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Round pneumonia is a radiological manifestation of pulmonary lesion. This is found as spherical or oval-shaped radio-opacity on chest X-ray. Round pneumonia has been reported in literature uncommonly. Round pneumonia was first time reported in the radiology literature in 1954 (Wagner et al., 1998). It was first recognized in children. In 1973, Rose and Ward reviewed 21 cases of round pneumonia in children. Radiological findings resembled pulmonary and mediastinal masses. Since then, time and again, round pneumonia has been reported in children; but, this is also found rarely in adults. There are many causes of round pneumonia in adults, for example, infectious and noninfectious. It may mimic pulmonary neoplasms due to its radiological appearance. Hence, the usual diagnostic challenge of round pneumonia is to differentiate pneumonia from bronchogenic carcinoma. Here we present an interesting case of round pneumonia in an adult female.

Purpose Tourism is an important economic activity, and a significant contributor to employment, growth and sustainable development for most of the predominantly small island developing states of the Caribbean. Community-based tourism, given its intuitively natural alignment with the interests and greater inclusiveness of local actors and communities, is considered to be an important contributor to sustainable tourism. This study aims to evaluate the potential for digital technologies to amplify the distinctiveness, enhance service delivery and ultimately contribute to the sustainability of community tourism contexts. Design/methodology/approach The research uses a form of participatory action research that involves active collaboration between researchers and practitioners. The authors propose a framework approach for implementing smart community initiatives within a community tourism context. Findings The human-centered, participatory framework approach described in this research can help to empower community tourism by providing increased visibility and enhanced service delivery for small operators. These outcomes can become important contributions to enhancing inclusive and sustainable development and capacity for participatory, integrated and sustainable local communities – a key outcome for sustainable development goal 11 – sustainable cities and communities. Research limitations/implications The research is ongoing with the value outcomes still emerging. The empirical domain is confined to a single geographical context, so the findings and insights may not be generalizable. Practical implications Beyond the emerging research insights, the project produced specific digital artifacts such as geospatial data and technology platforms; and process outcomes such as training, capacity-building and empowerment of community members. In particular, youth trained to create and maintain the digital infrastructure (community mapping) provide an important local capability that can be re-purposed for other types of field-based data collection activities, thus providing alternative economic opportunities. Originality/value The map-based information and digital content are localized to a specific geographical context, using data mapped by local actors, who possess the best local knowledge about what the community has to offer. The approach and supporting technologies can be readily replicated into other communities.

Sleep disturbance is common in patients with advanced interstitial lung disease (ILD) often complicated by pulmonary hypertension (PH) and may contribute to poor quality of life. The etiology of sleep disturbance and the relationship between PH and sleep architecture in patients with ILD remains unknown.We performed a retrospective cohort study comparing sleep architecture on polysomnography in patients with ILD with and without PH, defined as mean pulmonary artery pressure on right heart catheterization ≥ 20 mmHg. We tested the hypothesis that patients with ILD and PH would have increased wake time after sleep onset (WASO) compared to patients with ILD without PH using univariate analysis and multivariable linear regression.In our cohort of patients with ILD who underwent polysomnography (N = 49), patients with PH had lower total diffusion capacity for carbon monoxide (DLCO) (9.28 vs. 12.87 ml/min/mmHg, P = 0.04) and percent DLCO (39% vs. 53%, P = 0.03). On polysomnography, patients with PH had increased percentage of total sleep time with saturation 90% (T90) (17% vs. 6%, P = 0.03), decreased N2 sleep (181 vs. 233 min, P = 0.03), decreased %N2 sleep (59% vs. 66%, P = 0.04), increased %N1 sleep (22% vs. 14%, P = 0.02), decreased sleep efficiency (62% vs. 72%, P = 0.03), and increased WASO (133 vs. 84 min, P = 0.01). In multivariable analysis, PH was associated with a 43-min increase in WASO (95% CI 6.2-80.2, P = 0.02).Patients with ILD and PH have decreased total and %N2 sleep, increased %N1 sleep, decreased sleep efficiency, and increased WASO, likely indicating increased sleep fragmentation.

