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Malik A Althobiani,1,2 Bilal Khan,1 Amar J Shah,1,3 Yatharth Ranjan,4 Renata G Mendes,1,5 Amos Folarin,4 Swapna Mandal,1,3 Joanna C Porter,1,6 John R Hurst1,3 1UCL Respiratory, University College London, London, UK; 2Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK; 4Department of Health Informatics and Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK; 5Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Paulo, Brazil; 6Department of Respiratory Medicine, University College London Hospital (UCLH), London, UKCorrespondence: Malik A Althobiani, UCL Respiratory, University College London, London, UK, Email malik.althobiani.20@ucl.ac.ukObjective: To investigate clinicians’ perspectives on the current use of wearable technology for detecting COPD exacerbations, and to identify potential facilitators and barriers to its adoption in clinical settings.Methods: A mixed-method survey was conducted through an online survey platform involving clinicians working with COPD patients. The questionnaires were developed by an expert panel specialising in respiratory medicine at UCL. The questionnaire evaluated clinicians’ perspectives on several aspects: the current extent of wearable technology utilisation, the perceived feasibility, and utility of these devices, as well as the potential facilitators and barriers that hinder its wider implementation.Results: Data from 118 clinicians were included in the analysis. Approximately 80% of clinicians did not currently use information from wearable devices in routine clinical care. A majority of clinicians did not have confidence in the effectiveness of wearables and their consequent impact on health outcomes. However, clinicians highlighted the potential value of wearables in helping deliver personalised care and more rapid assistance. Ease of use, technical support and accessibility of data were considered facilitating factors for wearable utilisation. Costs and lack of technical knowledge were the most frequently reported barriers to wearable utilisation.Conclusion: Clinicians’ perspectives of the use of wearable technology to detect and monitor COPD exacerbations are variable. While accessibility and technical support facilitate wearable implementation, cost, technical issues, and knowledge act as barriers. Our findings highlight the facilitators and barriers to using wearables in patients with COPD and emphasise the need to assess patients’ perspectives on wearable acceptability.Keywords: wearable technology, COPD exacerbations, clinicians’ perspectives

Polliana B Dos Santos,1 Rodrigo P Simões,1,2 Cássia da L Goulart,1 Meliza G Roscani,3 Renan S Marinho,1 Patrícia Faria Camargo,1 Renata F Arbex,1 Guilherme Casale,3 Cláudio R Oliveira,3 Renata G Mendes,1 Ross Arena,4 Audrey Borghi-Silva1 1Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil; 2Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Minas Gerais, Brazil; 3Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil; 4Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USACorrespondence: Audrey Borghi-SilvaCardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, UFSCar, São Carlos, São Paulo, BrazilTel +551633066704Fax +551633612081Email audrey@ufscar.brAim: Our aim was to assess: 1) the impact of the eccentric left ventricular hypertrophy (ELVH) on exercise performance in patients diagnosed with chronic heart failure (CHF) alone and in patients with co-existing CHF and chronic obstructive pulmonary disease (COPD) and 2) the relationship between left and right cardiac function measurements obtained by doppler echocardiography, clinical characteristics and primary measures of cardiorespiratory fitness.Methods: The current study included 46 patients (CHF:23 and CHF+COPD:23) that performed advanced pulmonary function tests, echocardiography and symptom-limited, incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer.Results: Patients with CHF+COPD demonstrated a lower work rate, peak oxygen uptake (VO2), oxygen pulse, rate pressure product (RPP), circulatory power (CP) and ventilatory power (VP) compared to those only diagnosed with CHF. In addition, significant correlations were observed between VP and relative wall thickness (r: 0.45 p: 0.03),VE/VCO2 intercept and Mitral E/e’ ratio (r: 0.70 p: 0.003) in the CHF group. Significant correlations were found between indexed left ventricle mass and RPP (r: − 0.47; p: 0.02) and relative VO2 and right ventricle diameter (r: − 0.62; p: 0.001) in the CHF+COPD group.Conclusion: Compared to a diagnosis of CHF alone, a combined diagnosis of CHF+COPD induced further impairments in cardiorespiratory fitness. Moreover, echocardiographic measures of cardiac function are related to cardiopulmonary exercise performance and therefore appear to be an important therapeutic target when attempting to improve exercise performance and functional capacity.Keywords: heart failure, chronic obstructive pulmonary disease, eccentric hypertrophy, ventricular dysfunction, cardiopulmonary exercise testing, echocardiography

Jaber S Alqahtani,1,2 Renata G Mendes,3 Abdulelah Aldhahir,1,4 Daniel Rowley,5 Mohammed D AlAhmari,2,6 George Ntoumenopoulos,7 Saeed M Alghamdi,8,9 Jithin K Sreedharan,2 Yousef S Aldabayan,10 Tope Oyelade,11 Ahmed Alrajeh,10 Carlo Olivieri,12 Maher AlQuaimi,13 Jerome Sullivan,14 Mohammed A Almeshari,15 Antonio Esquinas16 1UCL Respiratory, University College London, London, UK; 2Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; 3Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Paulo, Brazil; 4Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 5Pulmonary Diagnostics & Respiratory Therapy Services, University of Virginia Medical Center, Charlottesville, VA, USA; 6Dammam Health Network, Dammam, Saudi Arabia; 7Consultant Physiotherapist, Physiotherapy Department St Vincent’s Hospital Sydney, Sydney, NSW, Australia; 8National Heart and Lung Institute, Imperial College London, London, UK; 9Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 10Respiratory Care, King Faisal University, Al-Ahsa, Saudi Arabia; 11UCL Institute for Liver and Digestive Health, London, UK; 12Emergency Department, Ospedale Sant’Andrea, Vercelli 13100, Italy; 13Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 14President, International Council for Respiratory Care, Professor Emeritus & Respiratory Care Program Director, The University of Toledo, Toledo, OH, USA; 15Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 16Director International NIV School, Intensive Care Unit, Hospital Morales Meseguer, Murcia, SpainCorrespondence: Jaber S AlqahtaniUCL Respiratory, University College London, Rowland Hill Street, London NW3 2PF, UKEmail Alqahtani-Jaber@hotmail.comBackground: As the global outbreak of COVID-19 continues to ravage the world, it is important to understand how frontline clinicians manage ventilatory support and the various limiting factors.Methods: An online survey composed of 32 questions was developed and validated by an international expert panel.Results: Overall, 502 respondents from 40 countries across six continents completed the survey. The mean number (±SD) of ICU beds was 64 ± 84. The most popular initial diagnostic tools used for treatment initiation were arterial blood gas (48%) and clinical presentation (37.5%), while the national COVID-19 guidelines were the most used (61.2%). High flow nasal cannula (HFNC) (53.8%), non-invasive ventilation (NIV) (47%), and invasive mechanical ventilation (IMV) (92%) were mostly used for mild, moderate, and severe COVID-19 cases, respectively. However, only 38.8%, 56.6% and 82.9% of the respondents had standard protocols for HFNC, NIV, and IMV, respectively. The most frequently used modes of IMV and NIV were volume control (VC) (36.1%) and continuous positive airway pressure/pressure support (CPAP/PS) (40.6%). About 54% of the respondents did not adhere to the recommended, regular ventilator check interval. The majority of the respondents (85.7%) used proning with IMV, with 48.4% using it for 12– 16 hours, and 46.2% had tried awake proning in combination with HFNC or NIV. Increased staff workload (45.02%), lack of trained staff (44.22%) and shortage of personal protective equipment (PPE) (42.63%) were the main barriers to COVID-19 management.Conclusion: Our results show that general clinical practices involving ventilatory support were highly heterogeneous, with limited use of standard protocols and most frontline clinicians depending on isolated and varied management guidelines. We found increased staff workload, lack of trained staff and shortage of PPE to be the main limiting factors affecting global COVID-19 ventilatory support management.Keywords: COVID-19, ventilation, respiratory, clinical management, proning, mechanical ventilation, NIV, HFNC

