The ADO Index as a Predictor of Two-Year Mortality in General Practice-Based Chronic Obstructive Pulmonary Disease Cohorts.

BACKGROUND: Existing prediction models for mortality in chronic obstructive pulmonary disease (COPD) patients have not yet been validated in primary care, which is where the majority of patients receive care. OBJECTIVES: Our aim was to validate the ADO (age, dyspnoea, airflow obstruction) index as a predictor of 2-year mortality in 2 general practice-based COPD cohorts. METHODS: Six hundred and forty-six patients with COPD with GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I-IV were enrolled by their general practitioners and followed for 2 years. The ADO regression equation was used to predict a 2-year risk of all-cause mortality in each patient and this risk was compared with the observed 2-year mortality. Discrimination and calibration were assessed as well as the strength of association between the 15-point ADO score and the observed 2-year all-cause mortality. RESULTS: Fifty-two (8.1%) patients died during the 2-year follow-up period. Discrimination with the ADO index was excellent with an area under the curve of 0.78 [95% confidence interval (CI) 0.71-0.84]. Overall, the predicted and observed risks matched well and visual inspection revealed no important differences between them across 10 risk classes (p = 0.68). The odds ratio for death per point increase according to the ADO index was 1.50 (95% CI 1.31-1.71). CONCLUSIONS: The ADO index showed excellent prediction properties in an out-of-population validation carried out in COPD patients from primary care settings. © 2014 S. Karger AG, Basel.

Cardiac magnetic resonance imaging in clinical practice

Objective To evaluate and describe indications, mainly diagnoses and cardiac magnetic resonance imaging findings observed in clinical practice. Materials and Methods Retrospective and descriptive study of cardiac magnetic resonance performed at a private hospital and clinic in the city of Niterói, RJ, Brazil, in the period from May 2007 to April 2011. Results The sample included a total of 1000 studies performed in patients with a mean age of 53.7 ± 16.2 years and predominance for male gender (57.2%). The majority of indications were related to assessment of myocardial perfusion at rest and under pharmacological stress (507/1000; 51%), with positive results in 36.2% of them. Suspected myocarditis was the second most frequent indication (140/1000; 14%), with positive results in 63.4% of cases. These two indications were followed by study of arrhythmias (116/1000; 12%), myocardial viability (69/1000; 7%) and evaluation of cardiomyopathies (47/1000; 5%). In a subanalysis, it was possible to identify that most patients were assessed on an outpatient basis (58.42%). Conclusion Cardiac magnetic resonance has been routinely performed in clinical practice, either on an outpatient or emergency/inpatient basis, and myocardial ischemia represented the main indication, followed by investigation of myocarditis, arrhythmogenic right ventricular dysplasia and myocardial viability.

Personal constructs in systemic practice

This paper intends to elaborate the relationship between Kelly's Personal Construct Theory (PCT) and the systemic therapies beyond their notable similarities. Kelly's constructive alternativism is situated in the context of the current constructivist orientation that the family therapy movement seems to be adopting. A model of change is presented based on PCT's experience cycle. From this cycle, the relationship between behaviors and constructions is elaborated incorporating Procter's (52, 53) notions of the Family Construct System (FCS) andposition. This model allows for interventions both at behavioral and construction levels, as well as allowing for a certain technical eclecticism while, at the same time, retaining a strong theoretical coherence. This approach is discussed in the context of the debate about strategizing, power, and control held by authors such as Golann, Hoffman, and Tomm. Finally, some implications for research are outlined.

Group preference structures in AHP–group decision making

This paper presents a procedure that allows us to determine the preference structures(PS) associated to each of the different groups of actors that can be identified in a groupdecision making problem with a large number of individuals. To that end, it makesuse of the Analytic Hierarchy Process (AHP) (Saaty, 1980) as the technique to solvediscrete multicriteria decision making problems. This technique permits the resolutionof multicriteria, multienvironment and multiactor problems in which subjective aspectsand uncertainty have been incorporated into the model, constructing ratio scales correspondingto the priorities relative to the elements being compared, normalised in adistributive manner (wi = 1). On the basis of the individuals’ priorities we identifydifferent clusters for the decision makers and, for each of these, the associated preferencestructure using, to that end, tools analogous to those of Multidimensional Scaling.The resulting PS will be employed to extract knowledge for the subsequent negotiationprocesses and, should it be necessary, to determine the relative importance of thealternatives being compared using anyone of the existing procedures

