Adequate Patient Characterization in COPD: Reasons to Go Beyond GOLD Classification

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) serves as a guide to treat and manage different severity classes of patients with COPD. It was suggested that the five categories of FEV1 % predicted (GOLD 0–4), can be applied for selecting different therapeutic approaches. However, validation of these selective properties is very poor. To determine the relevance of the GOLD staging system for estimating the severity of clinical problems, GOLD 2 (n=70) and GOLD 3 (n=65) patients were drawn from a prospective cohort of patients with COPD and evaluated crosssectionally by a newly developed Nijmegen Integral Assessment Framework (NIAF). The NIAF is a detailed assessment of a wide range of aspects of health status (HS). Significant, though small, differences were found in Static Lung Volumes, Exercise Capacity, Subjective Pulmonary Complaints, Subjective Impairment, and Health-Related QoL, besides Airflow of course. Moreover, overlap between scores of these five HS sub-domains was substantial, indicating small clinical relevance for discernment. No significant differences were found in nine other aspects of HS. It is concluded that GOLD stages do not discriminate in any aspect of HS other than airflow obstruction, and therefore do not help the clinician in deciding which treatment modalities are appropriate

Parameterized optimized effective potential for atoms

The optimized effective potential equations for atoms have been solved by parameterizing the potential. The expansion is tailored to fulfill the known asymptotic behavior of the effective potential at both short and long distances. Both single configuration and multi configuration trial wave functions are implemented. Applications to several atomic systems are presented improving previous works. The results here obtained are very close to those calculated in either the Hartree-Fock and the multi configurational Hartree-Fock framework.Comment: 8 pages, 3 figure

Changes in Economic Inequality in Europe and Latin America in the First Decades of the Twenty-First Century

This open access volume identifies the common and specific aspects of social mechanisms that generate inequalities, through comparative analyses of different dimensions in which inequalities are expressed. It includes studies on social inequalities in 5 European and 5 Latin American countries, along 11 thematic axes: inequalities in the labour market and labour trajectories; asymmetries in the relationship between training and employment; inequalities in work and family life; educational inequalities; geographical and social inequalities: ethnicity and language; social inequalities, migration and space; uncertainty, strategies, resources and capabilities; inequality of opportunity: intergenerational social mobility; social policies; gender inequalities; and research methodology. This volume is the result of a large collaborative project on social inequality funded by the European Commission: the International Network for Comparative Analysis of Social Inequalities. Taking into account diverse perspectives and approximations, the collaborators have created a general analytical framework as a model of analysis of social inequalities. The various contributions in this volume help readers gain a global outlook and help reflect on social inequalities in a comparative perspective. This volume addresses social science graduate and postgraduate students, researchers, social policy makers, as well as a broader academic audience interested in social inequality.Fil: Salvia, Hector Agustin. Universidad Catolica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Assessing the stages of the grieving process in chronic obstructive pulmonary disease (COPD): validation of the Acceptance of Disease and Impairments Questionnaire (ADIQ)

Item does not contain fulltextBACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) encounter many (gradual) losses due to their disease, which trigger a grieving process. This process is characterized by stages of denial, resistance, sorrow, and acceptance. PURPOSE: This study examined whether these stages are conceptually distinct and whether the Acceptance of Disease and Impairments Questionnaire (ADIQ) can validly and reliably measure these stages in three samples of patients with COPD in the Netherlands. METHODS: Exploratory factor analysis (EFA) was performed on 145 outpatients with moderate to severe COPD. Confirmatory factor analyses were performed on 303 outpatients with mild to very severe COPD and 127 patients entering an inpatient pulmonary rehabilitation program. Furthermore, internal reliability, construct validity, sensitivity to change, and floor and ceiling effects were examined. RESULTS: EFA yielded a four-factor solution that explained 73.2 % of variance. Confirmatory factor analyses showed a good fit of the four-factor structure in all study samples. Cronbach's alpha reliability coefficients were .79 or higher. Subscales showed to be sensitive to change. CONCLUSIONS: Four distinct stages of grief are recognized in COPD. The ADIQ is a valid and reliable instrument to measure these stages: denial, resistance, sorrow, and acceptance. Measuring the stages of grieving is important for disease management: addressing patients with a specific therapeutic approach for the stage they are in could help to motivate patients to engage in self-management and change their lifestyle

Delayed explosion of hydrogen high pressure jets in a highly obstructed geometry

Delayed explosions of accidental high pressure hydrogen releases are an important risk scenario in safety studies of production plants, transportation pipelines and fuel cell vehicles charging stations. Such explosions were widely explored in multiple experimental and numerical investigations. Explosion of high pressure releases in highly obstructed geometries with high blockage ratio is a much more complicated phenomenon. This paper is dedicated to the experimental investigation of the influence of obstacles on a delayed deflagration of hydrogen jets. The computational fluid dynamics (CFD) code FLACS is used to reproduce experimental data. In the current study the computed overpressure signals are compared to the experimentally measured ones at different monitoring points. Simulations are in close agreement with experimental results and can be used to predict overpressure where experimental pressure detectors were saturated. For homogenous stationary clouds a new approach of equivalent mixture of H2/air (~16.5%) to stoichiometric mixture of CH4/air is suggested. This approach is validated versus experimental data from the literature in terms of overpressure maxima. A parametric study is performed using FLACS for various concentrations in the same geometry in order to identify a possible transition from deflagration to detonation

Course of normal and abnormal fatigue in patients with chronic obstructive pulmonary disease, and its relationship with domains of health status

OBJECTIVE: To examine the difference between patients with normal and patients with abnormal fatigue on aspects of health status, and investigate the natural course of fatigue in patients with Chronic Obstructive Pulmonary Disease (COPD). METHODS: Fatigue, physiological functioning, functional impairment, symptoms, and Quality of Life (QoL) were measured in 168 patients with COPD, and longitudinal data on fatigue of 77 patients were collected. RESULTS: Fifty percent of patients had abnormal fatigue. Patients with abnormal fatigue reported significantly more problems on the sub-domains of functional impairment (except actual physical activity), symptoms, and QoL as compared to patients with normal fatigue. With respect to physiological functioning patients with normal fatigue scores had better exercise capacity. Four years later the percentage of patients with abnormal fatigue was increased to 64%. In 1/3 of the patients an increase of more than the minimal clinically important difference was found. CONCLUSION: Many COPD patients suffer from abnormal fatigue. Patients with abnormal fatigue have more limitations on many aspects of health status, especially on symptoms, functional impairment, and QoL. PRACTICE IMPLICATIONS: Fatigue should be evaluated in usual care with a questionnaire that corrects for normal fatigue in order to tailor treatment to patients' need