Скорая медицинская помощь как критерий оценки эффективности антиастматической программы

An analysis of seeking the emergency care by asthma patients during the Asthma Program implementation (1995 to 2002) was performed in Smolensk. A close inverse correlation between number of patients receiving corticosteroids and their seeking the emergency care was found resulted from widespread adoption of inhaled corticosteroid therapy. During the 8-year asthma program implementation period numbers of calls to the emergency care service, emergent hospital admissions and patients seeking the emergency care reduced 3.1, 2.7, 2.2 times respectively.Проведен анализ обращаемости больных астмой на станцию скорой медицинской помощи Смоленска за период работы в городе антиастматической программы (1995-2002 г.). В период быстрого и широкого внедрения ингаляционной стероидной терапии выявлена тесная обратная корреляционная связь между выборочной долей больных, получающих стероидные препараты, и обращаемостью их на станцию скорой помощи. За 8 лет работы программы р городе число вызовов скорой помощи снизилось в 3,1 раза, экстренная госпитализация — в 2,7 раза, а число больных, пользующихся услугами скорой помощи, — в 2,2 раза

Вентиляционные нарушения и показатели артериальной ригидности у пациентов с хронической обструктивной болезнью легких

The aim of the study was to identify the correlation between ventilation disorders of the lungs and the development of arterial stiffness in patients with chronic obstructive pulmonary disease (COPD).Methods. The following parameters were evaluated in the patients (n = 61) enrolled in the study: spirometry, bodyplethysmography, cardiac-ankle vascular index (CAVI) and an ancho-brachial vascular index. Additionally, the pulse wave propagation velocity was calculated in the area from the ostium of the aorta to the infragenicular arteries.Results. According to the study results, a direct correlation, characterized by moderate to noticeable strength, was found between the parameters of pulmonary ventilation (bronchial resistance, intrathoracic gas volume, residual lung volume (RLV), total lung capacity (TLC), RLV/TLC) and the CAVI parameter, characterizing vascular stiffness on the section from the aorta ostium to the infragenicular arteries. It was shown that the best method for assessing changes in blood vessels is CAVI, which is independent of the level of blood pressure at the moment of the study.Conclusion. It has been established that if there is a correlation between impaired ventilation and arterial stiffness, the systemic nature of the lesion in COPD is confirmed, which explains the high incidence of cardiovascular diseases in patients with COPD. Целью работы явилось установление взаимосвязей между вентиляционными нарушениями легких и развитием артериальной ригидности (АР) у больных хронической обструктивной болезнью легких (ХОБЛ).Материалы и методы. У пациентов (n = 61), принявших участие в исследовании, проводились спирометрия, бодиплетизмография, оценивались показатели сердечно-лодыжечного индекса (cardial-ankle vascular index – CAVI) и анклобрахиального сосудистого индекса, выполнялся расчет скорости распространения пульсовой волны на участке от устья аорты до артерий голени.Результаты. По результатам исследования выявлена прямая корреляционная связь от умеренной до заметной силы между показателями легочной вентиляции (бронхиальное сопротивление, внутригрудной объем газа, остаточный объем легких (ООЛ), общая емкость легких (ОЕЛ), ООЛ / ОЕЛ) и показателем CAVI, характеризующим жесткость сосудов на участке от устья аорты до артерий голени. Показано, что оптимальным методом оценки изменений в сосудах является CAVI, не зависящий от уровня артериального давления на момент исследования.Заключение. Установлено, что при наличии взаимосвязи между нарушением вентиляции легких и АР подтверждается системный характер поражения при ХОБЛ, чем объясняется высокая частота встречаемости сердечно-сосудистых заболеваний у пациентов с ХОБЛ.

Итоги реализации положений GINA в практическое здравоохранение (6 лет работы Смоленска по антиастматической программе)

The results of six-year health-care system efforts in antiasthmatic program dedicated to the implementation of the principal guidelines of GINA were evaluated in Smolensk city. The educational programs for physicians and patients, and financial support of preferential release of antiasthmatic drugs have led to the radical changes in basic treatment of bronchial asthma. During the six-year period, the 23-fold increase in the proportion of inhalation glucocorticoids use has been accompanied by 1.7- and 1.5-fold decrease of the use of system steroids and cromoglycates, respectively. At the same period of time, in Smolensk the number of ambulance calls for asthmatic attack, the emergency hospitalization, the rate of disablement due to asthma, and primary disablement have been decreased 2.4, 2.3, 1.7, and 3.3 times, respectively.В Смоленске проведена оценка 6-летней работы здравоохранения по антиастматической программе, направленной на реализацию основных положений GINA. Образовательные программы для врачей и пациентов, финансовое обеспечение льготного отпуска антиастматических средств позволили координально изменить подход к базисной терапии больных астмой. Увеличение доли ингаляционных глюкокортикоидов сопровождалось снижением в 23 раза в структуре антиастматической терапии за 6 лет использования системных стероидов (в 1,7 раза), кромонов (в 1,5 раза). За этот период число вызовов скорой помощи к больным с приступом астмы уменьшилось в 2,4 раза, экстренная госпитализация в стационар сократилась в 2,3 раза, доля инвалидизирующей астмы в городе снизилась в 1,7 раза, а первичный выход на инвалидность – в 3,3 раза

