Lobar Pneumonia: A Bacteriological and Clinical Investigation of 100 Cases

The following is a summary of the observations which were made during the course of the present investigation. (I) Isolation and identification of the pneumococcus A. The intraperitoneal inoculation of mice proved an excellent method of obtaining pneumococci in sufficient quantity for purposes of identification. B. The sodium taurocholate solution gave good results in most cases, but two strains of Type I. organisms were met with which were insoluble in the taurocholate solution. C. The microscopic agglutination test which was carried out in conjunction with the macroscopic test was found to give results which were in perfect agreement with the results obtained by the older method. (II) Incidence of the serological types. The percentage incidence of the different types is shown in Table III. Prom Tables IV. and VI. it will be seen that in the age group 16 to 60 the greatest number of cases were due to Type II organisms, while in the 1 to 15 age group the greatest number were due to Type I organisms. (III) Clinical Investigation of the cases. A. In the clinical examination of the cases there was no evidence that any train of symptoms existed by which one type could be distinguished from another. Certain minor differences did however exist between the various types. In Type I. cases the onset of the condition was more often associated with shivering. The temperatures in these cases tended to run at a slightly higher level and were less liable to remissions than in the other types. In Group IV. cases, more especially among the adults there was a greater percentage of cases giving a history of previous respiratory disease. B. In the present series of cases, blood stained sputa were met with in 63% of the cases. Among the adults 80% had blood stained sputa, and of this number 67.9% were met with in cases due to the fixed types, and 12.3% in Group IV. cases. Between the fixed types there was a slightly greater incidence in Type II. than in Type I. C. Complications. The number of cases which developed complications was relatively small. Of the four cases manlfesting involvement of the nervous system 50% were due to Group IV organisms. (IV) Mortality The mortality rate in the present series was only 9%. This is in contrast to the high death rate of 50% in cases due to Type III. pneumococci. (V) Lung puncture Lung puncture affords an accurate means of obtaining the organism in cases where sputum is not available. In one case, the type of pneumococcus isolated from the lung Juice differed from that isolated from the sputum. (VI) Significance of a bacteraemia in lobar pneumonia The presence of a bacteraemia in cases of lobar pneumonia, as estimated by finding the pneumococcus in 2 c. cs of blood, is of grave significance. In the present series 60% of the cases with a bacteraemia terminated fatally

El Farol Revisited

This article is concerned with the global behavior of agents in the El Farol bar problem. In particular, we discuss the global attendance in terms of its mean and variance, and show that there is a strong dependence of both on the externally imposed comfort level. We present a possible interpretation for the observed behavior, and propose that the mean attendance converges to the perceived threshold value as opposed to the actually imposed one.Comment: 6 pages, 3 figure

Patient and researcher perspectives on facilitating patient and public involvement in rheumatology research

No abstract available

Predictors of poor function in RA based on two prospective UK inception cohorts. Do comorbidities matter?

© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/)Objectives. Evidence suggests that factors beyond disease activity associate with functional disability in RA. The primary study objective was to explore associations between comorbidities, sociodemographic factors and functional outcomes at five and 10 years.  Methods. RA patients from two UK prospective cohorts were grouped into low (<1.5) and high (1.5) five- and 10-year health assessment questionnaire (HAQ) score. Clinical variables (e.g. disease activity, rheumatoid nodules, erosions) and sociodemographic factors (e.g. ethnicity, deprivation) were recorded at baseline and yearly thereafter. Comorbidity was measured using the Rheumatic Diseases Comorbidity Index (RDCI). Binary logistic regression models were fitted using multiple imputation.  Results. In total, 2701 RA patients were recruited (mean age 56.1 years, 66.9% female). A total of 1718 (63.4%) had five-year and 820 (30.4%) 10-year follow-up data. In multivariable analysis, no association was found between RDCI and HAQ 1.5 at five or 10 years. Sociodemographic factors (increased age at disease onset, female gender, minority ethnicity) were associated with higher odds of HAQ 1.5 at five and 10 years, with worse deprivation additionally associated with HAQ 1.5 at 10 years (OR 0.79, 95% CI: 0.69, 0.90).  Conclusion. Comorbidities at baseline have not been found to be associated with worse RA functional outcome in the long-term. On the other hand, sociodemographic factors, independently of disease measures, are associated with worse functional outcome in RA at five and 10 years, in models adjusting for comorbidity burden. Tailoring management interventions according to not only clinical disease parameters but also patient sociodemographic factors may improve long-term outcomes including functional disability.Peer reviewe

Neurophysiology and Neural Computation

Contains reports on three research projects

Physiology

Contains reports on three research projects

Personalised care packages for people with rheumatoid arthritis: a mixed-methods study

© 2024 The Author(s). . Published by BMJ. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC), https://creativecommons.org/licenses/by-nc/4.0/Objectives Disease management in rheumatoid arthritis (RA) requires holistic assessment. We aimed to design personalised care packages suitable for people with RA. Methods This study was conducted using a mixed-methods approach and exploratory sequential design. Consensus workshops were held, involving people with RA and healthcare professionals (HCPs) treating them. Subsequently, an online survey sought views on future care packages for people with RA at relevant disease progression/stages, based on (1) results from previous quantitative data analyses (eg, socioeconomic/clinical factors), and (2) themes identified during workshops. Results Two conceptual care pathways were identified: (1) around the time of RA diagnosis, an early opportunity to influence the disease course; (2) for individuals with established RA, emphasising the importance of ‘the right MDT member at the right time’. Three care packages were suggested: (1) early care package (around RA diagnosis): introduction to MDT; (2) continuity of care package (established RA): primary/secondary providers; and (3) personalised holistic care package: integral to packages 1 and 2, implemented alongside allied health professionals. The survey received 41 responses; 82.9% agreed that people with RA need a consistent ‘early care package’ at diagnosis. 85.4% approved of additional care packages tailored to individuals’ clinical, psychological and social needs when moving to different stages of their long-term disease. Fleiss’ Kappa calculations demonstrated fair level of agreement among respondents. Conclusion Two care pathways, with three tailored care packages, were identified, with potential to improve management of people with RA. Future research will help to determine if such care packages can impact clinical (including patient-reported) outcomes.Peer reviewe