Uncontrolled pilot studies demonstrated promising results of endoscopic lung volume reduction using emphysematous lung sealant (ELS) in patients with advanced, upper lobe predominant emphysema. We ...aimed to evaluate the safety and efficacy of ELS in a randomised controlled setting.Patients were randomised to ELS plus medical treatment or medical treatment alone. Despite early termination for business reasons and inability to assess the primary 12-month end-point, 95 out of 300 patients were successfully randomised, providing sufficient data for 3- and 6-month analysis.57 patients (34 treatment and 23 control) had efficacy results at 3 months; 34 (21 treatment and 13 control) at 6 months. In the treatment group, 3-month lung function, dyspnoea, and quality of life improved significantly from baseline when compared to control. Improvements persisted at 6 months with >50% of treated patients experiencing clinically important improvements, including some whose lung function improved by >100%. 44% of treated patients experienced adverse events requiring hospitalisation (2.5-fold more than control, p=0.01), with two deaths in the treated cohort. Treatment responders tended to be those experiencing respiratory adverse events.Despite early termination, results show that minimally invasive ELS may be efficacious, yet significant risks (probably inflammatory) limit its current utility.
A round‐robin study has been carried out to estimate the impact of the human element in small‐angle scattering data analysis. Four corrected datasets were provided to participants ready for analysis. ...All datasets were measured on samples containing spherical scatterers, with two datasets in dilute dispersions and two from powders. Most of the 46 participants correctly identified the number of populations in the dilute dispersions, with half of the population mean entries within 1.5% and half of the population width entries within 40%. Due to the added complexity of the structure factor, far fewer people submitted answers on the powder datasets. For those that did, half of the entries for the means and widths were within 44 and 86%, respectively. This round‐robin experiment highlights several causes for the discrepancies, for which solutions are proposed.
A data‐analysis round robin was performed using four real‐world datasets to quantify the role of the human factor in analysis; the 46 responses show that the analyses by different researchers and laboratories may not be directly comparable, with large reporting inconsistencies in distribution widths and volume fractions. Several underlying causes for these inconsistencies are highlighted that can be addressed by the community.
A 73-year-old man with a history of postpneumonectomy empyema and a long-term chest tube since 1979 presented with fever, chills, leukocytosis, and purulent fluid from the left tube thoracostomy. CT ...scan and bronchoscopy demonstrated a right lower lobe pneumonia and a left mainstem dehiscence with direct communication to the left tube thoracostomy. He underwent primary closure of the bronchopleural fistula with latissimus dorsi muscle flap coverage after antibiotic therapy for right lower lobe pneumonia.
A Round Robin study has been carried out to estimate the impact of the human element in small-angle scattering data analysis. Four corrected datasets were provided to participants ready for analysis. ...All datasets were measured on samples containing spherical scatterers, with two datasets in dilute dispersions, and two from powders. Most of the 46 participants correctly identified the number of populations in the dilute dispersions, with half of the population mean entries within 1.5% and half of the population width entries within 40%, respectively. Due to the added complexity of the structure factor, much fewer people submitted answers on the powder datasets. For those that did, half of the entries for the means and widths were within 44% and 86% respectively. This Round Robin experiment highlights several causes for the discrepancies, for which solutions are proposed.
Gamma-aminobutyric acid receptor agonist medications are the most commonly used sedatives for intensive care unit (ICU) patients, yet preliminary evidence indicates that the alpha(2) agonist ...dexmedetomidine may have distinct advantages.
To compare the efficacy and safety of prolonged sedation with dexmedetomidine vs midazolam for mechanically ventilated patients.
Prospective, double-blind, randomized trial conducted in 68 centers in 5 countries between March 2005 and August 2007 among 375 medical/surgical ICU patients with expected mechanical ventilation for more than 24 hours. Sedation level and delirium were assessed using the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the ICU.
Dexmedetomidine (0.2-1.4 microg/kg per hour n = 244) or midazolam (0.02-0.1 mg/kg per hour n = 122) titrated to achieve light sedation (RASS scores between -2 and +1) from enrollment until extubation or 30 days.
Percentage of time within target RASS range. Secondary end points included prevalence and duration of delirium, use of fentanyl and open-label midazolam, and nursing assessments. Additional outcomes included duration of mechanical ventilation, ICU length of stay, and adverse events.
