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Pressurized Metered-Dose Inhalers
Published in Anthony J. Hickey, Sandro R.P. da Rocha, Pharmaceutical Inhalation Aerosol Technology, 2019
Sandro R.P. da Rocha, Balaji Bharatwaj, Rodrigo S. Heyder, Lin Yang
Another requirement for propellants is that they need to be environmentally acceptable. While volumes of propellants used in the manufacture of medicinal aerosols are very small (ca. 2%) compared to other industries (CMR 2017), it is clear that HFAs will be eventually phased out due to environmental issues. Another strong motivator for phase out of HFAs is the fact that alternative propellants for other industries have already been identified and are in use (Harby 2017). There is, therefore, a decreasing motivation for the industry to continue producing HFAs for medicinal aerosols as it becomes less cost effective due to smaller production volumes. Clearly, phasing out HFAs does not mean interrupting the supply of HFA-based pMDIs. Similarly to CFCs, we can expect extensions on their use for medicinal purposes if necessary. The question is then how soon will they be phased out. The answer is that it really depends on how much effort and resources the industry and federal governments are willing to invest in the study of alternative propellants for medicinal aerosols. It is worth noticing that the reformulation of all pMDI products in other forms of portable inhalers, even if possible, may also take significant time, cost and effort, not to mention challenges in acceptability and patient compliance.
Neurorehabilitation
Published in Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner, The Integrated Nervous System, 2017
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner
Over the last few decades, researchers have established a motor classification for CP that allows prediction of whether a child will eventually walk independently or will require the support of a walker or a wheelchair for independent mobility. This tool, the Gross Motor Function Classification System ER (expanded and revised; see Palisano et al., 2007), can allow motor prediction soon after diagnosis and the classification appears to be fairly stable into the second decade of life. Any clinician working with individuals with this diagnosis should be aware of this scale, as this knowledge will help in the setting of reasonable motor goals. Classification systems are also evolving for upper extremity function (Manual Ability Classification System; Eliasson et al., 2006) and communication (Communication Function Classification System; Cooley Hidecker et al., 2011). These systems of classification promote focused assessment, efficient and clear communication among clinicians and allow grouping of patients for treatment/monitoring protocols and multi-centre research.
Propellants
Published in Hans Bisgaard, Chris O’Callaghan, Gerald C. Smaldone, Drug Delivery to the Lung, 2001
Martyn R. Partridge, Ashley A. Woodcock
Driving the whole process as the environmental controller is the Montreal Protocol. Ultimately, complete transition to new inhalers will take place only when the final essential use exemption is withdrawn. At present, each signatory government to the protocol that manufactures CFC-containing pMDIs makes an application, usually 2 years ahead, for a certain tonnage of CFCs, which they anticipate they will require. This application must include information about planned usage in the year for which application is made compared to historical usage, justification for essential use, and information about the proportion of pMDIs for use within that country and the amount going for export. Some stockpiling of CFCs to allow for transportation difficulties or other impediments to manufacture is allowed, but the size of stockpiles is carefully monitored. Each year applications for future uses of CFCs are carefully scrutinised by the TOC, which gives advice to the TEAP which makes recommendations to the OEWG. This process of implementation of the Montreal Protocol is clearly the ultimate control process overseeing phase-out, with the mechanism by which this happens being the withdrawal of essential use exemptions and thus the withdrawal of CFCs. It is an ultimate guillotine rather than a finely tuned process, and the signatories to the Montreal Protocol, in conjunction with the United Nations Environmental Programme, have recommended that each country should develop a national strategy for the smooth and planned changeover from CFC to non-CFC propellant pMDIs.
Construct-concurrent validity and reliability of the European Child Environment Questionnaire (ECEQ) in a sample of Turkish children with cerebral palsy
Published in Disability and Rehabilitation, 2022
Özge Çankaya, Mintaze Kerem Günel, Pınar Özdemir
In this study, GMFCS-E&R, MACS, and CFCS classification systems were used to identify the functional status of the children and we showed differences between mild-moderate (level I–II–III) and severe (IV–V) children with CP according to environmental factors. We found significant differences according to functional levels. Levels IV–V children with CP need a higher environmental redesign, support, and encouragement than levels I–III children with CP in all classification systems. Badia et al. [29] only used GMFCS and stated that non-ambulatory children with CP more needs all domains of environmental factors. Salavati et al. [25] used both GMFCS and MACS but did not show differences according to the severity of CP. While previous studies applied GMFCS-E&R and MACS, the present study additionally evaluated children’s CFCS levels. Colver et al. [30] showed that moderate to severe children with CP had less access to the physical environment, transport, and social support, and they experienced less positive attitudes from family members, other people in public places, and friends. Hidecker et al. [31] stated that using all GMFCS-E&R, MACS, and CFCS classification systems together provide a more detailed opinion about the children’s function than the use of anyone alone. We suggested that not only children’s levels of ambulation and hand functions determine their needs, but communication also plays an important role in establishing personal interactions.
Effectiveness of a parent-implemented language intervention for late-to-talk children: a real-world retrospective clinical chart review
Published in International Journal of Speech-Language Pathology, 2020
Elaine Y. L. Kwok, Barbara Jane Cunningham, Janis Oram Cardy
The CFCS was originally developed for use with children with cerebral palsy (Hidecker et al., 2011), but has recently been validated for use with preschoolers with a range of speech and language impairments other than cerebral palsy (Hidecker, Cunningham, Thomas-Stonell, Oddson, & Rosenbaum, 2017). SLPs classified children’s communication skills into one of five levels of function at each assessment point (Hidecker et al., 2011). Functional communication levels include: level I (effective sender and receiver with unfamiliar and familiar partners); level II (effective but slower-paced sender and/or receiver with unfamiliar and familiar partners); level III (effective sender and effective receiver with familiar partners); level IV (inconsistent sender and/or receiver with familiar partners); and level V (seldom effective sender and receiver with familiar partners). Most young children who are late talkers would be classified as CFCS level IV as communication breakdowns are common and they do not consistently understand or express themselves even with familiar partners (e.g. parents, childcare providers).
Moving research tools into practice: the successes and challenges in promoting uptake of classification tools
Published in Disability and Rehabilitation, 2018
Barbara Jane Cunningham, Mary Jo Cooley Hidecker, Nancy Thomas-Stonell, Peter Rosenbaum
Uptake of the CFCS in Ontario was accomplished through a long-standing partnership between members of our research group and the Ontario Ministry of Children and Youth Services. Two authors of this paper (NT-S & PR) were part of a team that worked with the Ministry to develop the Focus on the Outcomes of Communication Under Six (FOCUS©), the outcome measurement tool currently being used provincially to evaluate children’s progress in therapy [31]. The CFCS was introduced to the Ministry by the developers of the FOCUS©, who wanted a consistent way to classify children’s functional communication skills to ensure that the FOCUS© measured change for children at varying ages, communicative abilities, and with differing communication disorders. The research team worked closely with administrators to ensure leadership was informed and on board with use of the CFCS as part of the provincial program evaluation. Values surrounding evidence-based practice and innovation were also promoted within the program as the provincial evaluation was rolled out. As part of the provincial program evaluation clinicians working in the PSLP were mandated to use both the FOCUS© and CFCS every six months with all children accessing services.