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  • 1
    Publication Date: 2018-03-27
    Description: Introduction Chronic obstructive pulmonary disease (COPD) is a progressive disease affecting 3 million people in the UK, in which patients exhibit airflow obstruction that is not fully reversible. COPD treatment guidelines are largely informed by randomised controlled trial results, but it is unclear if these findings apply to large patient populations not studied in trials. Non-interventional studies could be used to study patient groups excluded from trials, but the use of these studies to estimate treatment effectiveness is in its infancy. In this study, we will use individual trial data to validate non-interventional methods for assessing COPD treatment effectiveness, before applying these methods to the analysis of treatment effectiveness within people excluded from, or under-represented in COPD trials. Methods and analysis Using individual patient data from the landmark COPD Towards a Revolution in COPD Health (TORCH) trial and validated methods for detecting COPD and exacerbations in routinely collected primary care data, we will assemble a cohort in the UK Clinical Practice Research Datalink (selecting people between 1 January 2004 and 1 January 2017) with similar characteristics to TORCH participants and test whether non-interventional data can generate comparable results to trials, using cohort methodology with propensity score techniques to adjust for potential confounding. We will then use the methodological template we have developed to determine risks and benefits of COPD treatments in people excluded from TORCH. Outcomes are pneumonia, COPD exacerbation, mortality and time to treatment change. Groups to be studied include the elderly (〉80 years), people with substantial comorbidity, people with and without underlying cardiovascular disease and people with mild COPD. Ethics and dissemination Ethical approval has been granted by the London School of Hygiene & Tropical Medicine Ethics Committee (Ref: 11997). The study has been approved by the Independent Scientific Advisory Committee of the UK Medicines and Healthcare Products Regulatory Agency (protocol no. 17_114R). An application to use the TORCH trial data made to has been approved. In addition to scientific publications, dissemination methods will be developed based on discussions with patient groups with COPD.
    Keywords: Open access, Epidemiology, Epidemiology
    Electronic ISSN: 2044-6055
    Topics: Medicine
    Published by BMJ Publishing
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  • 2
    Publication Date: 2012-12-14
    Description: A subset of ultraluminous X-ray sources (those with luminosities of less than 10(40) erg s(-1); ref. 1) are thought to be powered by the accretion of gas onto black holes with masses of approximately 5-20M cicled dot, probably by means of an accretion disk. The X-ray and radio emission are coupled in such Galactic sources; the radio emission originates in a relativistic jet thought to be launched from the innermost regions near the black hole, with the most powerful emission occurring when the rate of infalling matter approaches a theoretical maximum (the Eddington limit). Only four such maximal sources are known in the Milky Way, and the absorption of soft X-rays in the interstellar medium hinders the determination of the causal sequence of events that leads to the ejection of the jet. Here we report radio and X-ray observations of a bright new X-ray source in the nearby galaxy M 31, whose peak luminosity exceeded 10(39) erg s(-1). The radio luminosity is extremely high and shows variability on a timescale of tens of minutes, arguing that the source is highly compact and powered by accretion close to the Eddington limit onto a black hole of stellar mass. Continued radio and X-ray monitoring of such sources should reveal the causal relationship between the accretion flow and the powerful jet emission.〈br /〉〈span class="detail_caption"〉Notes: 〈/span〉Middleton, Matthew J -- Miller-Jones, James C A -- Markoff, Sera -- Fender, Rob -- Henze, Martin -- Hurley-Walker, Natasha -- Scaife, Anna M M -- Roberts, Timothy P -- Walton, Dominic -- Carpenter, John -- Macquart, Jean-Pierre -- Bower, Geoffrey C -- Gurwell, Mark -- Pietsch, Wolfgang -- Haberl, Frank -- Harris, Jonathan -- Daniel, Michael -- Miah, Junayd -- Done, Chris -- Morgan, John S -- Dickinson, Hugh -- Charles, Phil -- Burwitz, Vadim -- Della Valle, Massimo -- Freyberg, Michael -- Greiner, Jochen -- Hernanz, Margarita -- Hartmann, Dieter H -- Hatzidimitriou, Despina -- Riffeser, Arno -- Sala, Gloria -- Seitz, Stella -- Reig, Pablo -- Rau, Arne -- Orio, Marina -- Titterington, David -- Grainge, Keith -- England -- Nature. 2013 Jan 10;493(7431):187-90. doi: 10.1038/nature11697. Epub 2012 Dec 12.〈br /〉〈span class="detail_caption"〉Author address: 〈/span〉Physics Department, University of Durham, Durham DH1 3LE, UK.〈br /〉〈span class="detail_caption"〉Record origin:〈/span〉 〈a href="" target="_blank"〉PubMed〈/a〉
    Print ISSN: 0028-0836
    Electronic ISSN: 1476-4687
    Topics: Biology , Chemistry and Pharmacology , Medicine , Natural Sciences in General , Physics
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