Evaluating Patient Preferences of Maintenance Therapy for the Treatment of Chronic Obstructive Pulmonary Disease: A Discrete Choice Experiment in the UK, USA and Germany.

Introduction: With increasing availability of different treatments for chronic obstructive pulmonary disease (COPD), we sought to understand patient preferences for COPD treatment in the UK, USA, and Germany using a discrete choice experiment (DCE). Methods: Qualitative research identified six attributes associated with COPD maintenance treatments: ease of inhaler use, exacerbation frequency, frequency of inhaler use, number of different inhalers used, side effect frequency, and out-of-pocket costs. A DCE using these attributes, with three levels each, was designed and tested through cognitive interviews and piloting. It comprised 18 choice sets, selected using a D-efficient experimental design. Demographics and disease history were collected and the final DCE survey was completed online by participants recruited from panels in the UK, USA and Germany. Responses were analyzed using mixed logit models, with results expressed as odds ratios (ORs). Results: Overall, 450 participants (150 per country) completed the DCE; most (UK and Germany, 97.3%; USA, 98.0%) were included in the final analysis. Based on relative attribute importance, avoidance of side effects was found to be most important (UK: OR 11.65; USA: OR 7.17; Germany: OR 11.45; all p<0.0001), followed by the likelihood of fewer exacerbations (UK: OR 2.22; USA: OR 1.63; Germany: OR 2.54; all p<0.0001) and increased ease of use (UK: OR 1.84; USA: OR 1.84; Germany: OR 1.60; all p<0.0001). Number of inhalers, out-of-pocket costs, and frequency of inhaler use were found to be less important. Preferences were relatively consistent across the three countries. All participants required a reduction in exacerbations to accept more frequent inhaler use or use of more inhalers. Conclusion: When selecting COPD treatment, individuals assigned the highest value to the avoidance of side effects, experiencing fewer exacerbations, and ease of inhaler use. Ensuring that patients' preferences are considered may encourage treatment compliance

Parameterized lower bound and NP-completeness of some HH-free Edge Deletion problems

For a graph $H$, the $H$-free Edge Deletion problem asks whether there exist at most $k$ edges whose deletion from the input graph $G$ results in a graph without any induced copy of $H$. We prove that $H$-free Edge Deletion is NP-complete if $H$ is a graph with at least two edges and $H$ has a component with maximum number of vertices which is a tree or a regular graph. Furthermore, we obtain that these NP-complete problems cannot be solved in parameterized subexponential time, i.e., in time $2^{o(k)}\cdot |G|^{O(1)}$, unless Exponential Time Hypothesis fails.Comment: 15 pages, COCOA 15 accepted pape

Unit Interval Editing is Fixed-Parameter Tractable

Given a graph~$G$ and integers $k_1$, $k_2$, and~$k_3$, the unit interval editing problem asks whether $G$ can be transformed into a unit interval graph by at most $k_1$ vertex deletions, $k_2$ edge deletions, and $k_3$ edge additions. We give an algorithm solving this problem in time $2^{O(k\log k)}\cdot (n+m)$, where $k := k_1 + k_2 + k_3$, and $n, m$ denote respectively the numbers of vertices and edges of $G$. Therefore, it is fixed-parameter tractable parameterized by the total number of allowed operations. Our algorithm implies the fixed-parameter tractability of the unit interval edge deletion problem, for which we also present a more efficient algorithm running in time $O(4^k \cdot (n + m))$. Another result is an $O(6^k \cdot (n + m))$-time algorithm for the unit interval vertex deletion problem, significantly improving the algorithm of van 't Hof and Villanger, which runs in time $O(6^k \cdot n^6)$.Comment: An extended abstract of this paper has appeared in the proceedings of ICALP 2015. Update: The proof of Lemma 4.2 has been completely rewritten; an appendix is provided for a brief overview of related graph classe

OH Production from the Photolysis of Isoprene-derived Peroxy Radicals: Cross-sections, quantum yields and atmospheric implications

