Patient-reported outcome measures for chronic obstructive pulmonary disease: the exclusion of people with low literacy skills and learning disabilities

<p>Background: Patient-reported outcome measures (PROMs) are intended to reflect outcomes relevant to patients. They are increasingly used for healthcare quality improvement. To produce valid measures, patients should be involved in the development process but it is unclear whether this usually includes people with low literacy skills or learning disabilities. This potential exclusion raises concerns about whether these groups will be able to use these measures and participate in quality improvement practices.</p> <p>Methods: Taking PROMs for chronic obstructive pulmonary disease (COPD) as an exemplar condition, our review determined the inclusion of people with low literacy skills and learning disabilities in research developing, validating, and using 12 PROMs for COPD patients. The studies included in our review were based on those identified in two existing systematic reviews and our update of this search. Results People with low literacy skills and/or learning disabilities were excluded from the development of PROMs in two ways: explicitly through the participant eligibility criteria and, more commonly, implicitly through recruitment or administration methods that would require high-level reading and cognitive abilities. None of the studies mentioned efforts to include people with low literacy skills or learning disabilities.</p> <p>Conclusion: Our findings suggest that people with low literacy skills or learning disabilities are left out of the development of PROMs. Given that implicit exclusion was most common, researchers and those who administer PROMs may not even be aware of this problem. Without effort to improve inclusion, unequal quality improvement practices may become embedded in the health system.</p&gt

IL-17 can be protective or deleterious in murine pneumococcal pneumonia

Streptococcus pneumoniae is the major bacterial cause of community-acquired pneumonia, and the leading agent of childhood pneumonia deaths worldwide. Nasal colonization is an essential step prior to infection. The cytokine IL-17 protects against such colonization and vaccines that enhance IL-17 responses to pneumococcal colonization are being developed. The role of IL-17 in host defence against pneumonia is not known. To address this issue, we have utilized a murine model of pneumococcal pneumonia in which the gene for the IL-17 cytokine family receptor, Il17ra, has been inactivated. Using this model, we show that IL-17 produced predominantly from γδ T cells protects mice against death from the invasive TIGR4 strain (serotype 4) which expresses a relatively thin capsule. However, in pneumonia produced by two heavily encapsulated strains with low invasive potential (serotypes 3 and 6B), IL-17 significantly enhanced mortality. Neutrophil uptake and killing of the serotype 3 strain was significantly impaired compared to the serotype 4 strain and depletion of neutrophils with antibody enhanced survival of mice infected with the highly encapsulated SRL1 strain. These data strongly suggest that IL-17 mediated neutrophil recruitment to the lungs clears infection from the invasive TIGR4 strain but that lung neutrophils exacerbate disease caused by the highly encapsulated pneumococcal strains. Thus, whilst augmenting IL-17 immune responses against pneumococci may decrease nasal colonization, this may worsen outcome during pneumonia caused by some strains

Interleukin-17 is required for control of chronic lung infection caused by Pseudomonas aeruginosa

Chronic pulmonary infection with Pseudomonas aeruginosa is a feature of cystic fibrosis (CF) and other chronic lung diseases. Cytokines of the IL-17 family have been proposed as important in the host response to P. aeruginosa infection through augmenting antibacterial immune responses, although their pro-inflammatory effect may contribute to lung damage that occurs as a result of chronic infection. We set out to explore the role of IL-17 in the host response to chronic P. aeruginosa infection. We used a murine model of chronic pulmonary infection with CF-related strains of P. aeruginosa. We demonstrate that IL-17 cytokine signaling is essential for survival and prevention of chronic infection at 2 weeks post-inoculation using two different P. aeruginosa strains. Following infection, there was a marked expansion of cells within mediastinal lymph nodes, comprised mainly of innate lymphoid cells (ILCs); ∼90% of IL-17 producing cells had markers consistent with Group 3 ILCs. A smaller percentage of IL-17+ cells had markers consistent with a B1 phenotype. In lung homogenates 14 days following infection, there was a significant expansion of IL-17+ cells – about 50% of these were CD3+, split equally between CD4+ Th17 cells and γδ T cells, while the CD3- IL-17+ cells were almost exclusively Group 3 ILCs. Further experiments with B cell deficient mice showed that B cell production of IL-17 or natural antibodies did not provide any defence against chronic P. aeruginosa infection. Thus, IL-17 rather than antibody is a key element in host defence against chronic pulmonary infection with P. aeruginosa

Charge and spin state readout of a double quantum dot coupled to a resonator

State readout is a key requirement for a quantum computer. For semiconductor-based qubit devices it is usually accomplished using a separate mesoscopic electrometer. Here we demonstrate a simple detection scheme in which a radio-frequency resonant circuit coupled to a semiconductor double quantum dot is used to probe its charge and spin states. These results demonstrate a new non-invasive technique for measuring charge and spin states in quantum dot systems without requiring a separate mesoscopic detector

Some Empirical Criteria for Attributing Creativity to a Computer Program

Peer reviewedPostprin

Impacts of boundary layer turbulence and land surface process parameterizations on simulated sea breeze characteristics

This paper investigates the sensitivity of sea breeze (SB) simulations to combinations of boundary-layer turbulence and land-surface process parameterizations implemented in the MM5 mesoscale meteorological mode for an observed SB case over the Swedish west coast. Various combinations from four different planetary boundary layer (PBL) schemes [Blackadar, Gayno-Seaman (GS), Eta, MRF], and two land surface model (LSM) schemes (SLAB, Noah) with different complexity are designed to simulate a typical SB case over the Swedish west coast. The simulations are conducted using two-way interactively nested grids. Simulated 10-m winds are compared against observed near-surface wind data from the GÖTE2001 campaign to examine the diurnal cycle of wind direction and speed for SB timing. The SB (vertical) circulation is also compared in the different experiments. The results show that the different combinations of PBL and LSM parameterization schemes result in different SB timing and vertical circulation characteristics. All experiments predict a delayed SB. The vertical component of the SB circulation varies in the experiments, among which the GS PBL scheme produces the strongest SB circulation. Evident differences between the SLAB and Noah LSMs are also found, especially in maximum of updraft and downdraft velocities of the SB vertical circulation. The results have significant implications for convective initiation, air quality studies and other environmental problems in coastal areas