Inquiry-based leadership:The influence of affective attitude, experienced social pressure and self-efficacy

Purpose The purpose of this paper is to improve the understanding of psychological factors that influence inquiry-based leadership. This study investigates how affective attitude, experienced social pressure, and self-efficacy relate to aspects of inquiry-based school leadership. A school leader’s inquiry habit of mind, data literacy, and the extent to which he or she creates a culture of inquiry in the school are each identified as aspects of inquiry-based leadership. Design/methodology/approach Data were collected from questionnaires completed by a sample of 79 school leaders. Findings A significant relationship was found between self-efficacy regarding inquiry-based leadership and all aspects of inquiry-based leadership. Affective attitude toward inquiry-based leadership was significantly related to creating a culture of inquiry. There was no unique relationship between experienced social pressure and inquiry-based leadership. Practical implications Administrators and educators of school leaders who aim to stimulate inquiry-based school leadership should not only focus on increasing the capacity of school leaders to lead their school in an inquiry-based way, but they should also focus on leaders’ self-efficacy and on fostering leaders’ positive attitude toward inquiry-based school leadership. Administrators and educators can, for example, give positive feedback, emphasize the added value of inquiry-based leadership, encourage working with critical friends, and stimulate collaboration with other leaders. Originality/value This study addresses two gaps in the existing research, by focusing on inquiry-based leadership instead of data use and on psychological factors instead of knowledge and skills that are related to this type of leadership

Assessing and Improving Positional Accuracy and its Effects on Areal Estimation at Coleambally Irrigation Area

If management decisions are made with geospatial data that have not been assessed for positional accuracy, then debate about both methodologies of measurement and management decisions can occur. This debate, in part, can be avoided by assessing the positional accuracy of geospatial data, leading to increased confidence (decreased uncertainty) in both the data and the decisions made from the data. In this study, we assessed the positional accuracy of two Geographic Information System (GIS) baseline datasets at the Coleambally Irrigation Area (CIA); high-resolution digital aerial photography acquired in January 2000, and the Digital Topographic Data Base (DTDB) roads data. We also assessed areal error of paddock measurements from an improved accuracy version of the high-resolution digital aerial photography. Positional accuracies were assessed by comparing well-defined features from both baseline datasets (original aerial photography and DTDB roads) to high-level accuracy Differential Global Positioning System (DGPS) data for the same features. This assessment showed that neither baseline dataset met the National Mapping Council of Australia’s standards of map accuracy. Consequently, we processed the original digital photography to create an improved dataset, which was over 2.5 times more accurate than the original photography, and over 4 times more accurate than the DTDB data. The improved dataset also met the map accuracy standard for Australia. We also assessed areal error by comparing paddock boundaries delineated from the improved dataset to those delineated from a DGPS associated with paddock soil surveys. The 90% confidence interval measured from the improved data for any individual paddock is approximately at the ± 5% target error set by Coleambally Irrigation Limited (CIL). The 95% confidence interval is roughly ± 6%. Overall areal error of multiple paddocks is much lower than the individual case with the 95% confidence interval for 2 paddocks being from about ± 4% error reducing to less than ± 2% for 8 or more paddocks. Knowledge of both positional and areal accuracies of the improved high-resolution digital aerial photography provides a means to more effectively manage environmental compliance of rice farmers at CIA and gives the CIL justification for making management decisions from this spatial data

Effective Prolonged Therapy with Voriconazole in a Lung Transplant Recipient with Spondylodiscitis Induced by Scedosporium apiospermum

Scedosporium/Pseudallescheria species are frequently seen in cystic fibrosis patients. However, disseminated forms after lung transplantation in these patients are rarely seen, but often with poor outcome. In this case report we describe a lung transplant recipient with cystic fibrosis who developed a spondylodiscitis that was caused by Scedosporium apiospermum. The patient was treated with anti-fungal treatment by voriconazole for over three years with a clinical good response and without the need for surgical intervention. To our opinion this is the first anti-fungal treated case of invasive disease caused by Scedosporium/Pseudallescheria in a cystic fibrosis (CF) patient who underwent lung transplantation that survived

Monocyte derived macrophages from lung transplantation patients have an increased M2 profile

