Clinical significance of bronchodilator responsiveness evaluated by forced vital capacity in COPD: SPIROMICS cohort analysis

Objective: Bronchodilator responsiveness (BDR) is prevalent in COPD, but its clinical implications remain unclear. We explored the significance of BDR, defined by post-bronchodilator change in FEV1 (BDRFEV1) as a measure reflecting the change in flow and in FVC (BDRFVC)reflecting the change in volume. Methods: We analyzed 2974 participants from a multicenter observational study designed to identify varying COPD phenotypes (SPIROMICS). We evaluated the association of BDR with baseline clinical characteristics, rate of prospective exacerbations and mortality using negative binomial regression and Cox proportional hazards models. Results: A majority of COPD participants exhibited BDR (52.7%). BDRFEV1 occurred more often in earlier stages of COPD, while BDRFVC occurred more frequently in more advanced disease. When defined by increases in either FEV1 or FVC, BDR was associated with a self-reported history of asthma, but not with blood eosinophil counts. BDRFVC was more prevalent in subjects with greater emphysema and small airway disease on CT. In a univariate analysis, BDRFVC was associated with increased exacerbations and mortality, although no significance was found in a model adjusted for post-bronchodilator FEV1. Conclusion: With advanced airflow obstruction in COPD, BDRFVC is more prevalent in comparison to BDRFEV1 and correlates with the extent of emphysema and degree of small airway disease. Since these associations appear to be related to the impairment of FEV1,BDRFVC itself does not define a distinct phenotype nor can it be more predictive of outcomes, but it can offer additional insights into the pathophysiologic mechanism in advanced COPD. Clinical trials registration: ClinicalTrials.gov: NCT01969344T4

Recovery of Salmonella Enteritidis and Campylobacter coli injected into hatching eggs that are cold-stored and incubated through day 18 of incubation

SUMMARY: Salmonella and Campylobacter spp. are important foodborne pathogens of concern. Both horizontal and vertical transmission of Salmonella into poultry flocks is well documented to occur, whereas only horizontal transmission of Campylobacter has been confirmed. The objective of this study was to evaluate the ability of Salmonella and Campylobacter to translocate from egg contents into the embryo during incubation. Three experiments were performed comparing Salmonella recovery from eggs that were cold-stored (48 h) and incubated up to D15 or D18 of incubation. Four experiments were performed comparing Campylobacter recovery from eggs that were cold-stored and incubated up to D15 or D18 of incubation. Eggs were injected with 102-3 CFU Salmonella Enteritidis or 103 CFU Campylobacter coli into the albumen or yolk, and sampling of the egg contents and viable embryos was performed periodically during cold-storage and incubation. In the Salmonella experiments, egg contents from yolk injected eggs sampled during incubation were 100% positive, and no viable embryos were present. In contrast, Salmonella albumen injected eggs sampled on D18 had 51% positive egg contents and 37% positive embryos. In the Campylobacter experiments, 15% of embryos of yolk injected eggs were positive at D15, but no egg contents or embryos were positive at D18 of incubation. Results indicate that the albumen is likely to be the site for contamination than the yolk for forming eggs resulting in Salmonella positive embryos. Additionally, Campylobacter vertical transmission appears to be unlikely, but if it does occur, the location of the contamination is more likely the yolk contents

Montmorillonite Flame Retardant PU Foams and Their Preparation

In the current networked world, outsourcing of information technology or even of entire business processes is often a prominent design alternative. In the general case, outsourcing is the distribution of economically viable activities over a collection of networked organizations. To evaluate outsourcing decision alternatives, we need to make a conceptual model of each of them. However, in an outsourcing situation, many actors are involved that are reluctant to spend too many resources on exploring alternatives that are not known to be cost-effective. Moreover, the particular risks involved in a specific outsourcing decision have to be identified as early as possible to focus the decision-making process. In this paper, we present a risk-driven approach to conceptual modeling of outsourcing decision alternatives, in which we model just enough of each alternative to be able to make the decision. We illustrate our approach with an example