Does pulmonary rehabilitation address cardiovascular risk factors in patients with COPD?

Background Patients with COPD have an increased risk of cardiovascular disease. Whilst pulmonary rehabilitation has proven benefit for exercise tolerance and quality of life, any effect on cardiovascular risk has not been fully investigated. We hypothesised that pulmonary rehabilitation, through the exercise and nutritional intervention, would address these factors. Methods Thirty-two stable patients with COPD commenced rehabilitation, and were compared with 20 age and gender matched controls at baseline assessment. In all subjects, aortic pulse wave velocity (PWV) an independent non-invasive predictor of cardiovascular risk, blood pressure (BP), interleukin-6 (IL-6) and fasting glucose and lipids were determined. These measures, and the incremental shuttle walk test (ISWT) were repeated in the patients who completed pulmonary rehabilitation. Results On commencement of rehabilitation aortic PWV was increased in patients compared with controls (p < 0.05), despite mean BP, age and gender being similar. The IL-6 was also increased (p < 0.05). Twenty-two patients completed study assessments. In these subjects, rehabilitation reduced mean (SD) aortic PWV (9.8 (3.0) to 9.3 (2.7) m/s (p < 0.05)), and systolic and diastolic BP by 10 mmHg and 5 mmHg respectively (p < 0.01). Total cholesterol and ISWT also improved (p < 0.05). On linear regression analysis, the reduction in aortic PWV was attributed to reducing the BP. Conclusion Cardiovascular risk factors including blood pressure and thereby aortic stiffness were improved following a course of standard multidisciplinary pulmonary rehabilitation in patients with COPD

The Sherwood simulation suite: overview and data comparisons with the Lyman-α forest at redshifts 2≤z≤5

We introduce a new set of large-scale, high-resolution hydrodynamical simulations of the intergalactic medium: the Sherwood simulation suite. These are performed in volumes of 103–1603h−3 comoving Mpc3, span almost four orders of magnitude in mass resolution with up to 17.2 billion particles, and employ a variety of physics variations including warm dark matter and galactic outflows. We undertake a detailed comparison of the simulations to high-resolution, high signal-to-noise observations of the Ly α forest over the redshift range 2 ≤ z ≤ 5. The simulations are in very good agreement with the observational data, lending further support to the paradigm that the Ly α forest is a natural consequence of the web-like distribution of matter arising in Λcold dark matter cosmological models. Only a small number of minor discrepancies remain with respect to the observational data. Saturated Ly α absorption lines with column densities NHI>1014.5cm−2 at 2 4. Finally, the temperature of intergalactic gas in the simulations may be slightly too low at z = 2.7 and a flatter temperature–density relation is required at z = 2.4, consistent with the expected effects of non-equilibrium ionization during He ii reionization

Does wage rank affect employees' well-being?

How do workers make wage comparisons? Both an experimental study and an analysis of 16,000 British employees are reported. Satisfaction and well-being levels are shown to depend on more than simple relative pay. They depend upon the ordinal rank of an individual's wage within a comparison group. “Rank” itself thus seems to matter to human beings. Moreover, consistent with psychological theory, quits in a workplace are correlated with pay distribution skewness

Relational Concurrent Refinement II: Internal Operations and Outputs

Two styles of description arise naturally in formal specification: state-based and behavioural. In state-based notations, a system is characterised by a collection of variables, and their values determine which actions may occur throughout a system history. Behavioural specifications describe the chronologies of actions -- interactions between a system and its environment. The exact nature of such interactions is captured in a variety of semantic models with corresponding notions of refinement; refinement in state based systems is based on the semantics of sequential programs and is modelled relationally. Acknowledging that these viewpoints are complementary, substantial research has gone into combining the paradigms. The purpose of this paper is to do three things. First, we survey recent results linking the relational model of refinement to the process algebraic models. Specifically, we detail how variations in the relational framework lead to relational data refinement being in correspondence with traces-divergences, singleton failures and failures-divergences refinement in a process semantics. Second, we generalise these results by providing a general flexible scheme for incorporating the two main ''erroneous'' concurrent behaviours: deadlock and divergence, into relational refinement. This is shown to subsume previous characterisations. In doing this we derive relational refinement rules for specifications containing both internal operations and outputs that corresponds to failures-divergences refinement. Third, the theory has been formally specified and verified using the interactive theorem prover KIV

