Asthma in the elderly: underperceived, underdiagnosed and undertreated; a community survey

AbstractBronchial asthma is now increasingly recognized in the elderly and is associated with significant morbidity and mortality. The aims of this study were two-fold: first, to assess the prevalence and, second, to evaluate diagnostic awareness, therapeutic management and patient perception of bronchial asthma among elderly patients in the community.From the age-sex register of an urban general practice in NE England, 2004 patients aged >65 years were eligible for inclusion. Response to an initial screening questionnaire on respiratory symptomatology was 68% (n = 1362). Of these, 869 patients had respiratory symptoms: 390 voluntarily agreed to be evaluated further including assessment of airway physiology. In this group 369390 had obstructive spirometry and, of these, 95 patients fulfilled clinical and physiological criteria of bronchial asthma. Prevalence of asthma within this age cohort was minimally and rather crudely assigned at 4.5% (952004).Among the 95 patients so-defined patients with asthma [age 70 ± 8 years (mean ± sd), FEV1 = 0·96 ± 0.41, 33 male, 75 life-long non-smokers], subjective awareness, perception and attribution of pulmonary symptoms were poor. Further, despite tangible evidence of reversible and significant airflow limitation, only 21 were receiving inhaled glucocorticoid therapy (median daily dose 400 μg).Asthma in the elderly remains poorly perceived, poorly recognized and suboptimally treated. These findings are particularly apposite in the light of current epidemiological trends in asthma mortality and morbidity in elderly age cohorts

A gauge model for quantum mechanics on a stratified space

In the Hamiltonian approach on a single spatial plaquette, we construct a quantum (lattice) gauge theory which incorporates the classical singularities. The reduced phase space is a stratified K\"ahler space, and we make explicit the requisite singular holomorphic quantization procedure on this space. On the quantum level, this procedure furnishes a costratified Hilbert space, that is, a Hilbert space together with a system which consists of the subspaces associated with the strata of the reduced phase space and of the corresponding orthoprojectors. The costratified Hilbert space structure reflects the stratification of the reduced phase space. For the special case where the structure group is $\mathrm{SU}(2)$, we discuss the tunneling probabilities between the strata, determine the energy eigenstates and study the corresponding expectation values of the orthoprojectors onto the subspaces associated with the strata in the strong and weak coupling approximations.Comment: 38 pages, 9 figures. Changes: comments on the heat kernel and coherent states have been adde

One-Loop QCD Corrections to the Thermal Wilson Line Model

We calculate the time independent four-point function in high temperature (T) QCD and obtain the leading momentum dependent terms. Furthermore, we relate these derivative interactions to derivative terms in a recently proposed finite T effective action based on the SU(3) Wilson Line and its trace, the Polyakov Loop. By this procedure we thus obtain a perturbative matching at finite T between QCD and the effective model. In particular, we calculate the leading perturbative QCD-correction to the kinetic term for the Polyakov Loop.Comment: Minor changes, one reference adde

Pion-Muon Asymmetry Revisited

Long ago an unexpected and unexplainable phenomena was observed. The distribution of muons from positive pion decay at rest was anisotropic with an excess in the backward direction relative to the direction of the proton beam from which the pions were created. Although this effect was observed by several different groups with pions produced by different means, the result was not accepted by the physics community, because it is in direct conflict with a large set of other experiments indicating that the pion is a pseudoscalar particle. It is possible to satisfy both sets of experiments if helicity-zero vector particles exist and the pion is such a particle. Helicity-zero vector particles have direction but no net spin. For the neutral pion to be a vector particle requires an additional modification to conventional theory as discussed herein. An experiment is proposed which can prove that the asymmetry in the distribution of muons from pion decay is a genuine physical effect because the asymmetry can be modified in a controllable manner. A positive result will also prove that the pion is NOT a pseudoscalar particle.Comment: 9 pages, 3 figure

Generalized thermodynamics and Fokker-Planck equations. Applications to stellar dynamics, two-dimensional turbulence and Jupiter's great red spot

We introduce a new set of generalized Fokker-Planck equations that conserve energy and mass and increase a generalized entropy until a maximum entropy state is reached. The concept of generalized entropies is rigorously justified for continuous Hamiltonian systems undergoing violent relaxation. Tsallis entropies are just a special case of this generalized thermodynamics. Application of these results to stellar dynamics, vortex dynamics and Jupiter's great red spot are proposed. Our prime result is a novel relaxation equation that should offer an easily implementable parametrization of geophysical turbulence. This relaxation equation depends on a single key parameter related to the skewness of the fine-grained vorticity distribution. Usual parametrizations (including a single turbulent viscosity) correspond to the infinite temperature limit of our model. They forget a fundamental systematic drift that acts against diffusion as in Brownian theory. Our generalized Fokker-Planck equations may have applications in other fields of physics such as chemotaxis for bacterial populations. We propose the idea of a classification of generalized entropies in classes of equivalence and provide an aesthetic connexion between topics (vortices, stars, bacteries,...) which were previously disconnected.Comment: Submitted to Phys. Rev.

