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Background Interstitial lung abnormalities (ILA) may represent undiagnosed early-stage or subclinical interstitial lung disease (ILD). ILAs are often observed incidentally in patients who subsequently develop clinically overt ILD. There is limited information on consensus definitions for, and the appropriate evaluation of, ILA. Early recognition of patients with ILD remains challenging, yet critically important. Expert consensus could inform early recognition and referral. Research Question Can consensus-based expert recommendations be identified to guide clinicians in the recognition, referral, and follow-up of patients with or at risk of developing early ILDs? Study Design and Methods Pulmonologists and radiologists with expertise in ILD participated in two iterative rounds of surveys. The surveys aimed to establish consensus regarding ILA reporting, identification of patients with ILA, and identification of populations that might benefit from screening for ILD. Recommended referral criteria and follow-up processes were also addressed. Threshold for consensus was defined a priori as ≥ 75% agreement or disagreement. Results Fifty-five experts were invited and 44 participated; consensus was reached on 39 of 85 questions. The following clinically important statements achieved consensus: honeycombing and traction bronchiectasis or bronchiolectasis indicate potentially progressive ILD; honeycombing detected during lung cancer screening should be reported as potentially significant (eg, with the Lung CT Screening Reporting and Data System “S-modifier” [which indicates clinically significant or potentially significant noncancer findings]), recommending referral to a pulmonologist in the radiology report; high-resolution CT imaging and full pulmonary function tests should be ordered if nondependent subpleural reticulation, traction bronchiectasis, honeycombing, centrilobular ground-glass nodules, or patchy ground-glass opacity are observed on CT imaging; patients with honeycombing or traction bronchiectasis should be referred to a pulmonologist irrespective of FVC and diffusion capacity values; and patients with systemic sclerosis should be screened with pulmonary function tests for early-stage ILD. Interpretation Guidance for identifying clinically relevant ILA, with subsequent referral and follow-up, was established. These results lay the foundation for developing practical guidance on managing patients with ILA.

Understanding baseline characteristics that can predict the progression of lung disease such as chronic obstructive pulmonary disease (COPD) for current or former smokers may allow for therapeutic intervention, particularly for individuals at high risk of rapid disease progression or transition from non-COPD to COPD. Classic diagnostic criteria for COPD and disease severity such as the Global Initiative for Chronic Obstructive Lung Disease document are based on forced expiratory volume in 1 second (FEV(1)) and FEV(1) to forced vital capacity (FVC) ratio. Modeling changes in these outcomes jointly is beneficial given that they are correlated, and they are both required for specific disease classifications. Here, linear mixed models were used to model changes in FEV(1) and FEV(1)/FVC jointly for 5- and 10-year intervals, using important baseline predictors to better understand the factors that affect disease progression. Participants with predicted loss of FEV(1) and/or FEV(1)/FVC of at least 5% tended to have more emphysema, higher functional residual capacity, higher airway wall thickness as measured by Pi10, lower FVC to total lung capacity ratio and a lower body mass index at baseline, all relative to overall cohort averages. The model developed can be used to predict progression for any potential COPD individual, based on demographic, symptom, computed tomography, and comorbidity variables.

This article reports on original research investigating teacher wellbeing while teaching mathematics in relation to teacher identity. Using survey data from mathematics teachers (N = 402) participating in a teacher of mathematics support initiative, teacher wellbeing was operationally defined as the experience of wellbeing whilst teaching, allowing an applied understanding of wellbeing in relation to the activity of teaching. Teacher identity was construed from prior research by the authors (Willis et al., in: Math Educ Res J, 10.1007/s13394-021-00391-w, 2021) and operationalised for the current study in terms of a specific teacher of mathematics identity (ToMI) construct. The main research question for this investigation was directed at how well the ToMI construct, as a wellbeing variable, was able to predict teacher wellbeing while teaching, viewed as an ‘in situ’ or ‘active’ (applied) measure of wellbeing. Identity-Based Motivation (IBM) theory was used to frame the research, as it helps explain how the degree of congruency between identity and wellbeing may influence motivation to teach. Results indicated that although several important factors relate significantly to teacher of mathematics wellbeing, the ToMI construct predicted teacher wellbeing far above the ability of all other study factors combined, suggesting that a focus on the development of a professional identity for teachers is fundamental to the support of teacher wellbeing in schools. Suggestions for investigating this focus at the school level are also provided.

This article investigates the literature on mentoring and coaching and the embeddedness of these in wider fields which are referred as 'professional development' and 'teacher learning'. It concentrates on education but also considers selected work from other professions to provide a comparative perspective on the education material. There are clearly identifiable similarities across all of the literature reviewed, despite different lexicons. The review also identifies what appears to be recurrent theoretical and research issues and difficulties in the mentoring and coaching and professional development literatures. These have prima facie relevance for the teacher professional development projects and activities currently being underway by education jurisdictions across the globe. They are summarised at the end of the article.

