To ensure that it is the staff most suitable as trainers that bec

To ensure that it is the staff most suitable as trainers that becomes certified trainers, we have found it necessary to enroll twice as many course participants in the recruitment course as the number needed as certified trainers (Fig. 1). The trainer course is a 2 + 3 day course conducted by trainers from The Danish Medical Association. Based on an assessment of the pedagogical skills and understanding of the training concept, the participants could become certified trainers of the

communication course. The course for the clinical staff is a 2 + 1 day course. During the 4 week period separating the two parts of the courses, the participants rehearse and make video recordings of one of their own consultations. The departments are encouraged to appoint a coordinator C646 nmr responsible for sending out course material and for ensuring that all staff members attend the course. After having conducted the communication course for all health professionals at the departments selleck all newly recruited staff members must attend the same 2 + 1 day course, as described above. The courses are conducted for staff from several departments; therefore, the course program deviates from the department-specific program. Two programs covering communication modules relevant for the clinical departments have been designed; one program contains a module about ‘the motivational interview’ and the other program contains

a module about ‘the serious message.’ Furthermore, the program

also allowed for the possibility of addressing other communication issues based on the desires of the course participants. For radiology staff, medical laboratory assistants, secretaries, and hospital porters working in the service department individual TCL two day course has been designed. The programs are developed based on information gathered at meetings with the professionals. The programs remain in concordance with the concept of the main course for the clinical staff, and therefore also include the Calgary Cambridge guide and role playing, but the video recordings are omitted. It has been the intention to establish a program that is maintained after the project phase and which continues to develop and improve the communication competences of the employees. To accomplish this goal, a guideline for maintenance of communication skills has been developed. Thus, a network for the trainers intended to serve as a forum for exchange of experiences, knowledge, and for inspiration has already been established. Furthermore, the trainers will be given the opportunity of training in specific communication tasks. Finally, the departmental management is expected to plan yearly refresher programs for the staff. The document has been approved by the Council of Quality at Lillebælt Hospital. To date, 54 health professionals have been educated as certified trainers, and we plan to educate another 32 trainers.

All the 95%

All the 95% Selleckchem SB431542 confidence

intervals were two-sided t-type intervals and all P-values were from two-sided t-tests. For all tests, P-values less than 0.05 were considered significant ( Wolfsegger and Jaki, 2005 and Wolfsegger, 2007). We are grateful to Steve Jarantow, Deidra Bethea and Bethany Swencki-Underwood for their assistance in the physiochemical characterizing of the antibodies, and Bernie Scallon for helpful discussion. “
“Tactile input from the periphery activates several cortical areas. The primary somatosensory cortex (S1), located in the postcentral gyrus, carries out the first stage in cortical processing of somatosensory stimuli. Human somatosensory magnetic fields (SEF) following median nerve stimulation have been widely used to investigate the physiology of normal somatosensory cortical processing (Forss and Jousmaki, 1998, Hari and Forss, 1999, Huttunen et al., 2006, Inui et al., 2004, Kakigi et al., 2000, Kawamura et al.,

1996, Mima et al., 1998, Nagamine et al., 1998 and Wikstrom et al., 1996). Previous studies have reported that the amplitude of SEF components following median nerve stimulation is influenced by stimulus intensity and that S1 responses increase in amplitude with the increase of stimulus intensity (Hoshiyama and Kakigi, 2001, Jousmaki and Forss, 1998, Torquati et al., 2002 and Tsutada et al., 1999). Electrical stimuli (ES), which have been used in numerous somatosensory research studies, have been a useful tool for investigating cortical processing of somatosensory stimuli, but are considered to be unnatural stimuli. There have been several SEF studies using mechanical Chlormezanone stimuli (MS), e.g. pneumatic selleck chemicals stimulation and finger clips (Hoechstetter et al., 2000, Hoechstetter et al., 2001, Karageorgiou et al., 2008, Lin et al., 2003 and Lin

et al., 2005). However, the rise time for MS has not been clearly defined in these studies. Therefore, the temporal aspect of cortical activity following MS has not been identified as clearly as that following ES. Additionally, pneumatics and finger clip stimuli have limited points of application at various parts of the body. Although only Jousmaki et al. (2007) have presented a novel solution to produce tactile stimuli on various parts of the body in MEG studies, the stimulus intensity of their device is unclear. Previously, we have reported that SEF waveforms could be obtained following MS using a precise and consistent tactile stimulator driven by piezoelectric actuators, and clear SEF responses at S1 contralateral to the stimulated side were induced not only by mechanical-on stimulation, but also mechanical-off stimulation (Onishi et al., 2010). However, the relationship between the MS conditions (e.g. number of pins and area of stimuli) and SEF response remains unclear. Franzen and Offenloch (1969) reported that the cortical response increased when the amplitude of indentation for mechanical stimulation increased. Additionally, Wu et al.

