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La introduccion in vitro de tejido adulto de nogal (Juglans regia L.) representa una oportunidad de clonacion de genotipos elite, cuya seleccion ocurre en estados ontogenicos avanzados. Asi, con el objeto de desarrollar un protocolo que permita la propagacion masiva de genotipos valiosos a partir de material adulto, se compararon dos sistemas de induccion rizogenica de microtallos de nogal provenientes del cuarto subcultivo de un programa de introduccion in vitro de tejido adulto de nogal, previamente revigorizado mediante injerto tradicional. Se utilizo la induccion rizogenica por acido indol-3-butirico (AIB) y Agrobacterium rhizogenes. El proceso rizogenico se analizo tanto para induccion auxinica (T1: 3 mg L-1 AIB; T2: 5 mg L-1 AIB), como para induccion por A. rhizogenes (T3: A-477; T4: A-478), en dos fases. Una primera fase de induccion radicular, con una duracion de 3 dias en oscuridad; y una segunda fase de 27 dias, denominada de manifestacion radicular. En todos los tratamientos se evaluo porcentaje de enraizamiento y se caracterizaron los sistemas radiculares inducidos (numero, largo, diametro y zona de insercion de raices). Los mejores resultados de enraizamiento se obtuvieron en T2; sin embargo, la respuesta obtenida con A. rhizogenes no difiere de aquella lograda en T1, por lo que pareciera ser una metodologia de creciente interes para la rizogenesis adventicia en esta especie.

The fullerene adducts 1a and 1b, whose molecular shapes either promote or hinder the formation of 1-D stacks, have been examined for their potential to form 1-D wire-like domains in bulk-heterojunction organic solar cells. The photovoltaic efficiency of solar cells based on blends of the stacking fullerene 1a with regioregular poly(3-hexylthiophene-2,5-diyl) (P3HT) is greatly enhanced compared to nonstacking model fullerene 1b.

Dynamic hyperinflation and leg muscle fatigue are independently associated with exercise limitation in patients with chronic obstructive pulmonary disease (COPD). The aims of the present study were to examine 1) the relationship between these limitations and 2) the effect of delaying ventilatory limitation on exercise tolerance and leg muscle fatigue. In total, 11 patients with COPD (with a forced expiratory volume in one second of 52% predicted) completed two cycling bouts breathing either room air or heliox, and one bout breathing heliox but stopping at room air isotime. End-expiratory lung volume (EELV), leg muscle fatigue and exercise time were measured. On room air, end-exercise EELV was negatively correlated with leg fatigue. Heliox increased exercise time (from 346 to 530 s) and leg fatigue (by 15%). At isotime, there was no change in leg fatigue, despite a reduction in EELV compared with end-exercise, in both room air and heliox. The change in exercise time with heliox was best correlated with room air leg fatigue and end-inspiratory lung volume. Patients with chronic obstructive pulmonary disease who had greater levels of dynamic hyperinflation on room air had less muscle fatigue. These patients were more likely to increase exercise tolerance with heliox, which resulted in greater leg muscle fatigue.

BACKGROUND: There is evidence that combination therapy (CT) in the form of long-acting beta2-agonists (LABAs) and inhaled corticosteroids can improve lung function for patients with chronic obstructive pulmonary disease (COPD).OBJECTIVE: To determine the cost-effectiveness of using CT in none, all or a selected group of COPD patients.METHODS: A Markov model was designed to compare four treatment strategies: no use of CT regardless of COPD severity (patients receive LABA only); use of CT in patients with stage 3 disease only (forced expiratory volume in 1 s [FEV1] less than 35% of predicted); use of CT in patients with stages 2 and 3 disease only (FEV1less than 50% of predicted); and use of CT in all patients regardless of severity of COPD. Estimates of mortality, exacerbation and disease progression rates, quality-adjusted life years (QALYs) and costs were derived from the literature. Three-year and lifetime time horizons were used. The analysis was conducted from a health systems perspective.RESULTS: CT was associated with a cost of $39,000 per QALY if given to patients with stage 3 disease, $47,500 per QALY if given to patients with stages 2 and 3 disease, and $450,333 per QALY if given to all COPD patients. Results were robust to various assumptions tested in a Monte Carlo simulation.CONCLUSION: Providing CT for COPD patients in stage 2 or 3 disease is cost-effective. The message to family physicians and specialists is that as FEV1worsens and reaches 50% of predicted values, CT is recommended.

