The whole story: treatment outcomes with Symbicort®

AbstractAsthma is a chronic inflammatory disorder of the airways that has a considerable socioeconomic impact. Asthma management guidelines have been introduced to help provide better long-term control of asthma. Although recommended guidelines may increase the direct medication costs, the overall direct costs of asthma may be reduced due to fewer exacerbations. In addition, indirect costs due to lost productivity and mortality are reduced and patients have an improved quality of life. Inhaled corticosteroids are first-line therapy in the treatment of persistent asthma. Against this background, we have assessed the cost-effectiveness of Symbicort® (budesonide and formoterol in a single inhaler), atreatmentthat provides better control of asthma compared with budesonide alone.While the prescribing costs of Symbicort® were found to be higher than for budesonide alone, these were partially offset by reduced costs due to fewer asthma exacerbations and a reduced need for other medications. Combined long-term therapy with budesonide and formoterol also improves patient quality of life compared with budesonide alone. Two other factors associated with asthma treatment success and cost-effectiveness are patient/physician education and good patient adherence to prescribed therapy. The introduction of a single inhaler that is easy to use in simple treatment regimens may improve patient adherence to prescribed medication, thus resulting in improved asthma control and fewer exacerbations.Treatment with Symbicort® is more cost-effective than treatment with budesonide alone

Sudbury project (University of Muenster-Ontario Geological Survey): Summary of results - an updated impact model

In 1984 the Ontario Geological Survey initiated a research project on the Sudbury structure (SS) in cooperation with the University of Muenster. The project included field mapping (1984-1989) and petrographic, chemical, and isotope analyses of the major stratigraphic units of the SS. Four diploma theses and four doctoral theses were performed during the project (1984-1992). Specific results of the various investigations are reported. Selected areas of the SS were mapped and sampled: Footwall rocks; Footwall breccia and parts of the sublayer and lower section of the Sudbury Igneous Complex (SIC); Onaping Formation and the upper section of the SIC; and Sudbury breccia and adjacent Footwall rocks along extended profiles up to 55 km from the SIC. All these stratigraphic units of the SS were studied in substantial detail by previous workers. The most important characteristic of the previous research is that it was based either on a volcanic model or on a mixed volcanic-impact model for the origin of the SS. The present project was clearly directed toward a test of the impact origin of the SS without invoking an endogenic component. In general, our results confirm the most widely accepted stratigraphic division of the SS. However, our interpretation of some of the major stratigraphic units is different from most views expressed. The stratigraphy of the SS and its new interpretation is given as a basis for discussion

A role for fast rhythmic bursting neurons in cortical gamma oscillations in vitro

Basic cellular and network mechanisms underlying gamma frequency oscillations (30–80 Hz) have been well characterized in the hippocampus and associated structures. In these regions, gamma rhythms are seen as an emergent property of networks of principal cells and fast-spiking interneurons. In contrast, in the neocortex a number of elegant studies have shown that specific types of principal neuron exist that are capable of generating powerful gamma frequency outputs on the basis of their intrinsic conductances alone. These fast rhythmic bursting (FRB) neurons (sometimes referred to as "chattering" cells) are activated by sensory stimuli and generate multiple action potentials per gamma period. Here, we demonstrate that FRB neurons may function by providing a large-scale input to an axon plexus consisting of gap-junctionally connected axons from both FRB neurons and their anatomically similar counterparts regular spiking neurons. The resulting network gamma oscillation shares all of the properties of gamma oscillations generated in the hippocampus but with the additional critical dependence on multiple spiking in FRB cells

GABA-enhanced collective behavior in neuronal axons underlies persistent gamma-frequency oscillations

Gamma (30–80 Hz) oscillations occur in mammalian electroencephalogram in a manner that indicates cognitive relevance. In vitro models of gamma oscillations demonstrate two forms of oscillation: one occurring transiently and driven by discrete afferent input and the second occurring persistently in response to activation of excitatory metabotropic receptors. The mechanism underlying persistent gamma oscillations has been suggested to involve gap-junctional communication between axons of principal neurons, but the precise relationship between this neuronal activity and the gamma oscillation has remained elusive. Here we demonstrate that gamma oscillations coexist with high-frequency oscillations (>90 Hz). High-frequency oscillations can be generated in the axonal plexus even when it is physically isolated from pyramidal cell bodies. They were enhanced in networks by nonsomatic -aminobutyric acid type A (GABAA) receptor activation, were modulated by perisomatic GABAA receptor-mediated synaptic input to principal cells, and provided the phasic input to interneurons required to generate persistent gamma-frequency oscillations. The data suggest that high-frequency oscillations occurred as a consequence of random activity within the axonal plexus. Interneurons provide a mechanism by which this random activity is both amplified and organized into a coherent network rhythm

Efficacy of once-daily tiotropium Respimat in adults with asthma at GINA Steps 2-5

