The no hacks, no javascript, no tables and no conditional comments dropdown/flyout menu with png opacity background images.

Using the new multi-level menu system this has a better indication of the path taken through the menu structure.

A multi-level drop/fly menu using the new system and mouse clicks instead of hovers.

A multi-level drop/fly menu using the new system with manually adjusted widths for top and sub levels.

The previous menu with the ability to adjust the widths of all levels.

The previous menu with the ability to adjust the widths of all levels and center each level.

The multi level dropdown/flyout menu with the path through the menu highlighted.

A small restyle to make this menu system more robust and have an easy menu trail style.

Back to the very basic styling to produce this no hacks dropdown/flyout menu.

Using the latest no hack system to have top level images and dropdown boxes cntaing images and text

A single level dropdown with top level rollover images.

A totally new method of producing a dropdown menu with variable width and NO hacks of any kind, just html and css.

A flyline / dropdown menu with CSS3 enhancements for browsers that support animation.

A dropdown menu with a twist and CSS3 enhancements.

Using the w3.org HTML+TIME to produce a dropdown menu that works in IE browsers from IE5.5 upwards (and all other browsers).

Using the no hacks float drop technique to produce an image dropdown menu with popup tooltips.

A single level dropdown menu aimed at the Safari Mobile browser (iPhone, iPad and iPod Touch).

A dropdown menu with click to open/close, suitable for the iPad etc..

Using css3 transitons to animate a dropline/dropdown menu with 'current' page options.

A method of closing an open dropdown menu by tapping anywhere in the screen

A CSS3 hover / dropdown menu with sub menus staying open when moving the mouse off the menu.

A method of getting multi level dropdown/flyout menus to work in IE10 on touch screen devices.

A responsive dropdown/flyout menu that works on touch screen devices including Android OS and IE10.

News you don't want to miss for April 27:

1. Alameda County, along with five other Bay Area counties, announced the shelter in place order will be extended through the end of May, the San Francisco Chronicle reports.…

1. Uitvoerders van roofmoord op Leopoldine De Decker krijgen 28 jaar, opdrachtgevers hoeven niet terug naar de cel  Gazet van Antwerpen
2. Na negen uur in beraad: vier veroordelingen en één vrijspraak in roofmoord Leopoldine (76)  Het Nieuwsblad
3. Straffen tussen 3 en 29 jaar cel geëist in zaak roofmoord op Leopoldine De Decker  Gazet van Antwerpen
4. ASSISEN. Tot 28 jaar cel voor roofmoord op Leopoldine De Decker, familie opgelucht: “Nu kunnen we eindelijk verder met ons leven”  Het Laatste Nieuws
5. ASSISEN. Roofmoord op Leopoldine De Decker: 28 jaar cel voor uitvoerders, (deels) voorwaardelijke straffen voor opdrachtgevers  Het Laatste Nieuws
6. Hele verhaal bekijken via Google Nieuws

Francesca Conway, from the Department of Primary Care and Public Health at Imperial College London is co-author of an article on diagnosis of COPD. She joins us to discuss the major guideline recommendations, and highlights where they concur and where they differ. Read the full article: http://www.bmj.com/content/351/bmj.h6171

Helen talks about new research on prevention of recurrent VTE - and Carl things the evidence goes further, and we can extend prophylaxis for a year. 13.00 - CRP testing for antibiotic prescription in COPD exacerbations, should we start doing it in primary care settings - and what will that mean. We also hear from Chris Butler, one of the...

Interferon beta, a drug originally developed to treat chronic obstructive pulmonary disease, or COPD, is being explored as a possible cure for the severe lung infections caused by COVID-19, media reports confirmed Monday

Title: More Studies Link Vaping to Asthma, COPD
Category: Health News
Created: 1/14/2020 12:00:00 AM
Last Editorial Review: 1/14/2020 12:00:00 AM

Title: Screening for Other Health Problems May Aid COPD Survival
Category: Health News
Created: 5/4/2012 10:05:00 AM
Last Editorial Review: 5/4/2012 12:00:00 AM

