Inflammation and infections in unreported chronic obstructive pulmonary disease exacerbations

Purpose: COPD patients often do not report acute exacerbations to healthcare providers – unreported exacerbations. It is not known whether variances in symptoms, airway obstruction, aetiology and inflammatory responses account for differences in reporting of COPD exacerbations. The aims of the study were to compare symptoms, lung function changes, aetiology and inflammatory markers between exacerbations that were reported to healthcare providers or treated, with those that were unreported and untreated. Patients and methods: We recruited a cohort of COPD patients and collected clinical data and blood and airway samples when stable and during acute exacerbations. Virological and bacterial analyses were carried out and inflammatory markers measured. Results: We found no differences in symptoms, lung function, incidence of infection and inflammatory markers between reported and unreported exacerbations. Subjects who reported all exacerbations had higher BODE scores, lower FEV1 and more exacerbations compared with those who did not. Conclusion: The failure to report exacerbations is not related to the severity, aetiology or inflammatory profile of the exacerbation. Patients with less severe COPD and less frequent exacerbations are less likely to report exacerbations. The decision to report an exacerbation is not an objective marker of exacerbation severity and therefore studies that do not count unreported exacerbations will underestimate the frequency of clinically significant exacerbations. A better understanding of the factors that determine non-reporting of exacerbations is required to improve exacerbation reporting

Theoretical modelling of unbonded flexible pipe cross-sections

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN039612 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

A zero-stiffness elastic shell structure

A remarkable shell structure is described that, due to a particular combination of geometry and initial stress, has zero stiffness for any finite deformation along a twisting path; the shell is in a neutrally stable state of equilibrium. Initially the shell is straight in a longitudinal direction, but has a constant, nonzero curvature in the transverse direction. If residual stresses are induced in the shell by, for example, plastic deformation, to leave a particular resultant bending moment, then an analytical inextensional model of the shell shows it to have no change in energy along a path of twisted configurations. Real shells become closer to the inextensional idealization as their thickness is decreased; experimental thin-shell models have confirmed the neutrally stable configurations predicted by the inextensional theory. A simple model is described that shows that the resultant bending moment that leads to zero stiffness gives the shell a hidden symmetry, which explains this remarkable property

Cultural Life, Charitable Institutions and Cultural and Educational Activities of Philanthropists in the Kakheti Region During the Era of Tsarism

After the conquest of Georgia by Russia, the culture of Georgia took a new path, it was influenced not only by the imperialist policy of Russia, but also completely changed its character and purposefulness. The empire tried to turn this sphere into a weapon of conquest, zealously attacked those basic mental problems that would weaken the basis of the identity of the Georgian nation. Georgian schools and cultural institutions acquired the function that was the main goal conqueror: assimilation of the nation, destruction of ethnocultural and ethnohistorical traditions. These processes, as in other regions of Georgia, were actively carried out in Kakheti. Therefore, the study of the education and culture of the Kakheti region in the era of tsarism is one of the serious parts of this big problem

Inflammation and infections in unreported chronic obstructive pulmonary disease exacerbations

Maria Adelaide Calderazzo,1 Maria-Belen Trujillo-Torralbo,1,2 Lydia Joanne Finney,1 Aran Singanayagam,1 Eteri Bakhsoliani,1 Vijay Padmanaban,2 Tatiana Kebadze,1 Julia Aniscenko,1 Sarah L Elkin,1,2 Sebastian L Johnston,1,2 Patrick Mallia1,21National Heart and Lung Institute, Imperial College, London, UK; 2Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UKPurpose: COPD patients often do not report acute exacerbations to healthcare providers – unreported exacerbations. It is not known whether variances in symptoms, airway obstruction, aetiology and inflammatory responses account for differences in reporting of COPD exacerbations. The aims of the study were to compare symptoms, lung function changes, aetiology and inflammatory markers between exacerbations that were reported to healthcare providers or treated, with those that were unreported and untreated.Patients and methods: We recruited a cohort of COPD patients and collected clinical data and blood and airway samples when stable and during acute exacerbations. Virological and bacterial analyses were carried out and inflammatory markers measured.Results: We found no differences in symptoms, lung function, incidence of infection and inflammatory markers between reported and unreported exacerbations. Subjects who reported all exacerbations had higher BODE scores, lower FEV1 and more exacerbations compared with those who did not.Conclusion: The failure to report exacerbations is not related to the severity, aetiology or inflammatory profile of the exacerbation. Patients with less severe COPD and less frequent exacerbations are less likely to report exacerbations. The decision to report an exacerbation is not an objective marker of exacerbation severity and therefore studies that do not count unreported exacerbations will underestimate the frequency of clinically significant exacerbations. A better understanding of the factors that determine non-reporting of exacerbations is required to improve exacerbation reporting.Trial registration: ClinicalTrials.gov Identifier: NCT01376830. Registered June 17, 2011Keywords: chronic obstructive pulmonary disease, acute exacerbations, unreported exacerbation