The Effect of Incidental Consolidation on Management and Outcomes in COPD Exacerbations: Data from the European COPD Audit

OBJECTIVE There is controversy regarding the significance of radiological consolidation in the context of COPD exacerbation (eCOPD). While some studies into eCOPD exclude these cases, consolidation is a common feature of eCOPD admissions in real practice. This study aims to address the question of whether consolidation in eCOPD is a distinct clinical phenotype with implications for management decisions and outcomes. PATIENTS AND METHODS The European COPD Audit was carried out in 384 hospitals from 13 European countries between 2010 and 2011 to analyze guideline adherence in eCOPD. In this analysis, admissions were split according to the presence or not of consolidation on the admission chest radiograph. Groups were compared in terms of clinical and epidemiological features, existing treatment, clinical care utilized and mortality. RESULTS 14,111 cases were included comprising 2,714 (19.2%) with consolidation and 11,397 (80.8%) without. The risk of radiographic consolidation increased with age, female gender, cardiovascular diseases, having had two or more admissions in the previous year, and sputum color change. Previous treatment with inhaled steroids was not associated. Patients with radiographic consolidation were significantly more likely to receive antibiotics, oxygen and non-invasive ventilation during the admission and had a lower survival from admission to 90-day follow-up. CONCLUSIONS Patients admitted for COPD exacerbation who have radiological consolidation have a more severe illness course, are treated more intensively by clinicians and have a poorer prognosis. We recommend that these patients be considered a distinct subset in COPD exacerbation.

Comparing CFSR and conventional weather data for discharge and soil loss modelling with SWAT in small catchments in the Ethiopian Highlands

Accurate rainfall data are the key input parameter for modelling river discharge and soil loss. Remote areas of Ethiopia often lack adequate precipitation data and where these data are available, there might be substantial temporal or spatial gaps. To counter this challenge, the Climate Forecast System Reanalysis (CFSR) of the National Centers for Environmental Prediction (NCEP) readily provides weather data for any geographic location on earth between 1979 and 2014. This study assesses the applicability of CFSR weather data to three watersheds in the Blue Nile Basin in Ethiopia. To this end, the Soil and Water Assessment Tool (SWAT) was set up to simulate discharge and soil loss, using CFSR and conventional weather data, in three small-scale watersheds ranging from 112 to 477 ha. Calibrated simulation results were compared to observed river discharge and observed soil loss over a period of 32 years. The conventional weather data resulted in very good discharge outputs for all three watersheds, while the CFSR weather data resulted in unsatisfactory discharge outputs for all of the three gauging stations. Soil loss simulation with conventional weather inputs yielded satisfactory outputs for two of three watersheds, while the CFSR weather input resulted in three unsatisfactory results. Overall, the simulations with the conventional data resulted in far better results for discharge and soil loss than simulations with CFSR data. The simulations with CFSR data were unable to adequately represent the specific regional climate for the three watersheds, performing even worse in climatic areas with two rainy seasons. Hence, CFSR data should not be used lightly in remote areas with no conventional weather data where no prior analysis is possible.

Clinical Practice Recommendations For The Management And Prevention Of Cisplatin-Induced Hearing Loss Using Pharmacogenetic Markers

Currently no pharmacogenomics-based criteria exist to guide clinicians in identifying individuals who are at risk of hearing loss from cisplatin-based chemotherapy. This review summarizes findings from pharmacogenomic studies that report genetic polymorphisms associated with cisplatin-induced hearing loss and aims to (1) provide up-to-date information on new developments in the field; (2) provide recommendations for the use of pharmacogenetic testing in the prevention, assessment and management of cisplatin-induced hearing loss in children and adults; and (3) identify knowledge gaps to direct and prioritize future research. These practice recommendations for pharmacogenetic testing in the context of cisplatin-induced hearing loss reflect a review and evaluation of recent literature and are designed to assist clinicians in providing optimal clinical care for patients receiving cisplatin based chemotherapy.

