Predicting risk of COPD in primary care:development and validation of a clinical risk score

OBJECTIVES: To develop and validate a clinical risk score to identify patients at risk of chronic obstructive pulmonary disease (COPD) using clinical factors routinely recorded in primary care. DESIGN: Case–control study of patients containing one incident COPD case to two controls matched on age, sex and general practice. Candidate risk factors were included in a conditional logistic regression model to produce a clinical score. Accuracy of the score was estimated on a separate external validation sample derived from 20 purposively selected practices. SETTING: UK general practices enrolled in the Clinical Practice Research Datalink (1 January 2000 to 31 March 2006). PARTICIPANTS: Development sample included 340 practices containing 15 159 newly diagnosed COPD cases and 28 296 controls (mean age 70 years, 52% male). Validation sample included 2259 cases and 4196 controls (mean age 70 years, 50% male). MAIN OUTCOME MEASURES: Area under the receiver operator characteristic curve (c statistic), sensitivity and specificity in the validation practices. RESULTS: The model included four variables including smoking status, history of asthma, and lower respiratory tract infections and prescription of salbutamol in the previous 3 years. It had a high average c statistic of 0.85 (95% CI 0.83 to 0.86) and yielded a sensitivity of 63.2% (95% CI 63.1 to 63.3) and specificity 87.4% (95% CI 87.3 to 87.5). CONCLUSIONS: Risk factors associated with COPD and routinely recorded in primary care have been used to develop and externally validate a new COPD risk score. This could be used to target patients for case finding

Differences in the Prevalence of Non-Communicable Disease between Slum Dwellers and the General Population in a Large Urban Area in Brazil.

Residents of urban slums are at greater risk for disease than their non-slum dwelling urban counterparts. We sought to contrast the prevalences of selected non-communicable diseases (NCDs) between Brazilian adults living in a slum and the general population of the same city, by comparing the age and sex-standardized prevalences of selected NCDs from a 2010 survey in Pau da Lima, Salvador Brazil, with a 2010 national population-based telephone survey. NCD prevalences in both populations were similar for hypertension (23.6% (95% CI 20.9⁻26.4) and 22.9% (21.2⁻24.6), respectively) and for dyslipidemia (22.7% (19.8⁻25.5) and 21.5% (19.7⁻23.4)). Slum residents had higher prevalences of diabetes mellitus (10.1% (7.9⁻12.3)) and of overweight/obesity (46.5% (43.1⁻49.9)), compared to 5.2% (4.2⁻6.1) and 40.6% (38.5⁻42.8) of the general population in Salvador. Fourteen percent (14.5% (12.1⁻17.0)) of slum residents smoked cigarettes compared to 8.3% (7.1⁻9.5) of the general population in Salvador. The national telephone survey underestimated the prevalence of diabetes mellitus, overweight/obesity, and smoking in the slum population, likely in part due to differential sampling inside and outside of slums. Further research and targeted policies are needed to mitigate these inequalities, which could have significant economic and social impacts on slum residents and their communities

Reconstructing CMEs with Coordinated Imaging and In Situ Observations: Global Structure, Kinematics, and Implications for Space Weather Forecasting

See the pdf for detailsComment: 45 pages, 16 figures, ApJ, in pres

Using novel methodologies to examine the impact of artificial light at night on the cortisol stress response in dispersing Atlantic salmon (Salmo salarL.) fry

Artificial light at night (ALAN) is gaining recognition as having an important anthropogenic impact on the environment, yet the behavioural and physiological impacts of this stressor are largely unknown. This dearth of information is particularly true for freshwater ecosystems, which are already heavily impacted by anthropogenic pressures. Atlantic salmon (Salmo salar L.) is a species of conservation and economic importance whose ecology and behaviour is well studied, making it an ideal model species. Recent investigations have demonstrated that salmon show disrupted behaviour in response to artificial light; however, it is not yet clear which physiological processes are behind the observed behavioural modifications. Here, two novel non-invasive sampling methods were used to examine the cortisol stress response of dispersing salmon fry under different artificial lighting intensities. Fish egg and embryos were reared under differing ALAN intensities and individual measures of stress were subsequently taken from dispersing fry using static sampling, whereas population-level measures were achieved using deployed passive samplers. Dispersing fry exposed to experimental confinement showed elevated cortisol levels, indicating the capacity to mount a stress response at this early stage in ontogenesis. However, only one of the two methods for sampling cortisol used in this study indicated that ALAN may act as a stressor to dispersing salmon fry. As such, a cortisol-mediated response to light was not strongly supported. Furthermore, the efficacy of the two non-invasive methodologies used in this study is, subject to further validation, indicative of them proving useful in future ecological studies

2003 Manifesto on the California Electricity Crisis

The authors, an ad-hocgroup of professionals with experience in regulatory and energy economics, share a common concern with the continuing turmoil facing the electricity industry ("the industry") in California. Most ofthe authorsendorsed the first California Electricity Manifesto issued on January 25, 2001. Almost two years have passed since that first Manifesto. While wholesale electric prices have moderated and California no longer faces the risk of blackouts, in many ways the industry is in worse shape now than it was at the start of 2001. As a result, the group of signatories continues to have a deep concern with the conflicting policy directions being pursued for the industry at both the State and Federal levels of government and the impact the uncertainties associated with these conflicting policies will have, long term, on the economy of California. Theauthorshave once again convened under the auspices of the Institute of Management, Innovation and Organization at the University of California, Berkeley, to put forward ourtheir ideas on a basic set of necessary policies to move the industry forward for the benefit of all Californians and the nation. The authors point out that theydo not pretend to be "representative." They do bring, however, a very diverse range of backgrounds and expertise.Technology and Industry, Regulatory Reform

