Chest
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Causal directed acyclic graphs (cDAGs) have become popular tools for researchers to better examine biases related to causal questions. DAGs comprise a series of arrows connecting nodes that represent variables and in doing so can demonstrate the causal relation between different variables. cDAGs can provide researchers with a blueprint of the exposure and outcome relation and the other variables that play a role in that causal question. cDAGs can be helpful in the design and interpretation of observational studies in pulmonary, critical care, sleep, and cardiovascular medicine. They can also help clinicians and researchers to better identify the structure of different biases that can affect the validity of observational studies. ⋯ We use cDAGs and clinical examples that are mostly focused in the area of pulmonary medicine to describe the structure of confounding, selection bias, overadjustment bias, and detection bias. These principles are then applied to a more complex published case study on the use of statins and COPD mortality. We also introduce readers to other resources for a more in-depth discussion of causal inference principles.
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A 68-year-old man developed an erythematous, papular, pruritic rash on his right thigh 1 month prior to presentation. It subsequently spread to his other extremities and trunk. ⋯ He had a history of relapsing polychondritis for which he was prescribed infliximab and low-dose prednisone. He had never smoked tobacco, did not use alcohol or illicit substances, and had no significant travel history.
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Critical care airway management (CCAM) is a key skill for critical care physicians. Simulation-based training (SBT) may be an effective modality in training intensivists in CCAM. ⋯ Skill acquired through SBT of critical care fellows for CCAM transfers effectively to the real-life patient care arena. Second- and third-year fellows who had initially received SBT maintained skill at CCAM.
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We report the clinical history, laboratory findings, and imaging features of coronavirus disease 2019 (COVID-19) in a neonate whose mother was also a patient. The newborn was the youngest patient with COVID-19 in the world at the time he was diagnosed. This case has brought more attention and understanding to the epidemic and mode of transmission of the disease.
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Early-life stress is becoming an important determinant of immune system programming. Maternal prenatal distress is found to be associated with atopic disease in offspring but the separate effects of postnatal distress are not well-studied. ⋯ This population-based study provides evidence for sex-specific associations between maternal prenatal and postnatal distress, as well as the development of AD and asthma. The findings support recommendations for greater psychosocial support of mothers during pregnancy and early childhood to prevent childhood atopic disease.