Cracking the code : an approach to developing professional writing skills

The development of writing skills sufficient to meet the complexities of contemporary social work practice is a growing demand of employers and practice educators. This paper explores the development, implementation and evaluation of a university writing skills programme for social work students. The paper explores current pedagogical debate relating to student support and the development of writing skills and relates this debate to meeting the needs of social work students engaged in practice learning and professional practice. A number of questions are raised about current social work education in England and the needs of students entering from non-traditional academic backgrounds facing the increasingly rigorous demands of professional report writing. The discussion is then grounded in a practice example of staff from a university social work course and education guidance service working together to meet student need in respect of developing writing skills. The paper concludes by setting out a range of challenges arising from experience of the programme and a consideration of theory, and points to potential ways forward based on a social practice approach to teaching writing skills

Sex and gender in lung health and disease: more than just Xs and Ys

A new series explores the role of sex and gender-related factors in respiratory physiology, lung health, and across respiratory diseases https://bit.ly/3mP0BV

Exertional dyspnoea in pulmonary arterial hypertension.

Dyspnoea is a principal presenting symptom in pulmonary arterial hypertension (PAH), and often the most distressing. The pathophysiology of PAH is relatively well understood, with the primary abnormality of pulmonary vascular disease resulting in a combination of impaired cardiac output on exercise and abnormal gas exchange, both contributing to increased ventilatory drive. However, increased ventilatory drive is not the sole explanation for the complex neurophysiological and neuropsychological symptom of dyspnoea, with other significant contributions from skeletal muscle reflexes, respiratory muscle function, and psychological and emotional status. In this review, we explore the physiological aspects of dyspnoea in PAH, both in terms of the central cardiopulmonary abnormalities of PAH and the wider, systemic impact of PAH, and how these interact with common comorbidities. Finally, we discuss its relationship with disease severity

Pulmonary arterial hypertension registries: past, present and into the future

Registries have greatly contributed to knowledge about PAH epidemiology, risk factors, prognosis and treatment. Future registries face unique challenges but may benefit from integration of multiple data sources and capitalising on “Big Data” opportunitiesConflict of interest: J. Weatherald reports grants, personal fees and non-financial support from Janssen Inc. and Actelion, personal fees and non-financial support from Bayer, personal fees from Novartis, and grants from Alberta Lung Association, Canadian Vascular Network, European Respiratory Society and Canadian Thoracic Society, outside the submitted work. Conflict of interest: A. Reis reports grants, personal fees and non-financial support from Janssen Inc. and Actelion, outside the submitted work. Conflict of interest: O. Sitbon reports grants, personal fees and non-financial support from Actelion Pharmaceuticals, Bayer and Merck, grants from GlaxoSmithKline, grants, and personal fees from United Therapeutics and Gossamer Bio, outside the submitted work. Conflict of interest: M. Humbert reports personal fees from Actelion and Merck, and grants and personal fees from Bayer, GSK and United Therapeutics, outside the submitted work.info:eu-repo/semantics/publishedVersio

Pulmonary capillary blood volume and diffusing membrane capacity during exercise in humans:role of pulmonary artery pressure

During exercise, lung diffusing capacity for carbon monoxide (DL CO), pulmonary capillary blood volume (V c), and diffusing membrane capacity (D M) increase secondary to a rise in pulmonary artery pressure (PAP) and central blood volume mobilization. Although the role of central blood volume on DL CO is well established, the impact of PAP on DL CO, V c, and D M during exercise is less clear. Based on previous work, we tested the hypothesis that acute increases in PAP will potentiate exercise DL CO via increases in D M. Fifteen healthy young adults (7 females; age: 24 ± 4 yr) completed two bouts of cycling exercise at 60 W, with (CUFF) or without (CON) bilateral thigh cuff inflation pressurized to 90 mmHg. The multiple fractions of the inspired O 2-DL CO method were used to determine DL CO, V c, and D M at baseline and during both exercise conditions alongside estimates of cardiac output (Q _ c; impedance cardiography) and right ventricular systolic pressure (RVSP; echocardiography). CUFF exercise resulted in a larger increase in RVSP (CUFF: 44.7 ± 6.1 vs. CON: 38.9 ± 5.5 mmHg; P = 0.036) but not Q _ c (P = 0.644) or V _ o 2 (P = 0.976) compared with CON. DL CO was higher during the CUFF exercise (CUFF: 41 ± 6 vs. CON: 38 ± 6 mL/min/mmHg; P = 0.001) and was mediated by increases in D M (CUFF: 138 ± 55 vs. CON: 90 ± 39 mL/min/mmHg; P = 0.032), not V c (CUFF: 85 ± 18 vs. CON: 98 ± 27 mL/min/mmHg; P = 0.820). Increases in RVSP were positively related to D M (r rm = 0.82; P = 0.024) but inversely related to V c (r rm = -0.80, P = 0.029). Collectively, these data indicate that PAP primarily contributes to DL CO during low-intensity exercise via increases in capillary recruitment (i.e., D M).</p

