The Evolution of Inguinal Hernia Repair from the Langenbeck–Gerdy Subcutaneous Technique to Durham and Subsequent Dissection Procedures: A Historical Review
Alfredo Moreno-Egea, Carlos Moreno-Latorre, Alfredo Moreno-Latorre
Background: The history of radical hernia repair involves a period of intense surgical activity, influenced by factors of the time such as social development, hygiene, anesthesia, and antisepsis. Subcutaneous surgery, the initial option designed to avoid infections and peritonitis, was modified after the introduction of antisepsis, eventually leading to dissection surgery. Objective: We aim to analyze the publications from the period of radical hernia cures using current methodology, verifying when and how the transition occurred from subcutaneous surgery to dissection surgery. Methods: A literature review of the databases PubMed, LILACS, Cochrane Library, “Google” and university libraries is conducted. The following keywords were used: “anatomy and surgery”. A critical analysis of the known literature about this historical topic is carried out. Results: Under-vision dissection surgery, through incision of the aponeurosis of the external oblique muscle, began in England by Durham in 1866, almost 20 years before it was performed in France by Lucas-Championnière in 1885. Recurrences decreased after the introduction of the principle of closing the walls of the inguinal canal (Wood, 1860). The surgeon–anatomist Wood should be considered the first specialist in abdominal wall surgery, due to his extensive contributions from the pre-antiseptic era. The evolution of the radical cure of hernias was made possible by combining the knowledge of several countries: England, Germany, and Italy. Conclusions: Dissection surgery was initiated in England, Germany, and Italy, not in France. The influence of the French literature on the history of hernias is evident, to the detriment of the contributions of surgeons from other countries.
Assessing patient preferences for medical decision making - a comparison of different methods
Jakub Fusiak, Andreas Wolkenstein, Verena S. Hoffmann
BackgroundPatient preferences are a critical component of shared decision-making (SDM), particularly when choosing between treatment options with differing risks and outcomes. Many methods exist to elicit these preferences, but their complexity, usability, and acceptance vary.ObjectiveWe aim to gain insight into the acceptance, effort and preferences of participants regarding five different methods of preference assessment. Additionally, we investigate the influence of health status, experiences within the health system and of demographic factors on the results.MethodsWe conducted a cross-sectional online survey including five preference elicitation Methods: best-worst scaling, direct weighting, PAPRIKA (Potentially All Pairwise Rankings of all Possible Alternatives), time trade-off, and standard gamble. The questionnaire was distributed via academic and patient advocacy mailing lists, reaching both healthy individuals and those with acute or chronic illnesses. Participants rated each method using six standardized statements on a 5-point Likert scale. Additional items assessed general acceptance of algorithm-assisted preference assessments and the clarity of the questionnaire.ResultsOf 258 initiated questionnaires, 123 (48%) were completed and included in the analysis. Participants were diverse in age, gender, and health status, but predominantly highly educated and digitally literate. Across all measures, the PAPRIKA method received the highest ratings for clarity, usability, and perceived ability to express preferences. Simpler methods (best-worst scaling, direct weighting) were rated as less useful for capturing nuanced preferences, while abstract utility-based methods (standard gamble, time trade-off) were seen as cognitively demanding. Subgroup analyses showed minimal variation across demographic groups. Most participants (82%) could imagine using at least one of the presented methods in real clinical settings, but also emphasized the importance of physician involvement in interpreting results.ConclusionThe interactive PAPRIKA method best balanced cognitive demand and expressiveness and was preferred by most participants. Structured methods for preference elicitation may enhance SDM when integrated into clinical workflows and supported by healthcare professionals. Further research is needed to evaluate their use in real-world decisions and among more diverse patient populations.
Medicine, Public aspects of medicine
FEAST: JWST Uncovers the Emerging Timescales of Young Star Clusters in M83
Alice Knutas, Angela Adamo, Alex Pedrini
et al.