Most interestingly, however, this finding not only is obtained fo

Most interestingly, however, this finding not only is obtained for recording sites over the contralateral, but also for the ipsilateral hemisphere. As is evident from Fig. 1B, the P1 is primarily modulated by attention and not by stimulus presentation. The attended hemisphere (see the ‘attend’ condition in Fig. 1B) shows a general larger P1, regardless whether this hemisphere receives a stimulus (contralateral, attend) or not (ipsilateral, attend). This fact is also manifested statistically as a main effect for attention (at temporo-parietal sites) with

an absence of significant interactions with hemifield of presentation and hemisphere of recording for the P1. The important finding here is the large ipsilateral P1 and the Etoposide concentration fact that the P1 is modulated by attention in the ipsilateral hemisphere in the same way as in the contralateral hemispheres. We argue that this finding suggests an inhibitory function of the P1 and conflicts with

traditional interpretations. For the sake of clarity, we distinguish between three different hypotheses, which we term the (i) baseline, (ii) stimulus enhancement (or evoked), and (iii) inhibition hypothesis. The baseline hypothesis was suggested by Hillyard Ku-0059436 et al., 1998, Luck et al., 1994 and Luck and Hillyard, 1995. The idea here is that relative to a neutral baseline (e.g., relative to a neutral cue) the P1 is not increased by attention, but suppressed in the unattended condition. This interpretation is interesting because it also assumes an inhibitory function of the P1 but in the sense that inhibition reduces the P1 amplitude. Or in other words, if irrelevant information must be suppressed, the P1 will be smaller as compared to a case where attention is focused on relevant Tyrosine-protein kinase BLK information. The stimulus enhancement or evoked hypothesis predicts

that the P1 is enlarged if the processing of a stimulus (which evokes an ERP-component) is enhanced by attention. If a stimulus is not attended, it still will elicit an evoked component, but the component will be smaller as compared to attended stimuli. The inhibition hypothesis – which will be introduced below – assumes that the P1 reflects inhibitory processes that have different functions in task relevant and task irrelevant neural structures. In the former, inhibition operates to increase the signal to noise ratio (SNR), in the latter inhibition operates to block information processing. The central prediction here is that inhibition increases the P1. The question, in which way inhibition shapes the P1 amplitude in task relevant and irrelevant neuronal structures is discussed in detail in Section 3. The critical point now is the claim that the baseline and enhancement hypotheses will not be able to explain why a large P1 is generated at ipsilateral recording sites. Both interpretations appear plausible to explain the findings for the contra- but not those observed for the ipsilateral hemisphere.

Fisher’s least significant difference (LSD) was calculated at sig

Fisher’s least significant difference (LSD) was calculated at significance levels of P < 0.05

and P < 0.01. As shown in Table 1, the mean values of DT, ST, and FQN were 2.7 min, 4.6 min, and 54.8 mm, respectively, and the mean values of PC, SV, and WGC were 13.2%, 30.3 mL, and 31.7%, respectively. As reflected by standard deviation (SD) and coefficient of variation (CV) TSA HDAC purchase values, there were wide variations in the six quality traits among the wheat cultivars. In terms of CV value, the highest was ST (58.1%), followed by FQN (42.4%), DT (40.5%), SV (15.3%), WGC (10.1%), and PC (9.1%). This order indicated that the CV values of dough rheological properties were larger than those of flour qualities. As shown in Fig. 1, a normal distribution was found for PC, WGC, and SV of the wheat cultivars. However, DT, ST, and FQN were not normally distributed but showed marked ABT-199 mw left shifts. Z-statistics and significance levels based on the K–S normality test are listed in Table 2. The Z-statistics of PC, SV, and WGC were below the critical value (Z0.05 = 1.63), and their asymptomatic significance was larger than 0.05, indicating their normal distribution. However, the Z-statistics of DT, ST, and FQN were greater than the critical value, and their asymptomatic significances were ≤ 0.05, indicating that the rheological

