Development of a Consensus Statement for the Definition, Diagnosis, and Treatment of Acute Exacerbations of Idiopathic Pulmonary Fibrosis Using the Delphi Technique.

© 2015, The Author(s).Introduction: There is a lack of agreed and established guidelines for the treatment of acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF). This reflects, in part, the limited evidence-base underpinning the management of AE-IPF. In the absence of high-quality evidence, the aim of this research was to develop a clinician-led consensus statement for the definition, diagnosis and treatment of AE-IPF. Methods: A literature review was conducted to obtain published material on the definition and treatment of AE-IPF. The results of this review were circulated to an online panel of clinicians for review. Statements were then shared with ten expert respiratory clinicians who regularly treat patients with IPF. A Delphi technique was then used to develop a consensus statement for the definition, diagnosis and treatment of AE-IPF. During the first round of review, clinicians rated the clarity of each statement, the extent to which the statement should be included and provided comments. In two subsequent rounds of review, clinicians were provided with the group median inclusion rating for each statement, and any revised wording of statements to aid clarity. Clinicians were asked to repeat the clarity and inclusion ratings for the revised statements. Results: The literature review, online panel discussion, and face-to-face meeting generated 65 statements covering the definition, diagnosis, and management of AE-IPF. Following three rounds of blind review, 90% of clinicians agreed 39 final statements. These final statements included a definition of AE-IPF, approach to diagnosis, and treatment options, specifically: supportive measures, use of anti-microbials, immunosuppressants, anti-coagulants, anti-fibrotic therapy, escalation, transplant management, and long-term management including discharge planning. Conclusion: This clinician-led consensus statement establishes the ‘best practice’ for the management and treatment of AE-IPF based on current knowledge, evidence, and available treatments. Funding: Boehringer Ingelheim Ltd., Bracknell, West Berkshire, UK

Quantum Key Distribution using Multilevel Encoding: Security Analysis

We present security proofs for a protocol for Quantum Key Distribution (QKD) based on encoding in finite high-dimensional Hilbert spaces. This protocol is an extension of Bennett's and Brassard's basic protocol from two bases, two state encoding to a multi bases, multi state encoding. We analyze the mutual information between the legitimate parties and the eavesdropper, and the error rate, as function of the dimension of the Hilbert space, while considering optimal incoherent and coherent eavesdropping attacks. We obtain the upper limit for the legitimate party error rate to ensure unconditional security when the eavesdropper uses incoherent and coherent eavesdropping strategies. We have also consider realistic noise caused by detector's noise.Comment: 8 pages, 3 figures, REVTe

Maximum-Entropy Weighting of Multi-Component Earth Climate Models

A maximum entropy-based framework is presented for the synthesis of projections from multiple Earth climate models. This identifies the most representative (most probable) model from a set of climate models -- as defined by specified constraints -- eliminating the need to calculate the entire set. Two approaches are developed, based on individual climate models or ensembles of models, subject to a single cost (energy) constraint or competing cost-benefit constraints. A finite-time limit on the minimum cost of modifying a model synthesis framework, at finite rates of change, is also reported.Comment: Inspired by discussions at the Mathematical and Statistical Approaches to Climate Modelling and Prediction workshop, Isaac Newton Institute for Mathematical Sciences, Cambridge, UK, 11 Aug. to 22 Dec. 2010. Accepted for publication in Climate Dynamics, 8 August 201

Microstructured reactor as a pre-turbo catalytic converter

The idea of a structured catalytic converter placed immediately after engine exhaust valves, thus operating on high gas temperature and velocity, is explored. The assumption is that major part of the reactor operates in the entry region where Nusselt and Sherwood numbers are highly enhanced. In this work, flow resistances as well as heat and mass transfer coefficients were studied for gas velocities exceeding 50 m/s. Consequently, the transition range (between laminar and turbulent flows) was reached. The comparison with classic monolith has shown significant improvement in heat or mass transfer paid by slight increase in flow resistance

Assays to Detect β-Tubulin Codon 200 Polymorphism in Trichuris trichiura and Ascaris lumbricoides

The soil-transmitted helminths Ascaris lumbricoides and Trichuris trichiura are gastrointestinal nematodes causing many disabilities in tropical parts of the developing world. Control programs, such as “The Focussing Resources on Effective School Health” (FRESH) Partnership, have been implemented to remove human soil-transmitted nematodes through large-scale use of benzimidazole anthelmintic drugs for school-aged children in developing countries. The benzimidazole drugs albendazole and mebendazole are commonly used as a single annual treatment in areas where the burden is high. In veterinary nematodes, repeated use of these anthelmintics has selected for resistant populations. Resistance to benzimidazoles is commonly associated with a single amino acid substitution from phenylalanine to tyrosine in the β-tubulin gene at position 200. In this study, we have developed pyrosequencing assays for codon 200 in A. lumbricoides and T. trichiura to screen for this single nucleotide polymorphism (SNP) in β-tubulin. The 200Tyr SNP was detected at low frequency in T. trichiura from non-treated people from Kenya and at high frequency in T. trichiura from treated people from Panama. The presence of the resistance-associated SNP may play a role in the sometimes low and variable efficacy of benzimidazole anthelmintics against T. trichiura

