Adult Onset Still’s Disease: A Case Report with a Rare Clinical Manifestation and Pathophysiological Correlations

Adult-onset Still’s disease is an inflammatory multisystemic disease of unknown etiology. Pleuritis is the most common pulmonary manifestation and pleural effusions are usually exudates with a predominance of neutrophils. We report a case of an eosinophilic pleural effusion as a novel and hitherto unrecognized manifestation of active adult-onset Still’s disease. We also observed a marked NLRP3 inflammasome activation with increased production of IL-1β which coincided with the development and resolved upon remission of the pleural effusion suggesting a possible novel pathogenetic pathway for the development of pleural effusions in the context of the auto-inflammatory disorders

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: An international case-cohort study

We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts. A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (\u3baw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the Cindex. A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (\u3baw=0.65, IQR 0.53-0.72, p20 years of experience (C-index=0.72, IQR 0.0-0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70-0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72-0.75). Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Analysis of the experimental performance of light pipes

Light pipes can provide daylight and improve lighting conditions in buildings. Knowledge of their optical performance is a prerequisite for their successful integration into buildings. This article presents and analyses the experimental performance and the specific efficiency characteristics of a light pipe as integrated into an experimental test-cell. Extensive measurements are performed for eight continuous months under clear, cloudy and intermediate sky conditions. The spatial and temporal variability of the indoor illuminance is analysed using clustering techniques. It is found that there is an almost exponential relation between the average and the maximum indoor illuminance with the exterior illuminance levels. In parallel, a strong spatial inhomogeneity is observed under all sky conditions. The transmissivity or Daylight Penetration Factor of the light pipe is found to present a strong daily variation during the clear days while it was almost constant under cloudy sky condtions. A clear correlation of the light pipe's Daylight Penetration Factor is found against the solar azimuh and solar altitude especially under clear sky conditions. © 2017 Elsevier B.V

Cool roofs and cool pavements application in Acharnes, Greece

The continuously increasing urban temperature results to the well-known urban heat island phenomenon. Cool roofs and cool pavements are very promising mitigation techniques as they can be easily applied to new and existing buildings as well as urban spaces. In the present paper, the application of cool materials in the urban region of Acharnes municipality in Greece is described. Cool roofs in the form of ceiling tiles are installed on the rooftop of the municipality building while cool paving stones are used to replace conventional pavements. A series of monitoring activities are performed for the building and the urban region. Measurements of the outdoor meteorological conditions, the indoor thermal comfort of the case study building, the surface temperature of the roofs and pavements as well as thermal imaging are exploited for the analysis of the cool roofs and cool pavements’ performance. Thermal models using EnergyPlus and Envi-met are developed for the analysis of the cool roofs and cool pavements respectively. The overall study showed that the application of cool roofs results to 17% reduction in the annual cooling demand for the case study building while the surface temperature of the urban pavements is reduced by almost 10 K. © 2017 Elsevier Lt

Impact of Non-financial Disclosure Scores on the Cost of Equity Capital: Evidence from European Data in the Light of the Subprime Crisis

International audienceThis chapter explores the relationship between social, governance and environmental disclosure scores, on one hand, and the cost of capital, on the other. Its originality is the focus on the quality of corporate social responsibility (CSR) disclosure by studying global CSR at the same time as its three constituent dimensions. The empirical data it uses comes from Euronext SBF 120 companies over the period 2006 through 2011. The longitudinal study covers two separate periods (2006–2008 and 2009–2011). The corporate social responsibility disclosure scores (global, environment, social or governance) have an influence on the cost of capital. Moreover, financial analyst recommendations did, on the other hand, help lower the cost of capital. Lastly, the study shows that since 2009, financial analysts have increasingly taken the quality of CSR information disclosure into account in their Euronext SBF 120 stock recommendations

Corporate Governance and Sustainability Performance: Analysis of Triple Bottom Line Performance

The study empirically investigates the relationship between corporate governance and the triple bottom line sustainability performance through the lens of agency theory and stakeholder theory. We claim, in fact, that no single theory fully accounts for all the hypothesised relationships. We measure sustainability performance through manual content analysis on sustainability reports of the US-based companies. The study extends the existing literature by investigating the impact of selected corporate governance mechanisms on each dimension of sustainability performance, as defined by the GRI framework. Our approach allows to identify which governance mechanisms foster triple bottom line performance, also revealing that some mechanisms fit only specific dimension(s) of sustainability. The fact-based findings provide support for a new beginning in the theorising process in which the theories must try not only to provide rationale for the impact of corporate governance on sustainability, but also to explain which dimension of sustainability might be more affected. The most important implication for practitioners is the support for sustainability practices, which may be gained through implementation of particular corporate governance mechanisms. The findings contribute also to the improvement of the ongoing standard setting process, in particular as it concerns the in-depth revision of the economic dimension of sustainability carried out under the new GRI framework