Luiz Carlos S Carvalho-Jr,1 Renata Trimer,2 Guilherme PT Arêas,1,3 Flávia CR Caruso,1 Katiany TL Zangrando,1 Soraia Pilon Jürgensen,1 José C Bonjorno Jr,4 Cláudio Ricardo de Oliveira,4 Ramona Cabiddu,1 Renata G Mendes,1 Audrey Borghi-Silva1 1Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil; 2Physical Education and Health Department, University of Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul, Brazil; 3Department of Physiology Science, Federal University of Amazonas, Manaus, Amazonas, Brazil; 4Department of Medicine, Federal University of São Carlos, São Carlos, São Paulo, Brazil Background: Chronic obstructive pulmonary disease (COPD) manifests itself in complex ways, with local and systemic effects; because of this, a multifactorial approach is needed for disease evaluation, in order to understand its severity and impact on each individual. Thus, our objective was to study the correlation between easily accessible variables, usually available in clinical practice, and maximum aerobic capacity, and to determine models for peak oxygen uptake (VO2peak) estimation in COPD patients.Subjects and methods: Individuals with COPD were selected for the study. At the first visit, clinical evaluation was performed. During the second visit, the volunteers were subjected to the cardiopulmonary exercise test. To determine the correlation coefficient of VO2peak with forced expiratory volume in 1 second (FEV1) (% pred.) and the COPD Assessment Test score (CATs), Pearson or Spearman tests were performed. VO2 at the peak of the exercise was estimated from the clinical variables by simple and multiple linear regression analyses.Results: A total of 249 subjects were selected, 27 of whom were included after screening (gender: 21M/5F; age: 65.0±7.3 years; body mass index: 26.6±5.0 kg/m2; FEV1 (% pred.): 56.4±15.7, CAT: 12.4±7.4). Mean VO2peak was 12.8±3.0 mL·kg-1·min-1 and VO2peak (% pred.) was 62.1%±14.9%. VO2peak presented a strong positive correlation with FEV1 (% pred.), r: 0.70, and a moderate negative correlation with the CATs, r: -0.54. In the VO2peak estimation model based on the CAT (estimated VO2peak =15.148- [0.185× CATs]), the index explained 20% of the variance, with estimated error of 2.826 mL·kg-1·min-1. In the VO2peak estimation model based on FEV1 (estimated VO2peak =6.490+ [0.113× FEV1]), the variable explained 50% of the variance, with an estimated error of 2.231 mL·kg-1·min-1. In the VO2peak estimation model based on CATs and FEV1 (estimated VO2peak =8.441- [0.0999× CAT] + [0.1000× FEV1]), the variables explained 55% of the variance, with an estimated error of 2.156 mL·kg-1·min-1.Conclusion: COPD patients’ maximum aerobic capacity has a significant correlation with easily accessible and widely used clinical variables, such as the CATs and FEV1, which can be used to estimate peak VO2. Keywords: chronic obstructive pulmonary disease, exercise, oxygen uptake, symptoms

Erika Zavaglia Kabbach, Adriana Mazzuco, Audrey Borghi-Silva, Ramona Cabiddu, Aline Galvão Agnoleto, Jessica Fernanda Barbosa, Luiz Carlos Soares de Carvalho Junior, Renata Gonçalves Mendes Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil Background: Cardiac autonomic modulation (CAM) is impaired in patients with stable COPD. Exacerbation aggravates the patients’ health status and functional capacity. While the clinical and functional effects of exacerbation are known, no studies investigated CAM during exacerbation and whether there is a relationship between CAM and functional capacity and dyspnea.Methods: Thirty-two patients with moderate to severe COPD were enrolled into two groups: stable COPD (GSta, n=16) and acute exacerbation of COPD (GAE, n=16). The GAE patients were evaluated 24–48 hours after starting standard therapy for COPD exacerbation during hospitalization; the GSta patients were evaluated in an outpatient clinic and included in the study if no decompensation episodes had occurred during the previous month. The heart rate (HR) and R-wave peak detection intervals in ms (RRi) were registered using a heart rate monitor (Polar® system) at rest in seated position during 10 minutes. CAM was assessed by heart rate variability (HRV) linear and non-linear analysis. Functional capacity was evaluated by handgrip strength test, performed by Jamar® dynamometer, and dyspnea was scored using the modified scale of the Medical Research Council.Results: GAE presented higher parasympathetic CAM values compared with GSta for square root of the mean squared differences of successive RRi (RMSSD; 17.8±5.6 ms vs 11.7±9.5 ms); high frequency (HF; 111.3±74.9 ms2 vs 45.6±80.7 ms2) and standard deviation measuring the dispersion of points in the plot perpendicular to the line of identity (SD1; 12.7±3.9 ms vs 8.3±6.7 ms) and higher CAM values for standard deviation of the mean of all of RRi (STD RRi; 19.3±6.5 ms vs 14.3±12.5 ms); RRi tri (5.2±1.7 ms vs 4.0±3.0 ms); triangular inter­polation of NN interval histogram (TINN; 88.7±26.9 ms vs 70.6±62.2 ms); low frequency (LF; 203±210.7 ms2 vs 101.8±169.7 ms2) and standard deviation measuring the dispersion of points along the line of identity (SD2; 30.4±14.8 ms vs 16.2±12.54 ms). Lower values were observed for the complexity indices: approximate entropy (ApEn; 0.9±0.07 vs 1.06±0.06) and sample entropy (SampEn; 1.4±0.3 vs 1.7±0.3). Significant and moderate associations were observed between HF (nu) and handgrip strength (r=-0.58; P=0.01) and between LF (ms2) and subjective perception of dyspnea (r=-0.53; P=0.03).Conclusion: COPD exacerbated patients have higher parasympathetic CAM than stable patients. This should be interpreted with caution since vagal influence on the airways determines a narrowing and not a better clinical condition. Additionally, functional capacity was negatively associated with parasympathetic CAM in COPD exacerbation. Keywords: pulmonary disease, hospitalization, autonomic nervous system, functional capacity

Objective: To evaluate the autonomic activity of an adolescent with a single ventricle without surgical correction who participated in a physical therapy program. Methods: This was a 14-year-old female patient with a left-type single ventricle who had not undergone any surgical intervention. The autonomic activity was evaluated according to the heart rate variability in the supine and seated positions and by means of the respiratory sinus arrhythmia accentuation maneuver (RSA-M) in the beginning of the first, second and third years of outpatient cardiovascular physical therapy treatment. The RR intervals and beat-to-beat heart rate were calculated and stored for subsequent analysis. The heart rate variability was evaluated by means of the RMSSD and RMSM indexes and in the frequency domain with high and low frequency bands in normalized units (HFnu and LFnu, respectively) and using the LF/HF ratio. The cardiovascular physical therapy consisted of respiratory exercises associated with active and general resistance exercises, for two years. Results: From the first to the third year, the RMSM decreased (14.5%), LFnu band increased (42.2%), LF/HF ratio increased (117.0%) and HFnu decreased (35.2%). In all of the situations, the LFnu band was higher and HFnu was lower in the seated position. Additionally, the parasympathetic response to RSA-M increased from the first to the third years in 7.4% and 47.3%, respectively. Conclusions: We concluded that, for the patient studied, the reduction in heart rate variability seemed to be associated with the advance of the disease. Nevertheless, there was no damages related to postural change. In addition, the cardiovascular physical therapy proposed increased the parasympathetic response during RSA-M. [ABSTRACT FROM AUTHOR]

