Update on the management of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is a highly prevalent, underdiagnosed, and undertreated chronic lung disease. Early and appropriate treatment may help modify the course of the disease with respect to exacerbation timing and frequency, quality of life, and mortality. Steady progress continues to be made in understanding the disease pathogenesis and treatment modalities, and there is some evidence that outcomes are improving

Tracking Pediatric Asthma:The Massachusetts Experience Using School Health Records

The Massachusetts Department of Public Health, in collaboration with the U.S. Centers for Disease Control and Prevention Environmental Public Health Tracking Program, initiated a 3-year statewide project for the routine surveillance of asthma in children using school health records as the primary data source. School district nurse leaders received electronic data reporting forms requesting the number of children with asthma by grade and gender for schools serving grades kindergarten (K) through 8. Verification efforts from an earlier community-level study comparing a select number of school health records with primary care provider records demonstrated a high level of agreement (i.e., > 95%). First-year surveillance targeted approximately one-half (n = 958 schools) of all Massachusetts’s K–8 schools. About 78% of targeted school districts participated, and 70% of the targeted schools submitted complete asthma data. School nurse–reported asthma prevalence was as high as 30.8% for schools, with a mean of 9.2%. School-based asthma surveillance has been demonstrated to be a reliable and cost-effective method of tracking disease through use of an existing and enhanced reporting structure

Novel Therapeutic Strategies in the Topical Treatment of Atopic Dermatitis

Topical agents that are currently available for the treatment of atopic dermatitis may represent a valid approach in the management of mild or mild–moderate cases, whereas they are often supplemented with systemic therapies for handling more complex or unresponsive cases. The most used compounds include topical corticosteroids and calcineurin inhibitors, although their use might be burdened by side effects, poor response, and low patient compliance. Consequently, new innovative drugs with higher efficacy and safety both in the short and long term need to be integrated into clinical practice. A deeper understanding of the complex pathogenesis of the disease has led to identifying new therapeutic targets and to the development of innovative therapeutics. This narrative review aims to collect data on selected promising topical drugs that are in an advanced stage of development

Investigational systemic drugs for moderate to severe plaque psoriasis: What’s new?

Introduction: The therapeutic armamentarium for the treatment of psoriasis, a chronic inflammatory skin disease, is now reasonably broad and structured, with several therapeutic agents that demonstrated a successful long-term control of this condition. However, there are still unfulfilled gaps resulting from the inherent limitations of existing therapies, which have paved the way for the identification of new therapeutic strategies or the improvement of the existing ones. Areas covered: The aim of this review is to thoroughly explore new therapeutic strategies and novel drugs that are currently in the pipeline for the treatment of psoriasis, focusing primarily on agents that are currently in phase I/II of clinical development. Some of which retrace already existing therapeutic approaches, such as the IL23/Th17 pathway inhibition, while others unveil new and yet unexplored ones. Expert opinion: Since the therapeutic landscape of psoriasis is wide, it is not yet clear whether novel agents will fill the remaining gaps in the context of a broader and more diversified set of oral and biologic therapies. Nevertheless, with the development of precision medicine approaches, the development of innovative targeted drugs will still have a therapeutic rationale in psoriasis

Inverse Classification for Comparison-based Interpretability in Machine Learning

In the context of post-hoc interpretability, this paper addresses the task of explaining the prediction of a classifier, considering the case where no information is available, neither on the classifier itself, nor on the processed data (neither the training nor the test data). It proposes an instance-based approach whose principle consists in determining the minimal changes needed to alter a prediction: given a data point whose classification must be explained, the proposed method consists in identifying a close neighbour classified differently, where the closeness definition integrates a sparsity constraint. This principle is implemented using observation generation in the Growing Spheres algorithm. Experimental results on two datasets illustrate the relevance of the proposed approach that can be used to gain knowledge about the classifier.Comment: preprin

