Attitudes and access to lung volume reduction surgery for COPD: a survey by the British Thoracic Society.

OBJECTIVE: Lung volume reduction surgery for emphysema leads to improved survival in appropriately selected individuals, and it is therefore recommended in national and international guidelines for this group of patients. Despite this, fewer than 100 patients undergo the procedure each year in the UK. Our objective was to establish whether this reflects concerns about morbidity and mortality or difficulties in the referral pathway. DESIGN AND SETTING: We conducted a survey of members of the British Thoracic Society by email to investigate this in the second half of 2013. The survey included questions about access to investigations, the indications for lung volume reduction surgery (LVRS), whether a multidisciplinary meeting discussed eligibility of patients for LVRS and what the morbidity and mortality associated with the procedure was. RESULTS: There were 65 responses, 82% from respiratory physicians. Roughly half of the respondents were either unsure about the risks of death or prolonged (>30 days) hospital stay involved or significantly over-estimated them. In total, 70% did not have a specific multidisciplinary team to discuss the management of patients with advanced chronic obstructive pulmonary disease (COPD). There was no consensus as to which patients with COPD should undergo a CT scan to evaluate them for possible surgery. CONCLUSIONS: Patients with COPD require a systematic and multidisciplinary approach to assessment for LVRS and these survey data suggest that work is needed to deliver this evidence-based therapy in a consistent and comprehensive way across the UK

An evaluation of Saudi Arabia’s policies for economic diversification

The aim of this thesis is to evaluate Saudi Arabia's policies for diversification. Economic diversification only became a realistic possibility following the first major oil price rise in the early 1970's. Not surprisingly the immediate reaction was to follow the example of western industrialised countries, and consequently very ambitious plans were discussed. This over reaction was soon rationalised. The Second Development Plan covering the 1975-1980 period, laid the foundations for diversifying the economy by providing for the creation of a much needed infrastructure. It vas left to the Third Development Plan covering the 1980-1985 period, to define a selective approach to industrialisation so that only the economically feasible projects remained. It is rather too early to assess just how successful the Third Plan has been. The most that can fairly be asked is: has the Government begun to implement its policies for economic diversification? The abrupt change in revenues almost forced the Government to rely on imports for development if it wished to take immediate action because of its limited domestic economy. Consequently, industrialisation in Saudi Arabia is largely dependent on imports, and most diversification amounts to the implementation of import substitution policies. Export diversification is virtually the export of any goods or services other than oil. It is thus essential to analyse the determinants of imports and exports and to look at recent trends

On the Impossibility to Extend Triples of Mutually Unbiased Product Bases in Dimension Six

An analytic proof is given which shows that it is impossible to extend any triple of mutually unbiased (MU) product bases in dimension six by a single MU vector. Furthermore, the 16 states obtained by removing two orthogonal states from any MU product triple cannot figure in a (hypothetical) complete set of seven MU bases. These results follow from exploiting the structure of MU product bases in a novel fashion, and they are among the strongest ones obtained for MU bases in dimension six without recourse to computer algebra.Comment: 12 pages, identical to published versio

Structure of the proton-gated urea channel from the gastric pathogen Helicobacter pylori.

Half the world's population is chronically infected with Helicobacter pylori, causing gastritis, gastric ulcers and an increased incidence of gastric adenocarcinoma. Its proton-gated inner-membrane urea channel, HpUreI, is essential for survival in the acidic environment of the stomach. The channel is closed at neutral pH and opens at acidic pH to allow the rapid access of urea to cytoplasmic urease. Urease produces NH(3) and CO(2), neutralizing entering protons and thus buffering the periplasm to a pH of roughly 6.1 even in gastric juice at a pH below 2.0. Here we report the structure of HpUreI, revealing six protomers assembled in a hexameric ring surrounding a central bilayer plug of ordered lipids. Each protomer encloses a channel formed by a twisted bundle of six transmembrane helices. The bundle defines a previously unobserved fold comprising a two-helix hairpin motif repeated three times around the central axis of the channel, without the inverted repeat of mammalian-type urea transporters. Both the channel and the protomer interface contain residues conserved in the AmiS/UreI superfamily, suggesting the preservation of channel architecture and oligomeric state in this superfamily. Predominantly aromatic or aliphatic side chains line the entire channel and define two consecutive constriction sites in the middle of the channel. Mutation of Trp 153 in the cytoplasmic constriction site to Ala or Phe decreases the selectivity for urea in comparison with thiourea, suggesting that solute interaction with Trp 153 contributes specificity. The previously unobserved hexameric channel structure described here provides a new model for the permeation of urea and other small amide solutes in prokaryotes and archaea

THE USE OF INVERSE THEORY ON AN ILL-POSED ENVIRONMENTAL COMPOSITE SAMPLING PROBLEM

As an alternative to retesting, the use of inverse theory techniques is proposed to resolve the lack of information inherent in composite sampling methods. This paper evaluates the feasibility of combining composite sampling with the inverse theory technique of linear regularization on an environmental site characterization investigation. Federal legislation has mandated the cleanup of hazardous waste sites, creating the need to characterize these sites for various chemical constituents. An abundance of samples, high measurement costs, and limited budgets create the appeal of compositing samples. We propose that the number of costly laboratory analyses can be reduced by combining composite sampling and inverse theory techniques. The goal of the paper is to estimate the constituent concentration for the sample units used to construct the composite . A novel application of linear regularization is illustrated with a data set from an environmental investigation into mercury contamination at a waste disposal site in New Mexico. The disposal site has measurements at both the composite and sample unit level. This allows for a rare opportunity to evaluate the assumptions made about the compositing process and to compare estimates based on composite measurements with estimates based on sample unit measurements

The Efficacy of Peripheral Opioid Antagonists in Opioid-Induced Constipation and Postoperative Ileus: A Systematic Review of the Literature.