Tailings dams' breaks are environmental disasters with direct and intense degradation of soil. This study analyzed the impacts of B1 tailings dam rupture occurred in the Ribeirão Ferro-Carvão watershed (Brumadinho, Brazil) in January 25, 2019. Soil organic carbon (SOC) approached environmental degradation. The analysis encompassed wetlands (high-SOC pools) located in the so-called Zones of Decreasing Destructive Capacity (DCZ5 to DCZ1) defined along the Ferro-Carvão's stream bed and banks after the disaster. Remote sensed water indices were extracted from Landsat 8 and Sentinel-2 satellite images spanning the 2017-2021 period and used to distinguish the wetlands from other land covers. The annual SOC was extracted from the MapBiomas repository inside and outside the DCZs in the same period, and assessed in the field in 2023. Before the dam collapse, the DCZs maintained stable levels of SOC, while afterwards they decreased substantially reaching minimum values in 2023. The reductions were abrupt: for example, in the DCZ3 the decrease was from 51.28 ton/ha in 2017 to 4.19 ton/ha in 2023. Besides, the SOC increased from DCZs located near to DCZs located farther from the dam site, a result attributed to differences in the percentages of clay and silt in the tailings, which also increased in the same direction. The Ferro-Carvão stream watershed as whole also experienced a slight reduction in the average SOC levels after the dam collapse, from nearly 43 ton/ha in 2017 to 38 ton/ha in 2021. This result was attributed to land use changes related with the management of tailings, namely opening of accesses to remove them from the stream valley, creation of spaces for temporary deposits, among others. Overall, the study highlighted the footprints of tailings dams' accidents on SOC, which affect not only the areas impacted with the mudflow but systemically the surrounding watersheds. This is noteworthy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

AgCuSe nanoparticles could contribute to the growth of strongly light-absorbing thin films and solids with fast ion mobility, among other potential properties. Nevertheless, few methods have been developed so far for the synthesis of AgCuSe nanoparticles, and those reported deliver nanostructures with relatively large sizes and broad size and shape distributions. In this work, a colloidal cation exchange method is established for the easy synthesis of AgCuSe NPs with ca. 8 nm diameters and narrow size dispersion. Notably, in this lower size range the conucleation and growth of two stoichiometric ternary compounds are generally observed, namely the well-known eucairite AgCuSe compound and the novel fischesserite -like Ag 3 CuSe 2 phase, the latter being less thermodynamically stable as predicted computationally and assessed experimentally. An optimal range of Cu/Ag precursor molar ratio has been identified to ensure the growth of ternary nanoparticles and, more specifically, that of the metastable Ag 3 CuSe 2 nanophase isolated for the first occasion. The attained size range for the material paves the way for utilizing AgCuSe nanoparticles in new ways within the field of biomedicine: the results obtained here confirm the antibacterial activity of the new Ag x Cu y Se z nanoparticles against Gram-positive bacteria, with significantly low values of the minimal inhibitory concentration., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

ZnO/ZrO 2 catalysts have shown better activity in the CO 2 hydrogenation to methanol compared with single component counterparts, but the interaction between ZnO and ZrO 2 is still poorly understood. In particular, the effect of the ZrO 2 support phase (tetragonal vs. monoclinic) was not systematically explored. Here, we have synthesized ZnO/ZrO 2 catalysts supported on tetragonal ZrO 2 (ZnO/ZrO 2 -t) and monoclinic ZrO 2 (ZnO/ZrO 2 -m), which resulted in the formation of different ZnO x species, consisting of sub-nanometer ZnO moieties and large-sized ZnO particles, respectively. ZnO/ZrO 2 -t exhibited a higher methanol selectivity (81 vs. 39 %) and methanol yield (1.25 vs. 0.67 mmol g -1  h -1 ) compared with ZnO/ZrO 2 -m. The difference in performance was attributed to the redox state and degree of dispersion of Zn, based on spectroscopy and microscopy results. ZnO/ZrO 2 -t had a high density of ZnO x -ZrO y sites, which favored the formation of active HCOO* species and enhanced the yield and selectivity of methanol along the formate pathway. Such ZnO clusters were further dispersed on ZrO 2 -t during catalysis, while larger ZnO particles on ZnO/ZrO 2 -m remained stable throughout the reaction. This study shows that the phase of ZrO 2 supports can be used to control the dispersion of ZnO and the catalyst surface chemistry, and lead to enhanced catalytic performance., (© 2024 The Authors. Angewandte Chemie International Edition published by Wiley-VCH GmbH.)

Background: The Duke Activity Status Index (DASI) questionnaire has been the focus of numerous investigations - its discriminative and prognostic capacity has been continuously explored, supporting its use in the clinical setting, specifically during rehabilitation in patients with chronic heart failure (CHF).However, studies exploring optimal DASI questionnaire threshold scores are limited., Objective: To investigate optimal DASI questionnaire thresholds values in predicting mortality in a CHF cohort and assess mortality rates based on the DASI questionnaire using a thresholds values obtained., Methodology: This is a prospective cohort study with a 36-month follow-up in patients with CHF. All patients completed a clinical assessment, followed by DASI questionnaire, pulmonary function, and echocardiography. The Receiver Operating Characteristic (ROC) curve analysis was used to discriminate the DASI questionnaire score in determining the risk of mortality. For survival analysis, the Kaplan-Meier model was used to explore the impact of ≤/>23 points on mortality occurring during the 36-month follow-up., Results: One hundred and twenty-four patients were included, the majority being elderly men. Kaplan Meier analysis revealed that ≤/> 23 was a strong predictor of CHF mortality over a 36-month follow-up., Conclusion: A score of ≤/>23 presents good discriminatory capacity to predict mortality risk in 36 months in patients with CHF, especially in those with reduced or mildly reduced ejection fraction. Age, ejection fraction, DASI questionnaire score and use of digoxin are risk factors that influence mortality in this population., (© 2024. The Author(s).)

