Clinical and financial consequences of setting up an asthma clinic at St. Luke’s Hospital

The effects of setting up an asthma clinic were assessed in an audit study. A comparison was made between the quality and quantity of medication used by patients before and after attending the asthma clinic. The number and severity of exacerbations during a six month period before and a six month period after attending were also assessed. The cost of treatment before and after was also calculated. In 14% of patients, occupational factors, drugs or underlying lung disease were significant contributors to asthma. The number of acute episodes of severe asthma were reduced from 98 to 47, with hospital admissions falling from 26 to 1. Pulmonary function (%FEV1) improved in the group as a whole with the number of patients having their best FEV above 80% improving from 44 to 71. In spite of the expense of high cost drugs and the running costs of the clinic there were substantial savings largely from the reduced number of hospital admissions. The calculated annual cost fell from Lm 22,769 to Lm 10,654.peer-reviewe

The Cambridge Project: reflections on a university-based AS social group

University can be a challenging social environment for students on the autism spectrum. The Cambridge Asperger Syndrome Project was set up in 2009 to draw on insider perspectives to provide guidance on supporting individuals on the autism spectrum at university. This paper focuses on a social group set up over the course of the project. It provides background on why this group might be needed, and reflects on the outcomes of the group. The authors found that taking part in this group served as a social confidence booster and a safe space for some students on the autism spectrum at Cambridge. Students particularly valued the opportunity to spend time with peers. The authors of this paper are particularly interested in collaborating with other colleagues to develop this work further

Cognitive facilitation following intentional odor exposure

This paper reviews evidence that, in addition to incidental olfactory pollutants, intentional odor delivery can impact cognitive operations both positively and negatively. Evidence for cognitive facilitation/interference is reviewed alongside four potential explanations for odor-induced effects. It is concluded that the pharmacological properties of odors can induce changes in cognition. However, these effects can be accentuated/attenuated by the shift in mood following odor exposure, expectancy of cognitive effects, and cues to behavior via the contextual association with the odor. It is proposed that greater consideration is required in the intentional utilization of odors within both industrial and private locations, since differential effects are observed for odors with positive hedonic qualities

Generalized thermodynamics of q-deformed bosons and fermions

We study the thermostatistics of q-deformed bosons and fermions obeying the symmetric algebra and show that it can be built on the formalism of q-calculus. The entire structure of thermodynamics is preserved if ordinary derivatives are replaced by an appropriate Jackson derivative. In this framework, we derive the most important thermodynamic functions describing the q-boson and q-fermion ideal gases in the thermodynamic limit. We also investigate the semi-classical limit and the low temperature regime and demonstrate that the nature of the q-deformation gives rise to pure quantum statistical effects stronger than undeformed boson and fermion particles.Comment: 8 pages, Physical Review E in pres

Second-line chemotherapy with temozolomide in recurrent oligodendroglioma after PCV (procarbazine, lomustine and vincristine) chemotherapy: EORTC Brain Tumor Group phase II study 26972

BACKGROUND: Oligodendroglial tumors are chemosensitive, with two-thirds of patients responding to PCV combination chemotherapy with procarbazine, lomustine (CCNU) and vincristine. Temozolomide (TMZ), a new alkylating and methylating agent has shown high response rates in recurrent anaplastic astrocytoma. We investigated this drug in recurrent oligodendroglial tumors (OD) and mixed oligoastrocytomas (OA) after prior PCV chemotherapy and radiation therapy. PATIENTS AND METHODS: In a prospective non-randomized multicenter phase II trial patients were treated with TMZ 150 mg/m(2) on days 1-5 in cycles of 28 days for 12 cycles. Eligible patients had a recurrence after prior PCV chemotherapy, with measurable and enhancing disease as shown by magnetic resonance imaging. Pathology and all responses were centrally reviewed. RESULTS: Thirty-two eligible patients were included. In four patients the pathology review did not confirm the presence of an OD or OA. Twelve of 24 patients [50%, 95% confidence interval (CI) 29% to 71%] evaluable for response to first-line PCV chemotherapy had responded to PCV. Temozolomide was in general well tolerated; the most frequent side-effects were hematological. One patient discontinued treatment due to toxicity. In seven of 28 patients (25%, 95% CI 11% to 45%) with histologically confirmed OD an objective response to TMZ was observed. Median time to progression for responding patients was 8.0 months. After 6 and 12 months from the start of treatment, 29% and 11% of patients, respectively, were still free from progression. CONCLUSIONS: TMZ may be regarded as the preferred second-line treatment in OD after failure of PCV chemotherapy. Further studies on TMZ in OD are indicated

Direct evidence of AGN feedback: a post-starburst galaxy stripped of its gas by AGN-driven winds

Post-starburst E+A galaxies show indications of a powerful starburst that was quenched abruptly. Their disturbed, bulge-dominated morphologies suggest that they are merger remnants. The more massive E+A galaxies are suggested to be quenched by active galactic nucleus (AGN) feedback, yet little is known about AGN-driven winds in this short-lived phase. We present spatially resolved integral field unit spectroscopy by the Keck Cosmic Web Imager of SDSS J003443.68 + 251020.9, at z = 0.118. The system consists of two galaxies, the larger of which is a post-starburst E+A galaxy hosting an AGN. Our modelling suggests a 400 Myr starburst, with a peak star formation rate of 120 M⊙ yr^(−1). The observations reveal stationary and outflowing gas, photoionized by the central AGN. We detect gas outflows to a distance of 17 kpc from the central galaxy, far beyond the region of the stars (∼3 kpc), inside a conic structure with an opening angle of 70 deg. We construct self-consistent photoionization and dynamical models for the different gas components and show that the gas outside the galaxy forms a continuous flow, with a mass outflow rate of about 24 M⊙ yr^(−1). The gas mass in the flow, roughly 10^9M⊙⁠, is larger than the total gas mass within the galaxy, some of which is outflowing too. The continuity of the flow puts a lower limit of 60 Myr on the duration of the AGN feedback. Such AGNs are capable of removing, in a single episode, most of the gas from their host galaxies and expelling enriched material into the surrounding circumgalactic medium

Prognostic utility of routine chimerism testing at 2 to 6 months after allogeneic hematopoietic cell transplantation.

