The diagnosis and treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease and chronic bronchitis.

The syndrome of chronic obstructive pulmonary disease (COPD) consists of chronic bronchitis (CB), bronchiectasis, emphysema, and reversible airway disease that combine uniquely in an individual patient. Older patients are at risk for COPD and its components--emphysema, CB, and bronchiectasis. Bacterial and viral infections play a role in acute exacerbations of COPD (AECOPD) and in acute exacerbations of CB (AECB) without features of COPD. Older patients are at risk for resistant bacterial organisms during their episodes of AECOPD and AECB. Organisms include the more-common bacteria implicated in AECOPD/AECB such as Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Less-common nonenteric, gram-negative organisms including Pseudomonas aeruginosa, gram-positive organisms including Staphylococcus aureus, and strains of nontuberculosis Mycobacteria are more often seen in AECOPD/AECB episodes involving elderly patients with frequent episodes of CB or those with bronchiectasis. Risk-stratified antibiotic treatment guidelines appear useful for purulent episodes of AECOPD and episodes of AECB. These guidelines have not been prospectively validated for the general population and especially not for the elderly population. Using a risk-stratification approach for elderly patients, first-line antibiotics (e.g., amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole, and doxycycline), with a more-limited spectrum of antibacterial coverage, are used in patients who are likely to have a low probability of resistant organisms during AECOPD/AECB. Second-line antibiotics (e.g., amoxicillin/clavulanic acid, second- or third-generation cephalosporins, and respiratory fluoroquinolones) with a broader spectrum of coverage are reserved for patients with significant risk factors for resistant organisms and those who have failed initial antibiotic treatment

Patient considerations in the treatment of COPD: focus on the new combination inhaler umeclidinium/vilanterol.

Medication adherence among patients with chronic diseases, such as COPD, may be suboptimal, and many factors contribute to this poor adherence. One major factor is the frequency of medication dosing. Once-daily dosing has been shown to be an important variable in medication adherence in chronic diseases, such as COPD. New inhalers that only require once-daily dosing are becoming more widely available. Combination once-daily inhalers that combine any two of the following three agents are now available: 1) a long-acting muscarinic antagonist; 2) a long acting beta2 agonist; and 3) an inhaled corticosteroid. A new once-daily inhaler with both a long-acting muscarinic antagonist, umeclidinium bromide, and a long acting beta2 agonist, vilanterol trifenatate, is now available worldwide for COPD treatment. It provides COPD patients convenience, efficacy, and a very favorable adverse-effects profile. Additional once-daily combination inhalers are available or will soon be available for COPD patients worldwide. The use of once-daily combination inhalers will likely become the standard maintenance management approach in the treatment of COPD because they improve medication adherence

Layout of Graphs with Bounded Tree-Width

A \emph{queue layout} of a graph consists of a total order of the vertices, and a partition of the edges into \emph{queues}, such that no two edges in the same queue are nested. The minimum number of queues in a queue layout of a graph is its \emph{queue-number}. A \emph{three-dimensional (straight-line grid) drawing} of a graph represents the vertices by points in $\mathbb{Z}^3$ and the edges by non-crossing line-segments. This paper contributes three main results: (1) It is proved that the minimum volume of a certain type of three-dimensional drawing of a graph $G$ is closely related to the queue-number of $G$. In particular, if $G$ is an $n$-vertex member of a proper minor-closed family of graphs (such as a planar graph), then $G$ has a $O(1)\times O(1)\times O(n)$ drawing if and only if $G$ has O(1) queue-number. (2) It is proved that queue-number is bounded by tree-width, thus resolving an open problem due to Ganley and Heath (2001), and disproving a conjecture of Pemmaraju (1992). This result provides renewed hope for the positive resolution of a number of open problems in the theory of queue layouts. (3) It is proved that graphs of bounded tree-width have three-dimensional drawings with O(n) volume. This is the most general family of graphs known to admit three-dimensional drawings with O(n) volume. The proofs depend upon our results regarding \emph{track layouts} and \emph{tree-partitions} of graphs, which may be of independent interest.Comment: This is a revised version of a journal paper submitted in October 2002. This paper incorporates the following conference papers: (1) Dujmovic', Morin & Wood. Path-width and three-dimensional straight-line grid drawings of graphs (GD'02), LNCS 2528:42-53, Springer, 2002. (2) Wood. Queue layouts, tree-width, and three-dimensional graph drawing (FSTTCS'02), LNCS 2556:348--359, Springer, 2002. (3) Dujmovic' & Wood. Tree-partitions of $k$-trees with applications in graph layout (WG '03), LNCS 2880:205-217, 200

How Does Restored Habitat For Chinook Salmon ( Oncorhynchus Tshawytscha ) In The Merced River In California Compare With Other Chinook Streams?

The amount of time and money spent on restoring rivers for declining populations of salmon has grown substantially in recent decades. But despite the infusion of resources, many studies suggest that salmon populations are continuing to decline, leading some to question the effectiveness of restoration efforts. Here we examine whether a particular form of salmon restoration—channel reconfiguration with gravel augmentation—generates physical and biological habitat that is comparable with other streams that support salmon. We compared a suite of habitat features known to influence the various life stages of Chinook salmon in a restoration project in California's Merced River with 19 other streams that also support Chinook that we surveyed in the same geographic region. Our survey showed that riffle habitats in the restored site of the Merced River have flow discharge and depth, substrate and food web characteristics that cannot be distinguished from other streams that support Chinook, suggesting that these factors are unlikely to be bottlenecks to salmon recovery in the Merced. However, compared with other streams in the region, the Merced has minimal riparian cover, fewer undercut banks, less woody debris and higher water temperatures, suggesting that these factors might limit salmon recovery. After identifying aspects in the Merced that differ from other streams, we used principal components analysis to correlate salmon densities to independent axes of environmental variation measured during our survey. These analyses suggested that salmon densities tend to be greatest in streams that have more undercut banks and woody debris and lower water temperatures. These are the same environmental factors that appear to be missing from the Merced River restoration effort. Collectively, our results narrow the set of candidate factors that may limit salmon recovery in channel reconfiguration restoration efforts. Copyright © 2012 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97512/1/rra1604.pd

