What this study adds: Three months of aerobic exercise training reduces the severity of symptoms of depression among pregnant women. A randomised trial was conducted. Participants were recruited from the prenatal care services of three hospitals in Cali, Colombia. Women who were interested in the study were invited to a screening visit at one of the centres. Sociodemographic data were recorded and

a detailed physical examination was performed by a physician to determine eligibility. After confirmation of eligibility, the women were MLN0128 in vitro randomly allocated to one of two groups: aerobic exercise plus usual prenatal care, or usual prenatal care only. Randomisation was performed using a permuted block design with a block size of 10 and exp:con ratios of 5:5, 6:4 or 4:6. Participants in the exercise group commenced the program when each block was completed, allowing supervised group exercise high throughput screening compounds sessions comprising three to five women. Baseline measures were taken the day before the exercise program commenced and outcomes were measured the day after the program was completed. The investigator responsible for randomly assigning participants to treatment groups did not know in advance which treatment the next person would receive (concealed allocation) and did not participate in administering the intervention or measuring outcomes. The investigators responsible for assessing eligibility and baseline measures were blinded to group allocation. Participants

and therapists administering the intervention were not blinded. The investigators responsible for outcome assessment were blinded to group allocation. All investigators received training before the trial and reminders during the trial regarding the protocol, the measurement procedures, and the methods and importance of maintaining

blinding. Measurements were taken at baseline (Month 0, which corresponded to 16–20 MTMR9 weeks of gestation) and at the end of the three-month intervention period (Month 3, week 28–32 of gestation). Pregnant women were eligible for the study if they were aged between 16 and 30 years, between 16 and 20 weeks of gestation, with a live foetus at the routine ultrasound scan. They were excluded if they had participated in a structured exercise program in the past six months or had a history of high blood pressure, chronic medical illnesses (cancer, renal, endocrine, psychiatric, neurologic, infectious, or cardiovascular diseases), persistent bleeding after week 12 of gestation, poorly controlled thyroid disease, placenta praevia, incompetent cervix, polyhydramnios, oligohydramnios, miscarriage in the last 12 months, or diseases that could interfere with participation, according to the recommendations of the American College of Sports Medicine (ACSM 2009) and the American College of Obstetricians and Gynecologists (Artal and O’Toole, 2003). At each participating centre two health professionals, who volunteered, were trained to recruit and assess eligibility.

When nutrients become scarce, E. gracilis

cells enter into a non-growth phase known as stationary phase and develop a multiple-stress resistance response. The presence of flavonoids in the stationary phase may be associated to that response. Differences were also observed in the distribution of chemical groups found between the photosynthetic strains, particularly regarding polyphenols. The flavonoids in UTEX were only found in the stationary phase, SB203580 mouse whereas MAT seems to produce them also in the exponential phase. Another group of phenols, the tannins, were only found in UTEX in the exponential phase; these were not detected in any of the growth phases of MAT. The screening methodology does not include quantification, but is widely used as qualitative method to study new source of natural products.22 For microalgae, particularly for E. gracilis, there is no information on this matter. Antioxidant production

in Euglena has been previously reported in Selleckchem ZVADFMK different strains, especially in relation to the presence of vitamin E and C and ß-Carotene. 23 Nevertheless, the antioxidant activity of E. gracilis had not been related to the polyphenols (and other polar compounds). In concordance with the presence of polyphenols, our study shows that the fractions of major polarity have the highest scavenging activity. At an initial stage, the antitumour activity may be inferred by simple bioassays such as the growth inhibition of wheat seeds. Antitumoral activity has been previously mentioned in Euglena, 8 but was related to paramylon. In this study we show evidence of antitumoral activity with extracts that lack paramylon, since paramylon stays in the residue (Fraction A). The wheat rootlet growth inhibition assay results suggest that phenols may be Bay 11-7085 responsible for the growth inhibition effect, but we cannot be conclusive

since some of the concentrations assayed stimulated growth. The primary biological activity test carried out complement the chemical screening and allows a first assessment of the potential of E. gracilis as a source of bioactive products. All authors have none to declare. The authors are indebted to Dr. Cristian Solari for valuable discussions. This investigation was supported by grants to VC, UBACYT 01/W290 and CONICET – PIP 283; PNUD ARG 02/018 BB-34UNPSJB and PME 216. “
“Traditional medicine has been used by 65%–80% of total world’s population as their chief means for the provision of health care as estimated by the World Health Organization. Current literature demonstrate that herbal medicine gained importance in developed countries in addition to its popularity in developing countries as the major form of medical treatment.1 From historical point of view the use of herbs for the management of different ailments attracted the researchers to develop medicines and pharmacological treatment of diseases. Various studies on marine plants revealed the presence of pharmacologically active substances.

