Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life

Exacerbations of chronic obstructive pulmonary disease (COPD) represent a significant clinical problem, and are associated with decreased lung function, worsening quality of life and decreased physical activity levels, with even a single exacerbation having detrimental effects. The occurrence of COPD exacerbations can also have a considerable impact on healthcare costs and mortality rates, with over one-fifth of patients hospitalized for a COPD exacerbation for the first time dying within one year of discharge. This highlights the need for COPD exacerbations to be a major focus in clinical practice. Furthermore, the substantial effect that COPD exacerbations can have on patient mental health should not be underestimated. Despite their clinical importance, COPD exacerbations are poorly recognized and reported by patients, and improving patient understanding and reporting of exacerbations to ensure prompt treatment may minimize their deleterious effects. Renewed focus on improving current clinical practice with support from evidence-based guidelines is required. This also raises a challenge to payors, healthcare systems and government policies to do more to tackle the considerable outstanding burden of COPD exacerbations

Phase I and II Archaeological Testing at 321 and 323 South Street, Easton Maryland, Home of the Family of the Buffalo Soldier, 2012

The University of Maryland, College Park, Archaeology in Annapolis Project, conducted Phase I and II archaeological excavations of the property in Easton, Maryland, known as the Home of the Family of the Buffalo Soldier (HFBS) from July 9th through July 20th 2012. The Housing Authority of the Town of Easton owns this property, located at 323 South St., and excavations were conducted at the request of Historic Easton, Inc., with the Housing Authority’s permission, and forms a part of The Hill Project to document and publicize the history of the Easton neighborhood known as The Hill, which has been home to a community of free African Americans since the late eighteenth century. This first excavation within The Hill Project successfully tested the potential for research archaeology to serve the interests of The Hill’s resident and descendant communities, and excavation at the HFBS contributed to The Hill Project’s ongoing historic preservation and community revitalization efforts. Four shovel test pits (STPs) and three 5’x5’ test units were excavated in yard spaces. The Hill’s free black community dates to the late eighteenth century. However, documentary and oral history indicated that the standing built environment at the HFBS dated only to the period of the first African American owners of the site, from ca. 1879. Shedding light on the development of the community through time, archaeological remains documented at the site suggest that this period was the first inhabitation of the property, despite the inhabitation of other properties nearby for the one hundred years prior. They indicate that much yard space has been used in the late nineteenth and twentieth centuries for activities including gardening, play, and trash disposal. Two US Army buttons from ca. 1900 support the site’s association with Buffalo Soldier William Gardner and his family, who curated his discharge papers in the house. The site remained open to the general public during excavation and was actively interpreted to site visitors. During and since the excavation, the HFBS has received many visitors, including many Hill residents, and has attracted much news interest. As of the summer of 2013, it has been included in regular walking tours of The Hill’s historical heritage. The excavations determined that the archaeological record at the HFBS, and likely across The Hill, is quite intact and can support active research. Both the HFBS and The Hill are therefore eligible for inclusion in the National Register of Historic Places under criterion D. Because of the integrity and uniqueness of the archaeological record at the HFBS, we recommend that the site be protected for further archaeological research. However, since the communities’ interest in researching the origins and early development of the free African American community that existed on The Hill during the time of slavery can be more effectively addressed elsewhere in the neighborhood, we recommend that excavation at the HFBS be a secondary priority for archaeologists for the present

Phase II Archaeological Testing on Schwar’s Row (18AP120), Annapolis, Maryland, 2012