Introduction: Lung transplantation (LTx) is a last treatment option for patients with an end-stage pulmonary disease. Although the monocyte-macrophage lineage is accepted to be clinically important only little is known about the effect of immunosuppressive drugs in combination with chronic rejection. It is likely that local inflammatory conditions and immunosuppressive medication alter the activation state of macrophages. The goal of this study was to determine how monocyte derived macrophage subsets were affected in LTx patients. Methods: PBMC's were obtained by ficoll density gradient centrifugation and cultured in RPMI with 10% FCS for 7 days. For identification and quantification of cultured monocyte derived macrophages fluorescence-activated cell sorting analysis was performed. Markers including; CD16, CD64, CD200r, CD163 and CD14 were used to determine M1, M2a and M2b macrophages. Results: Transplantation patients showed an increased and frequency (p = 0.0245) for M2a macrophages compared to healthy controls. Also, median fluorescence intensity of CD163, CD64, HLA-DR and CD200r increased with transplantation. Discussion: An increase in M2 phenotype macrophages in transplantation patients is in line with the latest findings in solid organ transplantation. M2 macrophages are associated with tissue-regeneration and diminished capacity of host defence, possibly leading to fibrosis development [1]. What this exactly means for the disease process and current clinical assessment requires further investigation

Exceptional LAS Requests in Eurotransplant:Analysis of an 8-year Effort to Improve Lung Allocation for Precarious Patients

PURPOSE: Following introduction of the lung allocation score (LAS) in 2011, Eurotransplant member centers can apply for an exceptional LAS (eLAS) if the calculated LAS insufficiently reflects the perceived transplant benefit for a patient, specifically in case of primary pulmonary hypertension group 1 and 4; combined lung+non-renal transplantation; rare diseases; or extracorporeal support. Each eLAS proposal is evaluated by a LAS Review Board, consisting of ≥3 lung transplant experts, which subsequently declines or approves the eLAS request in consensus of ≥3 votes. In case of a lower than accepted score, predefined business rules to assign LAS percentiles are used. METHODS: A retrospective analysis of all eLAS requests in Eurotransplant from December 2011 until September 2019. RESULTS: Overall, 5183 lung transplants (deceased donors) were performed and 420 eLAS requests were made (Germany 52%, Netherlands 18%, Austria 18%, Belgium 13%), of which 116 (28%) were approved. Most eLAS requests concerned group B/Pulmonary vascular disease (44%), followed by group C/Cystic fibrosis or immunodeficiency disorder (28%), then group D/Restrictive lung disease (15%) and finally group A/Obstructive lung disease (11%); whereas 10 patients (2%) were not classified. The proportion of accepted eLAS requests significantly differed between countries (Germany 25%, Netherlands 37%, Austria 20%, Belgium 36%) (p=0.042). eLAS requests decreased in the Netherlands following its LAS introduction in 2014 (2011-2014 mean 13/yr vs. 2015-2019 mean 4.6/yr; p=0.060). However, since 2015 an overall annual increasing number of eLAS requests is seen, with doubling of the eLAS requests in 2018 vs. 2015, but no difference in acceptance rate (2015-2018: 22.4%) (Figure). Acceptance rates were 38% for Group B, 21% for Group C, 20% for Group D and 11% for Group A. CONCLUSION: The observed variations require further investigation to optimize lung allocation for specific patient populations in Eurotransplant

The relationship of fat and muscle measurements with emphysema and bronchial wall thickening in smokers

Introduction Differences in body composition in patients with COPD may have important prognostic value and may provide opportunities for patient-specific management. We investigated the relation of thoracic fat and muscle with computed tomography (CT)-measured emphysema and bronchial wall thickening. Methods Low-dose baseline chest CT scans from 1031 male lung cancer screening participants from one site were quantified for emphysema, bronchial wall thickening, subcutaneous fat, visceral fat and skeletal muscle. Body composition measurements were performed by segmenting the first slice above the aortic arch using Hounsfield unit thresholds with region growing and manual corrections. COPD presence and severity were evaluated with pre-bronchodilator spirometry testing. Results Participants had a median age of 61.5 years (58.6–65.6, 25th–75th percentile) and median number of 38.0 pack-years (28.0–49.5); 549 (53.2%) were current smokers. Overall, 396 (38.4%) had COPD (256 Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1, 140 GOLD 2–3). Participants with COPD had less subcutaneous fat, visceral fat and skeletal muscle (p<0.001 for all). With increasing GOLD stages, subcutaneous (p=0.005) and visceral fat values (p=0.004) were higher, and skeletal muscle was lower (p=0.004). With increasing severity of CT-derived emphysema, subcutaneous fat, visceral fat and skeletal muscle values were lower (p<0.001 for all). With increasing CT-derived bronchial wall thickness, subcutaneous and visceral fat values were higher (p<0.001 for both), without difference in skeletal muscle. All statistical relationships remained when adjusted for age, pack-years and smoking status. Conclusion COPD presence and emphysema severity are associated with smaller amounts of thoracic fat and muscle, whereas bronchial wall thickening is associated with fat accumulation

A joint physics and radiobiology DREAM team vision - Towards better response prediction models to advance radiotherapy.

