Predictors of therapy resistant asthma: outcome of a systematic evaluation protocol

Background: It has been suggested that asthmatic subjects with persisting symptoms despite adequate maintenance therapy should be systematically evaluated to identify factors contributing to poor control. The aims of this study were to examine the prevalence of these factors in a cohort of sequentially referred poorly controlled asthmatics, and to determine if any factor or combination of factors predicted true therapy resistant asthma (TRA).

Methods: Patients were evaluated using a systematic evaluation protocol including induced sputum analysis, psychiatric assessment, ear, nose and throat examination, pulmonary function testing, high resolution CT scan of the thorax, and 24 hour dual probe ambulatory oesophageal pH monitoring; any identified provoking factor was treated. Asthma was managed according to BTS guidelines.

Results: Of 73 subjects who completed the assessment, 39 responded to intervention and 34 had TRA. Subjects with TRA had a greater period of instability, a higher dose of inhaled steroids at referral, more rescue steroid use, and a lower best percentage forced expiratory volume in 1 second (FEV1%). Oesophageal reflux, upper airway disease, and psychiatric morbidity were common (57%, 95%, 49%, respectively) but were not more prevalent in either group. Using multivariate logistic regression analysis, inhaled steroid dose >2000 µg BDP, previous assessment by a respiratory specialist, and initial FEV1% of <70% at referral predicted a final diagnosis of TRA.

Conclusions: In poorly controlled asthmatics there is a high prevalence of co-morbidity, identified by detailed systematic assessment, but no difference in prevalence between those who respond to intervention and those with TRA. Targeted treatment of identified co-morbidities has minimal impact on asthma related quality of life in those with therapy resistant disease.

Outcome measurement and service evaluation - a note on research design.

The purpose of this research note is to demonstrate how an individualised quality of life instrument could be adapted to provide a more accurate estimate of the impact of a social service on a person’s quality of life. An increase in quality of life between the start and end of a service is often taken as an indication that the service impacted positively on quality of life. The modifications to the quality of life instrument suggested in this paper show that this assumption is not always accurate and should be questioned directly.

d-outcome measurement for a nonlocality test

For the purpose of a nonlocality test, we propose a general correlation observable of two parties by utilizing local d- outcome measurements with SU(d) transformations and classical communications. Generic symmetries of the SU(d) transformations and correlation observables are found for the test of nonlocality. It is shown that these symmetries dramatically reduce the number of numerical variables, which is important for numerical analysis of nonlocality. A linear combination of the correlation observables, which is reduced to the Clauser- Home-Shimony-Holt (CHSH) Bell's inequality for two outcome measurements, leads to the Collins-Gisin-Linden-Massar-Popescu (CGLMP) nonlocality test for d-outcome measurement. As a system to be tested for its nonlocality, we investigate a continuous- variable (CV) entangled state with d measurement outcomes. It allows the comparison of nonlocality based on different numbers of measurement outcomes on one physical system. In our example of the CV state, we find that a pure entangled state of any degree violates Bell's inequality for d(greater than or equal to2) measurement outcomes when the observables are of SU(d) transformations.

The effects of cryopreservation on testicular sperm nuclear DNA fragmentation and its relationship with assisted conception outcome following intracytoplasmic sperm injection

M.E.M. Thompson-Cree, Neil McClure, Eilish T. Donnelly, Kristine E. Steele and Sheena E.M. Lewis