Snowball Earth climate dynamics and Cryogenian geology–geobiology

Geological evidence indicates that grounded ice sheets reached sea level at all latitudes during the long‐lived Sturtian (717–659 Ma) and Marinoan (ca 645–635 Ma) glaciations. Combined U-­‐Pb and Re-­‐Os geochronology suggests that the Sturtian glacial onset and both terminations were globally synchronous. Geochemical data imply that atmospheric pCO2 was 102x modern at the Marinoan termination, consistent with Snowball Earth hysteresis. Sturtian glaciation followed the breakup of a tropical supercontinent, and its onset coincided with the equatorial emplacement of a large igneous province. Modeling shows that the small thermal inertia of a globally frozen surface reverses the annual-mean Hadley circulation, resulting in equatorial net sublimation and net deposition elsewhere. Oceanic ice thickens, forming a sea glacier that flows gravitationally toward the equator, sustained by the hydrologic cycle and by basal freeze-on and melting. Tropical ice sheets flow faster as CO2 rises, but lose mass and become sensitive to orbital forcing. Dust accumulation in the equatorial zone engenders supraglacial oligotrophic meltwater ecosystems, favorable for cyanobacteria and many eukaryotes. Meltwater flushing through moulins enables organic burial and submarine deposition of subaerially-­‐erupted volcanic ash. The subglacial ocean is turbulent and well­‐mixed, in response to geothermal heating and conductive heat loss through the ice cover, increasing with latitude. Cap carbonates, unique to Snowball Earth terminations, are products of intense weathering and ocean stratification. Whole-­ocean warming and ice-sheet forebulge collapse allow marine coastal inundations to progress long after ice-sheet disappearance. The evolutionary legacy of Snowball Earth is perceptible in fossils and living organisms

Awake prone positioning in adults with COVID-19

Importance: The impact of awake prone positioning (APP) on clinical outcomes in patients with COVID-19 and acute hypoxemic respiratory failure (AHRF) remains uncertain. Objective: To assess the association of APP with improved clinical outcomes among patients with COVID-19 and AHRF, and to identify potential effect modifiers. Data Sources: PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched through August 1, 2024. Study Selection: Randomized clinical trials (RCTs) examining APP in adults with COVID-19 and AHRF that reported intubation rate or mortality were included. Data Extraction and Synthesis: Individual participant data (IPD) were extracted according to PRISMA-IPD guidelines. For binary outcomes, logistic regression was used and odds ratio (OR) and 95% CIs were reported, while for continuous outcomes, linear regression was used and mean difference (MD) and 95% CIs were reported. Main Outcomes and Measures: The primary outcome was survival without intubation. Secondary outcomes included intubation, mortality, death without intubation, death after intubation, escalation of respiratory support, intensive care unit (ICU) admission, time from enrollment to intubation and death, duration of invasive mechanical ventilation, and hospital and ICU lengths of stay. Results: A total of 14 RCTs involving 3019 patients were included; 1542 patients in the APP group (mean [SD] age, 59.3 [14.1] years; 1048 male [68.0%]) and 1477 in the control group (mean [SD] age, 59.9 [14.1] years; 979 male [66.3%]). APP improved survival without intubation (OR, 1.42; 95% CI, 1.20-1.68), and it reduced the risk of intubation (OR, 0.70; 95% CI, 0.59-0.84) and hospital mortality (OR, 0.77; 95% CI, 0.63-0.95). APP also extended the time from enrollment to intubation (MD, 0.93 days; 95% CI, 0.43 to 1.42 days). In exploratory subgroup analyses, improved survival without intubation was observed in patients younger than age 68 years, as well as in patients with a body mass index of 26 to 30, early implementation of APP (ie, less than 1 day from hospitalization), a pulse saturation to inhaled oxygen fraction ratio of 155 to 232, respiratory rate of 20 to 26 breaths per minute (bpm), and those receiving advanced respiratory support at enrollment. However, none of the subgroups had significant interaction with APP treatment. APP duration 10 or more hours/d within the first 3 days was associated with increased survival without intubation (OR, 1.85; 95% CI, 1.37-2.49). Conclusions and Relevance: This IPD meta-analysis found that in adults with COVID-19 and AHRF, APP was associated with increased survival without intubation and with reduced risks of intubation and mortality, including death after intubation. Prolonged APP duration (10 or more hours/d) was associated with better outcomes

Screening strategies for pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is rare and, if untreated, has a median survival of 2–3 years. Pulmonary arterial hypertension may be idiopathic (IPAH) but is frequently associated with other conditions. Despite increased awareness, therapeutic advances, and improved outcomes, the time from symptom onset to diagnosis remains unchanged. The commonest symptoms of PAH (breathlessness and fatigue) are non-specific and clinical signs are usually subtle, frequently preventing early diagnosis where therapies may be more effective. The failure to improve the time to diagnosis largely reflects an inability to identify patients at increased risk of PAH using current approaches. To date, strategies to improve the time to diagnosis have focused on screening patients with a high prevalence [systemic sclerosis (10%), patients with portal hypertension assessed for liver transplantation (2–6%), carriers of mutations of the gene encoding bone morphogenetic protein receptor type II, and first-degree relatives of patients with heritable PAH]. In systemic sclerosis, screening algorithms have demonstrated that patients can be identified earlier, however, current approaches are resource intensive. Until, recently, it has not been considered possible to screen populations for rare conditions such as IPAH (prevalence 5–15/million/year). However, there is interest in the use of artificial intelligence approaches in medicine and the application of diagnostic algorithms to large healthcare data sets, to identify patients at risk of rare conditions. In this article, we review current approaches and challenges in screening for PAH and explore novel population-based approaches to improve detection