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BACKGROUND COPD and bronchiectasis are common and exacerbations contribute to their morbidity and mortality. Predictive factors for frequency of future exacerbations include previous exacerbation frequency and airway colonisation. Earlier treatment of exacerbations is likely to reduce severity. OBJECTIVE To determine whether changes in physiological variables or symptom scores can predict exacerbations of chronic airway disease in participants colonised with Pseudomonas aeruginosa or Haemophilus influenzae METHODS We performed a longitudinal observational cohort study of 30 participants with bronchiectasis and/or COPD, at least 2 exacerbations per year and colonisation with Pseudomonas aeruginosa or Haemophilus influenzae. Daily symptom and physiological data were collected comprising pulse rate, blood pressure, oxygen saturation, peak flow rate, step count, weight and temperature. Exacerbations (defined as the onset of new antibiotics for respiratory symptoms) were collected, and predictive values for abnormal values in the ten days prior to an exacerbation were calculated. RESULTS 30 participants were recruited collecting a total of 39,534 physiological and 25,334 symptom data points across 5,358 participant-days including 78 exacerbations. Peak flow rate and weight were significantly different at the point of exacerbation but no significant trends around exacerbation were noted and no clinically beneficial predictive value was found in overall or individually adjusted models. Symptom scores trended to worsening for 10 days either side of an exacerbation, but of insufficient magnitude for prediction with AUROC values of 0.4-0.6. CONCLUSIONS This study demonstrated a lack of utility for either physiological or visual analogue scale symptom predictors in early detection of exacerbations in participants with frequent exacerbation and airway colonisation. This suggests that the self-management education provided as standard of care is superior to either of these other approaches. INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.6636

This chapter explores the particular relationship that existed between 'unbought' northern Protestant tenants and their landlords in Northern Ireland following partition and the creation of the new state. It examines the campaign for land reform, the progress of the Act, and its implications for landed estates in Northern Ireland. By exploring the responses to the Act among northern tenants, many of whom were Protestant unionists, it seeks to highlight the complexity of social, religious and economic relationships in the north of Ireland during the opening decades of the twentieth century.

This article offers a new analysis into young people’s perspectives towards Welsh-medium study at post-compulsory level. Drawing on data from semi-structured interviews with twenty-six 15–16-year olds attending a Welsh-medium secondary school in the South Wales Valleys (an area of Wales with a low proportion of Welsh speakers), this article will highlight how the linguistic context of the area affects perspectives towards Welsh-medium study. This paper will also illustrate how perspectives towards language of study is shaped by the types of educational pathways that young people aspire to pursue at post-compulsory level with different factors impacting on the perspectives of academically orientated and vocationally orientated students.

IntroductionThe prognosis of malignant pleural mesothelioma (MPM) is poor, with a median survival of 8–12 months. The ability to predict prognosis in MPM would help clinicians to make informed decisions regarding treatment and identify appropriate research opportunities for patients. The aims of this study were to examine associations between clinical and pathological information gathered during routine care, and prognosis of patients with MPM, and to develop a 6-month mortality risk prediction model.MethodsA retrospective cohort study of patients diagnosed with MPM at Queen Alexandra Hospital, Portsmouth, UK between December 2009 and September 2013. Multivariate analysis was performed on routinely available histological, clinical and laboratory data to assess the association between different factors and 6-month survival, with significant associations used to create a model to predict the risk of death within 6 months of diagnosis with MPM.Results100 patients were included in the analysis. Variables significantly associated with patient survival in multivariate analysis were age (HR 1.31, 95% CI 1.09 to 1.56), smoking status (current smoker HR 3.42, 95% CI 1.11 to 4.20), chest pain (HR 2.14, 95% CI 1.23 to 3.72), weight loss (HR 2.13, 95% CI 1.18 to 3.72), platelet count (HR 1.05, 95% CI 1.00 to 1.10), urea (HR 2.73, 95% CI 1.31 to 5.69) and adjusted calcium (HR 1.47, 95% CI 1.10 to 1.94). The resulting risk model had a c-statistic value of 0.76. A Hosmer-Lemeshow test confirmed good calibration of the model against the original dataset.ConclusionRisk of death at 6 months in patients with a confirmed diagnosis of MPM can be predicted using variables readily available in clinical practice. The risk prediction model we have developed may be used to influence treatment decisions in patients with MPM. Further validation of the model requires evaluation of its performance on a separate dataset.

Identifying vertebral fractures is prudent in the management of osteoporosis and the current literature suggests that less than one-third of incidental vertebral fractures are reported. The aim of this study is to determine the prevalence of reported and unreported vertebral fractures in computerized tomography pulmonary angiograms (CTPA) and their relevance to clinical outcomes. All acutely unwell patients aged 75 or older who underwent CTPAs were reviewed retrospectively. 179 CTPAs were reviewed to identify any unreported vertebral fractures. A total of 161 were included for further analysis. Of which, 14.3% (23/161) were reported to have a vertebral fracture, however, only 8.7% (14/161) of reports used the correct terminology of &lsquo, fracture&rsquo, On subsequent review, an additional 19.3% (31/161) were noted to have vertebral fractures. Therefore, the overall prevalence of vertebral fractures was 33.5% (54/161). A total of 22.2% (12/54) of patients with a vertebral fracture on CTPA sustained a new fragility fracture during the follow-up period (4.5 years). In comparison, a significantly lower 10.3% (11/107) of patients without a vertebral fracture developed a subsequent fragility fracture during the same period (p = 0.04). Overall mortality during the follow-up period was significantly higher for patients with vertebral fractures (68.5%, 37/54) as compared to those without (45.8%, 49/107, p = 0.006). Vertebral fractures within the elderly population are underreported on CTPAs. The significance of detecting incidental vertebral fractures is clear given the increased rates of subsequent fractures and mortality. Radiologists and physicians alike must be made aware of the importance of identifying and treating incidental, vertebral fragility fractures.