We present JWST NIRCam observations of the emerging young star clusters (eYSCs) detected in the nearby spiral galaxy M83. The NIRcam mosaic encompasses the nuclear starburst, the bar, and the inner spiral arms. The eYSCs, detected in Pa α and Br α maps, have been largely missed in previous optical campaigns of young star clusters (YSCs). We distinguish between eYSCI, if they also have compact 3.3 μ m polycyclic aromatic hydrocarbon (PAH) emission associated with them, and eYSCII, if they only appear as compact Pa α emitters. We find that the variations in the 3.3 μ m PAH feature are consistent with an evolutionary sequence where eYSCI evolve into eYSCII and then optical YSCs. This sequence is clear in the F300M−F335M (tracing the excess in the 3.3 μ m PAH feature) and the F115W−F187N (tracing the excess in Pa α ) colors, which become increasingly bluer as clusters emerge. The central starburst stands out as the region where the most massive eYSCs are currently forming in the galaxy. We estimate that only about 20% of eYSCs will remain detectable as compact YSCs. Combining eYSCs and YSCs (≤10 Myr), we recover an average clearing timescale of 6 Myr in which clusters transition from embedded to fully exposed. We see evidence of shorter emergence timescales (∼5 Myr) for more massive (>5 × 10 ^3 M _⊙ ) clusters, while star clusters of ∼10 ^3 M _⊙ about 7 Myr. We estimate that eYSCs remain associated with the 3.3 μ m PAH emission for 3–4 Myr. Larger samples of eYSC and YSC populations will provide stronger statistics to further test environmental and cluster mass dependencies on the emergence timescale.
Episodes from the history of infinitesimals
Mikhail G. Katz
Infinitesimals have seen ups and downs in their tumultuous history. In the 18th century, d'Alembert set the tone by describing infinitesimals as chimeras. Some adversaries of infinitesimals, including Moigno and Connes, picked up on the term. We highlight the work of Cauchy, Noël, Poisson and Riemann. We also chronicle reactions by Moigno, Lamarle and Cantor, and signal the start of a revival with Peano.
History-Guided Video Diffusion
Kiwhan Song, Boyuan Chen, Max Simchowitz
et al.
Classifier-free guidance (CFG) is a key technique for improving conditional generation in diffusion models, enabling more accurate control while enhancing sample quality. It is natural to extend this technique to video diffusion, which generates video conditioned on a variable number of context frames, collectively referred to as history. However, we find two key challenges to guiding with variable-length history: architectures that only support fixed-size conditioning, and the empirical observation that CFG-style history dropout performs poorly. To address this, we propose the Diffusion Forcing Transformer (DFoT), a video diffusion architecture and theoretically grounded training objective that jointly enable conditioning on a flexible number of history frames. We then introduce History Guidance, a family of guidance methods uniquely enabled by DFoT. We show that its simplest form, vanilla history guidance, already significantly improves video generation quality and temporal consistency. A more advanced method, history guidance across time and frequency further enhances motion dynamics, enables compositional generalization to out-of-distribution history, and can stably roll out extremely long videos. Project website: https://boyuan.space/history-guidance
Review of the African golden-spotted genera Haplopacha and Dasychirinula (Lepidoptera, Lasiocampidae, Poecilocampinae)
Tesfu Fekensa Tujuba, Roman V. Yakovlev, Aidas Saldaitis
et al.
African golden-spotted lappet moths from the genera Haplopacha Aurivillius, 1905 and Dasychirinula Hering, 1926 are reviewed. Antennae, heads and legs are investigated in addition to the traditional comparison of habitus, genitalia, and distribution areas. Two new genera are established and four new species are described as a result: Eudoumbia gen. n. with the type-species Eudoumbia thorogood sp. n. from Angola, Namibia, and Botswana; Auripluvia gen. n. with the type species Auripluvia sophia sp. n. from Ethiopia; Haplopacha mason sp. n. from Tanzania; and Dasychirinula julia sp. n. from Ethiopia. One species is reattributed to the new genus as Eudoumbia ndoumoi (Dupont, Simonsen & Zilli, 2016) stat. n. One new synonymy is established for two Tanzanian species: Dasychirinula chrysogramma Hering, 1926 = Haplopacha lunata Dupont, Simonsen & Zilli, 2016 syn. n.; and one potential synonymy is remarked between Haplopacha tangani Dupont, Simonsen & Zilli, 2016 from Tanzania and Malawi and Haplopacha riftensis Dupont, Simonsen & Zilli, 2016 from Malawi. Photos of the related material stored in the main collections of Ditsong National Museum of Natural History (Pretoria, RSA) and Natural History Museum of Zimbabwe (Bulawayo, Zimbabwe) are showed.
The beginning of a success story: basalmost members of the extant ophiuroid clade from the Silurian of Gotland, Sweden
Ben Thuy, Mats E. Eriksson, Manfred Kutscher
et al.