Exploring the role and transformative potential of human rights in development practice and food security : case study from Malawi

Avhandlingen är en analys av den roll som mänskliga rättigheter spelar i utvecklingssamarbete i allmänhet och tre matsäkerhetsprojekt i Malawi i synnerhet. Författaren undersöker huruvida mänskliga rättigheter kan bidra till samhälleliga förändringsprocesser. Undersökningen har en diskursiv syn på mänskliga rättigheter; rättigheter ses som sociala konstruktioner skapade av människor, konstruktioner som förändras i takt med att aktörerna ger dem ny mening. Människorättsbaserade utvecklingsstrategier riktar uppmärksamheten mot olika aktörers skyldigheter samt vikten av att mänskliga rättigheter inte kränks genom utvecklingspolitiska beslut. En analys som utgår från mänskliga rättigheter kan leda till att nya frågor lyfts fram: vem har skyldigheter, vem har rättigheter, och varför förverkligas inte dessa? Fokus flyttas till hur politiska, ekonomiska och juridiska strukturer kan förändras så att de främjar mänskliga rättigheter. Författaren använder empiriskt material från Malawi för att visa vilken roll mänskliga rättigheter och så kallade människorättsprinciper spelar inom tre projekt: (1) ett mathjälpsprojekt; (2) ett rättighetsbaserat projekt med fokus på att stärka strategier för livsuppehälle; (3) ett juridiskt projekt inom ramen för vilket man skapat ett lagförslag om rätten till föda. Analysen visar att det rättighetsbaserade projektet strävade efter den mest djupgående samhälleliga förändringen. Människorättsprinciperna ansvarighet och deltagande handlade inte endast om verksamheten inom projektet utan man strävade även efter att stärka dessa principer mellan medborgare och myndigheter. Rättigheter, som ett sätt att tala, tänka och handla, inte som abstrakta juridiska normer, påverkade de lokala aktörernas sätt att kräva bl.a. tjänster av lokala myndigheter. Teoretiskt kan man säga att det rättighetsbaserade projektet representerar ett aktörsperspektiv på mänskliga rättigheter där aktörernas egna uppfattningar om vad de är berättigade till samt krav på myndigheters ansvar formade vilken mening rättigheterna kom att få.

Meristematic endodermis and secretory structures in adventitious roots of Richterago Kuntze (Mutisieae-Asteraceae)

The meristematic endodermis in adventitious roots of Richterago species originates in one of the fundamental meristem cells, which undergo sucessive anticlinal and periclinal divisions to build the inner cortex. The meristematic endodermis or proendodermis remains as a meristematic layer until its differentiation into endodermis, with Casparian strip. When sieve elements differentiate, endodermic secretory canals of esquizogenous origin are present at the region adjacent to primary phloem. Articulated laticifers, with cells perforated at both terminal and transversal walls, also occur during initial phases of secondary development. Presence of inulin as reserve carbohydrate in the inner cortex and vascular tissue may be related to abiotic factors, as an adaptive strategy of these species.

Genesis and Evolution of Brittle Structures In Southwestern Finland and Western South Africa. Insights into Fault Reactivation, Fluid Flow and Structural Maturity in Precambrian Cratons