Introduction: Coexistence of chronic obstructive pulmonary disease(COPD) and heart failure(HF) is associated with systemic inflammation, myocardial injury, and arterial stiffening, impacting cardiovascular risk and prognosis in patients. Arterial stiffness, reduced nitric oxide synthesis, and altered cardiac autonomic control further link COPD and HF pathophysiology, emphasizing the need for comprehensive cardiovascular assessment., Objective: To investigate a cardiovascular profile in patients hospitalized with exacerbation COPD(ECOPD) in coexistence with HF compared with isolated diseases., Methods: A cross-sectional study including patients diagnosed with ECOPD and decompensated HF, approached between 24 and 48 h after hospital admission. Assessments included: endothelial function by brachial artery flow-mediated vasodilation(FMD); hemodynamic through analysis of pulse wave and arterial stiffness by carotid-femoral pulse wave velocity(cfPWV) and cardiac autonomic modulation(CAM) by heart rate variability(HRV)., Results: The mean FMD was 4.45 %, indicating endothelial dysfunction in all patients. Date is present in mean(confidence interval) sequency COPD(n = 12), COPD-HF(n = 21) and HF(n = 21). FMD: 5.47(3.96-6.91); 2.66(0.09-3.48); 4.60(2.30-6.43) p < 0.01. However, COPD-HF had worse FMD. Arterial stiffens (AIx: 29.0(19.0-42.6); 34.6(24.3-43.2); 14.5(8.0-24.0)p < 0.01; cfPWV: (6.5(5.4-7.2); 7.7(7.0-8.5); 6.0(5.0-6.5)); COPD-HF also showed greater activation of the sympathetic nervous system compared to patients with isolated diseases (PNS: 1.32(-2.53 to -0.62); -2.33(-2.60 to -2.12); -1.32(-1.42 to -1.01) p < 0.01; SNS: 3.50(1.40-8.55); 7.11(5.70-8.29); 2.32(1.78-5.01) p < 0.01). In addition, rMSSD, NN 50 , pNN 50 , and TINN also indicate worse CAM in the COPD-HF group compared to isolated diseases., Conclusion: During hospitalization, the worst impairment in vascular function and cardiac autonomic modulation were found in patients with COPD and HF comorbidity compared to the isolated diseases(HF or COPD)., Competing Interests: Declaration of competing interest All authors declare no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To investigate the effects of implementing early multiprofessional mobilization on quality indicators of intensive care in Brazil., Design: This is a retrospective cohort study., Setting: A Brazilian educational and research-intensive care unit (ICU)., Participants: A total of 1047 patients were hospitalized from May 2016 to April 2018., Interventions: Implementation of early multiprofessional mobilization using the MobilizAÇÃO Program (MAP)., Main Outcome Measures: Clinical, ventilation and safety quality indicators, and physical function before (preprogram period) and after (postprogram period) the MAP., Results: There was a reduction in sedation time (4 vs 1d), hospital stay (21 vs 14d) and ICU stay (14 vs 7d), mechanical ventilation (8 vs 4d), hospital death rate (46% vs 26%) (P<.001), and ICU readmission (21% vs 16%; P=.030) from pre to post MAP. Successful weaning (42% vs 55%) and discharge rate (50% vs 71%) (P<.001) increased after MAP. No differences were found to safety quality indicators between periods. After MAP, complex physical functions assessed using the Manchester Mobility Score (MMS) were more frequent. The in-bed intervention was a predictor for readmission (P=.009; R²=0.689) and death (P=.035; R²=0.217), while walking was a predictor for successful weaning (P=.030; R²=0.907) and discharge (P=.033; R²=0.373). The postprogram period was associated with the MMS at ICU discharge (P<.001; R²=0.40)., Conclusions: Early mobilization implementation through changes in low mobility culture and multiprofessional actions improved quality indicators, including clinical, ventilation, and physical functional quality, without compromising patient safety in the ICU., (Copyright © 2024 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Evolution of the Pd active centers in size and spatial distribution leads to an irreversible deactivation in many high-temperature catalytic processes. This research demonstrates the use of a defective alumina (Al 2 O 3-x ) as catalyst support to anchor Pd atoms and suppress the growth of Pd clusters in catalytic methane oxidation. A combination of operando spectroscopy and density functional theory (DFT) calculations provide insights into the evolution of Pd species and reveals distinct catalytic methane oxidation mechanisms on Pd single atoms, clusters, and nanoparticles (NPs). Among these Pd species, the cluster active centers are found to be the most favorable participants in methane oxidation due to their high dispersion, high content of Pd 2+ oxidation state, and resistance to deactivation by carbonates, bicarbonates, and water. The Pd/Al 2 O 3-x catalyst shows increased stability with respect to a Pd/Al 2 O 3 counterpart during simulated aging in alternating reducing and oxidizing conditions due to stronger interactions with the support. This study demonstrates that defect engineering of non-reducible supports can constrain the evolution of active centers, which holds promising potential for widespread utilization across diverse industrial catalytic processes, including various hydrogenation and oxidation reactions., (© 2024. The Author(s).)

Impaired lung function, respiratory muscle weakness and exercise intolerance are present in COPD and contribute to poor prognosis. However, the contribution of the combination of these manifestations to define prognosis in COPD is still unknown. This study aimed to define cut-off points for both inspiratory and expiratory muscle strength (MIP and MEP, respectively) for mortality prediction over 42-months in patients with COPD, and to investigate its combination with other noninvasive established prognostic measures (FEV 1 , V̇O 2peak and 6MWD) to improve risk identification. Patients with COPD performed pulmonary function, respiratory muscle strength, six-minute walk and cardiopulmonary exercise tests, and were followed over 42 months to analyze all-cause mortality. A total of 79 patients were included. The sample was mostly (91.1%) comprised of severe (n = 37) and very severe (n = 34) COPD, and 43 (54%) patients died during the follow-up period. Cut-points of ≤ 55 and ≤ 80 cmH 2 O for MIP and MEP, respectively, were associated with increased risk of death (log-rank p = 0.0001 for both MIP and MEP) in 42 months. Furthermore, MIP and MEP substantially improved the mortality risk assessment when combined with FEV 1 (log-ranks p = 0.006 for MIP and p < 0.001 for MEP), V̇O 2peak (log-rank: p < 0.001 for both MIP and MEP) and 6MWD (log-ranks: p = 0.005 for MIP; p = 0.015 for MEP). Thus, patients severely affected by COPD presenting MIP ≤ 55 and/or MEP ≤ 80 cmH2O are at increased risk of mortality. Furthermore, MIP and MEP substantially improve the mortality risk assessment when combined with FEV1, V̇O2peak and 6MWD in patients with COPD., (© 2024. The Author(s).)

Purpose/Aim: Cardiovascular function is controlled and regulated by a functional brain-heart axis. Although the exact mechanism is not fully understood, several studies suggest a hemispheric asymmetry in the neural control of cardiovascular function. Thus, the purpose of this study was to examine whether endothelial function and arterial compliance differ between individuals with left- and right-sided strokes. Materials and Methods: This was a cross-sectional exploratory study. Thirty individuals more than 6 months after stroke participated in the study. The endothelial function was assessed by ultrasound-measured flow-mediated dilation of the nonparetic arm brachial artery (baFMD). The arterial stiffness was assessed by measuring carotid-femoral pulse wave velocity (cfPWV) and central aortic pulse wave analysis [augmentation index (AIx), augmentation index normalized to a heart rate of 75 bpm (AIx@75) and reflection magnitude (RM)] using applanation tonometry. Results: Participants with right-sided stroke had worse endothelial function than those with left-sided stroke. This difference (baFMD = 2.51%) was significant ( p  = 0.037), and it represented a medium effect size ( r  = 0.38). Likewise, they had higher arterial stiffness than those with left-sided stroke. This difference (AIx = 10%; RM = 7%) was significant ( p  = 0.011; p  = 0.012), and it represented a medium effect size ( r  = 0.48; r  = 0.47). Conclusions: Our findings suggest that individuals with right-sided stroke have reduced endothelial function and arterial compliance compared to those with left-sided stroke. These data may indicate that those with right-sided strokes are more susceptible to cardiovascular events.

The remarkable development of colloidal nanocrystals with controlled dimensions and surface chemistry has resulted in vast optoelectronic applications. But can they also form a platform for quantum materials, in which electronic coherence is key? Here, we use colloidal, two-dimensional Bi 2 Se 3 crystals, with precise and uniform thickness and finite lateral dimensions in the 100 nm range, to study the evolution of a topological insulator from three to two dimensions. For a thickness of 4-6 quintuple layers, scanning tunneling spectroscopy shows an 8 nm wide, nonscattering state encircling the platelet. We discuss the nature of this edge state with a low-energy continuum model and ab initio GW-Tight Binding theory. Our results also provide an indication of the maximum density of such states on a device.