Poor diet among older adults is a risk factor for developing multiple chronic diseases. Dietary recall comprises an important component in intervention research and clinical care. Commonly used tools include the web-based automated self-administered 24-hour assessment (ASA-24). Yet voice assistant (VAS) systems (i.e., Amazon Alexa) have not been developed for this purpose. Hence, we evaluated patient perceptions on performing a VAS-based dietary assessment among older adults. Community-dwelling adults (age 65+ years) participated in two virtual sessions who reported their past 24-hour intake, first using ASA-24, and then using a VAS. All completed a Likert questionnaire (binary, % strongly agree/strongly disagree reported) regarding the simplicity of using both systems, completion time, and user satisfaction. Semi-structured interviews allowed us to ask about technology use. Of the 40 participants (100% enrolled), mean age was 69±1.0 years (85% female, 100% white, 5% Latinx). Only 40% owned a VAS; 60% reported having VAS experience prior to the study. After completing both sessions, 80% preferred a VAS over the ASA-24. Participants reported that web-based recalls were unnecessarily complex (60%), time-consuming (50%), and 60% did not wish to use them. Comparatively, VAS recalls were intuitive (75%), easily reportable (85%), and there was willingness to report food while preparing meals (85%). In 16 participants, we evaluated themes of VAS use including easier navigation, less time, and ability to have a natural conversation. A VAS provides a more convenient, conversational, and computerless interaction to report meals over web-based solutions suggesting they hold promise for dietary recall in older adults.

Background Higher dietary intake of protein has also been associated with increased risk of type 2 diabetes, yet losing weight improves glucose metabolism and homeostasis. We evaluated whether a multicomponent weight loss intervention in older persons with obesity aged 65+ years augmented with protein supplementation impacts glucose homeostasis. Methods A 12-week, non-randomized, parallel group intervention in 28 older rural adults with obesity (body mass index (BMI)≥30kg/m2) was conducted at a community aging center of a protein and non-protein arms. Both received individualized, weekly dietitian visits with twice weekly physical therapist-led group strength training classes; aerobic exercise was prescribed outside the classes. The protein group was provided with whey protein supplementation three times weekly post-strength training. Pre/post fasting glucose, insulin, and c-peptide levels were assessed with HOMA-IR and HOMA beta-cell function calculated. Results Mean age was 72.9±4.4 (86% female) and 73.0±6.3 (79% female), p=0.94, with baseline BMI of 37.6±6.9 and 36.6±5.5, in the protein and non-protein groups, respectively. Mean weight-loss was -3.45±2.86kg and -5.79±3.08kg (both p< 0.001; Δ p=0.047). Visceral fat decreased less in the protein group (-0.02mL vs. -1.02ml;p=0.007), while appendicular lean mass did not (p=0.44). There was lower fasting glucose (protein:-4mg±13.9mg/dL vs. non-protein: 12.2±25.8, effect size:-0.40;p=.10), insulin (-1.32±4.68 vs. -7.79±10.14, ES:0.82;p=0.01), and higher c-peptide (-0.02±0.67 vs. -0.69±1.25,ES:0.66;p=0.06) at follow-up. HOMA-IR also decreased less (-0.18±0.64 vs. -1.08±1.50, ES:0.78; p=0.02) and b-cell function (-3.94±22.61 vs. -16.81±33.85; ES:0.45; p=0.09]). Conclusions A multicomponent obesity intervention incorporating protein supplementation led to lower degree of weight loss and mitigated the benefit on glucose homeostasis.

Introduction Evidence suggests a positive association between muscle mass and cognitive impairment exists. Mid-upper arm muscle circumference (MUMC) is a simple measure that may provide prognostic information on cognitive status. Methods We included adults aged ≥55 years from the China Health and Nutrition Survey 1997-2018 with MUAC and triceps skinfold (TSF) measurements at each visit. Cognition was estimated based on a subset of the modified Telephone Interview for Cognitive Status (TICS, 0─27). Sex-stratified linear mixed-effects models accounting for within-individual and within-community correlation assessed the association between MUAC and the ratio of MUAC:TSF with TICS across age. We tested whether the rate of cognitive decline by age differed by quartiles of MUAC and MUAC:TSF in separate models. In cases of no statistical differences in cognitive declines by age, we tested whether overall cognitive function was associated with quartiles of MUAC and MUAC:TSF across all ages. Results Of 5,964 adults (53% female, age 62.4±6.4), mean MUAC was 26.6±3.74 and 26.2±3.9 cm, mean MUAC:TSF ratio was 2.9±1.6 and 1.94±1.1, and baseline TICS was 15.4±6.1 and 13.2±6.4 for men and women, respectively. MUAC was not associated with the rate of cognitive decline. Lower MUAC was associated with higher overall cognitive function scores for men (p=0.01) and women (p=0.05). For men and women there was no association between MUAC:TSF ratio and either cognitive decline or overall function. Conclusion MUMC can be a marker to predict overall cognitive function across this period in the lifecycle, suggesting that declining MUAC may help predict lower overall cognitive function

