Peak Flow Research Articles

Effects of single and combined urinary polycyclic aromatic hydrocarbon effects on lung function in the U.S. adult population

BackgroundThe impact of polycyclic aromatic hydrocarbons (PAHs) on lung function has garnered attention, but studies mostly focus on individual effect. This study investigates urinary PAH metabolites as biomarkers of exposure and assesses the relationships between single and combined exposures to nine urinary PAH metabolites and lung function in adults.MethodsData from 4040 adults in the 2007–2012 National Health and Nutrition Examination Survey (NHANES) were analyzed. Weighted generalized linear models estimated the effects of individual PAH metabolites on lung function. Additionally, weighted quantile sum (WQS) regression, quantile g-computation (qgcomp), and Bayesian kernel machine regression (BKMR) were employed to evaluate the combined impacts of multiple PAH metabolites.ResultsAnalyses of individual PAH metabolites revealed negative associations with lung function, excluding forced vital capacity (FVC). The WQS, qgcomp, and BKMR models consistently showed that exposure to multiple PAH metabolites was associated with lung function decrease. WQS indicated that 2-hydroxynaphthalene (2-NAP) was the largest contributor to the reductions in forced expiratory volume in 1 s (FEV1), FVC, peak expiratory flow (PEF), and forced expiratory flow from 25 to 75% of FVC (PEF25-75%). Additionally, 1-hydroxypyrene (1-PYR) was the primary PAH metabolite contributing to the decreases in FEV1/FVC and fractional exhaled nitric oxide (FeNO). The combined effect of urinary PAH metabolites did not affect FVC in the current smokers or FeNO in nonsmokers, but decreased FEV1/FVC in current smokers.ConclusionThis study strengthens the negative relationships between multiple PAH metabolites exposure and lung function in adults. Given the limitations of this study, including the lack of knowledge of other exposure pathways and the uncertainty of urinary metabolites, further research is necessary to explore the mechanisms underlying these associations and to address the limitations in exposure assessment.

Predictive Value of Diaphragm and Lung Ultrasonography for Weaning Failure in Critically Ill Patients with Acute Respiratory Failure Due to COVID-19 Pneumonia.

This study analyzed weaning characteristics and assessed the association of clinical and ultrasonographic indices-maximum inspiratory pressure (MIP), rapid shallow breathing index (RSBI), peak flow expiratory (PFE), diaphragm-thickening fraction (DTF), diaphragm thickness (DT), diaphragm excursion (DE), diaphragm-RSBI (D-RSBI), and lung ultrasound (LUS) patterns-with weaning failure. This retrospective cohort study included critically ill COVID-19 patients aged 18 and older who had been on invasive mechanical ventilation for at least 48 h and undergoing weaning. Exclusion criteria included absence of ultrasound assessments, neuromuscular diseases, and chronic cardio-respiratory dysfunction. Among 61 patients, 44.3% experienced weaning failure, 27.9% failed the spontaneous breathing trial (SBT), 16.4% were re-intubated within 48 h, and 28% required tracheostomy. Weaning failure was associated with prolonged ventilation (29 vs. 7 days, p < 0.001), extended oxygen therapy, longer ICU stays, and higher ICU mortality. These patients had higher pressure support, lower oxygenation levels, a higher RSBI, and a lower MIP. While PEF, DTF, DE, and D-RSBI showed no significant differences, both right and left diaphragm thicknesses and the inspiratory thickness of the left diaphragm were reduced in failure cases. LUS scores were significantly higher before and after SBT in the failure group. Bivariate analysis identified RSBI [OR = 1.04 (95% CI = 1.01-1.07), p = 0.010], MIP [OR = 0.92 (95% CI = 0.86-0.99), p = 0.018], and LUS [OR = 1.15 (95% CI = 0.98-1.35), p = 0.025] as predictors of weaning failure; however, these associations were not confirmed in multivariate analysis. Ultrasound provides supplementary information during weaning, but no definitive association between ultrasound indices and weaning failure was confirmed in this study.