Background: The management of COPD has been based on the premise of identifying problems that guide personalised treatment based on a multidimensional assessment, known as treatable traits. Exacerbation of COPD (ECOPD) results in physical and functional impairments, limitation of daily activities and negative impact on patients' quality of life and prognosis. In this context, identifying treatable traits in patients with ECOPD is essential to properly guide individualised patient care. There is a need to develop a performance-based toolkit to identify the main treatable traits of functioning in hospitalised patients with ECOPD., Methods and Analysis: This is a study protocol of a survey method observational study to develop a performance-based toolkit. The study will include the following steps: 1) definition of treatable traits by both physiotherapists who provide or have provided care to hospitalised patients with ECOPD on a regular basis, and patients who have experienced at least one ECOPD which required hospitalisation; 2) selection of the most appropriate measures (markers) for each treatable trait based on established criteria and a previous systematic review; and 3) implementation of the toolkit in a pilot/feasibility study with hospitalised patients with ECOPD., Conclusion: The development of a feasible performance-based toolkit with the best markers for each key treatable trait of functioning in hospitalised patients with ECOPD will make it possible to create individualised patient care for the specific demands of these patients., Competing Interests: Conflict of interest: N.T. Leonardi reports support for the present manuscript from FAPESP (São Paulo Research Foundation), and support for attending meetings and/or travel from FAPESP outside the submitted work. Conflict of interest:D.M.O. Kawakami reports support for the present manuscript from FAPESP (São Paulo Research Foundation), and support for attending meetings and/or travel from FAPESP outside the submitted work. Conflict of interest:J. Cruz reports receiving support to attend the European Respiratory Society Congress 2022 as the representative of the Early Career Members of Assembly 9 and is a member of the editorial board of ERJ Open Research (unpaid). Conflict of interest:C. Burtin has nothing to disclose. Conflict of interest:A. Borghi-Silva reports support for the present manuscript from FAPESP (São Paulo Research Foundation), and support for attending meetings and/or travel from FAPESP outside the submitted work. Conflict of interest:R.G. Mendes reports support for the present manuscript from FAPESP (São Paulo Research Foundation), and support for attending meetings and/or travel from FAPESP outside the submitted work., (Copyright ©The authors 2024.)

Introduction: Rates of mortality and re-admission after a hospitalised exacerbation of COPD are high and resistant to change. COPD guidelines do not give practical advice about the optimal selection of inhaled drugs and device in this situation. We hypothesised that a failure to optimise inhaled drug and drug delivery prior to discharge from hospital after an exacerbation would be associated with a modifiable increased risk of re-admission and death. We designed a study to 1) develop a practical inhaler selection tool to use at the point of hospital discharge and 2) implement this tool to understand the potential impact on modifying inhaler prescriptions, clinical outcomes, acceptability to clinicians and patients, and the feasibility of delivering a definitive trial to demonstrate potential benefit., Methods: We iteratively developed an inhaler selection tool for use prior to discharge following a hospitalised exacerbation of COPD using surveys with multiprofessional clinicians and a focus group of people living with COPD. We surveyed clinicians to understand their views on the minimum clinically important difference (MCID) for death and re-admission following a hospitalised exacerbation of COPD. We conducted a mixed-methods implementation feasibility study using the tool at discharge, and collated 30- and 90-day follow-up data including death and re-admissions. Additionally, we observed the tool being used and interviewed clinicians and patients about use of the tool in this setting., Results: We completed the design of an inhaler selection tool through two rounds of consultations with 94 multiprofessional clinicians, and a focus group of four expert patients. Regarding MCIDs, there was majority consensus for the following reductions from baseline being the MCID: 30-day readmissions 5-10%, 90-day readmissions 10-20%, 30-day mortality 5-10% and 90-day mortality 5-10%. 118 patients were assessed for eligibility and 26 had the tool applied. A change in inhaled medication was recommended in nine (35%) out of 26. Re-admission or death at 30 days was seen in 33% of the switch group and 35% of the no-switch group. Re-admission or death at 90 days was seen in 56% of the switch group and 41% of the no-switch group. Satisfaction with inhalers was generally high, and switching was associated with a small increase in the Feeling of Satisfaction with Inhaler questionnaire of 3 out of 50 points. Delivery of a definitive study would be challenging., Conclusion: We completed a mixed-methods study to design and implement a tool to aid optimisation of inhaled pharmacotherapy prior to discharge following a hospitalised exacerbation of COPD. This was not associated with fewer re-admissions, but was well received and one-third of people were eligible for a change in inhalers., Competing Interests: Conflict of interest: A. De Soyza declares research grants in support of investigator and investigator-initiated trials from Sanofi-Aventis, Lilly, Boehringer Ingelheim and AstraZeneca; consulting fees from AstraZeneca, Insmed, Sanofi, Bayer, GSK, Boehringer Ingelheim and Zambon; speakers’ fees from AstraZeneca, Insmed, Sanofi, Bayer, GSK, Boehringer Ingelheim and Zambon; and advisory board membership for AstraZeneca, Insmed, Sanofi, Bayer, GSK, Boehringer Ingelheim and Zambon, all in the 36 months prior to manuscript submission. Conflict of interest: M. Dobson declares NIHR Research for Patient Benefit co-applicant funding to their institution in relation to the present work. Conflict of interest: C. Echevarria declares research grants from GlaxoSmithKline and NIHR, in the 36 months prior to manuscript submission. Conflict of interest: G. Martin declares NIHR Research for Patient Benefit co-applicant funding to their institution in relation to the present work. Conflict of interest: R.G. Mendes declares payment for participation in scientific events from Fundação de Apoio à Pesquisa do Estado de São Paulo. Conflict of interest: E. Sapey declares NIHR Research for Patient Benefit co-applicant funding to their institution in relation to the present work. Conflict of interest: J.R. Hurst declares funding for a PhD studentship from AstraZeneca; consulting fees to them and their institution from AstraZeneca and GlaxoSmithKline; payment or honoraria to themselves for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, Boehringer Ingelheim, Chiesi, Sanofi and Takeda; support in kind for attending meetings from AstraZeneca; payment to them and their institution for participation on an Advisory Board for AstraZeneca; and donation of oximeters from Nonin, all in the 36 months prior to manuscript submission. Conflict of interest: All other authors declare no competing interests., (Copyright ©The authors 2024.)

Objectives: During the Coronavirus disease (COVID-19) pandemic, clinicians recommended awake-prone positioning (APP) to avoid the worst outcomes. The objectives of this study were to investigate if APP reduces intubation, death rates, and hospital length of stay (HLOS) in acute COVID-19., Methods: We performed a retrospective cohort with non-mechanically ventilated patients hospitalized in a reference center in Manaus, Brazil, 2020. Participants were stratified into APP and awake-not-prone positioning (ANPP) groups. Also, we conducted a systematic review and performed a meta-analysis to understand if this intervention had different outcomes in resource-limited settings (PROSPERO CRD42023422452)., Results: A total of 115 participants were allocated into the groups. There was no statistical difference between both groups regarding time to intubation (HR: 0.861; 95CI: 0.474-1.1562; p=0.622) and time to death (HR: 1.666; 95CI: 0.939-2.951; p=0.081). APP was not significantly associated with reduced HLOS. A total of 86 articles were included in the systematic review, of which 76 (88,3%) show similar findings after APP. Also, low/middle, and high-income countries were similar regarding such outcomes., Conclusion: APP in COVID-19 does not present clinical improvement that affects mortality, intubation rate and HLOS. The lack of a prone position protocol, obtained through a controlled study, is necessary. After 3 years, APP benefits are still inconclusive.