This paper provides an insight into an explorative school-improvement program, known as the Indigenous Schools ‘readiness’ Program (ISRP) which sought to deal with educational challenges in a novel, yet evidenceinformed manner. Specifically, the program sought to engage a school’s teaching staff, what is referred to as the Talent in the program, to deal with localised Indigenous school challenges by having them conceptualise and deliver their improvement plans through three inter-related elements: ‘readiness’, Talent and Adaptive Solutions. The paper suggests that despite the best intentions of parties involved, establishing and maintaining such a program, at least to the point of being able to properly implement and evaluate it, requires that the schooling context, i.e., the community in which it serves, has first created the required community conditions. In effect, engaged its own adaptive solution to inherent challenges.

The scale at which the human race consumes data has increased exponentially in recent years. One key part in this increase has been the usage of smart phones and connected devices by the populous. Multi-level heterogeneous networks are the driving force behind this mobile revolution, but these are constrained with limited bandwidth and over-subscription. Scheduling users on these networks has become a growing issue. In recent years grammar-guided genetic programming (G3P) has shown its capability to evolve beyond human-competitive network schedulers. Despite the performance of the G3P schedulers, a large margin of improvement is demonstrated to still exist. In the pursuit of this goal we recently proposed a multi-level grammar approach to generating schedulers. The complexity of the grammar was increased at various stages during evolution, allowing for individuals to add more complex functions through variation operations. The goal is to evolve good quality solutions before allowing the population to specialise more as the grammar functionality increased in a layered learning way. In this paper the results of this initial study are replicated, and confirmed, and it is seen that this approach improves the quality of the evolved schedulers. However, despite the gain in performance, we notice that the proposed approach comes with an acute sensitivity to the generation at which the grammar complexity is increased. Therefore, we put forward a novel seeding strategy and show that the seeding strategy mitigates the shortcomings of the original approach. The use of the seeding strategy outperforms the original approach in all the studied cases, and thus yields a better overall performance than the state-of-the-art G3P generated schedulers.

Hemophagocytic lymphohistiocytosis (HLH) is a severe systemic inflammatory syndrome that is often fatal. In the adult population, it is believed to develop secondary to immune dysregulation due to rheumatologic, infectious, malignant, and recently, immunomodulatory drugs. It’s co-occurrence with phagocytosis by non-macrophage cells has not been previously well defined. We present a case of lenalidomide-associated HLH with concurrent plasma cell hemophagocytosis in a patient with controlled multiple myeloma (MM).

As life expectancy increases, so does the risk of developing multiple chronic conditions (MCC). This is concerning as there is a growing obesity epidemic in older adults which is also associated with developing chronic diseases. Both obesity and MCC also increase the risk of frailty, yet the intersection of the three is not well understood. We evaluated the relationship between obesity, multimorbidity, and frailty using data from adults ≥65 years from the National Health and Aging Trends Survey. Obesity was classified using standard body mass index categories (e.g., ≥30kg/m2) and waist circumference (WC; females≥88cm; males≥102cm). MCC was classified as having ≥2 chronic conditions. Adjusted logistic regression models evaluated the association of BMI or WC categories on MCC (yes/no). An analysis limited to persons with obesity evaluated the relationship between frailty phenotypes (e.g, robust, pre-frail, frail) and MCC. Of the 4,967 participants (59.7% female), 79% resided in a private residence. The 70-79 age category was most prevalent. In those with MCC, there were 1,511 (30.4%) classified as having obesity using BMI, and 3,358 (67.6%) using WC. In those without MCC, there were 287 (17.6%) and 744 (51.7%). Compared to normal BMI, the odds of MCC was 0.71 [0.46,1.09], 1.25 [1.08,1.45] and 2.59 [2.15,3.11] in underweight, overweight and obesity. In pre-frailty and frailty, the odds of MCC were 2.52 [1.77,3.59] and 8.35 [3.7,18.85] in BMI-defined obesity. Using WC, the odds were 2.38 [1.94,2.91], and 5.89 [3.83,9.06]. Obesity using both BMI and WC are both strongly associated with multimorbidity and frailty.

