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Decline has long been a central concern of international relations scholarship, but analysts have only recently begun to investigate whether a change in international status influences a state's domestic politics. A new theoretical framework for understanding the domestic political consequences of relative national decline posits that eroding national status activates two sets of social psychological dynamics that contribute to domestic conflict inside declining states. First, eroding state status prompts some groups to strengthen their commitment to the state's status and dominant national identity, at the same time as it prompts other groups to disidentify from the state. Second, eroding status produces incentives for substate actors to derogate and scapegoat one another. These dynamics are particularly likely to contribute to center-periphery conflict in multinational states after instances of acute status loss. The plausibility of the argument is demonstrated by showing how the erosion of Spain's status (especially because of military failure in the 1898 Spanish-American War and the subsequent loss of its last colonies in the Americas) intensified domestic conflict in Spain during the first decades of the twentieth century. Findings indicate that decline may actually exacerbate domestic conflict, making it more difficult for states to adopt appropriate reforms.

The Origin Replication Complex subunit 4 (ORC4) is one in six subunits of the Origin Replication Complexes (ORCs) which is essential for initiating licensing at DNA replication origins and recruiting adaptor molecules necessary for various cellular processes. Previously, we reported that ORC4 also plays a vital role in polar body extrusion (PBE) during oogenesis in which half the chromosomes are extruded from the oocyte. We hypothesized that ORC4 might play a broader role in chromatin elimination. We tested its role in enucleation during the development of erythrocytes. Murine erythroleukemia (MEL) cells can be propagated in culture indefinitely and can be induced to enucleate their DNA by treatment with Vacuolin-1, thereby mimicking normal erythrocyte enucleation. We found that ORC4 appeared around the nuclei of the MEL cells with Vacuolin-1 treatment, gradually increasing in thickness before enucleation. We then tested whether ORC4 was required for MEL enucleation by down regulating ORC4 with siRNA-ORC4 during Vacuolin-1 treatment and found that this prevented MEL enucleation. These data are consistent with the model that ORC4 is required for erythroblast enucleation just as it is for oocyte PBE. They suggest a new model in which ORC4 expression is a marker for the initiation to the enucleation pathway.

Vasectomy is a widely used surgical technique creating an obstructive azoospermia. Although sperm cannot be ejaculated, the testis maintains sperm production in vasectomized males. The continuous accumulation of sperm deposited in the epididymis and the vas deferens fraction necessarily need to be degraded and eliminated. While the elimination process is carried out by granulomas that form after vasectomy, the detailed mechanisms of sperm degradation are still not known. The aim was to assess whether sperm chromatin fragmentation (SCF), a mechanism that degrades the entire sperm genome at the toroid linker regions (TLR), is activated after vasectomy in sperm cells. We vasectomized mice and evaluated the presence of TLR-specific double-strand breaks through pulsed-field gel electrophoresis and the Comet assay at 1, 2 and 3 weeks after surgery. Results for DNA damage (Olive tail moment) at single-cell level showed an increase of double-strand breaks after vasectomy for vas deferens sperm after 1, 2 and 3 weeks post-vasectomy (21.78 ± 2.29; 19.71 ± 1.79 and 32.59 ± 1.81, respectively), compared to mock surgery (7.04 ± 1.03; 10.10 ± 1.29 and 8.64 ± 0.85, respectively; P 0.05). Pulsed-field gel electrophoresis showed the presence of double-stranded breaks between 15 kb and 145 kb, indicating that DNA breaks were produced mainly in the sperm TLRs. Results presented here suggest that SCF is a mechanism activated in vas deferens after vasectomy to degrade sperm DNA when they cannot be ejaculated, preventing their function This research was supported by the European Union’s Horizon 2020 Research and Innovation Scheme under the Marie Skłodowska-Curie grant agreement No. 801342 (Tecniospring INDUSTRY; TECSPR-19- 1-0003), to J.R.-M.; the NIH, grant number GM123048 to W.S.W.; the Catalan Agency for Management of University and Research Grants, Regional Government of Catalonia, Spain (2017-SGR-1229); the Catalan Institution for Research and Advanced Studies (ICREA); and La Marató de TV3 Foundation (214/857-202039)

