Evaluating Patient Preferences of Maintenance Therapy for the Treatment of Chronic Obstructive Pulmonary Disease: A Discrete Choice Experiment in the UK, USA and Germany.

Introduction: With increasing availability of different treatments for chronic obstructive pulmonary disease (COPD), we sought to understand patient preferences for COPD treatment in the UK, USA, and Germany using a discrete choice experiment (DCE). Methods: Qualitative research identified six attributes associated with COPD maintenance treatments: ease of inhaler use, exacerbation frequency, frequency of inhaler use, number of different inhalers used, side effect frequency, and out-of-pocket costs. A DCE using these attributes, with three levels each, was designed and tested through cognitive interviews and piloting. It comprised 18 choice sets, selected using a D-efficient experimental design. Demographics and disease history were collected and the final DCE survey was completed online by participants recruited from panels in the UK, USA and Germany. Responses were analyzed using mixed logit models, with results expressed as odds ratios (ORs). Results: Overall, 450 participants (150 per country) completed the DCE; most (UK and Germany, 97.3%; USA, 98.0%) were included in the final analysis. Based on relative attribute importance, avoidance of side effects was found to be most important (UK: OR 11.65; USA: OR 7.17; Germany: OR 11.45; all p<0.0001), followed by the likelihood of fewer exacerbations (UK: OR 2.22; USA: OR 1.63; Germany: OR 2.54; all p<0.0001) and increased ease of use (UK: OR 1.84; USA: OR 1.84; Germany: OR 1.60; all p<0.0001). Number of inhalers, out-of-pocket costs, and frequency of inhaler use were found to be less important. Preferences were relatively consistent across the three countries. All participants required a reduction in exacerbations to accept more frequent inhaler use or use of more inhalers. Conclusion: When selecting COPD treatment, individuals assigned the highest value to the avoidance of side effects, experiencing fewer exacerbations, and ease of inhaler use. Ensuring that patients' preferences are considered may encourage treatment compliance

Combining deep and handcrafted image features for MRI brain scan classification

Progresses in the areas of artificial intelligence, machine learning, and medical imaging technologies have allowed the development of the medical image processing field with some astonishing results in the last two decades. These innovations enabled the clinicians to view the human body in high-resolution or three-dimensional cross-sectional slices, which resulted in an increase in the accuracy of the diagnosis and the examination of patients in a non-invasive manner. The fundamental step for MRI brain scans classifiers is their ability to extract meaningful features. As a result, many works have proposed different methods for features extraction to classify the abnormal growths in brain MRI scans. More recently, the application of deep learning algorithms to medical imaging lead to impressive performance enhancements in classifying and diagnosing complicated pathologies such as brain tumors. In this study, a deep learning feature extraction algorithm is proposed to extract the relevant features from MRI brain scans. In parallel, handcrafted features are extracted using the modified grey level co-occurrence matrix (MGLCM) method. Subsequently, the extracted relevant features are combined with handcrafted features to improve the classification process of MRI brain scans with SVM used as the classifier. The obtained results proved that the combination of the deep learning approach and the handcrafted features extracted by MGLCM improves the accuracy of classification of the SVM classifier up to 99.30%

A Cross-Sectional Study of People with Epilepsy and Neurocysticercosis in Tanzania: Clinical Characteristics and Diagnostic Approaches.

Neurocysticercosis (NCC) is a major cause of epilepsy in regions where pigs are free-ranging and hygiene is poor. Pork production is expected to increase in the next decade in sub-Saharan Africa, hence NCC will likely become more prevalent. In this study, people with epilepsy (PWE, n=212) were followed up 28.6 months after diagnosis of epilepsy. CT scans were performed, and serum and cerebrospinal fluid (CSF) of selected PWE were analysed. We compared the demographic data, clinical characteristics, and associated risk factors of PWE with and without NCC. PWE with NCC (n=35) were more likely to be older at first seizure (24.3 vs. 16.3 years, p=0.097), consumed more pork (97.1% vs. 73.6%, p=0.001), and were more often a member of the Iraqw tribe (94.3% vs. 67.8%, p=0.005) than PWE without NCC (n=177). PWE and NCC who were compliant with anti-epileptic medications had a significantly higher reduction of seizures (98.6% vs. 89.2%, p=0.046). Other characteristics such as gender, seizure frequency, compliance, past medical history, close contact with pigs, use of latrines and family history of seizures did not differ significantly between the two groups. The number of NCC lesions and active NCC lesions were significantly associated with a positive antibody result. The electroimmunotransfer blot, developed by the Centers for Disease Control and Prevention, was more sensitive than a commercial western blot, especially in PWE and cerebral calcifications. This is the first study to systematically compare the clinical characteristics of PWE due to NCC or other causes and to explore the utility of two different antibody tests for diagnosis of NCC in sub-Saharan Africa

Innovator resilience potential: A process perspective of individual resilience as influenced by innovation project termination

Innovation projects fail at an astonishing rate. Yet, the negative effects of innovation project failures on the team members of these projects have been largely neglected in research streams that deal with innovation project failures. After such setbacks, it is vital to maintain or even strengthen project members’ innovative capabilities for subsequent innovation projects. For this, the concept of resilience, i.e. project members’ potential to positively adjust (or even grow) after a setback such as an innovation project failure, is fundamental. We develop the second-order construct of innovator resilience potential, which consists of six components – self-efficacy, outcome expectancy, optimism, hope, self-esteem, and risk propensity – that are important for project members’ potential of innovative functioning in innovation projects subsequent to a failure. We illustrate our theoretical findings by means of a qualitative study of a terminated large-scale innovation project, and derive implications for research and management

Renal transplantation at the University of Pittsburgh: the impact of FK506.