Declining mortality rates and an aging population have contributed to increasing rates of multimorbidity (≥2 chronic conditions) in the United States. Obesity is an important risk factor for the development of chronic diseases. We evaluated the association between obesity and multimorbidity, and how the prevalence of concomitant obesity has changed over time. We used data from 8,883 individuals aged ≥60 years with data on body mass index (BMI) and self-reported comorbidities from the National Health and Nutrition Examination Surveys 2005-2014. Logistic regression was used to quantify the association between BMI categories (

Contains fulltext : 194255.pdf (Publisher’s version ) (Open Access) BACKGROUND: Emphysema has considerable variability in its regional distribution. Craniocaudal emphysema distribution is an important predictor of the response to lung volume reduction. However, there is little consensus regarding how to define upper lobe-predominant and lower lobe-predominant emphysema subtypes. Consequently, the clinical and genetic associations with these subtypes are poorly characterized. METHODS: We sought to identify subgroups characterized by upper-lobe or lower-lobe emphysema predominance and comparable amounts of total emphysema by analyzing data from 9,210 smokers without alpha-1-antitrypsin deficiency in the Genetic Epidemiology of COPD (COPDGene) cohort. CT densitometric emphysema was measured in each lung lobe. Random forest clustering was applied to lobar emphysema variables after regressing out the effects of total emphysema. Clusters were tested for association with clinical and imaging outcomes at baseline and at 5-year follow-up. Their associations with genetic variants were also compared. RESULTS: Three clusters were identified: minimal emphysema (n = 1,312), upper lobe-predominant emphysema (n = 905), and lower lobe-predominant emphysema (n = 796). Despite a similar amount of total emphysema, the lower-lobe group had more severe airflow obstruction at baseline and higher rates of metabolic syndrome compared with subjects with upper-lobe predominance. The group with upper-lobe predominance had greater 5-year progression of emphysema, gas trapping, and dyspnea. Differential associations with known COPD genetic risk variants were noted. CONCLUSIONS: Subgroups of smokers defined by upper-lobe or lower-lobe emphysema predominance exhibit different functional and radiological disease progression rates, and the upper-lobe predominant subtype shows evidence of association with known COPD genetic risk variants. These subgroups may be useful in the development of personalized treatments for COPD.

Rural older adults aged ≥65 years with obesity (body mass index (BMI) ≥30 kg/m2) showed an overall favorable response to a six-month, technology-based weight-management intervention. Our objective was to characterize how friends or family support for eating and exercise behaviors at baseline was associated with baseline weight and intervention response. We analyzed data from six subscales of the Social Support and Exercise Survey from 44 participants. Six-month weight change (≥5% of baseline) was considered clinically-significant. For each subscale, continuous and categorial outcomes were modeled with linear and logistic regression models, respectively, adjusted for sex and age. Crude associations of social support clusters, generated in an exploratory hierarchical cluster analysis, and weight outcomes were evaluated. The sample was 73.2 ± 3.9 years, 73% female, with mean baseline weight 97.8±16.3 kg and BMI 36.5±5.2 m/kg2. Family encouragement for healthy eating was negatively associated with baseline weight (β=-0.53, p=0.046). Social support scores were not associated with either six-month weight loss outcome (p>0.10). Two exploratory clusters were found: Cluster 1 (C1) (n=34) and Cluster 2 (C2) (n=9). C2 had higher mean social encouragement and discouragement, with lower mean baseline weight (90.0±11.7 vs 99.8±16.8kg C1; p=0.10). Weight loss was comparable (C1 4.6±3.7 versus C2 4.8±2.6kg; p=0.89), with no differences in clinically-significant weight loss (C1 45% versus C2 67%; p=0.46). These pilot data suggest that family member social support may act as collaterals to support clinical outcomes in the community. Evaluating different types within family support may elucidate associations with physiological outcomes in larger samples.

This article is about teacher education reform. At the time of writing, teacher education (which is predominately the domain of universities in Australia), has undergone numerous critical reviews with little change effect. The teaching profession's struggles to cope with a changing world has been documented and an increasing push from Australian governments, at both the state and federal level for improved school outcomes are regular pieces in the national Australian press. A cadre of teacher education commentators call for a rethink on teacher education. This article showcases a disruptive model in teacher education and answers some of the ponderings around what teacher education could be and how it could be organised differently for the different world in which teachers now have to operate. More specifically, the article examines the Bachelor of Learning Management (BLM) which was developed at CentralQueenslandUniversityin2000andisstillinoperationtoday. TheBLMwas the first major revision and redevelopment of teacher education in Australia in twenty five years: this fact alone makes the BLM an interesting case study.

