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Understanding tissue biology's heterogeneity is crucial for advancing precision medicine. Despite the centrality of the immune system in tissue homeostasis, a detailed and comprehensive map of immune cell distribution and interactions across human tissues and demographics remains elusive. To fill this gap, we harmonised data from 12,981 single-cell RNA sequencing samples and curated 29 million cells from 45 anatomical sites to create a comprehensive compositional and transcriptional healthy map of the healthy immune system. We used this resource and a novel multilevel modelling approach to track immune ageing and test differences across sex and ethnicity. We uncovered conserved and tissue-specific immune-ageing programs, resolved sex-dependent differential ageing and identified ethnic diversity in clinically critical immune checkpoints. This study provides a quantitative baseline of the immune system, facilitating advances in precision medicine. By sharing our immune map, we hope to catalyse further breakthroughs in cancer, infectious disease, immunology and precision medicine., Competing Interests: FJR receives institutional support as a coinvestigator and is subcontracted by the Peter MacCallum Cancer Centre for an investigator-initiated trial, which receives funding support from Sanofi/Regeneron Pharmaceuticals. The remaining authors declare no competing interests.

Acute severe ulcerative colitis (ASUC) is a distinctive ulcerative colitis flare presentation characterised by the presence of systemic inflammation as well as bloody diarrhoea, and occurs at least once in 25% of patients with ulcerative colitis during their disease course. Each episode carries a risk of complications, need for colectomy, and mortality. Little is known about ASUC pathogenesis, although impaired host-microbiota crosstalk involving pathobionts is suspected. In this Review, we discuss unanswered questions and results from the latest research on the medical-first-line, second-line, and potential third-line therapies-and surgical management of ASUC. We detail promising options for management, such as the use of enteral nutrition in combination with intravenous steroids, the ability to predict early failure of first-line or second-line therapies, and the emerging role of JAK inhibitors. An optimal framework to personalise therapy on the basis of multiomics tools is yet to be developed., Competing Interests: Declaration of interests PR declares consulting fees from AbbVie, Amgen, and Janssen. CLWS has served as a speaker for DiaSorin, has received research funding from the Robert C Bulley Charitable Foundation and St Vincent's Hospital Melbourne Research Endowment Fund, and is supported by a National Health and Medical Research Council (NHMRC) postgraduate scholarship. MC has served as a speaker, as a consultant, or has received research or education funding from MSD, AbbVie, Hospira, Pfizer, Takeda, Janssen, Ferring, Shire Pharmaceuticals, Dr Falk, Tillots Pharma, Biogen, Lilly, and Gilead. PDC has served as a consultant, an advisory board member, or a speaker for AbbVie, Baxter, Ferring, Janssen, Celltrion, Emerge Health, Shire, and Takeda, and is supported by an NHMRC Emerging Leader 2 Fellowship and has received research support from AbbVie, Ferring, Shire, Janssen, and Takeda. AS declares consulting fees from Johnson & Johnson and Stryker. DL declares counselling, boards, and transport or fees from AbbVie, Amgen, Biogaran, Biogen, Celltrion, Ferring, Galapagos, Janssen, Lilly, MSD, Pfizer, Prometheus, Roche, Takeda, and Theradiag., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Inappropriate cardiac telemetry use is associated with reduced patient flow and increased healthcare costs., Aim: To evaluate the outcomes of guideline-based application of cardiac telemetry., Methods: Phase I involved a prospective audit (March to August 2011) of telemetry use at a tertiary hospital. Data were collected on indication for telemetry and clinical outcomes. Phase II prospectively included patients more than 18 years under general medicine requiring ward-based telemetry. As phase II occurred at a time remotely from phase I, an audit similar to phase I (phase II - baseline) was completed prior to a 3-month intervention (May to August 2015). The intervention consisted of a daily telemetry ward round and an admission form based on the American Heart Association guidelines (class I, telemetry indicated; class II, telemetry maybe indicated; class III, telemetry not indicated). Patient demographics, telemetry data, and clinical outcomes were studied. Primary endpoint was the percentage reduction of class III indications, while secondary endpoint included telemetry duration., Results: In phase I (n = 200), 38% were admitted with a class III indication resulting in no change in clinical management. A total of 74 patients was included in phase II baseline (mean ± standard deviation (SD) age 73 years ± 14.9, 57% male), whilst 65 patients were included in the intervention (mean ± SD age 71 years ± 18.4, 35% male). Both groups had similar baseline characteristics. There was a reduction in class III admissions post-intervention from 38% to 11%, P < 0.001. Intervention was associated with a reduction in median telemetry duration (1.8 ± 1.8 vs 2.4 ± 2.5 days, P = 0.047); however, length of stay was similar in both groups (P > 0.05)., Conclusion: Guideline-based telemetry admissions and a regular telemetry ward round are associated with a reduction in inappropriate telemetry use., (© 2017 Royal Australasian College of Physicians.)