Relational legacies impacting on veteran transition from military to civilian life: trajectories of acquisition, loss and re-formulation of a sense of belonging

The veteran cohort has been inextricably linked in the general public's mind by media generated perceptions of high risk and fear of crime, echoed in wider contemporary debates linking issues of place, social identity, social exclusion (Pain 2000) and a loss of belonging in wider communities (Walklate 1998). Despite the growing interest in the longer term outcomes of transition from military to civilian life from policy-makers, practitioners and academics, few qualitative studies explore the social and relational impacts of this transitional experience on those who have experienced it. Tensions and frustrations expressed by ex-forces personnel, engaging in addictions services with a history of engagement in the criminal justice sector, are explored through the lens of belongingness, loss and related citizenship frameworks to expose temporal impacts on the acquisition, loss and reformulation of a sense of belonging across the life course. The relevance of a significant loss of belonging in the transition from military to civilian life is useful, given the widely accepted damaging consequences of having this need thwarted. This paper concludes that a broader understanding of this largely disenfranchised grief (Doka, 2002) can enable more informed reflexive opportunities to facilitate a valued military veteran citizenship status and thereby contribute to the formulation of current policy debates concerning the veteran question

A Metastasis or a Second Independent Cancer? Evaluating the Clonal Origin of Tumors Using Array-CGH Data

When a cancer patient develops a new tumor it is necessary to determine if this is a recurrence (metastasis) of the original cancer, or an entirely new occurrence of the disease. This is accomplished by assessing the histo-pathology of the lesions, and it is frequently relatively straightforward. However, there are many clinical scenarios in which this pathological diagnosis is difficult. Since each tumor is characterized by a genetic fingerprint of somatic mutations, a more definitive diagnosis is possible in principle in these difficult clinical scenarios by comparing the fingerprints. In this article we develop and evaluate a statistical strategy for this comparison when the data are derived from array comparative genomic hybridization, a technique designed to identify all of the somatic allelic gains and losses across the genome. Our method involves several stages. First a segmentation algorithm is used to estimate the regions of allelic gain and loss. Then the broad correlation in these patterns between the two tumors is assessed, leading to an initial likelihood ratio for the two diagnoses. This is then further refined by comparing in detail each plausibly clonal mutation within individual chromosome arms, and the results are aggregated to determine a final likelihood ratio. The method is employed to diagnose patients from several clinical scenarios, and the results show that in many cases a strong clonal signal emerges, occasionally contradicting the clinical diagnosis. The “quality” of the arrays can be summarized by a parameter that characterizes the clarity with which allelic changes are detected. Sensitivity analyses show that most of the diagnoses are robust when the data are of high quality

Structural Topic Models for Open-Ended Survey Responses

Collection and especially analysis of open-ended survey responses are relatively rare in the discipline and when conducted are almost exclusively done through human coding. We present an alternative, semiautomated approach, the structural topic model (STM) (Roberts, Stewart, and Airoldi 2013; Roberts et al. 2013), that draws on recent developments in machine learning based analysis of textual data. A crucial contribution of the method is that it incorporates information about the document, such as the author's gender, political affiliation, and treatment assignment (if an experimental study). This article focuses on how the STM is helpful for survey researchers and experimentalists. The STM makes analyzing open-ended responses easier, more revealing, and capable of being used to estimate treatment effects. We illustrate these innovations with analysis of text from surveys and experiments

Pregnancy and childbirth in English prisons : institutional ignominy and the pains of imprisonment

© 2020 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.With a prison population of approximately 9000 women in England, it is estimated that approximately 600 pregnancies and 100 births occur annually. Despite an extensive literature on the sociology of reproduction, pregnancy and childbirth among women prisoners is under‐researched. This article reports an ethnographic study in three English prisons undertaken in 2015‐2016, including interviews with 22 prisoners, six women released from prison and 10 staff members. Pregnant prisoners experience numerous additional difficulties in prison including the ambiguous status of a pregnant prisoner, physical aspects of pregnancy and the degradation of the handcuffed or chained prisoner during visits to the more public setting of hospital. This article draws on Erving Goffman's concepts of closed institutions, dramaturgy and mortification of self, Crewe et al.'s work on the gendered pains of imprisonment and Crawley's notion of ‘institutional thoughtlessness’, and proposes a new concept of institutional ignominy to understand the embodied situation of the pregnant prisoner.Peer reviewe

Science and Values on the High Desert: Dams and Irrigation on the Deschutes River, Oregon

More than a century of irrigation water withdrawals, reclamation, and the construction of the Pelton-Round Butte hydroelectric complex have altered the Deschutes River in central Oregon. An examination of these human impacts in the Deschutes Basin finds the geomorphic and hydrologic impacts downstream of the hydroelectric complex to be less substantial than typically expected, while irrigation water withdrawals in the upper basin remain a serious issue. Mitigation and restoration efforts have achieved success in the larger context of the status quo of water rights and water use in the American West, though much work remains before anadromous fish reestablish a presence in the Deschutes Basin