Title: Smoke-Free Laws May Help Prevent COPD Hospitalizations
Category: Health News
Created: 4/25/2014 2:35:00 PM
Last Editorial Review: 4/28/2014 12:00:00 AM

Title: COPD Tied to Raised Risk for Sudden Cardiac Death
Category: Health News
Created: 4/29/2015 12:00:00 AM
Last Editorial Review: 4/29/2015 12:00:00 AM

Title: Another HIV Hazard: Higher Risk for COPD
Category: Health News
Created: 2/20/2020 12:00:00 AM
Last Editorial Review: 2/21/2020 12:00:00 AM

Although elevated blood or sputum eosinophils are present in many patients with COPD, uncertainties remain regarding the anatomical distribution pattern of lung-infiltrating eosinophils. Basophils have remained virtually unexplored in COPD. This study mapped tissue-infiltrating eosinophils, basophils and eosinophil-promoting immune mechanisms in COPD-affected lungs.

Surgical lung tissue and biopsies from major anatomical compartments were obtained from COPD patients with severity grades Global Initiative for Chronic Obstructive Lung Disease stages I–IV; never-smokers/smokers served as controls. Automated immunohistochemistry and in situ hybridisation identified immune cells, the type 2 immunity marker GATA3 and eotaxins (CCL11, CCL24).

Eosinophils and basophils were present in all anatomical compartments of COPD-affected lungs and increased significantly in very severe COPD. The eosinophilia was strikingly patchy, and focal eosinophil-rich microenvironments were spatially linked with GATA3⁺ cells, including type 2 helper T-cell lymphocytes and type 2 innate lymphoid cells. A similarly localised and interleukin-33/ST2-dependent eosinophilia was demonstrated in influenza-infected mice. Both mice and patients displayed spatially confined eotaxin signatures with CCL11⁺ fibroblasts and CCL24⁺ macrophages.

In addition to identifying tissue basophilia as a novel feature of advanced COPD, the identification of spatially confined eosinophil-rich type 2 microenvironments represents a novel type of heterogeneity in the immunopathology of COPD that is likely to have implications for personalised treatment.

Inhaled corticosteroid (ICS)–based therapy is often used for patients with chronic obstructive pulmonary disease (COPD). However, this approach is under scrutiny because of ICS overuse in patients for whom it is not recommended and because of concerns about adverse events, particularly pneumonia, with long-term ICS use. Evidence suggests ICS may be beneficial in specific patients, namely, those with high blood eosinophil counts (eg, ≥300 cells/µL) or who are at a high risk of exacerbations. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 ABCD assessment tool, these patients belong in group D. For these patients, recommended initial treatment includes ICS in combination with long-acting β2-agonists (LABAs) when blood eosinophil counts are ≥300 cells/µL or LABA + long-acting muscarinic antagonist (LAMA) when patients are highly symptomatic, that is, with greater dyspnea and/or exercise limitation. Follow-up treatments for patients with persistent dyspnea and/or exacerbations may include LABA + ICS, LABA + LAMA, or LABA + LAMA + ICS, with use of ICS being guided by blood eosinophil counts. In this review, differences in the inflammatory mechanism underlying COPD and asthma and the role of ICS treatment in COPD are summarized. Furthermore, findings from recent clinical trials where use of ICS-based dual or triple therapy in COPD was compared with LABA + LAMA therapy and trials in which ICS withdrawal was evaluated in patients with COPD are reviewed. Finally, a step-by-step guide for ICS withdrawal in patients who are unlikely to benefit from this treatment is proposed. A video of the author discussing the overall takeaway of the review article could be downloaded from the link provided: https://www.youtube.com/watch?v=Uq7Sr5jqPDI.