In clinical practice, the presence of wheezing generally indicates an airway disease. In rare circumstances, adjacent mediastinal structures may compress the tracheobronchial tree leading to obstructive physiology. Compression of the tracheobronchial region by an enlarged pulmonary artery (PA) is exceedingly rare. We present here a case of pulmonary hypertension, where the enlarged PA resulted in obstructive lung physiology with a relevant review of the literature.

Pulmonary rehabilitation (PR) is part of the recommended management plan of pulmonary hypertension (PHTN) and is important to better quality of life and exercise tolerance. This study aimed at determining effectiveness of PR on exercise capacity. Retrospective chart analysis was conducted on patients referred to our PHTN clinic for PR. Patients who had PHTN diagnosed on right heart catheterization (defined by mean pulmonary artery pressure>25 mmHg) and completed a standardized 12-week PR program were considered for the study. Patients' baseline exercise tolerance was recorded as speed attainable on a treadmill and duration of exercise in minutes. Demographics, age, sex, and oxygen use were obtained from chart review. Eighteen PHTN patients (5 male, 13 female; mean age 67.7±11.6 years) were considered for the study (six World Health Organization [WHO] group 1 pulmonary arterial hypertension [33.33%], eight WHO group III PHTH [44.44%], two WHO group IV and two WHO V PHTN [11.11%]). Treadmill speed improved following rehabilitation (1.3 mph [interquartile range {IQR}, 1.0-1.8 mph] to 2.2 mph [IQR, 1.3-2.8 mph]; P

Idelalisib is a novel treatment option for patients with chronic lymphocytic leukemia. A rare, but, fatal complication of using Idelalsib is drug induced pneumonitis. This article presents a case of Idelalsib induced pneumonitis in a patient with chronic lymphocytic leukemia along with a brief discussion of management plan.

Forced vital capacity (FVC) and slow vital capacity (SVC) are non-invasive tests of respiratory function. Although FVC has been extensively studied and is used in most PFT (pulmonary function test) labs, SVC can also be used in clinical practice as it is a more comfortable and convenient test to perform. SVC-based diagnostic criteria can lead to earlier detection of obstructive lung disease. In contrast to FVC, SVC is less affected by respiratory muscle fatigue, airflow patency, expiratory muscle weakness and air leakage making it an appropriate test of respiratory function in patients of amyotrophic lateral sclerosis (ALS) and other neuromuscular disorders. As respiratory insufficiency is the major cause of mortality in ALS patients, regular SVC measurement provides the respiratory functional status, so that early treatment can be started which improves the survival and quality of life in these patients. The purpose of this article is to highlight the importance of considering SVC in clinical practice.

Nivolumab is a recently approved medication that shows significant clinical activity for various types of malignancies such melanoma, renal cell carcinoma and non-small cell carcinoma. Pneumonitis is a rare, but, possibly fatal manifestation that still remains ambiguous. This article presents a case of nivolumab induced pneumonitis in a patient with melanoma and discusses management plans.

Pulmonary arterial hypertension (PAH) is a rare and devastating disease which is characterized by worsening dyspnea and exercise tolerance. These patients are often found to have concomitant, depression, anxiety and impaired health-related quality of life (HRQOL). The interrelationship of dyspnea, depression and HRQOL in these patients is not well studied. Retrospective analysis was performed on 46 PAH patients (mean age 51.73). Patients completed Medical Outcomes Study Short - Form 36 V2 (SF-36) to measure HRQOL, Modified Medical Research Council (mMRC) Dyspnea Scale and Zung Depression Scale (ZDS). Physical Health Composite Scores (PCS) and Mental Health Composite Scores (MCS) were derived from SF-36. Spearman’s correlation was computed to determine degree of correlation between pairs of scales. 46 patients (12 males, 34 females; median age 51.4 yr) with confirmed PAH were considered for the study of which 36 patients (9 males, 27 females, median age 50.1 yr), were eligible for further analysis. MMRC Dyspnea Scale Score was 1.0 (Q1 to Q3:1.0 to 2.0). Median MCS was 52.1 (Q1 to Q3:41.7 to 57.1) and PCS was 37.9 (Q1 to Q3: 30.7 to 49.6). There was a significant negative correlation between dyspnea and PCS (r =−0.660, P

