Search

Simona Frasca. 2014. Italian Birds of Passage: The Diaspora of Neapolitan Musicians in New York. New York: Palgrave Macmillan. 263pp. ISBN 978-1-137-32241-8 (hbk).

Background: Non-suppression of fractional exhaled nitric oxide (FeNO) during remotely monitored inhaled corticosteroid (ICS) therapy is associated with persistent symptoms and blood eosinophilia. To provide mechanistic insight, we assessed sputum type 2 cytokines and chemokines before and after a FeNO suppression test. Methods: FeNO suppression was performed in 44 patients with severe asthma and FeNO > 40 ppb. FeNO was monitored for 7 days of 1000μg of fluticasone propionate delivered via an INCATM device, with clinical and sputum sampling on days 0 and 7. FeNO suppression was defined as a 42% reduction in FeNO. Sputum supernatant was analyzed in 15 paired samples by ELISA (Prostaglandin D2, Leukotriene E4) and MSD assays (IL-4,-5,-13,-25,-33, CCL26, TSLP). Results: Suppressors (n=21) vs non-suppressors had a greater drop in ACQ-5 (mean∆: -1.2 vs -0.3, p Conclusion: Failure to suppress FeNO during ICS treatment was associated with steroid-unresponsive sputum PGD2 and LTE4 levels.

Background: Prednisolone is widely used to treat acute exacerbations of airway disease. There is evidence that they act by depleting circulating eosinophils within hours of the first dose. Potentially the anti-IL-5 biologics may be a safer and longer-lasting alternative, although whether they deplete blood eosinophils as quickly as prednisolone is unclear. Methods: We assessed blood eosinophil counts at baseline and, 2, 4, 6, 8, 24 and 96 h, or until blood eosinophils Results: Groups did not differ significantly in demographics, inhaled corticosteroid dose, lung function and baseline blood eosinophil count. The mean(SD) time for blood eosinophil level to decrease 50% from baseline was 25.8(14.3), 1.7(0.7) and 2.5(0.4) hours on mepolizumab, benralizumab and prednisolone respectively (p≤0.001 for both benralizumab and prednisolone compared to mepolizumab) (Fig. 1). Conclusion: Benralizumab depletes blood eosinophils as rapidly as prednisolone and may therefore be an alternative treatment for acute eosinophilic asthma exacerbations. Larger studies comparing this approach to current treatment are awaited.

Sugar-sweetened beverage (SSB) consumption is a high-risk dietary behaviour and represents a pressing public health concern.Objective: The present research aimed to utilize temporal self-regulation...

Background and objective New Zealand (NZ) and Australia (AU) have similarly high asthma prevalence; both have universal public health systems, but different criteria for subsidized medicines. We explored differences in asthma management and asthma-related outcomes between these countries. Methods A web-based survey was administered in AU (2012) and NZ (2013) to individuals aged ≥16 years with current asthma, drawn randomly from web-based panels, stratified by national population proportions. Symptom control was assessed with the Asthma Control Test (ACT). Healthcare utilization was assessed from reported urgent doctor/hospital visits in the previous year. Results NZ (n = 537) and Australian (n = 2686) participants had similar age and gender distribution. More NZ than Australian participants used inhaled corticosteroid (ICS)-containing medication (68.8% vs 60.9%; P = 0.006) but ICS/long-acting β2-agonist (LABA) constituted 44.4% of NZ and 81.5% of Australian total ICS use (P

