Patient adherence in COPD Bourbeau, J; Bartlett, S J
Thorax,
09/2008, Letnik:
63, Številka:
9
Journal Article
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Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimise disease management. As with other chronic diseases, poor adherence is common and results in ...increased rates of morbidity, healthcare expenditures, hospitalisations and possibly mortality, as well as unnecessary escalation of therapy and reduced quality of life. Examples include overuse, underuse, and alteration of schedule and doses of medication, continued smoking and lack of exercise. Adherence is affected by patients' perception of their disease, type of treatment or medication, the quality of patient provider communication and the social environment. Patients are more likely to adhere to treatment when they believe it will improve disease management or control, or anticipate serious consequences related to non-adherence. Providers play a critical role in helping patients understand the nature of the disease, potential benefits of treatment, addressing concerns regarding potential adverse effects and events, and encouraging patients to develop self-management skills. For clinicians, it is important to explore patients' beliefs and concerns about the safety and benefits of the treatment, as many patients harbour unspoken fears. Complex regimens and polytherapy also contribute to suboptimal adherence. This review addresses adherence related issues in COPD, assesses current efforts to improve adherence and highlights opportunities to improve adherence for both providers and patients.
Abstract
Ki67 immunohistochemistry (IHC), commonly used as a proliferation marker in breast cancer, has limited value for treatment decisions due to questionable analytical validity. The ...International Ki67 in Breast Cancer Working Group (IKWG) consensus meeting, held in October 2019, assessed the current evidence for Ki67 IHC analytical validity and clinical utility in breast cancer, including the series of scoring studies the IKWG conducted on centrally stained tissues. Consensus observations and recommendations are: 1) as for estrogen receptor and HER2 testing, preanalytical handling considerations are critical; 2) a standardized visual scoring method has been established and is recommended for adoption; 3) participation in and evaluation of quality assurance and quality control programs is recommended to maintain analytical validity; and 4) the IKWG accepted that Ki67 IHC as a prognostic marker in breast cancer has clinical validity but concluded that clinical utility is evident only for prognosis estimation in anatomically favorable estrogen receptor–positive and HER2-negative patients to identify those who do not need adjuvant chemotherapy. In this T1-2, N0-1 patient group, the IKWG consensus is that Ki67 5% or less, or 30% or more, can be used to estimate prognosis. In conclusion, analytical validity of Ki67 IHC can be reached with careful attention to preanalytical issues and calibrated standardized visual scoring. Currently, clinical utility of Ki67 IHC in breast cancer care remains limited to prognosis assessment in stage I or II breast cancer. Further development of automated scoring might help to overcome some current limitations.
Breast cancers are complex ecosystems of malignant cells and the tumour microenvironment
. The composition of these tumour ecosystems and interactions within them contribute to responses to cytotoxic ...therapy
. Efforts to build response predictors have not incorporated this knowledge. We collected clinical, digital pathology, genomic and transcriptomic profiles of pre-treatment biopsies of breast tumours from 168 patients treated with chemotherapy with or without HER2 (encoded by ERBB2)-targeted therapy before surgery. Pathology end points (complete response or residual disease) at surgery
were then correlated with multi-omic features in these diagnostic biopsies. Here we show that response to treatment is modulated by the pre-treated tumour ecosystem, and its multi-omics landscape can be integrated in predictive models using machine learning. The degree of residual disease following therapy is monotonically associated with pre-therapy features, including tumour mutational and copy number landscapes, tumour proliferation, immune infiltration and T cell dysfunction and exclusion. Combining these features into a multi-omic machine learning model predicted a pathological complete response in an external validation cohort (75 patients) with an area under the curve of 0.87. In conclusion, response to therapy is determined by the baseline characteristics of the totality of the tumour ecosystem captured through data integration and machine learning. This approach could be used to develop predictors for other cancers.
Abstract
Coupling qubits to a superconducting resonator provides a mechanism to enable long-distance entangling operations in a quantum computer based on spins in semiconducting materials. Here, we ...demonstrate a controllable spin-photon coupling based on a longitudinal interaction between a spin qubit and a resonator. We show that coupling a singlet-triplet qubit to a high-impedance superconducting resonator can produce the desired longitudinal coupling when the qubit is driven near the resonator’s frequency. We measure the energy splitting of the qubit as a function of the drive amplitude and frequency of a microwave signal applied near the resonator antinode, revealing pronounced effects close to the resonator frequency due to longitudinal coupling. By tuning the amplitude of the drive, we reach a regime with longitudinal coupling exceeding 1 MHz. This mechanism for qubit-resonator coupling represents a stepping stone towards producing high-fidelity two-qubit gates mediated by a superconducting resonator.
The nonlinear equation of Boussinesq (1877) is a foundational approach for studying groundwater flow through an unconfined aquifer, but solving the full nonlinear version of the Boussinesq equation ...remains a challenge. Here, we present an exact solution to the full nonlinear Boussinesq equation that not only applies to sloping aquifers but also accounts for source and sink terms such as bedrock seepage, an often significant flux in headwater catchments. This new solution captures the hysteretic relationship (a loop rating curve) between the groundwater flow rate and the water table height, which may be used to provide a more realistic representation of streamflow and groundwater dynamics in hillslopes. In addition, the solution provides an expression where the flow recession varies based on hillslope parameters such as bedrock slope, bedrock seepage, aquifer recharge, plant transpiration, and other factors that vary across landscape types.