In heart failure (HF), longitudinal changes in ventricular ejection fraction are poorly studied. The authors' objective was to document the dynamic changes in systolic function of both ventricles during acute HF and after a 3-month follow-up period, and to identify factors associated with ventricular improvement. A limited access dataset from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial provided by The National Heart, Lung, and Blood Institute was analyzed. In patients admitted to the hospital with acute HF, both ventricles were evaluated by echocardiography on admission, at discharge, and at 3 months. From baseline to 3 months, left ventricular ejection fraction (LVEF) increased in 43.4% of patients, decreased in 23.9%, and remained unchanged in 32.7%. Similarly, right ventricular systolic function improved in 40.9%, deteriorated in 25.0%, and remained stable in 34.1%. Weight loss during index admission and cardiac index/cardiac output increase were the only factors associated with LVEF improvement from baseline to month 3. There was no difference between ischemic and nonischemic etiology. In acute HF, ischemic or nonischemic, systolic function of the ventricles improved during 3 months in about 40% of patients and remained unchanged or deteriorated in the rest. Weight loss and increase in cardiac index/output during hospitalization was associated with improvement in LVEF.

Caregiver's burden is a multidimensional phenomenon affecting care-givers physically, emotionally and socially. It is critical to examine the burden of caregivers, because of the complex responsibility they have with their partners. There are relatively few studies that have examined factors linked with psychological burden amongst caregivers of pulmonary arterial hypertension (PAH) patients. Hence, it is pertinent to develop a good understanding of these factors and develop appropriate management strategies, modified to assist PAH caregivers.

Rapunzel syndrome a rare presentation occurs predominantly in young women or girls with psychiatric or emotional disordersand consists of trichobezoarwith a tail extending at least to the jejunum with symptoms suggestive of obstruction. With less than40 cases reported in literature till date we report a case in a young female diagnosed clinico-radiologically and treated surgicallywith removal of an intact trichobezoar extending from stomach till the jejunum.

The function of the right ventricle (RV) in heart failure (HF) has been mostly ignored until recently. A 2006 report of the National Heart, Lung, and Blood Institute identified a gap between RV research efforts and its clinical importance compared with that of the left ventricle. This recent shift in paradigm is fueled by the prognostic value ascribed to RV failure in HF and morbidity/mortality after myocardial infarction and surgery. In this review, we examine the significance of RV failure in the HF setting, its clinical presentation and pathophysiology, and ways to evaluate RV function using echocardiographic measurements. Furthermore, we discuss the medical management of RV failure including traditional therapies like beta-blockers and newer options like nitric oxide, phosphodiesterase inhibitors, and calcium sensitizers. Mechanical support is also examined. Finally, this review places an emphasis on RV failure in the setting of left ventricular assist devices and heart transplantation.

Serum uric acid (SUA) is a product of xanthine oxidase (XO). Apoptosis and tissue hypoxia lead to increased purine catabolism, which, in turn, increases XO activity and subsequently SUA levels. The purpose of this study was to perform a meta-analysis to evaluate the evidence supporting SUA as a predictor of all-cause mortality in patients with heart failure (HF) and to determine the SUA cut-off for the increase in risk. A search of the MEDLINE database (1966 to March 2009) supplemented by manual searches of bibliographies of key relevant articles was performed. The authors selected all cohort studies in which SUA was measured and mortality was reported in patients with HF. The pooled relative risk (RR) with the corresponding 95% confidence interval (CI) for all-cause mortality using the fixed-effects method was calculated. The effects of SUA on all-cause mortality at different SUA cut-offs using meta-regression was evaluated. The search strategy yielded 358 studies, of which only 6 met our eligibility criteria. The studies, however, comprised 1456 evaluable patients with HF, with a median ejection fraction of 32% (range, 26%-40%). The RR of all-cause mortality was 2.13 (95% CI, 1.78-2.55) for SUA>6.5 mg/dL compared with 7 mg/dL are associated with higher all-cause mortality.