Due to the fragility of the ophiuroid (brittle star) skeleton, the bulk of the group’s fossil record consists of dissociated ossicles preserved as microfossils. In spite of their great potential as basis for taxonomic and phylogenetic studies, however, ophiuroid ossicles from the Paleozoic have received very little attention so far. Here, we provide an exhaustive taxonomic assessment of such fossils retrieved from sieving residues from the Silurian of Gotland, Sweden. This material was used in a previous study to describe two key taxa that allowed constraining the origin of the extant ophiuroid clade. The remaining taxa belonging to that same lineage are described in the present paper. The evidence at hand suggests that the stem of the extant ophiuroid clade was formed by two genera, Ophiopetagno and Ophiolofsson gen. nov., including six and five species, respectively, and spanning at least the upper Llandovery through upper Ludlow. We conclude that Ophiopetagno and Ophiolofsson represent sister genera that coexisted through most of the Silurian in the shallow tropical seas of Gotland. They underwent repeated body size reductions in correlation with environmental perturbations, with Ophiopetagno paicei eventually giving rise to Muldaster haakei; the first member of the living Ophiuroidea. Herein, we also introduce two new clades, Ankhurida clade nov. and Ophiovalida clade nov., and the following eight new species: Ophiolofsson joelmciveri gen. et sp. nov., O. obituary gen. et sp. nov., O. immolation gen. et sp. nov., O. archspire gen. et sp. nov., O. hendersonorum gen. et sp. nov., Ophiopetagno bonzo sp. nov., O. kansas sp. nov., O. doro sp. nov.; and two probably new species in open nomenclature: Ophiopetagno sp. 1, and Ophiopetagno sp. 2.
Anti-de Sitter → de Sitter transition driven by Casimir forces and mitigating tensions in cosmological parameters
Luis A. Anchordoqui, Ignatios Antoniadis, Dieter Lüst
Over the last few years, low- and high-redshift observations set off tensions in the measurement of the present-day expansion rate H0 and in the determination of the amplitude of the matter clustering in the late Universe (parameterized by S8). It was recently noted that both these tensions can be resolved if the cosmological constant parametrizing the dark energy content switches its sign at a critical redshift zc∼2. However, the anti-de Sitter (AdS) swampland conjecture suggests that the postulated switch in sign of the cosmological constant at zero temperature seems unlikely because the AdS vacua are an infinite distance apart from de Sitter (dS) vacua in moduli space. We provide an explanation for the required AdS → dS crossover transition in the vacuum energy using the Casimir forces of fields inhabiting the bulk. We then use entropy arguments to claim that any AdS → dS transition between metastable vacua must be accompanied by a reduction of the species scale where gravity becomes strong. We provide a few examples supporting this AdS → dS uplift conjecture.
Psychosocial consequences of growing up as Austrian occupation children in post-World-War II Austria
Nele Hellweg, Heide Glaesmer, Barbara Stelzl-Marx
et al.
Background: During the post-World War II occupation of Austria, approximately 20,000–30,000 ‘children born of war’ (CBOW), also called occupation children were born through intimate contacts between Austrian women and occupation soldiers. Research on other CBOW populations indicates that CBOW mostly grow up under difficult conditions, sometimes with strong long-term mental health consequences.Objective: To examine whether comparable psychosocial consequences can be found in Austrian occupation children (AOC), a first quantitative study was carried out.Method: Child maltreatment, post-traumatic stress disorder, depression and somatization, and general life satisfaction were assessed in a sample of 98 AOC using self-report instruments. Results were compared to a sample of German occupation children (GOC; N = 146).Results: High prevalence of above threshold full (10.2%) and partial (14.3%) PTSD, somatic (16.3%) and depressive (11.1%) symptomatology were found in AOC. They were at high risk of child maltreatment (e.g. emotional abuse: 53.6%), which was associated with current symptomatology. Notably, AOC tended to report high levels of general life satisfaction. No differences were found between GOC and AOC.Conclusions: Findings highlight the complex and long-term effects of developmental conditions and childhood maltreatment on mental health of CBOW, even decades later. Findings of high life satisfaction provide evidence of resilience and maturation processes across the lifespan.
Chronicling Germany: An Annotated Historical Newspaper Dataset
Christian Schultze, Niklas Kerkfeld, Kara Kuebart
et al.