Manganese is an attractive element for sustainable solutions. It is largely available in the earth's crust, making it ideal for cost-effective and large-scale applications. Especially MnO nanoparticles have recently received attention for applications in battery technology. However, manganese has many oxidation states that are energetically very similar, indicating that they may easily transform from one to the other. Herein, the reversible oxidation of MnO nanoparticles to Mn 3 O 4 studied with in situ transmission electron microscopy is shown. The oxygen sublattices of MnO and Mn 3 O 4 are found to be perfectly aligned, and an atomic mechanism where the transformation is facilitated by the migration of Mn cations on the shared O sublattice is proposed. Even when protected with an amorphous carbon layer, MnO particles are highly unstable and oxidize to Mn 3 O 4 in ethanol. The poor stability of MnO lacks discussion in many battery-related works, and strategies aimed at avoiding this should be developed., (© 2023 The Authors. Small published by Wiley-VCH GmbH.)

The six-minute step test (6MST) has been shown to be effective in assessing exercise capacity in individuals with COPD regardless of severity and, despite its easy execution, accessibility and validity, information on the prognostic power of this test remains uncertain. The aim of this study is to investigate whether the 6MST can predict the occurrence of exacerbations in patients with COPD. This is a prospective cohort study with a 36-month follow-up in patients with COPD. All patients completed a clinical assessment, followed by pulmonary function testing and a 6MST. The 6MST was performed on a 20 cm high step; heart rate, blood pressure, oxygen saturation, BORG dyspnea and fatigue were collected. Sixty-four patients were included in the study, the majority being elderly men. Performance on the 6MST demonstrated lower performance compared to normative values proposed in the literature, indicating a reduced functional capacity. Kaplan Meier analysis revealed that ≤ 59 steps climbed during the 6MST was a strong predictor of COPD exacerbation over a 36-month follow-up. We have identified a minimal threshold number of steps (≤ 59) obtained through the 6MST may be able predict the risk of exacerbations in patients with COPD., (© 2024. The Author(s).)

Background: Prediabetes (PD) is defined as impaired fasting glucose and/or impaired glucose tolerance (IGT) and may be associated with high risk of cardiovascular injury. It is recommended that PD patients be screened for signs of arterial stiffness and cardiovascular injury to reinforce therapeutic strategies., Objectives: To identify pulse wave velocity values discriminative for arterial stiffness and cardiovascular injury in PD patients., Methods: A cross-sectional study was conducted with PD (N=43) and normoglycemic (N=37) patients who underwent clinical evaluation, arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor, laboratory blood analysis, investigation of morphological and functional cardiac variables by transthoracic echocardiogram, and assessment of carotid intima-media-thickness (CIMT) by carotid ultrasonography. A statistical analysis was performed using SPSS software and values of p<0.05 were considered significant., Results: A cfPWV cut-off value of 6.9 m/s was identified for IGT (Sensitivity [SE]: 74% and Specificity [SP]: 51%). Comparison of general data and risk factors between subsets with values above and below this cutoff value revealed higher rates of fasting glucose (p=0.02), obesity (p=0.03), dyslipidemia (p=0.004), early signs of left ventricle (p=0.017) and right ventricle (p=0.03) impaired diastolic function, and elevated CIMT in subjects with cfPWV ≥ 6.9m/s (p=0.04)., Conclusions: In PD patients, a cfPWV cutoff of 6.9 m/s was considered a discriminative value for arterial stiffness. These findings highlight the value of early investigation of cardiovascular injury and aggressive therapy strategies with good control of risk factors in PD., Competing Interests: Conflicts of interest: No conflicts of interest declared concerning the publication of this article., (Copyright© 2023 The authors.)

Background: Weber classification stratifies cardiac patients based on peak oxygen consumption (V̇O 2 ), the gold-standard measure of exercise capacity., Objective: To determine if Weber classification is a useful tool to discriminate clinical phenotypes in COPD patients and to evaluate if disease severity and other clinical measures can predict V̇O 2peak ., Methods: Three hundred and six COPD patients underwent cardiopulmonary exercise testing (CPX) and were divided according to Weber class: 1) Weber A (n = 34); 2) Weber B (n = 88); 3) Weber C (n = 138); and 4) Weber D (n = 46)., Results: Weber class D patients demonstrated a reduced V̇O 2 peak , heart rate (HR), minute ventilation (V̇ E ) , oxygen (O 2 ) pulse, circulatory power (CP), oxygen uptake efficiency slope (OUES), oxygen saturation (SpO 2 %), delta (Δ)HR and ΔSpO 2 when compared to Weber A and B (p<0.05). Moreover, Dyspnea and the V̇ E /carbon dioxide production (V̇CO 2 ) slope were higher in Weber D compared with Weber C and A (p<0.001). Hierarchical regression analysis demonstrated significant predictors of V̇O 2peak (R 2 = 0.131; Adj R 2  = 1.25), including HR (β=0.5757; t = 5.7; P<0.001) and forced expiratory volume in one second (FEV 1 ) (β=0.119; t = 2.16; P<0.03). Among the Weber C + D groups, predictors of V̇O 2peak (R = 0.78; R 2 = 0.60; Adj R 2 =0.59), dyspnea (β=0.076; t = 1.111; P<0.27) and maximal voluntary ventilation (MVV) (β=0.75; t = 1.14; P<0.00)., Conclusion: Weber classification may be a useful tool to stratify cardiorespiratory fitness in COPD patients. Other clinical measures may be useful in predicting peak V̇O 2 in mild-to-severe COPD, moreover different phenotypes may be important tool to improve physical capacity of chronic disease patients., Competing Interests: Declaration of Competing Interest No potential conflict of interest was reported by the authors., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Individuals with COPD have an imbalance of cardiac autonomic control. In this context, HRV is considered an important tool for assessing cardiac sympathetic and parasympathetic balance, however it is a dependent evaluator measure and subject to methodological biases that may compromise the interpretation of results., Objective: This study examines the inter- and intrarater reliability of HRV parameters derived from short-term recordings in individuals with COPD., Methodology: Fifty-one individuals of both genders with COPD clinical diagnosis confirmed by the pulmonary function test and aged ≥50 years were included. The RR interval (RRi) were recorded during a 10 min period on supine position using a portable heart rate monitor (Polar® H10 model). The data were transferred into Kubios® HRV Standard analysis software and analyzed within the stable sessions containing 256 sequential RRi., Results: The intraclass correlation coefficient (ICC) ranged from 0.942 to 1.000 according to the intrarater analysis by Researcher 01 and 0.915 to 0.998 to the intrarater by Researcher 02. The interrater ICC ranged from 0.921 to 0.998. The coefficient of variation was up to 8.28 for Researcher 01 intrarater analysis, 9.06 for Researcher 02 intrarater analysis and 13.07 for interrater analysis., Conclusion: The measurement of HRV using a portable heart rate device in individuals with COPD present acceptable values of intra- and interrater reliability, supporting the use of HRV in the clinical and scientific scenario. Furthermore, it is important that the data analysis be performed by the same experienced evaluator., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict/competing of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To translate and cross-culturally adapt the COPD in Low- and middle-income countries (LMICs) Assessment (COLA) questionnaire into Brazilian Portuguese, a case-finding instrument for chronic obstructive pulmonary disease (COPD)., Methods: Translation and cross-cultural adaptation were completed in six steps: the original version was translated into Brazilian Portuguese by two native speakers of the target language; the translated versions were synthesized; back-translation was performed by two native speakers of the original language; the back-translation and the Brazilian Portuguese version of the COLA were reviewed and harmonized by an expert committee of specialists; and, then, the pre-final version was tested by 30 health professionals who were asked if the items were clear to understand. The acceptability, clarity, and understandability of the translated version were evaluated. A final review of the questionnaire was produced by the authors and approved by the author of the original questionnaire., Results: Some idiomatic, semantic, and experiential inconsistencies were identified and properly adjusted. Item 3 was considered the most unclear item (23,3%). Items 7, 8, and 9 presented clarity above 80% (93%, 90%, and 90%, respectively). Suggestions were discussed and incorporated into the tool and COLA was found to be clear and easy to understand., Conclusions: The Brazilian version of the COLA was easily understood by healthcare professionals and adapted to Brazilian culture. Translation and cultural adaptation of the COLA instrument into Brazilian Portuguese can be an important case-finding instrument for chronic obstructive pulmonary disease in Brazil.