Peak expiratory flow predicts the occurrence of postoperative pneumonia after esophagectomy for esophageal cancer.

Expiratory flow is an important factor in the achievement of airway clearance that is required to prevent postoperative pneumonia (POP). Although peak expiratory flow (PEF) has been shown to predict the occurrence of POP in lung cancer patients after lobectomy, its predictive power in relation to esophagectomy for esophageal cancer remains unknown. This study assesses PEF as a predictor of POP in patients with esophageal cancer undergoing radical esophagectomy. We conducted a single-center, retrospective cohort study of patients who underwent radical esophagectomy with gastric tube reconstruction at our institution between January 2007 and December 2022. Preoperative pulmonary functions, including PEF, were assessed before surgery. Additionally, POP was diagnosed as a Clavien-Dindo classification of Grade II or higher. Survival and pneumonia incidence were compared using the Kaplan-Meier method. Logistic regression analysis was used to examine the relationship between these variables and POP. The study included 513 patients, of which 441 were men. POP occurred in 86 patients (16.7%). When all patients were stratified by %PEF into two groups, the group with %PEF lower that 80% had significantly poorer prognosis and higher incidence of pneumonia. Multivariable logistic regression analysis indicated that %PEF (OR: 0.986, 95%CI: 0.974-0.999, P = 0.030), along with age, BMI, preoperative treatment, and recurrent laryngeal nerve palsy were independent protective factors against POP. These results reveal that %PEF predicts the development of POP following esophagectomy for esophageal cancer.

Peak expiratory flow predicts motoric cognitive risk syndrome: A cohort study.

Poor respiratory function, including low peak expiratory flow (PEF), is a risk factor for dementia. Motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by slow gait and subjective cognitive complaints. However, the association between PEF and MCR remains unclear. This study examined the cross-sectional and longitudinal association between PEF and MCR. The National Health and Aging Trends Study (NHATS), which is a nationally representative cohort of adults ≥65 years of age in the United States, was analyzed from 2011 to 2017. Logistic regression and discrete-time proportional hazards models tested the association of PEF standardized residuals (SR) at baseline with prevalent and incident MCR, respectively. The models adjusted for multiple sociodemographic and health-related covariates. Among 5328 participants (57% women) included at baseline, lower PEF SR was associated with higher prevalence of MCR. Compared with the ≥80 PEF SR percentile group, the <30 and 30-50 percentile groups had significantly higher odds of prevalent MCR (OR 3.04 [95% CI 1.85, 5.01]; OR 2.06 [95% CI 1.19, 3.54], respectively). Over six years of follow-up, lower PEF SR was also associated with higher incidence of MCR. Compared with the ≥80 PEF SR percentile group, the <30 and 30-50 percentile groups had significantly higher risk of incident MCR (HR 1.81 [95% CI 1.24, 2.66]; HR 1.55 [95% CI 1.02, 2.34], respectively). Lower PEF was associated with higher prevalence and incidence of MCR. Poor respiratory function should be further investigated as a potentially modifiable risk factor for MCR and cognitive decline.

Lentinan combined with docetaxel and nedaplatin in the treatment of pulmonary tuberculosis complicated by nonsmall cell lung cancer

Purpose: To investigate the efficacy and safety of lentinan combined with docetaxel and nedaplatin (DN) in the treatment of pulmonary tuberculosis complicated by non-small cell lung cancer (NSCLC). Methods: A total of 100 patients diagnosed with pulmonary tuberculosis combined with NSCLC in Ankang People's Hospital, Ankang, China were randomized equally into study and control groups. Control group received standard anti-tuberculosis therapy and intravenous chemotherapy regimen based on docetaxel (75 mg/m² on day 1) and nedaplatin (80 – 100 mg/m²), while the study group received, in addition, lentinan (given intravenously every two days). The patients received a total of 2 courses of treatment. Tumor response, survival, adverse reactions, quality of life score, and pulmonary function indices were compared before and after treatment. Results: The study group showed significantly higher total response rate than the control group (p &lt; 0.05). Median overall survival and progression-free survival in the study group was significantly higher than in the control group (p &lt; 0.05). Also, the study group showed significantly lower incidence of adverse reactions compared to control group (p &lt; 0.05). Quality of life score, maximum voluntary ventilation (MVV) and peak expiratory flow (PEF) levels in the study group was significantly higher compared to control group (p &lt; 0.05). Conclusion: Lentinan combination with DN chemotherapy regimen improves response rate, prolongs survival, reduces incidence of adverse reactions, improves quality of life and pulmonary function in patients with pulmonary tuberculosis complicated by NSCLC. These findings provide a new perspective for future studies on the application of lentinan in the treatment of pulmonary tuberculosis complicated by NSCLC.