Chronic obstructive pulmonary disease (COPD) is a major respiratory illness in Canada that is preventable and treatable but unfortunately remains underdiagnosed. The purpose of the present article from the Canadian Thoracic Society is to provide up-to-date information so that patients with this condition receive optimal care that is firmly based on scientific evidence. Important summary messages for clinicians are derived from the more detailed Update publication and are highlighted throughout the document. Three key messages contained in the update are: use targeted screening spirometry to establish a diagnosis and initiate prompt management (including smoking cessation) of mild COPD; improve dyspnea and activity limitation in stable COPD using new evidence-based treatment algorithms; and understand the importance of preventing and managing acute exacerbations, particularly in moderate to severe disease.

Fumonisin ft{ and B2, members ofa new class of mycotoxins, were measured in culture material of Fusarium moniliforme MRC826, and in two corn samples associated with field cases of equine leukoencephalomalacia. The compounds were detected by thin-layer chromatography (TLC) with confirmation by liquid secondary ion-mass spectrometry (SIMS) and by gas chromatography/mass spectrometry (GC/MS). Reference standards were isolated from cultures of F. moniliforme on corn. The level of fumonisin B! was about 600 mg/kg in the culture material and 150 and 20 mg/kg in the two naturally contaminated samples.

Background The effect that neonatal bacille Calmette-Guerin (BCG) vaccination has on tuberculin skin test (TST) results is not well evaluated in preschool children. Methods This was a retrospective cohort study of TST results in aboriginal children in Saskatchewan reserve communities. Records from the centralized provincial tuberculosis program were searched for aboriginal children aged 0 to 4 years during the time period 1991 to 1999. Only the first TST result reported as part of infant and preschool screening programs was considered. Children with active tuberculosis and those evaluated as part of a contact-tracing program were excluded. The BCG-vaccinated and unvaccinated groups were compared using wheal size cut points of 5 mm, 10 mm, and 15 mm. Results Data from 1,086 children with neonatal BCG vaccination and 1,867 unvaccinated children were analyzed. The rate of TST reactions was higher in vaccinated children at all ages, using a cut point of 5 mm. The rate of TST reactions was no different in vaccinated children ≥ 1 year old when using a cut point of 15 mm. When using a cut point of 10 mm, the rate of TST reactions was higher at age 1 year but not different at age 4 years in the vaccinated children. Conclusion The rate of TST reactions in preschool aboriginal children living on a reserve who have received neonatal BCG vaccination is affected by the cut point and age. The BCG vaccination status and age should therefore be considered when interpreting TST reactivity in the clinical assessment of aboriginal children participating in a tuberculosis control program.

