scholarly journals Re-drawing the Maps for Endemic Mycoses

2020 ◽  
Vol 185 (5) ◽  
pp. 843-865
Author(s):  
Nida Ashraf ◽  
Ryan C. Kubat ◽  
Victoria Poplin ◽  
Antoine A. Adenis ◽  
David W. Denning ◽  
...  
Keyword(s):  
Climate Change ◽  
Clinical Practice ◽  
Diagnostic Tests ◽  
Medical Literature ◽  
Systemic Disease ◽  
Fungal Diseases ◽  
The Past ◽  
Geographic Boundaries ◽  
Endemic Fungi ◽  
Endemic Mycoses

AbstractEndemic mycoses such as histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, and talaromycosis are well-known causes of focal and systemic disease within specific geographic areas of known endemicity. However, over the past few decades, there have been increasingly frequent reports of infections due to endemic fungi in areas previously thought to be “non-endemic.” There are numerous potential reasons for this shift such as increased use of immune suppressive medications, improved diagnostic tests, increased disease recognition, and global factors such as migration, increased travel, and climate change. Regardless of the causes, it has become evident that our previous understanding of endemic regions for these fungal diseases needs to evolve. The epidemiology of the newly described Emergomyces is incomplete; our understanding of it continues to evolve. This review will focus on the evidence underlying the established areas of endemicity for these mycoses as well as new data and reports from medical literature that support the re-thinking these geographic boundaries. Updating the endemic fungi maps would inform clinical practice and global surveillance of these diseases.

scholarly journals Demystifying the Medical Literature

2016 ◽  
Vol 6 (4) ◽  
pp. 556-567
Author(s):  
Christopher Greeley
Keyword(s):  
Scientific Knowledge ◽  
Evidence Based Medicine ◽  
Diagnostic Tests ◽  
Medical Literature ◽  
Current Medical ◽  
Evidence Based ◽  
The Past ◽  
Based Medicine ◽  
Critical Literature ◽  
Historic Background

The published literature is not just the ongoing record of current medical and scientific knowledge; it is a record of the past and can give an eye toward future knowledge. Reading the published literature can give a view of the evolution of knowledge on a particular question, the growth of a discipline, the identification of new diseases, and the refinement of diagnostic tests. The reality is that most busy physicians read only the abstract of an article. The purpose of this article is to place published medical literature into a context and to provide some considerations for critically evaluating articles. This paper will provide historic background of evidence-based medicine and medical publications. Specific strategies for critical literature appraisal are highlights and pitfalls to avoid are outlined.

Evidence-Based Guidelines—An Introduction

Hematology ◽  
2008 ◽  
Vol 2008 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Wendy Lim ◽  
Donald M. Arnold ◽  
Veronika Bachanova ◽  
Richard L. Haspel ◽  
Rachel P. Rosovsky ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
North America ◽  
Practice Guidelines ◽  
Diagnostic Tests ◽  
Medical Literature ◽  
Evidence Based ◽  
Cooperative Groups ◽  
Professional Societies ◽  
Evidence Based Guidelines

Abstract Recommendations in the form of clinical practice guidelines are increasingly common. Clinical guidelines are systematically developed statements designed to help administrators, practitioners and patients make decisions about appropriate health care for specific circumstances. In North America, guidelines developed by professional societies, government panels and cooperative groups are frequently used to measure quality, to allocate resources and to determine how health care dollars are spent. For clinicians, guidelines provide a summary of the relevant medical literature and offer assistance in deciding which diagnostic tests to order, which treatments to use for specific conditions, when to discharge patients from the hospital, and many other aspects of clinical practice.