Sperm nuclei present a highly organized and condensed chromatin due to the interchange of histones by protamines during spermiogenesis. This high DNA condensation leads to an almost inert chromatin, with the impossibility of conducting gene transcription as in most other somatic cells. The major chromosomal structure responsible for DNA condensation is the formation of protamine-DNA toroids containing 25 to 50 kilobases of DNA. These toroids are connected by toroid linker regions (TLR) which attach them to the nuclear matrix, as matrix attachment regions (MAR) do in somatic cells. Despite this high degree of condensation, evidence shows that sperm chromatin contains vulnerable elements that can be degraded even in fully condensed chromatin, which may correspond to chromatin regions that transfer functionality to the zygote at fertilization. This chapter covers an updated review of our model for sperm chromatin structure and its potential functional elements that affect embryo development.

Background The analysis of chromatin integrity has become an important determinant of sperm quality. In frozen-thawed bovine sperm, neither the sequence of post-thaw injury events nor the dynamics of different types of sperm DNA breaks are well understood. The aim of the present work was to describe such sperm degradation aftermath focusing on DNA damage dynamics, and to assess if this parameter can predict pregnancy rates in cattle. Results A total of 75 cryopreserved ejaculates from 25 Holstein bulls were evaluated at two post-thawing periods (0-2 h and 2-4 h), analyzing global and double-stranded DNA damage through alkaline and neutral Comet assays, chromatin deprotamination and decondensation, sperm motility, viability, acrosomal status, and intracellular levels of total ROS, superoxides and calcium. Insemination of 59,605 females was conducted using sperm from the same bulls, thus obtaining the non-return to estrus rates after 90 d (NRR). Results showed an increased rate of double-stranded breaks in the first period (0-2 h: 1.29 ± 1.01%/h vs. 2-4 h: 0.13 ± 1.37%/h; P P < 0.0001). Regarding sperm physiology, viability decrease rate was different between the two periods (0-2 h: − 4.49 ± 1.79%/h vs. 2-4 h: − 2.50 ± 3.39%/h; P = 0.032), but the progressive motility decrease rate was constant throughout post-thawing incubation (0-2 h: − 4.70 ± 3.42%/h vs. 2-4 h: − 1.89 ± 2.97%/h; P > 0.05). Finally, whereas no correlations between bull fertility and any dynamic parameter were found, there were correlations between the NRR and the basal percentage of highly-damaged sperm assessed with the alkaline Comet (Rs = − 0.563, P = 0.003), between NRR and basal progressive motility (Rs = 0.511, P = 0.009), and between NRR and sperm with high ROS at 4 h post-thaw (Rs = 0.564, P = 0.003). Conclusion The statistically significant correlations found between intracellular ROS, sperm viability, sperm motility, DNA damage and chromatin deprotamination suggested a sequence of events all driven by oxidative stress, where viability and motility would be affected first and sperm chromatin would be altered at a later stage, thus suggesting that bovine sperm should be used for fertilization within 2 h post-thaw. Fertility correlations supported that the assessment of global DNA damage through the Comet assay may help predict bull fertility.

Why and how do weak states challenge the status quo? This article builds on analyses of hierarchy in International Relations to develop a more comprehensive and inclusive understanding of the concept of revisionism. We argue that while weak actors cannot generally directly challenge their position in a stratified hierarchy, they may be able to undermine or subvert the discourses that constitute these hierarchies. This approach is likely to be attractive and feasible under two conditions: when other approaches to reform have been frustrated, and when social and political resources are available to facilitate such subversive challenges. We illustrate this argument by analyzing the Treaty on the Prohibition of Nuclear Weapons as a subversive revisionist project. Small states—frustrated by their inability to negotiate meaningful reform through the status quo framework—partnered with civil society and drew upon discursive resources developed during prior subversive revisionist projects in an effort to stigmatize nuclear weapons and subvert the discourses constituting the advantaged positions of those possessing them. While the Treaty on the Prohibition of Nuclear Weapons (TPNW) is unlikely to directly persuade nuclear weapon states to abandon their arsenals, it could have unpredictable consequences across a related range of hierarchic fields that constitute the status quo order.