Comme nous le mentionnions dans notre Page du president le mois dernier, la Societe canadienne de thoracologie (SCT) vient de terminer un processus complet de planification strategique, le tout premier du genre pour notre organisme. Nous estimons important de partager avec vous l’essence de ce document, puisqu’il servira de guide a notre organisation pour les annees a venir. Le rapport de 65 pages a ete remis a la SCT par la firme Association Strategy Group, le 20 decembre 2006. Le depot de ce rapport mettait le point final a un processus de six mois qui a per-mis une analyse detaillee du milieu suite a des entrevues aupres des principaux temoins privilegies, a un sondage aupres des membres de la SCT et aupres de la FNSCC, a une seance de planification d’une journee avec le conseil d’administration, a de nombreux rapports interimaires, pour aboutir a la soumission du rapport definitif, revu et approuve par le conseil d’administration de la SCT. Les observations des auteurs et les conclusions de leur rapport ont ete a la fois informatives et directes. De toute evidence, si de nombreuses realisations dont elle peut etre fiere jalonnent l’histoire de la SCT depuis sa creation, il y a 50 ans, il lui reste beaucoup a faire si elle veut continuer de croitre et remplir son mandat tout en repondant aux besoins de ses membres actuels et futurs. Premiere etape de cette demarche inedite, les principales parties interessees se sont entendues sur une vision commune pour la SCT : « Ameliorer la sante pulmonaire de tous les canadiens. » Dans le but de tracer la route a suivre par la Societe et d’etablir les bases de sa planification future, la mission suivante a ete adoptee : « La Societe canadienne de thoracologie promeut la sante pulmonaire par son soutien au milieu de la pneumologie en faisant preuve de leadership, en favorisant la collaboration, la recherche, la formation, la defense des interets des groupes concernes et la prestation des meilleurs soins en pneumologie au Canada. » Aux chapitres de la recherche, du perfectionnement et de la formation professionnelle, de la defense des interets, des adhesions, de l’infrastructure et des ressources, de la gouvernance et des communications, un ensemble d’objectifs, de strategies et de tactiques ont ete mis de l’avant en vue de l’atteinte des objectifs communs. Il a ensuite fallu prioriser ces objectifs strategiques et tactiques en un plan d’action concret. Vingt mesures d’action specifiques, chacune sous la responsabilite d’un chef ou d’une equipe charges de leur concretisation, ont ete identifiees et des dates ont ete fixees pour leur instauration et leur achevement. Parmi les principales mesures initiales, mentionnons : Charger le comite de planification a long terme (nouvellement forme et compose des derniers presidents sortants de la SCT, sous la presidence de Gerald Cox) d’entreprendre une analyse dans le but d’identifier le modele de gouvernance le mieux adapte a la SCT pour qu’elle realise sa mission. Dans un premier temps, il lui faudra etablir la structure de gouvernance, etablir la hierarchisation des rapports entre personnel et benevoles, evaluer les competences de base recherchees chez les grands benevoles, mettre sur pied les plans de releve et les processus d’evaluation, Demander au conseil d’administration qu’il travaille a l’obtention d’un niveau approprie de dotation pour veiller a la bonne marche des tâches de supervision, de coordination et d’integration des activites, de maniere a pouvoir appliquer avec succes tous les aspects du plan strategique, Demander au comite executif d’identifier les ressources humaines, financieres et technologiques necessaires a l’application du plan strategique, les postes ou les ressources pourraient etre reassignees a d’autres fins et les competences et outils dont le personnel doit etre pourvu pour s’acquitter efficacement de ses tâches, Demander au comite executif de definir et de documenter le role et les rapports de la SCT avec l’Association pulmonaire canadienne, ainsi que les regles d’engagement. Codifier les besoins et dresser la liste des enjeux qui doivent etre abordes relativement aux ressources financieres et humaines et etablir les politiques appropriees. Egalement, renforcer les liens entre la SCT, les Professionnels canadiens en sante respiratoire (PCSR) et les societes thoraciques provinciales et regionales. L’objectif de ces mesures initiales est de rendre le milieu et l’orientation du travail propices a un bon niveau de communication, au recrutement et a la fidelisation des adherents, au recrutement et a la fidelisation des benevoles, aux collectes de fonds pour l’application du plan strategique de la SCT et de preparer le terrain en vue de l’atteinte des objectifs des collectes de fonds, le tout dans le but de faire progresser la SCT sur les plans du leadership, de la recherche, des collaborations, de la formation, de la defense des interets des groupes concernes et de la prestation de soins cliniques de la plus haute qualite. Depuis le depot du rapport final, nous avons avance significativement sur un certain nombre de fronts. Cette phase est tres importante et sollicite tout le milieu canadien de la pneumologie et bon nombre de ces mesures ne pouvaient attendre a « demain ». Nous avons travaille tres fort ces dernieres semaines pour nous doter du soutien administratif approprie, regler certains problemes de gouvernance, mettre la touche finale a un budget serieux et officialiser nos rapports avec l’Association pulmonaire canadienne. Malheureusement, des choix difficiles ont du etre faits et les contraintes budgetaires actuelles signifient que certains projets valables n’ont pas pu etre finances. Mais si nos projets immediats sont couronnes de succes, nous estimons que la SCT en ressortira plus forte et mieux en mesure de repondre positivement aux demandes de cette nature qui lui seront adressees a l’avenir. Les resultats de ces efforts constants seront egalement partages lors de diverses activites de la SCT entourant le Sommet pour un cadre de travail en sante respiratoire d’avril prochain, a Ottawa. Ce Sommet, auquel participeront des representants des gouvernements et autres partenaires subventionnaires, aura pour but de clarifier nos besoins en matiere de recherche en pneumologie au Canada. Il est impossible de resumer l’ensemble du processus de planification strategique et du rapport, mais j’espere en avoir offert un bon apercu, dans ses grandes lignes. Je serais (ou nous serions) bien naif(s) de presumer qu’un simple document peut changer significativement une organisation, ou la perception qu’en ont les individus. En realite, nous venons de franchir une premiere etape. Mais je vous invite a surveiller ce qui se passe a la SCT; prenez le temps de vous tenir au courant et restez a l’affut. Et si ce que vous voyez et entendez vous plait, n’hesitez pas a devenir un membre actif de la Societe canadienne de thoracologie. Ensemble, travaillons a la construction des 50 prochaines annees de la SCT. Imaginez l’avenir qui lui est reserve.