properties were non-normally distributed. As shown in Table 3, PC was significantly (P < 0.05) positively correlated with DT. SV showed significant positive correlations with the three rheological properties (DT, ST, and FQN), with Pearson's correlation coefficients 0.45, 0.54, and 0.52, respectively. WGC was significantly negatively correlated with ST (P < 0.01) and FQN (P < 0.05). The dough rheological properties and flour quality of wheat cultivars released in different periods were evaluated to identify trends of genetic improvement. As shown in Fig. 2, DT of cultivars released in period IV was 3.3 min, which was 17.9% higher than that of cultivars

released in period I. Similarly, ST and FQN of cultivars released in period IV were 71.1% and 44.3% higher than those of cultivars released in period I. DT, ST, and FQN increased with time, showing that breeders have made marked improvements in dough rheological properties of wheat in China. However, PC, SV, and PAK5 WGC did not show a consistent increase or decrease during different breeding periods (Fig. 3). The highest PC was observed in period II, whereas the highest SV was found in period IV. Because the dough rheological properties were non-normally distributed, the K–W test for non-parametric data was used to determine the significance of differences among the mean values (Table 2). The results showed that the flour quality characteristics could be divided into two categories on the basis of their significance levels (asymptotic significance < 0.05). The significance levels of DT, ST, and FQN were all below 0.05 (0.

For estimating POM, as in the case of SPM, the value of bbp(443)

For estimating POM, as in the case of SPM, the value of bbp(443) also seems to be the most appropriate from the statistical point of view. The following statistical formula is suggested (see Table 1 and Figure 3b): equation(2) POM=37.6(bbp(443))0.774.POM=37.6bbp4430.774. The standard error factor X in this case is 1.48, which is not much higher than in the case of the SPM formula given by equation (1). Please note at this point, that for the southern Baltic Sea samples taken into consideration in this work, the variation in the ratio between

POM and SPM concentrations was rather limited. As reported by the author earlier (see S.B. Woźniak et al. (2011)), the average value of POM/SPM for southern Baltic samples was about 0.8 and the appropriate coefficient of variation (CV, defined as the ratio selleckchem of the standard deviation to the average value and expressed as a percentage) of that ratio was only about 22%. This means that in most cases the composition of suspended matter encountered in the southern Baltic is dominated by organic

matter. This fact may explain and justify the existence of similarly strong statistical relationships between SPM and bbp, and between POM and bbp. With regard to the estimation of POC concentrations, it turns out that the statistical results are slightly better when coefficients an rather than bbpare used. The following formula for the BTK inhibitor in vivo blue light wavelength of 443 nm (see Table 1 Galeterone and Figure 3c) gave the best statistical results: equation(3) POC=0.766(an(443))0.971.POC=0.766an4430.971. However, the standard error factor X in this case is 1.59, a distinctly higher value than in the case

of formulas  (1) and (2). Thus it is expected that the quality of the estimates of POC concentrations with formula  (3) would in most cases be inferior to that for SPM or POM. Finally, for estimating Chl a the best statistical results are obtained for the following formula based on coefficient an at the green light wavelength of 555 nm (see Table 1 and Figure 3d): equation(4) Chla=50.7an5550.975. This formula has a standard error factor X of 1.54 (note that this time the other formula based on coefficient an at the blue band of 443 nm has a higher standard error factor of 1.59). All four simplified empirical formulas presented above ((1), (2), (3) and (4)) are put forward as the best candidates from among the 16 different statistical formulas listed in Table 1. Obviously, these four formulas offer a potential accuracy that is rather limited and far from perfect – the corresponding standard error factors X lie between 1.43 and 1.59 – so everyone interested in the potential application of these formulas has to be aware of this.

The higher spatial resolution (250–500 m) and bigger spectral wid

The higher spatial resolution (250–500 m) and bigger spectral width (20 nm) of MODIS visual ‘land’ bands are very informative for the visual identification and analysis of turbid coastal water features

compared to the spectrally narrow (10 nm) and spatially less detailed (1 km) MODIS ‘ocean’ bands (Gurova 2009). However, for the spectral analysis of these features we used normalized water leaving radiances (nLw) (Gordon & Wang 1994) and spectral diffuse attenuation coefficients of downwelling irradiance Kd_Lee (Lee et al. 2005), calculated from the ‘ocean’ bands (8–16), specially designed for such purposes. Images were processed from L1A level with Seadas 6.23 software, using the MUMM atmospheric correction algorithm Ipilimumab purchase (Ruddick et al. 2000), which is the best suited to turbid Baltic Sea waters (Woźniak et al. 2008). CDOM absorption coefficients aCDOM(400) were calculated using an empirical algorithm specially developed for the Baltic Sea and successfully validated ( Kowalczuk et al., 2005 and Kowalczuk et al., 2010). MODIS Sea Surface Temperature (SST) products were calculated with the standard algorithm implemented in Seadas 6.2 ( Brown & Minnett 1999). Wide Swath Mode images from Advanced Synthetic Aperture Radar (ASAR instrument on board the Envisat satellite)