The heritability of chronic obstructive pulmonary disease (COPD) cannot be fully explained by recognized genetic risk factors identified as achieving genome-wide significance. In addition, the combined contribution of genetic variation to COPD risk has not been fully explored. We sought to determine: (1) whether studies of variants from previous studies of COPD or lung function in a larger sample could identify additional associated variants, particularly for severe COPD; and (2) the impact of genetic risk scores on COPD. We genotyped 3,346 single-nucleotide polymorphisms (SNPs) in 2,588 cases (1,803 severe COPD) and 1,782 control subjects from four cohorts, and performed association testing with COPD, combining these results with existing genotyping data from 6,633 cases (3,497 severe COPD) and 5,704 control subjects. In addition, we developed genetic risk scores from SNPs associated with lung function and COPD and tested their discriminatory power for COPD-related measures. We identified significant associations between SNPs near PPIC (P = 1.28 X 10(-8)) and PPP4R4/SERPINA1 (P = 1.01 X 10(-8)) and severe COPD; the latter association may be driven by recognized variants in SERPINA1. Genetic risk scores based on SNPs previously associated with COPD and lung function had a modest ability to discriminate COPD (area under the curve, similar to 0.6), and accounted for a mean 0.9-1.9% lower forced expiratory volume in 1 second percent predicted for each additional risk allele. In a large genetic association analysis, we identified associations with severe COPD near PPIC and SERPINA1. A risk score based on combining genetic variants had modest, but significant, effects on risk of COPD and lung function.

There is increasing pressure for society to move towards more sustainable use of its resources, and calls in the literature have been made to reassess marketing’s role in achieving such goals. This research examines how key behavioural factors influence household water use, in the context of a social marketing programme to reduce household water consumption. A model of the key drivers of household water consumption is developed and tested using a sample of 909 households in a regional city in Australia. The findings from this study support the model developed and show that in the absence of price as a rationing mechanism, the social marketing programme significantly reduces household water consumption. \ud \ud Statement of contribution: This is the first study to develop a comprehensive and empirically tested model of the non-price drivers of household water consumption, within the context of a social marketing intervention. The findings make a contribution to the field of consumer behaviour and social marketing by illustrating key behavioural drivers of water consumption. Consequently the study also shows how marketers can assist in preserving essential goods and services such as water.

Water shortages are an increasingly significant social and economic issue in many countries. Increasing the supply of water is one solution (e.g. desalination plants, new dams), but such measures are expensive. Using price to manage household water demand may be viewed as socially unequitable and politically contentious. Social marketing campaigns, where voluntary behaviour change is the goal, provide the potential to foster sustainable consumption of an increasingly scarce yet essential resource. This paper details a case study of successful water demand management in a drought affected region of South-Eastern Australia. In this region, water consumption was reduced to more sustainable levels through a targeted and successful social marketing campaign. This case is of significant relevance to the field of Social Marketing where there are increasing calls for research into environmental issues in general and water consumption in particular (Kotler, 2011). The extant research literature and this case study are integrated to form several propositions about household water consumption behaviour. Consequently, this paper contributes to the literature by providing a conceptualisation of how residents respond to water conservation related social marketing campaigns. Key issues include the potential for reciprocal behaviour by consumers when a water authority is perceived to manage the water problem effectively, and linking behaviour change through structural approaches (e.g. subsidies and restrictions) and voluntarist approaches (e.g. attitudinal change). Copyright © 2013 John Wiley & Sons, Ltd.

BackgroundTuberous sclerosis complex is a genetic disorder affecting every organ system, but disease manifestations vary significantly among affected individuals. The diverse and varied presentations and progression can be life-threatening with significant impact on cost and quality of life. Current surveillance and management practices are highly variable among region and country, reflective of the fact that last consensus recommendations occurred in 1998 and an updated, comprehensive standard is lacking that incorporates the latest scientific evidence and current best clinical practices.MethodsThe 2012 International Tuberous Sclerosis Complex Consensus Group, comprising 79 specialists from 14 countries, was organized into 12 separate subcommittees, each led by a clinician with advanced expertise in tuberous sclerosis complex and the relevant medical subspecialty. Each subcommittee focused on a specific disease area with important clinical management implications and was charged with formulating key clinical questions to address within its focus area, reviewing relevant literature, evaluating the strength of data, and providing a recommendation accordingly.ResultsThe updated consensus recommendations for clinical surveillance and management in tuberous sclerosis complex are summarized here. The recommendations are relevant to the entire lifespan of the patient, from infancy to adulthood, including both individuals where the diagnosis is newly made as well as individuals where the diagnosis already is established.ConclusionsThe 2012 International Tuberous Sclerosis Complex Consensus Recommendations provide an evidence-based, standardized approach for optimal clinical care provided for individuals with tuberous sclerosis complex.