Hydrogeomorphic response of steep streams following severe wildfire in the Western cascades, Oregon

AbstractSevere wildfire may alter steep mountain streams by increasing peak discharges, elevating sediment and wood inputs into channels, and increasing susceptibility to landslides and debris flows. In the Pacific Northwest, where mean annual precipitation is high and mean fire‐return intervals range from decades to centuries, understanding of steep stream response to fire is limited. We evaluate the hydrologic and geomorphic response of ~100‐m‐long steep stream reaches to the large‐scale and severe 2020 fires in the Western Cascade Range, Oregon. In the two runoff seasons after the fires, peak flows in burned reaches were below the 2‐year recurrence interval flood, a level sufficient to mobilize the median grain size of bed material, but not large enough to mobilize coarser material and reorganize channel morphology. Sediment inputs to study streams consisted of two road‐fill failure landslides, slumps, sheetwash, and minor bank erosion; precipitation thresholds to trigger debris flows were not exceeded in our sites. There was a 50% increase in the number of large wood pieces in burned reaches after the fires. Changes in fluxes of water, sediment, and wood induced shifts in the balance of sediment supply to transport capacity, initiating a sequence of sediment aggradation and bed‐material fining followed by erosion and bed‐material coarsening. Gross channel form showed resilience to change, and an unburned reference reach exhibited little morphologic change. Post‐fire recruitment of large wood will likely have long‐term implications for channel morphology and habitat heterogeneity. Below‐average precipitation during the study period, combined with an absence of extreme precipitation events, was an important control on channel responses. Climate change may have a complex effect on stream response to wildfire by increasing the propensity for both drought and extreme rain events and by altering vegetation recovery patterns.

Designing nature to be a solution for climate change in cities: A meta-analysis

Nature-based solutions (NbS) are designed as a win-win strategy to address societal challenges while providing biodiversity, social, and economic benefits. However, uncertainties and gaps persist, particularly regarding the criteria that define a NbS measure and the specific requirements for a solution to be fully recognized as such, which limit the full potential of these strategies in practice. Another persistent issue is the lack of data on strategy responses across different implementation scales (local, city, regional) and climatic zones (temperate, arid, tropical). This article provides an overview of the potential of NbS to promote climate adaptation in cities. Our meta-analysis, which compiled 7163 records from 89 articles worldwide, indicates that integrating NbS strategies with traditional approaches (gray infrastructure and sustainable technologies) is the most effective response to concurrently address multiple climate-related hazards. Flooding had the highest impact at 35.7 %, followed by increased runoff at 30.5 %. Peak flow and water pollution both had an impact of 10.3 %, while temperature increase accounted for 5.7 %, and decreases in thermal comfort made up 5.0 %. We concluded that all evaluated strategies reduced the impact of climate-related hazards, but this reduction was twice as large when incorporating NbS (18.6 % vs 8.1 %). We also demonstrate that this effect is observed under projected climate scenarios, reinforcing the role of NbS in making cities more resilient and sustainable.

Enhancing Cough Motor Learning in Parkinson's Disease Through Variable Practice During Skill Training.