2% and 54.0%, respectively). Noninferiority (lower limit of the 95% CI greater than −10%) was met for A/H1N1 and B. For A/H3N2, the difference in the proportions of responders was −4.6%, with a lower limit of the 95% CI of −10.4% (Table 3). The proportion of responders in the PCV13 + TIV group for A/H1N1 (80.3%), A/H3N2 (58.0%), and B (52.2%) exceeded the EMA guidance value of >30% (Table 3) [16].

The HAI geometric mean titres (GMTs) were similar in the 2 groups (PCV13 + TIV compared with Placebo + TIV) at baseline and rose substantially after vaccination. Of note, baseline HAI GMTs for A/H3N2 in both groups was higher than those for A/H1N1 and B in both groups (Table 4). The GMFR in the PCV13 + TIV group was ≥4.1 and exceeded the EMA guidance value of >2.0 [16]. The proportion of participants achieving HAI titres ≥40 for A/H1N1, A/H3N2, and B in the PCV13 + TIV group exceeded the EMA guidance value of >60% (Table Proteasome inhibitor review 5) [16]. Baseline

antibody GMC for pneumococcal serotypes ranged from 0.21 μg/mL (serotype 4) to 2.67 μg/mL (serotype 19A) in the PCV13 + TIV group, and 0.19 μg/mL (serotype 4) to 2.77 μg/mL (serotype 19A) in the Placebo + TIV group (data not shown). One month after administration of PCV13 in each group, the overall IgG GMCs were lower in the PCV13 + TIV group relative to INK1197 ic50 the PCV13 group (administered 1 month after Placebo + TIV). The noninferiority criterion for IgG GMC ratios was met for all serotypes except 19F, for which the lower limit of the 95% CI was 0.49, just below the predetermined lower limit of >0.5 (2-fold criterion) (Table 6). Local reactions at the pneumococcal injection site were DNA ligase similar after PCV13 + TIV relative to after PCV13 (administered 1 month after Placebo + TIV) and were 46.9% and 46.6%, respectively; the majority was mild (Table 7). Systemic events were reported more frequently after PCV13 + TIV relative to Placebo + TIV (60.1% vs. 50.5%), with statistical evidence of a percentage difference between the two groups

for any systemic event (95% CI 3.4; 15.7), chills (95% CI 0.5; 8.9), rash (95% CI 0.4; 6.6), and new muscle pain (95% CI 4.9; 15.6) (Table 8). Systemic events were reported more frequently after PCV13 + TIV relative to PCV13 alone (60.1% vs. 48.5%), with statistical evidence of a percentage difference for any systemic event (95% CI 5.4; 17.8), fatigue (95% CI 2.8; 14.9), headache (95% CI 2.1; 13.8), chills (95% CI 0.4; 9.0), decreased appetite (95% CI 1.0; 10.2), new joint pain (95% CI 0.1; 9.2), and any aggravated joint pain (95% CI 2.7; 11.4) (Table 8). Overall, fever rates were low and fever was mild or moderate in severity. There were no vaccine-related serious adverse events (SAEs) during the study. One SAE (angina pectoris with ST-segment elevation on day 10) after placebo in the PCV13 + TIV/Placebo group caused withdrawal of a participant.

KC cells (Culicoides variipennis) were grown at 28 °C in Schneider’s Drosophila medium, supplemented with 10% foetal bovine serum (FBS). BHK-21 cells (European Collection Alisertib chemical structure of Animal cell Cultures: ECACC – 84100501), or BSR cells (a clone of BHK-21 a gift from Dr. Noel Tordo, Institut Pasteur)

were grown at 37 °C in Glasgow’s Minimum-Essential-Medium supplemented with 10% FBS. BTV-4(SPA2003/01) was from blood of sheep showing severe clinical disease (Spain 2003). The virus was isolated in embryonated eggs then adapted to BHK-21 cells (E1/BHK4). BTV-4(SPA2003/01) was used for RNA extraction/cDNA synthesis for the purpose of generating protein expression constructs. BTV-4-Italy03 and BTV-8-France-28 were isolated in embryonated eggs, from sheep-blood (Italy), or cow-blood (France), then adapted to BHK-21 cells (BTV-4-E1/BHK4 or BTV-8-E1/BHK2). These isolates were used for homologous and heterologous challenge of IFNAR−/− mice. Six weeks-old female Balb/cByJ mice were obtained from Charles River laboratories. Groups of six animals were immunised

