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Summary: Mantle cell lymphoma (MCL) is clinically and biologically heterogeneous. While various prognostic features have been proposed, none currently impact therapy selection, particularly in older patients, for whom treatment is primarily dictated by age and comorbidities. Herein, we undertook a comprehensive comparison of clinicopathological features in a cohort of patients 60 years and older, uniformly treated with bendamustine and rituximab, with a median survival of >8 years. The strongest prognostic indicators in this cohort were a high‐risk call by a simplified MCL international prognostic index (s‐MIPI) (HR: 3.32, 95% CI: 1.65–6.68 compared to low risk), a high‐risk call by MCL35 (HR: 10.34, 95% CI: 2.37–45.20 compared to low risk) and blastoid cytology (HR: 4.21, 95% CR: 1.92–9.22 compared to classic). Patients called high risk by both the s‐MIPI and MCL35 had the most dismal prognosis (HR: 11.58, 95% CI: 4.10–32.72), while those with high risk by either had a moderate but clinically relevant prognosis (HR: 2.95, 95% CI: 1.49–5.82). A robust assay to assess proliferation, such as MCL35, along with stringent guidelines for cytological evaluation of MCL, in combination with MIPI, may be a strong path to risk‐stratify older MCL patients in future clinical trials. [ABSTRACT FROM AUTHOR]

Pulmonary rehabilitation (PR) may not suit all individuals with chronic obstructive pulmonary disease (COPD) and may not result in increased physical activity. Higher levels of physical activity are associated with reduced mortality and morbidity. The aim of this study was to assess the feasibility of conducting a trial to investigate the effectiveness of a clinician-facilitated physical activity intervention (PAI) versus PR in improving physical activity in patients with COPD referred to PR. In this randomised controlled mixed methods feasibility study, all patients referred to PR who were eligible and willing were assessed at baseline and then randomised to the PAI or to PR. The assessments were repeated post-intervention and at 3-month follow-up. The main outcome was step count measured by Actigraph. Semi-structured interviews were conducted post-intervention. The N = 50 patients; mean (SD) age, 64.1(8.6) years, 24M were recruited and randomised; N = 23 (PAI) and n = 26 (PR): one patient was excluded from the analysis as that person did not meet the GOLD diagnostic criteria. Key feasibility criteria were met; recruitment was 11%, dropouts in PAI were 26% (n = 6) and 50% (n = 13/26) PR. Participants in both groups experienced a range of health benefits from their respective programmes. The PAI appears to be effective in increasing step counts in people with COPD: mean change (standard deviation) [confidence interval] for the PAI group was 972.0(3230.3)[-1080.3 to 3024.4], n = 12 and 4.3(662.7)[-440.9 to 449.5], n = 11 for the PR group. The PAI met all domains of fidelity. This study provides key information to inform a future-randomised controlled trial in physical activity. [ABSTRACT FROM AUTHOR]

Objective: Chronic disease (CD) accounts for two-thirds of emergency medical admissions and approximately 80% of all healthcare costs. Presently, "integrated care" refers to GP care punctuated by specialist input on an inpatient/outpatient basis. It does not explicitly involve the Emergency Department (ED). Most (70-80%) patients presenting to ED are discharged. Many of these are also acute episodes of a CD,but are not incorporated as part of any integrated care pathway. This project aims to: (1) Quantify CD-related discharges from the ED (2) Develop an initiative to integrate these visits into CD care. (3) Assess whether such an initiative improves quality. Method: 1000 consecutive ED presentations were reviewed over a 2-month period; patients with coexisting CDs were noted, as was whether CD was a contributing or determining factor to presenting. A pro-forma was developed in conjunction with CD specialists, two of whom are national clinical leads in CD management (COPD and CCF). The pro-forma was implemented in a subset of CD-related discharges, the first 50 of which were also accompanied by a questionnaire to evaluate the pro-forma's usefulness. Multiple accessory quality improvement (QI) initiatives were also initiated such as care bundles and checklists. Results: A diagnosed CD was recorded in 46% of presentations; in 47% of these CD related to the ED presentation. While CD patients were more likely to be admitted (32% vs. 8%), the majority were discharged (68%). The questionnaire response rate was 56% with 95% finding the intervention useful, 45% reporting it affected therapy (55% for diabetes) and 30% reporting it affected patient management in non-therapeutic ways, such as appointment scheduling. We report progress in accessory QI initiatives. Conclusions: The ED is under-represented in the current model of integrated care: (1) The cohort of CD-related discharges from the ED was more than twice those admitted; (2) These presentations constitute a gap in integrated care, which can be closed; (3) In doing so, the ED stands to improve the quality of integrated care. [ABSTRACT FROM AUTHOR]

The article offers information on Celtis occidentalis, a fastigiate common hackberry species. Common hackeberry is a plant that can tolerate both hot and cold temperatures. It is a native of New Hampshire, North Dakota, Oklahoma and Georgia. Celtis occidentalis originated as a chance seedling, discovered in western Kansas. It is characterized with pubescent young branches, mature leaves, serrate leaf margins and drupe. It reproduces in budded nursery liners with lateral branches. According to the author, Celtis occidentalis is an ideal plant for urban settings and other locations.