BACKGROUND:The N95 filtering facepiece respirator (FFR) is the most popular individual protective device to reduce exposure to particulate matter. However, concerns have been raised with regard to its use because it can increase respiratory resistance and dead space. Therefore, this study assessed the safety of N95 use in patients with COPD and air-flow limitation.METHODS:This prospective study was performed at a tertiary hospital and enrolled 97 subjects with COPD. The subjects were monitored for symptoms and physiologic variables during a 10-min rest period and 6-min walking test while wearing an N95.RESULTS:Of the 97 subjects, 7 with COPD did not wear the N95 for the entire test duration. This mask-failure group showed higher British modified Medical Research Council dyspnea scale scores and lower FEV1 percent of predicted values than did the successful mask use group. A modified Medical Research Council dyspnea scale score ≥ 3 (odds ratio 167, 95% CI 8.4 to >999.9; P = .008) or a FEV1 < 30% predicted (odds ratio 163, 95% CI 7.4 to >999.9; P = .001) was associated with a risk of failure to wear the N95. Breathing frequency, blood oxygen saturation, and exhaled carbon dioxide levels also showed significant differences before and after N95 use.CONCLUSIONS:This study demonstrated that subjects with COPD who had modified Medical Research Council dyspnea scale scores ≥ 3 or FEV1 < 30% predicted wear N95s only with care.

BACKGROUND:The threshold of the lower limit of the normal range of lung function has been suggested to be more accurate than the 0.7 fixed ratio (FEV1/FVC < 0.7) for a diagnosis of COPD. We aimed to explore the health status and risk factors of patients overdiagnosed with COPD when using the lower limit of the normal range as a diagnostic reference.METHODS:Subjects with COPD diagnosed by a pulmonologist according to guidelines of the Global Initiative for Chronic Obstructive Lung Disease were recruited from October 2016 to April 2018. Overdiagnosed COPD was defined as FEV1/FVC that meets the criterion of the 0.7 fixed ratio but not the the lower limit of the normal range criterion. Spirometry and questionnaires were performed by eligible subjects.RESULTS:Of the 513 subjects included in the final analysis, 20 (3.9%) were overdiagnosed when using the lower limit of the normal range as the diagnostic reference. The subjects who were overdiagnosed were older, weighed more, had better lung function, lower modified Medical British Research Council scores, and higher St. George's Respiratory Questionnaire and 36-item Short Form Survey scores than the subjects who were correctly diagnosed. Older age, heavier weight, exposure to cooking oil fumes, or a new-built or newly renovated home were associated with an increased risk of overdiagnosis of COPD (age adjusted odds ratio (OR) 1.17, 95% CI 1.09–1.26; weight adjusted OR 1.08, 95% CI 1.03–1.13; exposure to cooking oil fumes adjusted OR 3.00, 95% CI, 1.04–8.68; exposure to new-built or newly renovated home adjusted OR 10.88, 95% CI 1.46–80.87.CONCLUSIONS:The subjects with overdiagnosed COPD had a better health status and lung function than the subjects who were correctly diagnosed. Older age, heavier weight, and exposure to cooking oil fumes or a new-built or newly renovated home were factors associated with the overdiagnosis of COPD. These findings may help reduce overdiagnosis of COPD.

Objective

We aimed to assess adherence to the Australian national guideline (COPD-X) against audited practice, and to document the outcomes of patients hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (COPD) at discharge and 28 days after.

Inhaled corticosteroid/long-acting β₂-agonist combination therapy is a recommended treatment option for patients with chronic obstructive pulmonary disease (COPD) and increased exacerbation risk, particularly those with elevated blood eosinophil levels. SOPHOS (NCT02727660) evaluated the efficacy and safety of two doses of budesonide/formoterol fumarate dihydrate metered dose inhaler (BFF MDI) versus formoterol fumarate dihydrate (FF) MDI, each delivered using co-suspension delivery technology, in patients with moderate-to-very severe COPD and a history of exacerbations.

In this phase 3, randomised, double-blind, parallel-group, 12–52-week, variable length study, patients received twice-daily BFF MDI 320/10 µg or 160/10 µg, or FF MDI 10 µg. The primary endpoint was change from baseline in morning pre-dose trough forced expiratory volume in 1 s (FEV₁) at week 12. Secondary and other endpoints included assessments of moderate/severe COPD exacerbations and safety.

