Body mass index, airflow obstruction and dyspnea and body mass index, airflow obstruction, dyspnea scores, age and pack years-predictive properties of new multidimensional prognostic indices of chronic obstructive pulmonary disease in primary care.

BACKGROUND: The assessment of the severity of chronic obstructive pulmonary disease (COPD) should involve a multidimensional approach that is now clearly shown to be better than using spirometric impairment alone. The aim of this study is to validate and compare novel tools without an exercise test and to extend prognostic value to patients with less severe impairment of Forced expiratory volume 1 s. METHODS: A prospective, observational, primary care cohort study identified 458 eligible patients recruited from the primary care clinics in the northeast of England in 1999-2002. A new prognostic indicator - body mass index, airflow obstruction and dyspnea (BOD) together with the conventional prognostic indices age, dyspnea and airflow obstruction (ADO), global initiative for chronic obstructive lung disease (GOLD) and new GOLD matrix were studied. We also sought to improve prognostication of BOD by adding age (A) and smoking history as pack years (S) to validate BODS (BOD with smoking history) and BODAS (BOD with smoking history and age) as prognostic tools and the predictive power of each was analyzed. RESULTS: The survival of the 458 patients was assessed after a median of 10 years when the mortality was found to be 33.6%. The novel indices BOD, BODS, and BODAS were significantly predictive for all-cause mortality in our cohort. Furthermore with ROC analysis the C statistics for BOD, BODS, and BODAS were 0.62, 0.66, and 0.72, respectively (P < 0.001 for each), whereas ADO and GOLD stages had a C statistic of 0.70 (P < 0.001) and 0.56 (P < 0.02), respectively. GOLD Matrix was not significant in this cohort. CONCLUSION: BOD, BODS, and BODAS scores are validated predictors of all-cause mortality in a primary care cohort with COPD.

Developmental validation of the PowerPlex(®) Fusion System for analysis of casework and reference samples: A 24-locus multiplex for new database standards.

The original CODIS database based on 13 core STR loci has been overwhelmingly successful for matching suspects with evidence. Yet there remain situations that argue for inclusion of more loci and increased discrimination. The PowerPlex(®) Fusion System allows simultaneous amplification of the following loci: Amelogenin, D3S1358, D1S1656, D2S441, D10S1248, D13S317, Penta E, D16S539, D18S51, D2S1338, CSF1PO, Penta D, TH01, vWA, D21S11, D7S820, D5S818, TPOX, DYS391, D8S1179, D12S391, D19S433, FGA, and D22S1045. The comprehensive list of loci amplified by the system generates a profile compatible with databases based on either the expanded CODIS or European Standard Set (ESS) requirements. Developmental validation testing followed SWGDAM guidelines and demonstrated the quality and robustness of the PowerPlex(®) Fusion System across a number of variables. Consistent and high-quality results were compiled using data from 12 separate forensic and research laboratories. The results verify that the PowerPlex(®) Fusion System is a robust and reliable STR-typing multiplex suitable for human identification.

Precision in Diagnosing and Classifying COPD: Comparison of Historical Height with Current Height and Arm Span to Predict FEV(1).

BACKGROUND: Measured reductions in lung function, as a result of COPD, use a measured current value and make comparisons to a determined 'normal' value arrived at using a regression equation based upon a patients height. Osteoporosis is a recognised co-morbidity in patients with chronic obstructive pulmonary disease (COPD) and may cause excessive height loss resulting in the 'normal' values and disease progression being under-estimated. PURPOSE: The aim of the study was to examine the height variation in a cohort of COPD patients and controls over a 7-8 years period and evaluate its impact on estimates of lung function and hence COPD progression. METHODS: In 1999-2002 we studied a cohort of primary care patients in Sunderland, UK with and without COPD and reexamined 104 (56 male) during 2007-2009. We calculated FEV(1)% predicted for actual and estimated height (armspan/1.03 and armspan/1.01 in males and females respectively). RESULTS: In 1999-2002 the subjects were aged 62.6 ± 9.4 years, BMI was 26.4± 4.7 kg/m2, predicted FEV(1) was 59.0 ±16.0, and mean actual height was 167.3±8.9cm. The actual height changed significantly (p<0.001) by 2cms over time in both genders. Whilst the overall classifications of the cohort did not change significantly when armspan was used to determine height and hence normal lung volume, individual cases did move to a classification of higher severity. CONCLUSIONS: The study suggests that current measured height may underestimate the degree of impairment of FEV(1) and hence progression of COPD. The use of height, derived from armspan, may give a more accurate measure of 'normal' lung volumes and hence the degree of impairment.

The composition of PM10 as collected by a conventional TEOM, a modified TEOM and a Partisol gravimetric monitor at a kerbside site in the North East of England.

The composition of airborne particulate matter sampled by a conventional TEOM, an experimental modified TEOM, operated at a lower temperature but fitted with a drier to remove moisture and a Partisol, installed at a kerbside site in the North East of England, has been investigated. The results indicate that there is a seasonal variation in the composition of PM(10) as sampled by the three monitors, with chloride concentration being significantly higher in the winter. The Partisol was found to sample a higher mass of chloride and nitrate, however the differences between the monitors was only significant for chloride. Both TEOM's were found to sample a greater mass of sulphate, although the variability in the data collected meant that significance of the results was not proven statistically. The range of artifacts associated with PM(10) monitors is reviewed. Difficulties in the interpretation of results due to the variable nature of airborne particulate matter and the ability of filter based systems to accurately represent the composition of atmospheric particles are considered.

Interpretation of roadside PM10 monitoring data from Sunderland, United Kingdom.

Roadside PM10 has been monitored by Partisol at three sites in Sunderland between August 1997 and February 1998. The sites chosen were an inner city kerbside site; a roadside site adjacent to a dual carriageway on the outskirts of Sunderland with an open aspect; and a rural site. The results indicate that there is a seasonal variation in the relationship between the sites in terms of monitored PM10. In the winter there is a poor correlation between the sites whereas in the summer significant correlations are obtained. Of the sites monitored PM10 is consistently highest at the inner city roadside site. During the summer, exceedances of the U.K. 50 microg m(-3) standard (DETR, 2000) are associated with conditions suitable for the build-up of photochemical pollution however during the winter period exceedances are recorded during a variety of weather conditions. At the dual carriageway site PM2.5 has also been recorded and contributions to measured PM10 are 77% in summer and 68% in winter. The results illustrate a number of inconsistencies between this study utilising the Partisol and others reporting results where PM10 has been monitored by TEOM.