BACKGROUND: Tuberous sclerosis complex is highly variable in clinical presentation and findings. Disease manifestations continue to develop over the lifetime of an affected individual. Accurate diagnosis is fundamental to implementation of appropriate medical surveillance and treatment. Although significant advances have been made in the past 15 years in the understanding and treatment of tuberous sclerosis complex, current clinical diagnostic criteria have not been critically evaluated or updated since the last clinical consensus conference in 1998. METHODS: The 2012 International Tuberous Sclerosis Complex Consensus Group, comprising 79 specialists from 14 countries, was organized into 12 subcommittees, each led by a clinician with advanced expertise in tuberous sclerosis complex and the relevant medical subspecialty. Each subcommittee focused on a specific disease area with important diagnostic implications and was charged with reviewing prevalence and specificity of diseaseassociated clinical findings and their impact on suspecting and confirming the diagnosis of tuberous sclerosis complex. RESULTS: Clinical features of tuberous sclerosis complex continue to be a principal means of diagnosis. Key changes compared with 1998 criteria are the new inclusion of genetic testing results and reducing diagnostic classes from three (possible, probable, and definite) to two (possible, definite). Additional minor changes to specific criterion were made for additional clarification and simplification. CONCLUSIONS: The 2012 International Tuberous Sclerosis Complex Diagnostic Criteria provide current, updated means using best available evidence to establish diagnosis of tuberous sclerosis complex in affected individuals.

Campylobacter concisus is a member of the oral microbiota that has been associated with the development of inflammatory bowel diseases. However, the role of the bacterium in disease aetiology remains poorly understood. Here, we examine optimal conditions for the growth of C. concisus, and the pathogenic potential of this bacterium in human gastrointestinal cells from the upper tract. Further, the presence of C. concisus in the lower tract of Crohn's disease (CD) patients undergoing therapy is observed, and the associations of C. concisus with the abundance of other microbial taxa and compounds they produce are evaluated. C. concisus strains had the ability to tolerate moderate levels of acidity, adhere to and invade esophageal and gastric cells; however, these properties did not correlate with their pathogenic potential in intestinal cells. The presence of the bacterium in the lower gut of CD patients was associated with an increased relative abundance of Faecalibacterium and Lachnospiraceae incertae sedis. Short chain fatty acids that can be produced by these microbial species did not appear to be responsible for this association. However, we identified genetic similarity between C. concisus and Firmicutes, specifically within aspartate and glutamate racemases. The potential pathogenesis of C. concisus in the upper gastrointestinal tract, and the responsiveness of the bacterium to therapy in a subset of CD patients warrant further investigation into whether this bacterium has a causal role in disease or its presence is incidental.

Treatment and prognoses of diffuse parenchymal lung diseases (DPLDs) varies by diagnosis. Obtaining a uniform diagnosis among observers is difficult.Evaluate diagnostic agreement between academic and community-based physicians for patients with DPLDs, and determine if an interactive approach between clinicians, radiologists, and pathologists improved diagnostic agreement in community and academic centers.Retrospective review of 39 patients with DPLD. A total of 19 participants reviewed cases at 2 community locations and 1 academic location. Information from the history, physical examination, pulmonary function testing, high-resolution computed tomography, and surgical lung biopsy was collected. Data were presented in the same sequential fashion to three groups of physicians on separate days.Each observer's diagnosis was coded into one of eight categories. A kappa statistic allowing for multiple raters was used to assess agreement in diagnosis. Interactions between clinicians, radiologists, and pathologists improved interobserver agreement at both community and academic sites; however, final agreement was better within academic centers (kappa = 0.55-0.71) than within community centers (kappa = 0.32-0.44). Clinically significant disagreement was present between academic and community-based physicians (kappa = 0.11-0.56). Community physicians were more likely to assign a final diagnosis of idiopathic pulmonary fibrosis compared with academic physicians.Significant disagreement exists in the diagnosis of DPLD between physicians based in communities compared with those in academic centers. Wherever possible, patients should be referred to centers with expertise in diffuse parenchymal lung disorders to help clarify the diagnosis and provide suggestions regarding treatment options.