Opioid-induced constipation has a negative impact on quality of life for patients with chronic pain and can affect more than a third of patients. A related but separate entity is postoperative ileus, which is an abnormal pattern of gastrointestinal motility after surgery. Nonselective μ-opioid receptor antagonists reverse constipation and opioid-induced ileus but cross the blood-brain barrier and may reverse analgesia. Peripherally acting μ-opioid receptor antagonists target the μ-opioid receptor without reversing analgesia. Three such agents are US Food and Drug Administration approved. We reviewed the literature for randomized controlled trials that studied the efficacy of alvimopan, methylnaltrexone, and naloxegol in treating either opioid-induced constipation or postoperative ileus. Peripherally acting μ-opioid receptor antagonists may be effective in treating both opioid-induced bowel dysfunction and postoperative ileus, but definitive conclusions are not possible because of study inconsistency and the relatively low quality of evidence. Comparisons of agents are difficult because of heterogeneous end points and no head-to-head studies

Developing and testing accelerated partner therapy for partner notification for people with genital Chlamydia trachomatis diagnosed in primary care: a pilot randomised controlled trial

Background Accelerated partner therapy (APT) is a promising partner notification (PN) intervention in specialist sexual health clinic attenders. To address its applicability in primary care, we undertook a pilot randomised controlled trial (RCT) of two APT models in community settings. Methods Three-arm pilot RCT of two adjunct APT interventions: APTHotline (telephone assessment of partner(s) plus standard PN) and APTPharmacy (community pharmacist assessment of partner(s) plus routine PN), versus standard PN alone (patient referral). Index patients were women diagnosed with genital chlamydia in 12 general practices and three community contraception and sexual health (CASH) services in London and south coast of England, randomised between 1 September 2011 and 31 July 2013. Results 199 women described 339 male partners, of whom 313 were reported by the index as contactable. The proportions of contactable partners considered treated within 6 weeks of index diagnosis were APTHotline 39/111 (35%), APTPharmacy 46/100 (46%), standard patient referral 46/102 (45%). Among treated partners, 8/39 (21%) in APTHotline arm were treated via hotline and 14/46 (30%) in APTPharmacy arm were treated via pharmacy. Conclusions The two novel primary care APT models were acceptable, feasible, compliant with regulations and capable of achieving acceptable outcomes within a pilot RCT but intervention uptake was low. Although addition of these interventions to standard PN did not result in a difference between arms, overall PN uptake was higher than previously reported in similar settings, probably as a result of introducing a formal evaluation. Recruitment to an individually randomised trial proved challenging and full evaluation will likely require service-level randomisation

Navigating TEFRA Partnership Audits in Multi-Tiered Entity Structures

The Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) established a unified procedure for determining the tax treatment of partnership items at the partnership level rather than the partner level. Although these rules addressed a serious and real administrative problem in the assessment of partnership level deficiencies, they also created a complex process with many new problems and potential traps. One particularly unique set of challenges arises in the context of multi-tiered entities.Multi-tiered entities are partnerships that have a partnership or other pass-through entity as a partner. The pass-through partner is commonly referred to as a “tier,” and the partnership in which it holds its interest is the “source” partnership. The partners who hold an interest in the source partnership through a pass-through partner are “indirect partners” of the source partnership. TEFRA procedures apply to all partners, whether direct partners, pass-through partners, and indirect partners. Pass-through partners and indirect partners face unique issues in navigating the TEFRA rules. This article highlights some common issues.The Internal Revenue Service (IRS) provides notices of the beginning of an audit to the partnership and “notice partners,” generally those partners identified on the partnership’s return. Pass-through partners are required to pass the information along to their partners, but any partnership proceedings and adjustments apply to indirect partners even if they did not receive notice of the proceedings. Indirect partners therefore may wish to follow the special procedure to become notice partners and therefore receive notifications directly from the IRS. This may be particularly important if the pass-through partner is in bankruptcy or the indirect partner holds less than 1% interest in a large partnership. All partners have a right to participate in certain administrative proceedings. However, some rights are limited to notice partners, such as the right to file a protest to a notice of final partnership administrative adjustment (FPAA) or the right to file a petition for redetermination in Tax Court. Further, the tax matters partner (TMP) can reach a settlement with the IRS that binds all partners who are not notice partners, while notice partners can accept the settlement or not. Thus, indirect partners may wish to protect these rights by follow the special procedure to become notice partners.Finally, the statute of limitations for assessment of taxes attributable to partnership items is longer for “unidentified partners”; it does not expire until one year after the unidentified partner is identified to the IRS. Becoming a notice partner may therefore prevent an indefinite extension of the statute of limitations for indirect partners. This is particularly important if the indirect partner, whether knowingly or unknowingly, takes a position on its tax return that is inconsistent with the partnership’s return.In many ways, TEFRA reduced the procedural burden on partners by streamlining the process and reducing overall audit costs. In exchange for this benefit, TEFRA’s procedures in many cases shift the notice burden to pass-through partners and limit an indirect partner’s right to control the resolution of its tax liability. Pass-through partners and indirect partners should approach a TEFRA audit with caution. A pass-through partner should take care to comply with TEFRA’s notice requirements to avoid potential liability to its partners. Likewise, indirect partners should protect their rights to participate in partnership-level proceedings and to control the resolution of their own tax liability