Introduction: Fatigue is a known symptom of advanced lung disease and impacts quality of life and psychological health. Many of these patients undergo pulmonary rehabilitation as part of their therapy. Understanding the effect of pulmonary rehabilitation on fatigue in these patients is important, as one may be able to design more focused rehabilitation programs. The aim of this study is to evaluate the effect of pulmonary rehabilitation on fatigue as measured by the Fatigue Severity Scale (FSS) in patients with advanced lung disease. Material and Methods: Patients were enrolled in a standardized 6 week pulmonary rehabilitation program. They were asked to complete questionnaires to evaluate their self-reported fatigue (FSS), and depression as measured by Geriatric Depression Scale (GDS). The GDS is a self-reported assessment tool used to identify depression in patients. The FSS is a validated instrument that indicates a perception of fatigue that might require medical intervention. Participants completed questionnaires both at baseline and after completing the standardized pulmonary rehabilitation program. Data was analyzed in Statistical Analysis System (SAS). The change in FSS was evaluated using the Wilcoxon signed-rank test. p-values < 0.05 were considered statistically significant. Results: 21 patients (12 females; 9 males; mean age 64.3 ± 11.2 yrs) were considered for the study. Pre-pulmonary rehabilitation FSS scores ranged from 1.6 to 6.7 (mean score of 4.6 ± 1.7). Post pulmonary rehabilitation FSS scores ranged 1.0 to 6.2 (mean score of 3.9 ± 1.6). The median pre-rehabilitation FSS was 5.3 (inter quartile range; Q1–Q3: 3.0–6.1), and median post rehabilitation FSS was 3.9 (inter quartile range; Q1–Q3: 2.6–5.1). There was a significant decrease in FSS scores after completing pulmonary rehabilitation program (p < 0.0208). There was a decrease in GDS (pre-rehabilitation, mean: 5.5 ± 3.6; post-rehabilitation, mean: 4.2 ± 2.9), but this decrease was not statistically significant. The change in GDS correlated with the change in FSS (Spearman Correlation Coefficient 0.525, p < 0.0146). Conclusions: Patients with advanced lung disease reported a measurable component of fatigue. Participating in pulmonary rehabilitation resulted in significant improvement in patient’s self-reported fatigue severity. Further studies are necessary to evaluate and design interventions to improve fatigue in in the setting of advanced lung disease.

Decisional guidance is defined as how a decision support system (DSS) influences its users as they structure and execute the decision-making process. It is assumed that decisional guidance has profound effects on decision making, but these effects are understudied and empirically unproven. This paper describes an empirical, laboratory-experiment-based evaluation of the effectiveness of deliberate decisional guidance and its four types. We developed and used a comprehensive model consisting of four evaluation criteria: decision quality, user satisfaction, user learning, and decision-making efficiency. On these criteria, we compared decisional guidance versus no guidance, informative versus suggestive decisional guidance, and predefined versus dynamic decisional guidance. We found that deliberate decisional guidance was more effective on all four criteria; suggestive guidance was more effective in improving decision quality and user satisfaction, and informative guidance was more effective in user learning about the problem domain, whereas dynamic guidance was more effective than predefined guidance in improving decision quality and user learning; and both suggestive guidance and dynamic guidance reduced the decision time.