Background Exhaled nitric oxide (FeNO) and blood eosinophil count (B-eos) correlate with sputum eosinophil count in asthma and COPD, and cut-off values have been introduced to help decision making. However, these cut-off values have not been validated in large heterogeneous clinical cohorts. Our aim was to assess in a real life mixed airways disease population the abilities of currently recommended cut-off values of FeNO, blood eosinophil count and their combinations to predict the presence of airway inflammation as reflected by sputum eosinophil and neutrophil count. Methods We recruited 310 subjects with obstructive airway disease (260 with asthma,50 with COPD) from a tertiary referral centre. Induced sputum cell differentials, FeNO, B-eos and spirometry were measured. FeNO and B-eos were categorised as low ( 50 ppb and ≥0.3 x 109 cells/L), respectively. A composite variable of FeNO and B-eos was formed with four categories as follows: both high, either high, both low, and all other combinations. We assessed the ability of FeNO, B-eos and their composite to predict the presence of sputum eosinophilia (≥3%) and neutrophilia (>61%). Results The majority of subjects were on maintenance ICS (84.2%) and/or LABA (73.9%) and smaller proportions on LAMA (26.1%) and oral corticosteroids (16.1%). Both FeNO and B-eos were better in predicting sputum eosinophilia than in predicting neutrophilia. Having both FeNO and B-eos high was associated with an 80.4% probability of having sputum eosinophilia and a 25.5% probability of having sputum neutrophilia. On the other hand, having both FeNO and B-eos low was associated with a probability of only 2.9% of having sputum eosinophilia and a 61.8% probability of having sputum neutrophilia (Figure 1). B-eos performed equally well in subjects with asthma or COPD while FeNO performed better in subjects with asthma. Conclusion Currently recommended cut-off values of FeNO and B-eos have good ability to predict presence or absence of sputum eosinophilia in a mixed group of subjects with airways disease. These markers in combination also have a moderate ability to predict presence or absence of sputum neutrophilia.

Introduction Many patients with asthma have type-2 low, neutrophilic asthma, and this has been linked to elevated IL-17A levels. We aimed to explore the role of IL-17A in asthma using two approaches: i) mass cytometry by time of flight (CyTOF) profiling of blood and sputum for IL-17A-expressing cells; and ii) in vitro modelling of the effects of IL-17A in epithelial inflammation and the modulatory effects of this produced by major asthma therapies, namely corticosteroids and macrolides. Methods We collected blood and sputum from patients with well-phenotyped severe asthma. Sputum cells and peripheral blood mononuclear cells were stimulated and stained for intracellular cytokines and extracellular markers using metal-conjugated antibodies. Samples were analysed using the Helios CyTOF 3, and results analysed using FlowJo. We used the bronchial epithelial cell line BEAS-2B to determine whether IL-17A can induce an inflammatory response in epithelial cells, both acting alone and in synergy with different toll-like receptor (TLR) agonists. We investigated Fluticasone and Azithromycin in modulating IL-17A-induced effects. Results We were able to identify the major IL-17A-expressing cell subsets in severe neutrophilic asthma (figure 1), and showed the predominant source was the distinct CD4+ IL-17A+ (Th17) cell population. By contrast expression of other intracellular cytokines was more widespread across diverse T cell subsets. In vitro modelling demonstrated that IL-17A alone induces the release of IL-8 and IL-6 from BEAS-2B cells at low levels, but in synergy with the different TLR agonists had a pleiotropic effect whereby low concentrations of IL-17A reduced the TLR-induced cytokine expression, while higher concentrations of IL-17A had synergistic effects. Fluticasone and Azithromycin both suppressed epithelial cytokine release. This suppression was independent of IL-17A. Conclusions We have demonstrated the applicability of CyTOF to samples from respiratory patients and confirmed the predominant IL-17A producing cell-type is CD4+ IL-17A+ T cells in asthma. IL-17A appears to have a pleotropic role in regulating epithelial inflammation with low concentrations providing a suppressive, presumed homeostatic effect on epithelial cytokine release and higher concentrations inducing epithelial release of inflammatory cytokines associated with neutrophilic inflammation. Our data suggests that commonly used treatments for asthma had no effect on this pathway.

