Evaluating Patient Preferences of Maintenance Therapy for the Treatment of Chronic Obstructive Pulmonary Disease: A Discrete Choice Experiment in the UK, USA and Germany.

Introduction: With increasing availability of different treatments for chronic obstructive pulmonary disease (COPD), we sought to understand patient preferences for COPD treatment in the UK, USA, and Germany using a discrete choice experiment (DCE). Methods: Qualitative research identified six attributes associated with COPD maintenance treatments: ease of inhaler use, exacerbation frequency, frequency of inhaler use, number of different inhalers used, side effect frequency, and out-of-pocket costs. A DCE using these attributes, with three levels each, was designed and tested through cognitive interviews and piloting. It comprised 18 choice sets, selected using a D-efficient experimental design. Demographics and disease history were collected and the final DCE survey was completed online by participants recruited from panels in the UK, USA and Germany. Responses were analyzed using mixed logit models, with results expressed as odds ratios (ORs). Results: Overall, 450 participants (150 per country) completed the DCE; most (UK and Germany, 97.3%; USA, 98.0%) were included in the final analysis. Based on relative attribute importance, avoidance of side effects was found to be most important (UK: OR 11.65; USA: OR 7.17; Germany: OR 11.45; all p<0.0001), followed by the likelihood of fewer exacerbations (UK: OR 2.22; USA: OR 1.63; Germany: OR 2.54; all p<0.0001) and increased ease of use (UK: OR 1.84; USA: OR 1.84; Germany: OR 1.60; all p<0.0001). Number of inhalers, out-of-pocket costs, and frequency of inhaler use were found to be less important. Preferences were relatively consistent across the three countries. All participants required a reduction in exacerbations to accept more frequent inhaler use or use of more inhalers. Conclusion: When selecting COPD treatment, individuals assigned the highest value to the avoidance of side effects, experiencing fewer exacerbations, and ease of inhaler use. Ensuring that patients' preferences are considered may encourage treatment compliance

Smart Cities at Play: Lived Experiences, Emerging Forms of Playfulness, and Problems of Participation

In recent years, the notion of smart cities has become the focus of a growing body of research. To date, much of this attention has revolved around the technical aspect, with related concerns including the creation and implementation of suitable smart city technologies. What is notably missing from these discussions, however, is a consideration of the lived experience of supposedly \u27smart spaces\u27 and the extent to which physical and digital environments are currently producing new forms of play and playfulness that can be contextualized within this field. With this in mind, the purpose of our workshop is as follows. First, to provide a platform for researchers and practitioners to engage with these issues that often remain hidden when discussions solely focus on technology. Second, to develop a draft research agenda for challenges that will serve as a primer for future studies examining the topic

Student Learning Outcomes of an Interdisciplinary Fashion Event

The purposes of a cross-college fashion show held at a Mid-Atlantic university were to: a) provide a platform for developing or emergent professionals to display their career talents, b) provide an opportunity for students to work collaboratively across multiple creative disciplines, c) give students a holistic academic experience, and d) support undergraduate scholarships. Such an interdisciplinary event for students from various majors across a university may stimulate the growth of knowledge and motivate real-life applications

Women's experiences of factors affecting treatment engagement and adherence in internet delivered behavioural activation for postnatal depression

ArticleCrown Copyright © 2014 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).Introduction Women with postnatal depression (PND) face significant barriers to treatment that may be overcome by internet based delivery of treatment. Demand for a self-help internet postnatal treatment offered via a parenting site was high, but attrition rates were also high. Aims To gain patient perspectives on engagement and barriers to the Netmums' “Helping with Depression” treatment. Method Semi-structured interviews were conducted with 17 participants selected from the Netmums trial. Results Thematic analysis revealed motivators and barriers to treatment. Women reported that the flexibility and anonymity of internet interventions fit with their postnatal circumstances. They identified that the relevance of the intervention to their personal circumstances, expectations of motherhood, stigma about depression and motherhood, hopelessness about their ability to improve, previous negative experiences with treatment and treatment seeking, and a lack of practical and emotional support contributed to feelings of being overwhelmed. Women who felt more overwhelmed were more likely to discontinue treatment. Women suggested that support would reduce the impact of barriers and improve adherence. Discussion Open access, self-help internet interventions are acceptable to women with postnatal depression, but it is critical to provide tailoring and support to help overcome barriers and improve treatment adherence

Teachers’ pedagogical decision-making and influences on this when teaching students with severe intellectual disabilities

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.This article focuses on teachers’ pedagogical decision-making and influences on this decision-making when teaching students with severe intellectual disabilities. The research reported and discussed forms part of an international collaborative research project in the south west of England and Florida, US. The study is set within the broader socio-political context of inclusion, contributing a pedagogical dimension to other aspects of inclusion, such as placement, curriculum and accountability. Houssaye’s (2000) pedagogical interaction model is examined and adapted to situate and analyse teachers’ pedagogical decision-making, and influences on this, when teaching students with severe intellectual disabilities. The study shows a prominence and privileging of pedagogical decisions and influences around teacher-student pedagogical interactions over curriculum-teacher or curriculum-student pedagogical interactions. The implications of this emphasis are considered in the historical context of teaching and learning models and approaches for this group of learners.This article emerges from a collaborative international project between the University of Exeter and the University of South Florida, which was partly funded by the Global Academic Partnership (GAP) each institution is part of