The correct detection of dense article layout and the recognition of characters in historical newspaper pages remains a challenging requirement for Natural Language Processing (NLP) and machine learning applications on historical newspapers in the field of digital history. Digital newspaper portals for historic Germany typically provide Optical Character Recognition (OCR) text, albeit of varying quality. Unfortunately, layout information is often missing, limiting this rich source's scope. Our dataset is designed to enable the training of layout and OCR modells for historic German-language newspapers. The Chronicling Germany dataset contains 693 annotated historical newspaper pages from the time period between 1852 and 1924. The paper presents a processing pipeline and establishes baseline results on in- and out-of-domain test data using this pipeline. Both our dataset and the corresponding baseline code are freely available online. This work creates a starting point for future research in the field of digital history and historic German language newspaper processing. Furthermore, it provides the opportunity to study a low-resource task in computer vision
History of Germany
Jan Štembera
Helmut Miiller, Kari Friedrich Krieger, Hanna Vollrath: Dějiny Německa. Přeloženo z německého originálu Deutsche Geschichte in Schlaglichtern. Nakladatelství Lidové noviny, Praha 1995, 590 stran, ISBN 80-7106-125-5.
The long history of OSINT
Ludo Block
ABSTRACT This article presents the findings of exploratory research into the origins of OSINT for which it discusses three case studies from, respectively, the United States, Germany and the Netherlands. Many authors writing on open source intelligence assume that the first OSINT practices emerged at the eve of the Second World War with the establishment of the BBC Monitoring Services and the Foreign Broadcast Monitoring Service. Building on existing studies, which are supplemented with original archive research, this article demonstrates that OSINT has a much longer and richer history. Methodical efforts to collect and exploit information from publicly available sources to fulfil intelligence requirements are documented as early as halfway the 19th century in the United States and early 20th century in Europe.
Development and Human Testing of Chemical Warfare Agents and Means of Treatment of Lesions in Germany in 1933–1945
N. I. Shilo
Despite serious attention to the issues of war crimes and crimes against humanity, committed on an unprecedented scale in concentration camps in Nazi Germany, the problem of medical experiments on prisoners appears to be one of the least-studied in modern Russian historiography. Moreover, no special attention was paid to testing chemical weapons on humans. The aim of this work is to review the history of the development and testing of chemical warfare agents (CWA) in Germany in 1933–1945. During the First World War, Germany was one of the leading countries in the sphere of military chemistry in the world. After the Versailles treaty this potential was largely lost as a result of the restrictions. After the National Socialist German Workers' Party (NSDAP) came to power, Germany not only restored, but also increased its military power and achieved a qualitative superiority over its opponents in the field of chemical weapons. The tests of CWA, as well as the study of the effectiveness of the means and protocols for the treatment of the lesions caused by CWA, were carried out both by the military structures of the Wehrmacht and the SS, and by civilian research and academic institutions. Experiments on prisoners were carried out in the concentration camps of Dachau, Ravensbrück, Auschwitz-Birkenau, Buchenwald, Sachsenhausen, Natzweiler-Struthof, Neuengamme, etc. Basically, the damaging effects of sulfur mustard and phosgene was investigated. In Auschwitz-Birkenau «a study of the action of various chemical preparations was carried out on the orders of German firms». After the war several SS doctors, who performed involuntary experiments on humans, were convicted by military tribunals for war crimes and crimes against humanity. Seven doctors were sentenced to death and executed on June 2, 1948, at the prison for war criminals in Landsberg, Bavaria. As a result of the Nuremberg trials, the Nuremberg Code was drawn up. It was the first international document that introduced ethical standards for scientists engaged in experiments on humans. It consisted of 10 principles, including the necessity of voluntary informed consent of the patient for the participation in medical experiments after providing him with full information about the nature, duration and purpose of the experiment; on the methods of its implementation; about all the perceived inconveniences and dangers associated with the experiment, and, finally, the possible consequences for the physical or mental health of the subject, which may arise as a result of his participation in the experiment.
Probing magnetic ordering in air stable iron-rich van der Waals minerals
Muhammad Zubair Khan, Oleg E. Peil, Apoorva Sharma
et al.