Background Asthma and COPD have different diagnostic labels but share underlying sputum inflammatory types in common. Whilst eosinophilic inflammation is best understood, neutrophilic and mixed inflammation have not been well characterised to date. Aims We aimed to compare clinical characteristics and lung function in the different sputum inflammatory groups in a heterogeneous group of patients with obstructive airway disease. Methods Patients of the Special Airways Clinic were invited to participate in this study. Those who consented were assessed at baseline and follow up visits using ACQ-5, AQLQ, Euroqol, HADS questionnaires and VAS symptoms. Lung function was assessed by spirometry and exhaled nitric oxide, and blood and sputum profiling were undertaken. Participants were divided into four sputum inflammatory groups: paucigranulocytic (sputum eosinophils 61%), eosinophilic (eosinophils ≥3% and neutrophils ≤61%) and mixed (eosinophils ≥3% and neutrophils >61%). Data were pooled across all visits and analysed by sputum inflammatory group, using a mixed model, for lung function analysis. Results We analysed data from 203 patients (Table 1). The paucigranulocytic group was youngest and the neutrophilic oldest. There were no significant differences among groups for ethnicity, BMI, family history, comorbidities or respiratory sensitisations. The paucigranulocytic group had a predominance of never smokers, the neutrophilic group were 56.5% ex-smokers and the highest proportion of current smokers was in the mixed group. Total IgE was highest in eosinophilics. There were no significant differences in medication use, symptom severity, healthcare utilisation or quality of life among the different groups. FEV1 percent predicted and FEV1/FVC ratio were higher in paucigranulocytics compared with mixed (p=0.001, p Conclusions Inflammatory groups had similar demographics and clinical characteristics; however, severity of airflow obstruction was worst in the mixed and neutrophilic inflammatory groups, and neutrophilic inflammation alone was associated with least reversibility of airflow obstruction.

Foodborne illness, or food poisoning, is a global health issue, affecting over 600 million people each year. Contrary to lay beliefs, the majority of food poisoning occurs as a result of improperly handling food within the home. The past decade has seen an increase in research using theoretical frameworks to investigate predictors of safe food handling, however, this research has been hampered by a focus on motivational models of behaviour and the conceptualisation of safe food handling as a unitary behaviour. Additionally, little research has investigated safe food handling in relation to a particularly susceptible group: young children. Therefore, the aim of this study was to use a dual process theory to explore the predictors of four safe food handling behaviours among parents of young children. One-hundred and thirty-six participants, recruited via CloudResearch, completed self-report measures of intention, habit, self-control, self-efficacy and safe food handling knowledge, and, one week later, completed self-report measures of their engagement in safe food handling behaviours. Results of logistic regression analyses revealed that intention, self-control and self-efficacy significantly predicted cleaning hands and surfaces before preparing food, and knowledge significantly predicted cooking food properly and storing raw and cooked food separately. These findings suggest that there is no one consistently significant predictor of all four safe food handling behaviours, however, knowledge did appear to be an important influence on safe food handling behaviours less familiar to consumers over and above other known predictors for safe food handling behaviours. Educational interventions should focus on increasing safe food handling knowledge for less familiar safe food handling behaviours whereas self-control interventions may be more beneficial for increasing more familiar behaviours such as cleaning hands and surfaces before preparing food.

New Zealand (NZ) and Australia (AU) have similarly high asthma prevalence; both have universal public health systems, but different criteria for subsidized medicines. We explored differences in asthma management and asthma-related outcomes between these countries.A web-based survey was administered in AU (2012) and NZ (2013) to individuals aged ≥16 years with current asthma, drawn randomly from web-based panels, stratified by national population proportions. Symptom control was assessed with the Asthma Control Test (ACT). Healthcare utilization was assessed from reported urgent doctor/hospital visits in the previous year.NZ (n = 537) and Australian (n = 2686) participants had similar age and gender distribution. More NZ than Australian participants used inhaled corticosteroid (ICS)-containing medication (68.8% vs 60.9%; P = 0.006) but ICS/long-acting βThis comparison, which included the first nationally representative data for asthma control in NZ, showed that poorly controlled asthma is common in both NZ and AU, despite subsidized ICS-containing medications. The greater use of ICS-alone in NZ relative to ICS/LABA does not appear to have compromised population-level asthma outcomes, perhaps due to better adherence in NZ. Different ICS/LABA subsidy criteria and different patient copayments may also have contributed to these findings.

Birmingham's St Patrick's Day parade claims to be the largest of such events in the UK and the third best attended in the world. Despite resorting to universal advertising proclamations that for one day ‘everyone is a little bit Irish’, this annual march continues to foster the unique musical character of the local diaspora; a metanarrative for the wider, fractious journey of the Irish community into the West Midlands over the past sixty years. This paper examines the primary event in Birmingham's calendar by way of the sounds of the spectacle, considering the musical display that is presented in the processional mode to a static audience sharing city-centre streets one Sunday morning every March. By engaging with the theories on performance of Domenico Pietropaolo, Mikhail Bakhtin and Stephen Greenblatt, this paper argues that it is in the audible space of the parade that Birmingham creates Breda Gray's Ireland ‘of global flows’.