Background
Peripheral blood monocyte counts have been associated with poor outcomes in interstitial lung disease (ILD). However, studies are limited by variable biomarker thresholds, analytic ...approaches and heterogenous populations. This systematic review and meta-analysis characterised the relationship between monocytes and clinical outcomes in ILD.
Methods
Electronic database searches were performed. Two reviewers screened abstracts and extracted data. Pooled estimates (hazard ratios (HRs)) of monocyte count thresholds were calculated for their association with mortality using ≥0.6×10
9
and >0.9×10
9
cells·L
−1
for unadjusted models and ≥0.95×10
9
cells·L
−1
for adjusted models, using random effects, with heterogeneity and bias assessed. Disease progression associated with monocytes >0.9×10
9
cells·L
−1
was also calculated.
Results
Of 3279 abstracts, 13 were included in the systematic review and eight in the meta-analysis. The pooled unadjusted HR for mortality for monocyte counts ≥0.6×10
9
cells·L
−1
was 1.71 (95% CI 1.34–2.19, p<0.001, I
2
=0%) and for monocyte counts >0.90×10
9
cells·L
−1
it was 2.44 (95% CI 1.53–3.87, p=0.0002, I
2
=52%). The pooled adjusted HR for mortality for monocyte counts ≥0.95×10
9
cells·L
−1
was 1.93 (95% CI 1.24–3.01, p=0.0038 I
2
=69%). The pooled HR for disease progression associated with increased monocyte counts was 1.83 (95% CI 1.40–2.39, p<0.0001, I
2
=28%).
Conclusions
Peripheral blood monocyte counts were associated with an increased risk of mortality and disease progression in patients with ILD.
Purpose
To describe ocular clinical findings, gross/histopathologic findings, and treatment regimens in a series of migratory chuck‐will's‐widows (Antrostomus carolinensis) (CWW) with corneal ...epithelial defects.
Methods
Seven CWW were presented to the South Florida Wildlife Center (SFWC). Four presented with bilateral (OU) corneal ulceration; two developed corneal ulceration OU; one had no ocular lesions. Treatment protocols for patients with corneal ulcers included the following: medical therapy only or medical therapy combined with an additional procedure. Four patients including the bird with no ocular lesions were euthanized, and one patient died. Their globes were submitted for histopathology. Two patients were released.
Results
Clinical findings prior to enucleation included superficial corneal ulceration with redundant epithelium persisting weeks to >1 month. On histopathology, epithelium in nonulcerated globes was remarkably thin; this was considered normal. Common histopathologic findings of ulcerated globes revealed epithelial and conjunctival attenuation with an acellular superficial stromal layer and hypercellular mid‐stromal layer. One globe healed with medical therapy and cotton tip applicator debridement. Four globes healed by combination of medical therapy, equine amnion, nictitating membrane (NM) flap, and temporary tarsorrhaphy. No globes healed with diamond burr debridement or grid keratotomy.
Conclusions
Factors that may be contributing to these corneal epithelial defects include, but are not limited to, normally thin epithelium, exposure keratopathy, neurotrophic disease, epithelial turnover and inadequate stem cell recruitment, inherited/genetic causes, and unidentified infectious agents (eg, viral etiologies). Of the 12 eyes treated, one healed with medical therapy/cotton tip applicator debridement, and four healed with medical therapy/equine amnion/nictitating membrane flap/temporary tarsorrhaphy.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Humanism has long celebrated the human, including those qualities that make us uniquely human, as well as the vastness of human potential. Humanistic psychology has further sought to understand what ...it means to be human and what conditions facilitate human flourishing and the unfolding of potential. Transhumanism, a movement advocating technologically aided human enhancements, represents a new and rapidly growing manifestation of humanistic ideals. Transhumanism identifies physical human limitations as limitations on potential and seeks to remove all such limits, understanding and often celebrating the fact that such changes could make us no longer recognizably human. Transhuman aims include technologically aided radical human enhancements in longevity, health, intelligence, emotion, morality, and more. While the implications of transhumanism are being widely debated within fields such as philosophy and religion, contributions from psychology are scarce. With its wealth of wisdom into the heart of issues around what it means to be human, humanistic psychology is particularly well-suited to exploring transhuman issues. In addition to making a case for the involvement of humanistic psychology in transhumanism, the current work explores several specific areas in which humanistic psychology may be fruitfully applied, such as issues of potential and agency.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
ObjectivesThe diagnostic process for patients with interstitial lung diseases (ILD) remains complex. The aim of this study was to characterise the diagnostic care pathway and identify barriers and ...potential solutions to access a timely and accurate ILD diagnosis.DesignThis mixed-method study was comprised of a quantitative chart review, patient and physician surveys and focus groups.ResultsChart review was completed for 97 patients. Median time from symptom onset to ILD diagnosis was 12.0 (IQR 20.5) months, with 46% diagnosed within 1 year. Time from first computed tomography (CT) scan to respirology referral was 2.4 (IQR 21.2) months. Referrals with a prior CT were triaged sooner than referrals without (1.7±1.6 months vs 3.9±3.3 months, p=0.013, 95% CI 0.48 to 2.94). On patient surveys (n=70), 51% felt that their lung disease was not recognised early enough. Commonly reported challenges to timely diagnosis included delayed presentation to primary care, initial misdiagnoses and long wait-times for specialists. Forty-five per cent of physicians (n=20) identified diagnostic delays, attributed to delayed presentations to primary care (58%), initial misdiagnoses (67%) and delayed chest imaging (75%). Themes from patient and respirologist focus groups included patient-related, healthcare provider-related and system-related factors leading to delays in diagnosis.ConclusionsThis mixed-methods study identified patient and system-related factors that contribute to diagnostic delays for patients with ILD, with most delays occurring prior to respirology referral. ILD awareness and education, earlier presentation to primary care, expedited access to chest imaging and earlier referral to respirology may expedite diagnosis.
