Search

Pulmonary rehabilitation programmes including aerobic training improve cardiorespiratory fitness in patients with COPD, but the optimal programme design is unclear. We used random effects additive component network meta-analysis to investigate the relative effectiveness of different programme components on fitness measured by V̇O2peakin COPD. The included 59 studies involving 2191 participants demonstrated that V̇O2peakincreased after aerobic training of at least moderate intensity with the greatest improvement seen following high intensity training. Lower limb aerobic training (SMD 0.56 95% CI 0.32;0.81, intervention arms=86) and the addition of non-invasive ventilation (SMD 0.55 95% CI 0.04;1.06, intervention arms=4) appeared to offer additional benefit but there was limited evidence for effectiveness of other exercise and non-exercise components.

The early history of deuterostomes, the group composed of the chordates, echinoderms and hemichordates1, is still controversial, not least because of a paucity of stem representatives of these clades2–5. The early Cambrian microscopic animal Saccorhytus coronariuswas interpreted as an early deuterostome on the basis of purported pharyngeal openings, providing evidence for a meiofaunal ancestry6and an explanation for the temporal mismatch between palaeontological and molecular clock timescales of animal evolution6–8. Here we report new material of S. coronarius, which is reconstructed as a millimetric and ellipsoidal meiobenthic animal with spinose armour and a terminal mouth but no anus. Purported pharyngeal openings in support of the deuterostome hypothesis6are shown to be taphonomic artefacts. Phylogenetic analyses indicate that S. coronariusbelongs to total-group Ecdysozoa, expanding the morphological disparity and ecological diversity of early Cambrian ecdysozoans.

Interfacility transfer of pediatric patients to a children’s hospital is a complex process that can be time consuming and dissatisfying for referring providers. We aimed to improve the efficiency of communication and acceptance for interfacility transfers to our hospital.We implemented iterative improvements to the process in 2 phases from 2013 to 2016 (pediatric medicine) and 2019 to 2022 (pediatric critical care and surgery). Key interventions included creation of a hospitalist position to manage transfers with broad ability to accept patients and transition to direct phone access for transfer requests to streamline connection. Effective initiatives from Phase 1 were adapted and spread to the other services in Phase 2. Data were manually extracted monthly from call transcripts and monitored by using statistical process control (SPC) charts. Primary outcome measures were time from call to connection to a provider and number of providers added to the call before making a disposition decision.Average time from call initiation to provider connection for pediatric medicine calls decreased from 11 minutes to 5 minutes. The average number of internal physicians on each call before acceptance decreased from 2.1 to 1.3. In Phase 2, time to provider connection decreased from 11 to 4 minutes for pediatric critical care calls and 16 to 5 minutes for pediatric surgery calls.We streamlined the process of accepting incoming transfer requests throughout our children’s hospital. Prioritizing direct communication led to efficient disposition decisions and progression toward transfer and was effective for multiple service lines.

Minority physicians have been persistently underrepresented in medicine (URiM) when compared with their representation in the general U.S. population. There is evidence that diversifying the physician workforce would have a positive impact on healthcare delivery. While programs have been implemented to diversify the physician workforce, there has been less emphasis and progress in diversifying academic medical centers (AMCs) at the faculty level. This review sought to provide an update in the literature on the published outcomes and components of programs designed to increase the racial/ethnic diversity of faculty at AMCs.

Regional networks for the management of knowledge and technology are considered. Based on these regional networks their policies are evaluated.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous inflammatory airway disease. The epithelial-derived IL-33 and its receptor ST2 have been implicated in airway inflammation and infection. We aimed to determine whether astegolimab, a selective ST2 IgG2 monoclonal antibody, reduces exacerbations in COPD.

