Beyond a consensus classification for idiopathic interstitial pneumonias: progress and controversies

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74699/1/j.1365-2559.2008.03173.x.pd

Hypersensitivity pneumonitis: an overlooked cause of cough and dyspnea.

Hypersensitivity pneumonitis (HP) is an immune-mediated pulmonary disorder involving inflammation of the lung interstitium, terminal bronchioles, and alveoli caused by the immune response to the inhalation of an offending environmental airborne agent. It can manifest as exertional dyspnea, fatigue, weight loss, and progressive respiratory failure if left untreated. Because of its protean features, it can be misdiagnosed as other common obstructive lung conditions such as asthma. If triggers are not avoided, it can progress to irreversible pulmonary fibrosis. In this article, we present the case of a 51-year-old male who presented to our hospital with recurrent bouts of dyspnea and cough, initially diagnosed as an asthma exacerbation. He received a final diagnosis of HP after investigation of his workplace revealed airborne spores and surface molds from multiple fungal species, serology revealed eosinophilia, and computed tomography showed bronchiectasis. Avoidance of occupational exposure resulted in significant improvement of his respiratory symptoms after two months

Peer navigation improves diagnostic follow-up after breast cancer screening among Korean American women: results of a randomized trial

To test an intervention to increase adherence to diagnostic follow-up tests among Asian American women. Korean American women who were referred for a diagnostic follow-up test (mainly diagnostic mammograms) and who had missed their follow-up appointment were eligible to participate in the study. Women from two clinics (n = 176) were randomly allocated to a usual care control arm or a peer navigator intervention arm. A 20-min telephone survey was administered to women in both study arms six months after they were identified to assess demographic and socio-economic characteristics and the primary outcome, self-reported completion of the recommended follow-up exam. Among women who completed the survey at six-month follow-up, self-reported completion of follow-up procedures was 97% in the intervention arm and 67% in the control arm (p < 0.001). Based on an intent-to-treat analysis of all women who were randomized and an assumption of no completion of follow-up exam for women with missing outcome data, self-reported completion of follow-up was 61% in the intervention arm and 46% in the usual care control arm (p < 0.069). Our results suggest that a peer navigator intervention to assist Korean American women to obtain follow-up diagnostic tests after an abnormal breast cancer screening test is efficacious

γδ T cells protect against lung fibrosis via IL-22

Inflammation-induced pulmonary fibrosis (PF) leads to irreversible loss of lung function and is a predictor of mortality in numerous lung diseases. Why some subjects with lung inflammation but not others develop PF is unclear. In a mouse model of hypersensitivity pneumonitis that progresses to lung fibrosis upon repeated exposure to the ubiquitous microorganism Bacillus subtilis, γδ T cells expand in the lung and inhibit collagen deposition. We show that a subset of these γδ cells represents the predominant source of the Th17 cytokine IL-22 in this model. Preventing expression of IL-22, either by mutating the aryl hydrocarbon receptor (AhR) or inhibiting AhR signaling, accelerated lung fibrosis. Direct blockade of IL-22 also enhanced collagen deposition in the lung, whereas administration of recombinant IL-22 inhibited lung fibrosis. Moreover, the presence of protective γδ T cells and IL-22 diminished recruitment of CD4+ T cells to lung. These data reveal a protective pathway that involves the inhibition of αβ T cells by regulatory IL-22–secreting γδ T cells

Social Work in Health Care in 2025: The Landscape and Paths of Transformation

Social work in health care will, over the next 25 years, be transformed in concert with a complex and rapidly changing healthcare landscape and critical advances in behavioral and social science. Professional practice, research and education will be shaped by evolving patterns of health and illness, changing population demographics, developments in medicine, behavioral and social science, technology innovation and applications, and healthcare delivery cost and market forces. The profession’s practice, research and educational communities must take actions now to guide the necessary transformation of social work in health care and, in the process, significantly influence the delivery of behavioral and psychosocial health care

Use of Markers for the Detection and Treatment of Lung Cancer

The unacceptably high morbidity and mortality associated with the diagnosis of lung cancer mandates new approaches toward the early detection and treatment of this disease. Enhanced understanding of the molecular biology of the carcinogenic process is identifying many potential markers of risk of lung cancer occurrence as well as of poor prognosis. Identification of high risk populations who are at greatest risk of being diagnosed with and dying from lung cancer would allow delivery of more intensive screening and interventions to the individuals who are most likely to benefit from such strategies. This review examines the current status of markers of lung cancer risk, early detection, and prognosis, and their applicability to current standards of clinical care

Building the Profession’s Research Infrastructure

Beginning in 1988, the social work profession undertook a twenty-five year endeavor to enhance its research capacity and to assure greater representation of social work research needs, priorities and findings at the federal level, where major policy initiatives take place. Described here are some of the key processes, highlighting the efforts to achieve professional solidarity, and the interventions, by social workers, federal "insiders" and outside advocacy agents that carried the work forward. Details and accomplishments of this long-term, carefully sustained, and still incomplete professional self-strengthening change strategy provide insights for future collective professional endeavors. Twenty-five years ago the social work profession began a sustained effort to strengthen its research infrastructure in support of demonstrating practice effectiveness, advancing knowledge for critical social problems, and informing national policy. The steps and processes undertaken and the outcomes achieved by this effort have been described elsewhere (Austin, 1998; Corvo, Zlotnik, & Chen, 2008; TFSWR, 1991; Zlotnik, Biegel, & Solt, 2002; Zlotnik & Solt, 2006, 2008). What we want to capture through this, our eye-witness account, are some of the nuanced and specific actions, obstacles, and decisions involved in this effort. Recreating this case study of a profession's self-strengthening change strategy – targeted both to the external environment and its own internal one – can provide insights for future profession-wide, collective efforts