Barriers to Asthma Treatment in the United States: Results From the Global Asthma Physician and Patient Survey

BACKGROUND: The Global Asthma Physician and Patient (GAPP) survey evaluated the perceptions of both physicians and patients on the management of asthma. Here we present the results from the United States (US) subpopulation of the GAPP survey. METHODS: The GAPP Survey was a large, global study (physicians, n = 1733; patients, n = 1726; interviews, n = 3459). In the US, 208 adults (aged ≥ 18 years) with asthma and 224 physicians were recruited. Respondents were questioned using self-administered online interviews with close-ended questionnaires. RESULTS: Physician and patient responses were found to differ in regard to perception of time spent on asthma education, awareness of disease symptoms and their severity, asthma medication side effects, and adherence to treatment and the consequence of nonadherence. Comparison of the US findings with the global GAPP survey results suggest the US physician-patient partnership compared reasonably well with the other countries in the survey. Both patients and physicians cited a need for new asthma medication. CONCLUSIONS: Similar to the global GAPP survey, the US-specific findings indicate that in general there is a lack of asthma control, poor adherence to therapy, and room for improvement in patient-physician communication and partnership in treating asthma

The CUORE Cryostat: A 1-Ton Scale Setup for Bolometric Detectors

The cryogenic underground observatory for rare events (CUORE) is a 1-ton scale bolometric experiment whose detector consists of an array of 988 TeO2 crystals arranged in a cylindrical compact structure of 19 towers. This will be the largest bolometric mass ever operated. The experiment will work at a temperature around or below 10 mK. CUORE cryostat consists of a cryogen-free system based on pulse tubes and a custom high power dilution refrigerator, designed to match these specifications. The cryostat has been commissioned in 2014 at the Gran Sasso National Laboratories and reached a record temperature of 6 mK on a cubic meter scale. In this paper, we present results of CUORE commissioning runs. Details on the thermal characteristics and cryogenic performances of the system will be also given.Comment: 7 pages, 2 figures, LTD16 conference proceedin

A detector module with highly efficient surface-alpha event rejection operated in CRESST-II Phase 2

The cryogenic dark matter experiment CRESST-II aims at the direct detection of WIMPs via elastic scattering off nuclei in scintillating CaWO$_4$ crystals. We present a new, highly improved, detector design installed in the current run of CRESST-II Phase 2 with an efficient active rejection of surface-alpha backgrounds. Using CaWO$_4$ sticks instead of metal clamps to hold the target crystal, a detector housing with fully-scintillating inner surface could be realized. The presented detector (TUM40) provides an excellent threshold of ${\sim}\,0.60\,$keV and a resolution of $\sigma\,{\approx}\,0.090$ keV (at 2.60$\,$keV). With significantly reduced background levels, TUM40 sets stringent limits on the spin-independent WIMP-nucleon scattering cross section and probes a new region of parameter space for WIMP masses below 3$\,$GeV/c$^2$. In this paper, we discuss the novel detector design and the surface-alpha event rejection in detail.Comment: 9 pages, 6 figure

Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Allergy and Asthma European Network (GA2LEN)

Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases. Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change. The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction. In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant. Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect the physician’s considerations of disease features, phenotype, and response to previous therapy

Allergic diseases in the elderly: biological characteristics and main immunological and non-immunological mechanisms

Life expectancy and the number of elderly people are progressively increasing around the world. Together with other pathologies, allergic diseases also show an increasing incidence in geriatric age. This is partly due to the growing emphasis on a more accurate and careful diagnosis of the molecular mechanisms that do not allow to ignore the real pathogenesis of many symptoms until now unknown, and partly to the fact that the allergic people from 20 years ago represent the elderly population now. Moreover, environmental pollution predisposes to the onset of allergic asthma and dermatitis which are the result of internal pathologies more than the expression of allergic manifestations. At the same time the food contamination permits the onset of allergic diseases related to food allergy. In this review we provide the state of the art on the physiological changes in the elderly responsible for allergic diseases, their biological characteristics and the major immunological and extra immunological mechanisms. Much emphasis is given to the management of several diseases in the elderly, including anaphylactic reactions. Moreover, some new features are discussed, such as management of asthma with the support of physical activity and the use of the AIT as prevention of respiratory diseases and for the purpose of a real and long lasting benefit. The mechanisms of adverse reactions to drugs are also discussed, due to their frequency in this age, especially in polytherapy regimens. Study of the modifications of the immune system is also of great importance, as regards to the distribution of the lymphocytes and also the presence of a chronic inflammatory disease related to the production of cytokines, especially in prevision of all the possible therapies to be adopted to allow an active and healthy agin