Persistent ill health after acute COVID-19—referred to as long COVID, the post-acute COVID-19 syndrome, or the post-COVID-19 condition—has emerged as a major concern. We undertook an international consensus exercise to identify research priorities with the aim of understanding the long-term effects of acute COVID-19, with a focus on people with pre-existing airways disease and the occurrence of new-onset airways disease and associated symptoms. 202 international experts were invited to submit a minimum of three research ideas. After a two-phase internal review process, a final list of 98 research topics was scored by 48 experts. Patients with pre-existing or post-COVID-19 airways disease contributed to the exercise by weighting selected criteria. The highest-ranked research idea focused on investigation of the relationship between prognostic scores at hospital admission and morbidity at 3 months and 12 months after hospital discharge in patients with and without pre-existing airways disease. High priority was also assigned to comparisons of the prevalence and severity of post-COVID-19 fatigue, sarcopenia, anxiety, depression, and risk of future cardiovascular complications in patients with and without pre-existing airways disease. Our approach has enabled development of a set of priorities that could inform future research studies and funding decisions. This prioritisation process could also be adapted to other, non-respiratory aspects of long COVID.

This article examines the law surrounding communications with putative and actual class members. It seeks to provide a set of clear guidelines for attorneys involved in class litigation, detailing what kinds of communications are permissible, which are suspect, and how to stop errant communications from the opposing side.

Classical sections, such as the Maidiping and Daqiao Mine sections of South Sichuan (China), expose early Cambrian deposits that are crucial for understanding the biological and environmental evolution of Yangtze Craton. These sequences are rich in Terreneuvian small shelly fossils, which can be assigned to assemblages I and III from South China. The Anabarites trisulcatus–Protohertzina anabarica Assemblage Zone (Assemblage I) is recognized at the lower Maidiping Formation. The second assemblage (Paragloborilus subglobosus–Purella squamulosa Assemblage Zone) cannot be verified in South Sichuan, although previous reports claimed its existence based on the occurrence of Paragloborilus subglobosus. The third assemblage (Watsonella crosbyi Assemblage Zone) is confirmed in the upper Maidiping Formation. The abundant bioclasts in this interval indicate abrasions and bioerosions by winnowing or starved sedimentation. Carbon isotope values from the Maidiping section present no negative excursion at the presumed Ediacaran–Cambrian transition. A positive carbon isotope excursion is observed in the Upper Maidiping Formation (Assemblage III) which is correlated to the ZHUCE excursion in the Dahai Member of eastern Yunnan. The shallow-water deposits of South Sichuan can be correlated with the South China, western Mongolia and Siberia successions based on biozonations and carbon isotope trends. Supplementary material: Isotope data are available at https://doi.org/10.6084/m9.figshare.c.5326834 Thematic collection: This article is part of the Advances in the Cambrian Explosion collection available at: https://www.lyellcollection.org/cc/advances-cambrian-explosion [ABSTRACT FROM AUTHOR]

Hereditary hemochromatosis may lead to hepatic cirrhosis, cardiomyopathy, diabetes, arthritis, and impotence (1,2). In the Caucasian population, HFE gene mutations (C282Y and H63D) are present in the majority of patients [...]

Eccentric cycling (ECC) may be an attractive exercise method in COPD because of both low cardiorespiratory demand and perception of effort compared with conventional concentric cycling (CON) at matched mechanical loads. However, it is unknown whether ECC can be performed by individuals with COPD at an intensity able to cause sufficient metabolic stress to improve aerobic capacity.

Despite the wide-ranging benefits of pulmonary rehabilitation, conflicting results remain regarding whether people with COPD can improve their peak oxygen uptake (V˙O2peak)with aerobic training.

