Development of a battery of instruments for detailed measurement of health status in patients with COPD in routine care: the Nijmegen Clinical Screening Instrument

Contains fulltext : 80284.pdf (publisher's version ) (Closed access)PURPOSE: To compose a battery of instruments that provides a detailed assessment of health status (HS) in COPD but that is applicable and clinically meaningful in routine care. METHODS: In a previous study, we developed the Nijmegen Integral Assessment Framework (NIAF) that organizes existing tests and instruments by the sub-domains of HS they measure. Based on clinical and statistical criteria (correlation coefficients and Cronbach alpha's) we selected for each sub-domain instruments from the NIAF. A COPD-study group was used to determine c-scores, and two control groups were used to determine the score ranges indicating normal functioning versus clinically relevant problems for each sub-domain. Existing questionnaire completion software (TestOrganiser) was adapted to enhance clinical applicability. RESULTS: The NCSI measures eleven sub-domains of physiological functioning, symptoms, functional impairment, and quality of life. The TestOrganiser automatically processes the data and produces the graphical PatientProfileChart, which helps to easily interpret results. This envisages the problem areas and discrepancies between the different sub-domains. CONCLUSION: The NCSI provides a valid and detailed picture of a patient's HS within 15-25 min. In combination with the PatientProfileChart, the NCSI can be used perfectly in routine care as screening instrument and as a guide in patient-tailored treatment

Spatially Resolved [CII] Emission in SPT0346-52: A Hyper-starburst Galaxy Merger at z similar to 5.7

SPT0346-52 is one of the most most luminous and intensely star-forming galaxies in the universe, with LFIR > 10 L 13 and S » - - SFR 4200 yr kpc M 1 2. In this paper, we present ~ 0. 15 ALMA observations of the [ ] C II 158 μm emission line in this z = 5.7 dusty star-forming galaxy. We use a pixellated lensing reconstruction code to spatially and kinematically resolve the source-plane [ ] C II and rest-frame 158 μm dust continuum structure at ∼700 pc (∼0 12) resolution. We discuss the [ ] C II deficit with a pixellated study of the L[C II]/LFIR ratio in the source plane. We find that individual pixels within the galaxy follow the same trend found using unresolved observations of other galaxies, indicating that the deficit arises on scales 700 pc. The lensing reconstruction reveals two spatially and kinematically separated components (∼1 kpc and ∼500 km s−1 apart) connected by a bridge of gas. Both components are found to be globally unstable, with Toomre Q instability parameters 1 everywhere. We argue that SPT0346-52 is undergoing a major merger, which is likely driving the intense and compact star formation

A massive core for a cluster of galaxies at a redshift of 4.3

Massive galaxy clusters have been found that date to times as early as three billion years after the Big Bang, containing stars that formed at even earlier epochs1,2,3. The high-redshift progenitors of these galaxy clusters—termed ‘protoclusters’—can be identified in cosmological simulations that have the highest overdensities (greater-than-average densities) of dark matter4,5,6. Protoclusters are expected to contain extremely massive galaxies that can be observed as luminous starbursts7. However, recent detections of possible protoclusters hosting such starbursts8,9,10,11 do not support the kind of rapid cluster-core formation expected from simulations12: the structures observed contain only a handful of starbursting galaxies spread throughout a broad region, with poor evidence for eventual collapse into a protocluster. Here we report observations of carbon monoxide and ionized carbon emission from the source SPT2349-56. We find that this source consists of at least 14 gas-rich galaxies, all lying at redshifts of 4.31. We demonstrate that each of these galaxies is forming stars between 50 and 1,000 times more quickly than our own Milky Way, and that all are located within a projected region that is only around 130 kiloparsecs in diameter. This galaxy surface density is more than ten times the average blank-field value (integrated over all redshifts), and more than 1,000 times the average field volume density. The velocity dispersion (approximately 410 kilometres per second) of these galaxies and the enormous gas and star-formation densities suggest that this system represents the core of a cluster of galaxies that was already at an advanced stage of formation when the Universe was only 1.4 billion years old. A comparison with other known protoclusters at high redshifts shows that SPT2349-56 could be building one of the most massive structures in the Universe today

The Self-Selection of Democracies into Treaty Design: Insights from International Environmental Agreements

Generally, democratic regime type is positively associated with participating in international environmental agreements. In this context, this study focuses on the legal nature of an agreement, which is linked to audience costs primarily at the domestic level that occur in case of non-compliance and are felt especially by democracies. Eventually, more legalized (\hard-law") treaties make compliance potentially more challenging and democratic leaders may anticipate the corresponding audience costs, which decreases the likelihood that democracies select themselves into such treaties. The empirical implication of our theory follows that environmental agreements with a larger share of democratic members are less likely to be characterized by hard law. This claim is tested using quantitative data on global environmental treaties. The results strongly support our argument, shed new light on the relationship between participation in international agreements and the form of government, and also have implications for the \words-deeds" debate in international environmental policy-making

ALMA observations of atomic carbon inz ∼ 4 dusty star-forming galaxies

We present ALMA [CI]($1-0$) (rest frequency 492 GHz) observations for a sample of 13 strongly-lensed dusty star-forming galaxies originally discovered at 1.4mm in a blank-field survey by the South Pole Telescope. We compare these new data with available [CI] observations from the literature, allowing a study of the ISM properties of $\sim 30$ extreme dusty star-forming galaxies spanning a redshift range 2 < z < 5. Using the [CI] line as a tracer of the molecular ISM, we find a mean molecular gas mass for SPT-DSFGs of $6.6 \times 10^{10}$ M$_{\odot}$. This is in tension with gas masses derived via low-$J$ $^{12}$CO and dust masses; bringing the estimates into accordance requires either (a) an elevated CO-to-H$_2$ conversion factor for our sample of $\alpha_{\rm CO} \sim 2.5$ and a gas-to-dust ratio $\sim200$, or (b) an high carbon abundance $X_{\rm CI} \sim 7\times10^{-5}$. Using observations of a range of additional atomic and molecular lines (including [CI], [CII], and multiple transitions of CO), we use a modern Photodissociation Region code (3D-PDR) to assess the physical conditions (including the density, UV radiation field strength, and gas temperature) within the ISM of the DSFGs in our sample. We find that the ISM within our DSFGs is characterised by dense gas permeated by strong UV fields. We note that previous efforts to characterise PDR regions in DSFGs may have significantly underestimated the density of the ISM. Combined, our analysis suggests that the ISM of extreme dusty starbursts at high redshift consists of dense, carbon-rich gas not directly comparable to the ISM of starbursts in the local Universe