1. In an unselected adult renal transplant population, FK506 as the primary immunosuppressive agent yielded one- and 2-year actuarial patient survival rates of 95% and 93% and one- and 2-year actuarial graft survival rates of 89% and 83%, respectively. Forty-nine percent of successfully transplanted patients were weaned off steroids. 2. In pediatric renal transplant patients, FK506 has been associated with 100% one- and 3-year actuarial patient survival rates and 98% and 85% one- and 3-year actuarial graft survival rates, respectively. Sixty-two percent of successfully transplanted patients were taken off prednisone, with dramatic improvements in height. 3. FK506 has been used successfully in rescuing 70-74% of adult or pediatric renal transplant patients with an acute rejection that failed conventional therapy. 4. Kidney/bone marrow transplantation under FK506 therapy has been successfully performed without graft-versus-host disease and with routine augmentation of chimerism. 5. The side effects of FK506 included nephrotoxicity, neurotoxicity, and diabetogenicity; they were comparable to those seen with CsA. 6. FK506 is an important new addition to the immunosuppressive armamentarium in renal transplant patients

Nekrasov Functions and Exact Bohr-Sommerfeld Integrals

In the case of SU(2), associated by the AGT relation to the 2d Liouville theory, the Seiberg-Witten prepotential is constructed from the Bohr-Sommerfeld periods of 1d sine-Gordon model. If the same construction is literally applied to monodromies of exact wave functions, the prepotential turns into the one-parametric Nekrasov prepotential F(a,\epsilon_1) with the other epsilon parameter vanishing, \epsilon_2=0, and \epsilon_1 playing the role of the Planck constant in the sine-Gordon Shroedinger equation, \hbar=\epsilon_1. This seems to be in accordance with the recent claim in arXiv:0908.4052 and poses a problem of describing the full Nekrasov function as a seemingly straightforward double-parametric quantization of sine-Gordon model. This also provides a new link between the Liouville and sine-Gordon theories.Comment: 10 page

Impaired Competence for Pretense in Children with Autism: Exploring Potential Cognitive Predictors.

Lack of pretense in children with autism has been explained by a number of theoretical explanations, including impaired mentalising, impaired response inhibition, and weak central coherence. This study aimed to empirically test each of these theories. Children with autism (n=60) were significantly impaired relative to controls (n=65) when interpreting pretense, thereby supporting a competence deficit hypothesis. They also showed impaired mentalising and response inhibition, but superior local processing indicating weak central coherence. Regression analyses revealed that mentalising significantly and independently predicted pretense. The results are interpreted as supporting the impaired mentalising theory and evidence against competing theories invoking impaired response inhibition or a local processing bias. The results of this study have important implications for treatment and intervention

f(R) Gravities, Killing Spinor Equations, "BPS" Domain Walls and Cosmology

We derive the condition on f(R) gravities that admit Killing spinor equations and construct explicit such examples. The Killing spinor equations can be used to reduce the fourth-order differential equations of motion to the first order for both the domain wall and FLRW cosmological solutions. We obtain exact "BPS" domain walls that describe the smooth Randall-Sundrum II, AdS wormholes and the RG flow from IR to UV. We also obtain exact smooth cosmological solutions that describe the evolution from an inflationary starting point with a larger cosmological constant to an ever-expanding universe with a smaller cosmological constant. In addition, We find exact smooth solutions of pre-big bang models, bouncing or crunching universes. An important feature is that the scalar curvature R of all these metrics is varying rather than a constant. Another intriguing feature is that there are two different f(R) gravities that give rise to the same "BPS" solution. We also study linearized f(R) gravities in (A)dS vacua.Comment: 37 pages, discussion on gravity trapping in RSII modified, typos corrected, further comments and references added; version to appear in JHE

Reduction of circulating cholesterol and apolipoprotein levels during sepsis

Sepsis with multiple organ failure is frequently associated with a substantial decrease of cholesterol levels. This decrease of cholesterol is strongly associated with mortality suggesting a direct relation between inflammatory conditions and altered cholesterol homeostasis. The host response during sepsis is mediated by cytokines and growth factors, which are capable of influencing lipid metabolism. Conversely lipoproteins are also capable of modulating cytokine production during the inflammatory response. Therefore the decrease in circulating cholesterol levels seems to play a crucial role in the pathophysiology of sepsis. In this review the interaction between cytokines and lipid metabolism and its clinical consequences will be discussed