The finances of academic medical centers (AMCs) are complex and rapidly evolving. This financial environment can have important effects on faculty expectations, compensation, and the work environment. This article describes the commonly used concepts and models related to financial decision-making in Pulmonology and Critical Care divisions across AMCs in the United States. Faculty clinical productivity is often measured by work relative value units, which are set nationally for a discrete piece of physician work and attempt to equilibrate aspects of care across specialties. The expected clinical productivity and salary for a given faculty member are often determined relative to one or more national benchmarks developed from data submitted by departments and schools across the country. The most commonly used benchmarks include those from the Association of American Medical Colleges and the Medical Group Management Association. Changes to the paradigm of fee for service reimbursement are beginning to change physician compensation and incentive structures. In addition, research and education are key academic missions for faculty. It is important to understand the limitations of extramural research funding and implications for the support of research infrastructure. Measurements of productivity within education have been less codified, but some centers are attempting to create educational relative value units similar to those used in clinical productivity. In summary, faculty should understand basic concepts of finances. This knowledge includes a common set of terms and concepts that can help all faculty understand basic financial considerations in their work and lead to success for their divisions.

The Niuniuzhai section in Leibo County, southern Sichuan, China, is part of the western carbonate platform of the Yangtze Block. The section is crucial for correlating early Cambrian successions in the eastern Yunnan and southern Sichuan areas. A comprehensive biostratigraphic analysis of small skeletal fossils (SSFs) from this section identifies three SSF assemblages: (1) the oldest from an interval of uncertain age affinity in the middle and upper Dahai Member of the Zhujiaqing Formation; (2) the Watsonella crosbyiAssemblage Zone (Zone Ⅲ) in the upper Dahai Member of the Zhujiaqing Formation; and (3) the Sinosachites flabelliformis–Tannuolina zhangwentangiAssemblage Zone (Zone IV) in the middle Shiyantou Formation. These SSF assemblage zones in the Niuniuzhai section correlate well with sections from eastern Yunnan and southern Sichuan, indicating a coherent Terreneuvian succession on the the Yangtze Platform and in other continents.

Chronic obstructive pulmonary disease (COPD) is characterised by reduced exercise tolerance and improving physical performance is an important therapeutic goal. A variety of exercise tests are commonly used to assess exercise tolerance, including laboratory and field-based tests. The responsiveness of these tests to common COPD interventions is yet to be compared, but may inform test selection in clinical and research settings.

Model compounds, such as 12-Aminohexadecanoic acid and kaolinite, mare utilized to simulate adsorption under different salinities. The experiments showed that the total organic carbon content adsorbed to kaolinite is 0.166% and 0.082% under high and low salinity conditions, respectively. The kaolinite (001) adsorption behavior of organic matter was simulated by molecular dynamics (MD) technology in the presence of Na+. In addition, the adsorption process was not only statistically analysed but the adsorption energy of state organic matter at the clay surface and the sources of adsorption energy are calculated. It is shown that the increase of Na+is conducive to the adsorption of the organic matter, which is also supported by the experimental results. The adsorption of organic matter is mainly controlled by functional groups of -CH2on the kaolinite surface. Density functional theory (DFT) calculations further indicate that the 2s orbital of Na+is hybridized with -OH of kaolinite and the 2p orbital of -COO-of 12-Aminohexadecanoic acid under bridging action. Thus, the electron compensation mechanism of Na+was clarified. This study provides a molecular perspective on the interaction mechanisms between organic matter and kaolinite, which is beneficial to the field of biogeochemistry and environmental effects.

Byline: Michael Steiner, Javier Alfonso Gil, Oliver Ehret, Michael Ploder, Rudiger Wink Most scientific studies on innovation deal with high-technology sectors, although medium-technology industries are still the most relevant contributors to employment and market shares in Europe. Based on three different methodological approaches (social network analysis, regression analysis and qualitative research), the importance of technology-specific, firm-specific and region-specific factors on the structure of innovation networks in medium-technology sectors is investigated. It can be shown within this explorative study that networks in the four investigated case regions increasingly rely on knowledge instead of material linkages and firm characteristics determine the position of organisations within the networks. The actual structure of networks and the choice, which firm-specific factors are important for network positions, vary across the regions and cannot be explained by general regional characteristics. Thus, more concrete research on single regions is still necessary.

