Risk factors for acute exacerbations of COPD in a primary care population: A retrospective observational cohort study

Objectives: To evaluate risk factors associated with exacerbation frequency in primary care. Information on exacerbations of chronic obstructive pulmonary disease (COPD) has mainly been generated by secondary care-based clinical cohorts. Design: Retrospective observational cohort study. Setting: Electronic medical records database (England and Wales). Participants: 58 589 patients with COPD aged ≥40 years with COPD diagnosis recorded between 1 April 2009 and 30 September 2012, and with at least 365 days of follow-up before and after the COPD diagnosis, were identified in the Clinical Practice Research Datalink. Mean age: 69 years; 47% female; mean forced expiratory volume in 1s 60% predicted. Outcome measures: Data on moderate or severe exacerbation episodes defined by diagnosis and/or medication codes 12 months following cohort entry were retrieved, together with demographic and clinical characteristics. Associations between patient characteristics and odds of having none versus one, none versus frequent (≥2) and one versus frequent exacerbations over 12 months follow-up were evaluated using multivariate logistic regression models. Results: During follow-up, 23% of patients had evidence of frequent moderate-to-severe COPD exacerbations (24% one; 53% none). Independent predictors of increased odds of having exacerbations during the follow-up, either frequent episodes or one episode, included prior exacerbations, increasing dyspnoea score, increasing grade of airflow limitation, females and prior or current history of several comorbidities (eg, asthma, depression, anxiety, heart failure and cancer). Conclusions: Primary care-managed patients with COPD at the highest risk of exacerbations can be identified by exploring medical history for the presence of prior exacerbations, greater COPD disease severity and co-occurrence of other medical conditions

Knowledge and the artefact

This paper discusses ways that knowledge may be found in or through artefacts. One purpose is to suggest situations where artefacts might be central to a narrative, rather than secondary to a text. A second purpose is to suggest ways that design and production of artefacts might be instrumental in eliciting knowledge. Four general situations are proposed: (1) Simple Forms - an artefact demonstrates or describes a principle or technique. (2) Communication of Process - artefacts arising from a process make the process explicit. (3) Artefacts Within the Research - artefacts are instrumental in advancing the research by communicating ideas or information. (4) Knowledge Elicited by Artefacts - artefacts provide a stimulus or context which enables information to be uncovered. .</p

Standard-M mobile satellite terminal employing electronic beam squint tracking

In recent years, extensive experience has been built up at the University of Bristol in the use of the Electronic Beam Squint (EBS) tracking technique, applied to large earth station facilities. The current interest in land mobile satellite terminals, using small tracking antennas, has prompted the investigation of the applicability of the EBS technique to this environment. The development of an L-band mechanically steered vehicle antenna is presented. A description of the antenna is followed by a detailed investigation of the tracking environment and its implications on the error detection capability of the system. Finally, the overall hardware configuration is described along with plans for future work

Preliminary Canopy Removal Experiments in Algal Dominated Communities Low on the Shore and in the Shallow Subtidal on the Isle of Man

The algal dominated communities immediately above and below the low-water spring level on a moderately exposed Manx shore were investigated by canopy removal experiments. Fucus serratus, Laminaria digitata and L. hyperborea were removed. Competition was shown to be important in determining the zonation of L. digitata and the distribution along the wave exposure gradient of other species such as Alaria esculenta, Desmarestia aculeata and D. viridis, and L. saccharina. Many species of algal epiphytes were early colonizers of canopy removal areas suggesting that competition from canopy algae usually restricts them to an epiphytic habit. The results indicate that interactions between macrophytes are much more important than grazing in structuring these communities

Brain natriuretic peptide and NT-proBNP levels reflect pulmonary artery systolic pressure in trekkers at high altitude.

Our objective was to evaluate the utility of the natriuretic peptides BNP (brain natriuretic peptide) and NT-proBNP as markers of pulmonary artery systolic pressure (PASP) in trekkers ascending to high altitude (HA). 20 participants had BNP and NT-proBNP assayed and simultaneous echocardiographic assessment of PASP performed during a trek to 5150 m. PASP increased significantly (p=0.006) with ascent from 24+/-4 to 39+/-11 mm Hg at 5150 m. At 5150 m those with a PASP>/=40 mm Hg (n=8) (versus those with PASP/=400 pg/ml) rise in NT-proBNP at 5150 m (n=4) PASP was significantly higher: 45.9+/-7.5 vs. 32.2+/-6.2 mm Hg (p=0.015). BNP and NT-proBNP may reflect elevated PASP, a central feature of high altitude pulmonary oedema, at HA

AMPHIBIAN RESPONSE TO A LARGE-SCALE HABITAT RESTORATION IN THE PRAIRIE POTHOLE REGION

Over the next half-century, scientists anticipate that nearly one third of the currently recognized 7,450 amphibian species will become extinct. Many organizations have responded to the challenge of conserving amphibian biodiversity, some indirectly. Under the auspices of the Iowa Great Lakes Management Plan, the United States Fish and Wildlife Service, Department of Natural Resources, and their partners have been implementing habitat restoration efforts designed to protect water quality, provide recreational opportunities, and benefit wildlife at the regional level. With this program, over 130 wetlands have been created in the past 30 years on recently purchased public lands—one of the largest wetland restoration projects conducted in the Prairie Pothole Region of the Great Plains. While amphibians were not the main target of these restorations, we show that in response, 121 new breeding populations of native Northern Leopard Frogs (Lithobates pipiens; n = 80) and Eastern Tiger Salamanders (Ambystoma tigrinum; n = 41) have been established; in addition, we found 19 populations of non-native American Bullfrogs (L. catesbeianus). Using the program PRESENCE, we show that leopard frog occupancy was greatest in newer (&lt;18 years old), intermediate-sized wetlands, and that tiger salamander occupancy was greatest in small wetlands without fish and larval bullfrogs. These data imply that because native amphibians responded positively to these newly established wetlands, habitat availability has likely been a factor in limiting population numbers. Further, these data suggest the presence of fishes and introduced bullfrogs interferes with the ability of tiger salamanders to colonize restored wetlands

Four dimensional Lie symmetry algebras and fourth order ordinary differential equations

Realizations of four dimensional Lie algebras as vector fields in the plane are explicitly constructed. Fourth order ordinary differential equations which admit such Lie symmetry algebras are derived. The route to their integration is described.Comment: 12 page

A spectrum of carbon dioxide from 800 to 5500 cm-1

An atlas of CO2 lines obtained from long path length samples at 296 K is presented. Many of the line centers are marked and their positions tabulated