No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors ...associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.
The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.
2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7–9). The proportion of patients reporting full recovery was unchanged between 5 months (501 25·5% of 1965) and 1 year (232 28·9% of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 95% CI 0·46–0·99), obesity (0·50 0·34–0·74) and invasive mechanical ventilation (0·42 0·23–0·76). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 IQR 0·74–1·00), at 5 months (0·74 0·64–0·88) to 1 year (0·75 0·62–0·88), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.
The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.
UK Research and Innovation and National Institute for Health Research.
...there is frequent reluctance to perform surgical lung biopsy in patients with clinically unclassifiable ILD due to safety concerns. ...it should accommodate all forms of fibrotic ILD and different ...types of diagnostic criteria (e.g., criteria based vs. consensus based). ...it should be agnostic to changes in existing diagnostic criteria or the creation of new diagnostic criteria. ...it should balance diagnostic certainty with clinical practicality, a balance that may differ in clinical vs. research settings.
The functionalization of methane, ethane, and other alkanes derived from fossil fuels is a central goal in the chemical enterprise. Recently, a photocatalytic system comprising Ce
Cl
(OR)
Ce
, ...cerium(IV); OR, -OCH
or -OCCl
CH
was disclosed. The system was reportedly capable of alkane activation by alkoxy radicals (RO•) formed by Ce
-OR bond photolysis. In this work, we present evidence that the reported carbon-hydrogen (C-H) activation of alkanes is instead mediated by the photocatalyst NEt
CeCl
(NEt
, tetraethylammonium), and RO• are not intermediates. Spectroscopic analyses and kinetics were investigated for C-H activation to identify chlorine radical (Cl•) generation as the rate-limiting step. Density functional theory calculations support the formation of Cl•alcohol adducts when alcohols are present, which can manifest a masked RO• character. This result serves as an important cautionary note for interpretation of radical trapping experiments.
Pneumocystis jiroveci pneumonia (PJP) is associated with high morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Little is known about PJP infections after HSCT because of ...the rarity of disease given routine prophylaxis. We report the results of a Center for International Blood and Marrow Transplant Research study evaluating the incidence, timing, prophylaxis agents, risk factors and mortality of PJP after autologous (auto) and allogeneic (allo) HSCT. Between 1995 and 2005, 0.63% allo recipients and 0.28% auto recipients of first HSCT developed PJP. Cases occurred as early as 30 days to beyond a year after allo HSCT. A nested case cohort analysis with supplemental data (n=68 allo cases, n=111 allo controls) revealed that risk factors for PJP infection included lymphopenia and mismatch after HSCT. After allo or auto HSCT, overall survival was significantly poorer among cases vs controls (P=0.0004). After controlling for significant variables, the proportional hazards model revealed that PJP cases were 6.87 times more likely to die vs matched controls (P<0.0001). We conclude PJP infection is rare after HSCT but is associated with high mortality. Factors associated with GVHD and with poor immune reconstitution are among the risk factors for PJP and suggest that protracted prophylaxis for PJP in high-risk HSCT recipients may improve outcomes.
Background. Candida species are the fourth most common cause of bloodstream infection and are the leading cause of invasive fungal infection among hospitalized patients in the United States. However, ...the frequency and outcomes attributable to the infection are uncertain. This retrospective study set out to estimate the incidence of candidemia in hospitalized adults and children in the United States and to determine attributable mortality, length of hospital stay, and hospital charges related to candidemia. Methods. We used the Nationwide Inpatient Sample 2000 for adult patients and the Kids' Inpatient Database 2000 for pediatric patients. We matched candidemia-exposed and candidemia-unexposed patients by the propensity scores for the probability of candidemia exposure, which were derived from patient characteristics. Attributable outcomes were calculated as the differences in estimates of outcomes between propensity score–matched patients with and without candidemia. Results. In the United States in 2000, candidemia was diagnosed in an estimated 1118 hospital admissions of pediatric patients and 8949 hospital admissions of adult patients, yielding a frequency of 43 cases per 100,000 pediatric admissions (95% confidence interval CI, 35–52 cases per 100,000 pediatric admissions) and 30 cases per 100,000 adult admissions (95% CI, 26–34 cases per 100,000 adult admissions). In pediatric patients, candidemia was associated with a 10.0% increase in mortality (95% CI, 6.2%–13.8%), a mean 21.1-day increase in length of stay (95% CI, 14.4–27.8 days), and a mean increase in total per-patient hospital charges of $92,266 (95% CI, $65,058–$119,474). In adult patients, candidemia was associated with a 14.5% increase in mortality (95% CI, 12.1%–16.9%), a mean 10.1-day increase in length of stay (95% CI, 8.9–11.3 days), and a mean increase in hospital charges of $39,331 (95% CI, $33,604–$45,602). Conclusion. The impact of candidemia on excess mortality, increased length of stay, and the burden of cost of hospitalization underscores the need for improved means of prevention and treatment of candidemia in adults and children.
Super star clusters are the end product of star formation under the most extreme conditions. As such, studying how their final stellar populations are assembled from their natal progenitor gas clouds ...can provide strong constraints on star formation theories. An obvious place to look for the initial conditions of such extreme stellar clusters is gas clouds of comparable mass and density, with no star formation activity. We present a method to identify such progenitor gas clouds and demonstrate the technique for the gas in the inner few hundred pc of our Galaxy. The method highlights three clouds in the region with similar global physical properties to the previously identified extreme cloud, G0.253 + 0.016, as potential young massive cluster (YMC) precursors. The fact that four potential YMC progenitor clouds have been identified in the inner 100 pc of the Galaxy, but no clouds with similar properties have been found in the whole first quadrant despite extensive observational efforts, has implications for cluster formation/destruction rates across the Galaxy. We put forward a scenario to explain how such dense gas clouds can arise in the Galactic Centre environment, in which YMC formation is triggered by gas streams passing close to the minimum of the global Galactic gravitational potential at the location of the central supermassive black hole, Sgr A*. If this triggering mechanism can be verified, we can use the known time interval since closest approach to Sgr A* to study the physics of stellar mass assembly in an extreme environment as a function of absolute time.
