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Kienenberger ZE, Farber TO, Teresi ME, Milavetz F, Singh SB, Larson Ode K, Thoma T, Weiner RL, Burlage KR, Fischer AJ. Patient and Caregiver Perceptions of Airway Clearance Methods Used for Cystic Fibrosis. Can Respir J 2023; 2023:1422319. [PMID: 37547298 PMCID: PMC10403321 DOI: 10.1155/2023/1422319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/06/2023] [Accepted: 06/24/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Cystic Fibrosis Foundation guidelines recommend people with CF perform daily airway clearance. This can be difficult for patients, as some find it time consuming or uncomfortable. Data comparing airway clearance methods are limited. We surveyed patients and their families to understand which methods are preferred and identify obstacles to performing airway clearance. Methods We designed a REDCap survey and enrolled participants in 2021. Respondents reported information on airway clearance usage, time commitment, and medication use. They rated airway clearance methods for effectiveness, comfort, time commitment, importance, and compatibility with other treatments. The analysis included descriptive statistics and clustering. Results 60 respondents started and 52 completed the survey. The median patient age was 20 years. Respondents experienced a median of four airway clearance methods in their lifetime, including chest wall oscillation (vest, 92%), manual chest physical therapy (CPT, 88%), forced expiration technique (huff or cough, 77%), and exercise (75%). Past 30-day use was highest for exercise (62%) and vest (57%). The time commitment was generally less than 2 hours daily. Of those eligible for CFTR modulators, 53% reported decreased time commitment to airway clearance after starting treatment. On a scale of 0-100, respondents rated CFTR modulators as their most important treatment (median 99.5), followed by exercise (88). Discussion. Patients and caregivers are familiar with several methods of airway clearance for CF. They report distinct strengths and limitations of each method. Exercise and vest are the most common methods of airway clearance. The use of CFTR modulators may reduce patient-reported time commitment to airway clearance.
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Affiliation(s)
- Zoe E. Kienenberger
- Pediatrics, University of Iowa, Iowa City, IA, USA
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | | | | | | | | | | | | | | | - Kathryn R. Burlage
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
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Mavroulis S, Ilgac M, Tunçağ M, Lekkas E, Püskülcü S, Kourou A, Sextos A, Mavrouli M, Can G, Thoma T, Manousaki M, Karveleas N. Emergency response, intervention, and societal recovery in Greece and Turkey after the 30th October 2020, M W = 7.0, Samos (Aegean Sea) earthquake. Bull Earthq Eng 2022; 20:7933-7955. [PMID: 35210982 PMCID: PMC8753335 DOI: 10.1007/s10518-022-01317-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
On 30 October 2020, an Mw = 7.0 earthquake struck the Eastern Aegean Sea with considerable impact on Samos Island in Greece and the area of Izmir in Turkey. It was the most lethal seismic event in 2020 worldwide, and the largest and most destructive in the Aegean Sea since the 1955 earthquake that also affected both countries. The Civil Protection authorities in Greece and Turkey were effectively mobilized responding to the earthquake emergency. The main response actions comprised initial announcements of the earthquake and first assessment of the impact, provision of civil protection guidelines through emergency communication services, search and rescue operations,medical care, set up of emergency shelters and provisions of essential supplies, psychological support, as well as education, training activities and financial support to the affected population. From the comparison of the Civil Protection framework and the implemented response actions, it is seen that actions at both sides of the eastern Aegean Sea, followed a single-hazard approach in disaster management with similar response activities coordinated by a main Civil Protection agency, which was in close cooperation with the respective authorities at a national, regional and local level. Based on the presented information, it is concluded that the post-earthquake response and emergency management were satisfactory in both countries, with valuable lessons learnt ahead of the next major earthquake. To this end, many aspects can be further addressed to enhance community resilience and introduce a multi-hazard approach in (natural and man-made) disaster management.