When re-learning a motor skill, practicing a variety of treatment targets promotes error processing and the exploration of motor control strategies, which initially disrupts accuracy during training (motor performance), but ultimately enhances generalization, retention, and transfer (motor learning). Cough skill training (CST) is feasible and efficacious to improve cough strength; however, previous studies have used the same practice target during training. Our goal was to examine the impact of CST with variable practice on motor performance, motor learning, and respiratory system adaptations. The study was a prospective three-visit single group design. Twenty individuals with Parkinson's disease (PD) and concomitant dysphagia and dystussia completed two sessions of CST involving three randomized practice targets. Cough, lung volume, and airway clearance outcomes were assessed before and after treatment sessions with long-term retention evaluated after 1 month. Peak expiratory flow rate improved after CST with variable practice for voluntary single (β = 0.35 L/s) and sequential (β = 0.22 L/s) cough, which were maintained after 1 month without treatment. The ability to expel material from the upper airway demonstrated a small magnitude of improvement (β = -1.87%). During CST, participants altered lung volume based on the treatment target and lung volume decreased during reflex cough after completing CST. Individuals with PD demonstrated improvements in several aspects of motor learning after two sessions of CST with variable practice. Increasing lung volume may not be an implicit strategy to upregulate voluntary cough strength in this treatment paradigm. The findings support the need for larger investigations exploring the potential benefits of this CST approach.

Predictive Value of Physiological Values and Symptom Scores for Exacerbations in Bronchiectasis and Chronic Obstructive Pulmonary Disease With Frequent Exacerbations: Longitudinal Observational Cohort Study.

COPD (chronic obstructive pulmonary disease) and bronchiectasis are common, and exacerbations contribute to their morbidity and mortality. Predictive factors for the frequency of future exacerbations include previous exacerbation frequency and airway colonization. Earlier treatment of exacerbations is likely to reduce severity. This study tested the hypothesis that, in a population with bronchiectasis, COPD, or both who have frequent exacerbations and airway colonization, changes in symptom scores or physiological variables within 10 days prior to an exacerbation would allow the prediction of the event. We performed a 6-month, longitudinal, observational, cohort study among 30 participants with bronchiectasis, COPD, or both; at least 2 exacerbations per year; and colonization with Pseudomonas aeruginosa or Haemophilus influenzae. Daily symptom and physiological data were collected, comprising pulse rate, blood pressure, oxygen saturation, peak flow rate, step count, weight, and temperature. Exacerbations (defined as the onset of new antibiotic use for respiratory symptoms) were collected, and predictive values for abnormal values in the 10 days prior to an exacerbation were calculated. A total of 30 participants were recruited, collecting a total of 39,534 physiological and 25,334 symptom data points across 5358 participant-days; these included 78 exacerbations across 27 participants, with the remaining 3 participants not having exacerbations within the 6-month observation period. Peak flow rate, oxygen saturation, and weight were significantly different at the point of exacerbation (all P<.001), but no significant trends around exacerbation were noted and no clinically beneficial predictive value was found in the overall or individually adjusted model. Symptom scores tended to worsen for 10 days on either side of an exacerbation but were of insufficient magnitude for prediction, with area under the receiver operating characteristic curve values of ranging from 0.4 to 0.6. Within this small cohort with bronchiectasis, COPD, or both and airway colonization, physiological and symptom variables did not show sufficient predictive value for exacerbations to be of clinical utility. The self-management education provided as standard of care may be superior to either of these approaches, but benefit in another or larger cohort cannot be excluded. RR2-10.2196/resprot.6636.

Longitudinal study on peak expiratory flow monitoring and its impact on quality of life in childhood asthma

Objective To evaluate the impact of peak expiratory flow (PEF) monitoring using a smart peak flow (SPF) device on the quality of life (QoL) and satisfaction among children with asthma. Methods This 3-month prospective cohort study enrolled 71 children aged 7 to 17 years with physician-diagnosed asthma. Participants used the SPF device twice daily, with measurements recorded automatically. Quality of life was assessed using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and asthma control was assessed using the Asthma Control Test (ACT) or Childhood Asthma Control Test (C-ACT). Adherence to PEF measurements and satisfaction with the device were evaluated. Results Seventy-one children (mean age 11.4 years) completed the study. Adherence to twice-daily PEF measurements decreased significantly over three months (from 50.0% at 1 month to 39.9% at 3 months, p < 0.001). Children with good adherence (38.0%) showed significant improvements in PAQLQ scores, while those with poor adherence (62.0%) did not. COVID-19 infection resulted in a significant decrease in %PEF rate and increased peak flow variability. Despite device-related issues, overall satisfaction was high (85.19% for good adherence users vs. 88.64% for poor adherence users, p = 0.671). Conclusion Regular PEF monitoring improves QoL in children with asthma by enabling early detection of symptom changes and better management. However, maintaining adherence to regular PEF monitoring is challenging. Further research with control groups is needed to validate these findings.