Radiotherapy developed empirically through experience balancing tumour control and normal tissue toxicities. Early simple mathematical models formalized this practical knowledge and enabled effective cancer treatment to date. Remarkable advances in technology, computing, and experimental biology now create opportunities to incorporate this knowledge into enhanced computational models. The ESTRO DREAM (Dose Response, Experiment, Analysis, Modelling) workshop brought together experts across disciplines to pursue the vision of personalized radiotherapy for optimal outcomes through advanced modelling. The ultimate vision is leveraging quantitative models dynamically during therapy to ultimately achieve truly adaptive and biologically guided radiotherapy at the population as well as individual patient-based levels. This requires the generation of models that inform response-based adaptations, individually optimized delivery and enable biological monitoring to provide decision support to clinicians. The goal is expanding to models that can drive the realization of personalized therapy for optimal outcomes. This position paper provides their propositions that describe how innovations in biology, physics, mathematics, and data science including AI could inform models and improve predictions. It consolidates the DREAM team's consensus on scientific priorities and organizational requirements. Scientifically, it stresses the need for rigorous, multifaceted model development, comprehensive validation and clinical applicability and significance. Organizationally, it reinforces the prerequisites of interdisciplinary research and collaboration between physicians, medical physicists, radiobiologists, and computational scientists throughout model development. Solely by a shared understanding of clinical needs, biological mechanisms, and computational methods, more informed models can be created. Future research environment and support must facilitate this integrative method of operation across multiple disciplines

Fluticasone/formoterol combination therapy is as effective as fluticasone/salmeterol in the treatment of asthma, but has a more rapid onset of action: an open-label, randomized study

<p>Abstract</p> <p>Background</p> <p>The inhaled corticosteroid (ICS) fluticasone propionate (fluticasone) and the long-acting β₂-agonist (LABA) formoterol fumarate (formoterol) are being made available as a combination product (fluticasone/formoterol, <b><it>flutiform</it></b>^®) in a single aerosol inhaler. This 12-week, open-label, randomized, active-controlled, parallel-group, multicentre, phase 3 study compared the efficacy and safety of fluticasone/formoterol with the commercially available combination product fluticasone/salmeterol.</p> <p>Methods</p> <p>Patients aged ≥ 18 years (N = 202) with mild-to-moderate–severe, persistent asthma for ≥ 6 months prior to screening were included in the study. After a screening phase (4–10 days), eligible patients were randomized 1:1 to receive fluticasone/formoterol or fluticasone/salmeterol during the 12-week treatment period. The primary objective was to demonstrate non-inferiority of fluticasone/formoterol versus fluticasone/salmeterol, measured by pre-dose forced expiratory volume in the first second (FEV₁), at week 12.</p> <p>Results</p> <p>Fluticasone/formoterol was comparable to fluticasone/salmeterol for the primary efficacy endpoint, mean pre-dose FEV₁at week 12. The new combination was also comparable to fluticasone/salmeterol for change from baseline to week 12 in pre-dose FEV₁, change from pre-dose FEV₁at baseline to 2-hour post-dose FEV₁at week 12 and discontinuations due to lack of efficacy. Importantly, fluticasone/formoterol was superior to fluticasone/salmeterol in time to onset of action throughout the duration of the study. The two treatments demonstrated similar results for various other secondary efficacy parameters, including other lung function tests, patient-reported outcomes, rescue medication use, asthma exacerbations and Asthma Quality of Life Questionnaire scores. Fluticasone/formoterol was well tolerated and had a good safety profile that was similar to fluticasone/salmeterol.</p> <p>Conclusions</p> <p>The results of this study indicate that fluticasone/formoterol is as effective as fluticasone/salmeterol, and has a more rapid onset of action, reflecting the faster bronchodilatory effects of formoterol compared with those of salmeterol. If patients perceive the benefits of therapy with fluticasone/formoterol more rapidly than with fluticasone/salmeterol, this could have a positive impact on preference and adherence.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00476073">NCT00476073</a></p