were obtained from ESA archives. With a medium spatial resolution of 75 m pixel− 1, the ASAR WSM images, especially those obtained by multi-sensor approach, are very useful MAPK inhibitor for detailed spatial analysis of hydrodynamic features affecting the water surface (Gurova & Ivanov 2011). Secondly, examples of submesoscale eddies in SEB were selected from a series of measurements of sea surface currents in the marine area near the Curonian Spit (the Zelenogradsk-Rybachiy section) and the northern shore of the Sambian Peninsula, made by the coastal radar Sea Sonde CODAR system in 2006 and 2007. Two resolutions for a 30 × 30-cell grid were used in these measurements – 500 m cell− 1 and 250 m cell− 1 (Gorbatsky et al., 2007 and Babakov

et al., 2008). To analyse the wind statistics we used wind data at altitude 10 m from a coupled Cell Penetrating Peptide sea-ice-ocean model of the Baltic Sea (BSIOM) with a spatial resolution of 1.2 nautical miles, which has been shown to provide realistic values when compared to field measurements (Rudolph & Lehmann 2006). Verification comparison of modelling data for a 6-hour average wind with measurements at point D6, located 20 km from the coast of the Curonian Spit, for a period of 92 days, showed general correspondence between the modelled data and measurements (Figure 2). Therefore, the wind statistics in this paper (Table 1 (see page 639) and wind diagrams in Figure 7 (see page 644)) were obtained using BSIOM data.

We would like to thank Elena Couñago for her help in preparing th

We would like to thank Elena Couñago for her help in preparing the cartography and to Cristina Santa Marta

and Lobo Orensanz for their careful and critical reading of the manuscript. “
“The presence in seawater of dissolved and suspended organic substances, treated collectively as organic matter, means that this medium is not just a solution of inorganic salts. Organic matter plays a key role in a variety of natural (physical and biological) processes occurring in the marine environment, especially in NVP-BEZ235 price shelf seas like the Baltic, where its concentration is substantial (Seager and Slabaugh, 2004 and Kuliński and Pempkowiak, 2008). These processes include oxygen depletion, as well as complex formation with both organic

and inorganic compounds, which facilitates the downward transport of chemical substances (C, N, P, heavy metals, organic pollutants) in the water column. Organic matter influences the chemical Talazoparib nmr and physical properties of seawater, including the light field and alkalinity (Dera, 1992, Hedges, 2002 and Kuliński et al., 2014). Aquatic organic matter is commonly divided into particulate organic matter – POM and dissolved organic matter – DOM. Both fractions are important components of the carbon cycle. POM in the marine environment is composed of phytoplankton, zooplankton, bacteria and dead organic material (detritus), while dissolved organic matter comprises molecules of both high and low molecular weight. Both POM and DOM originate from internal and external sources (river run-off, atmosphere, sediments) (Emerson & Hedges 2008). Organic matter is most often measured as organic carbon (OC), which makes up some 45% of organic matter (Chester 2003). In the oceans, the OC concentration is < 1.5 mg dm− 3, but in coastal areas it amounts to as much as 8 mg dm− 3 (Hansell, 2002 and Gardner et al., 2006). Like organic matter, organic carbon

is for practical purposes divided into two principal fractions: particulate organic carbon (POC) and dissolved organic carbon (DOC). Methocarbamol Both fractions can be separated by passing seawater through, for example, 0.4 μm glass-fibre filters. The POC and DOC concentrations in the Baltic Sea have been a subject of interest for many years (Jurkovskis et al., 1976, Pempkowiak, 1983, Pempkowiak et al., 1984, Emelyanov, 1995, Ferrari et al., 1996, Grzybowski, 2003 and Grzybowski and Pempkowiak, 2003, Burska 2005, Pempkowiak et al., 2006, Kuliński and Pempkowiak, 2008, Dzierzbicka-Głowacka et al., 2010, Dzierzbicka-Głowacka et al., 2011 and Szymczycha et al., 2014). Concentrations of DOC and POC in Baltic seawater have been reported to range from 3.2 to 7.7 mgC dm− 3 (Jurkovskis et al., 1976, Grzybowski and Pempkowiak, 2003 and Kuliński and Pempkowiak, 2011) and from 0.1 to 1.4 mgC dm− 3 (Burska 2005, Kuliński & Pempkowiak 2011).