Multiplicity dependence of jet-like two-particle correlations in p-Pb collisions at sNN\sqrt{s_{NN}} = 5.02 TeV

Two-particle angular correlations between unidentified charged trigger and associated particles are measured by the ALICE detector in p-Pb collisions at a nucleon-nucleon centre-of-mass energy of 5.02 TeV. The transverse-momentum range 0.7 $< p_{\rm{T}, assoc} < p_{\rm{T}, trig} <$ 5.0 GeV/$c$ is examined, to include correlations induced by jets originating from low momen\-tum-transfer scatterings (minijets). The correlations expressed as associated yield per trigger particle are obtained in the pseudorapidity range $|\eta|<0.9$. The near-side long-range pseudorapidity correlations observed in high-multiplicity p-Pb collisions are subtracted from both near-side short-range and away-side correlations in order to remove the non-jet-like components. The yields in the jet-like peaks are found to be invariant with event multiplicity with the exception of events with low multiplicity. This invariance is consistent with the particles being produced via the incoherent fragmentation of multiple parton--parton scatterings, while the yield related to the previously observed ridge structures is not jet-related. The number of uncorrelated sources of particle production is found to increase linearly with multiplicity, suggesting no saturation of the number of multi-parton interactions even in the highest multiplicity p-Pb collisions. Further, the number scales in the intermediate multiplicity region with the number of binary nucleon-nucleon collisions estimated with a Glauber Monte-Carlo simulation.Comment: 23 pages, 6 captioned figures, 1 table, authors from page 17, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/161

Multi-particle azimuthal correlations in p-Pb and Pb-Pb collisions at the CERN Large Hadron Collider

Measurements of multi-particle azimuthal correlations (cumulants) for charged particles in p-Pb and Pb-Pb collisions are presented. They help address the question of whether there is evidence for global, flow-like, azimuthal correlations in the p-Pb system. Comparisons are made to measurements from the larger Pb-Pb system, where such evidence is established. In particular, the second harmonic two-particle cumulants are found to decrease with multiplicity, characteristic of a dominance of few-particle correlations in p-Pb collisions. However, when a $|\Delta \eta|$ gap is placed to suppress such correlations, the two-particle cumulants begin to rise at high-multiplicity, indicating the presence of global azimuthal correlations. The Pb-Pb values are higher than the p-Pb values at similar multiplicities. In both systems, the second harmonic four-particle cumulants exhibit a transition from positive to negative values when the multiplicity increases. The negative values allow for a measurement of $v_{2}\{4\}$ to be made, which is found to be higher in Pb-Pb collisions at similar multiplicities. The second harmonic six-particle cumulants are also found to be higher in Pb-Pb collisions. In Pb-Pb collisions, we generally find $v_{2}\{4\} \simeq v_{2}\{6\}\neq 0$ which is indicative of a Bessel-Gaussian function for the $v_{2}$ distribution. For very high-multiplicity Pb-Pb collisions, we observe that the four- and six-particle cumulants become consistent with 0. Finally, third harmonic two-particle cumulants in p-Pb and Pb-Pb are measured. These are found to be similar for overlapping multiplicities, when a $|\Delta\eta| > 1.4$ gap is placed.Comment: 25 pages, 11 captioned figures, 3 tables, authors from page 20, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/87

Charge separation relative to the reaction plane in Pb-Pb collisions at sNN=2.76\sqrt{s_{\rm NN}}= 2.76 TeV

Measurements of charge dependent azimuthal correlations with the ALICE detector at the LHC are reported for Pb-Pb collisions at $\sqrt{s_{\rm NN}} = 2.76$ TeV. Two- and three-particle charge-dependent azimuthal correlations in the pseudo-rapidity range $|\eta| < 0.8$ are presented as a function of the collision centrality, particle separation in pseudo-rapidity, and transverse momentum. A clear signal compatible with a charge-dependent separation relative to the reaction plane is observed, which shows little or no collision energy dependence when compared to measurements at RHIC energies. This provides a new insight for understanding the nature of the charge dependent azimuthal correlations observed at RHIC and LHC energies.Comment: 12 pages, 3 captioned figures, authors from page 2 to 6, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/286

A note on comonotonicity and positivity of the control components of decoupled quadratic FBSDE