There was no difference in percentage of time within the target RASS range (77.3% for dexmedetomidine group vs 75.1% for midazolam group; difference, 2.2% 95% confidence interval {CI}, -3.2% to 7.5%; P = .18). The prevalence of delirium during treatment was 54% (n = 132/244) in dexmedetomidine-treated patients vs 76.6% (n = 93/122) in midazolam-treated patients (difference, 22.6% 95% CI, 14% to 33%; P < .001). Median time to extubation was 1.9 days shorter in dexmedetomidine-treated patients (3.7 days 95% CI, 3.1 to 4.0 vs 5.6 days 95% CI, 4.6 to 5.9; P = .01), and ICU length of stay was similar (5.9 days 95% CI, 5.7 to 7.0 vs 7.6 days 95% CI, 6.7 to 8.6; P = .24). Dexmedetomidine-treated patients were more likely to develop bradycardia (42.2% 103/244 vs 18.9% 23/122; P < .001), with a nonsignificant increase in the proportion requiring treatment (4.9% 12/244 vs 0.8% 1/122; P = .07), but had a lower likelihood of tachycardia (25.4% 62/244 vs 44.3% 54/122; P < .001) or hypertension requiring treatment (18.9% 46/244 vs 29.5% 36/122; P = .02).
There was no difference between dexmedetomidine and midazolam in time at targeted sedation level in mechanically ventilated ICU patients. At comparable sedation levels, dexmedetomidine-treated patients spent less time on the ventilator, experienced less delirium, and developed less tachycardia and hypertension. The most notable adverse effect of dexmedetomidine was bradycardia.
clinicaltrials.gov Identifier: NCT00216190 Published online February 2, 2009 (doi:10.1001/jama.2009.56).
Improved medical care of individuals with Down syndrome (DS) has led to an increase in life expectancy to over the age of 60 years. In conjunction, there has been an increase in age‐related ...co‐occurring conditions including Alzheimer's disease (AD). Understanding the factors that underlie symptom and age of clinical presentation of dementia in people with DS may provide insights into the mechanisms of sporadic and DS‐associated AD (DS‐AD). In March 2019, the Alzheimer's Association, Global Down Syndrome Foundation and the LuMind IDSC Foundation partnered to convene a workshop to explore the state of the research on the intersection of AD and DS research; to identify research gaps and unmet needs; and to consider how best to advance the field. This article provides a summary of discussions, including noting areas of emerging science and discovery, considerations for future studies, and identifying open gaps in our understanding for future focus.
Understanding the areas used by migratory marine animals and their movements is critical in supporting management decisions that target their conservation. This is especially important for long-lived ...species with large geographic extents and are more vulnerable to multiple threats. We conducted a literature review on data collected for 173 marine mammal, marine fish, sea turtle, and seabird species and determined that tracking animal movements with telemetry methods was the most effective tool for demonstrating ecological connectivity. From the references included for review, we found more references for sea turtles than other taxa, and more information was collected for all four taxa in the northern hemisphere. In addition, 30 % of references presented methods to process the raw telemetry tracks, only 11 % of references mentioned a repository for archiving data, and there was no significant trend in the number of references and current conservation level. For four case study species (Atlantic bluefin tuna, humpback whale, loggerhead sea turtle, and wandering albatross), we found more information published for adults and on the descriptions of sites focused on feeding and breeding activities, while sites used for migration and connectivity among areas used for migration were not well represented. Although connectivity data were published for most of the migratory marine species we reviewed, several knowledge gaps existed and there were limitations of the data presented within publications for direct applications to area-based management. We provided recommendations to address research gaps and guidance to improve the integration of connectivity data into area-based management decisions.
•Conserving marine connectivity is critical for ecosystem functioning.•Migratory species movements demonstrate marine connectivity, but data gaps exist.•We gave guidance for presenting connectivity research to improve uptake in management.
The distributions of migratory species in the ocean span local, national and international jurisdictions. Across these ecologically interconnected regions, migratory marine species interact with ...anthropogenic stressors throughout their lives. Migratory connectivity, the geographical linking of individuals and populations throughout their migratory cycles, influences how spatial and temporal dynamics of stressors affect migratory animals and scale up to influence population abundance, distribution and species persistence. Population declines of many migratory marine species have led to calls for connectivity knowledge, especially insights from animal tracking studies, to be more systematically and synthetically incorporated into decision-making. Inclusion of migratory connectivity in the design of conservation and management measures is critical to ensure they are appropriate for the level of risk associated with various degrees of connectivity. Three mechanisms exist to incorporate migratory connectivity into international marine policy which guides conservation implementation: site-selection criteria, network design criteria and policy recommendations. Here, we review the concept of migratory connectivity and its use in international policy, and describe the Migratory Connectivity in the Ocean system, a migratory connectivity evidence-base for the ocean. We propose that without such collaboration focused on migratory connectivity, efforts to effectively conserve these critical species across jurisdictions will have limited effect.
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