with proteins to assess NAb production. Six weeks-old female IFNAR−/− mice (genetic background: A129SvEvBrd) were obtained from B&K Universal Ltd. Groups of six animals were used for immunisation with soluble expressed-proteins followed by homologous or heterologous challenge with live BTV. Immunisation protocols were approved by ethics committees at the Pirbright Institute (license number 70/6133) and ANSES (license number 12/04/11-5). Previous analysis has indicated that BTV-VP2

is potentially made of two related domains [18]. We used BTV-4(SPA2003/01) PI3K Inhibitor Library price VP2 domains which encompassed amino acid sequences 63–471 (44.5 kDa) and 555–956 (46 kDa) (nucleotide positions: 187–1326 and 1663–2868, Genbank accession: KJ700442). VP5 lacked aa 1–100 (used sequence encompassed nucleotide positions 289–1581, Genbank accession: AJ783908) while the full-length aa sequence of VP7 was used (nucleotide positions: 1–1050, Genbank accession: KJ700443). All cDNAs were cloned into pGEX-4T-2 (expressing GST). The resulting plasmids are pGEX-BTV4VP2D1, pGEX-BTV4VP2D2, STK38 pGEX-BTV4VP5 and pGEXBTV4VP7. Their sequences were confirmed by comparison to parental virus sequences. Theoretical sizes of the GST-fused proteins are 70.5 kDa (VP2 domain 1), 72 kDa (VP2 domain 2), 73 kD (VP5 lacking aa 1–100) and 64.5 kDa for the VP7. The full-length ORFs of VP2, VP5 and VP7 were also cloned in the mammalian-expression plasmid pCIneo (pCIneo-BTV-4VP2, pCIneo-BTV-4VP5, or pCIneo-BTV-4VP7). pGEX-BTV4VP2D1, pGEX-BTV4VP2D2, pGEX-BTV4VP5 and pGEXBTV4VP7 were used to transform C41 bacteria, known to improve solubility of expressed proteins [28]. Overnight bacterial cultures were grown in 2XYT medium at 37 °C. On the day of expression bacterial cultures were grown until OD600 reached 0.6, then fusion-protein expression was induced by addition of 0.5 mM IPTG and incubation of the cultures at 28 °C for 4 h with shaking at 200 rpm.

There is a need to innovate and think differently — what Queen Ulrika Eleonora did three centuries back in Sweden. It was her visionary thinking and leadership which led to improve maternal health. Today, Sweden maternal mortality is less than 5 per lakh live births. Learning a lesson from the past, we should do the following to ensure that no women should die giving a life. • Empower household and communities Although the government is trying to improve maternal health care and services under the National Health Mission Programme, there is need to accelerate these. Some of these are: • Ensure hundred percent institutional delivery by skilled attendant nurses or doctors at birth for all women. India

can reduce maternal death by Selinexor mw learning DNA Damage inhibitor lessons from the past and by improving maternal health care services, but it needs political and societal commitment. There is no conflict of interest. The author is thankful to Professor Jay Satia for the idea to develop this paper and Ms. Moi Lee Liow for her comments and suggestions. “
“Misoprostol is recommended by the Danish Association of Obstetricians and Gynecologists for induction of labor [1]. It is

used off-label as Cytotec®, a medication that is currently only registered as treatment of gastric ulcers. The authors of the two latest Cochrane meta-analyses on misoprostol-induced labor underline the lack of sufficient statistical power to measure rare and serious side effects. Thus, they call on readers to report incidents of uterine rupture [2] and [3]. We report a case that draws attention to these issues: 1) misoprostol even when used in small doses on an unscarred uterus Oxygenase might cause uterine rupture and 2) side effects in the setting of off-label use should be reported to national reporting systems, where such systems are available. A woman, who had delivered her first baby via uncomplicated vaginal delivery, is induced at 42 + 0 weeks of gestation due to routine procedure in a Danish hospital in 2009. Apart from the gestation her pregnancy is normal. The patient record does not reveal the Bishops Score, but her cervix is initially described as no

cervical dilatation, 2 cm in length, posterior location. At 11.53 am 25 μg misoprostol is placed in the posterior fornix of her vagina. Approximately 1 h later, at 1.00 pm after a normal CTG, she leaves the hospital according to hospital policy. She returns home to await contractions and does not receive further treatment with misoprostol. 7 h later, at eight o’clock pm she calls the hospital due to increasing labor pains. She is encouraged to stay at home. 10 min past midnight, 13 h after the misoprostol was inserted, she returns to the hospital now with strong contractions occurring every 2–3 min. She is 3–4 cm dilated, cervix is 1/2–1 cm, posterior location and soft with the fetal head present at the pelvic brim. She is in pain, and asks for an epidural block.

