Comparison of outcome measures for patients with chronic obstructive pulmonary disease (COPD) in an outpatient setting

BACKGROUND: To assist clinicians and researchers in choosing outcome measures for patients with chronic obstructive pulmonary disease attending routine outpatient clinics, a comparative assessment was undertaken of four questionnaires designed to reflect the patients' perception of their physical and emotional health in terms of their feasibility, validity, reliability, and responsiveness to health change. METHODS: Two condition specific questionnaires, the St George's Respiratory Questionnaire (SGRQ) and Guyatt's Chronic Respiratory Questionnaire (CRQ), and two generic questionnaires, the Short Form-36 Health Survey (SF-36) and Euroqol (EQ), were compared for their discriminative and evaluative properties. Spirometric tests and a walking test were also performed. One hundred and fifty six adults who were clinically judged to have COPD and who attended an outpatient chest clinic were assessed at recruitment and six and 12 months later. Patients were also asked whether their health had changed since their last assessment. RESULTS: Completion rates and consistency between items for dimensions of the SGRQ were lower than for dimensions of the other questionnaires. The distributions of responses were skewed for certain dimensions in all questionnaires except the CRQ. Validity was supported for all instruments insofar as patients' scores were associated with differences in disease severity. The generic questionnaires better reflected other health problems. All instruments were reliable over time. The condition specific questionnaires were more responsive between baseline and first follow up visit but this difference did not persist. While certain dimensions of the SF-36 were responsive to patient perceived changes, this did not apply to the derived single index of the EQ. The rating scale of the EQ, however, provided a quick and easy indicator of change. CONCLUSIONS: Evidence from this study supports the CRQ and the SF-36 as comprehensive outcome measures for patients with longstanding COPD

Five year report on the medical follow up of Marshallese receiving special medical care related to 1954 Bravo fallout radiation (January 1992--1996)

This is the 17th and final report of the Marshall Islands Medical Program as carried out by the Brookhaven National Laboratory (BNL). The purpose of these publications has been to provide information on the medical status of 253 Marshallese exposed to radiation fallout in 1954. The medical program fulfills a commitment to disclose unique medical information relevant to public health. Details of the Bravo thermonuclear accident that caused the exposure have been published. A 1955 article in the Journal of the American Medical Association, which described the acute medical effects on the population that required special medical care, remains a definitive and relevant description of events. Marshallese participation in this Congressionally mandated program is voluntary. Throughout the 44 years of the program, each participating individual`s relevant medical findings, laboratory data, disease morbidity, and mortality have been published in the BNL reports in a manner preserving patient confidentiality. In each report, there has been an attempt to interpret these findings and to infer the role of radiation exposure in their development. An equally important aspect of the reports has been the presentation of data that allows for analyses of the medical consequences of the Marshallese exposure

Improving the measurement of QALYs in dementia: Developing patient- and carer-reported health state classification systems using Rasch analysis

Objectives: Cost-utility analysis is increasingly used to inform resource allocation. This requires a means of valuing health states before and after intervention. Although generic measures are typically used to generate values, these do not perform well with people with dementia. We report the development of a health state classification system amenable to valuation for use in studies of dementia, derived from the DEMQOL system, a measure of health-related quality of life in dementia by patient self-report (DEMQOL) and carer proxy-report (DEMQOL-Proxy). Methods: Factor analysis was used to determine the dimensional structure of DEMQOL and DEMQOL-Proxy. Rasch analysis was subsequently used to investigate item performance across factors in terms of item-level ordering, functioning across subgroups, model fit and severity-range coverage. This enabled the selection of one item from each factor for the classification system. A sample of people with a diagnosis of mild/moderate dementia (n=644) and a sample of carers of those with mild/moderate dementia (n=683) were used. Results: Factor analysis found different 5-factor solutions for DEMQOL and DEMQOL-Proxy. Following item reduction and selection using Rasch analysis, a 5-dimension classification for DEMQOL and a 4-dimension classification for DEMQOL-Proxy were developed. Each item contained 4 health state levels. Conclusion: Combining Rasch and classical psychometric analysis is a valid method of selecting items for dementia health state classifications from both the patient and carer perspectives. The next stage is to obtain preference weights so that the measure can be used in the economic evaluation of treatment, care and support arrangements for dementia

Measurements of Scintillation Efficiency and Pulse-Shape for Low Energy Recoils in Liquid Xenon

Results of observations of low energy nuclear and electron recoil events in liquid xenon scintillator detectors are given. The relative scintillation efficiency for nuclear recoils is 0.22 +/- 0.01 in the recoil energy range 40 keV - 70 keV. Under the assumption of a single dominant decay component to the scintillation pulse-shape the log-normal mean parameter T0 of the maximum likelihood estimator of the decay time constant for 6 keV < Eee < 30 keV nuclear recoil events is equal to 21.0 ns +/- 0.5 ns. It is observed that for electron recoils T0 rises slowly with energy, having a value ~ 30 ns at Eee ~ 15 keV. Electron and nuclear recoil pulse-shapes are found to be well fitted by single exponential functions although some evidence is found for a double exponential form for the nuclear recoil pulse-shape.Comment: 11 pages, including 5 encapsulated postscript figure