Many scholars and policymakers assume that attacks on forward deployed U.S. troops—“tripwires”—will prompt strong domestic political support for escalation against the attacker. This conjecture informs policy and has deep theoretical roots, yet it is undertheorized and largely untested. We identify and develop two theoretical mechanisms – reputation and revenge – capable of explaining why such attacks might prompt support for escalation, even though prior research shows that casualties suffered during a conflict reduce support for intervention. We then use two survey experiments to examine whether and how attacks influence Americans’ support for intervention. We find that hypothetical attacks on contingents of troops deployed overseas increase support for escalation only modestly and in ways that better reflect demands for revenge rather than concerns about reputation. Our findings imply that confident assessments that forward deployed troops serve as strong pre-commitment devices need to be tempered, pending further theoretical and empirical analysis.

Recent research has provided evidence that conflict improves a belligerent’s status. I argue that this finding is based on a specification error. The relationship between the CINC index, which is u...

Analysts writing about the future of today’s international order sometimes assume that China’s sensitivity to international position makes it an especially dangerous rising power (see e.g. Allison ...

Denied status claims can produce serious interstate conflict and accommodation may thus be an important means of avoiding conflict with rising and reemerging status seekers such as China and Russia. But accommodation is an underdeveloped concept. This article draws on scholarship about recognition and hierarchy to propose a novel means of understanding status accommodation: as behavior that sends signals to status seekers about the validity of claims to stratified rights. This framework implies that acts that signal status denial (and thus cause conflict over status) may be driven by three broad kinds of processes: anxiety about a state's position in the world; incompatibility between nonstatus interests and claims to status-implicated rights; and fears about the implications of status accommodation for the validity of discourses and ideas that produce both international and domestic order. These dynamics—especially the latter two—may be linked to domestic political mechanisms and concerns in ways that analysts do not fully appreciate. I illustrate the framework by examining the forces that drove the United States to deny Japanese claims to equal status during the decades before World War II.

Unimensional accounts of revisionism – those that align states along a single continuum from supporting the status quo to seeking a complete overhaul of the international system – miss important variation between a desire to alter the balance of military power and a desire to alter other elements of international order. We propose a two-dimensional property space that generates four ideal types: status-quo actors, who are satisfied with both order and the distribution of power; reformist actors, who are fine with the current distribution of power but seek to change elements of order; positionalist actors, who see no reason to alter the international order but do aim to shift the distribution of power; and revolutionary actors, who want to overturn both international order and the distribution of capabilities. This framework helps make sense of a number of important debates about hegemony and international order, such as the possibility of revisionist hegemonic powers, controversies over the concept of ‘soft balancing’, and broader dynamics of international goods substitution during power transitions.

The importance of concerns about status in world politics has rarely been as evident as it is today. Yet our understanding of how status dynamics influence politics and foreign policy remains limited. Dominant approaches draw on insights from social psychology about individual attitudes and behavior, but scale these up to build accounts of states as unitary or anthropomorphic actors. This results in serious theoretical problems and analytical blind spots. In this article, I offer a new framework – still rooted in social psychological insights about intergroup status dynamics – that addresses these problems. I recast the fundamental question from one about how states react to status dissatisfaction to one about how individuals – with different psychological profiles, different interests, and different positions within the national community – react to anxiety about the status of the state with they identify. I develop four broad logics that inform responses to national status dissatisfaction: identification change, emulation, transformation, and rejection. These logics subsume familiar arguments about how states seek status, but they also accommodate additional variation and explanatory possibilities. They thus constitute a more flexible framework that is better suited than existing alternatives to understand the full variety of ways in which status dynamics may influence world politics.

We have previously shown that the DNA replication licensing factor ORC4 forms a cage around the chromosomes that are extruded in both polar bodies during murine oogenesis, but not around the chromosomes that are retained in the oocyte or around the sperm chromatin. We termed this structure the ORC4 cage. Here, we tested whether the formation of the ORC4 cage is necessary for polar body extrusion (PBE). We first experimentally forced oocytes to extrude sperm chromatin as a pseudo-polar body and found that under these conditions the sperm chromatin did become enclosed in an ORC4 cage. Next, we attempted to prevent the formation of the ORC4 cage by injecting peptides that contained sequences of different domains of the ORC4 protein into metaphase II (MII) oocytes just before the cage normally forms. Our rationale was that the ORC4 peptides would block protein-protein interactions required for cage formation. Two out of six tested peptides prevented the ORC4 cage formation and simultaneously inhibited PBE, resulting in the formation of two pronuclei (2 PN) that were retained in the oocyte. Together, these data demonstrate that ORC4 oligomerization is required to form the ORC4 cage and that it is required for PBE. J. Cell. Biochem. 118: 2941–2949, 2017. © 2017 Wiley Periodicals, Inc.

