What We Mean When We Talk About Adherence In Respiratory Medicine

The Respiratory Effectiveness Group (REG; www.effectivenessevaluation.org) supported the Expert Adherence Panel Meeting at which many of the concepts presented in this paper were first discussed. REG also supported the manuscript submission costs. ALD, EvG, and MdB have received funding from the European Community's 7th Framework (FP7/2007-2013) under grant agreement no. 282593. Teva supported the meeting costs at which the concepts in this paper were discussed by the co-authors and the open access publication fee for this article. The authors had full editorial control over the ideas presented.Peer reviewedPublisher PD

The relentless march of mass coral bleaching: a global perspective of changing heat stress

The global coral bleaching event of 2014-2017 resulted from the latest in a series of heat stress events that have increased in intensity. We assessed global- and basin-scale variations in sea surface temperature-based heat stress products for 1985-2017 to provide the context for how heat stress during 2014-2017 compared with the past 3 decades. Previously, undefined "Heat Stress Year" periods (used to describe interannual variation in heat stress) were identified for the Northern and Southern Hemispheres, in which heat stress peaks during or shortly after the boreal and austral summers, respectively. The proportion of reef pixels experiencing bleaching-level heat stress increased through the record, accelerating during the last decade. This increase in accumulated heat stress at a bleaching level is a result of longer stress events rather than an increase in the peak stress intensity. Thresholds of heat stress extent for the three tropical ocean basins were established to designate "global" events, and a Global Bleaching Index was defined that relates heat stress extent to that observed in 1998. Notably, during the 2014-2017 global bleaching event, more than three times as many reefs were exposed to bleaching-level heat stress as in the 1998 global bleaching

Global coral bleaching event detection from satellite monitoring of extreme heat stress

Over the past four decades, coral bleaching events have occurred with increasing frequency and severity, directly linked to increasing ocean temperature due to climate change. For the latter half of that period, satellite monitoring by NOAA Coral Reef Watch in near real-time has provided invaluable insight into bleaching risk. Here, we describe a novel application of those products to develop basin-scale tools for tracking the development of extreme heat events that enable monitoring of global coral bleaching events. Case studies of historical extreme events (1982-2018) across the three tropical ocean basins (Indian, Pacific and Atlantic) were analysed using this basin-scale approach to identify key thresholds of heat stress extent for the definition of global bleaching. Global-scale events are apparent when all three tropical basins experience heat stress in at least 10% of reef-containing locations. An 8-month ‘detection window’ was determined as the optimal period of time through which pixels exposed to heat stress should continue to be counted as part of a basin-scale event to account for seasonal variations across ocean basins. Understanding the broader context of basin-scale conditions can inform management of individual reefs, management networks and other reef stakeholders. Operationalising this product for near real-time delivery will provide an effective communication of the status of coral reefs around the world during an era of unprecedented climate threats

Public Sector Reform and Governance for Adaptation: Implications of New Public Management for Adaptive Capacity in Mexico and Norway

Although many governments are assuming the responsibility of initiating adaptation policy in relation to climate change, the compatibility of “governance-for-adaptation” with the current paradigms of public administration has generally been overlooked. Over the last several decades, countries around the globe have embraced variants of the philosophy of administration broadly called “New Public Management” (NPM) in an effort to improve administrative efficiencies and the provision of public services. Using evidence from a case study of reforms in the building sector in Norway, and a case study of water and flood risk management in central Mexico, we analyze the implications of the adoption of the tenets of NPM for adaptive capacity. Our cases illustrate that some of the key attributes associated with governance for adaptation—namely, technical and financial capacities; institutional memory, learning and knowledge; and participation and accountability—have been eroded by NPM reforms. Despite improvements in specific operational tasks of the public sector in each case, we show that the success of NPM reforms presumes the existence of core elements of governance that have often been found lacking, including solid institutional frameworks and accountability. Our analysis illustrates the importance of considering both longer-term adaptive capacities and short-term efficiency goals in public sector administration reform

Airflow limitation or static hyperinflation: which is more closely related to dyspnea with activities of daily living in patients with COPD?