In the rapidly expanding field of two-dimensional materials, magnetic monolayers show great promise for the future applications in nanoelectronics, data storage, and sensing. The research in intrinsically magnetic two-dimensional materials mainly focuses on synthetic iodide and telluride based compounds, which inherently suffer from the lack of ambient stability. So far, naturally occurring layered magnetic materials have been vastly overlooked. These minerals offer a unique opportunity to explore air-stable complex layered systems with high concentration of local moment bearing ions. We demonstrate magnetic ordering in iron-rich two-dimensional phyllosilicates, focusing on mineral species of minnesotaite, annite, and biotite. These are naturally occurring van der Waals magnetic materials which integrate local moment baring ions of iron via magnesium/aluminium substitution in their octahedral sites. Due to self-inherent capping by silicate/aluminate tetrahedral groups, ultra-thin layers are air-stable. Chemical characterization, quantitative elemental analysis, and iron oxidation states were determined via Raman spectroscopy, wavelength disperse X-ray spectroscopy, X-ray absorption spectroscopy, and X-ray photoelectron spectroscopy. Superconducting quantum interference device magnetometry measurements were performed to examine the magnetic ordering. These layered materials exhibit paramagnetic or superparamagnetic characteristics at room temperature. At low temperature ferrimagnetic or antiferromagnetic ordering occurs, with the critical ordering temperature of 38.7 K for minnesotaite, 36.1 K for annite, and 4.9 K for biotite. In-field magnetic force microscopy on iron bearing phyllosilicates confirmed the paramagnetic response at room temperature, present down to monolayers.
A Brief History of Space VLBI
Leonid I. Gurvits
Space Very Long Baseline Interferometry is a radio astronomy technique distinguished by a record-high angular resolution reaching single-digit microseconds of arc. The paper provides a brief account of the history of developments of this technique over the period 1960s-2020s.
Note on episodes in the history of modeling measurements in local spacetime regions using QFT
Doreen Fraser, Maria Papageorgiou
The formulation of a measurement theory for relativistic quantum field theory (QFT) has recently been an active area of research. In contrast to the asymptotic measurement framework that was enshrined in QED, the new proposals aim to supply a measurement framework for measurements in local spacetime regions. This paper surveys episodes in the history of quantum theory that contemporary researchers have identified as precursors to their own work and discusses how they laid the groundwork for current approaches to local measurement theory for QFT.
en
physics.hist-ph, quant-ph
‘Root of all success’: Plasticity in root architecture of invasive wild radish for adaptive benefit
Samik Bhattacharya, Franziska Gröne, Felix Przesdzink
et al.
Successful plant establishment in a particular environment depends on the root architecture of the seedlings and the extent of edaphic resource utilization. However, diverse habitats often pose a predicament on the suitability of the fundamental root structure of a species that evolved over a long period. We hypothesized that the plasticity in the genetically controlled root architecture in variable habitats provides an adaptive advantage to worldwide-distributed wild radish (Raphanus raphanistrum, Rr) over its close relative (R. pugioniformis, Rp) that remained endemic to the East Mediterranean region. To test the hypothesis, we performed a reciprocal comparative analysis between the two species, growing in a common garden experiment on their native soils (Hamra/Sandy for Rr, Terra Rossa for Rp) and complementary controlled experiments mimicking the major soil compositions. Additionally, we analyzed the root growth kinetics via semi-automated digital profiling and compared the architecture between Rr and Rp. In both experiments, the primary roots of Rr were significantly longer, developed fewer lateral roots, and showed slower growth kinetics than Rp. Multivariate analyses of seven significant root architecture variables revealed that Rr could successfully adapt to different surrogate growth conditions by only modulating their main root length and number of lateral roots. In contrast, Rp needs to modify several other root parameters, which are very resource-intensive, to grow on non-native soil. Altogether the findings suggest an evo-devo adaptive advantage for Rr as it can potentially establish in various habitats with the minimal tweak of key root parameters, hence allocating resources for other developmental requirements.
Le concept de perfectibilité chez Georg Forster, vecteur d’une critique interne des civilisations européennes ?