In this issue, Agarwal and colleagues (1) have attempted the Herculean effort of sifting through hundreds of publications and several meta-analyses of those publications to answer a question that continues to plague clinicians in artificial reproduction technologies (ART) clinics. Simply stated, the question is “When is it appropriate to ask patients to spend more money to obtain a diagnosis of the status of DNA damage in the sperm as a tool for both the patient and clinician to decide on a course of treatment?”.

In advanced-stage diffuse large B-cell lymphoma (DLBCL), the presence of an activated B-cell phenotype or a non–germinal center (GCB) phenotype, coexpression of MYC and BCL2 by immunohistochemistry, and the cooccurrence of MYC and BCL2 or BCL6 rearrangements are associated with inferior outcomes. It is unclear whether these variables remain prognostic in stage I/II patients. In this retrospective study, we evaluated the prognostic impact of cell of origin (COO), as well as dual-expressor (DE) status and molecular double-hit (DH) status, in stage I/II DLBCL by positron emission tomography with computed tomography (PET-CT). A total of 211 patients treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)–like regimens, with or without radiotherapy, was included. The median follow-up in the entire cohort was 4 years (range, 0.4-9.4), with estimated 4-year progression-free survival (PFS) and overall survival (OS) rates of 85% (95% confidence interval [CI], 79-89) and 88% (95% CI, 83-92), respectively. By univariable analysis, DE (PFS: hazard ratio [HR], 1.27; 95% CI, 0.58-2.81, P = .55 and OS: HR, 1.40; 95% CI, 0.60-3.30; P = .44), DH (PFS: HR, 1.21; 95% CI, 0.27-5.31; P = .80 and OS: HR, 0.61; 95% CI, 0.08-4.73; P = .64), and non-GCB status (PFS: HR, 1.59; 95% CI, 0.83-3.03; P = .16 and OS: HR, 1.80; 95% CI, 0.89-3.67; P = .10) were associated with poorer outcomes. In patients with PET-CT–defined stage I/II DLBCL treated with R-CHOP–like therapy, with or without radiation, COO and DE and DH status were not significantly associated with inferior PFS or OS.

The role of detergent formulation on the cleaning of a complex carbohydrate-fat food soil from stainless steel surfaces was studied using a modified version of the millimanipulation device described by Ali et al. (2015b) which allowed the force required to scrape the soil from the surface to be measured as the soil is immersed, in situ and in real time. This allowed the influence of temperature, solution chemistry and time on the mechanical forces (rheology) and removal behaviour of the soil to be studied – in effect quantifying the relationships in Sinner’s cleaning circle. The soil simulated a burnt-on baked-on deposit and featured regular cracking in the 300 μm thick layer. The removal force decreased noticeably on hydration: the cleaning mechanism was then determined by the agents present. At 20ºC, below the temperature at which the fat phase was mobile, removal was characterised by cohesive failure except in the presence of the cationic surfactant CTAB, which promoted adhesive failure and fast decay in removal force. At 50ºC, when the fat was mobile, a transition between cohesive and adhesive failure was observed at pH 7 which was inhibited at higher pH. Adhesive failure and fast decay in removal force was observed at higher pH and 50ºC in the presence of the anionic and non-ionic surfactants, SDBS and TX-100, respectively., EPSRC iCASE Studentship Support from Proctor & Gamble

In early years, Dr. Donald S. Coffey fostered the development of a new model for the organization of DNA in the sperm nucleus that had many unexpected similarities to that of somatic cells. This was surprising because it was well known that mammalian sperm DNA is more compact than the DNA in mitotic chromosomes, and the fact that some of the major structural components of somatic cell DNA organization were retained in the sperm cell was not predicted. The highly compact sperm DNA is organized into loop domains that are attached at their bases to a proteinaceous nuclear matrix, at specific matrix attachment regions (MARs). This organization is required for DNA synthesis of the paternal genome hours after fertilization, and also participates in an apoptotic-like degradation of the DNA under certain conditions. The tight packaging of the sperm chromatin is due entirely to the replacement of histones by protamines, but the sperm DNA loop domain organization is not changed by this transition, and is probably inherited by the paternal pronucleus in the newly formed embryo.