The bedrock of old crystalline cratons is characteristically saturated with brittle structures formed during successive superimposed episodes of deformation and under varying stress regimes. As a result, the crust effectively deforms through the reactivation of pre-existing structures rather than by through the activation, or generation, of new ones, and is said to be in a state of 'structural maturity'. By combining data from Olkiluoto Island, southwestern Finland, which has been investigated as the potential site of a deep geological repository for high-level nuclear waste, with observations from southern Sweden, it can be concluded that the southern part of the Svecofennian shield had already attained structural maturity during the Mesoproterozoic era. This indicates that the phase of activation of the crust, i.e. the time interval during which new fractures were generated, was brief in comparison to the subsequent reactivation phase. Structural maturity of the bedrock was also attained relatively rapidly in Namaqualand, western South Africa, after the formation of first brittle structures during Neoproterozoic time. Subsequent brittle deformation in Namaqualand was controlled by the reactivation of pre-existing strike-slip faults.In such settings, seismic events are likely to occur through reactivation of pre-existing zones that are favourably oriented with respect to prevailing stresses. In Namaqualand, this is shown for present day seismicity by slip tendency analysis, and at Olkiluoto, for a Neoproterozoic earthquake reactivating a Mesoproterozoic fault. By combining detailed field observations with the results of paleostress inversions and relative and absolute time constraints, seven distinctm superimposed paleostress regimes have been recognized in the Olkiluoto region. From oldest to youngest these are: (1) NW-SE to NNW-SSE transpression, which prevailed soon after 1.75 Ga, when the crust had sufficiently cooled down to allow brittle deformation to occur. During this phase conjugate NNW-SSE and NE-SW striking strike-slip faults were active simultaneous with reactivation of SE-dipping low-angle shear zones and foliation planes. This was followed by (2) N-S to NE-SW transpression, which caused partial reactivation of structures formed in the first event; (3) NW-SE extension during the Gothian orogeny and at the time of rapakivi magmatism and intrusion of diabase dikes; (4) NE-SW transtension that occurred between 1.60 and 1.30 Ga and which also formed the NW-SE-trending Satakunta graben located some 20 km north of Olkiluoto. Greisen-type veins also formed during this phase. (5) NE-SW compression that postdates both the formation of the 1.56 Ga rapakivi granites and 1.27 Ga olivine diabases of the region; (6) E-W transpression during the early stages of the Mesoproterozoic Sveconorwegian orogeny and which also predated (7) almost coaxial E-W extension attributed to the collapse of the Sveconorwegian orogeny. The kinematic analysis of fracture systems in crystalline bedrock also provides a robust framework for evaluating fluid-rock interaction in the brittle regime; this is essential in assessment of bedrock integrity for numerous geo-engineering applications, including groundwater management, transient or permanent CO2 storage and site investigations for permanent waste disposal. Investigations at Olkiluoto revealed that fluid flow along fractures is coupled with low normal tractions due to in-situ stresses and thus deviates from the generally accepted critically stressed fracture concept, where fluid flow is concentrated on fractures on the verge of failure. The difference is linked to the shallow conditions of Olkiluoto - due to the low differential stresses inherent at shallow depths, fracture activation and fluid flow is controlled by dilation due to low normal tractions. At deeper settings, however, fluid flow is controlled by fracture criticality caused by large differential stress, which drives shear deformation instead of dilation.

Risk Assessment of Modern Landfill Structures in Finland

The purpose of this thesis was to investigate environmental permits of landfills with respect to the appropriateness of risk assessments focusing on contaminant migration, structures capable to protect the environment, waste and leachate management and existing environmental impacts of landfills. According to the requirements, a risk assessment is always required to demonstrate compliance with environmental protection requirements if the environmental permit decision deviates from the set requirements. However, there is a reason to doubt that all relevant risk factors are identified in current risk assessment practices in order to protect people end environment. In this dissertation, risk factors were recognized in 12 randomly selected landfills. Based on this analysis, a structural risk assessment method was created. The method was verified with two case examples. Several development needs were found in the risk assessments of the environmental permit decisions. The risk analysis equations used in the decisions did not adequately take into account all the determining factors like waste prospects, total risk quantification or human delineated factors. Instead of focusing on crucial factors, the landfill environmental protection capability is simply expressed via technical factors like hydraulic conductivity. In this thesis, it could be shown, that using adequate risk assessment approaches the most essential environmental impacts can be taken into account by consideration of contaminant transport mechanisms, leachate effects, and artificial landfill structures. The developed structural risk analysing (SRA) method shows, that landfills structures could be designed in a more cost-efficient way taking advantage of recycled or by-products. Additionally, the research results demonstrate that the environmental protection requirements of landfills should be updated to correspond to the capability to protect the environment instead of the current simplified requirements related to advective transport only.

The micromorphology of Paleoseismic soft sediment deformation structures in glacial deposits from three sample sites in Scotland /