In environments with high concentrations of biogenic volatile organic compounds and low concentrations of nitrogen oxides (NOx = NO + NO2), significant discrepancies have been found between measured and modeled concentrations of hydroxyl radical (OH). The photolysis of peroxy radicals from isoprene (HO-Iso-O2) in the near ultraviolet represents a potential source of OH in these environments, yet has not been considered in atmospheric models. This paper presents measurements of the absorption cross-sections for OH formation (σRO2,OH) from the photolysis of HO-Iso-O2 at wavelengths from 310–362.5 nm via direct observation by laser-induced fluorescence of the additional OH produced following laser photolysis of HO-Iso-O2. Values of σRO2,OH for HO-Iso-O2 ranged from (6.0 ± 1.6) × 10-20 cm2 molecule-1 at 310 nm to (0.5 ± 0.15) × 10-20 cm2 molecule-1 at 362.5 nm. OH photodissociation yields from HO-Iso-O2 photolysis, ϕOH,RO2, were determined via comparison of the measured values of σRO2,OH to the total absorption cross-sections for HO-Iso-O2 (σRO2), which were obtained using a newly-constructed spectrometer. ϕOH,RO2 was determined to be 0.13 ± 0.037 at wavelengths from 310–362.5 nm. To determine the impact of HO-Iso-O2 photolysis on atmospheric OH concentrations, a modeling case-study for a high-isoprene, low-NOx environment (namely, the 2008 Oxidant and Particle Photochemical Processes above a South-East Asian Tropical Rainforest (OP-3) field campaign, conducted in Borneo) was undertaken using the detailed Master Chemical Mechanism. The model calculated that the inclusion of HO-Iso-O2 photolysis in the model had increased the OH concentration by only 1% on average from 10:00–16:00 local time. Thus, HO-Iso-O2 photolysis alone is insufficient to resolve the discrepancy seen between measured OH concentrations and those predicted by atmospheric chemistry models in such environments

Direct evidence for a substantive reaction between the Criegee intermediate, CH₂OO, and the water vapour dimer

The C1 Criegee intermediate, CH2OO, reaction with water vapour has been studied. The removal rate constant shows a quadratic dependence on [H2O], implying reaction with the water dimer, (H2O)2. The rate constant, kCH2OO+(H2O)2 = (4.0 ± 1.2) × 10−12 cm3 molecule−1 s−1, is such that this is the major atmospheric sink for CH2OO

Evaluation of a novel antibody to define histone 3.3 G34R mutant brain tumours

Missense somatic mutations affecting histone H3.1 and H3.3 proteins are now accepted as the hallmark of paediatric diffuse intrinsic pontine gliomas (DIPG), non-brain stem paediatric high grade gliomas (pHGG) as well as a subset of adult glioblastoma multiforme (GBM). Different mutations give rise to one of three amino acid substitutions at two critical positions within the histone tails, K27M, G34R/V. Several studies have highlighted gene expression and epigenetic changes associated with histone H3 mutations; however their precise roles in tumourigenesis remain incompletely understood. Determining how such amino acid substitutions in a protein affect its properties can be challenging because of difficulties in detecting and tracking mutant proteins within cells and tissues. Here we describe a strategy for the generation of antibodies to discriminate G34R and G34V mutant histone H3 proteins from their wild-type counterparts. Antibodies were validated by western blotting and immunocytochemistry, using recombinant H3.3 proteins and paediatric GBM cell lines. The H3-G34R antibody demonstrated a high degree of selectivity towards its target sequence. Accordingly, immunostaining on a cohort of 22 formalin-fixed paraffin embedded tumours with a previously known H3.3 G34R mutation status, detected successfully the corresponding mutant protein in 11/11 G34R cases. Since there was a high concordance between genotype and immunohistochemical analysis of G34R mutant tumour samples, we analysed a series of tissue microarrays (TMAs) to assess the specificity of the antibody in a range of paediatric brain tumours, and noted immunoreactivity in 2/634 cases. Importantly, we describe the generation and validation of highly specific antibodies for G34 mutations. Overall our work adds to an extremely valuable portfolio of antibodies, not only for histopathologic detection of tumour-associated mutant histone sequences, but also facilitating the study of spatial/anatomical aspects of tumour formation and the identification of downstream targets and pathways in malignant glioma progression

