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.
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
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
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
•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.
Abstract Objective The minimally invasive surgical (MIS) approach to hysterectomy (vaginal or laparoscopic), when compared with laparotomy, results in shorter length of stay, fewer minor and major ...complications, and quicker return to normal activity. The complexity of the hysterectomy procedure or pathology may affect the success of an MIS approach. This study examined the indications, complications, and outcomes of all hysterectomies performed, irrespective of the severity of pathology or patient habitus, in a Canadian tertiary level gynaecologic surgical referral service. Methods We performed a retrospective chart review of all hysterectomies performed by a single surgeon between September 2007 and June 2011, noting indications, complications, and outcomes. One-way analysis of variance was used to calculate the influence of various factors across surgery types. Significance was set at P < 0.05 for all tests. Results A total of 305 cases were included; 291 of these (95.4%) were managed through an MIS approach, providing a technicity rate of 95.4%. Mean patient age was 45.5 years, and mean BMI was 28.9. The main indicators for surgery were fibroids (42.0%), pain (38.4%), and heavy menstrual bleeding (37.4%). Eighty-one percent of cases were tertiary referrals. Of the laparoscopic cohort, endometriosis was moderate-severe in 61.2% of patients. Mean length of stay was 1.14 days, mean uterine weight was 277.6 g, and mean estimated blood loss was 179 mL. Conclusion This retrospective study of a tertiary level referral gynaecologic service suggests that complex hysterectomy may be effectively and efficiently managed through an MIS approach.
Risk-adjustment models are widely used methodological approaches within the healthcare industry to measure hospital performance and quality of care. However, the Centers for Medicare and Medicaid ...Services (CMS) do not fully adjust for socioeconomic status (SES) in acute myocardial infarction (AMI) models. A review and evidence synthesis was conducted to identify associations of SES factors with hospital readmission and mortality in AMI patients.
Multiple electronic databases were queried to identify studies assessing risk for AMI-related mortality or hospital readmissions and SES factors. Identified studies were screened by title and abstract. Full-text reviews followed for articles meeting the inclusion criteria, including quality assessments. Data were extracted from all included studies, and evidence synthesis was performed to identify associations between SES factors and outcome variables.
Ten studies were included in the review. One study showed that Black patients had higher AMI-related readmission rates compared to White patients (mean difference 4.3% SD 1.4%, p < 0.001). Another study showed that income inequality was associated with increased risk of AMI-related readmissions (RR 1.18 95% CI, 1.13-1.23). One study found that unemployed individuals experienced significantly greater rates of AMI-related mortality than those working full-time (HR 2.08, 1.51-2.87). According to another study, lack of health insurance was associated with worse rates for in-hospital AMI-related mortality (OR 1.77, 1.72-1.82). Based on one study, AMI-related mortality was higher in those with <8 years of education compared to those with >16 years (17.5% vs. 3.5%, p < 0.0001). Five of six studies found a significant association between ZIP code/neighborhood/location and AMI-related readmission or mortality.
Race, ZIP code/neighborhood/location, insurance status, income/poverty, and education comprise SES factors found to be associated with AMI-related mortality and/or readmission outcomes. Including these SES factors in future updates of CMS's risk-adjusted models has the potential to provide more appropriate compensation mechanisms to hospitals.
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