Chronic obstructive pulmonary disease (COPD) is a major respiratory illness in Canada that is both preventable and treatable. Our understanding of the pathophysiology of this complex condition continues to grow and our ability to offer effective treatment to those who suffer from it has improved considerably. The purpose of the present educational initiative of the Canadian Thoracic Society (CTS) is to provide up to date information on new developments in the field so that patients with this condition will receive optimal care that is firmly based on scientific evidence. Since the previous CTS management recommendations were published in 2003, a wealth of new scientific information has become available. The implications of this new knowledge with respect to optimal clinical care have been carefully considered by the CTS Panel and the conclusions are presented in the current document. Highlights of this update include new epidemiological information on mortality and prevalence of COPD, which charts its emergence as a major health problem for women; a new section on common comorbidities in COPD; an increased emphasis on the meaningful benefits of combined pharmacological and nonpharmacological therapies; and a new discussion on the prevention of acute exacerbations. A revised stratification system for severity of airway obstruction is proposed, together with other suggestions on how best to clinically evaluate individual patients with this complex disease. The results of the largest randomized clinical trial ever undertaken in COPD have recently been published, enabling the Panel to make evidence-based recommendations on the role of modern pharmacotherapy. The Panel hopes that these new practice guidelines, which reflect a rigorous analysis of the recent literature, will assist caregivers in the diagnosis and management of this common condition.

The American College of Chest Physicians and Canadian Thoracic Society have jointly produced evidence-based guidelines for the prevention of exacerbations in chronic obstructive pulmonary disease (COPD). This educational article gives four perspectives on how these guidelines apply to the practical management of people with COPD. A current smoker with frequent exacerbations will benefit from support to quit, and from optimisation of his inhaled treatment. For a man with very severe COPD and multiple co-morbidities living in a remote community, tele-health care may enable provision of multidisciplinary care. A woman who is admitted for the third time in a year needs a structured assessment of her care with a view to stepping up pharmacological and non-pharmacological treatment as required. The overlap between asthma and COPD challenges both diagnostic and management strategies for a lady smoker with a history of asthma since childhood. Common threads in all these cases are the importance of advising on smoking cessation, offering (and encouraging people to attend) pulmonary rehabilitation, and the importance of self-management, including an action plan supported by multidisciplinary teams.

