Risk factors for COPD exacerbations in inhaled medication users: the COPDGene study biannual longitudinal follow-up prospective cohort.

BackgroundDespite inhaled medications that decrease exacerbation risk, some COPD patients experience frequent exacerbations. We determined prospective risk factors for exacerbations among subjects in the COPDGene Study taking inhaled medications.Methods2113 COPD subjects were categorized into four medication use patterns: triple therapy with tiotropium (TIO) plus long-acting beta-agonist/inhaled-corticosteroid (ICS ± LABA), tiotropium alone, ICS ± LABA, and short-acting bronchodilators. Self-reported exacerbations were recorded in telephone and web-based longitudinal follow-up surveys. Associations with exacerbations were determined within each medication group using four separate logistic regression models. A head-to-head analysis compared exacerbation risk among subjects using tiotropium vs. ICS ± LABA.ResultsIn separate logistic regression models, the presence of gastroesophageal reflux, female gender, and higher scores on the St. George's Respiratory Questionnaire were significant predictors of exacerbator status within multiple medication groups (reflux: OR 1.62-2.75; female gender: OR 1.53 - OR 1.90; SGRQ: OR 1.02-1.03). Subjects taking either ICS ± LABA or tiotropium had similar baseline characteristics, allowing comparison between these two groups. In the head-to-head comparison, tiotropium users showed a trend towards lower rates of exacerbations (OR = 0.69 [95 % CI 0.45, 1.06], p = 0.09) compared with ICS ± LABA users, especially in subjects without comorbid asthma (OR = 0.56 [95% CI 0.31, 1.00], p = 0.05).ConclusionsEach common COPD medication usage group showed unique risk factor patterns associated with increased risk of exacerbations, which may help clinicians identify subjects at risk. Compared to similar subjects using ICS ± LABA, those taking tiotropium showed a trend towards reduced exacerbation risk, especially in subjects without asthma.Trial registrationClinicalTrials.gov NCT00608764, first received 1/28/2008

New High Field State of Flux Line Lattice in Unconventional Superconductor CeCoIn_5

Ultrasound velocity measurements of the unconventional superconductor CeCoIn_5 with extremely large Pauli paramagnetic susceptibility reveal an unusual structural transformation of the flux line lattice (FLL) in the vicinity of the upper critical field. The transition field coincides with that at which heat capacity measurements reveal a second order phase transition. The lowering of the sound velocity at the transition is consistent with the collapse of the FLL tilt modulus and a crossover to quasi two-dimensional FLL pinning. These results provide a strong evidence that the high field state is the Fulde-Ferrel-Larkin-Ovchinikov phase, in which the order parameter is spatially modulated and has planar nodes aligned perpendicular to the vortices.Comment: 5 pages, 4 figure

Microwave Surface-Impedance Measurements of the Magnetic Penetration Depth in Single Crystal Ba1-xKxFe2As2 Superconductors: Evidence for a Disorder-Dependent Superfluid Density

We report high-sensitivity microwave measurements of the in-plane penetration depth $\lambda_{ab}$ and quasiparticle scattering rate $1/\tau$ in several single crystals of hole-doped Fe-based superconductor Ba$_{1-x}$K$_x$Fe$_2$As$_2$ ($x\approx 0.55$). While power-law temperature dependence of $\lambda_{ab}$ with the power $\sim 2$ is found in crystals with large $1/\tau$, we observe exponential temperature dependence of superfluid density consistent with the existence of fully opened two gaps in the cleanest crystal we studied. The difference may be a consequence of different level of disorder inherent in the crystals. We also find a linear relation between the low-temperature scattering rate and the density of quasiparticles, which shows a clear contrast to the case of d-wave cuprate superconductors with nodes in the gap. These results demonstrate intrinsically nodeless order parameters in the Fe-arsenides.Comment: 4 pages, 4 figures, 1 table. Accepted for publication in Phys. Rev. Lett. Changed title as suggested by the PRL editor

Internal phase inversion narrow bandwidth MEMS filter

This paper reports a novel capacitively coupled twin beam resonator internal phase inversion filter fabricated in a SOI MEMS process. A narrow bandwidth of 0.0157% is demonstrated with a low control-voltage of -0.87 V. The bandwidth can be substantially reduced by utilizing an electrical coupling spring as opposed to a mechanical coupling-spring. The bandwidth is tunable with control achieved using a differential DC bias. A summary and comparison with other members of the phase inversion filter family is also included

Vortex Solid-Liquid Transition in Bi2_{2}Sr2_{2}CaCu2_{2}O8+δ_{8+\delta} with a High Density of Strong Pins

The introduction of a large density of columnar defects in %underdoped Bi$_{2}$Sr$_{2}$CaCu$_{2}$O$_{8+\delta}$ crystals does not, at sufficiently low vortex densities, increase the irreversibility line beyond the first order transition (FOT) field of pristine crystals. At such low fields, the flux line wandering length $r_{w}$ behaves as in pristine %Bi$_{2}$Sr$_{2}$CaCu$_{2}$O$_{8+\delta}$ crystals. Next, vortex positional correlations along the $c$--axis in the vortex Bose glass at fields above the FOT are smaller than in the low--field vortex solid. Third, the Bose-glass-to-vortex liquid transition is signaled by a rapid decrease in c-axis phase correlations. These observations are understood in terms of the ``discrete superconductor'' model.Comment: 4 pages, 4 figures Submitted to Phys. Rev. B Rapid Comm. 16-1-2004 Revised version 18-3-200

Defect-unbinding and the Bose-glass transition in layered superconductors

The low-field Bose-glass transition temperature in heavy-ion irradiated Bi_2Sr_2CaCu_2O_8+d increases progressively with increasing density of irradiation-induced columnar defects, but saturates for densities in excess of 1.5 x10^9 cm^-2. The maximum Bose-glass temperature corresponds to that above which diffusion of two-dimensional pancake vortices between different vortex lines becomes possible, and above which the ``line-like'' character of vortices is lost. We develop a description of the Bose-glass line that is in excellent quantitative agreement with the experimental line obtained for widely different values of track density and material parameters.Comment: 4 pages, 4 figures, submitted to Phys. Rev. Let

High rates of suicide and attempted suicide using pesticides in Nickerie, Suriname, South America

Suicide and attempted suicide are identified as a serious mental health problem in Suriname, especially in the district of Nickerie. An epidemiological study in the Nickerie catchment area revealed high rates of suicide (48 per 100,000) and attempted suicide (207 per 100,000) on average in the years 2000–2004. Particularly remarkable is the high number of attempted suicides among males (49%), and the use of pesticides in both fatal (55%) and nonfatal suicidal behavior (44%). Probably this high incidence of suicidal behavior reflects the very poor economic situation of the district, poverty of most of the population, high levels of alcohol misuse, domestic violence, the rigidity of Hindustani culture regarding family traditions, the accessibility of pesticides, and the lack of future perspectives. Health care alone will not be sufficient to tackle this problem. One of the most urgent measures to prevent suicides is to stow away pesticides in locked cabinets with the key held by the proprietor