Air pollution and respiratory health in patients with COPD: should we focus on indoor or outdoor sources?

IntroductionWhile associations between ambient air pollution and respiratory health in chronic obstructive pulmonary disease (COPD) patients are well studied, little is known about individuals’ personal exposure to pollution and associated...

Flood Risks Analysis in Upton Upon Severn: Assessing the Baseline Conditions and Future Scenarios for 100 and 1000-year Flood Events with a 2050 Climate Change Perspective.

This paper investigates the flood risks in Upton upon Severn, a town in Worcestershire, England, which is prone to fluvial flooding from the River Severn. Historical events, such as the significant floods of 1947 and 2007, highlight the town’s vulnerability and underscore the importance of analysing current and future flood risks. This research uses a one-dimensional hydraulic model, using Flood Modeller and QGIS software, to assess baseline flood conditions and predict the potential impacts of severe and extreme flood events, including 1 in 100-year and 1 in 1000-year flood scenarios. Additionally, it examines the projected effects of climate change by incorporating a 20% increase in flood risk estimates for the year 2050. The model results reveal that the baseline scenario poses limited flood risks, with only 17 properties affected, and key infrastructure like the A4104 road remains passable. However, under the 1 in 100-year event, approximately 336 properties are at risk, with significant road blockages and a flooded area of 5.09 Km2. The 1 in 1000-year flood scenario predicts a peak flow of 1807 m3/s, threatening more properties and covering a larger area of land. When climate change is factored into the 1 in 100-year scenario, the risks become similar to those of the 1 in 1000-year event, with 500 properties and key infrastructure, including the fire station and primary school, at risk and the A4104 road becoming impassable. These findings provide vital insights for flood risk management, especially given the possible effects of climate change, and stress the need for long-term solutions to flooding.

Determining the respiratory functions and isometric strength differences among recreational athletes and non-athletes: a cross-sectional analysis

Understanding the differences in respiratory functions and isometric strength between recreational athletes and non-athletes has a significant importance in the fields of Sports science, exercise physiology, and performance enhancement. The purpose of this study was to determine the respiratory functions and isometric strength differences among recreational athletes and non-athletes. A cross-sectional design was selected for this research with 16 recreational athletes and 16 non-athletes. Respiratory functions were assessed using spirometry tests, measuring parameters such as forced vital capacity (FVC), peak expiratory flow rate (PEFR), and forced expiratory volume in one second (FEV1). Isometric strength was measured by a handheld dynamometer for dominant and non-dominant hands. The results of the study showed a significant difference between recreational athletes and non-athletes for respiratory function parameters (FVC = t-3.00, p-.006 &amp; FEV1= t-2.221, p-.011), whereas PEFR is insignificant (t-218, p-.219). The isometric strength is also significant between recreational athletes and non-athletes (Dominant arm = t—3.039, p-.005 &amp; non-dominant arm= t-.255, p-.001). The study findings revealed significant differences in respiratory functions and isometric strength between recreational athletes and non-athletes, and there was a significant relationship between parameters. Athletes typically exhibit remarkable isometric strength due to their consistent engagement in activities designed to enhance muscle function. Future research should give priority to conducting long term studies that directly compare the effects of different sports disciplines on respiratory functions and isometric strength. Keywords: Isometric Strength, Pulmonary Functions, Forced Vital Capacity, Peak Expiratory Flow Rate, FEV1, Recreational Athletes.