The nature of this research is to investigate paleoseismic deformation of glacial soft sediments from three sampling sites throughout the Scottish Highlands; Arrat's Mills, Meikleour and Glen Roy. The paleoseismic evidence investigated in this research will provide a basis for applying criteria to soft sediment deformation structures, and the trigger mechanisms that create these structures. Micromorphology is the tool used in this to investigate paleoseismic deformation structures in thin section. Thin section analysis, (micromorphology) of glacial sediments from the three sampling sites is used to determine microscale evidence of past earthquakes that can be correlated to modem-day events and possibly lead to a better understanding of the impact of earthquakes throughout a range of sediment types. The significance of the three sampling locations is their proximity to two major active fault zones that cross Scotland. The fault zones are the Highland Boundary Fault and the Great Glen Fault, these two major faults that parallel each other and divide the country in half Sims (1975) used a set of seven criteria that identified soft sediment deformation structures created by a magnitude six earthquake in Cahfomia. Using criteria set forth by Sims (1975), the paleoseismic evidence can be correlated to the magnitude of the deformation structures found in the glacial sediments. This research determined that the microstructures at Arrat's Mill, Meikleour and Glen Roy are consistent with a seismically induced origin. It has also been demonstrated that, even without the presence of macrostructures, the use of micromorphology techniques in detecting such activity within sediments is of immense value.

The effect of perturbation warning on attention switching abilities during dual-task performance in young and older adults

This study examined whether providing an auditory warning would facilitate attention switching abilities in older adults during dual-tasking. Fifteen young and 16 older adults performed a tracking task while recovering their balance from a support surface translation. For half of the trials, an auditory warning was presented to inform participants of the upcoming translation. Performance was quantified through electromyographic (EMG) recordings of the lower limb muscles, while the ability to switch attention between tasks was determined by tracking task error. Providing warning of an upcoming loss of balance resulted in both young and older adults increasing their leg EMG activity by 10-165% (p<0.05) in preparation for the upcoming translation. However, no differences in the timing of attention switching were observed with or without the warning (p=0.424). Together, these findings suggest that providing a perturbation warning has minimal benefits in improving attention switching abilities for balance recovery in healthy older adults.

The effects of consistency and inconsistency between attentional focus and task objective in learning a golf putting task

Converging evidence has demonstrated learning advantages when an individual is instructed to focus their attention externally. However, many of the motor tasks utilized in past research had clear external objectives (i.e., putting accuracy), creating a compatible relationship between an external focus of attention (i.e., outcome) and an external task objective (i.e., putting accuracy). The present study examined whether or not the consistency of instructions and task objective would differentially impact the acquisition of a golf putting task. Participants performed a putting task in a control condition or in one of four experimental conditions resulting from the factorial interaction of task instructions (internal or external) and task objective (internal or external). The retention and transfer data revealed that participants who received an external task objective demonstrated superior outcome scores. Participants who received technique information paired with outcome information demonstrated superior technique scores.

The role of the Ruah YHWH in creative transformation : a process theology perspective applied to Judges 14

La Ruah YHWH joue un rôle important dans la transformation créative de l’univers et des entités actuelles; cependant, une réflexion concernant les modalités de ce rôle reste à développer. La théologie processuelle offre une plateforme à partir de laquelle sont examinées diverses facettes des rôles que peut jouer la Ruah YHWH dans un monde où le chaos semble dominer. L’objectif de ce mémoire est justement d’explorer la Ruah YHWH dans son rôle de transformation créative au service, ultimement de l’ordre, de la paix et de l’harmonie dans le monde, les communautés, la vie des entités actuelles, etc. Le Chapitre 1 passe en revue des notions clés de la théologie processuelle. Le concept des “entités actuelles” est d’abord défini. Sont ensuite examinées les différentes phases du devenir d’une entité actuelle. Finalement, les concepts de “créativité” et de “transformation”, dans une perspective de la Ruah YHWH font l’objet d’observations attentives avant d’aborder « trois natures » de Dieu, à savoir primordiale, conséquente, et superjective. Le Chapitre 2 s’intéresse à la péricope centrale de ce mémoire : Juges 13:24-14:20. Le découpage de la structure de cette péricope est basé sur des critères de critique textuelle et d’analyse syntaxique. La première analyse s’attarde aux difficultés que le texte hébreu présente, alors que la deuxième met l’accent sur l’organisation structurelle des propositions grammaticales des versets. Les deux analyses me permettent ensuite de proposer une traduction du péricope. Le Chapitre 3 se veut une application de ce qui a été élaboré au Chapitre 1 sur la péricope analysée au Chapitre 2. Ce troisième chapitre permet de mettre en pratique une approche processuelle originale développée par Robert David dans son livre Déli_l’ ÉCRITURE. Dans la foulée des chapitres qui le précèdent, le Chapitre 4 propose quelques principes herméneutiques contemporains pouvant éclairer le rôle de la Ruah YHWH dans l’avancée créative du monde : vie, amour, et paix.