Triplet Supercurrents in clean and disordered half-metallic ferromagnets

Interfaces between materials with differently ordered phases present unique opportunities to study fundamental problems in physics. One example is the interface between a singlet superconductor and a half-metallic ferromagnet, where Cooper pairing occurs between electrons with opposite spin on the superconducting side, whereas the other exhibits 100% spin polarization. The recent surprising observation of a supercurrent through half-metallic CrO2 therefore requires a mechanism for conversion between unpolarized and completely spin-polarized supercurrents. Here, we suggest a conversion mechanism based on electron spin precession together with triplet-pair rotation at interfaces with broken spin-rotation symmetry. In the diffusive limit (short mean free path), the triplet supercurrent is dominated by inter-related odd-frequency s-wave and even-frequency p-wave pairs. In the crossover to the ballistic limit, further symmetry components become relevant. The interface region exhibits a superconducting state of mixed-spin pairs with highly unusual symmetry properties that open up new perspectives for exotic Josephson devices

Measuring the effect of enhanced cleaning in a UK hospital : a prospective cross-over study

Increasing hospital-acquired infections have generated much attention over the last decade. There is evidence that hygienic cleaning has a role in the control of hospital-acquired infections. This study aimed to evaluate the potential impact of one additional cleaner by using microbiological standards based on aerobic colony counts and the presence of Staphylococcus aureus including meticillin-resistant S. aureus. We introduced an additional cleaner into two matched wards from Monday to Friday, with each ward receiving enhanced cleaning for six months in a cross-over design. Ten hand-touch sites on both wards were screened weekly using standardised methods and patients were monitored for meticillin-resistant S. aureus infection throughout the year-long study. Patient and environmental meticillin-resistant S. aureus isolates were characterised using molecular methods in order to investigate temporal and clonal relationships. Enhanced cleaning was associated with a 32.5% reduction in levels of microbial contamination at handtouch sites when wards received enhanced cleaning (P < 0.0001: 95% CI 20.2%, 42.9%). Near-patient sites (lockers, overbed tables and beds) were more frequently contaminated with meticillin-resistant S. aureus/S. aureus than sites further from the patient (P = 0.065). Genotyping identified indistinguishable strains from both handtouch sites and patients. There was a 26.6% reduction in new meticillin-resistant S. aureus infections on the wards receiving extra cleaning, despite higher meticillin-resistant S. aureus patient-days and bed occupancy rates during enhanced cleaning periods (P = 0.032: 95% CI 7.7%, 92.3%). Adjusting for meticillin-resistant S. aureus patient-days and based upon nine new meticillin-resistant S. aureus infections seen during routine cleaning, we expected 13 new infections during enhanced cleaning periods rather than the four that actually occurred. Clusters of new meticillin-resistant S. aureus infections were identified 2 to 4 weeks after the cleaner left both wards. Enhanced cleaning saved the hospital £30,000 to £70,000.Introducing one extra cleaner produced a measurable effect on the clinical environment, with apparent benefit to patients regarding meticillin-resistant S. aureus infection. Molecular epidemiological methods supported the possibility that patients acquired meticillin-resistant S. aureus from environmental sources. These findings suggest that additional research is warranted to further clarify the environmental, clinical and economic impact of enhanced hygienic cleaning as a component in the control of hospital-acquired infection

Bilateral Assessment of Functional Tasks for Robot-assisted Therapy Applications

This article presents a novel evaluation system along with methods to evaluate bilateral coordination of arm function on activities of daily living tasks before and after robot-assisted therapy. An affordable bilateral assessment system (BiAS) consisting of two mini-passive measuring units modeled as three degree of freedom robots is described. The process for evaluating functional tasks using the BiAS is presented and we demonstrate its ability to measure wrist kinematic trajectories. Three metrics, phase difference, movement overlap, and task completion time, are used to evaluate the BiAS system on a bilateral symmetric (bi-drink) and a bilateral asymmetric (bi-pour) functional task. Wrist position and velocity trajectories are evaluated using these metrics to provide insight into temporal and spatial bilateral deficits after stroke. The BiAS system quantified movements of the wrists during functional tasks and detected differences in impaired and unimpaired arm movements. Case studies showed that stroke patients compared to healthy subjects move slower and are less likely to use their arm simultaneously even when the functional task requires simultaneous movement. After robot-assisted therapy, interlimb coordination spatial deficits moved toward normal coordination on functional tasks