Variability in the organisation and management of hospital care for COPD exacerbations in the UK

SummaryPrevious smaller UK audits have demonstrated wide variation in organisation, resources, and process of care for acute chronic obstructive pulmonary disease (COPD) admissions. Smallest units appeared to do less well.UK acute hospitals supplied information on (1) resources and organisation of care, (2) clinical data on process of care and outcomes for up to 40 consecutive COPD admissions. Comparisons were made against national recommendations.Eight thousand and thirteen admissions involved 7529 patients from 233 units (93% of UK acute Trusts). Twenty-six percent of units had at most one whole-time equivalent respiratory consultant while 12% had at least four. Thirty percent patients were admitted under a respiratory specialist and 48% discharged under their care whilst 28% had no specialist input at all. Variation in care provision was wide across all hospitals but patients in smaller hospitals had less access to specialist respiratory or admission wards, pulmonary rehabilitation programs, speciality triage or an early discharge scheme. Six percent of units did not have access to NIV and 18% to invasive ventilatory support.There remains wide variation in all aspects of acute hospital COPD care in the UK, with smaller hospitals offering fewest services. Those receiving specialist input are more likely to be offered interventions of proven effect. Management guidelines alone are insufficient to address inequalities of care and a clear statement of minimum national standards for resource provision and organisation of COPD care are required. This study provides a unique insight into the current state of care for patients admitted with COPD exacerbations in the UK

Six-Dimensional Yang Black Holes in Dilaton Gravity

We study the six-dimensional dilaton gravity Yang black holes of hep-th/0607193, which carry (1,-1) charge in SU(2)xSU(2) gauge group. We find what values of the asymptotic parameters (mass and scalar charge) lead to a regular horizon, and show that there are no regular solutions with an extremal horizon.Comment: 10 pages, 8 EPS graph

Factorized Q-Learning for Large-Scale Multi-Agent Systems

Deep Q-learning has achieved significant success in single-agent decision making tasks. However, it is challenging to extend Q-learning to large-scale multi-agent scenarios, due to the explosion of action space resulting from the complex dynamics between the environment and the agents. In this paper, we propose to make the computation of multi-agent Q-learning tractable by treating the Q-function (w.r.t. state and joint-action) as a high-order high-dimensional tensor and then approximate it with factorized pairwise interactions. Furthermore, we utilize a composite deep neural network architecture for computing the factorized Q-function, share the model parameters among all the agents within the same group, and estimate the agents' optimal joint actions through a coordinate descent type algorithm. All these simplifications greatly reduce the model complexity and accelerate the learning process. Extensive experiments on two different multi-agent problems demonstrate the performance gain of our proposed approach in comparison with strong baselines, particularly when there are a large number of agents.Comment: 7 pages, 5 figures, DAI 201

Dispersion Coefficients by a Field-Theoretic Renormalization of Fluid Mechanics

We consider subtle correlations in the scattering of fluid by randomly placed obstacles, which have been suggested to lead to a diverging dispersion coefficient at long times for high Peclet numbers, in contrast to finite mean-field predictions. We develop a new master equation description of the fluid mechanics that incorporates the physically relevant fluctuations, and we treat those fluctuations by a renormalization group procedure. We find a finite dispersion coefficient at low volume fraction of disorder and high Peclet numbers.Comment: 4 pages, 1 figure; to appear in Phys. Rev. Let

Vaccines and Immunotherapeutics for the Treatment of Malignant Disease

The employment of the immune system to treat malignant disease represents an active area of biomedical research. The specificity of the immune response and potential for establishing long-term tumor immunity compels researchers to continue investigations into immunotherapeutic approaches for cancer. A number of immunotherapeutic strategies have arisen for the treatment of malignant disease, including various vaccination schemes, cytokine therapy, adoptive cellular therapy, and monoclonal antibody therapy. This paper describes each of these strategies and discusses some of the associated successes and limitations. Emphasis is placed on the integration of techniques to promote optimal scenarios for eliminating cancer

Effects of a Large Mesospheric Temperature Enhancement on the Hydroxyl Rotational Temperature as Observedfrom the Ground