Streamflow Prediction with Time-Lag-Informed Random Forest and Its Performance Compared to SWAT in Diverse Catchments

This study introduces a time-lag-informed Random Forest (RF) framework for streamflow time-series prediction across diverse catchments and compares its results against SWAT predictions. We found strong evidence of RF’s better performance by adding historical flows and time-lags for meteorological values over using only actual meteorological values. On a daily scale, RF demonstrated robust performance (Nash–Sutcliffe efficiency [NSE] &gt; 0.5), whereas SWAT generally yielded unsatisfactory results (NSE &lt; 0.5) and tended to overestimate daily streamflow by up to 27% (PBIAS). However, SWAT provided better monthly predictions, particularly in catchments with irregular flow patterns. Although both models faced challenges in predicting peak flows in snow-influenced catchments, RF outperformed SWAT in an arid catchment. RF also exhibited a notable advantage over SWAT in terms of computational efficiency. Overall, RF is a good choice for daily predictions with limited data, whereas SWAT is preferable for monthly predictions and understanding hydrological processes in depth.

Lower peak expiratory flow rate is associated with a higher risk of pneumonia in patients with stroke.

Low peak expiratory flow (PEF) rate is common in patients with stroke. Studies on changes in PEF rates in patients with stroke often have small sample sizes, limiting the generalizability of their findings. This study aimed to compare the PEF rates between patients who were post-stroke with or without pneumonia and age- and sex-matched healthy controls and explore the PEF-pneumonia association among stroke survivors. Prospective observational study. Department of Rehabilitation, the First Affiliated Hospital of Wenzhou Medical University. Initially, 809 patients with stroke undergoing inpatient rehabilitation were recruited. Data collected included the demographics, stroke history, the presence of dysphagia, and the PEF rates on admission. Logistic regression analysis was conducted to identify the PEF threshold as predictive of pneumonia after adjusting for confounders. Patients with stroke had a mean PEF rate of 243.89±139.38 L/min, significantly lower than that of the normal control group. The PEF rate was significantly lower in the pneumonia group than in the non-pneumonia group (P<0.001). Within the stroke cohort, the PEF rates were lower than the predicted rates (P<0.001). Older age, lower PEF(%),and dysphagia were associated with a higher pneumonia risk post-stroke per stepwise multivariate logistic regression analysis. Furthermore, the combination of these three significant predictors (PEF(%), swallowing function, and age) yielded an area under the curve of 0.857 .Regarding age, the cut-off point of ≥65.5 years was the optimal level to discriminate the presence of pneumonia among patients with stroke. For PEF%,the cut-off point of <60% was the optimal level to discriminate the presence of pneumonia among patients with stroke. For screening dysphagia, the patients with impaired safety only and those with impaired safety and efficacy faced a higher pneumonia risk. Patients with stroke exhibited significantly lower peak expiratory flow rates compared to healthy controls after adjusting for age and sex and when compared to their reference values. Decreased PEF rates were independently associated with pneumonia development during inpatient rehabilitation in post-stroke patients. This study suggests that low PEF rates may predict pneumonia and that the prevention of PEF rate decline may prevent pneumonia development.

Effects of oral montelukast on pulmonary function and clinical symptoms in acute asthma exacerbations: a randomized, double-blind, placebo-controlled trial

Introduction: Montelukast is a leukotriene receptor antagonist that helps treat chronic asthma and allergic rhinitis by reducing inflammation and bronchoconstriction. However, oral montelukast’s effectiveness in managing acute asthma attacks has yet to be completely identified. Methods: This randomized, double-blind, placebo-controlled trial investigated the efficacy of oral montelukast in acute exacerbations of asthma. Seventy patients between 18 and 65 years of age with a primary diagnosis of asthma attack were included in the study and were randomly assigned to receive 10 mg of montelukast orally daily or placebo. Symptoms, signs, forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate (PEFR) were evaluated. Results: Our findings showed a statistically significant difference between montelukast and placebo regarding FEV1 (78.05 ± 7.84 vs. 72.05 ± 12.00, P = 0.016), PEFR (322.86 ± 28.95 vs. 290.86 ± 44.21, P = 0.003), and wheezing (P = 0.022) on the fifth day of treatment. Additionally, FEV1 and PEFR values were compared in two subgroups of patients, ICS users (ICSU) and non-ICS users (NICSU), in both the montelukast and placebo groups. In the montelukast group, while PEFR improved significantly for day 5 in both the ICSU (P = 0.007) and NICSU (P = 0.027) subgroups, FEV1 only improved in the ICSU (P = 0.009) subgroup compared to placebo. Conclusion: The present study demonstrated that oral montelukast administered in acute asthma exacerbation could lead to better values of PEFR and FEV1 on pulmonary function and improvement of wheezing in terms of symptoms.

