Phase II study of tight glycaemic control in COPD patients with exacerbations admitted to the acute medical unit.

BACKGROUND: Hyperglycaemia is associated with poor outcomes from exacerbations of chronic obstructive pulmonary disease (COPD). Glycaemic control could improve outcomes by reducing infection, inflammation and myopathy. Most patients with COPD are managed on the acute medical unit (AMU) outside intensive care (ICU). OBJECTIVE: To determine the feasibility, safety and efficacy of tight glycaemic control in patients on an AMU. DESIGN: Prospective, non-randomised, phase II, single-arm study of tight glycaemic control in COPD patients with acute exacerbations and hyperglycaemia admitted to the AMU. Participants received intravenous, then subcutaneous, insulin to control blood glucose to 4.4-6.5 mmol/l. Tight glycaemic control was evaluated: feasibility, protocol adherence; acceptability, patient questionnaire; safety, frequency of hypoglycaemia (capillary blood glucose (CBG) <2.2 mmol/l and 2.2-3.3 mmol/l); efficacy, median CBG, fasting CBG, proportion of measurements/time in target range, glycaemic variability. RESULTS: were compared with 25 published ICU studies. Results 20 patients (10 females, age 71 ± 9 years; forced expiratory volume in 1 s: 41 ± 16% predicted) were recruited. Tight glycaemic control was feasible (78% CBG measurements and 89% of insulin-dose adjustments were adherent to protocol) and acceptable to patients. 0.2% CBG measurements were <2.2 mmol/l and 4.1% measurements 2.2-3.3 mmol/l. The study CBG and proportion of measurements/time in target range were similar to that of ICU studies, whereas the fasting CBG was lower, and the glycaemic variability was greater. CONCLUSIONS: Tight glycaemic control is feasible and has similar safety and efficacy on AMU to ICU. However, as more recent ICU studies have shown no benefit and possible harm from tight glycaemic control, alternative strategies for blood glucose control in COPD exacerbations should now be explored. Trial registration number ISRCTN: 42412334. http://Clinical.Trials.gov NCT00764556

Partner support in a cohort of African American families and its influence on pregnancy outcomes and prenatal health behaviors

Abstract Background We examined how two indicators of partner involvement, relationship type and paternal support, influenced the risk of pregnancy outcomes (preterm birth, low birth weight) and health behaviors (prenatal care, drug use, and smoking) among African American women. Methods Interview and medical record data were obtained from a study of 713 adult African American women delivering singletons between March 2001 and July 2004. Women were enrolled prenatally if they received care at one of three Johns Hopkins Medical Institution (JHMI) prenatal clinics or post-partum if they delivered at JHMI with late, no or intermittent prenatal care. Relationship type was classified as married, unmarried/cohabitating, or unmarried/non-cohabitating. Partner support was assessed using an 8-item scale and was dichotomized at the median. Differences in partner support by pregnancy outcome and health behaviors were assessed using linear regression. To assess measures of partner support as predictors of adverse pregnancy outcomes and health behaviors, Poisson regression was used to generate crude and adjusted prevalence ratios (PR) and 95% confidence intervals (CI). Results There were no statistically significant differences in pregnancy outcomes or health behaviors by relationship type or when partner support was examined as a continuous or categorical variable. Modeled as a dichotomous variable, partner support was not associated with the risk of preterm birth (PR = 0.81, 95% CI = 0.56, 1.56), low birth weight (PR = 0.77, 96% CI = 0.48, 1.26), or health behaviors. Conclusions Paternal involvement was not associated with pregnancy outcomes or maternal health behaviors. Attention to measurement issues and other factors relevant for African American women are discussed

Simple computer model for the quantum Zeno effect

This paper presents a simple model for repeated measurement of a quantum system: the evolution of a free particle, simulated by discretising the particle's position. This model is easily simulated by computer and provides a useful arena to investigate the effects of measurement upon dynamics, in particular the slowing of evolution due to measurement (the `quantum Zeno effect'). The results of this simulation are discussed for two rather different sorts of measurement process, both of which are (simplified forms of) measurements used in previous simulations of position measurement. A number of interesting results due to measurement are found, and the investigation casts some light on previous disagreements about the presence or absence of the Zeno effect.Comment: REVTeX; 12 pages including 11 figures; figures reformatted to be more readable; some small changes made to the description of the mode

Quantum dynamics and statistics of two coupled down-conversion processes

In the framework of Heisenberg-Langevin theory the dynamical and statistical effects arising from the linear interaction of two nondegenerate down-conversion processes are investigated. Using the strong-pumping approximation the analytical solution of equations of motion is calculated. The phenomena reminiscent of Zeno and anti-Zeno effects are examined. The possibility of phase-controlled and mismatch-controlled switching is illustrated.Comment: 17 pages, 7 figure

