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Shapeshifters : a journey through the changing human body
\"From birth to death, a lyrical exploration of the role of transformation in human life. To be alive is to be in perpetual metamorphosis: growing, healing, learning, aging. In Shapeshifters, physician and writer Gavin Francis considers the inevitable changes all of our bodies undergo-such as birth, puberty, and death, but also laughter, sleeping, and healing-and those that only some of our bodies will: like getting a tattoo, experiencing psychosis, suffering anorexia, being pregnant, or undergoing a gender transition. In Francis's hands, each event becomes an opportunity to explore the meaning of identity and the natures-biological, psychological, and philosophical-of our selves. True to its own subject, Shapeshifters combines Francis's lyrical imagination and deep knowledge of medicine and the humanities for a life-altering read.\"--Publisher.
Book
Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort
Background
Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients.
Methods
Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox’s regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event.
Findings
Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 group (adjusted HR 1.65 (95% CI 1.11–2.46),
p
= 0.013), but not in influenza (1.74 (0.99–3.06),
p
= 0.052), or no viral infection groups (1.13 (0.68–1.86),
p
= 0.63). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups.
Interpretation
VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality.
Clinical trial registration
The study was registered at ClinicalTrials.gov, number NCT04359693.
Journal Article
Human errors : a panorama of our glitches, from pointless bones to broken genes
\"We humans like to think of ourselves as highly evolved creatures. But if we are supposedly evolution's greatest creation, why do we have such bad knees? Why do we catch head colds so often--two hundred times more often than a dog? How come our wrists have so many useless bones? Why is the vast majority of our genetic code pointless? And are we really supposed to swallow and breathe through the same narrow tube? Surely there's been some kind of mistake. As professor of biology Nathan H. Lents [posits] in [this book], our evolutionary history is nothing if not a litany of mistakes, each more entertaining and enlightening than the last\"-- Provided by publisher.
Book
Prevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation: a retrospective nationwide study
PurposeThrombocytopenia is a frequent and serious adverse event in patients treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock. Similarly to postcardiac surgery patients, heparin-induced thrombocytopenia (HIT) could represent the causative underlying mechanism. However, the epidemiology as well as related mortality regarding HIT and VA-ECMO remains largely unknown. We aimed to define the prevalence and associated 90-day mortality of HIT diagnosed under VA-ECMO.MethodsThis retrospective study included patients under VA-ECMO from 20 French centers between 2012 and 2016. Selected patients were hospitalized for more than 3 days with high clinical suspicion of HIT and positive anti-PF4/heparin antibodies. Patients were classified according to results of functional tests as having either Confirmed or Excluded HIT.ResultsA total of 5797 patients under VA-ECMO were screened; 39/5797 met the inclusion criteria, with HIT confirmed in 21/5797 patients (0.36% [95% CI] [0.21–0.52]). Fourteen of 39 patients (35.9% [20.8–50.9]) with suspected HIT were ultimately excluded because of negative functional assays. Drug-induced thrombocytopenia tended to be more frequent in Excluded HIT at the time of HIT suspicion (p = 0.073). The platelet course was similar between Confirmed and Excluded HIT (p = 0.65). Mortality rate was 33.3% [13.2–53.5] in Confirmed and 50% [23.8–76.2] in Excluded HIT (p = 0.48).ConclusionsPrevalence of HIT among patients under VA-ECMO is extremely low at 0.36% with an associated mortality rate of 33.3%, which appears to be in the same range as that observed in patients treated with VA-ECMO without HIT. In addition, HIT was ultimately ruled out in one-third of patients with clinical suspicion of HIT and positive anti-PF4/heparin antibodies.
Journal Article
Beyond conflict: exploring the spectrum of human–wildlife interactions and their underlying mechanisms
Humans have lived alongside and interacted with wild animals throughout evolutionary history. Even though wild animals can damage property, or injure humans and domesticated animals, not all interactions between humans and wildlife are negative. Yet, research has tended to focus disproportionately on negative interactions leading to negative outcomes, labelling this human–wildlife conflict. Studies have identified several factors, ranging from gender, religion, socio-economics and literacy, which influence people's responses to wildlife. We used the ISI Web of Knowledge database to assess quantitatively how human–wildlife interactions are framed in the scientific literature and to understand the hypotheses that have been invoked to explain these. We found that the predominant focus of research was on human–wildlife conflict (71%), with little coverage of coexistence (2%) or neutral interactions (8%). We suggest that such a framing is problematic as it can lead to biases in conservation planning by failing to consider the nuances of people's relationships with wildlife and the opportunities that exist for conservation. We propose a typology of human responses to wildlife impacts, ranging from negative to positive, to help moderate the disproportionate focus on conflict. We suggest that standardizing terminology and considering interactions beyond those that are negative can lead to a more nuanced understanding of human–wildlife relations and help promote greater coexistence between people and wildlife. We also list the various influential factors that are reported to shape human–wildlife interactions and, to generate further hypotheses and research, classify them into 55 proximate (correlates) and five ultimate (mechanisms) factors.