Mice were returned to normal water for a further two weeks following the cessation of treatment, to flush any residual in vivo antibiotics inhibiting bacterial culture. At the end of each treatment regimen, bacterial burden in the individual organs/tissues was determined as described previously; with the inclusion

of the liver as an additional potential reservoir of bacilli. Fig. 2A shows that 1 month of treatment was sufficient to clear residual bacilli from the spleen; but a further 2 months of treatment were required to consistently clear persistent BCG from the d.LNs in all animals. The pre-treatment burdens observed in both the spleen and d.LNs were equivalent to previous experiments Galunisertib ic50 (Fig. 2A cf. Fig. 1A). BCG in lungs and liver were undetectable in this experiment. As further experiments were critically dependant on consistent efficacy of treatment, a further experiment included

vaccinated mice given an additional 3 months rest after cessation of 3 months treatment. In contrast to immunised, untreated mice (which had a burden of 2.7 log10 CFU (±0.6) in the d.LNs ∼7.5 months p.i.), no viable BCG were detected in the treatment group (Fig. 2B) confirming the efficacy of antimicrobial treatment. To evaluate the effect of persistent BCG bacilli on specific IFN-γ responses, groups of mice were immunized with BCG or placebo control for 6 weeks, prior to treatment with antibiotics or placebo for 3 months. To ensure that: (a) analyses were

not influenced KU-57788 mw by short-lived effector T cell responses; and (b) BCG bacilli were effectively cleared, animals were until rested for 3 months after treatment. The frequency of BCG-specific IFN-γ secreting cells in the spleen was then evaluated by ex vivo ELISPOT stimulated with the defined protein cocktail. Fig. 2C shows that the significant IFN-γ response induced by BCG immunization (613 SFU/million cells) was completely abrogated in BCG abbreviated animals (p < 0.001). These data clearly demonstrate that, the persisting IFN-γ responses observed in BCG immunized animals were due to persistent BCG bacilli, rather than long-term memory. To further investigate whether this ablation of the IFN-γ responses (ELISPOT) in BCG abbreviated mice was specific to CD4 T cells and of what memory phenotype, the CD4 T cell responses specific to BCG in spleen and lung were assessed by intracellular cytokine staining (ICS) after stimulation with defined protein cocktail (Fig. 3). Fig. 3A shows BCG immunization induces significant populations of multifunctional CD4 T cells (IFN-γ+/IL-2+/TNF-α+, IFN-γ+/TNF-α+ and IL-2+/TNF-α+), in both spleen and lung-derived cells, with frequencies considerably higher in the lungs as reported previously [9]. ICS performed on d.LN samples of BCG immunized mice in previous experiments were unable to detect significant populations of cytokine producing cells (data not shown), and so were not performed here.

, 2011 and McDonald, 2008). The lack of individual-level data also prohibited analysis of family characteristics which may affect choices regarding school transportation.

For example, more active families may choose to live in more walkable neighborhoods, which may be reflected in their modes of school transportation. Walking was assessed at the school level, whereas built environment features were quantified at the school attendance boundary level. School attendance boundaries were selected as the unit of analysis, as these are most relevant to policy makers at TDSB. The application of school walking proportions to the whole school boundary was relevant, as attendance boundaries generally were within 1.6 km walking distance of the school. This study only buy Talazoparib looked at travel to school; however in Toronto, more children walk home from school in the afternoon than walk to school in the morning (Buliung et al., 2009). Therefore, the estimated walking proportions are conservative. Different built environment characteristics are also relevant at the home, route and

school level and on the trip to and from school (Mitra et al., 2010a, Mitra et al., 2010b, Panter et al., 2010 and Wong et al., 2011). Individual home and route characteristics could not be assessed given the ecological nature of the data. Results generally confirmed previous null findings of the effect of school level characteristics and walking (Panter et al., 2010), with the only significant characteristic being the presence of a school click here crossing guard.