Engine Technology Challenges for the High-Speed Civil Transport Plane

Ongoing NASA-funded and privately funded studies continue to indicate that an opportunity exists for a second generation supersonic commercial airliner, or High-Speed Civil Transport (HSCT), to become a key part of the 21 st century international air transportation system. Long distance air travel is projected to be the fastest growing segment of the air transportation market by the turn of the century with increases at about 5 percent per annum over the next two decades. This projection suggests that by the year 2015, more than 600,000 passengers per day will be traveling long distances, predominantly over water. These routes would provide the greatest potential for an HSCT to become a significant part of the international air transportation system. The potential market for an HSCT is currently projected to be anywhere from 500-1500 aircraft over the 2005-2030 time period. Such an aircraft fleet size would represent a considerable share of the potential long-range aircraft market. However, this projected HSCT fleet can become a reality only if technologies are developed which will allow an HSCT design that is (1) environmentally compatible and (2) economically viable. Simply stated, the HSCT will be a technology driven airplane. Without significant advances in airframe and propulsion technologies over the levels currently available, there will be no second generation supersonic airliner! This paper will briefly describe the propulsion technology challenges which must be met prior to any product launch decision being made by industry and the progress toward meeting these challenges through NASAs High-Speed Research (HSR) Program, a partnership between NASA and Boeing, General Electric and Pratt & Whitney

Recurrent De Novo NAHR Reciprocal Duplications in the ATAD3 Gene Cluster Cause a Neurogenetic Trait with Perturbed Cholesterol and Mitochondrial Metabolism.

Recent studies have identified both recessive and dominant forms of mitochondrial disease that result from ATAD3A variants. The recessive form includes subjects with biallelic deletions mediated by non-allelic homologous recombination. We report five unrelated neonates with a lethal metabolic disorder characterized by cardiomyopathy, corneal opacities, encephalopathy, hypotonia, and seizures in whom a monoallelic reciprocal duplication at the ATAD3 locus was identified. Analysis of the breakpoint junction fragment indicated that these 67 kb heterozygous duplications were likely mediated by non-allelic homologous recombination at regions of high sequence identity in ATAD3A exon 11 and ATAD3C exon 7. At the recombinant junction, the duplication allele produces a fusion gene derived from ATAD3A and ATAD3C, the protein product of which lacks key functional residues. Analysis of fibroblasts derived from two affected individuals shows that the fusion gene product is expressed and stable. These cells display perturbed cholesterol and mitochondrial DNA organization similar to that observed for individuals with severe ATAD3A deficiency. We hypothesize that the fusion protein acts through a dominant-negative mechanism to cause this fatal mitochondrial disorder. Our data delineate a molecular diagnosis for this disorder, extend the clinical spectrum associated with structural variation at the ATAD3 locus, and identify a third mutational mechanism for ATAD3 gene cluster variants. These results further affirm structural variant mutagenesis mechanisms in sporadic disease traits, emphasize the importance of copy number analysis in molecular genomic diagnosis, and highlight some of the challenges of detecting and interpreting clinically relevant rare gene rearrangements from next-generation sequencing data

Development of the Point-of-Care Key Evidence Tool (POCKET): a checklist for multi-dimensional evidence generation in point-of-care tests

Background This study aimed to develop the Point-of-Care Key Evidence Tool (POCKET); a multi-dimensional checklist to guide the evaluation of point-of-care tests (POCTs) incorporating validity, utility, usability, cost-effectiveness and patient experience. The motivation for this was to improve the efficiency of evidence generation in POCTs and reduce the lead-time for the adoption of novel POCTs. Methods A mixed qualitative and quantitative approach was applied. Following a literature search, a three round Delphi process was undertaken incorporating a semi-structured interview study and two questionnaire rounds. Participants included clinicians, laboratory personnel, commissioners, regulators (including members of National Institute for Health and Care Excellence [NICE] committees), patients, industry representatives and methodologists. Qualitative data were analysed based on grounded theory. The final tool was revised at an expert stakeholder workshop. Results Forty-three participants were interviewed within the semi-structured interview study, 32 participated in the questionnaire rounds and nine stakeholders attended the expert workshop. The final version of the POCKET checklist contains 65 different evidence requirements grouped into seven themes. Face validity, content validity and usability has been demonstrated. There exists a shortfall in the evidence that industry and research methodologists believe should be generated regarding POCTs and what is actually required by policy and decision makers to promote implementation into current healthcare pathways. Conclusions This study has led to the development of POCKET, a checklist for evidence generation and synthesis in POCTs. This aims to guide industry and researchers to the evidence that is required by decision makers to facilitate POCT adoption so that the benefits they can bring to patients can be effectively realised