Fibrotic interstitial lung disease - palliative care needs:a World-Café qualitative study

Objectives: The importance of palliative care in those with advanced fibrotic interstitial lung diseases (F-ILD) is recognised, but the palliative care requirements of patients and caregivers affected by F-ILD regardless of disease course are not established. We set out to explore this and identify optimal solutions in meeting the needs of a F-ILD population in Ireland. Methods: Implementing a World-Café qualitative research approach, we captured insights evolving, iteratively in interactive small group discussions in response to six predefined topics on palliative care and planning for the future. Thirty-nine stakeholders participated in the World-Café including 12 patients, 13 caregivers, 9 healthcare professionals, 4 industry representatives and 1 representative of the clergy. Results: Palliative care emerged as fundamental to the care and treatment of F-ILDs, regardless of disease progression. Unmet palliative care needs were identified as psychological and social support, disease education, inclusion of caregivers and practical/legal advice for disease progression and end-of-life planning. Participants identified diagnosis as a particularly distressing time for patients and families. They called for the introduction of palliative care discussions at this early-stage alongside improvements in integrated care, specifically increasing the involvement of primary care practitioners in referrals to palliative services. Conclusion: Patients and caregivers need discussions on palliative care associated with F-ILD to be included at the point of diagnosis. This approach may address persisting inadequacies in service provision previously identified over the course of the last decade in the UK, Ireland and European F-ILD patient charters.</p

IL-9 as a mediator of Th17-driven inflammatory disease

We report that like other T cells cultured in the presence of transforming growth factor (TGF) β, Th17 cells also produce interleukin (IL) 9. Th17 cells generated in vitro with IL-6 and TGF-β as well as purified ex vivo Th17 cells both produced IL-9. To determine if IL-9 has functional consequences in Th17-mediated inflammatory disease, we evaluated the role of IL-9 in the development and progression of experimental autoimmune encephalomyelitis, a mouse model of multiple sclerosis. The data show that IL-9 neutralization and IL-9 receptor deficiency attenuates disease, and this correlates with decreases in Th17 cells and IL-6–producing macrophages in the central nervous system, as well as mast cell numbers in the regional lymph nodes. Collectively, these data implicate IL-9 as a Th17-derived cytokine that can contribute to inflammatory disease

Interferon-gamma, interleukin-4 and interleukin-10 production by T helper cells reveals intact Th1 and regulatory TR1 cell activation and a delay of the Th2 cell response in equine neonates and foals

Cytokines produced by T helper (Th) cells are important in orchestrating the immune response during health and disease. Recent reports indicated that cytokine mRNA expression in foals is often quantitatively lower than that of adult horses suggesting that foal T cells are not fully mature. Here, peripheral blood mononuclear cells from foals and adult horses were stimulated with phorbol 12-myristate 13-acetate and analyzed for intracellular interferon-gamma (IFN-γ), interleukin-4 (IL-4) and IL-10 production, representing the Th1, Th2 and regulatory TR1 cell phenotypes respectively, by flow cytometry. In agreement with previous reports, all three cytokines were quantitatively reduced in foals compared to adults. However, the balance between Th1 and Th2 cytokines (IFN-γ/IL-4 ratio) showed a clear Th1-biased response in foals by 6 and 12 weeks of life, while similar IFN-γ/IL-10 ratios were found in foals and adult horses. By day 5 after birth, intracellular IFN-γ production by foal CD4+ and CD8+ T cells resembled that in adults. Overall, IL-4 production was low in foals. IL-4+ cells peaked at day 5 of age when IL-4 was mainly produced by IgE+ cells. Relative percentages of IL-4+ Th2 cells were significantly lower in foals at all time points. The data suggested that equine neonates and young foals have an impaired Th2 response, that the immune response of foals is Th1 biased, that IFN-γ production by Th and cytotoxic T cells is qualitatively similar to adult horses, and regulatory IL-10 production by T cells is developmentally mature in foals during the first three months of life

T cells at the site of autoimmune inflammation show increased potential for trogocytosis

CD4+ T cells acquire membrane fragments from antigen-presenting-cells via a process termed trogocytosis. Identifying which CD4+ T cells undergo trogocytosis in co-culture with Ag-loaded APC can enrich for antigen-reactive T cells without knowledge of their fine specificity or cytokine-production profiles. We sought to assess the suitability of this method to identify disease relevant effector and regulatory T cells during autoimmune inflammation. Trogocytosis efficiently identified MBP-reactive T cells in vitro and ex-vivo following immunization. However, Foxp3+ regulatory T cells constitutively displayed a higher rate of trogocytosis than their Foxp3- counterparts which limits the potential of trogocytosis to identify antigen-reactive Treg cells. During inflammation a locally elevated rate of trogocytosis (seen in both effector and regulatory T cells isolated from the inflamed CNS) precludes the use of trogocytosis as a measure of antigenic reactivity among cells taken from inflammatory sites. Our results indicate trogocytosis detection can enrich for Ag-reactive conventional T cells in the periphery but is limited in its ability to identify Ag-reactive Treg or T effector cells at sites of inflammation. Increased trogocytosis potential at inflammatory sites also draws into the question the biological significance of this phenomenon during inflammation, in Treg mediated suppression and for the maintenance of tolerance in health and disease