Background Systemic inflammation is associated with various complications in chronic obstructive pulmonary disease including weight loss, cachexia, osteoporosis, cancer and cardiovascular diseases. Inhaled corticosteroids attenuate airway inflammation, reduce exacerbations, and improve mortality in chronic obstructive pulmonary disease. Whether inhaled corticosteroids by themselves or in combination with a long-acting β2-adrenoceptor agonist repress systemic inflammation in chronic obstructive pulmonary disease is unknown. The Advair Biomarkers in COPD (ABC) study will determine whether the effects of inhaled corticosteroids alone or in combination with a long-acting β2-adrenoceptor agonist reduce systemic inflammation and improve health status in patients with chronic obstructive pulmonary disease. Methods/Design After a 4-week run-in phase during which patients with stable chronic obstructive pulmonary disease will receive inhaled fluticasone (500 micrograms twice daily), followed by a 4-week withdrawal phase during which all inhaled corticosteroids and long acting β2-adrenoceptor agonists will be discontinued, patients will be randomized to receive fluticasone (500 micrograms twice daily), fluticasone/salmeterol combination (500/50 micrograms twice daily), or placebo for four weeks. The study will recruit 250 patients across 11 centers in western Canada. Patients must be 40 years of age or older with at least 10 pack-year smoking history and have chronic obstructive pulmonary disease defined as forced expiratory volume in one second to vital capacity ratio of 0.70 or less and forced expiratory volume in one second that is 80% of predicted or less. Patients will be excluded if they have any known chronic systemic infections, inflammatory conditions, history of previous solid organ transplantation, myocardial infarction, or cerebrovascular accident within the past 3 months prior to study enrolment. The primary end-point is serum C-reactive protein level. Secondary end-points include circulating inflammatory cytokines such as interleukin-6 and interleukin-8 as well as health-related quality of life and lung function. Discussion If inhaled corticosteroids by themselves or in combination with a long-acting β2-adrenoceptor agonist could repress systemic inflammation, they might greatly improve clinical prognosis by reducing various complications in chronic obstructive pulmonary disease.

Background Spirometric inclusion criteria for asthma drug studies often require resting airflow obstruction and resting bronchoconstriction. By current standards, these criteria define suboptimal to poor asthma control. Objective To determine what proportion of asthmatic patients attending a tertiary University-based respiratory clinic meet typical drug study spriometric criteria of a baseline FEV 1 of 50% to 80% predicted and ≥ 15% change in FEV 1 improvement following 200 micrograms inhaled albuterol. Methods A retrospective review was performed on charts of white caucasian asthmatic patients attending three respiratory physician outpatient clinics at a University-based tertiary referral center. We reviewed charts of all patients with chronic asthma under current therapy. We excluded subjects with additional lung diseases that might affect lung function. Spirometric data were extracted from the most recent scheduled outpatient visit. Results We reviewed 590 charts of patients with mean age 35.3 ± 18.3 years (range 6 to 94), 43% male, and 50% atopic. There was objective evidence of variable airflow obstruction or airway hyperresonsiveness in 70.2%; the diagnosis of asthma was based on historical data alone in 29.8%. The majority of patients (87.5%) required inhaled corticosteroids with more than 50% using medium to high doses. Baseline FEV 1 was >80% in 84.6% of subjects, 50% to 80% in 14.4%, and 1 improved by ≥15% 10 to 15 minutes after 200 micrograms inhaled albuterol in 13.6%. Only 9.0% of the 590 asthmatic patients fulfilled both criteria (FEV 1 50% to 80% and Δ FEV 1 ≥ 15%). Conclusion Less than 10% of asthmatic patients attending a tertiary referral respiratory clinic fulfilled typical spirometry inclusion criteria for asthma drug trials. We suggest this approach to enrollment in asthma drug studies be re-evaluated.

