Bronchial thermoplasty: implementing best practice in the era of cost containment.

Increasing dependence on advanced technologies in the 21st century has created a dilemma between the practice and business of medicine. From information technology to robotic surgery, new technologies have expanded treatment possibilities and have potentially improved patient outcomes and safety. Simultaneously, their escalating costs limit access for certain patients and health care facilities. Nevertheless, medical decisions should not simply be based on cost. Input from physicians and other health care specialists as well as adherence to best practice position statements, are vital to implementing truly cost-effective strategies in medicine. Bronchial thermoplasty (BT), a US Food and Drug Administration approved bronchoscopy procedure in difficult-to-control persistent asthma, is a prime example of a new technology facing cost and implementation challenges. We discuss the specific indications and contraindications for BT and review recent real-world experiences that can provide the foundation for building a comprehensive asthma program that provides BT for difficult-to-control asthma patients who fail national guideline treatment recommendations after an adequate clinical trial of one. We also offer insight into the barriers to implementing a successful BT program and strategies for overcoming them

Classification of bifurcation diagrams in coupled phase-oscillator models with asymmetric natural frequency distributions

Synchronization among rhythmic elements is modeled by coupled phase-oscillators each of which has the so-called natural frequency. A symmetric natural frequency distribution induces a continuous or discontinuous synchronization transition from the nonsynchronized state, for instance. It has been numerically reported that asymmetry in the natural frequency distribution brings new types of bifurcation diagram having, in the order parameter, oscillation or a discontinuous jump which emerges from a partially synchronized state. We propose a theoretical classification method of five types of bifurcation diagrams including the new ones, paying attention to the generality of the theory. The oscillation and the jump from partially synchronized states are discussed respectively by the linear analysis around the nonsynchronized state and by extending the amplitude equation up to the third leading term. The theoretical classification is examined by comparing with numerically obtained one.Comment: 18 pages, 14 figure

EFFECTS OF COMPOST TEA MAKING FROM DIFFERENTLY TREATED COMPOST ON PLANT DISEASE CONTROL

Joint Research on Environmental Science and Technology for the Eart

LINX®, a novel treatment for patients with refractory asthma complicated by gastroesophageal reflux disease: a case report.

BackgroundGastroesophageal reflux disease is one of the most common comorbidities in patients with asthma. Gastroesophageal reflux disease can be linked to difficult-to-control asthma. Current management includes gastric acid suppression therapy and surgical antireflux procedures. The LINX® procedure is a novel surgical treatment for patients with gastroesophageal reflux disease refractory to medical therapy. To the best of our knowledge, we report the first case of successful treatment of refractory asthma secondary to gastroesophageal reflux disease using the LINX® procedure.Case presentationOur patient was a 22-year-old white woman who met the American Thoracic Society criteria for refractory asthma that had remained poorly controlled for 5 years despite progressive escalation to step 6 treatment as recommended by National Institutes of Health-National Asthma Education and Prevention Program guidelines, including high-dose oral corticosteroids, high-dose inhaled corticosteroid plus long-acting β2-agonist, leukotriene receptor antagonist, and monthly omalizumab. Separate trials with azithromycin therapy and roflumilast did not improve her asthma control, nor did bronchial thermoplasty help. Additional consultations with two other university health systems left the patient with few treatment options for asthma, which included cyclophosphamide. Instead, the patient underwent a LINX® procedure after failure of maximal medical therapy for gastroesophageal reflux disease with the additional aim of improving asthma control. After she underwent LINX® treatment, her asthma improved dramatically and was no longer refractory. She had normal exhaled nitric oxide levels and loss of peripheral eosinophilia after LINX® treatment. Prednisone was discontinued without loss of asthma control. The only immediate adverse effects due to the LINX® procedure were bloating, nausea, and vomiting.ConclusionsLINX® is a viable alternative to the Nissen fundoplication procedure for the treatment of patients with gastroesophageal reflux disease and poorly controlled concomitant refractory asthma

Symmetric hyperbolic system in the Ashtekar formulation

We present a first-order symmetric hyperbolic system in the Ashtekar formulation of general relativity for vacuum spacetime. We add terms from constraint equations to the evolution equations with appropriate combinations, which is the same technique used by Iriondo, Leguizam\'on and Reula [Phys. Rev. Lett. 79, 4732 (1997)]. However our system is different from theirs in the points that we primarily use Hermiticity of a characteristic matrix of the system to characterize our system "symmetric", discuss the consistency of this system with reality condition, and show the characteristic speeds of the system.Comment: 4 pages, RevTeX, to appear in Phys. Rev. Lett., Comments added, refs update

Riccati Solutions of Discrete Painlev\'e Equations with Weyl Group Symmetry of Type E8(1)E_8^{(1)}

We present a special solutions of the discrete Painlev\'e equations associated with $A_0^{(1)}$, $A_0^{(1)*}$ and $A_0^{(1)**}$-surface. These solutions can be expressed by solutions of linear difference equations. Here the $A_0^{(1)}$-surface discrete Painlev\'e equation is the most generic difference equation, as all discrete Painlev\'e equations can be obtained by its degeneration limit. These special solutions exist when the parameters of the discrete Painlev\'e equation satisfy a particular constraint. We consider that these special functions belong to the hypergeometric family although they seems to go beyond the known discrete and $q$-discrete hypergeometric functions. We also discuss the degeneration scheme of these solutions.Comment: 22 page

Neutron wave packet tomography

A tomographic technique is introduced in order to determine the quantum state of the center of mass motion of neutrons. An experiment is proposed and numerically analyzed.Comment: 4 pages, 3 figure