Lung function, symptoms and inflammation during exacerbations of non-cystic fibrosis bronchiectasis: a prospective observational cohort study.

Exacerbations of non-cystic fibrosis bronchiectasis cause significant morbidity but there are few detailed data on their clinical course and associated physiological changes. The biology of an exacerbation has not been previously described

Algorithm for AEEG data selection leading to wireless and long term epilepsy monitoring

Published versio

An analogue bandpass filter realisation of the Continuous Wavelet Transform

The Continuous Wavelet Transform (CWT) is a highly useful signal processing technique for which low power implementations are desirable, for example to allow the transform to be used in battery powered, portable devices. This paper describes a Low Power CWT (LPCWT) implementation that is based around the mathematical approximation of a mother wavelet and uses application specific information to guide the approximation process. Simulations comparing the LPCWT and CWT are carried out with the two giving equivalent signal processing performance. The LPCWT is suitable for realisation in any desired circuit topology.Published versio

Theoretical Study of Ag Interactions in Amorphous Silica RRAM Devices

In this study, Density Functional Theory (DFT) calculations were used to model the incorporation and diffusion of Ag in Ag/a-Si02/Pt resistive random-access memory (RRAM) devices. The Ag clustering mechanism is vital for understanding device operation and at this stage is unknown. In this paper an O vacancy (Vo) mediated cluster model is presented, where the Vo is identified as the principle site for Ag^{+} reduction. The Ag^{+} interstitial is energetically favored at the Fermi energies of Ag and Pt, indicating that Ag^{+} ions are not reduced at the Pt electrode via electron tunneling. Instead, Ag^{+} ions bind to Vo forming the [Ag/Vo]^{+} complex, reducing Ag^{+} via charge transfer from the Si atoms in the vacancy. The [Ag/Vo]^{+} complex is then able to trap an electron forming [Ag/Vo]^{0} at the Fermi energy of Pt. This complex is then able to act as a nucleation site for of Ag clustering with the formation of [Ag2/Vo]^{+} which is reduced by the above mechanism

IL-17A increases TNF-α-induced COX-2 protein stability and augments PGE<inf>2</inf> secretion from airway smooth muscle cells: Impact on β<inf>2</inf>-adrenergic receptor desensitization

© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Background IL-17A plays an important role in respiratory disease and is a known regulator of pulmonary inflammation and immunity. Recent studies have linked IL-17A with exacerbation in asthma and COPD. We have shown that the enzyme cyclooxygenase-2 (COX-2) and its prostanoid products, prostaglandin E2 (PGE2) in particular, are key contributors in in vitro models of infectious exacerbation; however, the impact of IL-17A was not known. Methods and Results We address this herein and show that IL-17A induces a robust and sustained upregulation of COX-2 protein and PGE2 secretion from airway smooth muscle (ASM) cells. COX-2 can be regulated at transcriptional, post-transcriptional and/or post-translational levels. We have elucidated the underlying molecular mechanisms responsible for the sustained upregulation of TNF-α-induced COX-2 by IL-17A in ASM cells and show that is not via increased COX-2 gene expression. Instead, TNF-α-induced COX-2 upregulation is subject to regulation by the proteasome, and IL-17A acts to increase TNF-α-induced COX-2 protein stability as confirmed by cycloheximide chase experiments. In this way, IL-17A acts to amplify the COX-2-mediated effects of TNF-α and greatly enhances PGE2 secretion from ASM cells. Conclusion As PGE2 is a multifunctional prostanoid with diverse roles in respiratory disease, our studies demonstrate a novel function for IL-17A in airway inflammation by showing for the first time that IL-17A impacts on the COX-2/PGE2 pathway, molecules known to contribute to disease exacerbation

Daily activity during stability and exacerbation of chronic obstructive pulmonary disease