Controller team possibilities for sectorless air traffic management

Sectorless air traffic management is an en-route concept, which eliminates the need for control sectors. Instead of assigning a geographic area (sector), air traffic controllers are assigned certain aircraft. Controllers are responsible for their assigned aircraft all the way from entry to exit. In previous simulations, one controller was responsible for six aircraft at the same time. As these aircraft can be located anywhere in the sectorless airspace, controllers were provided with one traffic display for each assigned aircraft. This discussion paper suggests other possibili-ties for providing traffic information to sectorless air traffic controllers. Instead of having one traffic display for each aircraft under control (tiled display), controllers could work with a general map, a zoom display to magnify certain traffic situations, or a combination of such displays. We revisit the concept of controller teams and explore alternatives. In addition to working alone or in pairs of executive and controller, the sectorless air traffic management concept opens possibilities for innovative teamwork. For example, there could be a team of one coordinator and several executives, or even a control-room team. This paper gives examples of new display and team ideas and discusses their respective advantages and disadvantages. We argue that the way traffic information is displayed to controllers affects their mental models and working methods. In addition, we provide results on the tiled display from previous simulations and introduce ideas for future research

Vorstandsvergütung mit Aktienoptionen | Sicherung der Anreizkompatibilität als gesellschaftsrechtliche Gestaltungsaufgabe

Die Verfasserin untersucht in einer interdisziplinär – ökonomisch und juristisch – angelegten Analyse die Anreizkompatibilität des Vergütungsinstruments der Aktienoption. Sie legt zunächst dar, wie Aktienoptionspläne gestaltet werden müssen, damit es nicht zu Disproportionalitäten bei der Gewinn- und Verlustbeteiligung der Aktionäre und der Vorstände kommt, die die gewollten Anreizwirkungen gefährden können. Sodann wird behandelt, wie eine anreizkompatible Ausgestaltung sichergestellt werden kann. Die bislang in der Literatur weitgehend vernachlässigte Frage, ob der Optionsplan als solcher – und nicht nur Elemente seiner Durchführung – zum Gegenstand einer Beschlußfassung der Hauptversammlung gemacht werden muß, wird erörtert. In einer Gesamtschau aller einschlägigen Kompetenznormen des Aktienrechts und der dazu entwickelten Rechtsprechung sowie unter Berücksichtigung der ökonomischen Potentiale für die Gefährdung der Interessen der Aktionäre kommt die Autorin zum Ergebnis, daß reale Optionspläne einer Mitwirkung der Hauptversammlung in Form eines qualifizierten Mehrheitsbeschlusses und virtuelle Optionspläne einer Mitwirkung in Form eines einfachen Mehrheitsbeschlusses bedürfen

Five transition strategies for sectorless ATM

In contrast to the traditional approach to air traffic management (ATM), which divides the airspace into sectors, sectorless air traffic management regards the airspace as a single unit. Instead of sectors, air traffic controllers are assigned several aircraft, which might not be in the same geographic region. Controllers are responsible for the assigned aircraft during their entire flight through the airspace from entry to exit. In previous papers we have detailed the sectorless ATM concept and shown that it is operationally feasible. One remaining question, however, is how to introduce the concept into operation. It is highly unlikely that sectorless ATM will be introduced for the entire airspace over a country, let alone a continent, in one step; a gradual introduction of the new concept limits the safety risks connected with new systems. Therefore, the concept will have to coexist with other ATM concepts. This discussion paper presents five different strategies for the introduction of sectorless ATM, namely element-wise, aircraft-wise, time-restricted, area-restricted, and top-down transition strategies. For each of these strategies we discuss advantages and disadvantages. In addition, we investigate the possibility of combining several strategies. In conclusion, we suggest a top-down transition strategy combined with an element-wise transition. This combined strategy limits the number of simultaneous changes but still takes full advantage of long-term planning. Furthermore, the number of controllers who have to be trained for the sectorless concept can be estimated quite accurately from the flight plans

Sectorless ATM and Advanced SESAR Concepts: Complement not Contradiction

With SESAR (Single European Sky ATM Research) there is a program well on the way to developing and implementing advanced ATM (Air Traffic Management) concepts. Beyond the scope of the SESAR programme in the LRM2020 project there are investigations on sectorless ATM taking place, which would mean not an evolution but a revolution of current ATM. This discussion paper argues that sectorless ATM can not only be integrated and exploited within the SESAR innovations framework but also continues SESAR’s shift towards a more aircraft-centered view. The paper elaborates on the possibilities of bringing together the two concepts and thus conjointly meeting the goals of SESAR and mastering the challenges of future ATM

Change of controller tasks in a sectorless ATM concept - first results

In a sectorless air traffic management concept the airspace is not divided into sectors but seen as one piece. An air traffic controller is no longer in charge of a sector but is responsible for individual flights which he or she controls from the entry into the airspace to the exit. This means that the controller has to keep track of several flights and traffic situations which might not be in the same geographic region. Naturally, such a considerable change of concept influences the tasks and way of working for the controller. This paper gives first results about how a sectorless concept might change controller tasks. It is debated which tools might best support such a concept and help the controller to maintain situational awareness. We review different models for task analysis and use them for a comparison of tasks in a sectored and a sectorless concept. Especially the role of a conflict detection tool and other automatic support systems is discussed. Real time simulations conducted at DLR provided first indications regarding changes in controller tasks, which are presented and analyzed. In a sectorless concept coordination with adjoining sectors is no longer necessary. The presented findings show that in addition the introduction of conflict detection tools could relieve the controller of planning tasks, thus shifting the main tasks more towards tactic control and monitoring. The discussion suggests a work environment and procedures which help the controller to exploit the benefits of sectorless control while retaining situational awareness and focus on the task of conflict avoidance