A Tale of 2 Continents – Some Tectonic Contrasts between the Central Andes and the North American Cordillera, as Illustrated by the Paelomagnetic Signatures

Comparison of patterns of paleomagnetic poles from orogenic belts with appropriate reference poles for the craton can help to delineate important large-scale tectonic processes. Comparison of the paleomagnetic signatures of the western Cordillera of North America and the central Andes shows that the western edges of these belts have had profoundly different Mesozoic and Cenozoic histories. Specifically, the North American Cordilleran pattern shows strong evidence of post-middle Cretaceous relative northward displacement of outboard crustal blocks, but there is almost no comparable evidence of margin-parallel displacement in the Andes. We speculate that this may largely be a consequence of a simple difference in shape: the convex-westward western margin of North America facilitates margin-parallel displacement as a response to oblique subduction, whereas the concave-westward margin of South America inhibits it. The patterns of block rotations found along the western edge of the two orogens also are quite different. Nearly everywhere within the western North American Cordillera crustal blocks have rotated clockwise since mid-Cretaceous time, reflecting a pervading state of dextral shear. Within the western Andes of Peru and northern Chile, however, Mesozoic and Cenozoic rocks in Peru (and northernmost Chile) are rotated strongly counterclockwise, whereas rocks of the same age in the remainder of Chile (to about latitude 48°S) are rotated clockwise. A model combining oroclinal bending and block rotations driven by oblique subduction can account for the paleomagnetic observations

Regional contributions of six preventable risk factors to achieving the 25 × 25 non-communicable disease mortality reduction target: a modelling study

Background Countries have agreed to reduce premature mortality from the four main non-communicable diseases (NCDs) by 25% from 2010 levels by 2025 (referred to as the 25 × 25 target). Countries also agreed on a set of global voluntary targets for selected NCD risk factors. Previous analyses have shown that achieving the risk factor targets can contribute substantially towards meeting the 25 × 25 mortality target at the global level. We estimated the contribution of achieving six of the globally agreed risk factor targets towards meeting the 25 × 25 mortality target by region. Methods We estimated the eff ect of achieving the targets for six risk factors (tobacco and alcohol use, salt intake, obesity, and raised blood pressure and glucose) on NCD mortality between 2010 and 2025. Our methods accounted for multicausality of NCDs and for the fact that, when risk factor exposure increases or decreases, the harmful or benefi cial eff ects on NCDs accumulate gradually. We used data for risk factor and mortality trends from systematic analyses of available country data. Relative risks for the eff ects of individual and multiple risks, and for change in risk after decreases or increases in exposure, were from reanalyses and meta-analyses of epidemiological studies. Findings The probability of dying between the ages 30 years and 70 years from the four main NCDs in 2010 ranged from 19% in the region of the Americas to 29% in southeast Asia for men, and from 13% in Europe to 21% in southeast Asia for women. If current trends continue, the probability of dying prematurely from the four main NCDs is projected to increase in the African region but decrease in the other fi ve regions. If the risk factor targets are achieved, the 25 × 25 target will be surpassed in Europe in both men and women, and will be achieved in women (and almost achieved in men) in the western Pacifi c; the regions of the Americas, the eastern Mediterranean, and southeast Asia will approach the target; and the rising trend in Africa will be reversed. In most regions, a more ambitious approach to tobacco control (50% reduction relative to 2010 instead of the agreed 30%) will contribute the most to reducing premature NCD mortality among men, followed by addressing raised blood pressure and the agreed tobacco target. For women, the highest contributing risk factor towards the premature NCD mortality target will be raised blood pressure in every region except Europe and the Americas, where the ambitious (but not agreed) tobacco reduction would have the largest benefi t. Interpretation No WHO region will meet the 25 × 25 premature mortality target if current mortality trends continue. Achieving the agreed targets for the six risk factors will allow some regions to meet the 25 × 25 target and others to approach it. Meeting the 25 × 25 target in Africa needs other interventions, including those addressing infectionrelated cancers and cardiovascular disease

DC-SIGN and DC-SIGNR Bind Ebola Glycoproteins and Enhance Infection of Macrophages and Endothelial Cells

AbstractEbola virus exhibits a broad cellular tropism in vitro. In humans and animal models, virus is found in most tissues and organs during the latter stages of infection. In contrast, a more restricted cell and tissue tropism is exhibited early in infection where macrophages, liver, lymph node, and spleen are major initial targets. This indicates that cellular factors other than the broadly expressed virus receptor(s) modulate Ebola virus tropism. Here we demonstrate that the C-type lectins DC-SIGN and DC-SIGNR avidly bind Ebola glycoproteins and greatly enhance transduction of primary cells by Ebola virus pseudotypes and infection by replication-competent Ebola virus. DC-SIGN and DC-SIGNR are expressed in several early targets for Ebola virus infection, including dendritic cells, alveolar macrophages, and sinusoidal endothelial cells in the liver and lymph node. While DC-SIGN and DC-SIGNR do not directly mediate Ebola virus entry, their pattern of expression in vivo and their ability to efficiently capture virus and to enhance infection indicate that these attachment factors can play an important role in Ebola transmission, tissue tropism, and pathogenesis