A 68-year-old male presented to the emergency department with retrosternal chest pain, presyncope, and then a pulseless electrical activity cardiac arrest. An ECG prior to his arrest revealed ST ...elevations in leads V1–V3, Q waves in lead V2, and reciprocal ST depressions in the lateral and inferior leads. He received thrombolytic therapy for a presumptive diagnosis of ST elevation myocardial infarction. Return of spontaneous circulation was achieved and he underwent a coronary angiogram. No critical disease was found and his left ventriculogram showed normal contraction. His ongoing metabolic acidosis and dependence on an intra-aortic balloon pump, despite adequate cardiac output, prompted a CT pulmonary angiogram which showed multiple segmental filling defects. He was treated for a pulmonary embolism and was discharged 5 days later. Acute pulmonary embolism (APE) has variable clinical presentations. To our knowledge, this is the first case report of an APE presenting with these ECG findings suggestive of myocardial ischemia. In this case report, we discuss the underlying physiological mechanisms responsible and offer management suggestions for emergency department and critical care physicians to better expedite the treatment of APE mimicking acute coronary syndrome on ECG.
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
•First study of use of oromucosal midazolam maleate (OMM) in adults in community.•Oromucosal midazolam maleate is safe to use by trained non-clinical carers.•10-mg dose of OMM is effective for ...cessation of seizure in adults at status risk.•Oromucosal midazolam maleate is an effective rescue medication in adults with epilepsy in community settings.
Oro-mucosal midazolam maleate (OMM) with suitable training to family and carers is being increasingly recognized as the treatment of choice to mitigate the development of status epilepticus in non-hospital community settings. There are no studies to describe the use, effectiveness, and suitable dosing of OMM in adults with epilepsy in community settings.
To describe the use, effectiveness, and dosing of OMM in the emergency treatment of epileptic seizures in community settings.
A retrospective observational study (2016–17) design was used with participant recruitment from four UK NHS secondary care outpatient clinics providing epilepsy management. Study sample was of adult people with epilepsy (PWE) having had a recent seizure requiring OMM. Data on patient demographics, patient care plans, details of a recent seizure requiring emergency medication, and dose of OMM were collected from medical records.
Study data from 146 PWE were included. The mean age of PWE was 41.0 years (SD 15.2) and mean weight was 64.8Kg (SD 18.2). Fifty-three percent of PWE were recorded as having intellectual disability. The most frequently used concomitant medications were lamotrigine (43%). The majority of seizures occurred at people’s homes (n = 92, 63%). OMM was most often administered by family/professional care-givers (n = 75, 48.4%). Generalized (tonic/clonic) seizures were recorded in most people (n = 106, 72.6%). The most common initial dose of OMM was 10 mg (n = 124, 84.9%). The mean time to seizure cessation after administration of this initial dose was 5.5 minutes (SD = 4.5, Median 5.0, IQR 2.1–5.0). Only a minority of seizures led to ambulance callouts (n = 18, 12.3%) or hospital admissions (n = 13, 9%).
This is the first observational study describing the use and effectiveness of OMM in adults in community settings. Minimal hospital admissions were reported in this cohort and the treatment was effective in ending seizures in adults in community settings.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The impact of polyolefin-based agricultural mulch films (including clear, black, and white-on-black films) on soil temperature and moisture content was studied, using a bare plot as a control, over a ...4-month period in central Ontario, Canada. Data indicate a negative correlation between the change in soil temperature under the films relative to bare soil and the absolute value of bare soil temperature. Additionally, a negative correlation between the effect of films on soil moisture and the moisture level of bare soil was indicated. All mulch films demonstrated qualitatively similar ability to insulate the soil from extremes in both temperature and moisture, suggesting a potentially reduced need for irrigation and protecting against early frost, high temperatures, overwatering, and drought.
The identification of C-type lectin (Group V) natural killer (NK) cell receptors in bony fish has remained elusive. Analyses of the Fugu rubripes genome database failed to identify Group V C-type ...lectin domains (Zelensky and Gready, BMC Genomics 5:51, 2004) suggesting that bony fish, in general, may lack such receptors. Numerous Group II C-type lectin receptors, which are structurally similar to Group V (NK) receptors, have been characterized in bony fish. By searching the zebrafish genome database we have identified a multi-gene family of Group II immune-related, lectin-like receptors (illrs) whose members possess inhibiting and/or activating signaling motifs typical of Group V NK receptors. Illr genes are differentially expressed in the myeloid and lymphoid lineages, suggesting that they may play important roles in the immune functions of multiple hematopoietic cell lineages.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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