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Background: Self-management programs have beneficial effects on asthma control, but their implementation in clinical practice is poor. Mobile health (mHealth) could play an important role in enhancing self-management. Objective: To assess the clinical effectiveness and technology acceptance of myAirCoach-supported self-management on top of usual care in patients with asthma using inhalation medication. Methods: Patients were recruited in 2 separate studies. The myAirCoach system consisted of an inhaler adapter, an indoor air-quality monitor, a physical activity tracker, a portable spirometer, a fraction exhaled nitric oxide device, and an app. The primary outcome was asthma control; secondary outcomes were exacerbations, quality of life, and technology acceptance. In study 1, 30 participants were randomized to either usual care or myAirCoach support for 3 to 6 months; in study 2, 12 participants were provided with the myAirCoach system in a 3-month before-after study. Results: In study 1, asthma control improved in the intervention group compared with controls (Asthma Control Questionnaire difference, 0.70; P =.006). A total of 6 exacerbations occurred in the intervention group compared with 12 in the control group (hazard ratio, 0.31; P =.06). Asthma-related quality of life improved (mini Asthma-related Quality of Life Questionnaire difference, 0.53; P =.04), but forced expiratory volume in 1 second was unchanged. In study 2, asthma control improved by 0.86 compared with baseline (P =.007) and quality of life by 0.16 (P =.64). Participants reported positive attitudes toward the system. Discussion: Using the myAirCoach support system improves asthma control and quality of life, with a reduction in severe asthma exacerbations. Well-validated mHealth technologies should therefore be further studied.

A 94-year-old patient with cardiogenic shock due tomyocardial infarction was admitted via the emergency room. A coronary angiography and intensive care were requested. The need for care due to dementia was known. After case discussion in the interdisciplinary and multiprofessional treatment team, the decision for a palliative care concept in the form of symptom control was made in the emergency room, taking into account the patient's medical history, the current situation, and the presumed patient consent. The integration of medical ethics aspects and palliativemedicine into geriatric emergency medicine will present a challenge in the future.

A 94-year-old patient with cardiogenic shock due tomyocardial infarction was admitted via the emergency room. A coronary angiography and intensive care were requested. The need for care due to dementia was known. After case discussion in the interdisciplinary and multiprofessional treatment team, the decision for a palliative care concept in the form of symptom control was made in the emergency room, taking into account the patient's medical history, the current situation, and the presumed patient consent. The integration of medical ethics aspects and palliativemedicine into geriatric emergency medicine will present a challenge in the future.

To address the need to preserve current genetic diversity before it is lost forever; further studies to adapt assisted reproductive technologies to various endangered species are needed, among other things. Roe deer (Capreolus capreolus), an over abundant wild deer, can serve as model species to develop or improve sperm cryopreservation of threatened or endangered deer species. The aim of this study was to compare the ability of three diluents (Berliner Cryomedium [BC]; Tris, citric acid, glucose [TCG]; TES, Tris, glucose) to support chilling, cryopreservation (with 5% glycerol; G) and postthaw incubation (at 22 °C and 37 °C) of roe deer spermatozoa collected by electroejaculation. Berliner Cryomedium was the diluent that better preserved roe deer spermatozoa during refrigeration, able to maintain motility for at least 14 days, longer than the other extenders. BC + G was the extender of choice for cryopreservation, showing higher viability compared with TCG + G (66.7 ± 3.4 vs. 54.5 ± 6.5; P < 0.05) and higher level of acrosome integrity compared with TES, Tris, glucose + G (79.4 ± 3.4 vs. 67.9 ± 5.0; P < 0.05). Maintaining the samples at 22 °C after thawing presented higher values in various parameters compared with 37 °C. The knowledge gained through this study can potentially act as a preliminary step toward development of new protocols to help increase the reproductive success of biologically similar, yet endangered, wild species. © 2016 Elsevier Inc.

A female mammal's reproductive function and output are limited by the energy she is able to extract from her environment. Previous studies of the interrelationships between energetic circumstances and reproductive function in a variety of mammal species have produced varied results, which do not all support the common assumption that higher female reproductive hormone levels, specifically progesterone, indicate better ovarian function and greater reproductive potential, and are associated with lower energetic stress. In the present study faecal progesterone and glucocorticoid levels were assessed in two troops of olive baboons (Papio anubis) in the same population. They face similar ecological challenges, except that one troop crop-raids, potentially affecting its energetic intake and stress levels. The energy intake of individual females was assessed by combining detailed feeding observations with nutritional analysis of food samples. The crop-raiding troop experienced 50% higher energy intake rates and 50% lower glucocorticoid levels compared to the non-crop-raiding troop alongside substantially lower progesterone levels. This suggests that energetic stress is associated with elevated progesterone levels and may be the cause of the non-crop-raiding troop’s lower reproductive output. By comparing groups which differ little, except in terms of food access, and also by directly assessing energy intake, our study addresses some of the design limitations of previous research investigating variation in progesterone levels and energetic stress. It therefore has the potential to contribute to greater understanding of the factors affecting differences in reproductive and stress hormone levels and reproductive function in mammals experiencing different energetic circumstances.

Members of the Bovini genus are classified as grazers. Smaller species of ruminants are not expected to be able to digest particularly fibrous diets and are more often classified as intermediate feeders or browsers. Anoas (Bubalus spp.) are interesting in this respect as they are the smallest representatives of the Bovini, being only 10-20% of the body weight of other species of the same genus. A feeding trial was carried out with four lowland anoas (Bubalus depressicornis) at London Zoo, investigating diet digestibility by total fecal collection and passage rates by the simultaneous administration of a fluid (Co-EDTA) and a particle (Cr-mordanted fibre <2 mm) marker. The diet consisted of legume hay, dairy cow pellets, browse, fruits, and vegetables. The achieved digestibility coefficients averaged 70±4% for dry matter and 57±7% for cell walls (NDF). Mean retention times for the total gastrointestinal tract were 25±4.1 hr for fluid and 39±6.7 hr for particles, respectively. The ratio of forestomach particle:fluid retention was 2.14±0.40. Additional information regarding anoa diets in captivity was collected through a survey targeting all institutions that have anoas in their collection currently. Suitability of the provided diet was evaluated using the ratio of unstructured:structured feeds (unstructured feeds pellets, grains, produce; structured feeds=roughage, browse) on a dry matter basis and an assumed complete consumption of offered unstructured diet items, with only the remaining intake capacity being met by structured items. The use of this ratio reliably predicted one facility that reported chronic diet-related problems. As other ruminants, anoas should receive a diet with restricted amounts of concentrates and fruits. The comparatively high fibre digestibility and the high selective particle retention in the forestomach suggest a classification of an intermediate/grazing ruminant.