Oxygen for breathlessness in patients with chronic obstructive pulmonary disease who do not qualify for home oxygen therapy

© 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Background: Breathlessness is a cardinal symptom of chronic obstructive pulmonary disease (COPD). Long-term oxygen therapy (LTOT) is given to improve survival time in people with COPD and severe chronic hypoxaemia at rest. The efficacy of oxygen therapy for breathlessness and health-related quality of life (HRQOL) in people with COPD and mild or no hypoxaemia who do not meet the criteria for LTOT has not been established. Objectives: To determine the efficacy of oxygen versus air in mildly hypoxaemic or non-hypoxaemic patients with COPD in terms of (1) breathlessness; (2) HRQOL; (3) patient preference whether to continue therapy; and (4) oxygen-related adverse events. Search methods: We searched the Cochrane Airways Group Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase, to 12 July 2016, for randomised controlled trials (RCTs). We handsearched the reference lists of included articles. Selection criteria: We included RCTs of the effects of non-invasive oxygen versus air on breathlessness, HRQOL or patient preference to continue therapy among people with COPD and mild or no hypoxaemia (partial pressure of oxygen (PaO2) > 7.3 kPa) who were not already receiving LTOT. Two review authors independently assessed articles for inclusion in the review. Data collection and analysis: Two review authors independently collected and analysed data. We assessed risk of bias by using the Cochrane 'Risk of bias tool'. We pooled effects recorded on different scales as standardised mean differences (SMDs) with 95% confidence intervals (CIs) using random-effects models. Lower SMDs indicated decreased breathlessness and reduced HRQOL. We performed subanalyses and sensitivity analyses and assessed the quality of evidence according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Main results: Compared with the previous review, which was published in 2011, we included 14 additional studies (493 participants), excluded one study and included data for meta-analysis of HRQOL. In total, we included in this review 44 studies including 1195 participants, and we included 33 of these (901 participants)in the meta-analysis. We found that breathlessness during exercise or daily activities was reduced by oxygen compared with air (32 studies; 865 participants; SMD -0.34, 95% CI -0.48 to -0.21; I2 = 37%; low-quality evidence). This translates to a decrease in breathlessness of about 0.7 points on a 0 to 10 numerical rating scale. In contrast, we found no effect of short-burst oxygen given before exercise (four studies; 90 participants; SMD 0.01, 95% CI -0.26 to 0.28; I2 = 0%; low-quality evidence). Oxygen reduced breathlessness measured during exercise tests (25 studies; 442 participants; SMD -0.34, 95% CI -0.46 to -0.22; I2 = 29%; moderate-quality evidence), whereas evidence of an effect on breathlessness measured in daily life was limited (two studies; 274 participants; SMD -0.13, 95% CI, -0.37 to 0.11; I2 = 0%; low-quality evidence). Oxygen did not clearly affect HRQOL (five studies; 267 participants; SMD 0.10, 95% CI -0.06 to 0.26; I2 = 0%; low-quality evidence). Patient preference and adverse events could not be analysed owing to insufficient data. Authors' conclusions: We are moderately confident that oxygen can relieve breathlessness when given during exercise to mildly hypoxaemic and non-hypoxaemic people with chronic obstructive pulmonary disease who would not otherwise qualify for home oxygen therapy. Most evidence pertains to acute effects during exercise tests, and no evidence indicates that oxygen decreases breathlessness in the daily life setting. Findings show that oxygen does not affect health-related quality of life

Changing Bases: Multistage Optimization for Matroids and Matchings

This paper is motivated by the fact that many systems need to be maintained continually while the underlying costs change over time. The challenge is to continually maintain near-optimal solutions to the underlying optimization problems, without creating too much churn in the solution itself. We model this as a multistage combinatorial optimization problem where the input is a sequence of cost functions (one for each time step); while we can change the solution from step to step, we incur an additional cost for every such change. We study the multistage matroid maintenance problem, where we need to maintain a base of a matroid in each time step under the changing cost functions and acquisition costs for adding new elements. The online version of this problem generalizes online paging. E.g., given a graph, we need to maintain a spanning tree $T_t$ at each step: we pay $c_t(T_t)$ for the cost of the tree at time $t$, and also $| T_t\setminus T_{t-1} |$ for the number of edges changed at this step. Our main result is an $O(\log m \log r)$-approximation, where $m$ is the number of elements/edges and $r$ is the rank of the matroid. We also give an $O(\log m)$ approximation for the offline version of the problem. These bounds hold when the acquisition costs are non-uniform, in which caseboth these results are the best possible unless P=NP. We also study the perfect matching version of the problem, where we must maintain a perfect matching at each step under changing cost functions and costs for adding new elements. Surprisingly, the hardness drastically increases: for any constant $\epsilon>0$, there is no $O(n^{1-\epsilon})$-approximation to the multistage matching maintenance problem, even in the offline case