Journal Article
Coexistence between human and wildlife: the nature, causes and mitigations of human wildlife conflict around Bale Mountains National Park, Southeast Ethiopia
Human–wildlife conflict occurs when the needs and behavior of wildlife impact negatively on humans or when humans negatively affect the needs of wildlife. To explore the nature, causes and mitigations of human wildlife conflict, the coexistence between human and wildlife assessment was conducted around Bale Mountains National Park. Data were collected by means of household questionnaires, focus group discussion, interview, field observation and secondary sources. The nature and extent of human wildlife conflict in the study area were profoundly impacted humans, wild animal and the environment through crop damage, habitat disturbance and destruction, livestock predation, and killing of wildlife and human. The major causes of conflict manifested that agricultural expansion (30%), human settlement (24%), overgrazing by livestock (14%), deforestation (18%), illegal grass collection (10%) and poaching (4%). To defend crop raider, farmers have been practiced crop guarding (34%), live fencing (26%), scarecrow (22%), chasing (14%), and smoking (5%). However, fencing (38%), chasing (30%), scarecrow (24%) and guarding (8%) were controlling techniques to defend livestock predator animals. As emphasized in this study, human–wildlife conflicts are negative impacts on both human and wildlife. Accordingly, possible mitigate possibilities for peaceful co-existence between human and wildlife should be create awareness and training to the local communities, identifying clear border between the closure area and the land owned by the residents, formulate rules and regulation for performed local communities, equal benefit sharing of the local communities and reduction of human settlement encroachment into the national park range. Generally, researcher recommended that stakeholders and concerned bodies should be creating awareness to local community for the use of wildlife and human–wildlife conflict mitigation strategies.
Journal Article
Risk factors for bronchiolitis hospitalization in infants: A French nationwide retrospective cohort study over four consecutive seasons (2009-2013)
Objectives: Large studies are needed to update risk factors of bronchiolitis hospitalization. We performed a nationwide analysis of hospitalization rates for bronchiolitis over four consecutive bronchiolitis seasons to identify underlying medical disorders at risk of bronchiolitis hospitalization and assess their frequency.Methods: Data were retrieved from the French National Hospital Discharge database. Of all infants discharged alive from maternity wards from January 2008 to December 2013 in France (N = 3,884,791), we identified four consecutive cohorts at risk of bronchiolitis during the seasons of 2009–2010 to 2012–2013. The main outcome was bronchiolitis hospitalization during a season. Individual risk factors were collected.Results: Among infants, 6.0% were preterm and 2.0% had ≥1 chronic condition including 0.2% bronchopulmonary dysplasia (BPD) and 0.2% hemodynamically significant congenital heart disease (HS-CHD). Bronchiolitis hospitalization rates varied between seasons (min: 1.26% in 2010–2011; max: 1.48% in 2012–2013; p<0.001). Except omphalocele, the following conditions were associated with an increased risk for bronchiolitis hospitalization: solid organ (9.052; 95% CI, 4.664–17.567) and stem cell transplants (6.012; 95% CI, 3.441–10.503), muscular dystrophy (4.002; 95% CI, 3.1095–5.152), cardiomyopathy (3.407; 95% CI, 2.613–4.442), HS-CHD (3.404; 95% CI, 3.153–3.675), congenital lung disease and/or bronchial abnormalities, Down syndrome, congenital tracheoesophageal fistula, diaphragmatic hernia, pulmonary hypertension, chromosomal abnormalities other than Down syndrome, hemodynamically non-significant CHD, congenital abnormalities of nervous system, cystic fibrosis, cleft palate, cardiovascular disease occurring during perinatal period, and BPD.Conclusion: Besides prematurity, BPD, and HS–CHD, eighteen underlying conditions were associated with a significant increased risk for bronchiolitis hospitalization in a nationwide population.
Journal Article