Pulmonary Hypertension in Patients with Chronic Fibrosing Idiopathic Interstitial Pneumonias

Background Pulmonary hypertension (PH) is a common finding in patients with chronic fibrosing idiopathic interstitial pneumonias (IIP). Little is known about the response to pulmonary vasodilator therapy in this patient population. COMPERA is an international registry that prospectively captures data from patients with various forms of PH receiving pulmonary vasodilator therapies. Methods We retrieved data from COMPERA to compare patient characteristics, treatment patterns, response to therapy and survival in newly diagnosed patients with idiopathic pulmonary arterial hypertension (IPAH) and PH associated with IIP (PH-IIP). Results Compared to patients with IPAH (n = 798), patients with PH-IIP (n = 151) were older and predominantly males. Patients with PH-IIP were treated predominantly with phosphodiesterase-5 inhibitors (88% at entry, 87% after 1 year). From baseline to the first follow-up visit, the median improvement in 6MWD was 30 m in patients with IPAH and 24.5 m in patients with PH-IIP (p = 0.457 for the difference between both groups). Improvements in NYHA functional class were observed in 22.4% and 29.5% of these patients, respectively (p = 0.179 for the difference between both groups). Survival rates were significantly worse in PH-IIP than in IPAH (3-year survival 34.0 versus 68.6%; p<0.001). Total lung capacity, NYHA class IV, and mixed-venous oxygen saturation were independent predictors of survival in patients with PH-IIP. Conclusions Patients with PH-IIP have a dismal prognosis. Our results suggest that pulmonary vasodilator therapy may be associated with short-term functional improvement in some of these patients but it is unclear whether this treatment affects survival

Transient hygro- and hydro-expansion of freely and restrained dried paper: the fiber-network coupling

The transient dimensional changes during \textit{hygro}-expansion and \textit{hydro}-expansion of freely and restrained dried, softwood and hardwood sheets and fibers is monitored, to unravel the governing micro-mechanisms occurring during gradual water saturation. The response of individual fibers is measured using a full-field global digital height correlation method, which has been extended to monitor the transient \textit{hydro}-expansion of fibers from dry to fully saturated. The \textit{hygro}- and \textit{hydro}-expansion is larger for freely versus restrained dried and softwood versus hardwood handsheets. The transient sheet-scale \textit{hydro}-expansion reveals a sudden strain and moisture content step. It is postulated that the driving mechanism is the moisture-induced softening of the so-called "dislocated regions" in the fiber's cellulose micro-fibrils, unlocking further fiber swelling. The strain step is negligible for restrained dried handsheets, which is attributed to the "dislocated cellulose regions" being locked in their stretched configuration during restrained drying, which is supported by the single fiber \textit{hydro}-expansion measurements. Finally, an inter-fiber bond model is exploited and adapted to predict the sheet-scale \textit{hygro}-expansion from the fiber level characteristics. The model correctly predicts the qualitative differences between freely versus restrained dried and softwood versus hardwood handsheets, yet, its simplified geometry does not allow for more quantitative predictions of the sheet-scale \textit{hydro}-expansion.Comment: 37 pages; 12 figures; 5 table

Omgaan met digitale nationale beleidskaarten

In dit werkdocument worden de resultaten besproken van een casestudy die onderdeel is van het project GeO3 - Omgaan met onzekerheid binnen Ruimtelijke Ordening. De directie Platteland van het ministerie van LNV heeft bij het publiceren van het meerjarenprogramma van Agenda Vitaal Platteland geen digitale viewer gepubliceerd omdat men bang was voor verkeerde interpretatie van de digitale kaarten. In dit project is gekeken naar methoden en cartografische oplossingen om voortaan zonder angst voor misinterpretaties digitale nationale beleidskaarten te kunnen verspreiden. De oplossing is gezocht in het opstellen van een handreiking, zodat kaarten ook daadwerkelijk weergeven wat er bedoeld is door de maker

The Effect of Provider Density on Lung Cancer Survival Among Blacks and Whites in the United States

IntroductionLung cancer mortality rates may vary with access to specialty providers and local resources. We sought to examine the effect of access to care, using density of lung cancer care providers, on lung cancer mortality among blacks and whites in the United States.MethodsWe examined U.S. county-level data for age-adjusted lung cancer mortality rates from 2003 to 2007. Our primary independent variable was per capita number of thoracic oncologic providers, adjusting for county-level smoking rates, socioeconomic status, and other geographic factors. Data were obtained from 2009 Area Resource File, National Center for Health Statistics, and the County Health Rankings Project.ResultsProviders of lung cancer care were unevenly distributed among the U.S. counties. For example, 41.4% of the U.S. population reside in counties with less than four thoracic surgeons per 100,000 people, 23.4% in counties with 4 to 15 surgeons per 100,000 people, and 35.3% in counties with more than 15 surgeons per 100,000 people. Geographically, 4.3% of whites compared with 11.2% of blacks lived in high lung cancer mortality zones. Lung cancer mortality did not vary by density of thoracic surgeons or oncology services; however, higher primary care provider density was associated with lung cancer mortality reduction of 4.1 per 100,000 for whites.ConclusionVariation in provider density for thoracic oncology in the United States was not associated with a difference in lung cancer mortality. Lower mortality associated with higher primary care provider density suggests that equitable access to primary care may lead to reduced cancer disparities

Body mass index after treatment for solid tumors in childhood

Overweight is frequently diagnosed in acute lymphoblastic leukaemia survivors, but less is known about body weight after treatment for a solid tumour. Objective: Assessment of the prevalence of under- and/or overweight after solid tumour treatment in childhood. Patients and methods: Inclusion criteria: diagnosis of solid tumour between 1972 and 1993, age at diagnosis below 21 years, complete remission more than five years post-treatment. Height and weight for BMI where retrospectively calculated five, ten and fifteen years post-treatment. The prevalence of over- and underweight in the survivors was compared with reference groups using the chi square test. The relation between under-/overweight and age at diagnosis and gender was evaluated with regression-analysis. Results: 337 survivors (198 male) met the inclusion criteria. Cancer diagnoses were: sarcoma (n = 74), blastoma (n = 65), brain tumour (n = 72), malignant lymphoma (n = 73), LCH (n = 24) and miscellaneous (n = 29). The prevalence of overweight was not increased. The prevalence of underweight was significantly increased in women until ten years post-treatment, in males until fifteen years post-treatment, and in survivors of blastoma, sarcoma or malignant lymphoma. There was no relation between BMI and gender or age at diagnosis. Conclusion: In long term solid tumour survivors the prevalence of underweight was increased whereas no increase of overweight was found.</p