Emmanuel Hourcade
History of Germany, History of France
Outpatient Clinic of Russian Red Cross in Berlin in 1920s —1930s
K. D. Kotelnikov
The documents of the League of Nations archive concerning the history of a unique emigrant institution — the Russian Ambulatory in Berlin are introduced into scientific circulation in the article. It is reported that for at least 17 years (since 1920), the clinic had pro-vided free assistance to the poor. The annual reports and correspondence of the clinic make it possible not only to assess the scale of the activities of the philanthropists of Russian Berlin and their humanitarian significance, but also to analyze information about the social and demographic processes in the emigrant community in the 1920s—1930s. It is noted that from 1920 to 1934 the clinic received 171,955 patients (more than one and a half thousand people a year, of all ages and nationalities). Information is given that doctors treated a wide range of diseases: cardiovascular, nervous, venereal, respiratory and digestive system, urogenital system, eye and ear, the consequences of injuries and trauma. It has been established that the outpatient clinic distributed free medicines, food, and basic necessities since the early 1930s and provided lunches and places in the Salvation Army dormitory for the homeless. The statistics of the clinic are presented with data on the ethnic composition of Russian Berlin (the most representative of the known ones), the aging of emigration in Germany, and the low birth rate in the 1930s and the spread of poverty associated with the Great Depression.
Slavic languages. Baltic languages. Albanian languages
Standardisation of Clinical Assessment, Management and Follow-Up of Acute Hospitalised Exacerbation of COPD: A Europe-Wide Consensus
Ramakrishnan S, Janssens W, Burgel PR
et al.
Sanjay Ramakrishnan,1– 3 Wim Janssens,4 Pierre-Regis Burgel,5 Marco Contoli,6 Frits ME Franssen,7 Neil J Greening,8 Timm Greulich,9 Iwein Gyselinck,4 Andreas Halner,1 Arturo Huerta,10 Rebecca L Morgan,11 Jennifer K Quint,12 Lowie EGW Vanfleteren,13 Kristina Vermeersch,4 Henrik Watz,14 Mona Bafadhel1 1Respiratory Medicine Unit, Nuffield Department of Medicine - Experimental Medicine, University of Oxford, Oxford, UK; 2 National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, UK; 3School of Medical and Health Sciences, Edith Cowan University, Perth, Australia; 4Department of Respiratory Diseases, UZ Leuven, Research Group BREATHE, KU Leuven, Leuven, Belgium; 5Faculty of Medicine, University of Paris and INSERM 1016 Institut Cochin, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; 6Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy; 7Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands; 8Department of Respiratory Sciences, NIHR Leicester Biomedical Research Centre (Respiratory), Glenfield Hospital, Leicester, UK; 9Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps University, Member of the German Centre for Lung Research (DZL), Marburg, Germany; 10Pulmonary and Critical Care Division, Clinica Sagrada Familia, IDIBAPS August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; 11Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada; 12National Heart & Lung Institute, Imperial College, London, UK; 13COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Department of Internal Medicine and Clinical Nutrition at Institute of Medicine, SU Sahlgrenska, Göteborg, Sweden; 14Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, GermanyCorrespondence: Mona BafadhelRespiratory Medicine Unit, Nuffield Department of Medicine Experimental Medicine, University of Oxford, Oxford, UKTel +44 1865 612898Email mona.bafadhel@ndm.ox.ac.ukBackground: Despite hospitalization for exacerbation being a high-risk event for morbidity and mortality, there is little consensus globally regarding the assessment and management of hospitalised exacerbations of COPD. We aimed to establish a consensus list of symptoms, physiological measures, clinical scores, patient questionnaires and investigations to be obtained at time of hospitalised COPD exacerbation and follow-up.Methods: A modified Delphi online survey with pre-defined consensus of importance, feasibility and frequency of measures at hospitalisation and follow-up of a COPD exacerbation was undertaken.Findings: A total of 25 COPD experts from 18 countries contributed to all 3 rounds of the survey. Experts agreed that a detailed history and examination were needed. Experts also agreed on which treatments are needed and how soon these should be delivered. Experts recommended that a full blood count, renal function, C-reactive protein and cardiac blood biomarkers (BNP and troponin) should be measured within 4 hours of admission and that the modified Medical Research Council dyspnoea scale (mMRC) and COPD assessment test (CAT) should be performed at time of exacerbation and follow-up. Experts encouraged COPD clinicians to strongly consider discussing palliative care, if indicated, at time of hospitalisation.Interpretation: This Europe-wide consensus document is the first attempt to standardise the assessment and care of patients hospitalised for COPD exacerbations. This should be regarded as the starting point to build knowledge and evidence on patients hospitalised for COPD exacerbations.Keywords: COPD, disease exacerbation, hospitalisation, patient care, consensus development, expert opinion
Diseases of the respiratory system