Respiratory and functional benefits of manual diaphragmatic release for cleaning-laborers exposed to occupational hazards.

To examine the respiratory and functional benefits of manual diaphragmatic release for Cleaning-Laborers Exposed to Occupational Hazards. A randomized controlled trial of 36 participants aged 35-45years was randomly allocated into two groups. The experimental group (n=18); received manual diaphragm release along with respiratory training exercises, and the control group (n=18); received respiratory training exercises only. Three times/week for 12 consecutive weeks. The serum immunoglobulin E level, pulmonary functions [forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, and peak expiratory flow (PEF) rate (PEF)], chest wall mobility, and 6min walk-test performance were assessed pre- and post-intervention. There was a greater decline in serum immunoglobulin levels (p=0.003; Partial η2=0.23) and enhancement in pulmonary functions [FEV1 (p=0.025, Partial η2=0.14), FVC (p=0.017, Partial η2=0.16), FEV1/FVC (p=0.028, Partial η2=0.13), and PEF (p=0.012, Partial η2=0.17) in the experimental group. Further, there was a greater increase in chest mobility at the xiphoid level (p=0.002, Partial η2=0.25) in the experimental group, but this was not the case at the axillary level (p=0.29, Partial η2=0.03). Still, the 6min walk-test performance improved more significantly in the experimental group (p=0.002, Partial η2=0.24). The diaphragmatic release technique may offer a promising approach for mitigating distressing respiratory symptoms, enhancing immune function, and improving 6min walk-test performance among cleaning laborers with work-related respiratory hazards. The study was retrospectively registered at XXX (ID: NCT05802355).

To Study the Efficacy of Ultrasound Guided Pecto-Intercostal Fascial Plane Block in Patients Undergoing Midline Sternotomy in Open Cardiac Surgery: A Randomized Prospective Comparative Study.

The incidence of acute poststernotomy pain after cardiac surgery is 80%1. Pecto-intercostal fascial plane block (PIFB) adjacent to the sternum anesthetizes the anterior cutaneous branches of the intercostal nerves and may provide effective analgesia after sternotomy. A randomized controlled, double-blinded, prospective comparative trial was conducted at a tertiary care center on patients of midline sternotomy between 18 and 65 years and NYHA Class 2 and 3 for open cardiac surgery with the primary aim to evaluate analgesia on deep breathing after 3 hours of PIFB block bilaterally. A total of 60 patients were enrolled and randomly divided into three groups. PIFB was administered bilaterally before extubation, with 15 ml 0.125% bupivacaine plain (Group B), and bupivacaine+ clonidine 0.25 mcg/kg (Group B+C). Group C did not receive any intervention. All patients received acetaminophen 1 gram three times a day and injectable tramadol 1 mg/kg as a rescue analgesic. Baseline characteristics were similar among all the groups. The Numeric Rating Scale (NRS) for pain was statistically lower (P < 0.05) in Groups B and B+C compared to Group C at rest, deep breathing, and coughing at 3, 6, and 12 hours after extubation. NRS on deep breathing in Groups B, B+C, and C was {(2.3, 1.5, 4.4) at 3 hours, (2.3, 1.6, 4.3) at 6 hours, (2.8, 2.1, 3.9) at 12 hrs, and {(4.3, 3.5, 3.6)} at 24 hours after extubation. The peak expiratory flow rate was the highest in Group B. Rescue analgesia was not required in Group B. PIFB reduces sternotomy pain compared to the control group on deep breathing at 3 hours after block, with delayed requirement of rescue analgesia and improved respiratory mechanics in terms of peak expiratory flow rate at all time points. There is no benefit from adding clonidine.