ABSTRACTThis research investigates the relationship between concern over terrorism and negative attitudes toward unauthorized immigration before and after the 9/11 terrorist attacks. A hierarchical age-period-cohort analysis was conducted using nationally representative cross-sectional data to take into account macro-level influences on individual attitudes. Results suggest that concern over terrorism is positively related to negative attitudes toward immigration. Further, the relationship between concern over terrorism and negative attitudes toward unauthorized immigration became stronger in the decade following the 9/11 attacks. However, the findings do not support the hypothesis that 9/11 directly increased negative attitudes toward immigration.

Walde, D.H.-G., Weber, B., Erdtmann, B.-D. & Steiner, M. 20 June 2019. Taphonomy of Corumbella wernerifrom the Ediacaran of Brazil: sinotubulitid tube or conulariid test? Alcheringa43, 335–350. ISSN 0311-5518The problematic late Ediacaran tubular fossil Corumbella werneriis revised based on two-dimensional compressions, and new three-dimensionally preserved specimens from the Tamengo Formation of the Corumbá Region in Mato Grosso do Sul, west-central Brazil. These fossils represent some of the oldest skeletonized metazoans and were originally described from diagenetically compacted tubes that prompted conflicting interpretations as either Ediacaran coronate scyphozoan exoskeletons, or conulariid tests. Our new material from Corumbá permits a morphological and taphonomic revision of C. werneri, which we suggest was probably a calcareous sinotubulitid. Corumbella wernericlosely resembles the late Ediacaran Sinotubulitesfrom South China, as well as the Silurian worm tube Eoalvinellodes, which has similar exterior ornamentation. Ultrastructurally, the tubes of C. werneriexhibit a coarse sparitic microtexture, which we attribute to diagenetic alteration. Partial flexibility also supports interpretation as an originally weakly calcified, or entirely organic exoskeleton. We therefore reject placement of C. wernerias a conulariid scyphozoan, and instead, advocate possible relationships with marine annelids.Detlef Hans-Gert Walde [walde.detlef@gmail.com], University of Brasília, Institute of Geosciences, Brasília-DF, Brazil; Bernd Weber [bweber@zedat.fu-berlin.de], Freie Universität Berlin, Institut für Geologische Wissenschaften, Malteserstr. 74–100, D-12249 Berlin, Germany; Bernd-D. Erdtmann [berni1739@gmail.com], 1165 N Mountain View Road, Apache Junction, AZ 85119, USA; *Michael Steiner [Michael.Steiner@FU-Berlin.de], Freie Universität Berlin, Institut für Geologische Wissenschaften (Haus D), Malteserstr. 74–100, D-12249 Berlin, Germany.

Throughout the pharmaceutical industry, executives are worried. They fear they will not be able to meet the double-digit annual growth expectations implied by high market capitalizations. The requisite new drugs [...]

GENETICS IS a second critical wave that will have significant impact on pharmaceutical R&D. Where the genomics wave is technology-driven, the genetics wave is better viewed as data-driven. Where the [...]

Acute admission to hospital for an exacerbation of chronic respiratory disease (CRD) may impair skeletal muscle mass and function. We measured quadriceps thickness (Qthick), as a surrogate marker of muscle mass, at hospital admission, discharge, 6 weeks and 3 months in 55 patients with CRD. Qthickfell by 8.3% during the period of hospitalisation, which was sustained at 6 weeks, and only partially recovered at 3 months. Sustained loss was most marked in patients readmitted during the follow-up period. Acute reduction in quadriceps muscle mass occurs during hospitalisation, with prolonged and variable recovery, which is prevented with subsequent hospital readmission.

Hospitalizations for ambulatory care–sensitive conditions (ACSC) are measured to indicate health care system quality, with the premise that fewer hospitalizations would occur with better preceding outpatient care. Our objectives were to identify outpatient care received in the 7 days preceding acute pediatric hospitalizations and to compare receipt of outpatient care by hospitalization type (ACSC vs non-ACSC).

