Severe vocal cord dysfunction resistant to all current therapeutic interventions

SummaryVocal cord dysfunction (VCD) is characterised by paradoxical vocal cord adduction during inspiration or throughout the respiratory cycle, it results in wheeze, stridor, cough and dyspnoea. Although asthma and VCD can coexist, patients with VCD are frequently misdiagnosed with refractory asthma. It can severely restrict an individual's level of activity and effective therapeutic control can be difficult to achieve. We report the case of a patient who was treated with all available therapeutic interventions, including intralaryngeal botulinum toxin injection, but failure resulted in a permanent trachesotomy

Believability of new diseases reported in the 2014 Surgeon General's Report on smoking: Experimental results from a national survey of US adults

Background Tobacco use is the leading cause of preventable disease and death globally. The 2014 Surgeon General's Report included new diseases linked to smoking, including liver and colon cancer, diabetes and tuberculosis. As more diseases are linked to smoking, which diseases should we communicate to the public and what message source has the most impact? Methods Data were collected through a nationally representative phone survey of US adults (N = 5014), conducted from September 2014 through May 2015. We experimentally randomized participants to a 2 (new smoking disease messages - liver and colon cancers compared to diabetes and tuberculosis) by 4 (message sources - CDC, FDA, Surgeon General, and none) experiment. The outcome was message believability. Results About half the sample was female (51.5%) and 17.8% were a current smoker. Overall, 56% of participants said the messages were very believable. Cancer messages (liver and colon cancer) were significantly more believable than messages about chronic disease (tuberculosis and diabetes), 61% vs. 52%. Smokers were less likely to report both sets of new disease messages as very believable compared to non-smokers. Significantly more smokers intending to quit (44.5%) found the messages to be very believable compared to smokers not intending to quit (22.6%). Believability did not differ by message source. Conclusion Important differences exist in believability of disease messages about new tobacco-related information. Messages emphasizing the causal link between smoking and new diseases should be considered for use in mass media campaigns

Adolescents’ aided recall of targeted and non-targeted tobacco communication campaigns in the united states

We examined whether advertisements from two national tobacco control campaigns targeting adolescents (i.e., The Real Cost, Fresh Empire) and one campaign targeting adults (i.e., Tips from Former Smokers) were reaching adolescents. Data came from a national sample of adolescents aged 13 to 17 years (n = 975) surveyed by phone from August 2016 to May 2017. We assessed recall and attitudes toward five specific advertisements and three campaign slogans and examined differences by sub-groups. Almost all (95%) adolescents recalled seeing at least one campaign advertisement. Aided recall of The Real Cost and Tips from Former Smokers slogans was high (65.5% and 71.6%, respectively), while aided recall of Fresh Empire slogan was lower (15.3%) (χ2 p-value: p < 0.001); however, Black adolescents had higher odds of recalling the Fresh Empire ad (aOR: 2.28, 95% CI: 1.39, 3.73) and slogan (aOR: 2.64, 95% CI: 1.06, 6.54) compared to White adolescents. Increased exposure to the advertisements (i.e., recalling more advertisements) was significantly associated with higher odds of reporting negative feelings toward tobacco products in 4/5 models (aORs from 1.34 to 1.61). Large-scale national campaigns can have wide reach among both targeted and non-targeted audiences with added benefits for cumulative cross-campaign exposure to advertisements

Factors Influencing Trust in Agencies That Disseminate Tobacco Prevention Information

Several health-related agencies administer national and targeted public education campaigns to provide health information and change health-related behaviors. The trust the public has in these agencies as the source of the message impacts the effectiveness of their communication campaigns. In this study, we explore the perceived trust of agencies that communicate health messages in the tobacco control field. As part of a larger tobacco regulatory science study, we conducted six 90-min focus groups comprising 41 participants. Five main themes emerged pertinent to the agency: (1) its integrity, (2) its competence, (3) its motives, (4) how it is portrayed in the media, and (5) skepticism and mistrust about it. Given the significant resources spent on health messaging to the public and potential benefits offered by this communication, an understanding of public trust in the agencies as the source of health messages is important. Findings suggest health information may be ignored or discounted when there is mistrust in the agency sending those messages