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Affiliation(s)
- S. Mavroulis
- Department of Dynamic Tectonic Applied Geology, Faculty of Geology and Geoenvironment, National and Kapodistrian University of Athens, Athens, Greece
| | - M. Ilgac
- Department of Civil Engineering, Middle East Technical University, Ankara, Turkey
| | - M. Tunçağ
- Izmir Metropolitan Municipality, Izmir, Turkey
| | - E. Lekkas
- Department of Dynamic Tectonic Applied Geology, Faculty of Geology and Geoenvironment, National and Kapodistrian University of Athens, Athens, Greece
- Earthquake Planning and Protection Organization, Athens, Greece
| | - S. Püskülcü
- Turkish Earthquake Foundation, Ankara, Turkey
| | - A. Kourou
- Earthquake Planning and Protection Organization, Athens, Greece
| | - A. Sextos
- Department of Civil Engineering, University of Bristol, Bristol, UK
| | - M. Mavrouli
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G. Can
- Department of Civil Engineering, Middle East Technical University, Ankara, Turkey
| | - T. Thoma
- Earthquake Planning and Protection Organization, Athens, Greece
| | - M. Manousaki
- Earthquake Planning and Protection Organization, Athens, Greece
| | - N. Karveleas
- Earthquake Planning and Protection Organization, Athens, Greece
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Kienenberger Z, Farber T, Teresi M, Milavetz F, Singh S, Ode KL, Thoma T, Weiner R, Burlage K, Fischer A. 255: Patient and caregiver opinions of airway clearance methods used for cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Gao S, Emin M, Thoma T, Pastellas K, Castagna F, Shah R, Jimenez A, Patel N, Wei Y, Jelic S. Complement promotes endothelial von Willebrand factor and angiopoietin-2 release in obstructive sleep apnea. Sleep 2020; 44:6044216. [PMID: 33351148 PMCID: PMC8033461 DOI: 10.1093/sleep/zsaa286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/03/2020] [Indexed: 01/13/2023] Open
Abstract
STUDY OBJECTIVE Obstructive sleep apnea (OSA) is highly prevalent and triples vascular thromboembolic risk. Intermittent hypoxia (IH) during transient cessation of breathing in OSA impairs endothelial protection against complement. Complement activation stimulates the endothelial release of a pro-thrombotic von Willebrand factor (vWF). We investigated whether increased complement activity in OSA promotes the endothelial release of vWF and pro-inflammatory angiopoietin-2. We further investigated whether improving complement protection with statins reverses these changes. METHODS Using endothelial cells (ECs) and blood collected from OSA patients (n = 109) and controls (n = 67), we assessed whether altered cellular localization of complement inhibitor CD59 in OSA modulates exocytosis of Weibel-Palade bodies (WPB), secretory granules that store vWF and angiopoietin-2. These interactions were also assessed in vitro in ECs exposed to normoxia or IH with or without recombinant complement C9 and with or without atorvastatin. RESULTS Circulating levels of angiopoietin-2 were greater in OSA than controls and levels of vWF cleavage products correlated with OSA severity. In cultured ECs, IH enhanced complement-stimulated angiopoietin-2 and vWF release by reducing EC surface and increasing intracellular expression of complement inhibitor CD59. Intracellular CD59 co-localized with WPB in OSA. IH increased binding of intracellular CD59 to syntaxin-3, which dissociated syntaxin-3 from voltage-sensitive calcium channel Cav1.2, and activated WPB exocytosis in a calcium-dependent manner. Atorvastatin reversed IH-enhanced endothelial release of vWF and angiopoietin-2. CONCLUSIONS IH promotes the complement-mediated release of vWF and angiopoietin-2, which may contribute to pro-thrombotic and pro-inflammatory conditions in OSA. Statin reversed these effects, suggesting a potential approach to reduce cardiovascular risk in OSA.
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Affiliation(s)
- Su Gao
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | - Memet Emin
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | | | | | | | - Riddhi Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | | | - Neha Patel
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | - Ying Wei
- Division of Biostatistics, Columbia University College of Physicians and Surgeons, New York, NY
| | - Sanja Jelic
- Division of Pulmonary, Allergy, and Critical Care Medicine,Corresponding author. Sanja Jelic, Columbia University College of Physicians and Surgeons, Division of Pulmonary, Allergy, and Critical Care Medicine, 630 West 168th Street, PH8 Center, Room 101, New York, NY 10032.
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Bertram HH, Dugas M, Krüger F, Thoma T, Kühl U, Noutsias M, Hamm B, Gutberlet M. Untersuchung funktioneller und morphologischer Veränderungen und interventrikulärer Interaktionen bei Patienten mit chronischer Myokarditis. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bertram H, Thoma T, Felix R, Gutberlet M. MRT-Untersuchungen ventrikulärer Wandbewegungsstörungen bei Myokarditispatienten zur Beurteilung der Funktionsfähigkeit des Myokards. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Spors B, Thoma T, Freyhardt P, Kuhl U, Schultheiss HP, Felix R, Gutberlet M. Myokardiale Gewebecharakterisierung und Funktionsanalyse von Patienten mit bioptisch gesicherter Virusmyokarditis in der MRT. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Masuda G, Negishi M, Young C, Mukaiyama T, Hanai N, Uchikawa S, Thoma T, Yamazaki E. [Timed bacteriostatic and bactericidal activities of latamoxef against clinical strains of gram-negative bacteria]. Jpn J Antibiot 1983; 36:16-21. [PMID: 6221128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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