The primary analysis (modified intent-to-treat) population included 1843 patients (BFF MDI 320/10 µg, n=619; BFF MDI 160/10 µg, n=617; and FF MDI, n=607). BFF MDI 320/10 µg and 160/10 µg improved morning pre-dose trough FEV₁ at week 12 versus FF MDI (least squares mean differences 34 mL [p=0.0081] and 32 mL [p=0.0134], respectively), increased time to first exacerbation (hazard ratios 0.827 [p=0.0441] and 0.803 [p=0.0198], respectively) and reduced exacerbation rate (rate ratios 0.67 [p=0.0001] and 0.71 [p=0.0010], respectively). Lung function and exacerbation benefits were driven by patients with blood eosinophil counts ≥150 cells·mm^–3. The incidence of adverse events was similar, and pneumonia rates were low (≤2.4%) across treatments.

SOPHOS demonstrated the efficacy and tolerability of BFF MDI 320/10 µg and 160/10 µg in patients with moderate-to-very severe COPD at increased risk of exacerbations.

Background

COPD patients account for a large proportion of lung transplants; lung transplantation survival benefit for COPD patients is not well established.

Background

Positive serology for cytomegalovirus (CMV) has been associated with all-cause mortality risk but its role in COPD mortality is unknown. The objective of the present study was to assess the relationship between CMV serology and COPD mortality.

Bristol Myers Squibb CEO Giovanni Caforio credited COVID-19-related stocking for high sales of some products in the first quarter, including Eliquis, a blood thinner that's being snapped up to reduce clotting risk in patients with the virus. But the pandemic has limited access to oncology clinics and other non-COVID-19 services, raising challenges that could impact sales later this year.

"Helping foreign countries improve their criminal justice systems so they can cooperate more effectively with us and with their neighbors in real time is an important aspect of this department’s mission."

A former officer with the New Orleans Police Department (NOPD), was sentenced today to eight years in prison for conspiracy to obstruct justice and for misprision of a felony (for concealing a known crime), in connection with a federal investigation of two police-involved shootings that left two civilians dead and four others seriously wounded in the area of the Danziger Bridge in the days after Hurricane Katrina.

"The Justice Department opened its investigation of the New Orleans Police Department last year with a single mission: to work with all stakeholders to build a world class police force," said Assistant Attorney General Perez.

"Unfortunately, our conclusions reveal that many NOPD officers have failed to live up to what we rightfully expect from our law enforcement officers," said Deputy Attorney General Cole.

While many doctors have been complaining about the non-availability of safety equipment when they examine COVID-19 patients, a businessman has come to their aid by creating a cabin for such examinations, where they need not use PPEs.

The 38-year-old Vile Parle-based man has created an 'OPD' cabin that is divided into two sections for the doctor and patient. The doctor can examine the patient without using a mask or PPE as she/he does not come into direct contact with the patient, and can immediately sanitise the cabin after this. The businessman, Jatin Shah, gave one of the cabins free of cost to the Balasaheb Thackeray Trauma Care Centre at Jogeshwari last week, and every day doctors examine at least a 100 people in it.

Shah is involved with the aluminum industry and has used the material and glass to make the cabin. He has also donated 40 cabins to the Maharashtra, Goa and Karnataka governments to examine people at the states' borders.

Shah said, "I saw many videos on social media about the challenges doctors have been facing while treating COVID-19 patients. So I decided to invent something that would help them. Within two days I created this cabin and gave it to the Jogeshwari-based trauma care centre free of cost with the help of an NGO."

Jatin Shah, the businessman

Shah said, "At the borders, 4-6 hours after testing when the report comes, if a traveller is found to be COVID-19 positive, doctors send her/him to hospital and if any patient is found negative, she/he is allowed to enter the state. I took the help of Wipro general electric, which finalised the design of this cabin and asked the Seva trust in Mumbai to contact the hospital and get the cabin approved," Shah added.

Doctor speak

"The cabin is really useful. We sent our four labourers to Shah's factory to help him construct this cabin. We also issued a letter to him from hospital superintendent Vidhya Mane. Within two days he manufactured it and gave it to us," said Dr Rangnath Jawhar of Balasaheb Thackeray Trauma Care Centre.

Features of the cabin

The cabin is 8X4 ft and divided into two spaces separated by glass. One section is used by the doctor and the other by the patient. Screening equipment including a digital thermometer and a fever gun kept inside. Both sides have a mike and speaker. A 20 lt tank stores disinfectant which gets sprayed inside

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