After fertilization, the maternal and paternal chromosomes independently proceed through pronuclear formation. These chromatin reconfigurations occur within a shared cytoplasm thus exposing both gametes to the same factors. Here, we report that continuous cycloheximide [40 μg/mL] treatment of parthenogenotes, androgenotes, and ICSI embryos reveals ORC2 pronuclear instability in the maternal (MPN) but not the paternal pronucleus (PPN). When released from CHX after 8 h, the MPN can recover ORC2 and proceed through replication, however, parthenogenotes encounter severe mitotic defects while both ICSI embryos and androgenotes are able to recover and develop at significantly higher rates. Taken together, these data suggest cycloheximide treatment promotes an environment that asymmetrically affects the stability of ORC2 on the MPN, and the ability of the MPN to develop. Furthermore, the presence of the PPN in the zygote can ameliorate both effects. These data suggest further evidence for crosstalk between the two pronuclei during the first cell cycle of the embryo. J. Cell. Biochem. 117: 1806-1812, 2016. © 2016 Wiley Periodicals, Inc.

The origin recognition complex (ORC) proteins, ORC1-6, are the first known proteins that bind DNA replication origins to mark the competency for the initiation of DNA synthesis. These proteins have complex mechanisms of assembly into the ORC complex and unexpected localizations in the mitotic chromosomes, cytoplasm, and nuclear structures. The mammalian zygote is a potentially important model that may contribute to our understanding of the mechanisms and features influencing origin establishment and in the identification of other functions of the ORC proteins. Together with expected localizations to the chromatin during G1, we found an unexpected distribution in the cytoplasm that appeared to accumulate ORC proteins suggesting potential roles for ORC subunits in mitosis and chromatin segregation. ORC1, 2, 3, and 5 all localize to the area between the separating maternal chromosomes shortly after fertilization. ORC4 forms a cage around the set of chromosomes that will be extruded during polar body formation before it binds to the chromatin shortly before zygotic DNA replication. These data suggest that the ORC proteins may also play roles in preparing the cell for DNA replication in addition to their direct role in establishing functional replication origins.

Six proteins, ORC1-6, make up the origin recognition complex (ORC) that initiates licensing of DNA replication origins. We have previously reported that subunit ORC2 is localized between the separating maternal chromosomes at anaphase II just after fertilization and is present in zygotic pronuclei at G1. Here, we found that ORC1, 3, and 5 all localize between the chromosomes at anaphase II, but could not be detected in zygotic G1. ORC6 localized to the periphery of the nucleoli at all zygotic stages. We identified an unexpected potential role for ORC4 in polar body formation. We found that in both female meiotic divisions, ORC4 surrounds the set of chromosomes, as a sphere-like structure, that will eventually be discarded in the polar bodies, but not the chromosomes that segregate into the oocyte. None of the other five ORC proteins are involved in this structure. In Zygotic G1, ORC4 surrounds the nuclei of the polar bodies, but was not detectable in the pronuclei. When the zygote entered mitosis ORC4 was only detected in the polar body. However, ORC4 appeared on both sets of separating chromosomes at telophase. At this point, the ORC4 that was in the polar body also migrated into the nuclei, suggesting that ORC4 or an associated protein is modified during the first embryonic cell cycle to allow it to bind DNA. Our results suggest that ORC4 may help identify the chromosomes that are destined to be expelled in the polar body, and may play a role in polar body extrusion. extrusion. ORC4 surrounds the chromatin that will be extruded in the polar body in both female meiotic divisions, then makes a transition from the cytoplasm to the chromosomes at zygotic anaphase, suggesting multiple roles for this replication licensing protein.

One of the most intriguing questions in sperm biology is how the 3 f long DNA is packaged into an almost crystalline state in an ordered fashion that retains all its biological functions. Several aspects of this process are known; however, a model for the entire packaging still eludes us. We know that the DNA is packaged into very condensed toroids by protamines that protect it from insults during its journey from the male reproductive tract till the time of fertilization with the oocyte. The DNA is also organized by the sperm nuclear matrix to preserve its function and to direct the replication of the DNA in the embryo after fertilization. This particular level of chromatin packaging may also serve as a checkpoint for DNA integrity. At a higher level, sperm chromosomes appear to occupy discrete domains, with the telomeres of each chromosome paired and located at the periphery of the nucleus and the centromeres at the center. However, there are still many unanswered questions about such chromatin structure. There are several different types of sperm DNA damage assays, and each is sensitive to specific aspects of sperm chromatin structure. Understanding how the chromatin is packaged can therefore help to interpret these assays.