The collapse of B1 dam at the Córrego do Feijão mine of Vale, S.A., located in the Ferro-Carvão stream watershed (Brazil), released 11.7 Mm 3 of tailings rich in iron and manganese, and 2.8 Mm 3 entered the Paraopeba River 10 km downstream. Seeking to predict the evolution of environmental deterioration in the river since the dam break on January 25, 2019, the present study generated exploratory and normative scenarios based on predictive statistical models, and proposed mitigating measures and subsides to ongoing monitoring plans. The scenarios segmented the Paraopeba into three sectors: "anomalous" for distances ≤63.3 km from the B1 dam site, "transition" (63.3-155.3 km), and "natural" (meaning unimpacted by the mine tailings in 2019; >155.3 km). The exploratory scenarios predicted a spread of the tailings until reaching the "natural" sector in the rainy season of 2021, and their containment behind the weir of Igarapé thermoelectric plant located in the "anomalous" sector, in the dry season. Besides, they predicted the deterioration of water quality and changes to the vigor of riparian forests (NDVI index) along the Paraopeba River, in the rainy season, and a restriction of these impacts to the "anomalous" sector in the dry season. The normative scenarios indicated exceedances of chlorophyll-a in the period January 2019-January 2022, but not exclusively caused by the rupture of B1 dam as they also occurred in areas not affected by the accident. Conversely, the manganese exceedances clearly flagged the dam failure, and persist. The most effective mitigating measure is likely the dredging of the tailings in the "anomalous" sector, but currently it represents solely 4.6 % of what has entered the river. Monitoring is paramount to update the scenarios until the system enters a route towards rewilding, and must include water and sediments, the vigor of riparian vegetation, and the dredging., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Rationale: Chronic obstructive pulmonary disease (COPD) is a prevalent and burdensome condition in low- and middle-income countries (LMICs). Challenges to better care include more effective diagnosis and access to affordable interventions. There are no previous reports describing therapeutic needs of populations with COPD in LMICs who were identified through screening. Objectives: To describe unmet therapeutic need in screening-detected COPD in LMIC settings. Methods: We compared interventions recommended by the international Global Initiative for Chronic Obstructive Lung Disease COPD strategy document, with that received in 1,000 people with COPD identified by population screening at three LMIC sites in Nepal, Peru, and Uganda. We calculated costs using data on the availability and affordability of medicines. Measurement and Main Results: The greatest unmet need for nonpharmacological interventions was for education and vaccinations (applicable to all), pulmonary rehabilitation (49%), smoking cessation (30%), and advice on biomass smoke exposure (26%). Ninety-five percent of the cases were previously undiagnosed, and few were receiving therapy (4.5% had short-acting β-agonists). Only three of 47 people (6%) with a previous COPD diagnosis had access to drugs consistent with recommendations. None of those with more severe COPD were accessing appropriate maintenance inhalers. Even when available, maintenance treatments were unaffordable, with 30 days of treatment costing more than a low-skilled worker's daily average wage. Conclusions: We found a significant missed opportunity to reduce the burden of COPD in LMIC settings, with most cases undiagnosed. Although there is unmet need in developing novel therapies, in LMICs where the burden is greatest, better diagnosis combined with access to affordable interventions could translate to immediate benefit.

The result of the movement restrictions during the COVID-19 pandemic was an impromptu and abrupt switch from in-person to online teaching. Most focus has been on the perception and experience of students during the process. The aim of this international survey is to assess staffs' perspectives and challenges of online teaching during the COVID-19 lockdown. Cross-sectional research using a validated online survey was carried out in seven countries (Brazil, Saudi Arabia, Jordan, Indonesia, India, the United Kingdom, and Egypt) between the months of December 2021 and August 2022, to explore the status of online teaching among faculty members during the COVID-19 pandemic. Variables and response are presented as percentages while logistic regression was used to assess the factors that predict levels of satisfaction and the challenges associated with online instruction. A total of 721 response were received from mainly male (53%) staffs. Most respondents are from Brazil (59%), hold a Doctorate degree (70%) and have over 10 years of working experience (62%). Although, 67% and 79% have relevant tools and received training for online teaching respectively, 44% report that online teaching required more preparation time than face-to-face. Although 41% of respondents were uncertain about the outcome of online teaching, 49% were satisfied with the process. Also, poor internet bandwidth (51%), inability to track students' engagement (18%) and Lack of technical skills (11.5%) were the three main observed limitations. Having little or no prior experience of online teaching before the COVID-19 pandemic [OR, 1.58 (95% CI, 1.35-1.85)], and not supporting the move to online teaching mode [OR, 0.56 (95% CI,0.48-0.64)] were two main factors independently linked with dissatisfaction with online teaching. While staffs who support the move to online teaching were twice likely to report no barriers [OR, 2.15 (95% CI, 1.61-2.86)]. Although, relevant tools and training were provided to support the move to online teaching during COVID-19 lockdown, barriers such as poor internet bandwidth, inability to track students' engagement and lack of technical skills were main limitations observed internationally by teaching staffs. Addressing these barriers should be the focus of higher education institution in preparation for future disruptions to traditional teaching modes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: The aim of this study was to explore the effects of non-invasive positive pressure ventilation (NIPPV) associated with high-intensity exercise on heart rate (HR) and oxygen uptake (V̇O 2 ) recovery kinetics in in patients with coexistence of chronic obstructive pulmonary disease (COPD) and heart failure (HF)., Methods: This is a randomized, double blinded, sham-controlled study involving 14 HF-COPD patients, who underwent a lung function test and Doppler echocardiography. On two different days, patients performed incremental cardiopulmonary exercise testing (CPET) and two constant-work rate tests (80% of CPET peak) receiving Sham or NIPPV (bilevel mode - Astral 150) in a random order until the limit of tolerance (Tlim). During exercise, oxyhemoglobin and deoxyhemoglobin were assessed using near-infrared spectroscopy (Oxymon, Artinis Medical Systems, Einsteinweg, Netherland)., Results: The kinetic variables of both V̇O 2 and HR during the high-intensity constant workload protocol were significantly faster in the NIPPV protocol compared to Sham ventilation (P < 0.05). Also, there was a marked improvement in oxygenation and lower deoxygenation of both peripheral and respiratory musculature in TLim during NIPPV when contrasted with Sham ventilation., Conclusions: NIPPV applied during high-intensity dynamic exercise can effectively improve exercise tolerance, accelerate HR and V̇O 2 kinetics, improve respiratory and peripheral muscle oxygenation in COPD-HF patients. These beneficial results from the effects of NIPPV may provide evidence and a basis for high-intensity physical training for these patients in cardiopulmonary rehabilitation programs., Competing Interests: Declaration of Competing Interest No potential conflict of interest was reported by the authors., (Copyright © 2023 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Introduction: Hospitalised patients with exacerbations of COPD (ECOPD) may have physical and functional impairments that impact morbidity and readmission. Therefore, it is crucial to properly identify reduced functionality in these patients to support a personalised rehabilitation. The objective of this study is to summarise and compare the measurement properties of functionality performance-based outcome measures for hospitalised patients with ECOPD., Methods: A systematic review based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) was performed. The PubMed, Embase, PEDro and Cochrane databases were searched using terms related to functionality, hospitalised patients with ECOPD and measurement properties. Studies were selected and extracted by two researchers. The COSMIN Risk of Bias checklist was applied to assess the methodological quality of the studies and measurement property results were compared with the criteria for good measurement properties. Quality of evidence was graded using a modified Grades of Recommendation, Assessment, Development and Evaluation approach., Results: 13 studies were included with nine outcome measures, namely the 6-min pegboard ring test, the de Morton mobility index, the incremental shuttle walk test (ISWT), the 6-min walk test (6MWT), maximum inspiratory pressure (MIP), the Berg balance scale, 4-m gait speed, handgrip strength and the 6-min stepper test. Construct validity was rated as sufficient, except for the ISWT. Responsiveness, assessed only for MIP, was considered insufficient and measurement errors for the ISWT and 6MWT were insufficient, with a very low quality of evidence for all measurement properties., Conclusion: Measurement properties of performance-based outcome measures to assess functionality in patients hospitalised with ECOPD are still scarce, with very low evidence supporting validity and a lack of evidence of responsiveness and reliability. Further studies are needed to address this topic and guide assertive and personalised management., Competing Interests: Conflict of interest: N.T. Leonardi reports support for the present manuscript from FAPESP (São Paulo Research Foundation) in the form of English review and article processing charges, as well as support in attending meetings and travels to present products/results of the project. J.R. Hurst reports consulting fees from AstraZeneca, GSK; lecture honoraria from Boehringer Ingelheim, Chiesi, Sanofi, Takeda; travel support and advisory board participation from AstraZeneca; donation of oximeters from Nonin; outside the submitted work. J. Cruz reports travel support to attend the European Respiratory Society Congress 2022 as the representative of the Early Career Members of Assembly 9; and is a member of the Editorial Board of ERJ Open Research (unpaid); outside the submitted work. R.G. Mendes reports support for the present manuscript from FAPESP (São Paulo Research Foundation), in the form of project funding providing support for buying laboratory consumables materials and equipment and also article processing charges and maintenance costs, as well as attending meetings and travels to present products/results of the project. All other authors have nothing to disclose., (Copyright ©The authors 2023.)