A new methodology is described for rapidly determining the herbicide oryzalin in water, citrus fruits, and stone fruits by liquid chromatography with negative ion electrospray ionization tandem mass spectrometry (LC/MS/MS). Oryzalin is extracted from water using a polymeric sorbent solid phase extraction (SPE) column and from fruit using methanol. The water samples require no further purification, but an aliquot of the fruit sample extracts is diluted with water and purified using a polymeric 96 well SPE plate. Purified extracts are concentrated prior to determination by LC/MS/MS at m/z 345 (Q1) and m/z 281 (Q3) using an external standard for calibration. The validated limits of quantitation were 0.05 microg/L in water (drinking water, surface water, and groundwater) and 0.01 microg/g in citrus fruits (oranges and lemons) and stone fruits (peaches and cherries). Recoveries averaged 102% for water samples and 85-89% for the various types of fruit samples. For all fortification levels combined, the relative standard deviations ranged from 4 to 6% for water and from 2 to 4% for fruit.

This study explores the relationship between organizational control modes (behavior, outcome, and clan) andsoftware quality. Much of the previous work on organizational control has examined the choice of modes giventask characteristics. This research extends work in control theory by considering the impact of control modeson the increasingly critical organizational outcome of software quality. The research is set in the context ofsoftware development organizations in three of the largest software developing countries: India, Ireland, andIsrael (the 3Is). A cross sectional survey of 400 software development organizations across the 3Is will be usedto test the developed model. In addition to the theoretical contributions, the study will provide practicalimplications to support software project managers in making better organizational control choices.

Chronic obstructive pulmonary disease (COPD) is a common cause of disability and death in Canada. Moreover, morbidity and mortality from COPD continue to rise and the economic burden is enormous. The main goal of the Canadian Thoracic Society (CTS) Evidence-Based Guidelines is to optimize early diagnosis, prevention and management of COPD in Canada. Targeted spirometry is strongly recommended to expedite early diagnosis in smokers and exsmokers who develop respiratory symptoms, and who are at risk for COPD. Smoking cessation remains the single most effective intervention to reduce the risk of COPD and to slow its progression. Education, especially self-management plans, are key interventions in COPD. Therapy should be escalated in accordance with the increasing severity of symptoms and disability. Long acting anticholinergics and beta2-agonist inhalers should be prescribed for patients who remain symptomatic despite short-acting bronchodilator therapy. Inhaled steroids should not be used as first line therapy in COPD, but have a role in preventing exacerbations in patients with more advanced disease who suffer recurrent exacerbations. Management strategies consisting of combined modern pharmacotherapy and nonpharmacotherapeutic interventions (eg, pulmonary rehabilitation/exercise training) can effectively improve symptoms, activity levels, and quality of life, even in patients with severe COPD. Acute exacerbations of COPD cause significant morbidity and mortality and should be treated promptly with bronchodilators and a short course of oral steroids; antibiotics should be prescribed for purulent exacerbations. Patients with advanced COPD and respiratory failure require a comprehensive management plan that incorporates structured end-of-life care.

Dear Sir, We are grateful to Dr Khurana and Dr Aggarwal for their interest1 in our paper.2 On their first point, we agree that we should be careful about terminology. We evaluated a random sample of individuals representative of the general population rather than patients, so the findings that episodes of respiratory events occurred in these subjects would likely reflect real events in the general population. Furthermore, our study definition for exacerbations was the same standard questionnaire criteria for exacerbations used in clinical trials of selected patients with COPD.3 On the second point on aetiologies for non-COPD subgroup in this study, we would like to emphasise that ‘non-COPD’ was defined by the absence of chronic airflow limitation using the standard, although arbitrary spirometric criteria. We excluded those individuals with self-reported chronic obstructive lung diseases, …

Ethalfluralin is a herbicide that is effective for weed control on a wide variety of crops, including canola. A method is described for the determination of ethalfluralin residues in canola seed, meal, and refined oil. Residues are extracted from canola sample matrixes with acetonitrile. An aliquot of the extract is diluted with water and purified by C18 solid-phase extraction prior to analysis by capillary gas chromatography with mass selective detection. For all three sample matrixes, the method has a validated limit of quantitation of 0.02 μg/g and a limit of detection of 0.006 μg/g. Recoveries averaged 96 ± 7% for canola seed, 87 ± 6% for canola meal, and 89 ± 5% for refined oil. In a magnitude-of-residue study, canola seed from field plots that had been treated with ethalfluralin at one to three times the maximum label rate for weed control were found to contain no detectable residue of the herbicide. Keywords: Ethalfluralin; dinitroaniline; residues; canola; GC/MSD

