Comorbid Conditions in Idiopathic Pulmonary Fibrosis: Recognition and Management.

Idiopathic pulmonary fibrosis (IPF), a fibrosing interstitial pneumonia of unknown etiology, primarily affects older adults and leads to a progressive decline in lung function and quality of life. With a median survival of 3-5 years, IPF is the most common and deadly of the idiopathic interstitial pneumonias. Despite the poor survivorship, there exists substantial variation in disease progression, making accurate prognostication difficult. Lung transplantation remains the sole curative intervention in IPF, but two anti-fibrotic therapies were recently shown to slow pulmonary function decline and are now approved for the treatment of IPF in many countries around the world. While the approval of these therapies represents an important first step in combatting of this devastating disease, a comprehensive approach to diagnosing and treating patients with IPF remains critically important. Included in this comprehensive assessment is the recognition and appropriate management of comorbid conditions. Though IPF is characterized by single organ involvement, many comorbid conditions occur within other organ systems. Common cardiovascular processes include coronary artery disease and pulmonary hypertension (PH), while gastroesophageal reflux and hiatal hernia are the most commonly encountered gastrointestinal disorders. Hematologic abnormalities appear to place patients with IPF at increased risk of venous thromboembolism, while diabetes mellitus (DM) and hypothyroidism are prevalent metabolic disorders. Several pulmonary comorbidities have also been linked to IPF, and include emphysema, lung cancer, and obstructive sleep apnea. While the treatment of some comorbid conditions, such as CAD, DM, and hypothyroidism is recommended irrespective of IPF, the benefit of treating others, such as gastroesophageal reflux and PH, remains unclear. In this review, we highlight common comorbid conditions encountered in IPF, discuss disease-specific diagnostic modalities, and review the current state of treatment data for several key comorbidities

Does the Locally-Adaptive Model of Archaeological Potential (LAMAP) work for hunter-gatherer sites? A test using data from the Tanana Valley, Alaska

We report an assessment of the ability of the Locally-Adaptive Model of Archaeological Potential (LAMAP) to estimate archaeological potential in relation to hunter-gatherer sites. The sample comprised 182 known sites in the Tanana Valley, Alaska, which was occupied solely by hunter-gatherers for about 14,500 years. To estimate archaeological potential, we employed physiographic variables such as elevation and slope, rather than variables that are known to vary on short time scales, like vegetation cover. Two tests of LAMAP were carried out. In the first, we used the location of a random selection of 90 sites from all time periods to create a LAMAP model. We then evaluated the model with the remaining 92 sites. In the second test, we built a LAMAP model from 12 sites that pre-date 10,000 cal BP. This model was then tested with sites that post-date 10,000 cal BP. In both analyses, areas predicted to have higher archaeological potential contained higher frequencies of validation sites. The performance of LAMAP in the two tests was comparable to its performance in previous tests using archaeological sites occupied by agricultural societies. Thus, the study extends the use of LAMAP to the task of estimating archaeological potential of landscapes in relation to hunter-gatherer sites

Teletraffic Performance of GSM900/DCS1800 in Street Microcells

Radio planners often refer to the buildings in cities as "urban clutter," a nuisance they must accomrnodate. A more appropriate attitude for personal communication systems is to utilize the electromagnetic shielding offered by buildings to form microcells

Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care : lessons learnt from a mixed-methods feasibility study

Objectives: To test the feasibility of implementing a brief but intensive hybrid cognitive behavioural therapy (Hybrid CBT) for pain-related insomnia. Design: Mixed-methods, with qualitative process evaluation on a two-arm randomised controlled feasibility trial. Setting: Primary care. Participants: Twenty-five adult patients with chronic pain and insomnia. Intervention: Hybrid CBT or self-help control intervention. Primary and secondary outcome measures: Primary outcomes measures were the Insomnia Severity Index and interference scale of the Brief Pain Inventory (BPI). Secondary outcomes measures were the present pain intensity rating from the BPI, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale and EQ-5D-5L. Results: Fourteen participants were randomised to receive Hybrid CBT, 11 to receive the self-help control treatment. Of the 14 in the Hybrid CBT group, 9 (64%) completed all four treatment sessions (4 discontinued due to poor health; 1 due to time constraints). Adherence to the self-help control treatment was not monitored. The total number of participants completing the 12-week and 24-week follow-ups were 12 (6 in each group; Hybrid CBT: 43%; self-help: 55%) and 10 (5 in each group; Hybrid CBT: 36%; self-help: 45%). Based on the data available, candidate outcome measures appeared to be sensitive to changes associated with interventions. Thematic analysis of pre-postintervention interview data revealed satisfaction with treatment content among those who completed the Hybrid CBT, whereas those in the self-help control treatment wanted more contact hours and therapist guidance. Other practical suggestions for improvement included shortening the duration of each treatment session, reducing the amount of assessment paperwork, and minimising the burden of sleep and pain monitoring. Conclusion: Important lessons were learnt with regard to the infrastructure required to achieve better patient adherence and retention. Based on the qualitative feedback provided by a subset of treatment completers, future trials should also consider lowering the intensity of treatment and streamlining the data collection procedure. Trial registration number: ISRCTN17294365

High-fidelity single-shot readout for a spin qubit via an enhanced latching mechanism

The readout of semiconductor spin qubits based on spin blockade is fast but suffers from a small charge signal. Previous work suggested large benefits from additional charge mapping processes, however uncertainties remain about the underlying mechanisms and achievable fidelity. In this work, we study the single-shot fidelity and limiting mechanisms for two variations of an enhanced latching readout. We achieve average single-shot readout fidelities > 99.3% and > 99.86% for the conventional and enhanced readout respectively, the latter being the highest to date for spin blockade. The signal amplitude is enhanced to a full one-electron signal while preserving the readout speed. Furthermore, layout constraints are relaxed because the charge sensor signal is no longer dependent on being aligned with the conventional (2, 0) - (1, 1) charge dipole. Silicon donor-quantum-dot qubits are used for this study, for which the dipole insensitivity substantially relaxes donor placement requirements. One of the readout variations also benefits from a parametric lifetime enhancement by replacing the spin-relaxation process with a charge-metastable one. This provides opportunities to further increase the fidelity. The relaxation mechanisms in the different regimes are investigated. This work demonstrates a readout that is fast, has one-electron signal and results in higher fidelity. It further predicts that going beyond 99.9% fidelity in a few microseconds of measurement time is within reach.Comment: Supplementary information is included with the pape

Low temperature (down to 450° C) annealed TiAl contacts on N-type gallium nitride characterized by differential scanning calorimetry

International audienceThis work reports on Differential Scanning Calorimetry (DSC) measurements performed on Ti-Al metallic layers stacks deposited on n+-GaN. The aim is to get better understanding of the mechanisms leading to ohmic contact formation during the annealing stage. Two exothermic peaks were found, one below 500°C and the other one around 660°C. They can be respectively attributed to Al3Ti and Al2Ti compounds formation. The locations of these peaks provide clear evidence of solid-solid reac-tions. Lowest contact resistance is well correlated with the presence of Al3Ti compound, corresponding to Al(200nm)/Ti(50nm) stoichiometric ratio. Subsequently, Al(200 nm)Ti(50 nm) stacks on n+-GaN were annealed from 400°C to 650°C. Specific Contact Resistivity (SCR) values stay in the mid 10-5 Ω.cm² range for annealing temperatures between 450°C and 650°C. Such low-temperature annealed contacts on n+-GaN may open new device processing routes, simpler and cheaper, in which Ohmic and Schottky contacts are annealed together