by Irish governments throughout the 1920s which sought to limit women's participation in public life and the public sector. Such a requirement emerged in several countries in response to high unemployment and applied principally to women's white-collar occupations, leading some commentators to argue that it stemmed from a social consensus rather than an economic rationale. Despite opposition to the ban from the Irish National Teachers' Organisation (INTO) on the basis that it was unconstitutional, would lead to fewer marriages and that married women were in fact more suited to teaching children, it remained in place until 1958. Although the ban is much referred to as part of the gender ideology that informed legislation in the early years of independent Ireland, the particular history of married women teachers has been little researched in the academic context. Over 50 years since the rescinding of the ban, this article examines its impact through an analysis of primary sources, including government cabinet minutes and the public commentary of the INTO and positions this history within the international context.

Evaluation of educational materials on colorectal cancer screening in Appalachian Kentucky.

INTRODUCTION: Despite the availability of preventive screening for colorectal cancer, compliance with screening recommendations in Appalachian Kentucky is low. Although there are various cancer education materials available, none focus on Appalachian populations and few on low-literacy populations. The purpose of this study was to assess the type of information needed in written educational materials about colorectal cancer for Appalachian populations in Kentucky. METHODS: Seven focus groups were held in two Appalachian regions of Kentucky. Thirty-four members of the community participated in four focus groups held for the general public, and 15 staff members of primary care physicians' offices participated in three focus groups. One facilitator led all seven focus groups using a moderator's guide. Participants were asked to review and rank two fact sheets and two brochures about colorectal cancer according to perceived effectiveness. RESULTS: There was consensus between the general public focus groups and physician office staff focus groups about the ranking of materials. All groups preferred the Centers for Disease Control and Prevention's Screen for Life: National Colorectal Cancer Action Campaign fact sheet and brochure to the other materials. They indicated that factors such as print size, inclusion of diagrams, and clear and simple presentation of the information were important and made the materials easier to use and understand. A consensus was also reached among groups on the relative importance of types of information that should be provided in the materials. CONCLUSION: The use of educational materials to communicate messages about cancer screening is important in increasing awareness and providing valuable health information. Members of the Appalachian community and staff members of physicians' offices preferred and recommended use of Screen for Life materials for low-literacy and Appalachian populations over other educational materials.

Patterns of colorectal cancer incidence, risk factors, and screening in Kentucky.

BACKGROUND: Colorectal cancer incidence rates are higher in Kentucky than in the United States in general, and there are regional variations within the state. METHODS: This study investigates these variations in relation to lifestyle and health behaviors, combining data from the Kentucky Behavioral Risk Factor Surveillance System (BRFSS), and from the Kentucky Cancer Registry. We used Kentucky's fifteen Area Development Districts (ADDs) as units of analysis across a five-year period from 1993 to 97. RESULTS: Differences were observed across ADDs. ADDs with a higher prevalence of risk factors, with the exception of chronic alcohol drinking, had lower CRC rates. ADDs with a higher proportion of respondents having had recent routine check-ups had higher CRC incidence rates. CONCLUSIONS: In general, healthier lifestyles and positive health-related behaviors were associated with increased colorectal cancer incidence. This may be explained by the tendency for healthier individuals to receive regular check-ups and screening, thus increasing the detection rate of colorectal cancer.

Geographic trends in cervical cancer incidence and mortality in Kentucky, 1995-2000.

BACKGROUND: Kentucky's elevated cervical cancer incidence and mortality rates are well documented. However, in Kentucky, as in the United States as a whole, cervical cancer incidence and mortality have been decreasing. METHODS: To determine if the incidence and mortality declines in Kentucky are similar in different geographic regions of the state, incidence and mortality data for the six-year period 1995-2000 were analyzed by five geographic subdivisions. RESULTS: Overall, both incidence and mortality rates declined during the six-year period; however, there were variations in the decline by geographic subdivisions. In 1995-2000, the greatest percentage decrease (43%) in incidence rates among the geographic subdivisions occurred in Fayette/Jefferson counties while their mortality rates increased (12%). Conversely, the Appalachian region of the state had a lower percentage decrease (11%) in incidence with a concurrent percentage decrease in mortality (45%). CONCLUSIONS: Intensified screening efforts may have resulted in increased detection of early stage cervical disease; which provided a subsequent reduction in mortality for the Appalachian region of the state, while Fayette/Jefferson County has a mortality rate that slopes upward necessitating additional investigation.