Regular follow-up as part of an Asthma management plan : a study of hospitalised patients in Malta

Objective: To study the management of specific sub-groups of patients with asthma in Malta, using locally published guidelines for comparison. Method: A piloted, structured interview among patients between the ages of 14-59 years who were hospitalised with an admission diagnosis of acute asthma. In the case of repeated admissions, only the first interview was considered. All interviews were carried out by either of two clinical pharmacists and lasted about 30 minutes. The four-year prospective study started in February 1997 (one year before publication of the Malta guidelines) and finished in January 2001 (three years after publication). Main outcome measures: · Inhaled steroids on admission · Patient partnership: use of a written self-management plan and home peak flow monitoring · Patient compliance with inhaled steroids Results: 304 patients (68% females; mean population age 33.9 years SD 13.41) were interviewed over the four year period. Of the 304 patients, 32% were regularly followed up with the majority of patients (25.3%) being under specialist care; 54% of patients were not followed up as part of a long-term asthma management plan. It was not possible to obtain complete information in 14% of patients. The chi-square test was used to compare the two groups. With the exception of home peak flow monitoring, patients who were regularly followed up had statistically significant better management as recommended by the Malta asthma guidelines compared to those who were not regularly followed up. Conclusion: The findings of this study indicate that regular physician review results in better asthma management when assessed by comparison to published guidelines. However, despite regular follow up, certain aspects of patient care are inadequate in the light of the Malta asthma guidelines. It is suggested that the clinical pharmacist is well-placed to offer advice in order to promote adherence to guidelines.peer-reviewe

Generalized metallic pseudo-Riemannian structures

We generalize the notion of metallic structure in the pseudo-Riemannian setting, define the metallic Norden structure and study its integrability. We construct a metallic natural connection recovering as particular case the Ganchev and Mihova connection, which we extend to a metallic natural connection on the generalized tangent bundle. Moreover, we construct metallic pseudo-Riemannian structures on the tangent and cotangent bundles.Comment: 16 page

Generalized quasi-statistical structures

Given a non-degenerate $(0,2)$-tensor field $h$ on a smooth manifold $M$, we consider a natural generalized complex and a generalized product structure on the generalized tangent bundle $TM\oplus T^*M$ of $M$ and we show that they are $\nabla$-integrable, for $\nabla$ an affine connection on $M$, if and only if $(M,h,\nabla)$ is a quasi-statistical manifold. We introduce the notion of generalized quasi-statistical structure and we prove that any quasi-statistical structure on $M$ induces generalized quasi-statistical structures on $TM\oplus T^*M$. In this context, dual connections are considered and some of their properties are established. The results are described in terms of Patterson-Walker and Sasaki metrics on $T^*M$, horizontal lift and Sasaki metrics on $TM$ and, when the connection $\nabla$ is flat, we define prolongation of quasi-statistical structures on manifolds to their cotangent and tangent bundles via generalized geometry. Moreover, Norden and Para-Norden structures are defined on $T^*M$ and $TM$.Comment: 28 page

Nonminimal Inflation on the Randall-Sundrum II Brane with Induced Gravity

We study an inflation model that inflaton field is non-minimally coupled to the induced scalar curvature on the Randall-Sundrum (RS) II brane. We investigate the effects of the non-minimal coupling on the inflationary dynamics of this braneworld model. Our study shows that the number of e-folds decreases by increasing the value of the non-minimal coupling. We compare our model parameters with the minimal case and also with recent observational data. In comparison with recent observation, we obtain a constraint on the values that the non-minimal coupling attains.Comment: 15 pages, 5 figure