In this study, only objectively measured built environment features were assessed. Parent or child perceptions of the built environment are also important when explaining walking behavior in children, as ultimately, together they make decisions regarding school transportation mode (Kerr et al., 2006, McMillan, 2005 and Timperio et al., 2006). The use of both objective measurements together with perceptions of the traffic Ketanserin environment has been recommended, as these measures can differ (Pont et al., 2009 and Wong et al., 2011). Future work is planned to incorporate parent perceptions of the built environment and traffic danger along with the objective measures presented in this analysis. This study was the first to implement a large scale collection of objective observational counts of walking to school, together with objective built environment data from city databases and field surveys. The strengths of this study included the objective observational outcome data and the generalizability of results. The large sample represented virtually all regular program JK-6 schools in Toronto and results are likely generalizable to other regular program elementary schools in Toronto. Finally, this was the first time objective parcel level land use data that were used in a study of children’s active transportation to school in Toronto. To summarize, average walking proportions to school in Toronto were high, with large variability between schools.

9 and 10 Because of these biological activities the essential oil may be recommended as botanical preservative for enhancement of shelf life of food items. 11 The fruit of C. lanceolatus showed calcium channel blocking activity. 12 Earlier study with ethanolic extract of C. lanceolatus has expressed a potent cardio protective activity with strong elastase inhibition, DPPH radical scavenging activities, anti-inflammatory activity and flavanoids isolated from the aerial parts showed effective against Alzheimer’s disease. 13, 14, 15 and 16 Hence with these medicinal properties VE-821 in vivo the present plant became a subject of the present study to evaluate antibacterial activity. C. lanceolatus DC. were collected from different locations

of Mysore, Karnataka, India. The voucher of the specimen was deposited in the herbarium of DOS in Botany, University of Mysore, Mysore. Healthy disease free, mature leaves of the C. lanceolatus DC. were selected, washed under running tap water, shade dried and ground to moderately fine powder with the help of waring blender. About 20 g of the powdered material was subjected to cold extraction with petroleum ether, chloroform, ethyl-acetate and methanol separately. The solvent soaked material was left for 24–48 h in a rotary shaker and filtered using Whatman filter paper No1.

Each extracts EPZ-6438 datasheet was evaporated to dryness under reduce pressure using rotary flash evaporator and preserved at 5 °C in an air tight bottle for further phytochemical tests and antibacterial assays. 17 A qualitative phytochemical test for different solvent extracts C. lanceolatus leaf was determined as

per the standard protocols to decipher the presence or absence of various phyto-compounds such as carbohydrates, proteins, saponins, terpenoids, phytosterols, flavonones etc., by observing characteristic color changes. 18, 19 and 20 Standard cultures of human pathogenic bacteria such as Gram positive – Bacillus cereus (MTCC 1272), Bacillus subtilis (MTCC 121), Listeria monocytogenes (MTCC 839) Staphylococcus aureus (MTCC 7443), very Gram negative – Pseudomonas aeruginosa (MTCC 7903), Escherichia coli (MTCC 7410), Shigella flexineri (MTCC 1457), Vibrio parahaemolyticus (MTCC 451), Proteus mirabilis (MTCC 425) Erwinia carotovora (MTCC 1428), Agrobacterium tumefaciens (MTCC 431) and Pseudomonas syringae (MTCC 5102) and were procured from MTCC, Chandigarh, India. Authentic pure cultures of phytopathogenic Xanthomonas axonopodis pv. malvacearum, Xanthomonas campestris pv. vesicatoria, Xanthomonas oryzae pv. oryzae and Ralstonia solanacearum were procured from DANIDA research laboratory, University of Mysore, India. The test microorganisms were pre-cultured in nutrient broth and kept overnight in a rotary shaker at 37 °C, centrifuged at 10,000 rpm for 5 min, pellet was suspended in double distilled water and the cell density was standardized spectrophotometrically (A610 nm).