<p>Abstract</p> <p>Background</p> <p>Dyspnea while performing the activities of daily living has been suggested to be a better measurement than peak dyspnea during exercise. Furthermore, the inspiratory capacity (IC) has been shown to be more closely related to exercise tolerance and dyspnea than the FEV₁, because dynamic hyperinflation is the main cause of shortness of breath in patients with COPD. However, breathlessness during exercise is measured in most studies to evaluate this relationship.</p> <p>Purpose</p> <p>To evaluate the correlation between breathlessness during daily activities and airflow limitation or static hyperinflation in COPD.</p> <p>Methods</p> <p>We examined 167 consecutive outpatients with stable COPD. The Baseline Dyspnea Index (BDI) was used to evaluate dyspnea with activities of daily living. The relationship between the BDI score and the clinical measurements of pulmonary function was then investigated.</p> <p>Results</p> <p>The Spearman rank correlation coefficients (Rs) between the BDI score and the FEV₁(L), FEV₁(%pred) and FEV₁/FVC were 0.60, 0.56 and 0.56, respectively. On the other hand, the BDI score also correlated with the IC, IC/predicted total lung capacity (TLC) and IC/TLC (Rs = 0.45, 0.46 and 0.47, respectively). Although all of the relationships studied were strongly correlated, the correlation coefficients were better between dyspnea and airflow limitation than between dyspnea and static hyperinflation. In stepwise multiple regression analyses, the BDI score was most significantly explained by the FEV₁(R²= 26.2%) and the diffusion capacity for carbon monoxide (R²= 14.4%) (Cumulative R²= 40.6%). Static hyperinflation was not a significant factor for clinical dyspnea on the stepwise multiple regression analysis.</p> <p>Conclusion</p> <p>Both static hyperinflation and airflow limitation contributed greatly to dyspnea in COPD patients.</p

Contribution of microscopy for understanding the mechanism of action against trypanosomatids

Transmission electron microscopy (TEM) has proved to be a useful tool to study the ultrastructural alterations and the target organelles of new antitrypanosomatid drugs. Thus, it has been observed that sesquiterpene lactones induce diverse ultrastructural alterations in both T. cruzi and Leishmania spp., such as cytoplasmic vacuolization, appearance of multilamellar structures, condensation of nuclear DNA, and, in some cases, an important accumulation of lipid vacuoles. This accumulation could be related to apoptotic events. Some of the sesquiterpene lactones (e.g., psilostachyin) have also been demonstrated to cause an intense mitochondrial swelling accompanied by a visible kinetoplast deformation as well as the appearance of multivesicular bodies. This mitochondrial swelling could be related to the generation of oxidative stress and associated to alterations in the ergosterol metabolism. The appearance of multilamellar structures and multiple kinetoplasts and flagella induced by the sesquiterpene lactone psilostachyin C indicates that this compound would act at the parasite cell cycle level, in an intermediate stage between kinetoplast segregation and nuclear division. In turn, the diterpene lactone icetexane has proved to induce the external membrane budding on T. cruzi together with an apparent disorganization of the pericellar cytoskeleton. Thus, ultrastructural TEM studies allow elucidating the possible mechanisms and the subsequent identification of molecular targets for the action of natural compounds on trypanosomatids.Fil: Lozano, Esteban Sebastián. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; ArgentinaFil: Spina Zapata, Renata María. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos; ArgentinaFil: Barrera, Patricia Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos; ArgentinaFil: Tonn, Carlos Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis. Instituto de Investigaciones en Tecnología Química. Universidad Nacional de San Luis. Facultad de Química, Bioquímica y Farmacia. Instituto de Investigaciones en Tecnología Química; ArgentinaFil: Sosa Escudero, Miguel Angel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos; Argentin

Characteristics of control group participants who increased their physical activity in a cluster-randomized lifestyle intervention trial