ObjectivesTo characterise the sketetal muscle metabolic phenotype during early critical illness.MethodsVastus lateralis muscle biopsies and serum samples (days 1 and 7) were obtained from 63 intensive care patients (59% male, 54.7±18.0 years, Acute Physiology and Chronic Health Evaluation II score 23.5±6.5).Measurements and main resultsFrom day 1 to 7, there was a reduction in mitochondrial beta-oxidation enzyme concentrations, mitochondrial biogenesis markers (PGC1α messenger mRNA expression (−27.4CN (95% CI −123.9 to 14.3); n=23; p=0.025) and mitochondrial DNA copy number (−1859CN (IQR −5557–1325); n=35; p=0.032). Intramuscular ATP content was reduced compared tocompared with controls on day 1 (17.7mmol/kg /dry weight (dw) (95% CI 15.3 to 20.0) vs. 21.7 mmol/kg /dw (95% CI 20.4 to 22.9); p<0.001) and decreased over 7 days (−4.8 mmol/kg dw (IQR −8.0–1.2); n=33; p=0.001). In addition, the ratio of phosphorylated:total AMP-K (the bioenergetic sensor) increased (0.52 (IQR −0.09–2.6); n=31; p<0.001). There was an increase in intramuscular phosphocholine (847.2AU (IQR 232.5–1672); n=15; p=0.022), intramuscular tumour necrosis factor receptor 1 (0.66 µg (IQR −0.44–3.33); n=29; p=0.041) and IL-10 (13.6 ng (IQR 3.4–39.0); n=29; p=0.004). Serum adiponectin (10.3 µg (95% CI 6.8 to 13.7); p<0.001) and ghrelin (16.0 ng/mL (IQR −7–100); p=0.028) increased. Network analysis revealed a close and direct relationship between bioenergetic impairment and reduction in muscle mass and between intramuscular inflammation and impaired anabolic signaling. ATP content and muscle mass were unrelated to lipids delivered.ConclusionsDecreased mitochondrial biogenesis and dysregulated lipid oxidation contribute to compromised skeletal muscle bioenergetic status. In addition, intramuscular inflammation was associated with impaired anabolic recovery with lipid delivery observed as bioenergetically inert. Future clinical work will focus on these key areas to ameliorate acute skeletal muscle wasting.Trial registration numberNCT01106300.

Background: Concerns about the costs and quality of hospital care have led to increased interest in hospital readmissions in children. Children with medical complexity account for high proportions of inpatient utilization and have a higher risk of hospital readmission. Objective: To identify studies of discharge interventions to prevent hospital readmissions in children with medical complexity. Methods: We conducted a search to identify studies of discharge interventions. Included studies 1) described an intervention or modifiable risk factor around the time of hospital discharge 2) included pediatric patients with chronic illness and/or medical complexity and 3) reported subsequent hospital utilization. Results: We identified ten studies testing the following interventions: multi-faceted discharge bundle (including medication review, discharge education, and follow-up appointments) (s=1), post-discharge follow-up clinic visits (s=3), post-discharge phone calls (s=2), intensive follow-up interventions for very low birth weight infants (s=2), and education interventions in children hospitalized with asthma (s=2). Four studies reported reductions in readmissions. The discharge bundle correlated with an 11.1% decrease in 30-day readmission (9.9% vs. 8.8%, p<0.05). All three studies of post discharge follow-up clinic visits reported a decrease in 30-day readmission risk among children with follow-up scheduled within 30 days, though one study also reported that medically complex children with follow- up within three days had increased readmission risk. Conclusion: Evidence supporting discharge interventions for children with medical complexity is limited. Multi-faceted discharge interventions and post-discharge clinic visits may be effective.