Information Aggregation in Exponential Family Markets

We consider the design of prediction market mechanisms known as automated market makers. We show that we can design these mechanisms via the mold of \emph{exponential family distributions}, a popular and well-studied probability distribution template used in statistics. We give a full development of this relationship and explore a range of benefits. We draw connections between the information aggregation of market prices and the belief aggregation of learning agents that rely on exponential family distributions. We develop a very natural analysis of the market behavior as well as the price equilibrium under the assumption that the traders exhibit risk aversion according to exponential utility. We also consider similar aspects under alternative models, such as when traders are budget constrained

Deceptive body movements reverse spatial cueing in soccer

This article has been made available through the Brunel Open Access Publishing Fund.The purpose of the experiments was to analyse the spatial cueing effects of the movements of soccer players executing normal and deceptive (step-over) turns with the ball. Stimuli comprised normal resolution or point-light video clips of soccer players dribbling a football towards the observer then turning right or left with the ball. Clips were curtailed before or on the turn (-160, -80, 0 or +80 ms) to examine the time course of direction prediction and spatial cueing effects. Participants were divided into higher-skilled (HS) and lower-skilled (LS) groups according to soccer experience. In experiment 1, accuracy on full video clips was higher than on point-light but results followed the same overall pattern. Both HS and LS groups correctly identified direction on normal moves at all occlusion levels. For deceptive moves, LS participants were significantly worse than chance and HS participants were somewhat more accurate but nevertheless substantially impaired. In experiment 2, point-light clips were used to cue a lateral target. HS and LS groups showed faster reaction times to targets that were congruent with the direction of normal turns, and to targets incongruent with the direction of deceptive turns. The reversed cueing by deceptive moves coincided with earlier kinematic events than cueing by normal moves. It is concluded that the body kinematics of soccer players generate spatial cueing effects when viewed from an opponent's perspective. This could create a reaction time advantage when anticipating the direction of a normal move. A deceptive move is designed to turn this cueing advantage into a disadvantage. Acting on the basis of advance information, the presence of deceptive moves primes responses in the wrong direction, which may be only partly mitigated by delaying a response until veridical cues emerge

Hydrogen reduction of ilmenite: Towards an in situ resource utilization demonstration on the surface of the Moon

Water is one of the most vital resources required for future space exploration. By obtaining water from lunar regolith, humans are one step closer to being independent of Earth's resources enabling longer term exploration missions. Hydrogen reduction of ilmenite is often proposed as a technique for producing water on the Moon. ProSPA, a miniature analytical laboratory, will perform reduction of lunar soils as an In-Situ Resource Utilization (ISRU) demonstration on the lunar surface. The technique used by ProSPA will be useful for prospecting payloads with limited mass and power resources. This work considers the development and optimization of an ilmenite (FeTiO3) reduction procedure for use with the ProSPA instrument. It is shown that the reaction can be performed in a static (non-flowing) system, by utilizing a cold finger to collect the water produced from the reaction. Among the investigated parameters an initial H2:FeTiO3 ratio of 1, in this case equating to a hydrogen pressure of 418 mbar, proved to be best for providing maximum yields over 4 h when operating at 1000 °C. Results indicate that a maximum yield of 3.40 ± 0.17 wt % O2 can be obtained at 1000 °C (with a maximum possible yield of 10.5 wt % O2). When operating at higher temperatures of 1100 °C the ilmenite grains undergo a subsolidus reaction resulting in the formation of ferropseudobrookite and higher yields of 4.42 ± 0.18 wt % O2 can be obtained