The rotational temperature obtained from the rotational population distribution in the bands of the hydroxyl airglow has been shown to be a suitable proxy for the temperature at a height of 87 km [She and Lowe, 1998]. In this paper we examine in detail simultaneous observations on November 2–3, 1997, at Fort Collins, Colorado (41°N, 105°W), with both a sodium temperature lidar and the Coupling, Energetics, and Dynamics of Atmospheric Regions (CEDAR) OH mesospheric temperature mapper during which significant differences between the hydroxyl and lidar temperatures occur. The large differences are associated with a major temperature enhancement in the region of the peak of the hydroxyl emission. We model the effect on the shape of the emission rate profile of the hydroxyl airglow caused by the large temperature enhancement observed on this night by the lidar. As a result of the temperature sensitivity of the processes that give rise to the airglow, the profile shows major distortions from its normal shape. These distortions in turn lead to hydroxyl rotational temperatures that differ significantly from the 87-km lidar observations. The mean rotational temperature deduced in this way agrees well with the observed values. Such deviations in the temperature are expected to be rare, occurring only when a large temperature enhancement occurs near the peak of the airglow emission profile

Perinatal Cat and Dog Exposure and the Risk of Asthma and Allergy in the Urban Environment: A Systematic Review of Longitudinal Studies

Background. The literature is contradictory concerning pet exposure and the risk of development of asthma and other allergic diseases. Using longitudinal studies, we aimed to systematically review the impact of pet ownership in the critical perinatal period as a risk factor for allergies in childhood. Methods. Medline database was searched for urban cohort studies with perinatal exposure to cats and/or dogs and subsequent asthma or allergic disease. Results. Nine articles, comprising 6498 participants, met inclusion criteria. Six found a reduction in allergic disease associated with perinatal exposure to dogs or, cats or dogs. One study found no association. Two found increased risk only in high-risk groups. Conclusion. Longitudinal studies in urban populations suggest that perinatal pets, especially dogs, may reduce the development of allergic disease in those without a family history of allergy. Other unmeasured factors such as pet-keeping choices in allergic families may be confounding the association seen in these high-risk families, and further study is required

Polymorphic Microsatellite Loci for Virola sebifera (Myristicaceae) Derived from Shotgun 454 Pyrosequencing

This work is licensed under a Creative Commons Attribution License (CC-BY-NC-SA) (http://creativecommons.org/licenses/by-nc-sa/4.0/)Premise of the study: Polymorphic microsatellite loci were characterized in the dioecious neotropical rainforest tree Virola sebifera. The markers will be used to study ecological and genetic impacts of hunting and landscape change in this vertebrate-dispersed, insect-pollinated tree species. Methods and Results: Simple sequence repeat (SSR) markers were screened from genomic libraries of South American V. sebifera obtained by shotgun 454 pyrosequencing. Primer pairs were tested on Panamanian samples (N = 42). Approximately 52% of the 61 tested SSR markers amplified, and 16% were polymorphic. Ten selected polymorphic SSR loci contained seven to 15 alleles per locus, and polymorphic information content averaged 0.694. Observed heterozygosity ranged from 0.465 to 0.905, and expected heterozygosity was between 0.477 and 0.876. Conclusions: The 10 polymorphic loci will be useful in studying gene flow and genetic structure at local and regional spatial scales in V. sebifera

ImageNet Large Scale Visual Recognition Challenge

The ImageNet Large Scale Visual Recognition Challenge is a benchmark in object category classification and detection on hundreds of object categories and millions of images. The challenge has been run annually from 2010 to present, attracting participation from more than fifty institutions. This paper describes the creation of this benchmark dataset and the advances in object recognition that have been possible as a result. We discuss the challenges of collecting large-scale ground truth annotation, highlight key breakthroughs in categorical object recognition, provide a detailed analysis of the current state of the field of large-scale image classification and object detection, and compare the state-of-the-art computer vision accuracy with human accuracy. We conclude with lessons learned in the five years of the challenge, and propose future directions and improvements.Comment: 43 pages, 16 figures. v3 includes additional comparisons with PASCAL VOC (per-category comparisons in Table 3, distribution of localization difficulty in Fig 16), a list of queries used for obtaining object detection images (Appendix C), and some additional reference