Four patients with a history of acute exacerbations of COPD: implementing the CHEST/Canadian Thoracic Society guidelines for preventing exacerbations

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The certification of the mass fraction of carbon in cementite grains in a Fe-C matrix: IRMM-471

The report describes the production and certification of IRMM-471, a reference material certified for the carbon mass fraction of its cementite (Fe3C) grains. The Fe3C grains are dispersed within an iron pearlite matrix and present an average grain diameter between 20 µm and 50 μm. IRMM-471 has been produced and certified in order to be used as calibrant in electron probe micro-analyser (EPMA) for carbon determination in iron and steel products.JRC.D.2-Standards for Innovation and sustainable Developmen

European Respiratory Society guidelines for the management of adult bronchiectasis

Bronchiectasis in adults is a chronic disorder associated with poor quality of life and frequent exacerbations in many patients. There have been no previous international guidelines.The European Respiratory Society guidelines for the management of adult bronchiectasis describe the appropriate investigation and treatment strategies determined by a systematic review of the literature.A multidisciplinary group representing respiratory medicine, microbiology, physiotherapy, thoracic surgery, primary care, methodology and patients considered the most relevant clinical questions (for both clinicians and patients) related to management of bronchiectasis. Nine key clinical questions were generated and a systematic review was conducted to identify published systematic reviews, randomised clinical trials and observational studies that answered these questions. We used the GRADE approach to define the quality of the evidence and the level of recommendations. The resulting guideline addresses the investigation of underlying causes of bronchiectasis, treatment of exacerbations, pathogen eradication, long term antibiotic treatment, anti-inflammatories, mucoactive drugs, bronchodilators, surgical treatment and respiratory physiotherapy.These recommendations can be used to benchmark quality of care for people with bronchiectasis across Europe and to improve outcomes

Grammar disruption in a patient with Neuro-Sweet syndrome

This paper for the first time reports detailed neurolinguistic findings in a patient with Neuro-Sweet syndrome. In this patient the presenting symptoms of central nervous system (CNS) involvement primarily consisted of a selective grammar deficit restricted to spontaneous speech. On MRI a left prefrontal ischemic stroke (superior part BA 6) and two small subcortical left parietal infarctions were found. Neurolinguistic analyses, however, did not reveal a profile consistent with any observations of agrammatism caused by structural damage to the language areas critically involved in grammatical processing. It is hypothesized that selectively distorted grammar might reflect disruption of the frontosubcortical network involved in language processing. Prefrontal neurobehavioral abnormalities associated with functional disruption of the inferior medial frontal regions as demonstrated by SPECT, additionally suggest that agrammatic symptoms may be linked to a higher-level cognitive disorder following encephalopathic CNS involvement

The PEARL score predicts 90-day readmission or death after hospitalisation for acute exacerbation of COPD.

BACKGROUND: One in three patients hospitalised due to acute exacerbation of COPD (AECOPD) is readmitted within 90 days. No tool has been developed specifically in this population to predict readmission or death. Clinicians are unable to identify patients at particular risk, yet resources to prevent readmission are allocated based on clinical judgement. METHODS: In participating hospitals, consecutive admissions of patients with AECOPD were identified by screening wards and reviewing coding records. A tool to predict 90-day readmission or death without readmission was developed in two hospitals (the derivation cohort) and validated in: (a) the same hospitals at a later timeframe (internal validation cohort) and (b) four further UK hospitals (external validation cohort). Performance was compared with ADO, BODEX, CODEX, DOSE and LACE scores. RESULTS: Of 2417 patients, 936 were readmitted or died within 90 days of discharge. The five independent variables in the final model were: Previous admissions, eMRCD score, Age, Right-sided heart failure and Left-sided heart failure (PEARL). The PEARL score was consistently discriminative and accurate with a c-statistic of 0.73, 0.68 and 0.70 in the derivation, internal validation and external validation cohorts. Higher PEARL scores were associated with a shorter time to readmission. CONCLUSIONS: The PEARL score is a simple tool that can effectively stratify patients' risk of 90-day readmission or death, which could help guide readmission avoidance strategies within the clinical and research setting. It is superior to other scores that have been used in this population. TRIAL REGISTRATION NUMBER: UKCRN ID 14214

A Rac/Cdc42 exchange factor complex promotes formation of lateral filopodia and blood vessel lumen morphogenesis

