Testing for alpha-1 antitrypsin in COPD in outpatient respiratory clinics in Spain: A multilevel, cross-sectional analysis of the EPOCONSUL study

Background Alpha-1 antitrypsin deficiency (AATD) is the most common hereditary disorder in adults, but is under-recognized. In Spain, the number of patients diagnosed with AATD is much lower than expected according to epidemiologic studies. The objectives of this study were to assess the frequency and determinants of testing serum α1-antitrypsin (AAT) levels in COPD patients, and to describe factors associated with testing. Methods EPOCONSUL is a cross-sectional clinical audit, recruiting consecutive COPD cases over one year. The study evaluated serum AAT level determination in COPD patients and associations between individual, disease-related, and hospital characteristics. Results A total of 4,405 clinical records for COPD patients from 57 Spanish hospitals were evaluated. Only 995 (22.5%) patients had serum AAT tested on some occasion. A number of patient characteristics (being male [OR 0.5, p < 0.001], ≤55 years old [OR 2.38, p<0.001], BMI≤21 kg/m2 [OR 1.71, p<0.001], FEV1(%)<50% [OR 1.35, p<0.001], chronic bronchitis [OR 0.79, p < 0.001], Charlson index ≥ 3 [OR 0.66, p < 0.001], or history or symptoms of asthma [OR 1.32, p<0.001]), and management at a specialized COPD outpatient clinic [OR 2.73,p<0.001] were identified as factors independently associated with ever testing COPD patients for AATD. Overall, 114 COPD patients (11.5% of those tested) had AATD. Of them, 26 (22.8%) patients had severe deficiency. Patients with AATD were younger, with a low pack-year index, and were more likely to have emphysema (p<0.05). Conclusion Testing of AAT blood levels in COPD patients treated at outpatient respiratory clinics in Spain is infrequent. However, when tested, AATD (based on the serum AAT levels ≤100 mg/dL) is detected in one in five COPD patients. Efforts to optimize AATD case detection in COPD are needed.SEPA

Differences in the use of spirometry between rural and urban primary care centers in Spain

Objectives: The aim of this study is to evaluate the ability and practice of spirometry, training of technicians, and spirometry features in primary care centers in Spain, evaluating those located in a rural environment against those in urban areas. Methods: An observational cross-sectional study was conducted in 2012 by a telephone survey in 970 primary health care centers in Spain. The centers were divided into rural or urban depending on the catchment population. The survey contacted technicians in charge of spirometry and consisted of 36 questions related to the test that included the following topics: center resources, training doctors and technicians, using the spirometer, bronchodilator test, and the availability of spirometry and maintenance. Results: Although the sample size was achieved in both settings, rural centers (RCs) gave a lower response rate than urban centers (UCs). The number of centers without spirometry in rural areas doubled those in the urban areas. Most centers had between one and two spirometers. However, the number of spirometry tests per week was significantly lower in RCs than in UCs (4 [4.1%] vs 6.9 [5.7%], P,0.01). The availability of a specific schedule for conducting spirometries was higher in RCs than in UCs (209 [73.0%] vs 207 [64.2%], P=0.003). RCs were more satisfied with the spirometries (7.8 vs 7.6, P=0.019) and received more training course for interpreting spirometry (41.0% vs 33.2%, P=0.004). The performance of the bronchodilator test showed a homogeneous measure in different ways. The spirometer type and the reference values were unknown to the majority of respondents. Conclusion: This study shows the differences between primary care RCs and UCs in Spain in terms of performing spirometry. The findings in the present study can be used to improve the performance of spirometry in these area

Numerical and Analytical Model of an Electrodynamic Dust Shield for Solar Panels on Mars

Masuda and collaborators at the University of Tokyo developed a method to confine and transport particles called the electric curtain in which a series of parallel electrodes connected to an AC source generates a traveling wave that acts as a contactless conveyor. The curtain electrodes can be excited by a single-phase or a multi-phase AC voltage. A multi-phase curtain produces a non-uniform traveling wave that provides controlled transport of those particles [1-6]. Multi-phase electric curtains from two to six phases have been developed and studied by several research groups [7-9]. We have developed an Electrodynamic Dust Shield prototype using threephase AC voltage electrodes to remove dust from surfaces. The purpose of the modeling work presented here is to research and to better understand the physics governing the electrodynamic shield, as well as to advance and to support the experimental dust shield research

