‘You have to learn to live with it’: a qualitative and quantitative study of older people with asthma

Introduction: Asthma mortality has declined overall because of a range of public health initiatives. In western countries, the majority of asthma deaths now occur in people over the age of 50. The reasons for the poorer response of older age groups to public health asthma initiatives are not known. Objectives: We undertook a study to investigate the disease perspectives of older people with asthma and barriers which may exist and prevent optimal asthma care. Methods: Fifty‐five participants (16 male and 39 female) aged over 50 from an inner city, suburban area and a rural region were recruited. Lung function was measured, and questionnaire data on asthma symptoms, knowledge and control, medication use and respiratory health were collected. Participants were also interviewed in‐depth, and the quantitative and qualitative data were triangulated. Results: Participants with a duration of asthma for >30 years reported significantly fewer symptoms and better quality of life irrespective of asthma severity, indicating less appreciation of symptoms in those with a long asthma duration. Interviews revealed this was related to previous asthma management strategies when treatment options were limited. Participants with a recent diagnosis sought understanding of asthma and the reason for their illness. Initiatives to improve asthma care in older people need to reflect these findings. Conclusions: Self‐management strategies for older people need to be tailored according to the time of disease onset and the duration of disease. Please cite this paper as: Goeman DP, O’Hehir RE, Jenkins C, Scharf SL and Douglass JA. ‘You have to learn to live with it’: a qualitative and quantitative study of older people with asthma. The Clinical Respiratory Journal 2007; 1:99–105.     

The incidence of error in young children's Wh-questions.

Many current generativist theorists suggest that young children possess the grammatical principles of inversion required for question formation but make errors because they find it difficult to learn language-specific rules about how inversion applies. The present study analyzed longitudinal spontaneous sampled data from twelve 2-3-year-old English speaking children and the intensive diary data of 1 child (age 2;7 [years;months] to 2;11) in order to test some of these theories. The results indicated significantly different rates of error use across different auxiliaries. In particular, error rates differed across 2 forms of the same auxiliary subtype (e.g., auxiliary is vs. are), and auxiliary DO and modal auxiliaries attracted significantly higher rates of errors of inversion than other auxiliaries. The authors concluded that current generativist theories might have problems explaining the patterning of errors seen in children's questions, which might be more consistent with a constructivist account of development. However, constructivists need to devise more precise predictions in order to fully explain the acquisition of questions.     

The topical organization of the afferents to the caudatoputamen of the rat. A horseradish peroxidase study

The aim of the present study was to assess (1) whether the various brain areas known to send projections to the neostriatum of the rat (neocortex, thalamus, substantia nigra, ventral tegmental area and dorsal raphe nucleus) project to all parts of this structure, and (2) whether the subcortical projections show a topical organization. For these purposes, small deposits of horseradish peroxidase were delivered by iontophoretic application, so that the whole extent of the caudatoputamen could be covered in a total of 40 rats.Labeled cortical cells were present mainly in lamina V, and showed a roughly topographical organization. Small numbers of labelled cells were observed in the basal nucleus of the amygdala after injections into the dorsal and central parts of the caudatoputamen. The cells of origin of thalamic afferents to the neostriatum were found not only in the intralaminar nuclei, but also in various other anterior, ‘midline’, and posterior nuclei (e.g. the medial part of the medial geniculate body). In the thalamostriatal projection a topical organization was demonstrated, consisting of oblique thalamic zones, which cross the borders of several thalamic nuclei and project to different parts of the neostriatum. In the substantia nigra and ventral tegmental area many retrogradely labelled cells were present. This nigrostriatal projection appears to be organized along an oblique longitudinal neostriatal axis. The nucleus raphes dorsalis was labelled most abundantly after caudal and ventrolateral injections into the caudatoputamen.It is concluded that, despite the homogeneous cytoarchitectonic structure of the caudatoputamen in the rat, this brain area is rather heterogeneous as regards its afferent connections. In fact each part of the neostriatum receives a specific and unique combination of afferents. The main changes in the input of the neostriatum appear to occur along an oblique longitudinal axis, from the most rostromedial and dorsal part to the caudolateral and ventral part. Such a topographical organization suggests that the neostriatum is likely to be involved in very complex integrative functions involving several brain areas.     

Influence of the punch diameter and curvature on the yield pressure of MCC-compacts during Heckel analysis.