Objective Sepsis mortality is reported to be high worldwide, however recently the attributable fraction of mortality due to sepsis (AFsepsis) has been questioned. If improvements in treatment options are to be evaluated, it is important to know what proportion of deaths are potentially preventable or modifiable after a sepsis episode. The aim of the study was to establish the fraction of deaths directly related to the sepsis episode on the general wards and emergency departments. Results 839 patients were recruited over the two 24-h periods in 2016 and 2017. 521 patients fulfilled SEPSIS-3 criteria. 166 patients (32.4%) with sepsis and 56 patients (17.6%) without sepsis died within 90 days. Out of the 166 sepsis deaths 12 (7.2%) could have been directly related to sepsis, 28 (16.9%) possibly related and 96 (57.8%) were not related to sepsis. Overall AFsepsis was 24.1%. Upon analysis of the 40 deaths likely to be attributable to sepsis, we found that 31 patients (77.5%) had the Clinical Frailty Score ≥ 6, 28 (70%) had existing DNA-CPR order and 17 had limitations of care orders (42.5%). Electronic supplementary material The online version of this article (10.1186/s13104-018-3819-2) contains supplementary material, which is available to authorized users.

Additional file 1: Figure S1. Distribution of patient deaths according to their attribution to sepsis episode defined by different sepsis definitions.

The Middle Devonian Winnipegosis Formation of Saskatchewan is divisible into upper and lower members on the basis of a regionally developed argillaceous interval which forms the uppermost part of the lower member. The lower member consists of a regionally dolomitized marine carbonate of relatively constant thickness and lithology, attaining a maximum observed thickness of 54 ft. The upper member is a varied marine carbonate sequence, with three major facies developments. In the southwest lies a wedge of lithologically relatively consistent carbonates, reaching a maximum thickness of about 130 ft. along a northwest-trending axis extending through Weyburn and Elbow. In the north and east, bioclastic-pelletoidal carbonate banks with true reef intervals (up to 345 ft. thick), and finely laminated, interbank carbonates (up to 68 ft. thick) occur. The lower member was laid down in a broad epicontinental sea. The relatively shallow, open marine conditions culminated on two occasions in basin-wide, reducing, lagoonal conditions, evidenced by the medial and upper very bituminous argillaceous intervals containing impoverished faunas. The upper member appears to have been deposited in a shallow shelving sea which deepened toward the northeast. Using a regionally developed Amphipora zone as a datum, three pre-Amphipora tectonic-sedimentational regions are discernible: in the southwest, the Elbow-Weyburn basin, subsiding relatively rapidly to accommodate thick, shallow-water carbonates; in the north and east, the comparatively stable Saskatoon shelf, with thin laminated carbonates and basal carbonates of the bank sediments; and the mo e rapidly subsiding Meadow Lake-Sayese basin complex, with similar sediments, except that bank sedimentation was further advanced. In post-Amphipora time, subsidence continued in the north, accelerated in the shelf area to accommodate thick bank accumulations, whereas, in the southwestern basin, carbonate deposition was almost complete. Although no commercial quantities of oil or gas have been found in Saskatchewan, production of oil from the Winnipegosis in the Outlook and Redstone fields of northeastern Montana is encouraging. The occurrence of oil and gas "shows" in some drill-stem tests and of oil staining in the Winnipegosis Formation in Saskatchewan offers further encouragement, especially in the Elbow-Weyburn basin, which is a northwestern extension of the oil-producing facies of northeastern Montana. The presence in the southwestern basin of permeability traps resulting from differential dolomitization and recrystallization, and in the north and east, of important thickening in short distances, associated with variably porous bank carbonates, together with the widespread development of an excellent top seal i the form of the Prairie Evaporite salt or carbonate-anhydrite sequences, provide excellent conditions for the entrapment of hydrocarbons. End_of_Article - Last_Page 1570

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This thesis traces the development of Maurice Ravel’s pianism in relation to sonority, nuance and expression by addressing four main areas of research that have remained largely unexplored within Ravel scholarship: the origins of Ravel’s pianism and influences to which he was exposed during his formative training; his exploration of innovative pianistic techniques with particular reference to thumb deployment; his activities as performer and teacher, and role in defining a performance tradition for his piano works; his place in the French pianistic canon. Identifying the main research questions addressed in this study, an Introduction outlines the dissertation content, explains the criteria and objectives for the performance component (Public Recital) and concludes with a literature review. Chapter 1 explores the pianistic techniques Ravel acquired during his formative training, and considers how his study of specific works from the nineteenth-century piano repertory shaped and influenced his compositional style and pianism. Chapter 2 discusses Ravel’s implementation of his idiosyncratic ‘strangler’ thumbs as articulators of melodic, harmonic, rhythmic and textural material in selected piano works. Ravel’s role in defining a performance tradition for his piano works as disseminated to succeeding generations of pianists is addressed in Chapter 3, while Chapters 4 and 5 evaluate Ravel’s impact upon twentieth-century French pianism through considering how leading French piano pedagogues and performers responded to his trailblazing piano techniques. It will be shown that through his activities as teacher and performer, as well as composer, Ravel took control of every detail pertaining to his piano works with his meticulously notated scores, piano roll recordings and interpretive guidance imparted to other pianists, thus catalysing performance practices that promulgated a distinctively French twentieth-century pianistic tradition.