AAAI: an Argument Against Artificial Intelligence

The ethical concerns regarding the successful development of an Artificial Intelligence have received a lot of attention lately. The idea is that even if we have good reason to believe that it is very unlikely, the mere possibility of an AI causing extreme human suffering is important enough to warrant serious consideration. Others look at this problem from the opposite perspective, namely that of the AI itself. Here the idea is that even if we have good reason to believe that it is very unlikely, the mere possibility of humanity causing extreme suffering to an AI is important enough to warrant serious consideration. This paper starts from the observation that both concerns rely on problematic philosophical assumptions. Rather than tackling these assumptions directly, it proceeds to present an argument that if one takes these assumptions seriously, then one has a moral obligation to advocate for a ban on the development of a conscious AI

Exacerbation Recovery Patterns in Newly Diagnosed or Maintenance Treatment-Naïve Patients with COPD: Secondary Analyses of TICARI 1 Trial Data

Background: Little is known about the recovery patterns from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in newly diagnosed or maintenance treatment-naïve patients with COPD. This study describes the course of AECOPD in these patients at the time of treatment for the symptoms of acute respiratory tract infection (RTI). Methods: This study was a secondary analysis of data from a 12-week, randomized clinical trial (TICARI 1) testing the efficacy and safety of once-daily tiotropium 18 µg maintenance therapy versus placebo in newly diagnosed or maintenance treatment-naïve COPD patients with acute RTI symptoms for ≤7 days. Patients received standard care for AECOPD and RTI. Due to under-recruitment, the trial ended early and hence was underpowered to detect treatment differences. Data were pooled and exacerbation recovery patterns examined by using the EXAcerbation of Chronic Pulmonary Disease Tool (EXACT), forced expiratory volume in 1 second, rescue medication use, COPD Assessment Test™, Functional Assessment of Chronic Illness Therapy-Short Form, and Work Productivity and Activity Impairment Questionnaire: Respiratory Symptoms. Results: Of 140 patients, 73.6% had a prior COPD diagnosis without maintenance therapy; 80.0% had moderate-to-severe airflow obstruction. In addition to study drug, 40.0% were prescribed pharmacologic therapy (corticosteroids [34.3%], antibiotics [16.4%], and short-acting β2-adrenergic agonists [5.0%]) within ±7 days of randomization. Over 12 weeks, 78.6% exhibited symptomatic recovery (EXACT score) in a median of 5.0 days. Across all patients, 49.3% recovered without relapse, 29.3% recovered and then relapsed, and 21.4% had persistent symptoms (recovery criteria unmet). Conclusion: A substantial portion of newly diagnosed or maintenance treatment-naïve patients with COPD experience relapse or persistent symptoms following a clinic visit for AECOPD with symptoms of RTI. Whether initiating maintenance therapy could improve outcomes and reduce exacerbation risk requires further study

Shallow BF2 implants in Xe-bombardment-preamorphized Si: the interaction between Xe and F

Si(100) samples, preamorphized to a depth of ~30 nm using 20 keV Xe ions to a nominal fluence of 2×1014 cm-2 were implanted with 1 and 3 keV BF2 ions to fluences of 7×1014 cm-2. Following annealing over a range of temperatures (from 600 to 1130 °C) and times the implant redistribution was investigated using medium-energy ion scattering (MEIS), secondary ion mass spectrometry (SIMS), and energy filtered transmission electron microscopy (EFTEM). MEIS studies showed that for all annealing conditions leading to solid phase epitaxial regrowth, approximately half of the Xe had accumulated at depths of 7 nm for the 1 keV and at 13 nm for the 3 keV BF2 implant. These depths correspond to the end of range of the B and F within the amorphous Si. SIMS showed that in the preamorphized samples, approximately 10% of the F migrates into the bulk and is trapped at the same depths in a ~1:1 ratio to Xe. These observations indicate an interaction between the Xe and F implants and a damage structure that becomes a trapping site. A small fraction of the implanted B is also trapped at this depth. EXTEM micrographs suggest the development of Xe agglomerates at the depths determined by MEIS. The effect is interpreted in terms of the formation of a volume defect structure within the amorphized Si, leading to F stabilized Xe agglomerates or XeF precipitates