Tiotropium Respimat is an efficacious add-on to maintenance treatment in patients with symptomatic asthma. Currently, the Global Initiative for Asthma (GINA) strategy recommends tiotropium for patients at Steps 4–5. To assess the clinical benefits of tiotropium Respimat across asthma severities, GINA Steps 2–5, a post hoc analysis of five double-blind trials (12–48-weeks; patients aged 18–75 years) investigated the effect of tiotropium Respimat, 5 μg or 2.5 μg, versus placebo, on peak forced expiratory volume in 1 s (FEV1) within 3 h post-dose (FEV1(0–3h)) response, and Asthma Control Questionnaire-7 (ACQ-7) responder rate. GINA step grouping was based on patients’ background treatment regimen. Baseline characteristics of patients (N = 2926) were balanced between treatments. Tiotropium Respimat showed consistent improvements in lung function across GINA steps; placebo-corrected peak FEV1(0–3h) improvements after tiotropium Respimat 5 μg and 2.5 μg were: Step 2 (Week 8), 135 mL (95% confidence interval: 84, 187) and 155 mL (103, 206); Step 3 (Week 24), 187 mL (139, 235) and 235 mL (187, 283); Step 4 (Week 24), 111 mL (63, 159) and 181 mL (35, 326); Step 5 (Week 24; 5 μg only), 164 mL (5, 323). Asthma control improved with tiotropium Respimat versus placebo, showing statistical significance (nominal P value) with tiotropium Respimat 5 μg at Step 4 (odds ratio 1.36 [1.03, 1.78]). Safety profiles were similar between treatments. In conclusion, tiotropium Respimat add-on therapy improves lung function, and may improve asthma control, in adults across disease severities.</p

Encoding and retrieval in a CA1 microcircuit model of the hippocampus

Recent years have witnessed a dramatic accumulation of knowledge about the morphological, physiological and molecular characteristics, as well as connectivity and synaptic properties of neurons in the mammalian hippocampus. Despite these advances, very little insight has been gained into the computational function of the different neuronal classes; in particular, the role of the various inhibitory interneurons in encoding and retrieval of information remains elusive. Mathematical and computational models of microcircuits play an instrumental role in exploring microcircuit functions and facilitate the dissection of operations performed by diverse inhibitory interneurons. A model of the CA1 microcircuitry is presented using biophysical representations of its major cell types: pyramidal, basket, axo-axonic, bistratified and oriens lacunosummoleculare cells. Computer simulations explore the biophysical mechanisms by which encoding and retrieval of spatio-temporal input patterns are achieved by the CA1 microcircuitry. The model proposes functional roles for the different classes of inhibitory interneurons in the encoding and retrieval cycles

A combined numerical and experimental study of the 3D tumble structure and piston boundary layer development during the intake stroke of a gasoline engine

Due to its positive effect on flame propagation in the case of a well-defined breakdown, the formation of a large-scale tumble motion is an important goal in engine development. Cycle-to-cycle variations (CCV) in the tumble position and strength however lead to a fluctuating tumble breakdown in space and time and therefore to combustion variations, indicated by CCV of the peak pressure. This work aims at a detailed investigation of the large-scale tumble motion and its interaction with the piston boundary layer during the intake stroke in a state-of-the-art gasoline engine. To allow the validation of the flow near the piston surface obtained by simulation, a new measurement technique called “Flying PIV” is applied. A detailed comparison between experimental and simulation results is carried out as well as an analysis of the obtained flow field. The large-scale tumble motion is investigated based on numerical data of multiple highly resolved intake strokes obtained using scale-resolving simulations. A method to detect the tumble center position within a 3D flow field, as an extension of previously developed 2D and 3D algorithms, is presented and applied. It is then used to investigate the phase-averaged tumble structure, its characteristics in terms of angular velocity and the CCV between the individual intake strokes. Finally, an analysis is presented of the piston boundary layer and how it is influenced by the tumble motion during the final phase of the intake stroke

Towards an improved understanding of biogeochemical processes across surface-groundwater interactions in intermittent rivers and ephemeral streams

Surface-groundwater interactions in intermittent rivers and ephemeral streams (IRES), waterways which do not flow year-round, are spatially and temporally dynamic because of alternations between flowing, non-flowing and dry hydrological states. Interactions between surface and groundwater often create mixing zones with distinct redox gradients, potentially driving high rates of carbon and nutrient cycling. Yet a complete understanding of how underlying biogeochemical processes across surface-groundwater flowpaths in IRES differ among various hydrological states remains elusive. Here, we present a conceptual framework relating spatial and temporal hydrological variability in surface water-groundwater interactions to biogeochemical processing hotspots in IRES. We combine a review of theIRES biogeochemistry literature with concepts of IRES hydrogeomorphology to: (i) outline common distinctions among hydrological states in IRES; (ii) use these distinctions, together with considerations of carbon, nitrogen, and phosphorus cycles within IRES, to predict the relative potential for biogeochemical processing across different reach-scale processing zones (flowing water, fragmented pools, hyporheic zones, groundwater, and emerged sediments); and (iii) explore the potential spatial and temporal variability of carbon and nutrient biogeochemical processing across entire IRES networks. Our approach estimates the greatest reach-scale potential for biogeochemical processing when IRES reaches are fragmented into isolated surface water pools, and highlights the potential of relatively understudied processing zones, such as emerged sediments. Furthermore, biogeochemical processing in fluvial networks dominated by IRES is likely more temporally than spatially variable. We conclude that biogeochemical research in IRES would benefit from focusing on interactions between different nutrient cycles, surface-groundwater interactions in non-flowing states, and consideration of fluvial network architecture. Our conceptual framework outlines opportunities to advance studies and expand understanding of biogeochemistry in IRES