Along that area there was one bar (Figure 3) located 210–240 m fr

Along that area there was one bar (Figure 3) located 210–240 m from the shoreline and separated by a 4–7.1 m deep trough. Near the Strait of Baltiysk, on profiles 3p and 5p with respective ‘starting depths’ of 2.8 and 2.6 m, there are no accumulative forms in the nearshore (Figure 3). The longshore bars are mainly asymmetrical, with steeper shore-oriented slopes – 0.4°–2° (profiles 4mv, 8a, 13p) – or with steeper seaward slopes – 0.7°–2.3° (profiles 16p, 6mv, 1mv,

3a). The only bars located on profiles 1a, 4mv and 5mv are nearly symmetrical. The nearshore zone with bars, the surf zone, is inclined from 1.5° (profile 13p) to 2° (profiles 1a, 9a), and is delimited by depths of 5.3–6 m (Figure Selleckchem Ganetespib DAPT molecular weight 3). The width of this zone varies from 330 m (profile 2a) to 575 m (profile 5mv). The nearshore slope behind the most seaward longshore bar is flattish and inclined at 0.1°–0.6°. Grain-size analysis of the samples collected shows differentiation of sediment features along and across the coastal zone of the Vistula Spit. Across the shore, in the upper and middle part of the beach, fine and medium grained (0.24–0.5 mm), well sorted (1.25–1.39) sand is deposited (Figures 4a,4b). Only to the west of the village of Piaski (profiles 3a–4a, Figure 4b)

is the sand moderately sorted (1.42–1.58). Along the lower part of the beach and in the swash zone, the mean (MG) is higher and sorting (σG) is worse ( Figures 4a, 4b). Near the Strait of Baltiysk (profiles 3p–5mv) and near Piaski (profiles 2a–4a), the lower shore sediments are represented by moderately well, moderately, poorly, very poorly

sorted (1.5–2.6), coarse, very coarse sand, and along the swash zone by gravel (0.8–4.0 mm) ( Figures 4a, 4b). Montelukast Sodium Between these stretches (profiles 4mv–1a) and to the south-west of profile 4a (profiles 5a–10a), in the lower part of the beach, the grain size decreases to medium (0.25–0.5 mm), well sorted (0.4–1.27) sand ( Figures 4a, 4b). The grain size differentiation in the surf zone (0.9–6 m depth) is strictly related to morphology. The mean (MG) (0.18–1.46 mm) and sorting (σG) values (1.29–2.3) were higher in the trough between the longshore bars (profiles 1mv–10a; Figures 4a, 4b). The grain-size indices have the highest values in the trough near the village of Piaski: very poorly and poorly sorted (1.89–2.3) coarse sand and gravel (0.59–1.46 mm) (profiles 1a–3a, Figures 4a, 4b). In the north-eastern part of the Spit (profiles 3p–1mv) the sampling points were not related to the surf zone morphology. Greater grain size (0.25–0.4 mm) and sorting (1.3–1.6) were recorded at depths of 1–3 m between profiles 3p and 5mv ( Figures 4a, 4b). Along the flat nearshore slope, at depths of 10 and 7 m, the sediment consists mainly of fine grained (0.125–0.2 mm), moderately well (1.41 – 1.6) and well to very well sorted sand (1.22–1.33) (Figures 4a, 4b).

In conclusion, the A paulensis venom proteomic and pharmacologic

In conclusion, the A. paulensis venom proteomic and pharmacological profiling

was presented for the first time. By means of chromatography and mass spectrometry the venom compounds variability was showed, which featured 60 chromatographic fractions and 97 different components. Noteworthy are the low molecular mass compounds, such as 601.4 and 729.6 Da which are putative acylpolyamines, in addition to many peptide components, among Bioactive Compound Library chemical structure which 60% are between 3500 and 7999 Da. LD50 was defined and is in accordance to the values reported for tarantula spiders, which generally do not provoke severe envenoming. Despite that, A. paulensis venom induced many behavioral and physiological changes in mice, and edematogenic activity in rats. An inotropic effect produced on frog heart is probably due to the low FDA approved Drug Library molecular mass compounds present in the more hydrophilic fractions of venom that may act either by inducting the release of acetylcholine from parasympathetic terminals or by directly acting as a cholinergic agonist. Financial support: CNPq (303003/2009-0, 490068/2009-0, 564223/2010-7). CBFM and ACEC receive scholarship from CNPq, and CJA, HMD, JCG, JKAM and PG from CAPES. The authors acknowledge Rafael D. Melani and Karla G. Moreira for their assistance