Symptom-based staging for logopenic variant primary progressive aphasia

Background and purpose Logopenic variant primary progressive aphasia (lvPPA) is a major variant presentation of Alzheimer's disease (AD) that signals the importance of communication dysfunction across AD phenotypes. A clinical staging system is lacking for the evolution of AD-associated communication difficulties that could guide diagnosis and care planning. Our aim was to create a symptom-based staging scheme for lvPPA, identifying functional milestones relevant to the broader AD spectrum. Methods An international lvPPA caregiver cohort was surveyed on symptom development under an ‘exploratory’ survey (34 UK caregivers). Feedback from this survey informed the development of a ‘consolidation’ survey (27 UK, 10 Australian caregivers) in which caregivers were presented with six provisional clinical stages and feedback was analysed using a mixed-methods approach. Results Six clinical stages were endorsed. Early symptoms included word-finding difficulty, with loss of message comprehension and speech intelligibility signalling later-stage progression. Additionally, problems with hearing in noise, memory and route-finding were prominent early non-verbal symptoms. ‘Milestone’ symptoms were identified that anticipate daily-life functional transitions and care needs. Conclusions This work introduces a new symptom-based staging scheme for lvPPA, and highlights milestone symptoms that could inform future clinical scales for anticipating and managing communication dysfunction across the AD spectrum

Coronary Atherosclerosis Phenotypes in Focal and Diffuse Disease.

The interplay between coronary hemodynamics and plaque characteristics remains poorly understood. The aim of this study was to compare atherosclerotic plaque phenotypes between focal and diffuse coronary artery disease (CAD) defined by coronary hemodynamics. This multicenter, prospective, single-arm study was conducted in 5 countries. Patients with functionally significant lesions based on an invasive fractional flow reserve ≤0.80 were included. Plaque analysis was performed by using coronary computed tomography angiography and optical coherence tomography. CAD patterns were assessed using motorized fractional flow reserve pullbacks and quantified by pullback pressure gradient (PPG). Focal and diffuse CAD was defined according to the median PPG value. A total of 117 patients (120 vessels) were included. The median PPG was 0.66 (IQR: 0.54-0.75). According to coronary computed tomography angiography analysis, plaque burden was higher in patients with focal CAD (87% ± 8% focal vs 82% ± 10% diffuse; P = 0.003). Calcifications were significantly more prevalent in patients with diffuse CAD (Agatston score per vessel: 51 [IQR: 11-204] focal vs 158 [IQR: 52-341] diffuse; P = 0.024). According to optical coherence tomography analysis, patients with focal CAD had a significantly higher prevalence of circumferential lipid-rich plaque (37% focal vs 4% diffuse; P = 0.001) and thin-cap fibroatheroma (TCFA) (47% focal vs 10% diffuse; P = 0.002). Focal disease defined by PPG predicted the presence of TCFA with an area under the curve of 0.73 (95% CI: 0.58-0.87). Atherosclerotic plaque phenotypes associate with intracoronary hemodynamics. Focal CAD had a higher plaque burden and was predominantly lipid-rich with a high prevalence of TCFA, whereas calcifications were more prevalent in diffuse CAD. (Precise Percutaneous Coronary Intervention Plan [P3]; NCT03782688)

Coarse-Grained Finite-Temperature Theory for the Condensate in Optical Lattices

In this work, we derive a coarse-grained finite-temperature theory for a Bose condensate in a one-dimensional optical lattice, in addition to a confining harmonic trap potential. We start from a two-particle irreducible (2PI) effective action on the Schwinger-Keldysh closed-time contour path. In principle, this action involves all information of equilibrium and non-equilibrium properties of the condensate and noncondensate atoms. By assuming an ansatz for the variational function, i.e., the condensate order parameter in an effective action, we derive a coarse-grained effective action, which describes the dynamics on the length scale much longer than a lattice constant. Using the variational principle, coarse-grained equations of motion for the condensate variables are obtained. These equations include a dissipative term due to collisions between condensate and noncondensate atoms, as well as noncondensate mean-field. To illustrate the usefulness of our formalism, we discuss a Landau instability of the condensate in optical lattices by using the coarse-grained generalized Gross-Pitaevskii hydrodynamics. We found that the collisional damping rate due to collisions between the condensate and noncondensate atoms changes sign when the condensate velocity exceeds a renormalized sound velocity, leading to a Landau instability consistent with the Landau criterion. Our results in this work give an insight into the microscopic origin of the Landau instability.Comment: 38 pages, 2 figures. Submitted to Journal of Low Temperature Physic

Symptom-led staging for semantic and non-fluent/agrammatic variants of primary progressive aphasia. Alzheimer's & Dementia

INTRODUCTION: Here we set out to create a symptom-led staging system for the canonical semantic and non-fluent/agrammatic variants of primary progressive aphasia (PPA), which present unique diagnostic and management challenges not well captured by functional scales developed for Alzheimer’s disease and other dementias. METHODS: An international PPA caregiver cohort was surveyed on symptom development under six provisional clinical stages and feedback was analyzed using a mixed-methods sequential explanatory design. RESULTS: Both PPA syndromes were characterized by initial communication dysfunction and non-verbal behavioral changes, with increasing syndromic convergence and functional dependency at later stages. Milestone symptoms were distilled to create a prototypical progression and severity scale of functional impairment: the PPA Progression Planning Aid (“PPA-Squared”). DISCUSSION: This work introduces a symptom-led staging scheme and functional scale for semantic and non-fluent/agrammatic variants of PPA. Our findings have implications for diagnostic and care pathway guidelines, trial design, and personalized prognosis and treatment for PPA