This report is a summary of excavations conducted by Archaeology in Annapolis between May 29 2012 and July 6 2012 on Cornhill Street, Annapolis, Maryland. The report is divided into the following sections: Chapter 1: Introduction Chapter 2: Context and Historical Background Chapter 3: Archaeology and Interpretations Chapter 4: Conclusions and Recommendations Chapter 1 of this report is an introduction to the Cornhill Street excavations in 2012 at two areas designated Schwar’s Row East and Schwar’s Row West. Included within in this chapter are the dates of fieldwork, laboratory processing and analyses, the identification of key project staff, as well as research design and methodology. Chapter 2 of this report details the context and historical background of the properties. Included within this chapter is a short history of the ownership of the structures and the research questions for this investigation. Chapter 3 of this report details the results of archaeological testing of a total of four units at Schwar’s Row East and Schwar’s Row West. Included within this chapter is an account of stratigraphic layers, features, and significant artifacts encountered within individual test units. Also included within this chapter are interpretations of layers, features, and artifacts. Chapter 4 of this report details the conclusions based on the data recovered from these excavations and recommendations for further investigations

Magnetic-field-induced singularities in spin dependent tunneling through InAs quantum dots

Current steps attributed to resonant tunneling through individual InAs quantum dots embedded in a GaAs-AlAs-GaAs tunneling device are investigated experimentally in magnetic fields up to 28 T. The steps evolve into strongly enhanced current peaks in high fields. This can be understood as a field-induced Fermi-edge singularity due to the Coulomb interaction between the tunneling electron on the quantum dot and the partly spin polarized Fermi sea in the Landau quantized three-dimensional emitter.Comment: 5 pages, 4 figure

Acceptability of HIV self-sampling kits (TINY vial) among people of black African ethnicity in the UK: a qualitative study

Background: Increasing routine HIV testing among key populations is a public health imperative, so improving access to acceptable testing options for those in need is a priority. Despite increasing targeted distribution and uptake of HIV self-sampling kits (SSKs) among men who have sex with men in the UK, little is known about why targeted SSK interventions for black African users are not as wide-spread or well-used. This paper addresses this key gap, offering insight into why some groups may be less likely than others to adopt certain types of SSK interventions in particular contexts. These data were collected during the development phase of a larger study to explore the feasibility and acceptability of targeted distribution of SSKs to black African people. Methods: We undertook 6 focus groups with members of the public who self-identified as black African (n = 48), 6 groups with specialists providing HIV and social services to black African people (n = 53), and interviews with HIV specialist consultants and policy-makers (n = 9). Framework analysis was undertaken, using inductive and deductive analysis to develop and check themes. Results: We found three valuable components of targeted SSK interventions for this population: the use of settings and technologies that increase choice and autonomy; targeted offers of HIV testing that preserve privacy and do not exacerbate HIV stigma; and ensuring that the specific kit being used (in this case, the TINY vial) is perceived as simple and reliable. Conclusions: This unique and rigorous research offers insights into participants’ views on SSK interventions, offering key considerations when targeting this population.. Given the plethora of HIV testing options, our work demonstrates that those commissioning and delivering SSK interventions will need to clarify (for users and providers) how each kit type and intervention design adds value. Most significantly, these findings demonstrate that without a strong locus of control over their own circumstances and personal information, black African people are less likely to feel that they can pursue an HIV test that is safe and secure. Thus, where profound social inequalities persist, so will inequalities in HIV testing uptake – by any means

Ion acoustic wave experiments in a high school plasma physics laboratory

We describe a successful alliance between a university and several high schools. The alliance is centered on a laboratory experiment constructed by students and faculty. The experiment involves sophisticated concepts and equipment not readily available in high schools. Much of the experiment is directly related to the science and mathematics learned in high school, with opportunities to extend their understanding by applying it to a research experience. The experiment is in plasma physics, but a similar alliance can be implemented in any area of science. Although the number of high school students affected by any one alliance is small, the impact is potentially large in the scientific life of a participating student or teacher