In this small note we are concerned with the solution of Forward-Backward Stochastic Differential Equations (FBSDE) with drivers that grow quadratically in the control component (quadratic growth FBSDE or qgFBSDE). The main theorem is a comparison result that allows comparing componentwise the signs of the control processes of two different qgFBSDE. As a byproduct one obtains conditions that allow establishing the positivity of the control process.Comment: accepted for publicatio

Centrality dependence of charged particle production at large transverse momentum in Pb-Pb collisions at sNN=2.76\sqrt{s_{\rm{NN}}} = 2.76 TeV

The inclusive transverse momentum ($p_{\rm T}$) distributions of primary charged particles are measured in the pseudo-rapidity range $|\eta|<0.8$ as a function of event centrality in Pb-Pb collisions at $\sqrt{s_{\rm{NN}}}=2.76$ TeV with ALICE at the LHC. The data are presented in the $p_{\rm T}$ range $0.15<p_{\rm T}<50$ GeV/$c$ for nine centrality intervals from 70-80% to 0-5%. The Pb-Pb spectra are presented in terms of the nuclear modification factor $R_{\rm{AA}}$ using a pp reference spectrum measured at the same collision energy. We observe that the suppression of high-$p_{\rm T}$ particles strongly depends on event centrality. In central collisions (0-5%) the yield is most suppressed with $R_{\rm{AA}}\approx0.13$ at $p_{\rm T}=6$-7 GeV/$c$. Above $p_{\rm T}=7$ GeV/$c$, there is a significant rise in the nuclear modification factor, which reaches $R_{\rm{AA}} \approx0.4$ for $p_{\rm T}>30$ GeV/$c$. In peripheral collisions (70-80%), the suppression is weaker with $R_{\rm{AA}} \approx 0.7$ almost independently of $p_{\rm T}$. The measured nuclear modification factors are compared to other measurements and model calculations.Comment: 17 pages, 4 captioned figures, 2 tables, authors from page 12, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/284

Anisotropic flow of charged hadrons, pions and (anti-)protons measured at high transverse momentum in Pb-Pb collisions at sNN=2.76\sqrt{s_{\rm NN}}=2.76 TeV

The elliptic, $v_2$, triangular, $v_3$, and quadrangular, $v_4$, azimuthal anisotropic flow coefficients are measured for unidentified charged particles, pions and (anti-)protons in Pb-Pb collisions at $\sqrt{s_{\rm NN}} = 2.76$ TeV with the ALICE detector at the Large Hadron Collider. Results obtained with the event plane and four-particle cumulant methods are reported for the pseudo-rapidity range $|\eta|<0.8$ at different collision centralities and as a function of transverse momentum, $p_{\rm T}$, out to $p_{\rm T}=20$ GeV/$c$. The observed non-zero elliptic and triangular flow depends only weakly on transverse momentum for $p_{\rm T}>8$ GeV/$c$. The small $p_{\rm T}$ dependence of the difference between elliptic flow results obtained from the event plane and four-particle cumulant methods suggests a common origin of flow fluctuations up to $p_{\rm T}=8$ GeV/$c$. The magnitude of the (anti-)proton elliptic and triangular flow is larger than that of pions out to at least $p_{\rm T}=8$ GeV/$c$ indicating that the particle type dependence persists out to high $p_{\rm T}$.Comment: 16 pages, 5 captioned figures, authors from page 11, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/186

Transverse sphericity of primary charged particles in minimum bias proton-proton collisions at s=0.9\sqrt{s}=0.9, 2.76 and 7 TeV

Measurements of the sphericity of primary charged particles in minimum bias proton--proton collisions at $\sqrt{s}=0.9$, 2.76 and 7 TeV with the ALICE detector at the LHC are presented. The observable is linearized to be collinear safe and is measured in the plane perpendicular to the beam direction using primary charged tracks with $p_{\rm T}\geq0.5$ GeV/c in $|\eta|\leq0.8$. The mean sphericity as a function of the charged particle multiplicity at mid-rapidity ($N_{\rm ch}$) is reported for events with different $p_{\rm T}$ scales ("soft" and "hard") defined by the transverse momentum of the leading particle. In addition, the mean charged particle transverse momentum versus multiplicity is presented for the different event classes, and the sphericity distributions in bins of multiplicity are presented. The data are compared with calculations of standard Monte Carlo event generators. The transverse sphericity is found to grow with multiplicity at all collision energies, with a steeper rise at low $N_{\rm ch}$, whereas the event generators show the opposite tendency. The combined study of the sphericity and the mean $p_{\rm T}$ with multiplicity indicates that most of the tested event generators produce events with higher multiplicity by generating more back-to-back jets resulting in decreased sphericity (and isotropy). The PYTHIA6 generator with tune PERUGIA-2011 exhibits a noticeable improvement in describing the data, compared to the other tested generators.Comment: 21 pages, 9 captioned figures, 3 tables, authors from page 16, published version, figures from http://aliceinfo.cern.ch/ArtSubmission/node/308