Evaluation and Application of the Work-related Asthma Screening Questionnaire (Long-version) (WRASQ-L)TM

BackgroundThe Work-related Asthma (WRA) Screening Questionnaire (Long-Version)(WRASQ-L)TM is a screening questionnaire that could improve recognition of WRA. ObjectiveTo conduct a definitive evaluation of the WRASQ-LTM to justify its implementation in clinical settings. MethodsEmployed adults aged 18-75 years with asthma confirmed by objective measures and the ability to take time off work were eligible. Participants completed the WRASQ-LTM then monitored their peak expiratory flow at and away from work or completed a specific inhalation challenge test. Data were classified as WRA or non-WRA by two asthma specialists, blinded to WRASQ-LTM answers. Sensitivity (SN), specificity (SP), positive and negative predictive values (PPV and NPV, respectively) and Youden’s index were calculated for cut-offs of a positive screen. ResultsOf 106 participants (47.1±7.1 years (mean ± SD); 60 (57%) female), 14 (17%) were classified as WRA and were significantly younger in age than non-WRA participants (p=0.043). The questionnaire has high SN and NPV (90.9% and 93.1%, respectively), but low PPV and SP (32.1% and 26.0%, respectively). ConclusionsThe WRASQ-LTM has high SN and NPV. High SN is of primary interest to ensure that few false negative screens are missed and those with potential WRA are identified and continue to specialist care. The SN indicates utility of the questionnaire in clinical settings. Further benefits of the tool include its potential to prompt for education on the symptom-workplace relationship, workplace exposures, personal protective equipment use, and collect exposure and occupational history.

Data-driven forecasting framework for daily reservoir inflow time series considering the flood peaks based on multi-head attention mechanism

Accurate and reliable daily reservoir inflow forecast plays an essential role in several applications involving the management and planning of water resources, such as hydroelectric generation, flood control, water supply, and basin ecological dispatching. Runoff usually exhibits strong non-linearity, high uncertainty, and spatial and temporal variability. Existing techniques fail to capture complete dynamics change processes effectively. A data-driven forecasting framework for daily reservoir inflow time series considering the flood peaks based on a multi-head attention mechanism was developed, referred to as the GWOCS-VMD-CNN-Transformer (GCVCT). First, the model utilize Grey Wolf Optimizer coupled with Cuckoo Search (GWO-CS) algorithms to optimize parameters in variational mode decomposition model (VMD). This approach helps obtain highly correlated intrinsic mode function (IMF) components, enhancing the frequency resolution of the input dataset. The proposed method overcomes the bottleneck of other available methods by decomposing the time series to capture the main long-term and short-term properties of hydrological processes. Second, the convolution neural network and Transformer (CNN-Transformer) are based on a multi-head attention mechanism as the objective predictive method. Finally, six evaluation indicators verify the performance of the proposed approach. The approach’s reliability was evaluated using the historical daily reservoir inflow data from the Xiluodu (XLD) and Wudongde (WDD) reservoirs in the Jinsha River Basin, China. Several single and hybrid models were developed for comparative analysis. The results indicate that the proposed ensemble approach fits better than other developed model methods. The GCVCT model showed excellent performance in forecasting the inflows of XLD and WDD reservoirs, with NSE values of 0.985 and 0.984, respectively. Furthermore, the GCVCT framework forecast capacity for peak inflow was further verified through discussion and analysis of the 48 peak flows during the validation period, consistently outperforming other models in predicting peak flow for both study reservoirs. This framework provides an effective method for the scientific optimal scheduling of hydropower reservoirs, enabling more sustainable and efficient management practices. It also demonstrates the potential of powerful deep-learning models in intelligent hydrological forecasting.