BACKGROUND: During most COPD exacerbations, patients continue to live in the community but there is little information on changes in activity during exacerbations due to the difficulties of obtaining recent, prospective baseline data. METHODS: Patients recorded on daily diary cards any worsening in respiratory symptoms, peak expiratory flow (PEF) and the number of steps taken per day measured with a Yamax Digi-walker pedometer. Exacerbations were defined by increased respiratory symptoms and the number of exacerbations experienced in the 12 months preceding the recording of daily step count used to divide patients into frequent (> = 2/year) or infrequent exacerbators. RESULTS: The 73 COPD patients (88% male) had a mean (+/-SD) age 71(+/-8) years and FEV1 53(+/-16)% predicted. They recorded pedometer data on a median 198 days (IQR 134-353). At exacerbation onset, symptom count rose by 1.9(+/-1.3) and PEF fell by 7(+/-13) l/min. Mean daily step count fell from 4154(+/-2586) steps/day during a preceding baseline week to 3673(+/-2258) step/day during the initial 7 days of exacerbation (p = 0.045). Patients with larger falls in activity at exacerbation took longer to recover to stable level (rho = -0.56; p < 0.001). Recovery in daily step count was faster (median 3.5 days) than for exacerbation symptoms (median 11 days; p < 0.001). Recovery in step count was also faster in untreated compared to treated exacerbation (p = 0.030).Daily step count fell faster over time in the 40 frequent exacerbators, by 708 steps/year, compared to 338 steps/year in 33 infrequent exacerbators (p = 0.002). CONCLUSIONS: COPD exacerbations reduced physical activity and frequent exacerbations accelerate decline in activity over time

The nature of column boundaries in micro-structured silicon oxide nanolayers

Columnar microstructures are critical for obtaining good resistance switching properties in SiOx resistive random access memory (ReRAM) devices. In this work, the formation and structure of columnar boundaries are studied in sputtered SiOx layers. Using TEM measurements, we analyze SiOx layers in Me–SiOx–Mo heterostructures, where Me = Ti or Au/Ti. We show that the SiOx layers are templated by the Mo surface roughness, leading to the formation of columnar boundaries protruding from troughs at the SiOx/Mo interface. Electron energy-loss spectroscopy measurements show that these boundaries are best characterized as voids, which in turn facilitate Ti, Mo, and Au incorporation from the electrodes into SiOx. Density functional theory calculations of a simple model of the SiO2 grain boundary and column boundary show that O interstitials preferentially reside at the boundaries rather than in the SiO2 bulk. The results elucidate the nature of the SiOx microstructure and the complex interactions between the metal electrodes and the switching oxide, each of which is critically important for further materials engineering and the optimization of ReRAM devices

The Cost-effectiveness of Pixantrone for Third/Fourth-line Treatment of Aggressive Non-Hodgkin's Lymphoma

PURPOSE: Aggressive non-Hodgkin's lymphoma (aNHL) is associated with poor long-term survival after relapse, and treatment is limited by a lack of consensus regarding standard of care. Pixantrone was studied in a randomized trial in patients with relapsed or refractory aNHL who had failed ≥ 2 lines of therapy, demonstrating a significant improvement in complete or unconfirmed complete response and progression-free survival (PFS) compared with investigators' choice of single-agent therapy. The objective of this study was to assess the health economic implications of pixantrone versus current clinical practice (CCP) in the United Kingdom for patients with multiply relapsed or refractory aNHL receiving their third or fourth line of treatment. METHODS: A semi-Markov partition model based on overall survival and PFS was developed to evaluate the lifetime clinical and economic impact of treatment of multiply relapsed or refractory aNHL with pixantrone versus CCP. The empirical overall survival and PFS data from the PIX301 trial were extrapolated to a lifetime horizon. Resource use was elicited from clinical experts, and unit costs and utilities were obtained from published sources. The analysis was conducted from the perspective of the United Kingdom's National Health Service and personal social services. Outcomes evaluated were total costs, life-years, quality-adjusted life-years (QALYs), and cost per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted to assess uncertainty around the results. FINDINGS: Pixantrone was estimated to increase life expectancy by a mean of 10.8 months per patient compared with CCP and a mean gain of 0.56 discounted QALYs. The increased health gains were associated with an increase in discounted costs of approximately £18,494 per patient. The incremental cost-effectiveness ratio of pixantrone versus CCP was £33,272 per QALY gained. Sensitivity and scenario analyses suggest that the incremental cost-effectiveness ratio was sensitive to uncertainty in the PFS and overall survival estimates and the utility values associated with each health state. IMPLICATIONS: Pixantrone may be considered both clinically effective and cost-effective for patients with multiply relapsed or refractory aNHL who currently have a high level of unmet need