Denouement: World Politics, Systemic Leadership, and Climate Change

2018 ◽  
Author(s):  
William R. Thompson ◽  
Leila Zakhirova
Keyword(s):  
Climate Change ◽  
Global Warming ◽  
World Politics ◽  
First Century ◽  
Modern World ◽  
Climate Fluctuations ◽  
The Past ◽  
Agrarian Economy ◽  
Historical Processes

In this final chapter, we conclude by recapitulating our argument and evidence. One goal of this work has been to improve our understanding of the patterns underlying the evolution of world politics over the past one thousand years. How did we get to where we are now? Where and when did the “modern” world begin? How did we shift from a primarily agrarian economy to a primarily industrial one? How did these changes shape world politics? A related goal was to examine more closely the factors that led to the most serious attempts by states to break free of agrarian constraints. We developed an interactive model of the factors that we thought were most likely to be significant. Finally, a third goal was to examine the linkages between the systemic leadership that emerged from these historical processes and the global warming crisis of the twenty-first century. Climate change means that the traditional energy platforms for system leadership—coal, petroleum, and natural gas—have become counterproductive. The ultimate irony is that we thought that the harnessing of carbon fuels made us invulnerable to climate fluctuations, while the exact opposite turns out to be true. The more carbon fuels are consumed, the greater the damage done to the atmosphere. In many respects, the competition for systemic leadership generated this problem. Yet it is unclear whether systemic leadership will be up to the task of resolving it.

scholarly journals Emergency management of the paediatric patient with convulsive status epilepticus

2021 ◽  
Vol 26 (1) ◽  
pp. 50-57
Author(s):  
Kyle C McKenzie ◽  
Cecil D Hahn ◽  
Jeremy N Friedman
Keyword(s):  
Clinical Practice ◽  
Status Epilepticus ◽  
Emergency Management ◽  
Treatment Algorithm ◽  
Position Statement ◽  
Convulsive Status Epilepticus ◽  
Pharmacological Management ◽  
The Past ◽  
New Treatment ◽  
New Evidence

Abstract This guideline addresses the emergency management of convulsive status epilepticus (CSE) in children and infants older than 1 month of age. It replaces a previous position statement from 2011, and includes a new treatment algorithm and table of recommended medications based on new evidence and reflecting the evolution of clinical practice over the past several years. This statement emphasizes the importance of timely pharmacological management of CSE, and includes some guidance for diagnostic approach and supportive care.

scholarly journals The elusive parasite: comparing macroscopic, immunological, and genomic approaches to identifying malaria in human skeletal remains from Sayala, Egypt (third to sixth centuries AD)

2021 ◽  
Vol 13 (7) ◽  
Author(s):  
Alvie Loufouma Mbouaka ◽  
Michelle Gamble ◽  
Christina Wurst ◽  
Heidi Yoko Jäger ◽  
Frank Maixner ◽  
...  
Keyword(s):  
Diagnostic Tests ◽  
Sample Selection ◽  
Human Remains ◽  
Rapid Diagnostic Tests ◽  
Skeletal Remains ◽  
Pathological Changes ◽  
Human Skeletal Remains ◽  
The Past ◽  
A Site ◽  
Capture Sequencing

AbstractAlthough malaria is one of the oldest and most widely distributed diseases affecting humans, identifying and characterizing its presence in ancient human remains continue to challenge researchers. We attempted to establish a reliable approach to detecting malaria in human skeletons using multiple avenues of analysis: macroscopic observations, rapid diagnostic tests, and shotgun-capture sequencing techniques, to identify pathological changes, Plasmodium antigens, and Plasmodium DNA, respectively. Bone and tooth samples from ten individuals who displayed skeletal lesions associated with anaemia, from a site in southern Egypt (third to sixth centuries AD), were selected. Plasmodium antigens were detected in five of the ten bone samples, and traces of Plasmodium aDNA were detected in six of the twenty bone and tooth samples. There was relatively good synchronicity between the biomolecular findings, despite not being able to authenticate the results. This study highlights the complexity and limitations in the conclusive identification of the Plasmodium parasite in ancient human skeletons. Limitations regarding antigen and aDNA preservation and the importance of sample selection are at the forefront of the search for malaria in the past. We confirm that, currently, palaeopathological changes such as cribra orbitalia are not enough to be certain of the presence of malaria. While biomolecular methods are likely the best chance for conclusive identification, we were unable to obtain results which correspond to the current authentication criteria of biomolecules. This study represents an important contribution in the refinement of biomolecular techniques used; also, it raises new insight regarding the consistency of combining several approaches in the identification of malaria in past populations.