Key Points
A class of solutions of the nonlinear Boussinesq equation with source/sink terms is presented, which includes past solutions as special cases
The new solution applies to sloping aquifers and may include a head‐dependent rate of water seepage through the soil and bedrock interface
The analytical results capture hysteresis between the groundwater level and groundwater flow rate as a function of hillslope characteristics
Unwanted interaction between a quantum system and its fluctuating environment leads to decoherence and is the primary obstacle to establishing a scalable quantum information processing architecture. ...Strategies such as environmental and materials engineering, quantum error correction and dynamical decoupling can mitigate decoherence, but generally increase experimental complexity. Here we improve coherence in a qubit using real-time Hamiltonian parameter estimation. Using a rapidly converging Bayesian approach, we precisely measure the splitting in a singlet-triplet spin qubit faster than the surrounding nuclear bath fluctuates. We continuously adjust qubit control parameters based on this information, thereby improving the inhomogenously broadened coherence time (T2*) from tens of nanoseconds to >2 μs. Because the technique demonstrated here is compatible with arbitrary qubit operations, it is a natural complement to quantum error correction and can be used to improve the performance of a wide variety of qubits in both meteorological and quantum information processing applications.
The glomerulus is a highly specialized microvascular bed that filters blood to form primary urinary filtrate. It contains four cell types: fenestrated endothelial cells, specialized vascular support ...cells termed podocytes, perivascular mesangial cells, and parietal epithelial cells. Glomerular cell-cell communication is critical for the development and maintenance of the glomerular filtration barrier. VEGF, ANGPT, EGF, SEMA3A, TGF-β, and CXCL12 signal in paracrine fashions between the podocytes, endothelium, and mesangium associated with the glomerular capillary bed to maintain filtration barrier function. In this review, we summarize the current understanding of these signaling pathways in the development and maintenance of the glomerulus and the progression of disease.
Measurement underpins all quantitative science. A key example is the measurement of optical phase, used in length metrology and many other applications. Advances in precision measurement have ...consistently led to important scientific discoveries. At the fundamental level, measurement precision is limited by the number N of quantum resources (such as photons) that are used. Standard measurement schemes, using each resource independently, lead to a phase uncertainty that scales as 1/square root N-known as the standard quantum limit. However, it has long been conjectured that it should be possible to achieve a precision limited only by the Heisenberg uncertainty principle, dramatically improving the scaling to 1/N (ref. 3). It is commonly thought that achieving this improvement requires the use of exotic quantum entangled states, such as the NOON state. These states are extremely difficult to generate. Measurement schemes with counted photons or ions have been performed with N < or = 6 (refs 6-15), but few have surpassed the standard quantum limit and none have shown Heisenberg-limited scaling. Here we demonstrate experimentally a Heisenberg-limited phase estimation procedure. We replace entangled input states with multiple applications of the phase shift on unentangled single-photon states. We generalize Kitaev's phase estimation algorithm using adaptive measurement theory to achieve a standard deviation scaling at the Heisenberg limit. For the largest number of resources used (N = 378), we estimate an unknown phase with a variance more than 10 dB below the standard quantum limit; achieving this variance would require more than 4,000 resources using standard interferometry. Our results represent a drastic reduction in the complexity of achieving quantum-enhanced measurement precision.
Abstract
A fault-tolerant quantum processor may be configured using stationary qubits interacting only with their nearest neighbours, but at the cost of significant overheads in physical qubits per ...logical qubit. Such overheads could be reduced by coherently transporting qubits across the chip, allowing connectivity beyond immediate neighbours. Here we demonstrate high-fidelity coherent transport of an electron spin qubit between quantum dots in isotopically-enriched silicon. We observe qubit precession in the inter-site tunnelling regime and assess the impact of qubit transport using Ramsey interferometry and quantum state tomography techniques. We report a polarization transfer fidelity of 99.97% and an average coherent transfer fidelity of 99.4%. Our results provide key elements for high-fidelity, on-chip quantum information distribution, as long envisaged, reinforcing the scaling prospects of silicon-based spin qubits.
Quantum-dot spin qubits characteristically use oscillating magnetic or electric fields, or quasi-static Zeeman field gradients, to realize full qubit control. For the case of three confined ...electrons, exchange interaction between two pairs allows qubit rotation around two axes, hence full control, using only electrostatic gates. Here, we report initialization, full control, and single-shot readout of a three-electron exchange-driven spin qubit. Control via the exchange interaction is fast, yielding a demonstrated 75 qubit rotations in less than 2 ns. Measurement and state tomography are performed using a maximum-likelihood estimator method, allowing decoherence, leakage out of the qubit state space, and measurement fidelity to be quantified. The methods developed here are generally applicable to systems with state leakage, noisy measurements and non-orthogonal control axes.
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