A polarimetric Doppler radar time‐series simulator for biological applications

The high mobility of airborne organisms makes them inherently difficult to study, motivating the use of radars and radar networks as biological surveillance tools. While the utility of radar for ecological studies has been demonstrated, a number of challenges remain in expanding and optimizing their use for surveillance of birds, bats and insects. To explore these topics, a Lagrangian simulation scheme has been developed to synthesize realistic, polarimetric, pulsed Doppler radar baseband signals from modelled flocks of biological point scatterers. This radar simulation algorithm is described, and an application is presented using an agent-based model of the nocturnal emergence of a cave-dwelling colony of Brazilian free-tailed bats (Tadarida brasiliensis). Dualpolarization radar signals for an S-band weather surveillance radar are synthesized and used to develop a new extension of the spectral velocity azimuth display for polarimetric roost-ring signature analysis, demonstrating one capability of this simulation scheme. While these developments will have direct benefits for radar engineers and meteorologists, continuing investment in radar methods such as these will have cascading effects toward improving ecological models and developing new observational techniques for monitoring aerial wildlife

Political Mediation and American Old-Age Security Exceptionalism

Debates over America’s heavy reliance on employer-provided private pensions have understated the profound role organized labor played after World War II. Archival evidence from prominent unions and business associations suggests that the shift in organized labor’s strategy after the New Deal toward electoral activity helps explain critical interventions by Northern Democrats into the system of private pensioning in the postwar period that laid the foundation for America’s old-age security system. Such a strategy was insufficient, however, to expand Social Security. This article offers a political mediation account of electoral activity as a source of labor influence on social policy that draws on political institutionalist and class power theories

Using polarized maser to detect high-frequency relic gravitational waves

A GHz maser beam with Gaussian-type distribution passing through a homogenous static magnetic field can be used to detect gravitational waves (GWs) with the same frequency. The presence of GWs will perturb the electromagnetic (EM) fields, giving rise to perturbed photon fluxes (PPFs). After being reflected by a fractal membrane, the perturbed photons suffer little decay and can be measured by a microwave receiver. This idea has been explored to certain extent as a method for very high frequency gravitational waves. In this paper, we examine and develop this method more extensively, and confront the possible detection with the predicted signal of relic gravitational waves (RGWs). A maser beam with high linear polarization is used to reduce the background photon fluxes (BPFs) in the detecting direction as the main noise. As a key factor of applicability of this method, we give a preliminary estimation of the sensitivity of a sample detector limited by thermal noise using currently common technology. The minimal detectable amplitude of GWs is found to be $h_{\rm{min}}\sim10^{-30}$. Comparing with the known spectrum of the RGWs in the accelerating universe for $\beta=-1.9$, there is still roughly a gap of $4\sim 5$ orders. However, possible improvements on the detector can further narrow down the gap and make it a feasible method to detect high frequency RGWs.Comment: 20 pages, 6 figures, accepted for Phys. Rev.

Development of the Advancing the Patient Experience in COPD Registry:A Modified Delphi Study

Background: Chronic obstructive pulmonary disease (COPD) is commonly managed by family physicians, but little is known about specifics of management and how this may be improved. The Advancing the Patient Experience in COPD (APEX COPD) registry will be the first U.S. primary care, health system-based registry following patients diagnosed with COPD longitudinally, using a standardized set of variables to investigate how patients are managed in real life and assess outcomes of various management strategies.Objective: Gaining expert consensus on a standardized list of variables to capture in the APEX COPD registry.Methods: A modified, Delphi process was used to reach consensus on which data to collect in the registry from electronic health records (EHRs), patient-reported information (PRI) and patient-reported outcomes (PRO), and by physicians during subsequent office visits. The Delphi panel comprised 14 primary care and specialty COPD experts from the United States and internationally. The process consisted of 3 iterative rounds. Responses were collected electronically.Results: Of the initial 195 variables considered, consensus was reached to include up to 115 EHR variables, 34 PRI/PRO variables and 5 office-visit variables in the APEX COPD registry. These should include information on symptom burden, diagnosis, COPD exacerbations, lung function, quality of life, comorbidities, smoking status/history, treatment specifics (including side effects), inhaler management, and patient education/self-management.Conclusion: COPD experts agreed upon the core variables to collect from EHR data and from patients to populate the APEX COPD registry. Data will eventually be integrated, standardized and stored in the APEX COPD database and used for approved COPD-related research.</p