The utility of routine chimerism analysis as a prognostic indicator of subsequent outcomes after allogeneic hematopoietic cell transplantation (HCT) with myeloablative conditioning regimens remains controversial. To address this controversy, routine chimerism test results at 2 to 6 months after HCT with myeloablative conditioning regimens were evaluated for association with subsequent risk of chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, and overall mortality. Only 70 of 1304 patients (5%) had < 95% donor-derived cells in the marrow. Low donor chimerism in the marrow occurred more often in patients with low-risk diseases compared with those with higher-risk diseases and was significantly associated with a reduced risk of chronic GVHD. Among 673 patients evaluated, 164 (24%) had < 85% donor-derived T cells in the blood. Low donor T cell chimerism was more frequent in patients with low-risk diseases compared with those with higher-risk diseases, in those who received conditioning with busulfan compared with those who received conditioning with total body irradiation, and in those with lower-grade acute GVHD. Low donor T cell chimerism in the blood was significantly associated with a reduced risk of chronic GVHD but not with a reduced risk of relapse, NRM, or overall mortality. Routine testing of chimerism in the marrow and blood at 2 to 6 months after HCT with myeloablative conditioning regimens may be helpful in documenting engraftment in clinical trials, but provides only limited prognostic information in clinical practice

Methodological criteria for the assessment of moderators in systematic reviews of randomised controlled trials : a consensus study

Background: Current methodological guidelines provide advice about the assessment of sub-group analysis within RCTs, but do not specify explicit criteria for assessment. Our objective was to provide researchers with a set of criteria that will facilitate the grading of evidence for moderators, in systematic reviews. Method: We developed a set of criteria from methodological manuscripts (n = 18) using snowballing technique, and electronic database searches. Criteria were reviewed by an international Delphi panel (n = 21), comprising authors who have published methodological papers in this area, and researchers who have been active in the study of sub-group analysis in RCTs. We used the Research ANd Development/University of California Los Angeles appropriateness method to assess consensus on the quantitative data. Free responses were coded for consensus and disagreement. In a subsequent round additional criteria were extracted from the Cochrane Reviewers’ Handbook, and the process was repeated. Results: The recommendations are that meta-analysts report both confirmatory and exploratory findings for subgroups analysis. Confirmatory findings must only come from studies in which a specific theory/evidence based apriori statement is made. Exploratory findings may be used to inform future/subsequent trials. However, for inclusion in the meta-analysis of moderators, the following additional criteria should be applied to each study: Baseline factors should be measured prior to randomisation, measurement of baseline factors should be of adequate reliability and validity, and a specific test of the interaction between baseline factors and interventions must be presented. Conclusions: There is consensus from a group of 21 international experts that methodological criteria to assess moderators within systematic reviews of RCTs is both timely and necessary. The consensus from the experts resulted in five criteria divided into two groups when synthesising evidence: confirmatory findings to support hypotheses about moderators and exploratory findings to inform future research. These recommendations are discussed in reference to previous recommendations for evaluating and reporting moderator studies

Monolithically Integrated Electrically Pumped Continuous-Wave III-V Quantum Dot Light Sources on Silicon

In this paper, we report monolithically integrated IIIV quantum dot (QD) light-emitting sources on silicon substrates for silicon photonics. We describe the first practical InAs/GaAs QD lasers monolithically grown on an offcut silicon (001) substrate due to the realization of high quality III-V epilayers on silicon with low defect density, indicating that the large material dissimilarity between III-Vs and silicon is no longer a fundamental barrier limiting monolithic growth of III-V lasers on Si substrates. Although the use of offcut silicon substrates overcomes the antiphase boundary (APB) problem, it has the disadvantage of not being readily compatible with standard microelectronics fabrication, where wafers with on-axis silicon (001) substrates are used. We therefore report, to the best of our knowledge, the first electrically pumped continuous-wave (c.w.) InAs/GaAs QD lasers fabricated on on-axis GaAs/Si (001) substrates without any intermediate buffer layers. Based on the achievements described above, we move on to report the first study of post-fabrication and prototyping of various Si-based light emitting sources by utilizing the focused ion beam (FIB) technique, with the intention of expediting the progress toward large-scale and low-cost photonic integrated circuits monolithically integrated on a silicon platform. We compare two Si-based QD lasers with as-cleaved and FIB-made facets, and prove that FIB is a powerful tool to fabricate integrated lasers on silicon substrates. Using angled facet structures, which effectively reduce facet reflectivity, we demonstrate Si-based InAs/GaAs QD superluminescent light emitting diodes (SLDs) operating under c.w. conditions at room temperature for the first time. The work described represents significant advances towards the realization of a comprehensive silicon photonics technology