Abstract
The H2O Southern Galactic Plane Survey (HOPS) has mapped 100 deg2 of the Galactic plane for water masers and thermal molecular line emission using the 22 m Mopra telescope. We describe the ...automated spectral-line fitting pipelines used to determine the properties of emission detected in HOPS data cubes, and use these to derive the physical and kinematic properties of gas in the survey. A combination of the angular resolution, sensitivity, velocity resolution and high critical density of lines targeted make the HOPS data cubes ideally suited to finding precursor clouds to the most massive and dense stellar clusters in the Galaxy. We compile a list of the most massive HOPS ammonia regions and investigate whether any may be young massive cluster progenitor gas clouds. HOPS is also ideally suited to trace the flows of dense gas in the Galactic Centre. We find the kinematic structure of gas within the inner 500 pc of the Galaxy is consistent with recent predictions for the dynamical evolution of gas flows in the centre of the Milky Way. We confirm a recent finding that the dense gas in the inner 100 pc has an oscillatory kinematic structure with characteristic length-scale of 20 pc, and also identify similar oscillatory kinematic structure in the gas at radii larger than 100 pc. Finally, we make all of the above fits and the remaining HOPS data cubes across the 100 deg2 of the survey available to the community.
In the ProtecT trial, over 1600 men with PSA-detected localized prostate cancer were assigned to active monitoring, prostatectomy, or radiotherapy. Although more patients assigned to active ...monitoring had disease progression, overall survival was similar in the three groups.
The management of clinically localized prostate cancer that is detected on the basis of prostate-specific antigen (PSA) levels remains controversial. In the United States alone, an estimated 180,890 cases will be diagnosed in 2016, and 26,120 men will die from the disease.
1
The widespread use of PSA testing has resulted in a dramatic increase in the diagnosis and treatment of prostate cancer, but many men do not benefit from intervention because the disease is either indolent or disseminated at diagnosis. Prostate cancer often progresses slowly, and many men die of competing causes. In addition, interventions for prostate cancer can have . . .
This document provides clinical recommendations for the diagnosis of idiopathic pulmonary fibrosis (IPF). It represents a collaborative effort between the American Thoracic Society, European ...Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society.
The evidence syntheses were discussed and recommendations formulated by a multidisciplinary committee of IPF experts. The evidence was appraised and recommendations were formulated, written, and graded using the Grading of Recommendations, Assessment, Development, and Evaluation approach.
The guideline panel updated the diagnostic criteria for IPF. Previously defined patterns of usual interstitial pneumonia (UIP) were refined to patterns of UIP, probable UIP, indeterminate, and alternate diagnosis. For patients with newly detected interstitial lung disease (ILD) who have a high-resolution computed tomography scan pattern of probable UIP, indeterminate, or an alternative diagnosis, conditional recommendations were made for performing BAL and surgical lung biopsy; because of lack of evidence, no recommendation was made for or against performing transbronchial lung biopsy or lung cryobiopsy. In contrast, for patients with newly detected ILD who have a high-resolution computed tomography scan pattern of UIP, strong recommendations were made against performing surgical lung biopsy, transbronchial lung biopsy, and lung cryobiopsy, and a conditional recommendation was made against performing BAL. Additional recommendations included a conditional recommendation for multidisciplinary discussion and a strong recommendation against measurement of serum biomarkers for the sole purpose of distinguishing IPF from other ILDs.
The guideline panel provided recommendations related to the diagnosis of IPF.
With the advent of the Heliophysics/Geospace System Observatory (H/GSO), a complement of multi-spacecraft missions and ground-based observatories to study the space environment, data retrieval, ...analysis, and visualization of space physics data can be daunting. The Space Physics Environment Data Analysis System (SPEDAS), a grass-roots software development platform (
www.spedas.org
), is now officially supported by NASA Heliophysics as part of its data environment infrastructure. It serves more than a dozen space missions and ground observatories and can integrate the full complement of past and upcoming space physics missions with minimal resources, following clear, simple, and well-proven guidelines. Free, modular and configurable to the needs of individual missions, it works in both command-line (ideal for experienced users) and Graphical User Interface (GUI) mode (reducing the learning curve for first-time users). Both options have “crib-sheets,” user-command sequences in ASCII format that can facilitate record-and-repeat actions, especially for complex operations and plotting. Crib-sheets enhance scientific interactions, as users can move rapidly and accurately from exchanges of technical information on data processing to efficient discussions regarding data interpretation and science. SPEDAS can readily query and ingest all International Solar Terrestrial Physics (ISTP)-compatible products from the Space Physics Data Facility (SPDF), enabling access to a vast collection of historic and current mission data. The planned incorporation of Heliophysics Application Programmer’s Interface (HAPI) standards will facilitate data ingestion from distributed datasets that adhere to these standards. Although SPEDAS is currently Interactive Data Language (IDL)-based (and interfaces to Java-based tools such as Autoplot), efforts are under-way to expand it further to work with python (first as an interface tool and potentially even receiving an under-the-hood replacement). We review the SPEDAS development history, goals, and current implementation. We explain its “modes of use” with examples geared for users and outline its technical implementation and requirements with software developers in mind. We also describe SPEDAS personnel and software management, interfaces with other organizations, resources and support structure available to the community, and future development plans.
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