<p>Abstract</p> <p>Background</p> <p>Meaningful improvement in physical activity among control group participants in lifestyle intervention trials is not an uncommon finding, and may be partly explained by participant characteristics. This study investigated which baseline demographic, health and behavioural characteristics were predictive of successful improvement in physical activity in usual care group participants recruited into a telephone-delivered physical activity and diet intervention trial, and descriptively compared these characteristics with those that were predictive of improvement among intervention group participants.</p> <p>Methods</p> <p>Data come from the Logan Healthy Living Program, a primary care-based, cluster-randomized controlled trial of a physical activity and diet intervention. Multivariable logistic regression models examined variables predictive of an improvement of at least 60 minutes per week of moderate-to-vigorous intensity physical activity among usual care (n = 166) and intervention group (n = 175) participants.</p> <p>Results</p> <p>Baseline variables predictive of a meaningful change in physical activity were different for the usual care and intervention groups. Being retired and completing secondary school (but no further education) were predictive of physical activity improvement for usual care group participants, whereas only baseline level of physical activity was predictive of improvement for intervention group participants. Higher body mass index and being unmarried may also be predictors of physical activity improvement for usual care participants.</p> <p>Conclusion</p> <p>This is the first study to examine differences in predictors of physical activity improvement between intervention group and control group participants enrolled in a physical activity intervention trial. While further empirical research is necessary to confirm findings, results suggest that participants with certain socio-demographic characteristics may respond favourably to minimal intensity interventions akin to the treatment delivered to participants in a usual care group. In future physical activity intervention trials, it may be possible to screen participants for baseline characteristics in order to target minimal-intensity interventions to those most likely to benefit. (Australian Clinical Trials Registry, <url>http://www.anzctr.org.au/default.aspx</url>, ACTRN012607000195459)</p

Optimal spatiotemporal scales to aggregate satellite ocean color data for nearshore reefs and tropical coastal waters: two case studies

Remotely sensed ocean color data are useful for monitoring water quality in coastal environments. However, moderate resolution (hundreds of meters to a few kilometers) satellite data are underutilized in these environments because of frequent data gaps from cloud cover and algorithm complexities in shallow waters. Aggregating satellite data over larger space and time scales is a common method to reduce data gaps and generate a more complete time series, but potentially smooths out the small-scale, episodic changes in water quality that can have ecological influences. By comparing aggregated satellite estimates of Kd(490) with related in-water measurements, we can understand the extent to which aggregation methods are viable for filling gaps while being able to characterize ecologically relevant water quality conditions. In this study, we tested a combination of six spatial and seven temporal scales for aggregating data from the VIIRS instrument at several coral reef locations in Maui, Hawai‘i and Puerto Rico and compared these with in situ measurements of Kd(490) and turbidity. In Maui, we found that the median value of a 5-pixels, 7-days spatiotemporal cube of satellite data yielded a robust result capable of differentiating observations across small space and time domains and had the best correlation among spatiotemporal cubes when compared with in situ Kd(490) across 11 nearshore sites (R2 = 0.84). We also found long-term averages (i.e., chronic condition) of VIIRS data using this aggregation method follow a similar spatial pattern to onshore turbidity measurements along the Maui coast over a three-year period. In Puerto Rico, we found that the median of a 13-pixels, 13-days spatiotemporal cube of satellite data yielded the best overall result with an R2 = 0.54 when compared with in situ Kd(490) measurements for one nearshore site with measurement dates spanning 2016–2019. As spatiotemporal cubes of different dimensions yielded optimum results in the two locations, we recommend local analysis of spatial and temporal optima when applying this technique elsewhere. The use of satellite data and in situ water quality measurements provide complementary information, each enhancing understanding of the issues affecting coastal ecosystems, including coral reefs, and the success of management efforts

A Bayesian Belief Network to assess rate of changes in coral reef ecosystems

It is crucial to identify sources of impacts and degradation to maintain functions and services that the physical structure of coral reef provides. Here, a Bayesian Network approach is used to evaluate effects that anthropogenic and climate change disturbances have on coral reef structure. The network was constructed on knowledge derived from the literature and elicited from experts, and parameterised on independent data. Evaluation of the model was conducted through sensitivity analyses and data integration was fundamental to obtain a balanced dataset. Scenario analyses, conducted to assess the effects of stressors on the reef framework state, suggested that calcifying organisms and carbonate production, rather than bioerosion, had the largest influence on the reef carbonate budgetary state. Despite the overall budget remaining positive, anthropogenic pressures, particularly deterioration of water quality, affected reef carbonate production, representing a warning signal for potential changes in the reef state