Care bundles may be an effective tool to standardise care for patients admitted with an exacerbation of chronic obstructive pulmonary disease (COPD). However, it is unclear how care bundles can be implemented without the need for additional resources. We redeployed a respiratory early discharge service (REDS) to deliver a COPD discharge bundle. We audited the effect of this service redesign on length of stay (LOS) and uptake of referrals to smoking cessation and pulmonary rehabilitation services. Of 1,742 patients with COPD, 1,170 received the discharge care bundle. Mean LOS for patients who received the discharge care bundle was 6.17 days versus 7.08 days for patients who did not. Smoking cessation and pulmonary rehabilitation referrals increased during the project year. A COPD discharge care bundle can be implemented on a large scale by redeploying a REDS without an increase on hospital LOS.

BackgroundPulmonary rehabilitation (PR) improves exercise capacity and health status in patients with COPD, but many patients assessed for PR do not complete therapy. It is unknown whether socioeconomic deprivation associates with rates of completion of PR or the magnitude of clinical benefits bequeathed by PR.MethodsPR services across England and Wales enrolled patients to the National PR audit in 2015. Deprivation was assessed using Index of Multiple Deprivation (IMD) derived from postcodes. Study outcomes were completion of therapy and change in measures of exercise performance and health status. Univariate and multivariate analyses investigated associations between IMD and these outcomes.Results210 PR programmes enrolled 7413 patients. Compared with the general population, the PR sample lived in relatively deprived neighbourhoods. There was a statistically significant association between rates of completion of PR and quintile of deprivation (70% in the least and 50% in the most deprived quintiles). After baseline adjustments, the risk ratio (95% CI) for patients in the most deprived relative to the least deprived quintile was 0.79 (0.73 to 0.85), p<0.001. After baseline adjustments, IMD was not significantly associated with improvements in exercise performance and health status.ConclusionsIn a large national dataset, we have shown that patients living in more deprived areas are less likely to complete PR. However, deprivation was not associated with clinical outcomes in patients who complete therapy. Interventions targeted at enhancing referral, uptake and completion of PR among patients living in deprived areas could reduce morbidity and healthcare costs in such hard-to-reach populations.

Supplemental Digital Content is available in the text

A sure-fire formula for maintaining competitive advantage in the chemical industry is building on company skills. In the case of a major company, sustained profitability is assured either by focusing on the particular business that can make use of its abilities or putting up individual businesses and developing the required skills. The main idea is to determine the main skills needed in a particular operation and to assess the existing skills that the company boasts of. Ideally, the business chosen must be based on such skills which, in turn, must be enhanced and maximized.

Patients with moderate exacerbations of COPD and the eosinophilic phenotype have better outcomes with prednisolone. Whether this outcome is similar in patients hospitalized with a severe exacerbation of COPD is unclear. We investigated the rate of recovery of eosinophilic and noneosinophilic exacerbations in patients participating in a multicenter randomized controlled trial assessing health outcomes in hospitalized exacerbations.

Plexiform fibromyxoma tumor (PFT) is an exceedingly rare tumor, particularly in children where only four cases have been reported to date. The patient reported herein presented with abdominal pain and vomiting related to gastric outlet obstruction caused by a large, polypoid PFT. We describe the clinical features, diagnostic evaluation, and surgical treatment of this rare tumor in our patient. Further, we review the literature of FPT to bring attention to this rare gastric tumor to the Pediatric Surgeon.

Absence of established reference values limits application of quadriceps maximal voluntary contraction (QMVC) measurement. The impact of muscle mass inclusion in predictions is unclear. Prediction equations encompassing gender, age and size with (FFM+) and without (FFM−), derived in healthy adults (n=175), are presented and compared in two COPD cohorts recruited from primary care (COPD-PC, n=112) and a complex care COPD clinic (COPD-CC, n=189). Explained variance was comparable between the prediction models (R2: FFM+: 0.59, FFM−: 0.60) as were per cent predictions in COPD-PC (88.8%, 88.3%). However, fat-free mass inclusion reduced the prevalence of weakness in COPD, particularly in COPD-CC where 11.9% fewer were deemed weak.