scholarly journals Noncompaction Cardiomyopathy—History and Current Knowledge for Clinical Practice

2021 ◽  
Vol 10 (11) ◽  
pp. 2457
Author(s):  
Birgit J. Gerecke ◽  
Rolf Engberding
Keyword(s):  
Clinical Practice ◽  
Current Knowledge ◽  
Clinical Manifestations ◽  
Clinical Patient ◽  
Noncompaction Cardiomyopathy ◽  
The Past ◽  
Wide Range ◽  
Morphological Variants ◽  
A Current ◽  
Healthy Persons

Noncompaction cardiomyopathy (NCCM) has gained increasing attention over the past twenty years, but in daily clinical practice NCCM is still rarely considered. So far, there are no generally accepted diagnostic criteria and some groups even refuse to acknowledge it as a distinct cardiomyopathy, and grade it as a variant of dilated cardiomyopathy or a morphological trait of different conditions. A wide range of morphological variants have been observed even in healthy persons, suggesting that pathologic remodeling and physiologic adaptation have to be differentiated in cases where this spongy myocardial pattern is encountered. Recent studies have uncovered numerous new pathogenetic and pathophysiologic aspects of this elusive cardiomyopathy, but a current summary and evaluation of clinical patient management are still lacking, especially to avoid mis- and overdiagnosis. Addressing this issue, this article provides an up to date overview of the current knowledge in classification, pathogenesis, pathophysiology, epidemiology, clinical manifestations and diagnostic evaluation, including genetic testing, treatment and prognosis of NCCM.

Arteriovenous fistula cannulation in hemodialysis: A vascular access clinical practice guidelines narrative review

2021 ◽  
pp. 112972982110069
Author(s):  
Rui Pinto ◽  
Clemente Sousa ◽  
Anabela Salgueiro ◽  
Isabel Fernandes
Keyword(s):  
Clinical Practice ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Good Evidence ◽  
Preparation Technique ◽  
Patient Centered ◽  
The Past ◽  
Centered Care

The cannulation of an arteriovenous fistula (AVF) by the hemodialysis (HD) nurse is challenging. Despite it being the focus of extensive research, it is still one of the majors causes of damage making it prone to failure. A considerable number of Clinical Practice Guidelines (CPGs) for the management of vascular access (VA) have been published worldwide over the past two decades. This review aimed to assess all information available in the selected CPG regarding AVF cannulation for HD providing a comprehensive analysis in order to interpret possible future cannulation approaches. A total of seven CPGs were described in a coding table separated in seven subthemes: Initiation of cannulation, preparation, technique, needle selection, surveillance, pain, and education. Our analysis outlines current CPGs for HD VA cannulation with lack of good evidence support for the majority of the recommendations, showing that, there is an urgent need for international collaboration and coordination to ensure relevant and high-quality evidence. Future CPGs must consider recommendations with better grading of evidence aiming patient-centered care and nurse decision models that can potentially represent better AVF cannulation outcomes.

scholarly journals Ensemble models on palaeoclimate to predict India's groundwater challenge

2013 ◽  
Vol 2 (3) ◽  
Author(s):  
Partha Sarathi Datta
Keyword(s):  
Climate Change ◽  
Climate Models ◽  
Global Climate ◽  
Global Climate Models ◽  
Humid Climate ◽  
Ensemble Models ◽  
North West ◽  
The Past ◽  
The North ◽  
14C Age