Clipping Management and Nitrogen Fertilization of Turfgrass: Growth, Nitrogen Utilization, and Quality

The effect of returning grass clippings on turfgrass growth and quality has not been thoroughly examined. The objective of this research was to determine the effects of returning grass clippings in combination with varying N rates on growth, N utilization, and quality of turfgrass managed as a residential lawn. Two field experiments using a cool-season turfgrass mixture were arranged as a 2 x 4 factorial in a randomized complete block design with three replicates. Treatments included two clipping management practices (returned or removed) and four N rates (equivalent to 0, 98, 196, and 392 kg N ha(-1)). Soils at the two sites were a Paxton fine sandy loam (coarse-loamy, mixed, active, mesic Oxyaquic Dystrudepts) and a variant of a Hinckley gravelly sandy loam (sandy-skeletal, mixed, mesic Typic Udorthents). Returning clippings was found to increase clipping dry matter yields (DMYs) from 30 to 72%, total N uptake (NUP) from 48 to 60%, N recovery by 62%, and N use efficiency (NUE) from 52 to 71%. Returning grass clippings did not decrease turfgrass quality, and improved it in some plots. We found that N fertilization rates could be reduced 50% or more without decreasing turfgrass quality when clippings were returned. Overall, returning grass clippings was found to improve growth and quality of turfgrass while reducing N fertilization needs.

Management and outcomes of anorectal infection in the cancer patient

Background. The objective of this retrospective cohort study is to examine the presentation and outcomes for a contemporary series of cancer patients with anorectal infection. In addition, we seek to identify factors which are associated with surgical intervention. ^ Methods. The study cohort was identified from ICD-9 codes for diagnosis of infection of the anal and rectal region and patients who underwent a surgical oncology consultation between 1/2000 and 12/2006. Clinical presentation, treatment rendered, and outcomes were retrospectively recorded. ^ Results. Of the 100 patients evaluated by the surgical oncology service for anorectal infection, 42 were treated non-operatively and 58 underwent surgical intervention. Factors associated with surgical intervention based on logistic multivariable analysis included the diagnosis of an abscess (odds ratio [OR] 10.5; 95% confidence interval [CI] 2.9-38.5) and the documentation of erythema on physical examination (OR 3.1; 95% CI 1.1-8.4). Thrombocytopenia (platelets < 50,000) was associated with non-operative management (OR 0.3; 95% CI 0.1-0.7). Incision and drainage was the most common surgical procedure (79%) while a wide debridement for a necrotizing soft tissue infection was required in 2 patients. Infection-specific 90-day mortality was only 1% (N=1). However, the median overall survival for the entire cohort was only 14.4 months (95% CI 7.9-19.5). ^ Conclusions. Non-operative management is a reasonable treatment option for anorectal infection in patients with cancer. Identification of an abscess, erythema on physical exam, and thrombocytopenia were associated with management strategy. Although rare, necrotizing soft tissue infections are associated with significant mortality. ^

Analysis of a disaster medical track for the Certificate in Emergency Management and Preparedness Program at the University of Texas at Dallas

Since the tragic events of September 11, 2001, the United States has engaged in building the infrastructure and developing the expertise necessary to protect its borders and its citizens from further attacks against its homeland. One approach has been the development of academic courses to educate individuals on the nature and dangers of subversive attacks and to prepare them to respond to attacks and other large-scale emergencies in their roles as working professionals, participating members of their communities, and collaborators with first responders. An initial review of the literature failed to reveal any university-based emergency management courses or programs with a disaster medical component, despite the public health significance and need for such programs. In the Fall of 2003, The School of Management at The University of Texas at Dallas introduced a continuing education Certificate in Emergency Management and Preparedness Program. This thesis will (1) describe the development and implementation of a new Disaster Medical Track as a component of this Certificate in Emergency Management and Preparedness Program, (2) analyze the need for and effectiveness of this Disaster Medical Track, and (3) propose improvements in the track based on this analysis. ^

Organizational perspectives on the management and evaluation of large -scale multicenter controlled clinical trials: An exploratory study of participation in the beta -blocker heart attack trial