Mineralogical sources of groundwater fluoride in Archaen bedrock/regolith aquifers: Mass balances from southern India and north-central Sri Lanka

STUDY REGION: The Maheshwaram and Waipally catchments of Andhra Pradesh, India, and the Plonnaruwa catchment of north-central Sri Lanka. STUDY FOCUS: The distribution of F across eight crystalline phases and between the bedrock and the regolith at eleven sites in three catchments is documented. Mineral contributions to F release during weathering and regolith development are quantified. NEW HYDROLOGICAL INSIGHTS FOR THE REGION: An estimate of weathering duration for the in situ regolith in Andhra Pradesh, 250-380 Ka, is close to a previous estimate for southern India. Partial or total destruction of the primary F-bearing bedrock minerals and consistent depletion of F in the remnant minerals result in a much reduced total F content in the regolith. Leaching experiments and field relationships, however, indicate a greater potential for F mobilisation to groundwater from the regolith than the bedrock. Schemes for managed aquifer recharge should beware the risk of mobilising additional F to groundwater

Cometary ions detected by the Cassini spacecraft 6.5 au downstream of Comet 153P/Ikeya-Zhang

During March-April 2002, while between the orbits of Jupiter and Saturn, the Cassini spacecraft detected a significant enhancement in pickup proton flux. The most likely explanation for this enhancement was the addition of protons to the solar wind by the ionization of neutral hydrogen in the corona of comet 153P/Ikeya-Zhang. This comet passed relatively close to the Sun-Cassini line during that period, allowing pickup ions to be carried to Cassini by the solar wind. This pickup proton flux could have been further modulated by the passage of the interplanetary counterparts of coronal mass ejections past the comet and spacecraft. The radial distance of 6.5 Astronomical Units (au) traveled by the pickup protons, and the implied total tail length of 7.5 au make this cometary ion tail the longest yet measured

Linear Estimation of Location and Scale Parameters Using Partial Maxima

Consider an i.i.d. sample X^*_1,X^*_2,...,X^*_n from a location-scale family, and assume that the only available observations consist of the partial maxima (or minima)sequence, X^*_{1:1},X^*_{2:2},...,X^*_{n:n}, where X^*_{j:j}=max{X^*_1,...,X^*_j}. This kind of truncation appears in several circumstances, including best performances in athletics events. In the case of partial maxima, the form of the BLUEs (best linear unbiased estimators) is quite similar to the form of the well-known Lloyd's (1952, Least-squares estimation of location and scale parameters using order statistics, Biometrika, vol. 39, pp. 88-95) BLUEs, based on (the sufficient sample of) order statistics, but, in contrast to the classical case, their consistency is no longer obvious. The present paper is mainly concerned with the scale parameter, showing that the variance of the partial maxima BLUE is at most of order O(1/log n), for a wide class of distributions.Comment: This article is devoted to the memory of my six-years-old, little daughter, Dionyssia, who leaved us on August 25, 2010, at Cephalonia isl. (26 pages, to appear in Metrika

Insights into the genetics of the Zhonghua 11 Resistance to Meloidogyne graminicola and its molecular determinism in rice

This research and HN were funded by the Consultative Group for International Agricultural Research Program on rice-agrifood systems (CRP-RICE, 2017–2022), the French National Institute for Sustainable Development (IRD–France), and the International Join Laboratory (LMI-Rice 2) in Vietnam. Funding for some parts of this work was also provided through an SFC ODA GCRF award via the University of St Andrews, United Kingdom. The James Hutton Institute receives funding from the Rural and Environment Science and Analytical Services Division of the Scottish Government.Meloidogyne graminicola is a widely spread nematode pest of rice that reduces crop yield up to 20% on average in Asia, with devastating consequences for local and global rice production. Due to the ban on many chemical nematicides and the recent changes in water management practices in rice agriculture, an even greater impact of M. graminicola can be expected in the future, stressing the demand for the development of new sustainable nematode management solutions. Recently, a source of resistance to M. graminicola was identified in the Oryza sativa japonica rice variety Zhonghua 11 (Zh11). In the present study, we examine the genetics of the Zh11 resistance to M. graminicola and provide new insights into its cellular and molecular mechanisms. The segregation of the resistance in F2 hybrid populations indicated that two dominant genes may be contributing to the resistance. The incompatible interaction of M. graminicola in Zh11 was distinguished by a lack of swelling of the root tips normally observed in compatible interactions. At the cellular level, the incompatible interaction was characterised by a rapid accumulation of reactive oxygen species in the vicinity of the nematodes, accompanied by extensive necrosis of neighbouring cells. The expression profiles of several genes involved in plant immunity were analysed at the early stages of infection during compatible (susceptible plant) and incompatible (resistant plant) interactions. Notably, the expression of OsAtg4 and OsAtg7, significantly increased in roots of resistant plants in parallel with the cell death response, suggesting that autophagy is activated and may contribute to the resistance-mediated hypersensitive response. Similarly, transcriptional regulation of genes involved in hormonal pathways in Zh11 indicated that salicylate signalling may be important in the resistance response towards M. graminicola. Finally, the nature of the resistance to M. graminicola and the potential exploitation of the Zh11 resistance for breeding are discussed.Publisher PDFPeer reviewe