Double-beta decay of 130^{130}Te to the first 0+^{+} excited state of 130^{130}Xe with CUORICINO

The CUORICINO experiment was an array of 62 TeO$_{2}$ single-crystal bolometers with a total $^{130}$Te mass of $11.3\,$kg. The experiment finished in 2008 after more than 3 years of active operating time. Searches for both $0\nu$ and $2\nu$ double-beta decay to the first excited $0^{+}$ state in $^{130}$Xe were performed by studying different coincidence scenarios. The analysis was based on data representing a total exposure of N($^{130}$Te)$\cdot$t=$9.5\times10^{25}\,$y. No evidence for a signal was found. The resulting lower limits on the half lives are $T^{2\nu}_{1/2}(^{130} Te\rightarrow^{130} Xe^{*})>1.3\times10^{23}\,$y (90% C.L.), and $T^{0\nu}_{1/2}(^{130} Te\rightarrow^{130} Xe^{*})>9.4\times10^{23}\,$y (90% C.L.).Comment: 6 pages, 4 figure

Search for Neutrinoless Double-Beta Decay of 130^{130}Te with CUORE-0

We report the results of a search for neutrinoless double-beta decay in a 9.8~kg$\cdot$yr exposure of $^{130}$Te using a bolometric detector array, CUORE-0. The characteristic detector energy resolution and background level in the region of interest are $5.1\pm 0.3{\rm~keV}$ FWHM and $0.058 \pm 0.004\,(\mathrm{stat.})\pm 0.002\,(\mathrm{syst.})$~counts/(keV$\cdot$kg$\cdot$yr), respectively. The median 90%~C.L. lower-limit sensitivity of the experiment is $2.9\times 10^{24}~{\rm yr}$ and surpasses the sensitivity of previous searches. We find no evidence for neutrinoless double-beta decay of $^{130}$Te and place a Bayesian lower bound on the decay half-life, $T^{0\nu}_{1/2}>$~$2.7\times 10^{24}~{\rm yr}$ at 90%~C.L. Combining CUORE-0 data with the 19.75~kg$\cdot$yr exposure of $^{130}$Te from the Cuoricino experiment we obtain $T^{0\nu}_{1/2} > 4.0\times 10^{24}~\mathrm{yr}$ at 90%~C.L.~(Bayesian), the most stringent limit to date on this half-life. Using a range of nuclear matrix element estimates we interpret this as a limit on the effective Majorana neutrino mass, $m_{\beta\beta}< 270$ -- $760~\mathrm{meV}$.Comment: 6 pages, 5 figures, updated version as published in PR

Limits on Dark Matter Effective Field Theory Parameters with CRESST-II

CRESST is a direct dark matter search experiment, aiming for an observation of nuclear recoils induced by the interaction of dark matter particles with cryogenic scintillating calcium tungstate crystals. Instead of confining ourselves to standard spin-independent and spin-dependent searches, we re-analyze data from CRESST-II using a more general effective field theory (EFT) framework. On many of the EFT coupling constants, improved exclusion limits in the low-mass region (< 3-4 GeV) are presented.Comment: 7 pages, 9 figure

Analysis Techniques for the Evaluation of the Neutrinoless Double-Beta Decay Lifetime in 130^{130}Te with CUORE-0

We describe in detail the methods used to obtain the lower bound on the lifetime of neutrinoless double-beta ($0\nu\beta\beta$) decay in $^{130}$Te and the associated limit on the effective Majorana mass of the neutrino using the CUORE-0 detector. CUORE-0 is a bolometric detector array located at the Laboratori Nazionali del Gran Sasso that was designed to validate the background reduction techniques developed for CUORE, a next-generation experiment scheduled to come online in 2016. CUORE-0 is also a competitive $0\nu\beta\beta$ decay search in its own right and functions as a platform to further develop the analysis tools and procedures to be used in CUORE. These include data collection, event selection and processing, as well as an evaluation of signal efficiency. In particular, we describe the amplitude evaluation, thermal gain stabilization, energy calibration methods, and the analysis event selection used to create our final $0\nu\beta\beta$ decay search spectrum. We define our high level analysis procedures, with emphasis on the new insights gained and challenges encountered. We outline in detail our fitting methods near the hypothesized $0\nu\beta\beta$ decay peak and catalog the main sources of systematic uncertainty. Finally, we derive the $0\nu\beta\beta$ decay half-life limits previously reported for CUORE-0, $T^{0\nu}_{1/2}>2.7\times10^{24}$ yr, and in combination with the Cuoricino limit, $T^{0\nu}_{1/2}>4.0\times10^{24}$ yr.Comment: 18 pages, 18 figures. (Version 3 reflects only minor changes to the text. Few additional details, no major content changes.