Six months of twice weekly directly observed isoniazid and rifam-picin treatment of latent tuberculosis (TB) infection was implemented to improve the outcome of treatment. A total of 591 infected aborigines without previous tuberculosis or treatment of latent TB infection received twice weekly isoniazid and rifampicin for 6 mo from 1992 to 1995. The outcome was compared with 403 infected aborigines without previous tuberculosis or treatment of latent TB infection who received self-administered isoniazid daily for 1 yr from 1986 to 1989. Of patients, 487 (82%) completed the twice weekly 6-mo regimen compared with 77 (19%) who completed the daily 12-mo regimen. The main reason for incomplete treatment was default. Both groups were followed over a 6-yr period. The rate of tuberculosis in the twice-weekly isoniazid and rifampicin-treated patients was 0.9/1,000 patient-years compared with 9/1,000 patient-years in the daily isoniazid-treated patients. The rate of side effects was higher for directly observed treatment patients, 136/1,000 patient-years of drugs, compared with 39/ 1,000 patient-years for self-administered treatment patients. Life-threatening side effects such as skin allergic reactions and hepatitis were the same in both groups. A regimen of 52 doses of directly observed twice weekly isoniazid and rifampicin is an effective and well-tolerated regimen to improve the outcome of the treatment of latent tuberculosis infection in a population with a high rate of default with daily self-administered isoniazid.

OBJECTIVES:To evaluate various aspects of the management of adult patients who present to the emergency department with acute exacerbations of asthma and who are discharged from the emergency department without hospital admission. Further, to compare the results with accepted management guidelines for the emergency department treatment of asthma.DESIGN:A retrospective chart collection and review until each site contributed 50 patients to the survey.SETTING:Three tertiary care hospitals in the Saskatoon Health District, Saskatoon, Saskatchewan. The study period was from July 1, 1997 to November 18, 1997.POPULATION:Patients aged 17 years or older, who were discharged from the emergency department with the diagnosis of asthma.METHODS:Data were collected on 130 patients from 147 emergency department visits.RESULTS:A number of important physical examination findings were frequently not documented. In contrast to management guidelines, peak expiratory flow rates (44%) and spirometry (1%) were not commonly used in patient assessments. Only 59% of patients received treatment in the emergency departments with inhaled or systemic corticosteroids. Furthermore, specific follow-up plans were infrequently documented in the emergency department charts (37%).CONCLUSIONS:Adherence with published Canadian guidelines for the emergency department management of acute asthma exacerbations was suboptimal. Corticosteroid use in the emergency department was significantly less than recommended. Increased emphasis on education and implementation of accepted asthma management guidelines is necessary.

Objective: To test the hypothesis that respiratory function contributes to limit maximal exercise performance in patients with chronic heart failure by using the technique of dead space loading during exercise. Design: Blinded subjects underwent two maximal incremental exercise tests in random order on an upright bicycle ergometer: one with and one without added dead space. Setting: Tertiary-care university teaching hospital. Subjects: Seven patients with stable chronic heart failure (mean 6 SEM left ventricular ejection fraction, 27 6 3%). Results: Subjects were able to significantly increase their peak minute ventilation during exercise with added dead space when compared with control exercise (57.4 6 5.9 vs 50.0 6 5.6 L/min; p < 0.05). Peak oxygen uptake, workload, heart rate, and exercise duration were not significantly different between the added dead space and control tests. Breathing pattern was significantly deeper and slower at matched levels of ventilation during exercise with added dead space. Conclusion: Because patients with chronic heart failure had significant ventilatory reserve at the end of exercise and were able to further increase their maximal minute ventilation, we conclude that respiratory function does not contribute to limitation of exercise in patients with chronic heart failure. (CHEST 2000; 118:53‐ 60)