This paper describes several problems with the current Internet technologies and the way they are currently utilized in education and proposes an innovative solution. First, the paper discusses an activity matrix that maps learning activities involved in business education along two dimensions: level of monitoring and level of interaction. The paper then proposes a unifying framework that utilizes emerging Internet technologies to support these learning activities. The framework goes beyond a simple piece of software at the client level to provide a complete solution with the student client, the instructor client and the server level software. Furthermore, the paper describes the architecture, features and specific technologies used in an actual education support system developed from the framework.

The effectiveness of decision support systems (DSS) is enhanced through dynamic adaptation of support to the needs of the decision maker, to the problem, and to the decision context. We define this enhanced DSS as adaptive decision support systems (ADSS) and propose its architecture. In an ADSS, the decision maker controls the decision process. However, the system monitors the process to match support to the needs. The proposed architecture evolves from the traditional DSS models and includes an additional intelligent‘Adaptation’ component. The ‘Adaptation’ component workd with the data, model, and interface components to provide adaptive support. The architecture also integrates enhancements proposed in the past research. In this paper, we have illustrated the proposed architecture with two examples, a prototype system, and results from a preliminary empirical investigations

Serum uric acid (SUA) is a product of xanthine oxidase (XO). Apoptosis and tissue hypoxia lead to increased purine catabolism, which, in turn, increases XO activity and subsequently SUA levels. The purpose of this study was to perform a meta-analysis to evaluate the evidence supporting SUA as a predictor of all-cause mortality in patients with heart failure (HF) and to determine the SUA cut-off for the increase in risk. A search of the MEDLINE database (1966 to March 2009) supplemented by manual searches of bibliographies of key relevant articles was performed. The authors selected all cohort studies in which SUA was measured and mortality was reported in patients with HF. The pooled relative risk (RR) with the corresponding 95% confidence interval (CI) for all-cause mortality using the fixed-effects method was calculated. The effects of SUA on all-cause mortality at different SUA cut-offs using meta-regression was evaluated. The search strategy yielded 358 studies, of which only 6 met our eligibility criteria. The studies, however, comprised 1456 evaluable patients with HF, with a median ejection fraction of 32% (range, 26%-40%). The RR of all-cause mortality was 2.13 (95% CI, 1.78-2.55) for SUA6.5 mg/dL compared with6.5 mg/dL SUA level. There was a linear association (P.01) between SUA and mortality after 7 mg/dL. Uric acid is an important prognostic marker for all-cause mortality in HF. SUA levels7 mg/dL are associated with higher all-cause mortality.

This chapter introduces the open source software development process from a software quality perspective. It uses the attributes of software quality in a formal model and attempts to map them onto the principles of the open source process. Many stages of the open source process appear to have an ad-hoc approach. Although open source is not considered to be a formal methodology for software development, it has resulted in the development of very high quality software, both in the consumer and in the enterprise space. In this chapter, we hope to understand the open source process itself, and apply it to other methodologies in order to achieve better software quality. Additionally, this chapter will help in understanding the “Wild West” nature of open source and what it may hold for us in the future.

This chapter introduces the open source software development process from a software quality perspective. It uses the attributes of software quality in a formal model and attempts to map them onto the principles of the open source process. Many stages of the open source process appear to have an ad-hoc approach. Although open source is not considered to be a formal methodology for software development, it has resulted in the development of very high quality software, both in the consumer and in the enterprise space. In this chapter, we hope to understand the open source process itself, and apply it to other methodologies in order to achieve better software quality. Additionally, this chapter will help in understanding the “Wild West” nature of open source and what it may hold for us in the future.

Splenectomy predisposes patients to a slew of infectious and non-infectious complications including pulmonary vascular disease. Patients are at increased risk for venous thromboembolic events due to various mechanisms that may lead to chronic thromboembolic pulmonary hypertension (CTEPH). The development of CTEPH and pulmonary vasculopathy after splenectomy involves complex pathophysiologic mechanisms, some of which remain unclear. This review attempts congregate the current evidence behind our understanding about the etio-pathogenesis of pulmonary vascular disease related to splenectomy and highlight the controversies that surround its management.