Clinical and molecular characterization of HER2 amplified-pancreatic cancer

&lt;p&gt;Background: Pancreatic cancer is one of the most lethal and molecularly diverse malignancies. Repurposing of therapeutics that target specific molecular mechanisms in different disease types offers potential for rapid improvements in outcome. Although HER2 amplification occurs in pancreatic cancer, it is inadequately characterized to exploit the potential of anti-HER2 therapies.&lt;/p&gt; &lt;p&gt;Methods: HER2 amplification was detected and further analyzed using multiple genomic sequencing approaches. Standardized reference laboratory assays defined HER2 amplification in a large cohort of patients (n = 469) with pancreatic ductal adenocarcinoma (PDAC).&lt;/p&gt; &lt;p&gt;Results: An amplified inversion event (1 MB) was identified at the HER2 locus in a patient with PDAC. Using standardized laboratory assays, we established diagnostic criteria for HER2 amplification in PDAC, and observed a prevalence of 2%. Clinically, HER2- amplified PDAC was characterized by a lack of liver metastases, and a preponderance of lung and brain metastases. Excluding breast and gastric cancer, the incidence of HER2-amplified cancers in the USA is &#62;22,000 per annum.&lt;/p&gt; &lt;p&gt;Conclusions: HER2 amplification occurs in 2% of PDAC, and has distinct features with implications for clinical practice. The molecular heterogeneity of PDAC implies that even an incidence of 2% represents an attractive target for anti-HER2 therapies, as options for PDAC are limited. Recruiting patients based on HER2 amplification, rather than organ of origin, could make trials of anti-HER2 therapies feasible in less common cancer types.&lt;/p&gt

Believability of cigarette warnings about addiction: National experiments of adolescents and adults

Introduction: We conducted two experiments to examine the believability of three addictionfocused cigarette warnings and the influence of message source on believability among adolescents and adults in the United States. Methods: Experimental data were collected using national phone surveys of adolescents (age 13-17; n = 1125; response rate, 66%) and adults (age 18+; n = 5014; response rate, 42%). We assessed the believability of three cigarette warnings about addiction attributed to four message sources (Food and Drug Administration [FDA], Surgeon General, Centers for Disease Control and Prevention [CDC], no source). Results: The majority of adolescents and adults reported the three cigarette warnings were very believable (49%-81% for adolescents; 47%-76% for adults). We found four to five times higher odds of adolescents believing a warning that cigarettes are addictive (warning 1) or that nicotine was an addictive chemical (warning 2) compared to a warning that differentiated the addictive risks of menthol versus traditional cigarettes (warning 3), warning 1 adjusted odds ratio (aOR): 4.53, 95% confidence interval (CI): 3.10, 6.63; warning 2 aOR: 3.87, 95% CI: 2.70, 5.50. Similarly, we found three to five times higher odds of adults (including current smokers) believing the same warnings, warning 1 aOR: 3.74, 95% CI: 2.82, 4.95; warning 2 aOR: 3.24, 95% CI: 2.45, 4.28. Message source had no overall impact on the believability of warnings for either population. Conclusions: Our findings support the implementation of FDA's required warnings that cigarettes are addictive and that nicotine is an addictive chemical. These believable warnings may deter adolescents from initiating smoking and encourage adults to quit smoking. Implications: This article describes, for the first time, the believability of different cigarette warnings about addiction. We now know that the majority of adolescents and adults believe cigarette warnings that highlight cigarettes as addictive and that nicotine is an addictive chemical in tobacco. However, a warning that highlighted the relative risk of addiction for menthol cigarettes compared to traditional cigarettes was not as believable among either population. Our findings support the implementation of FDA's required warnings that cigarettes are addictive and that nicotine is an addictive chemical that may deter adolescents from initiating smoking and encourage adults to quit smoking

Building a viable weight management program in a patient-centered medical home

.001), an average decrease in HbA1c of 0.2 points (P=.004), and an average blood pressure reduction of 2.8 mmHg systolic (P=.002) and 1.9 mmHg diastolic (P=.03). One-third of participants (n=60) achieved clinically significant weight loss (&gt5%) at 18 months. The program has become financially sustainable through billing for preventive counseling services and a $125 out-of-pocket enrollment fee. CONCLUSIONS: WMP provides one model for primary care practices to de-velop a financially sustainable and evidence-based behavioral therapy weight management program for their patients with obesity. Future work will include assessment of longer-term program benefits, quality metrics, and health care costs.BACKGROUND AND OBJECTIVES: The growing prevalence of obesity in the United States and globally highlights the need for innovative strategies to provide obesity treatment in primary care settings. This report describes and evaluates the Weight Management Program (WMP), an interprofessional program in an academic family medicine clinic delivering intensive behavioral therapy (IBT) following evidenced-based guidelines. METHODS: We extracted WMP participant health data from the electronic health record and evaluated retrospectively. Eligible participants completed at least four WMP visits and had a baseline weight, blood pressure, and he-moglobin A1c (HbA1c) recorded within 1 year prior to their first visit. Paired t tests were used to assess changes in, weight, HbA1c and systolic and diastolic blood pressures from baseline. RESULTS: WMP counseled 673 patients over 3,895 visits from September 2015 to June 2019. Of these, 186 met eligibility criteria (at least four vis-its), with a median of eight visits (mean=11.3, SD=8.1). Participants saw an average weight decrease during program participation of 9.7 lbs (P&l