One of the challenges that higher education faces is to find how to approach the sustainability in an inclusive way to the student within all the different academic areas, how to move the sustainable development from the abstract field to the operational field. This research comes from the ecoliteracy and the pedagogical praxis as tools for rebuilding the teaching processes inside of universities. The purpose is to determine and describe which are the factors involved in the process of learning particularly in the Greenhouse-School Siembra UV. In the Greenhouse-School Siembra UV, of the University of Veracruz, are cultivated vegetables, medicinal plants and small cornfields under the usage of eco-technologies such as hydroponics, Wickingbed and Hugelkultur, which main purpose is the saving of space, labor and natural resources, as well as function as agricultural production alternatives in the urban and periurban zones. The sample was formed with students from different academic areas and who are actively involved in the greenhouse, as well as institutes from the University of Veracruz and governmental and nongovernmental departments. This project comes from a pedagogic praxis approach, from filling the needs that the different professional profiles of the university students have. All this with the purpose of generate a pragmatic dialogue with the sustainability. It also comes from the necessity to understand the factors that intervene in the students' praxis. In this manner is how the students are the fundamental unit in the sphere of sustainability. As a result, it is observed that those University of Veracruz students who are involved in the Greenhouse-school, Siembra UV, have enriched in different levels the sense of urban and periurban agriculture because of the diverse academic approaches they have and the interaction between them. It is concluded that the ecotechnologies act as fundamental tools for ecoliteracy in society, where it is strengthen the nutritional and food security from a sustainable development approach., {"references":["Runge Peña, Andrés Klaus; Muñoz Gaviria, Diego Alejandro (2012).\n\"Pedagogía y praxis (práctica educativa o educación. De nuevo: una\ndiferencia necesaria\". In Latinoamerican magazine of Educative Studies\n(Colombia), vol. 8, no. 2, July to December, Manizales, Colombia:\nUniversidad de Caldas, pp. 75-96.G.","Capra Fritjob (1997) The web of life: a new scientific understanding of\nliving systemes, Edit. Anchor W.-K. Chen, Linear Networks and Systems\n(Book style). Belmont, CA: Wadsworth, 1993, pp. 123–135.","De Alba, A. y Viesca, M., (Coords.) 1987. Educación Ambiental y\nEscuela Primaria en México. México: Secretaría de Desarrollo Urbano\ny Ecología (SEDUE).","González-Gaudiano, E., Andrade P., Ruiz, A., y Morelos, S., 1986,\nLineamientos Conceptuales y Metodológicos de la Educación Ambiental\nNo Formal. Dirección General de Promoción Ambiental y Participación\nComunitaria, México: Subsecretaría de Ecología.","Leff, E., 2004, Saber ambiental, sustentabilidad, racionalidad,\ncomplejidad, poder, siglo XXI, PNUMA, Buenos Aires, Argentina.H.","Complexus. 2004. Conclusiones del \"Foro de discusión en Educación\nSuperior y Desarrollo Sustentable\", organized by Consorcio Mexicano\nde Programas Ambientales Universitarios para el Desarrollo Sustentable\n(Complexus), León, Guanajuato.","Breitling, S. y Mogensen F., 1999, Action competence and\nenvironmental education. Cambridge J. Education 29(3):349-353.","Macedo, B., y Salgado, C., 2007, Educación ambiental y educación para\nel desarrollo sostenible en América Latina, OREALC/UNESCO\nSantiago (Oficina Regional de Educación de la UNESCO para América\nLatina y el Caribe).","Morín, E., 1999. Los siete saberes necesarios para la educación del\nfuturo. Ed. Magisterio. Bogotá. Colombia.\n[10] Moreneo, 1990 La estrategia aprendizaje en la educación formal:\nenseñar a pensar y sobre el pensar. Universidad Autónoma de\nBarcelona.\n[11] Nisbet, J. y Shucksmith,J., 1987: Estrategias de aprendizaje. Madrid:\nSantillana/Aula XXI.\n[12] Borroto, M.; Gutiérrez, I.; Talabera, B., Quesada, M.; Nuñez, A.,\nRodríguez, l. A.; 2011, Estrategia para la Educación Ambiental en\ncomunidades cubanas, Electronic magazine of environment 10:1-12.\n[13] Ortiz, M., J., Fuentes, G., A. y Masera, C., O., 2012, En búsqueda de\nalternativas tecnológicas para la solución de problemas socioecológicos,\nBoletín de la UNAM, Campus Morelia No. 36.\n[14] Turner, J., 1972, Freedom to Build, dweller control of the housing\nprocess. New York: Macmillan."]}

Our paper investigates household practices that use electricity, their relation to systems of provision and the enactment of domestic sociality. The results of this research conducted in the UK shed light on puzzling variations in electricity consumption across households posed by previous research. We argue for the need to attend to how household socialites influence and are influenced by electrical services and trace the links between these dynamics and the effects of wider cultural and socio-economic forces.