During angiogenesis, Rho GTPases influence endothelial cell migration and cell-cell adhesion; however it is not known whether they control formation of vessel lumens, which are essential for blood flow. Here, using an organotypic system that recapitulates distinct stages of VEGF-dependent angiogenesis, we show that lumen formation requires early cytoskeletal remodelling and lateral cell-cell contacts, mediated through the RAC1 guanine nucleotide exchange factor (GEF) DOCK4. DOCK4 signalling is necessary for lateral filopodial protrusions and tubule remodelling prior to lumen formation, whereas proximal, tip filopodia persist in the absence of DOCK4. VEGF-dependent Rac activation via DOCK4 is necessary for CDC42 activation to signal filopodia formation and depends on the activation of RHOG through the RHOG GEF, SGEF. VEGF promotes interaction of DOCK4 with the CDC42 GEF DOCK9. These studies identify a novel Rho-family GTPase activation cascade for the formation of endothelial cell filopodial protrusions necessary for tubule remodelling, thereby influencing subsequent stages of lumen morphogenesis

Back to the past: the individual and its role in creativity in organisations

O objetivo deste texto é realçar o papel do indivíduo na criatividade nas organizações. Esse papel tem sido estranhamente remetido para um plano secundário, à medida que as modernas visões da criatividade a definem, sobretudo, com relação ao contexto em que ocorre. De fato, na perspectiva atual, a criatividade não pode ser entendida sem se considerarem os contextos funcional, relacional e organizacional nos quais está inserido o trabalhador. Tais são as considerações da maior parte dos autores que escreve sobre o tópico, como sejam Amabile (1996), Csikszentmihalyi (1996), ou, mais recentemente, Glăveanu (2010a, 2010b). Essa corrente dominante, com origem no interacionismo psico-social, tem ainda influenciado o desenvolvimento teórico de outros conceitos em psicologia, sociologia, e, na sequência, nas ciências sociais e humanas, e na gestão. Essa supremacia no que concerne a criatividade, tem conduzido os autores a olvidar o papel do indivíduo no processo e no resultado criativos, chegando a retirar-lhe a responsabilidade e o protagonismo pela geração e produção de ideias. Desse modo, no presente texto, recuperam-se os argumentos em favor da centralidade da pessoa na criatividade, defendendo-se que esta tem uma existência isolada de influências externas, e que, como tal, devem relembrar-se as bases individuais da criatividadeThe goal of the current text is to highlight the role of the individual in creativity in organisations. This role has been strangely disregarded in recent years, as modern accounts of creativity have been emphasising the idea that creativity is only defined in context. This main stream argues that creativity is a process that essentially occurs within a functional, relational, and organisational context in which workers are inserted. Key authors defending such a position include the likes of Amabile (1996), Csikszentmihalyi (1996), and, more recently, Glăveanu (2010a, 2010b). This is a vision rooted in the psychosocial interactionist perspective, which has also had a considerable impact in other areas in psychology, sociology, management and other social and human sciences. This supremacy, with regards to creativity, has led many to forget the role of the individual person in the creative process and output, removing their responsibility and protagonism for generating and producing ideas. Hence, the current text intends to bring back to discussion the individual bases of creativity, that people can have an existence isolated from external influences, further defending that the concept can and should be defined out of context, rather than in contextinfo:eu-repo/semantics/publishedVersio

Basic Psychological Needs, Class-related Emotions and Satisfaction with Life in Spanish Teachers

The objective of this study was to examine possible antecedents and consequences of teachers’ emotions in the classroom. Based on a cognitive-social perspective and self-determination theory, we examined the relationship between basic psychological needs (BPNs), teachers’ class-related emotions and teachers’ life satisfaction. A sample of 595 teachers from Andalusia (Spain) participated in an online survey. A structural equation model was tested, in which BPNs predicted teachers’ emotions (β = .69; p < .001 positive emotions and β = -.42; p < .001 negative emotions). In addition, BPNs (β = .36; p < .001) and positive emotions (β = .23; p < .001) predicted satisfaction with life. The results show that the fulfilment of work-related BPNs is important to generate positive emotions and well-being in teachers. In addition, the study is the first to provide extensive details on the psychometric properties for assessing teacher emotions with the Achievement Emotions Questionnaire - Teachers (AEQ-T) in a Spanish sample