Observations of interplanetary dust by the Juno magnetometer investigation

One of the Juno magnetometer investigation's star cameras was configured to search for unidentified objects during Juno's transit en route to Jupiter. This camera detects and registers luminous objects to magnitude 8. Objects persisting in more than five consecutive images and moving with an apparent angular rate of between 2 and 18,000 arcsec/s were recorded. Among the objects detected were a small group of objects tracked briefly in close proximity to the spacecraft. The trajectory of these objects demonstrates that they originated on the Juno spacecraft, evidently excavated by micrometeoroid impacts on the solar arrays. The majority of detections occurred just prior to and shortly after Juno's transit of the asteroid belt. This rather novel detection technique utilizes the Juno spacecraft's prodigious 60 sq. m of solar array as a dust detector and provides valuable information on the distribution and motion of interplanetary (greater than a micron) dust. Plain Language Summary: The Juno magnetometer investigation uses star cameras co-located with the magnetic sensors at the outer end of one of Juno's solar arrays. These cameras compare images with an onboard star catalog to determine the orientation of the sensors in inertial space. They also serendipitously recorded multiple images of small particles excavated from the spacecraft by high-velocity dust impacts. We trace their trajectories back in time to demonstrate that they evolved from the spacecraft. This allows us to use the vast collecting area of Juno's solar arrays (60 sq. m)as a novel dust detector, sensitive to particles with a mass range never before measured in situ

Vision, mission, and values: From concept to execution at Mayo Clinic

Mayo Clinic displays steadfast commitment to patient care, referral relations, and health care quality through institutional examples of unique, value-add endeavors that are under way with the Mayo Clinic Patient Experience Subcommittee and the Referring Physician Office. In this article, we share the Mayo Model of Care and patient stories that embody the 8 Mayo Clinic values of respect, compassion, integrity, healing, teamwork, excellence, innovation, and stewardship. The Mayo founders imparted to their staff the passion for patient care by encouraging a fair and just culture for its employees. This culture allows the creation, maintenance, and improvement of clinical care, research studies, and educational curricula, which in turn propagate the mission–“To inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education, and research.

Four quasars above redshift 6 discovered by the Canada-France High-z Quasar Survey

The Canada-France High-z Quasar Survey (CFHQS) is an optical survey designed to locate quasars during the epoch of reionization. In this paper we present the discovery of the first four CFHQS quasars at redshift greater than 6, including the most distant known quasar, CFHQS J2329-0301 at z=6.43. We describe the observational method used to identify the quasars and present optical, infrared, and millimeter photometry and optical and near-infrared spectroscopy. We investigate the dust properties of these quasars finding an unusual dust extinction curve for one quasar and a high far-infrared luminosity due to dust emission for another. The mean millimeter continuum flux for CFHQS quasars is substantially lower than that for SDSS quasars at the same redshift, likely due to a correlation with quasar UV luminosity. For two quasars with sufficiently high signal-to-noise optical spectra, we use the spectra to investigate the ionization state of hydrogen at z>5. For CFHQS J1509-1749 at z=6.12, we find significant evolution (beyond a simple extrapolation of lower redshift data) in the Gunn-Peterson optical depth at z>5.4. The line-of-sight to this quasar has one of the highest known optical depths at z~5.8. An analysis of the sizes of the highly-ionized near-zones in the spectra of two quasars at z=6.12 and z=6.43 suggest the IGM surrounding these quasars was substantially ionized before these quasars turned on. Together, these observations point towards an extended reionization process, but we caution that cosmic variance is still a major limitation in z>6 quasar observations.Comment: 15 pages, 9 figures, AJ, in press, minor changes to previous versio

Cardiovascular and musculskeletal co-morbidities in patients with alpha 1 antitrypsin deficiency

Background Determining the presence and extent of co-morbidities is fundamental in assessing patients with chronic respiratory disease, where increased cardiovascular risk, presence of osteoporosis and low muscle mass have been recognised in several disease states. We hypothesised that the systemic consequences are evident in a further group of subjects with COPD due to Alpha-1 Antitrypsin Deficiency (A1ATD), yet are currently under-recognised. Methods We studied 19 patients with PiZZ A1ATD COPD and 20 age, sex and smoking matched controls, all subjects free from known cardiovascular disease. They underwent spirometry, haemodynamic measurements including aortic pulse wave velocity (aPWV), an independent predictor or cardiovascular risk, dual energy X-ray absorptiometry to determine body composition and bone mineral density. Results The aPWV was greater in patients: 9.9(2.1) m/s than controls: 8.5(1.6) m/s, p = 0.03, despite similar mean arterial pressure (MAP). The strongest predictors of aPWV were age, FEV1% predicted and MAP (all p < 0.01). Osteoporosis was present in 8/19 patients (2/20 controls) and was previously unsuspected in 7 patients. The fat free mass and bone mineral density were lower in patients than controls (p < 0.001). Conclusions Patients with A1ATD related COPD have increased aortic stiffness suggesting increased risk of cardiovascular disease and evidence of occult musculoskeletal changes, all likely to contribute hugely to overall morbidity and mortality