Neutron background in large-scale xenon detectors for dark matter searches

Simulations of the neutron background for future large-scale particle dark matter detectors are presented. Neutrons were generated in rock and detector elements via spontaneous fission and (alpha,n) reactions, and by cosmic-ray muons. The simulation techniques and results are discussed in the context of the expected sensitivity of a generic liquid xenon dark matter detector. Methods of neutron background suppression are investigated. A sensitivity of $10^{-9}-10^{-10}$ pb to WIMP-nucleon interactions can be achieved by a tonne-scale detector.Comment: 35 pages, 13 figures, 2 tables, accepted for publication in Astroparticle Physic

The large longitudinal spread of solar energetic particles during the January 17, 2010 solar event

We investigate multi-spacecraft observations of the January 17, 2010 solar energetic particle event. Energetic electrons and protons have been observed over a remarkable large longitudinal range at the two STEREO spacecraft and SOHO suggesting a longitudinal spread of nearly 360 degrees at 1AU. The flaring active region, which was on the backside of the Sun as seen from Earth, was separated by more than 100 degrees in longitude from the magnetic footpoints of each of the three spacecraft. The event is characterized by strongly delayed energetic particle onsets with respect to the flare and only small or no anisotropies in the intensity measurements at all three locations. The presence of a coronal shock is evidenced by the observation of a type II radio burst from the Earth and STEREO B. In order to describe the observations in terms of particle transport in the interplanetary medium, including perpendicular diffusion, a 1D model describing the propagation along a magnetic field line (model 1) (Dr\"oge, 2003) and the 3D propagation model (model 2) by (Dr\"oge et al., 2010) including perpendicular diffusion in the interplanetary medium have been applied, respectively. While both models are capable of reproducing the observations, model 1 requires injection functions at the Sun of several hours. Model 2, which includes lateral transport in the solar wind, reveals high values for the ratio of perpendicular to parallel diffusion. Because we do not find evidence for unusual long injection functions at the Sun we favor a scenario with strong perpendicular transport in the interplanetary medium as explanation for the observations.Comment: The final publication is available at http://www.springerlink.co

Non-neoclassical up/down asymmetry of impurity emission on Alcator C-Mod

We demonstrate that existing theories are insufficient to explain up/down asymmetries of argon x-ray emission in Alcator C-Mod ohmic plasmas. Instead of the poloidal variation, ñ[subscript z]/〈n[subscript z]〉, being of order the inverse aspect ratio, ϵ, and scaling linearly with B[subscript t][superscript _ over n][subscript e]/I[2 over p], it is observed over 0.8 < r/a < 1.0 to be of order unity and exhibits a threshold behaviour between 3.5 <B[subscript t][superscript _ over n][subscript e]/I[subscript p] < 4.0 (T10[superscript 20] m[superscript −3] MA[superscript −1]). The transition from a poloidally symmetric to asymmetric impurity distribution is shown to occur at densities just below those that trigger a reversal of the core toroidal rotation direction, thought to be linked to the transition between the linear and saturated ohmic confinement regimes. A possible drive is discussed by which anomalous radial transport might sustain the impurity density asymmetry as the ratio of the perpendicular to parallel equilibration times, τ[subscript ⊥,z]/τ[subscript ∥,z], approaches unity. This explanation requires a strong up/down asymmetry in radial flux which, while not observable on C-Mod, has been measured in TEXT and Tore Supra ohmic plasmas.United States. Dept. of Energy (Contract DE-FC02-99ER54512)United States. Dept. of Energy (Fusion Research Postdoctoral Research Program

Non-local heat transport, rotation reversals and up/down impurity density asymmetries in Alcator C-Mod ohmic L-mode plasmas

Several seemingly unrelated effects in Alcator C-Mod ohmic L-mode plasmas are shown to be closely connected: non-local heat transport, core toroidal rotation reversals, energy confinement saturation and up/down impurity density asymmetries. These phenomena all abruptly transform at a critical value of the collisionality. At low densities in the linear ohmic confinement regime, with collisionality ν[subscript *] ≤ 0.35 (evaluated inside of the q = 3/2 surface), heat transport exhibits non-local behaviour, core toroidal rotation is directed co-current, edge impurity density profiles are up/down symmetric and a turbulent feature in core density fluctuations with k[subscript θ] up to 15 cm[superscript −1] (k[subscript θ]ρ[subscript s] ~ 1) is present. At high density/collisionality with saturated ohmic confinement, electron thermal transport is diffusive, core rotation is in the counter-current direction, edge impurity density profiles are up/down asymmetric and the high k[subscript θ] turbulent feature is absent. The rotation reversal stagnation point (just inside of the q = 3/2 surface) coincides with the non-local electron temperature profile inversion radius. All of these observations suggest a possible unification in a model with trapped electron mode prevalence at low collisionality and ion temperature gradient mode domination at high collisionality.United States. Dept. of Energy (Contract DE-FC02-99ER54512)United States. Dept. of Energy. Office of Fusion Energy Sciences (Postdoctoral Research Program