Millimeter Imaging of MWC 758: Probing the Disk Structure and Kinematics

We investigate the structure and kinematics of the circumstellar disk around the Herbig Ae star MWC 758 using high-resolution observations of the ^(12)CO (3-2) and dust continuum emission at the wavelengths of 0.87 and 3.3 mm. We find that the dust emission peaks at an orbital radius of about 100 AU, while the CO intensity has a central peak coincident with the position of the star. The CO emission is in agreement with a disk in Keplerian rotation around a 2.0 M_⊙ star, confirming that MWC 758 is indeed an intermediate-mass star. By comparing the observation with theoretical disk models, we derive that the disk surface density Σ(r) steeply increases from 40 to 100 AU and decreases exponentially outward. Within 40 AU, the disk has to be optically thin in the continuum emission at millimeter wavelengths to explain the observed dust morphology, though our observations lack the angular resolution and sensitivity required to constrain the surface density on these spatial scales. The surface density distribution in MWC 758 disk is similar to that of "transition" disks, though no disk clearing has been previously inferred from the analysis of the spectral energy distribution (SED). Moreover, the asymmetries observed in the dust and CO emission suggest that the disk may be gravitationally perturbed by a low-mass companion orbiting within a radius of 30 AU. Our results emphasize that SEDs alone do not provide a complete picture of disk structure and that high-resolution millimeter-wave images are essential to reveal the structure of the cool disk mid-plane

A minor alternative transcript of the fumarylacetoacetate hydrolase gene produces a protein despite being likely subjected to nonsense-mediated mRNA decay

BACKGROUND: Coupling of alternative splicing with nonsense-mediated mRNA decay (NMD) may regulate gene expression. We report here the identification of a nonsense alternative transcript of the fumarylacetoacetate hydrolase (fah) gene, which produces a protein despite the fact that it is subject to NMD. RESULTS: During the characterization of the effects of the W262X nonsense mutation on FAH mRNA metabolism, two alternative transcripts (del100 and del231) of the fah gene were identified. Del100 lacks exon 8 and as a consequence, the reading frame is shifted and a premature termination codon appears at the 3'end of exon 10. Exons 8 and 9 are skipped in del231, without any disruption of the reading frame. Specific amplification of these transcripts demonstrate that they are produced through minor alternative splicing pathways, and that they are not caused by the W262X mutation per se. As shown with an antiserum raised against the C-terminal part of the putative DEL100 protein, the del100 transcript produces a protein, expressed at different levels in various human tissues. Interestingly, the del100 transcript seems to be subjected to nonsense-mediated mRNA decay, as its level was stabilized following a cycloheximide treatment. CONCLUSIONS: The del100 and del231 transcripts arise due to minor alternative splicing pathways and del100 is likely subjected to nonsense-mediated mRNA decay. However the remaining amount of transcript seems sufficient to produce a protein in different human tissues. This suggests that NMD has a broader role than simply eliminating aberrant transcripts and when coupled to alternative splicing, may act to modulate gene expression, by allowing the production of low amounts of protein

Chemical composition and origin of nebulae around Luminous Blue Variables

We use the analysis of the heavy element abundances (C, N, O, S) in circumstellar nebulae around Luminous Blue Variables to infer the evolutionary phase in which the material has been ejected. (1) We discuss the different effects that may have changed the gas composition of the nebula since it was ejected (2) We calculate the expected abundance changes at the stellar surface due to envelope convection in the red supergiant phase. If the observed LBV nebulae are ejected during the RSG phase, the abundances of the LBV nebulae require a significantly smaller amount of mass to be lost than assumed in evolutionary models. (3) We calculate the changes in the surface composition during the main sequence phase by rotation induced mixing. If the nebulae are ejected at the end of the MS-phase, the abundances in LBV nebulae are compatible with mixing times between 5 x 10^6 and 1 x 10^7 years. The existence of ON stars supports this scenario. (4) The predicted He/H ratio in the nebulae are significantly smaller than the current observed photospheric values of their central stars. Combining various arguments we show that the LBV nebulae are ejected during the blue SG phase and that the stars have not gone through a RSG phase. The chemical enhancements are due to rotation induced mixing, and the ejection is possibly triggered by near-critical rotation. During the ejection, the outflow was optically thick, which resulted in a large effective radius and a low effective temperature. This also explains the observed properties of LBV dust.Comment: 18 pages, 4 figures, to be published in The Astrophysical Journal, April 20, 200