Comorbid Conditions in Idiopathic Pulmonary Fibrosis: Recognition and Management.

Idiopathic pulmonary fibrosis (IPF), a fibrosing interstitial pneumonia of unknown etiology, primarily affects older adults and leads to a progressive decline in lung function and quality of life. With a median survival of 3-5 years, IPF is the most common and deadly of the idiopathic interstitial pneumonias. Despite the poor survivorship, there exists substantial variation in disease progression, making accurate prognostication difficult. Lung transplantation remains the sole curative intervention in IPF, but two anti-fibrotic therapies were recently shown to slow pulmonary function decline and are now approved for the treatment of IPF in many countries around the world. While the approval of these therapies represents an important first step in combatting of this devastating disease, a comprehensive approach to diagnosing and treating patients with IPF remains critically important. Included in this comprehensive assessment is the recognition and appropriate management of comorbid conditions. Though IPF is characterized by single organ involvement, many comorbid conditions occur within other organ systems. Common cardiovascular processes include coronary artery disease and pulmonary hypertension (PH), while gastroesophageal reflux and hiatal hernia are the most commonly encountered gastrointestinal disorders. Hematologic abnormalities appear to place patients with IPF at increased risk of venous thromboembolism, while diabetes mellitus (DM) and hypothyroidism are prevalent metabolic disorders. Several pulmonary comorbidities have also been linked to IPF, and include emphysema, lung cancer, and obstructive sleep apnea. While the treatment of some comorbid conditions, such as CAD, DM, and hypothyroidism is recommended irrespective of IPF, the benefit of treating others, such as gastroesophageal reflux and PH, remains unclear. In this review, we highlight common comorbid conditions encountered in IPF, discuss disease-specific diagnostic modalities, and review the current state of treatment data for several key comorbidities

Presentation of the acoustic and aerodynamic results of the Aladin 2 concept qualification testing

Wind tunnel tests were conducted of a scale model of the Aladin 2 aircraft. The propulsion system configuration is described and the air flow caused by jet ejection is analyzed. Three dimensional flow studies in the vicinity of the engine installation were made. Diagrams of the leading and trailing edge flaps are provided. Graphs are developed to show the aerodynamic performance under conditions of various airspeed and flap deflection

Arresting woodland bird decline in Australian agricultural landscapes: potential application of the European agri-environment model

This paper considered the applicability of the European model of land stewardship payments, in particular its support for biodiversity conservation in agricultural landscapes, to an Australian context. More broadly, the research approach described in the paper may also be applied to assessing the suitability of overseas stewardship schemes to the provision of any ecoservice in Australia, such as carbon sequestration and floodwater regulation

Research experiences for undergraduates in chemistry and biochemistry

Issued as final reportNational Science Foundation (U.S.

Cultural Historical Context of Qwu?gwes (Puget Sound, USA): A Preliminary Investigation

Recent research at the Puget Sound site of Qwu?gwes indicates that it contains a Late Period component of stone, bone-antler and shell artifacts, as well as a waterlogged section containing basketry, cordage and wooden artifacts and associated manufacturing debris. In order to place Qwu?gwes into the culture historical context of the Central Northwest Coast, we have applied cladistic tree-building methods to data derived from these artifacts and from artifacts commonly found in the northern part of Puget Sound, the Gulf of Georgia, the Strait of Juan de Fuca, Washington State, and Vancouver Island. The tree derived from the stone, bone-antler and shell data differs from the trees derived from the basketry data. This suggests that there was a difference in the transmission of information regarding the manufacture and use of the two groups of artifacts. Ideas pertaining to the artifacts made of stone, bone-antler and shell seem to have been shared widely, whereas ideas associated with the artifacts made of basketry were not. There are several possible explanations for this difference, but ethnographic evidence suggests that it is probably primarily a result of the basketry artifacts playing a role in ethnic identity signaling in a way that the stone, bone-antler and shell artifacts did not

Magnetically powered metachronal waves induce locomotion in self-assemblies

When tiny soft ferromagnetic particles are placed along a liquid interface and exposed to a vertical magnetic field, the balance between capillary attraction and magnetic repulsion leads to self-organization into well-defined patterns. Here, we demonstrate experimentally that precessing magnetic fields induce metachronal waves on the periphery of these assemblies, similar to the ones observed in ciliates and some arthropods. The outermost layer of particles behaves like an array of cilia or legs whose sequential movement causes a net and controllable locomotion. This bioinspired many-particle swimming strategy is effective even at low Reynolds number, using only spatially uniform fields to generate the waves

The acheulean handaxe: More like a bird's song than a beatles' tune?

The goal of this paper is to provoke debate about the nature of an iconic artifact— the Acheulean handaxe. Specifically, we want to initiate a conversation about whether or not they are cultural objects. The vast majority of archeologists assume that the behaviors involved in the production of handaxes were acquired by social learning and that handaxes are therefore cultural. We will argue that this assumption is not warranted on the basis of the available evidence and that an alternative hypothesis should be given serious consideration. This alternative hypothesis is that the form of Acheulean handaxes was at least partly under genetic control