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The recent observation that CMV-specific CD4+ T cells secrete large amounts of chemokines that protect these cells from HIV entry may also be a contributing factor [58]. Regardless of mechanism, this disproportionate CMV cellular reactivity during antiretroviral therapy is likely to be associated with harm, as we have recently demonstrated [9] and has been extensively demonstrated in the very old.
More recently, there is increasingly strong evidence that RDH restrictions could be associated with harm to patients.
The optimal agent for fluid resuscitation remains uncertain; significant anemia requires blood transfusion, but colloid solutions may be associated with harm and should be avoided.
Non-activation and delays in activation may be associated with harm and too liberal activation may cause system fatigue [ 9– 11].
However, a meta-analysis of 39 randomized trials examining the effect of bed rest on 15 different medical conditions and procedures demonstrated that bed rest was not beneficial and may be associated with harm [ 3].
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Current USPSTF recommendations find no mortality benefit in screening males younger than age 75 and indeed screening may be associated with harms related to over-evaluation (41).
To date we have little information on post-copulatory sexual selection in S. cynipsea (but see [ 68]), but if post-copulatory male-male competition were associated with harm levels, harmfulness could still be heritable, and we found some evidence for this.
But, in their discussion of whether more intense exercise was associated with harm, the authors were far more circumspect: "We don't have evidence to support faster or more frequent jogging, nor do our limited data rule out the possibility".
The researchers suggest that government drinking guidelines need to reflect actual consumption instead of reported drinking - especially when ascertaining what levels are associated with harm.
However, recent observational data suggest that in patients with pre-existing poorly controlled type 2 diabetes (defined as an HbA1c ≥7%) prior to their acute illness, targeting glucose concentrations < 10mmol/l is associated with harm [1].
Although red blood cell transfusion is a potentially lifesaving intervention in severely anemic and acutely bleeding patients, some observational studies have suggested that prolonged red cell storage before transfusion is associated with harm.
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