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

Tour idea

Letter that discusses the idea of giving tours of Alcatraz Prisonhttps://scholarlycommons.pacific.edu/moscone-alcatraz/1009/thumbnail.jp

Instructional Leadership, Teaching Quality, and Student Achievement: Suggestive Evidence from Three Urban School Districts

Does providing instruction-related professional development to school principals set in motion a chain of events that can improve teaching and learning in their schools? This report examines professional development efforts by the University of Pittsburgh's Institute for Learning in elementary schools in Austin, St. Paul, and New York City

Helping Low-Income Families Manage Childhood Asthma: Solutions for Healthcare & Beyond

Asthma is the most common childhood chronic illness, affecting more than seven million children nationwide. Managing chronic illness in a child is challenging for any family. Among the challenges is constant fear of an acute episode, a complex regimen of medications given daily or many times each day, frequent changes in prescriptions or dosages, coordinating multiple healthcare providers, and helping a child have as "normal" and active a childhood as his/her condition allows. Low-income children of color bear a heavier asthma burden than their white or more affluent peers. Those low-income children who live in urban areas such as Baltimore, Chicago, Los Angeles, and New York are particularly vulnerable. Families with limited resources struggle to provide their children with asthma the support that these children need

Barriers to Postsecondary Education in Maine: Making College the Obvious and Attainable Next Step for More Maine Students

The question of why more high school students do not go on to college has been the focus of recent research at the Mitchell Institute. Quint and Plimpton summarize this research, which involved more than 2,500 Maine students, educators and parents. They find that financial barriers are only one piece of a complicated puzzle. Other barriers include parental attitudes, whether any family members have attended college, the high school experience (i.e., what track the student is placed in), the quality of career planning in school and at home, and the level of active planning for college (while many students say they plan to go on to college, some do not take the specific steps necessary to actually do so). By sifting through the layers of what is happening in Maine’s secondary schools and among students and parents, Quint and Plimpton generate a set of practical recommendations for policymakers and educators alike

Observation of Spin Flips with a Single Trapped Proton

Radio-frequency induced spin transitions of one individual proton are observed for the first time. The spin quantum jumps are detected via the continuous Stern-Gerlach effect, which is used in an experiment with a single proton stored in a cryogenic Penning trap. This is an important milestone towards a direct high-precision measurement of the magnetic moment of the proton and a new test of the matter-antimatter symmetry in the baryon sector

Longitudinal Intra- and Inter-individual variation in T-cell subsets of HIV-infected and uninfected men participating in the LA Multi-Center AIDS Cohort Study.

To assess the intra-individual and inter-individuals biological variation and the effect of aging on lymphocyte T-cells subsets.We assessed lymphocyte phenotypes (CD3, CD4, and CD8 T-cells) in 89 HIV-1-infected and 88 uninfected white non-Hispanic men every 6 months, to examine the biological variation for those measurements, and the average change in lymphocyte phenotype over 34 years.The markers showed significant intra-individuality in HIV-infected and uninfected individuals with index of individuality of <1.4. No mean changes were seen over the 34 years, with the exception of percentage CD4T-cells in HIV-uninfected individuals.In the pre-HAART era, HIV-infected individuals experienced an increase in mean absolute CD3 T-cell numbers (11.21 cells/μL, P = 0.02) and absolute CD8 T-cell numbers (34.57 cell/μl, P < .001), and in the percentage of CD8 T-cells (1.45%, P < .001) per year and a significant decrease in mean absolute CD4 T-cell numbers (23.68 cells/μl, P < .001) and in the percentage of CD4 T-cells (1.49%, P < .001) per year.In the post-HAART era, no changes in mean levels were observed in absolute CD3 T-cell count (P = .15) or percentage (P = .99). Significant decreases were seen in mean count (8.56 cells/μl, P < .001) and percentage (0.59%, P < .001) of CD8 T-cells, and increases in mean absolute count (10.72 cells/μl, P < .001) and percentage (0.47%, P < .001) of CD4 T-cells.With the exception of CD4 (%), no average changes per year were seen in lymphocyte phenotype of HIV-uninfected men. The results of coefficients of variation of intra and inter-individuals of this study can be useful for HIV-1 infection monitoring and in addition the observation could be a useful guide for intra- and inter-individual coefficient variations, and establishing quality goal studies of different blood biomarkers in healthy and other diseases

My Alfond Grant CDA: Experience From 10 Years of Automatic Deposits for All Maine Newborns

For over a decade, the Alfond Scholarship Foundation has automatically enrolled every Maine-resident newborn into the United States’ first statewide, universal Child Development Account (CDA) by investing $500 on each child’s behalf in the NextGen 529 plan. This Policy Brief provides an overview of My Alfond Grant and tracks the growth of the CDA in the 10 years since it made the major policy-design change to implement automatic enrollment. The Brief also includes insights regarding partnerships and communications that have helped to improve My Alfond Grant’s ability to connect with Maine families

Exploring the impact of varying definitions of exacerbations of chronic obstructive pulmonary disease in routinely collected electronic medical records

Background: Validity of exposure and outcome measures in electronic medical records is vital to ensure robust, comparable study findings however, despite validation studies, definitions of variables used often differ. Using exacerbations of chronic obstructive pulmonary disease (COPD) as an example, we investigated the impact of potential misclassification of different definitions commonly used in publications on study findings. Methods: A retrospective cohort study was performed. English primary care data from the Clinical Practice Research Datalink Aurum database with linked secondary care data were used to define a population of COPD patients ≥40 years old registered at a general practice. Index date was the date eligibility criteria were met and end of follow-up was 30/12/19, death or end of data collection. Exacerbations were defined using 6 algorithms based on definitions commonly used in the literature, including one validated definition. For each algorithm, the proportion of frequent exacerbators (≥2 exacerbations/year) and exacerbation rates were described. Cox proportional hazard regression was used to investigate each algorithm on the association between heart failure and risk of COPD exacerbation. Findings: A total of 315,184 patients were included. Baseline proportion of frequent exacerbators varied from 2.7% to 15.3% depending on the algorithm. Rates of exacerbations over follow-up varied from 19.3 to 66.6 events/100 person-years. The adjusted hazard ratio for the association between heart failure and exacerbation varied from 1.45, 95% confidence intervals 1.42–1.49, to 1.01, 0.98–1.04. Interpretation: The use of high validity definitions and standardisation of definitions in electronic medical records is crucial to generating high quality, robust evidence