Cysts are commonly seen on CT scans of the lungs, and diagnosis can be challenging. Clinical and radiographic features combined with a multidisciplinary approach may help differentiate among various disease entities, allowing correct diagnosis. It is important to distinguish cysts from cavities because they each have distinct etiologies and associated clinical disorders. Conditions such as emphysema, and cystic bronchiectasis may also mimic cystic disease. A simplified classification of cysts is proposed. Cysts can occur in greater profusion in the subpleural areas, when they typically represent paraseptal emphysema, bullae, or honeycombing. Cysts that are present in the lung parenchyma but away from subpleural areas may be present without any other abnormalities on high-resolution CT scans. These are further categorized into solitary or multifocal/diffuse cysts. Solitary cysts may be incidentally discovered and may be an age related phenomenon or may be a remnant of prior trauma or infection. Multifocal/diffuse cysts can occur with lymphoid interstitial pneumonia, Birt-Hogg-Dubé syndrome, tracheobronchial papillomatosis, or primary and metastatic cancers. Multifocal/diffuse cysts may be associated with nodules (lymphoid interstitial pneumonia, light-chain deposition disease, amyloidosis, and Langerhans cell histiocytosis) or with ground-glass opacities (Pneumocystis jirovecii pneumonia and desquamative interstitial pneumonia). Using the results of the high-resolution CT scans as a starting point, and incorporating the patient’s clinical history, physical examination, and laboratory findings, is likely to narrow the differential diagnosis of cystic lesions considerably.

The National Heart, Lung, and Blood Institute-sponsored IPF Clinical Research Network (IPFnet) studies enrolled subjects with idiopathic pulmonary fibrosis (IPF) to evaluate drug therapies in treatment trials. An adjudication committee (AC) provided a structured review of cases in which there was uncertainty or disagreement regarding diagnosis or clinical event classification. This article describes the diagnosis and adjudication processes.The diagnostic process was based on review of clinical data and high-resolution CT scans with central review of lung biopsies when available. The AC worked closely with the data coordinating center to obtain clinical, radiologic, and histologic data and to communicate with the clinical centers. The AC used a multidisciplinary discussion model with four clinicians, one radiologist, and one pathologist to adjudicate diagnosis and outcome measures.The IPFnet trials screened 1,015 subjects; of these, 23 cases required review by the AC to establish eligibility. The most common diagnosis for exclusion was suspected chronic hypersensitivity pneumonitis. The AC reviewed 88 suspected acute exacerbations (AExs), 93 nonelective hospitalizations, and 16 cases of bleeding. Determination of AEx presented practical challenges to adjudicators, as necessary clinical data were often not collected, particularly when subjects were evaluated outside of the primary study site.The IPFnet diagnostic process was generally efficient, but a multidisciplinary adjudication committee was critical to assure correct phenotype for study enrollment. The AC was key in adjudicating all adverse outcomes in two IPFnet studies terminated early because of safety issues. Future clinical trials in IPF should consider logistical and cost issues as they incorporate AExs and hospitalizations as outcome measures.ClinicalTrials.gov; No.: NCT00517933, NCT00650091, NCT00957242; URL: www.clinicaltrials.gov.

Grammatical Evolution (GE) is applied to the problem of load balancing in heterogeneous cellular network deployments (HetNets). HetNets are multi-tiered cellular networks for which load balancing is a scalable means to maximise network capacity, assuming similar traffic from all users. This paper describes a proof of concept study in which GE is used in a genetic algorithm-like way to evolve constants which represent cell power and selection bias in order to achieve load balancing in HetNets. A fitness metric is derived to achieve load balancing both locally in sectors and globally across tiers. Initial results show promise for GE as a heuristic for load balancing. This finding motivates a more sophisticated grammar to bring enhanced Inter-Cell Interference Coordination optimisation into an evolutionary framework.

Recycling carbon present in residual streams enhances sustainability and creates local wealth. Enerkem Inc. is a leading biomass gasification company headquartered in Montreal, Quebec. The approach Enerkem has been developing involves: identification of low cost residual streams as feedstock, sorting, biotreatment (anaerobic and/or aerobic) and preparation of an ultimate residue (RDF). The latter is a rather uniform material that can be fed, as a fluff, to a bubbling bed gasifier in a staged gasification to carry out, sequentially, the needed chemical reactions that result in high syngas yields. Process can be adjusted to reach desired gas composition for synthesis or electricity generation as well as gas conditioning to produce an ultraclean syngas. Products for such a process are: i) syngas with an appropriate range of H2/CO ratios, ii) CO2 (which is recovered), iii) solid char as a residue composed of the inorganic fraction of the raw material and some unconverted carbon that “coats” the inorganic matrices, and