Track Reconstruction and Performance of DRIFT Directional Dark Matter Detectors using Alpha Particles

First results are presented from an analysis of data from the DRIFT-IIa and DRIFT-IIb directional dark matter detectors at Boulby Mine in which alpha particle tracks were reconstructed and used to characterise detector performance--an important step towards optimising directional technology. The drift velocity in DRIFT-IIa was [59.3 +/- 0.2 (stat) +/- 7.5 (sys)] m/s based on an analysis of naturally-occurring alpha-emitting background. The drift velocity in DRIFT-IIb was [57 +/- 1 (stat) +/- 3 (sys)] m/s determined by the analysis of alpha particle tracks from a Po-210 source. 3D range reconstruction and energy spectra were used to identify alpha particles from the decay of Rn-222, Po-218, Rn-220 and Po-216. This study found that (22 +/- 2)% of Po-218 progeny (from Rn-222 decay) are produced with no net charge in 40 Torr CS2. For Po-216 progeny (from Rn-220 decay) the uncharged fraction is (100 +0 -35)%.Comment: 27 pages, 12 figures, 5 tables. Submitted to Nuclear Instruments and Methods in Physics Research, Section A. Subj-class: Instrumentation and Detector

Barrier effects on the collective excitations of split Bose-Einstein condensates

We investigate the collective excitations of a single-species Bose gas at T=0 in a harmonic trap where the confinement undergoes some splitting along one spatial direction. We mostly consider onedimensional potentials consisting of two harmonic wells separated a distance 2 z_0, since they essentially contain all the barrier effects that one may visualize in the 3D situation. We find, within a hydrodynamic approximation, that regardless the dimensionality of the system, pairs of levels in the excitation spectrum, corresponding to neighbouring even and odd excitations, merge together as one increases the barrier height up to the current value of the chemical potential. The excitation spectra computed in the hydrodynamical or Thomas-Fermi limit are compared with the results of exactly solving the time-dependent Gross-Pitaevskii equation. We analyze as well the characteristics of the spatial pattern of excitations of threedimensional boson systems according to the amount of splitting of the condensate.Comment: RevTeX, 12 pages, 13 ps figure

Cigarette constituent health communications for smokers: Impact of chemical, imagery, and source

Introduction: Communication campaigns are incorporating tobacco constituent messaging to reach smokers, yet there is a dearth of research on how such messages should be constructed or will be received by smokers. Methods: In a 2 × 2 × 2 experiment, we manipulated three cigarette constituent message components: (1) the toxic constituent of tobacco (arsenic vs. lead) with a corresponding health effect, (2) the presence or absence of an evocative image, and (3) the source of the message (FDA vs. no source). We recruited smokers (N = 1669, 55.4% women) via an online platform and randomized them to one of the eight message conditions. Participants viewed the message and rated its believability and perceived effectiveness, the credibility of the message source, and action expectancies (ie, likelihood of seeking additional information and help with quitting as a result of seeing the message). Results: We found significant main effects of image, constituent, and source on outcomes. The use of arsenic as the constituent, the presence of an evocative image, and the FDA as the source increased the believability, source credibility, and perceived effectiveness of the tobacco constituent health message. Conclusions: Multiple elements of a constituent message, including type of constituent, imagery, and message source, impact their reception among smokers. Specifically, communication campaigns targeting smokers that utilize arsenic as the tobacco constituent, visual imagery, and the FDA logo may be particularly effective in changing key outcomes that are associated with subsequent attitude and behavioral changes. Implications: This article describes how components of communication campaigns about cigarette constituents are perceived. Multiple elements of a tobacco constituent message, including type of constituent, image, and message source may influence the reception of messages among current smokers. Communication campaigns targeting smokers that utilize arsenic as the tobacco constituent, visual imagery, and the FDA logo may be particularly effective in changing key outcomes among smokers. The effects of such campaigns should be examined, as well as the mechanisms through which such campaigns affect change