COPD, stage and treatment in a large outpatient clinic

Some COPD patients suffer from frequent exacerbations despite triple inhalation treatment. These frequent exacerbators should be identified, as exacerbations often lead to decreasing lung function and increasing mortality. Roflumilast reduces exacerbations in patients with a previous history of exacerbations. Our aim was to describe COPD patient characteristics and compare roflumilast treatment eligible to non-eligible patients. An observational cross-section study was conducted. Patients were included from a large COPD outpatient clinic. Information regarding COPD patient characteristics was registered on a standardized form and lung function was measured. Patients were categorized according to the GOLD classification. Eligibility for roflumilast treatment was assessed and patient characteristics compared between groups. 547 patients were included. Most patients (54%) were in GOLD group D. 62 patients (11.3%) met the criteria for treatment with roflumilast. Among the patients eligible for roflumilast treatment, only 14 patients (22.6%) were receiving treatment. There were no significant differences in FEV1, number of exacerbations, hospitalization due to exacerbation, MRC grade, age, smoking status and medication use between patients receiving roflumilast and not treated eligible patients. Our study documents low use of roflumilast treatment. In view of the established effect of roflumilast we think that this treatment should be considered more consistently as an option among COPD patients fulfilling the criteria for this therapy

Different methods for administering 17β-estradiol to ovariectomized rats result in opposite effects on ischemic brain damage

<p>Abstract</p> <p>Background</p> <p>Numerous stroke studies have controversially shown estrogens to be either neuroprotective or neurodamaging. The discordant results observed in rat brain ischemia models may be a consequence of discrepancies in estrogen administration modes resulting in plasma concentration profiles far from those intended. To test this hypothesis we reproduced in detail and extended an earlier study from our lab using a different mode of 17β-estradiol administration; home-made silastic capsules instead of commercial slow-release 17β-estradiol pellets. Four groups of female rats (n = 12) were ovariectomized and administered 17β-estradiol or placebo via silastic capsules. All animals underwent MCAo fourteen days after ovariectomy and were sacrificed three days later.</p> <p>Results</p> <p>In contrast to our earlier results using the commercial pellets, the group receiving 17β-estradiol during the entire experiment had significantly smaller lesions than the group receiving placebo (mean ± SEM: 3.85 ± 0.70% versus 7.15 ± 0.27% of total slice area, respectively; p = 0.015). No significant neuroprotection was found when the 17β-estradiol was administered only during the two weeks before or the three days immediately after MCAo.</p> <p>Conclusions</p> <p>The results indicate that different estrogen treatment regimens result in diametrically different effects on cerebral ischemia. Thus the effects of estrogens on ischemic damage seem to be concentration-related, with a biphasic, or even more complex, dose-response relation. These findings have implications for the design of animal experiments and also have a bearing on the estrogen doses used for peri-menopausal hormone replacement therapy.</p

Hvordan modtager folkeskoler økonomiske ressourcer, og hvilken betydning har det

Det ligger inden for det kommunale selvstyre at beslutte, hvor meget folkeskolen samlet set skal koste i en kommune, og hvordan fordelingen af økonomi imellem de enkelte folkeskoler skal være. I flere kommuner er tildelingen til de enkelte folkeskoler baseret på oplysninger om skolernes socioøkonomiske elevsammensætning, og i nogle kommuner resulterer det i en betydelig omfordeling skolerne imellem. Målet med de forskellige omfordelingstiltag er at sikre chancelighed blandt børn, men effekten er ikke undersøgt på systematisk vis. Derimod har en række undersøgelser set nærmere på betydningen af forskellige fagligt afgrænsede og økonomisk set langt billigere tiltag, der også er iværksat i forhold til at løfte det faglige niveau hos skolebørn. Denne artikel giver med udgangspunkt i en teoretisk baseret typologi over fordelingen af økonomisk beslutningskompetence på folkeskoleområdet et overblik over den viden, vi har i forhold til at løfte det faglige niveau hos skolebørn ved hjælp af økonomiske ressourcer. Endvidere diskuterer artiklen, hvordan vi opnår større viden (også) om de satsninger, der målt i kroner og ører er de mest ambitiøse. Artiklen beskriver i denne forbindelse og med udgangspunkt i et unikt datasæt fra Aarhus Kommune den økonomiske omfordeling imellem 40 aarhusianske folkeskoler og giver et første bud på, hvilken betydning omfordelingen har haft for 13.237 børn, der tog folkeskolens afgangseksamen i perioden 2009-2015

Breakdown of disordered media by surface loads

We model an interface layer connecting two parts of a solid body by N parallel elastic springs connecting two rigid blocks. We load the system by a shear force acting on the top side. The springs have equal stiffness but are ruptured randomly when the load reaches a critical value. For the considered system, we calculate the shear modulus, G, as a function of the order parameter, \phi, describing the state of damage, and also the ``spalled'' material (burst) size distribution. In particular, we evaluate the relation between the damage parameter and the applied force and explore the behaviour in the vicinity of material breakdown. Using this simple model for material breakdown, we show that damage, caused by applied shear forces, is analogous to a first-order phase transition. The scaling behaviour of G with \phi is explored analytically and numerically, close to \phi=0 and \phi=1 and in the vicinity of \phi_c, when the shear load is close but below the threshold force that causes material breakdown. Our model calculation represents a first approximation of a system subject to wear induced loads.Comment: 15 pages, 7 figure

Implementing Integrated Care – Lessons from the Odense Integrated Care Trial

Introduction: Creating coordination and concerted action between sectors of modern healthcare is an inherent challenge, and decision makers in search for solutions tend replicate new models across countries and settings. An example of this is the translation of the North West London integrated care pilot into a large-scale trial that took place in the Danish Municipality of Odense from 2013–2016. This article highlights the findings from our evaluation of the ill-fated project and discusses lessons learned. Methods: We examined implementation and short-term outcome in a multi-method evaluation based on qualitative interviews, direct observation, electronic surveys and quantitative analysis of change in ser­vice use and costs, using patient level data and a matched control group. Results and discussion: Despite an ambitious setup, ample financing, a shared governance structure and a well-functioning project organisation, implementation failed at the clinical level. Also, service use and costs for included patients increased significantly, without yielding the intended results. Primary explana­tions relate to an overly optimistic timeframe and a failure to take professionals’ wishes, daily practices and values into account. The results underline the importance of basing future attempts at integrated care on thorough studies of the perception of actual needs and timing, including rigorous pilot testing on a smaller scale, before attempting large-scale implementation