on some bioassays, Dr Paulo César Motta for identifying the spiders, and Dr Carlos Bloch from Mass Spectrometry Laboratory, EMBRAPA, Brazil. “
“Amphibian skin is characterized by the presence of mucous glands mainly associated to respiration and protection against desiccation, while granular (or poison) glands provide an arsenal of chemical compounds used for defense against opportunistic microorganisms and predators (Clark, 1997; Duellman and Trueb, 1986; Stebbins and

Cohen, 1997; Toledo and Jared, 1993, 1995; Rollins-Smith et al., 2002, 2005). Under the PJ34 HCl control of a holocryne mechanism (Simmaco et al., 1998), poison glands secrete a wide diversity of peptides, biogenic amines, steroids and alkaloids, all presenting a broad spectrum of biological activity (Auvymet et al., 2009; Bevins and Zasloff, 1990; Daly et al., 1987; Roseghini et al., 1989; Toledo and Jared, 1995; Van Zoggel et al., 2012). The family Hylidae (tree-frogs) is known to secrete polypeptide compounds, most of them with bioactive properties. Although the cutaneous secretions composition of the subfamily Phyllomedusinae is considered the most complex, it is well documented particularly for the genus Phyllomedusa ( Conlon et al., 2004; Erspamer et al., 1986, 1993; Faivovich et al., 2010). In fact, several species were studied and numerous peptides have been isolated based on their antimicrobial and analgesic activities.

67, 91, 106, 107, 108, 109, 110, 111, 112, 113, 114,

67, 91, 106, 107, 108, 109, 110, 111, 112, 113, 114, Selleckchem VX 809 115 and 116 However, adequate delivery of antibiotic to the airways through inhalation is a complex method influenced by several factors. Conditions that have to be optimised include the choice of nebuliser (jet

or ultrasonic, vibrating mesh inhaler), the drug formulation (aerosolised solution or dry powder), the particle size (must be between 1 μm and 5 μm for adequate deposition and delivery into lower airways), the chemical properties of the molecule (e.g. lipophilic or hydrophilic). Furthermore, patient characteristics including age and lung function, the respiratory cycle length and inspiratory/expiratory ratio, may also influence efficiency of inhaled antibiotic delivery. As seen with long-term systemic antibiotic use, selleck kinase inhibitor concern exists too for inhaled antibiotics regarding the possibility of resistance development during long-term treatment. As shown in Table 3, there is inconsistent evidence for the emergence of resistant pathogens during treatment with aerosolised antibiotics

in some respiratory conditions67 and 95 (Table 3). It is likely that risk of resistance development may be lessened by use of shorter courses, intermittent therapy (as currently practiced in cystic fibrosis) or alternating different antibiotic classes. To date, there have been only two published reports investigating the use of inhaled antibiotics in patients with of COPD. Dal Negro et al.117 examined the impacts of 14-day, twice daily treatment with inhaled tobramycin nebuliser solution on clinical outcome as well as inflammatory markers in bronchial secretions from a small cohort (n = 13) of multiresistant P. aeruginosa-colonised patients with severe COPD (FEV1 < 50% predicted). P. aeruginosa infection is associated with a severe degree of functional impairment in COPD, 118 and colonisation could well herald the presence of bronchiectasis, 41 and 119 suggesting a potential role for inhaled antibiotics. Indeed, such treatment resulted in a substantial reduction from baseline

of pro-inflammatory chemotactic mediators, including interleukin-1 beta (P < 0.03), interleukin-8 (P < 0.02) and eosinophilic cationic protein (P < 0.01). After the 6-month follow-up period, P. aeruginosa was considered to be eradicated in two patients, while P. aeruginosa density was reduced in a further four patients. Two-week treatment with inhaled tobramycin decreased the frequency of exacerbations by 42%, when compared with the 6-month period prior to initiating inhaled tobramycin therapy. 117 Although this study has many limitations, including its open-label design and its small size, it does suggest a therapeutic role for inhaled antibiotics in COPD patients, particularly those colonised with multiresistant P. aeruginosa.