The aim of this study was to assess cardiorespiratory coupling (CRC) in type 2 diabetes mellitus patients (T2DM) and apparently healthy individuals, in order to test the hypothesis that this method can provide additional knowledge to the information obtained through the heart rate variability (HRV). A cross-sectional study was conducted in T2DM patients(T2DMG=32) and health controls (CON=32). For CRC analysis, the electrocardiogram, arterial pressure, and thoracic respiratory movement were recorded at rest in supine position and during active standing. Beat-to-beat series of heart period and systolic arterial pressure were analyzed with the respiratory movement signal via a traditional non-causal approach, such as squared coherence function. In this sample of T2DM, no differences in HRV were observed when compared to the CON, but the T2DMG showed a reduction in resting CRC. We conclude that in CRC in T2DM, reflected by the squared coherence may already be compromised even before HRV changes., (Copyright © 2023. Published by Elsevier B.V.)

Objective: The aim of this study was to measure the reliability, internal consistency, and construct validity of the Kidney Symptom Questionnaire for the Brazilian population., Methods: This is a cross-cultural adaptation and questionnaire validation study. We included native Brazilians of both sex aged>18 years, as well as hypertensive and/or diabetic patients. All participants were assessed using Screening for Occult Renal Disease, EuroQol 5 Dimensions, 36-Item Short Form Survey, and the Kidney Symptom Questionnaire. We used Spearman's coefficient (rho) to measure the correlations between the Kidney Symptom Questionnaire and other instruments; Cronbach's alpha to measure internal consistency; and intraclass correlation coefficient, standard error of measurement, and minimum detectable change to measure test-retest reliability., Results: The sample was formed by 121 adult participants, mostly female, with systemic arterial hypertension and/or diabetes mellitus. We found excellent reliability (intraclass correlation coefficient≥0.978), adequate internal consistency (Cronbach's alpha≥0.860), and adequate construct validity on the Kidney Symptom Questionnaire domains; besides, we observed significant correlations between the Kidney Symptom Questionnaire and other instruments., Conclusion: The Brazilian version of the Kidney Symptom Questionnaire has adequate measurement properties to assess chronic/occult kidney disease in patients who do not require renal replacement therapy.

Background: Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) have decreased exercise tolerance, which may persist for months. In this context, little is known about the associations between muscle strength and recovery of exercise capacity., Objective: To assess whether respiratory and peripheral muscle strength influence recovery of exercise capacity in patients hospitalized due to AECOPD., Methods: Twenty-seven AECOPD patients (aged 69 ± 7 years, 56% male) were included. The following assessments were performed within 24 to 72 h of hospital admission: (i) respiratory muscle strength, measured by maximal inspiratory and expiratory pressures (MIP and MEP); (ii) peripheral muscle strength, assessed by handgrip and quadriceps muscle strength; and (iii) exercise capacity, measured by 6-min walking distance (6MWD). The 6MWD was reassessed 30 days later to determine the recovery of exercise capacity., Results: After 30 days, while 63% of the patients showed clinically important improvement in the 6MWD (recovery ≥ 30 m), 37% showed no change (recovery < 30 m). During hospital stay, the non-recovered group had lower quadriceps muscle strength compared to the recovered group (15 ± 5 vs. 22 ± 6 kgf; P = 0.006), with no significant difference for MIP, MEP and handgrip strength. Only quadriceps muscle strength was associated with recovery of exercise capacity (r = 0.56; P = 0.003)., Conclusion: AECOPD patients with quadriceps muscle weakness during hospitalization have poor recovery of exercise capacity after 30 days. This finding suggests the importance of early rehabilitation to improve quadriceps strength and accelerate functional recovery after AECOPD., Competing Interests: Declarations of Competing Interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: This is the first study to investigate the performance of 6MST in COPD patients divided into different symptom severity groups based on the CAT questionnaire score., Objectives: To evaluate the relationship between the degree symptomatology using the chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) with the six- minute step test (6MST) in COPD patients., Methods: This is a cross-sectional study in which 59 patients with COPD were evaluated. The groups were stratified according to the subsequent cutoff points: CAT <10 (little impact) n= 22; CAT 11-20 (moderate impact) n=20; CAT <20 (large impact) n=17. During 6MST the individuals were instructed to go up and down a single step with a height of 20 centimeters (cm)., Results: Comparing the groups in relation to performance on the 6MST, the number of climbs on the step were significantly higher in the CAT group <10 when compared to the CAT group >20, the variation in HR between rest and peak exercise (∆ HRpeak- rest) was lower in the CAT>20 group compared to the CAT<10 group and the CAT 11- 20 group. We found direct relationships between the number of ascents and descents in the 6MST vs the CAT score (r=0.35, p=0.007); and 6MST vs degree of obstruction of %FEV1 (r-0.46, p=0.002) We verified a linear regression model in which the FEV1 (L) and the CAT score influenced 29% in the performance of the 6MST., Conclusion: The COPD severity represented by the FEV 1 and the CAT score are associated and influenced by 29% the performance of 6-minute step test. Our findings may have important implications for the clinical evaluation of these patients as well as for rehabilitation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)