By day 2 volunteer measurements were 34 and 28 mm and clinic measurements 20 and 12 mm (left and right arms respectively). The volunteer reported that the Dorsomorphin molecular weight total duration of swelling was 13 days. Of vaccine-related AEs (detailed in Online Table B), 394 (68%) were local to the vaccine site and 183 (32%) were systemic. The median AE duration (and interquartile range, IQR) was 7 (3–12) and 2 (1–2) days for local and systemic vaccine-related AEs respectively. As expected, local vaccine responses (such as pain, redness, swelling and local tenderness)

occurred with almost every vaccine dose. The median duration (and IQR) of pain was 2 (1–3.25) days and most (88.2%) were mild. Systemic responses (e.g. headache, myalgia and tiredness) occurred frequently after vaccination (Fig. 1). Myalgia was most common, reported by 48% of volunteers. For the single vaccine dose-escalation groups 1–5, the frequency of local AEs did not alter as dose increased, but more systemic AEs (mostly mild in severity) were seen with increasing dose in MVA vaccinated volunteers (Fig. 2). The frequency of local AEs also varied little with successive vaccinations in the three-dose heterologous prime-boost groups FFM and MMF, but the proportion of AEs graded

moderate increased with successive doses in the MMF group (Fig. 3). There was no clear trend in AE duration during vaccination in these groups (Fig. 3d). Eleven volunteers (32%) had at least one blood result falling outside the study reference ranges during follow up, but none of these were associated Raf inhibitor with clinical symptoms and only two warranted referral to the general practitioner and for repeat testing or investigation (mild hyperbilirubinaemia at 28 μmol/L and a low haemoglobin of 9.8 g/dL which resolved at repeat testing). Three doses of MVA-PP and two doses of FP9-PP were assessed in single-dose small groups (n = 3), primarily for safety, before deciding on doses to be used in the larger prime-boost groups.

Immunogenicity for these groups was low, as expected in the absence of a booster dose, but pre-vaccination responses were also relatively high (Fig. 4). For MVA-PP there was a suggestion that immunogenicity was lower at the high dose (5 × 108 pfu). In deciding the dose to be used in the prime-boost groups, the following factors were considered: firstly, although all doses appeared safe, the frequency of systemic AEs was higher with increasing MVA-PP dose; secondly, there was no clear dose advantage for MVA-PP at high dose; and thirdly, the possibility of encountering anti-vector immunity cross-reactive between the different poxviruses. It was therefore decided that for each of the prime-boost groups, the low vaccine dose (1 × 108 pfu) would be used to prime and the intermediate dose (2 × 108 pfu) to boost.

31 Oxygen therapy should be titrated to achieve oxyhaemoglobin saturation (SpO2) between 88 and 92%,31 and is usually administered via nasal prongs or a venturi mask. Oxygen can also be delivered using high flow nasal cannulae, which may better CX-5461 in vivo meet the

inspiratory flow demands of severely dyspnoeic patients and is more tolerable than a face mask. Such systems can also provide humidification, which may be important to prevent sputum retention in patients with excess secretions; however, there is no evidence to guide practice in this area. Non-invasive ventilation is highly effective as a supportive therapy for people with AECOPD complicated by type-II respiratory failure. It unloads the respiratory muscles, restores acid-base balance and provides time for pharmaceutical therapies to be effective. A systematic review and meta-analysis showed that in patients with COPD and acute hypercapnic respiratory failure (PaCO2 > 45 mmHg, pH < 7.35), non-invasive ventilation reduced mortality compared to usual care

(RR 0.52, 95% CI 0.36 to 0.76) and reduced the need for intubation see more (RR 0.41, 95% CI 0.33 to 0.53).32 There are also benefits for the health system, with reduced length of stay in those treated with non-invasive ventilation (MD – 3.24 days, 95% CI –4.41 to –2.06).32 Physiotherapists are frequently involved in the delivery of non-invasive ventilation, including assessment and referral of appropriate patients, establishing patients on treatment, titration of pressures, optimising patient

to tolerance and monitoring treatment effects.33 Non-invasive ventilation may assist in delivery of other physiotherapy treatments such as early mobilisation. In a group of hospitalised patients who were recovering from acute-on-chronic respiratory failure, most of whom had COPD, the use of non-invasive ventilation and oxygen during walking resulted in clinically significant improvements in walking distance, oxyhaemoglobin saturation and exercise-induced dyspnoea compared to walking on oxygen alone.34 Non-invasive ventilation also improved endurance time for unsupported upper limb exercise. These results were obtained from patients who were as early as 2 days into their hospital admission, using inspiratory positive airway pressure ranging from 15 to 18 cmH2O and expiratory positive airway pressure ranging from 4 to 5 cmH2O. Physiotherapists frequently use breathing exercises to relieve dyspnoea, improve thoraco-abdominal co-ordination and enhance functional capacity in people with acute exacerbations of COPD. Commonly used techniques include breathing control (also known as diaphragmatic or abdominal breathing) and pursed lip breathing (gentle exhalation through lips that are pressed together).