A review of literature related to appointment-keeping served as the basis for the development of an organizational paradigm for the study of appointment-keeping in the Beta-blocker Heart Attack Trial (BHAT). Features of the organizational environment, demographic characteristics of BHAT enrollees, organizational structure and processes and previous organizational performance variables were measured so as to provide exploratory information relating to the appointment-keeping behavior of 3,837 participants enrolled at thirty-two Clinical Centers. Results suggest that the social context of individual behavior is an important consideration for the understanding of patient compliance. In particular, the degree to which previous organizational performance--as measured by obtaining recruitment goals--and the ability to utilize resources had particularly strong bivariate associations with appointment-keeping. Implications for future theory development, research and practical implications were provided as was a suggestion for the development of multidisciplinary research efforts conducted within the context of Centers for the study and application of adherence behaviors. ^

Long-term Tillage and Crop Rotation Effects on Soil Carbon and Soil Productivity

Tillage system and crop rotation have a significant, long-term effect on soil productivity and soil quality components such as soil carbon and other soil physical, biological, and chemical properties. In addition, both tillage and crop rotation have effects on weed and soil disease control. There is a definite need for well-defined, long-term tillage and crop rotation studies across the different soils and climate conditions in the state. The objective of this study was to evaluate the long-term effects of different tillage systems and crop rotations on soil productivity

Yields of Corn, Soybeans, and Alfalfa in Western Iowa: 1990 to 2011

The ISU Western Research Farm, Castana, Iowa is one of the oldest in Iowa dating to 1946. It also has a unique location in the loess hills of western Iowa. The research farm was set up to study the deep loess soils, particularly crop production and soil conservation methods. Although the work at the research farm has transitioned away from traditional plot work, yields of major crops grown at the farm, and climate data are collected each year. Crop yields are a reflection of current technologies and weather. In western Iowa, rainfall is especially critical and is often the limiting factor.

Climate and soil characteristics and soil arthropod abundance on Anchorage, Signy and Falkland Islands

Over a 2-year study, we investigated the effect of environmental change on the diversity and abundance of soil arthropod communities (Acari and Collembola) in the Maritime Antarctic and the Falkland Islands. Open Top Chambers (OTCs), as used extensively in the framework of the northern boreal International Tundra Experiment (ITEX), were used to increase the temperature in contrasting communities on three islands along a latitudinal temperature gradient, ranging from the Falkland Islands (51°S, mean annual temperature 7.5 °C) to Signy Island (60°S, -2.3°C) and Anchorage Island (67°S, -3.8°C). At each island an open and a closed plant community were studied: lichen vs. moss at the Antarctic sites, and grass vs. dwarf shrub at the Falkland Islands. The OTCs raised the soil surface temperature during most months of the year. During the summer the level of warming achieved was 1.7 °C at the Falkland Islands, 0.7 °C at Signy Island, and 1.1 °C at Anchorage Island. The native arthropod community diversity decreased with increasing latitude. In contrast with this pattern, Collembola abundance in the closed vegetation (dwarf shrub or moss) communities increased by at least an order of magnitude from the Falkland Islands (9.0 +/- 2 x 10**3 ind./m**2) to Signy (3.3 +/- 8.0 x 10**4 ind./m**2) and Anchorage Island (3.1 +/- 0.82 x 10**5 ind./m**2). The abundance of Acari did not show a latitudinal trend. Abundance and diversity of Acari and Collembola were unaffected by the warming treatment on the Falkland Islands and Anchorage Island. However, after two seasons of experimental warming, the total abundance of Collembola decreased (p < 0.05) in the lichen community on Signy Island as a result of the population decline of the isotomid Cryptopygus antarcticus. In the same lichen community there was also a decline (p < 0.05) of the mesostigmatid predatory mite Gamasellus racovitzai, and a significant increase in the total number of Prostigmata. Overall, our data suggest that the consequences of an experimental temperature increase of 1-2°C, comparable to the magnitude currently seen through recent climate change in the Antarctic Peninsula region, on soil arthropod communities in this region may not be similar for each location but is most likely to be small and initially slow to develop.

Public management and regional development

Este trabajo tiene por objetivo analizar los elementos de la gestión pública del desarrollo regional a partir de las condiciones del desarrollo regional y las nociones de desarrollo local y desarrollo sustentable. Bajo estas premisas se avanzan planteamientos esquemáticos en torno a la gestión pública del desarrollo local