A correlation of the cosmic microwave sky with large scale structure

We cross correlate the large-scale cosmic microwave background (CMB) sky measured by WMAP with two probes of large-scale structure at z ~ 1. The hard X-ray background, measured by the HEAO-1 satellite, is positively correlated with the WMAP data at the 2.5-3.0 sigma level. The number counts of radio galaxies in the NVSS survey are also correlated at a slightly weaker level (2.-2.5 sigma). These correlations appear to arise from both hemispheres on the sky and are resilient to changes in the levels of masking of the Galaxy and point sources, suggesting that foregrounds are not responsible for the signal. The implication is that some of the observed CMB fluctuations arise at low redshifts. The level of the correlations is consistent with that expected for the cosmological constant (Omega_Lambda = 0.72) concordance model resulting from the integrated Sachs-Wolfe effect. Thus, we may be observing dark energy's effect on the growth of structure.Comment: 8 pages, 3 postscript figure

Design and function of superfast muscles : new insights into the physiology of skeletal muscle

First published online as a Review in Advance on October 24, 2005. (Some corrections may occur before final publication online and in print)Author Posting. © Annual Reviews, 2005. This article is posted here by permission of Annual Reviews for personal use, not for redistribution. The definitive version was published in Annual Review of Physiology 68 (2006): 22.1-22.29, doi:10.1146/annurev.physiol.68.040104.105418.Superfast muscles of vertebrates power sound production. The fastest, the swimbladder muscle of toadfish, generates mechanical power at frequencies in excess of 200 Hz. To operate at these frequencies, the speed of relaxation has had to increase approximately 50-fold. This increase is accomplished by modifications of three kinetic traits: (a) a fast calcium transient due to extremely high concentration of sarcoplasmic reticulum (SR)-Ca2+ pumps and parvalbumin, (b) fast off-rate of Ca2+ from troponin C due to an alteration in troponin, and (c) fast cross-bridge detachment rate constant (g, 50 times faster than that in rabbit fast-twitch muscle) due to an alteration in myosin. Although these three modifications permit swimbladder muscle to generate mechanical work at high frequencies (where locomotor muscles cannot), it comes with a cost: The high g causes a large reduction in attached force-generating cross-bridges, making the swimbladder incapable of powering low-frequency locomotory movements. Hence the locomotory and sound-producing muscles have mutually exclusive designs.This work was made possible by support from NIH grants AR38404 and AR46125 as well as the University of Pennsylvania Research Foundation

Impact of shortened crop rotation of oilseed rape on soil and rhizosphere microbial diversity in relation to yield decline

Oilseed rape (OSR) grown in monoculture shows a decline in yield relative to virgin OSR of up to 25%, but the mechanisms responsible are unknown. A long term field experiment of OSR grown in a range of rotations with wheat was used to determine whether shifts in fungal and bacterial populations of the rhizosphere and bulk soil were associated with the development of OSR yield decline. The communities of fungi and bacteria in the rhizosphere and bulk soil from the field experiment were profiled using terminal restriction fragment length polymorphism (TRFLP) and sequencing of cloned internal transcribed spacer regions and 16S rRNA genes, respectively. OSR cropping frequency had no effect on rhizosphere bacterial communities. However, the rhizosphere fungal communities from continuously grown OSR were significantly different to those from other rotations. This was due primarily to an increase in abundance of two fungi which showed 100% and 95% DNA identity to the plant pathogens Olpidium brassicae and Pyrenochaeta lycopersici, respectively. Real-time PCR confirmed that there was significantly more of these fungi in the continuously grown OSR than the other rotations. These two fungi were isolated from the field and used to inoculate OSR and Brassica oleracea grown under controlled conditions in a glasshouse to determine their effect on yield. At high doses, Olpidium brassicae reduced top growth and root biomass in seedlings and reduced branching and subsequent pod and seed production. Pyrenochaeta sp. formed lesions on the roots of seedlings, and at high doses delayed flowering and had a negative impact on seed quantity and quality

Better Guidance Is Welcome, but without Blinders

David Peters and Sara Bennett provide a critical perspective on a three-part series on health systems guidance that examines how evidence should be used to strengthen health systems and improve the delivery of global health interventions

Stellar winds from Massive Stars

We review the various techniques through which wind properties of massive stars - O stars, AB supergiants, Luminous Blue Variables (LBVs), Wolf-Rayet (WR) stars and cool supergiants - are derived. The wind momentum-luminosity relation (e.g. Kudritzki et al. 1999) provides a method of predicting mass-loss rates of O stars and blue supergiants which is superior to previous parameterizations. Assuming the theoretical sqrt(Z) metallicity dependence, Magellanic Cloud O star mass-loss rates are typically matched to within a factor of two for various calibrations. Stellar winds from LBVs are typically denser and slower than equivalent B supergiants, with exceptional mass-loss rates during giant eruptions Mdot=10^-3 .. 10^-1 Mo/yr (Drissen et al. 2001). Recent mass-loss rates for Galactic WR stars indicate a downward revision of 2-4 relative to previous calibrations due to clumping (e.g. Schmutz 1997), although evidence for a metallicity dependence remains inconclusive (Crowther 2000). Mass-loss properties of luminous (> 10^5 Lo) yellow and red supergiants from alternative techniques remain highly contradictory. Recent Galactic and LMC results for RSG reveal a large scatter such that typical mass-loss rates lie in the range 10^-6 .. 10^-4 Mo/yr, with a few cases exhibiting 10^-3 Mo/yr.Comment: 16 pages, 2 figures, Review paper to appear in Proc `The influence of binaries on stellar population studies', Brussels, Aug 2000 (D. Vanbeveren ed.), Kluwe