The volume reduction behaviour of powders has been quantified by means of the 'in-die' yield pressure (YP) using Heckel analysis. However, because different YPs are reported for the same material, the experimental conditions influencing this material-constant were investigated. Silicified microcrystalline cellulose was compressed into flat-faced and convex tablets using a compaction simulator instrumented with load and displacement transducers. During compression, upper and lower punch force and displacement data were recorded and corrected for punch deformation. A symmetrical triangle wave compression profile was used and the instantaneous punch velocity was kept constant (5mm/s). Individual tablet height and weight were used for Heckel analysis. The influence of the 'effective compression pressure' (P(EFF)) (ranging from 10 to 350 MPa), punch diameter (PD) (4, 9.5 and 12 mm) and filling depth (FD) (4.5, 7.5 and 10.5mm) on YP was statistically evaluated using Response Surface Modelling software. A quadratic surface response equation, describing the relationship between P(EFF), PD, FD and YP, was proposed for concave (Adj R(2): 0.8424; S.D.: 14.60 MPa) and flat-faced (Adj R(2): 0.8409; S.D.: 4.49 MPa) punches. YP and tensile strength were mainly determined by P(EFF), irrespective of punch curvature. FD and PD had only a minor influence on the YP, although more pronounced for the concave punches. The method used resulted in reproducible P(EFF) and tensile strength values and the flat-faced tablets showed less weight variation. Flat-faced punches are preferred over punches with a concave surface when investigating the volume reduction behaviour of a powder by means of Heckel analysis and the experimental parameters should be reported.     

The Use of Cyclopenta[2,1‐b;3,4‐b′]dithiophene Analogues for the Development of Low‐Bandgap Materials

This paper presents the synthesis and characterization of low‐bandgap materials based on cyclopenta[1,2‐b;3,4‐b′]dithiophene (CPDT). An array of electron‐poor monomers is synthesized and used to prepare homo‐ and alternating donor–acceptor copolymers. This yields polymers with low bandgaps (E_g = 1.12–1.23 eV) and broad light absorption (400–1100 nm). The influence of the electron‐withdrawing substituent and the donor material on the polymer properties is studied. It is demonstrated that the low bandgap is not a result of intramolecular charge transfer, but of a transition localized in the electron‐poor CPDT monomer. The bandgap can be correlated with the substituent on the CPDT monomer and is relatively independent of other parameters, resulting in materials with an easily tunable bandgap.     

Cardiovascular safety of low-dose fenfluramine in Dravet syndrome: a review of its benefit-risk profile in a new patient population

Objective: Dravet syndrome (DS) is a rare, treatment-resistant epilepsy syndrome for which current treatment regimens are often ineffective. Fenfluramine is currently in development for treatment of DS, based on reports in the 1980s and 1990s of its anti-epileptic activity in pediatric patients with intractable epilepsy. However, fenfluramine was withdrawn from global markets in 1997 following reports of its association with pulmonary hypertension and heart valve disease in adult patients treated for obesity. This review was conducted to assess cardiac safety of fenfluramine when used at lower doses for treatment of DS.

Methods: Pubmed was searched for clinical studies of fenfluramine in obese adults who reported incidence of heart valve disease. These data were reviewed against published results from Belgian patients with DS who have been treated with low-dose fenfluramine for up to 28 years.

Results: Nine controlled studies of fenfluramine and related compounds (dexfenfluramine and/or phentermine) which assessed incidence and severity of cardiac valve disease in 3,268 treated patients and 2,017 control subjects have been reported. Mild or greater aortic valve regurgitation was found in 9.6% of treated patients compared with 3.9% of control subjects, and moderate or greater mitral valve regurgitation was found in 3.1% of treated patients and 2.5% of control subjects. Nineteen DS patients have been treated for up to 28 years with 10–20?mg/day fenfluramine, with no clinical signs or symptoms of cardiac valve disease or pulmonary hypertension. Slight and clinically unimportant changes in valve structure have been seen on echocardiography in five patients at some time during the observation period.

Conclusions: A different benefit-risk relationship appears to be emerging when fenfluramine is used at low doses for extended periods in young patients with DS. Continued cardiac assessments during ongoing Phase 3 clinical trials will provide additional safety information for this potential new and effective treatment.