Evaluation of an Electrostatic Dust Removal System with Potential Application in Next-Step Fusion Devices

The ability to manage inventories of carbon, tritium, and high-Z elements in fusion plasmas depends on means for effective dust removal. A dust conveyor, based on a moving electrostatic potential well, was tested with particles of tungsten, carbon, glass and sand. A digital microscope imaged a representative portion of the conveyor, and dust particle size and volume distributions were derived before and after operation. About 10 cu mm volume of carbon and tungsten particles were moved in under 5 seconds. The highest driving amplitude tested of 3 kV was the most effective. The optimal driving frequency was 210 Hz (maximum tested) for tungsten particles, decreasing to below 60 Hz for the larger sand particles. Measurements of particle size and volume distributions after 10 and 100 cycles show the breaking apart of agglomerated carbon, and the change in particle distribution over short timescales 1 s)

A Neural Circuit Arbitrates between Persistence and Withdrawal in Hungry Drosophila

In pursuit of food, hungry animals mobilize significant energy resources and overcome exhaustion and fear. How need and motivation control the decision to continue or change behavior is not understood. Using a single fly treadmill, we show that hungry flies persistently track a food odor and increase their effort over repeated trials in the absence of reward suggesting that need dominates negative experience. We further show that odor tracking is regulated by two mushroom body output neurons (MBONs) connecting the MB to the lateral horn. These MBONs, together with dopaminergic neurons and Dop1R2 signaling, control behavioral persistence. Conversely, an octopaminergic neuron, VPM4, which directly innervates one of the MBONs, acts as a brake on odor tracking by connecting feeding and olfaction. Together, our data suggest a function for the MB in internal state-dependent expression of behavior that can be suppressed by external inputs conveying a competing behavioral drive

Direct and Inverse Results on Row Sequences of Hermite-Padé Approximation

We give necessary and sufficient conditions for the convergence with geometric rate of the common denominators of simultaneous rational interpolants with a bounded number of poles. The conditions are expressed in terms of intrinsic properties of the system of functions used to build the approximants. Exact rates of convergence for these denominators and the simultaneous rational approximants are provided.The work of B. de la Calle Ysern received support from MINCINN under grant MTM2009-14668-C02-02 and from UPM through Research Group “Constructive Approximation Theory and Applications”. The work of J. Cacoq and G. López was supported by Ministerio de Economía y Competitividad under grants MTM2009-12740-C03-01 and MTM2012-36372-C03-01

State of the art in the determination of trace elements in seawater: a worldwide proficiency test

This manuscript presents the results of the International Measurement Evaluation Programme 40 (IMEP-40) study, a proficiency test (PT) which was organised to assess the worldwide performance of laboratories for the determination of trace elements in seawater. This PT supports the implementation of the European Union Water Framework Directive 2000/60/EC, which aims at achieving a long-term high level protection of the aquatic environment, covering lakes, ground water and coastal waters. Forty-six participants reported results. The test item was seawater containing the trace elements As, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, Se and Zn. The trace elements in the test item were present in very low concentrations to mimic natural levels. The results of the participants were rated with z and zeta (zeta) scores in accordance with ISO 13528 and ISO 17043. The standard deviation for proficiency assessment, , was set at 25 % of the respective assigned values for the 12 measured elements based on previous experience with similar PTs. The low levels of the trace elements combined with the high salt concentration of the seawater made the measurements challenging. Many laboratories were unable to detect or quantify the elements and reported "lower than X" values. The percentage of satisfactory performances (expressed as z scores) ranged from 41 % (Cr, Fe) to 86 % (Mo). The PT study showed that the use of proper standard methods, like ISO 17294-2, and sensitive techniques, like inductively coupled plasma mass spectrometry (ICP-MS), contributed to performing well in this PT round