In many parts of the world, freshwater crisis is largely due to increasing water consumption and pollution by rapidly growing population and aspirations for economic development, but, ascribed usually to the climate. However, limited understanding and knowledge gaps in the factors controlling climate and uncertainties in the climate models are unable to assess the probable impacts on water availability in tropical regions. In this context, review of ensemble models on δ18O and δD in rainfall and groundwater, 3H- and 14C- ages of groundwater and 14C- age of lakes sediments helped to reconstruct palaeoclimate and long-term recharge in the North-west India; and predict future groundwater challenge. The annual mean temperature trend indicates both warming/cooling in different parts of India in the past and during 1901–2010. Neither the GCMs (Global Climate Models) nor the observational record indicates any significant change/increase in temperature and rainfall over the last century, and climate change during the last 1200 yrs BP. In much of the North-West region, deep groundwater renewal occurred from past humid climate, and shallow groundwater renewal from limited modern recharge over the past decades. To make water management to be more responsive to climate change, the gaps in the science of climate change need to be bridged.

scholarly journals Observed Differences in Diagnostic Test Accuracy between Patient Subgroups: Is It Real or Due to Reference Standard Misclassification?

2007 ◽  
Vol 53 (10) ◽  
pp. 1725-1729 ◽  
Author(s):  
Corné Biesheuvel ◽  
Les Irwig ◽  
Patrick Bossuyt
Keyword(s):  
Clinical Practice ◽  
Diagnostic Test ◽  
Sensitivity And Specificity ◽  
Diagnostic Test Accuracy ◽  
Test Accuracy ◽  
Reference Standard ◽  
Target Condition ◽  
Test Sensitivity ◽  
The Past ◽  
Patient Subgroups

Abstract Before a new test is introduced in clinical practice, its accuracy should be assessed. In the past decade, researchers have put an increased emphasis on exploring differences in test sensitivity and specificity between patient subgroups. If the reference standard is imperfect and the prevalence of the target condition differs among subgroups, apparent differences in test sensitivity and specificity between subgroups may be caused by reference standard misclassification. We provide guidance on how to determine whether observed differences may be explained by reference standard misclassification. Such misclassification may be ascertained by examining how the apparent sensitivity and specificity change with the prevalence of the target condition in the subgroups.

scholarly journals Chlorine-free synthesis: An overview

2012 ◽  
Vol 84 (3) ◽  
pp. 411-423 ◽  
Author(s):  
Pietro Tundo
Keyword(s):  
Climate Change ◽  
Industrial Revolution ◽  
High Energy ◽  
Special Topic ◽  
Ozone Layer Depletion ◽  
The Past ◽  
Process Chemistry ◽  
End Products ◽  
Chemical Strategies ◽  
Topic Issue

Since the Industrial Revolution, chlorine has featured as an iconic molecule in process chemistry even though its production by electrolysis of sodium chloride is very energy-intensive. Owing to its high energy and reactivity, chlorine allows the manufacture of chlorinated derivatives in a very easy way: AlCl3, SnCl4, TiCl4, SiCl4, ZnCl2, PCl3, PCl5, POCl3, COCl2, etc. in turn are pillar intermediates in the production of numerous everyday goods. This kind of chloride chemistry is widely used because the energy is transferred to these intermediates, making further syntheses easy. The environmental and health constraints (toxicity and eco-toxicity, ozone layer depletion) and the growing need for energy (energy efficiency, climate change) force us to take advantage from available knowledge to develop new chemical strategies. Substitution of chlorine in end products in compounds where “chlorine is used in the making” means that we avoid electrolysis as primary energetic source; this makes chemistry “without chlorine” considerably more difficult and illustrates why it has not found favor in the past. The rationale behind this Special Topic issue is to seek useful and industrially relevant examples for alternatives to chlorine in synthesis, so as to facilitate the development of industrially relevant and implementable breakthrough technologies.

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