This non-data based paper is inspired by extensive clinical experience suggesting that behavior intervention plans tend to be overly rigid and, specifically, that the potential benefits of “humor” are frequently underappreciated. Behavior plans usually include descriptions of supports and of behaviors to be reinforced, and careful operational definitions of behavioral excesses, to be put on extinction, punished, or from which students are to be redirected to a more appropriate behavior. Subjective descriptions are difficult to define operationally, and this is likely one reason that humor is not typically addressed in behavior plans. In the current paper, I describe some potential benefits of humor and argue that we should sometimes use more flexible criteria for describing “inappropriate” behavior. I will provide behavioral analyses of some potential functions of “humor”, describe potential research methods, and describe cautions and recommendations regarding the use of humor in behavior intervention plans.

Sperm chromatin is the most compact form of DNA known, packaging the DNA into an almost crystalline state. A unique set of proteins called protamines, that exist only in sperm cells, accomplishes this by neutralizing the DNA's natural negative charges and coiling it into toroids. However, this crystallized DNA is organized in a manner that retains functionality and key parts of the DNA remain accessible to the cell.

During spermiogenesis, sperm chromatin undergoes the most drastic reorganization that is known from a relatively open configuration where the DNA is accessible to transcription factors and nucleases to an almost crystalline state in which the DNA is extremely inaccessible, and very protected. Much is known about the end state, but how the sperm cell accomplishes this transition is only now becoming clear. A new model based on a cooperation between transition proteins and specific histone variants to direct nucleosome disassembly and tight genome compaction by protamines is discussed.

The highly condensed chromatin of mammalian spermatozoa is usually considered to be biologically inert before fertilization. However, we have demonstrated that even in this compacted state, sperm chromatin is subject to degradation at open configurations associated with the nuclear matrix through a process we have termed sperm chromatin fragmentation (SCF). This suggests that a mechanism exists to monitor the health of spermatozoa during transit through the male reproductive tract and to destroy the genome of defective sperm cells. The site of DNA damage in SCF, the matrix attachment sites, are the same that we hypothesize initiate DNA synthesis in the zygote. When sperm that have damaged DNA are injected into the oocyte, the newly created zygote responds by delaying DNA synthesis in the male pronucleus and, if the damage is severe enough, arresting the embryo's development. Here we present a model for paternal DNA regulation by the nuclear matrix that begins during sperm maturation and continues through early embryonic development.

Background COPD exacerbations (eCOPD) deleteriously effects patient outcomes and healthcare spending. Emergency Department observation units (ED-Obs) provide short-term acute care in order to reduce resource utilisation, however successful COPD-specific programs in ED-Obs are lacking. Objectives Achieve 90% reliable implementation of COPD care-bundle among eCOPD patients discharged from ED-Obs by April 2017. The overall goal is to reduce 30 day all-cause ED revisits for eCOPD patients discharged from ED-Obs from the baseline rate of 49%. Methods Setting: An 800-bed academic hospital with 700 eCOPD ED encounters/year, out of which 20% triage to ED-Obs. All patients triaged to ED-Obs with eCOPD diagnosis were included. A five-element COPD bundle designed to mitigate system-level failures, was adopted from in-patient setting. The bundle components were: appropriate inhaler regimen, 30 day inhaler supply, personalised inhaler education, standardised discharge instructions and follow-up in 15 days. A multidisciplinary team was formed to support bundle implementation within the 24 hours ED-Obs stay using Model for Improvement. Bundle component adherence and 30 day ED revisit rates were monitored using SPC p-charts. Hospitalisation rate from ED-Obs was used as balancing measure. Results The patient characteristics were similar in baseline and post-bundle period. Multiple PDSA cycles were performed to achieve a final process (Figure 1). The adherence to COPD care bundle components has maintained >90% from 4/2017–8/2017 (Figure 2). The 30 day all-cause ED revisit rate reduced from 49% to 28% with a pending system-shift on SPC (Figure 3). Hospitalisation rate remained unchanged. Conclusions Improving care at discharge transition of eCOPD patients from ED-Obs to home through reliable adherence to COPD care-bundle reduces 30 day all-cause ED revisits.