British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia.

Biological influence on the morphology and micromorphology of selected Podzols (Spodosols) and Cambisols (Inceptisols) from the Eastern United States and Northeast Scotland

Biological activities greatly influence the formation of many soils, especially forest soils under cool humid climates. The objective of this study was to investigate the effects of vegetation and soil biota on the formation of selected soils. Field morphology, micromorphology, and carbon and organic matter analysis were determined on six Podzols (Spodosols) and two Cambisols (Inceptisols) from the eastern United States and north-east Scotland. Humification of plant material by soil fauna and fungi occurs in all organic horizons. Thick organic coatings are observed on soil peds and rock fragments from the E1 to the Bs horizon in a Haplic Podzol from Clingmans Dome Mt., TN. Thin sections reveal large accumulations of root material in different stages of decomposition in the spodic horizons of a Haplic Podzol from Whiteface Mt., NY. Organic carbon ranges from 5.4 to 8.5% in the spodic B horizons of the Whiteface Mt. Podzol. Earthworms and enchytraeids have a great effect on the structure of the surface and subsurface horizons in the Dystric Cambisols from Huntly and Clashindarroch Forests, Scotland and a Cambic Podzol from the Corrie Burn Basin, Scotland. Podzols from Speymouth Forest, Scotland (Gleyic Podzol), Cling-mans Dome Mt., and Whiteface Mt. have thick organic horizons. The Podzols from the Flatwoods in Georgia, the Pine Barrens in New Jersey, the Corrie Burn Basin, and the Cambisol from Huntly Forest have only A horizons at the surface. The Clashindarroch Forest soil has a very thin organic horizon. Warm and humid climates and sandy parent material are responsible for thick E horizons and lack of thick organic horizons in the Flatwoods (Carbic Podzol) and Pine Barrens (Ferric Podzol) soils. Earthworms and enchytraeids thrive in the Corrie Burn Basin and Huntly Forest soils due to the vegetation and the highly weathered basic parent material. The site at Clashindarroch once carried oak, and then birch forest, both of which produce a mild litter and also encourage earthworm and enchytraeids. This fauna is responsible for much mixing of the topsoil. The present conifer vegetation will eventually produce a deep litter and cause podzolization.

'Saig in Machai Fothúaid': On the Application and Extent of ‘the Macha’ in North-west Armagh

The seventh-century Patrician documents in the Book of Armagh, and other early sources such as Bethu Phátraic, contain references to the toponym Macha, which has been identified by the Dictionary of the Irish Language with either the ecclesiastical centre of Ard Macha or the ‘royal seat’ of Emain Macha. This article examines the evidence for the name in the sources and illustrates that Macha applies primarily to the plain in which both Ard Macha and Emain Macha are located. It is to be identified with Mag Macha ‘the plain of Macha’, familiar to us from the Dindshenchus, and further evidence of the organic potential of a given toponym is witnessed in later sources where the plain is referred to as Mag/Machaire na hE(a)mna ‘the plain of Emain’ and Machaire Aird/Arda Macha ‘the plain of Armagh’. The extent of Macha is difficult to establish with certainty, but it seems very likely that it stretched north to the River Blackwater as well as south towards Slíab Fúait.

Assessment of Intervention Fidelity and Recommendations for Researchers Conducting Studies on the Diagnosis and Treatment of Chronic Cough in the Adult: CHEST Guideline and Expert Panel Report

BACKGROUND: Successful management of chronic cough has varied in the primary research studies in the reported literature. One of the potential reasons relates to a lack of intervention fidelity to the core elements of the diagnostic and/or therapeutic interventions that were meant to be used by the investigators.

METHODS: We conducted a systematic review to summarize the evidence supporting intervention fidelity as an important methodologic consideration in assessing the effectiveness of clinical practice guidelines used for the diagnosis and management of chronic cough. We developed and used a tool to assess for five areas of intervention fidelity. Medline (PubMed), Scopus, and the Cochrane Database of Systematic Reviews were searched from January 1998 to May 2014. Guideline recommendations and suggestions for those conducting research using guidelines or protocols to diagnose and manage chronic cough in the adult were developed and voted upon using CHEST Organization methodology.

RESULTS: A total of 23 studies (17 uncontrolled prospective observational, two randomized controlled, and four retrospective observational) met our inclusion criteria. These articles included 3,636 patients. Data could not be pooled for meta-analysis because of heterogeneity. Findings related to the five areas of intervention fidelity included three areas primarily related to the provider and two primarily related to the patients. In the area of study design, 11 of 23 studies appeared to be underpinned by a single guideline/protocol; for training of providers, two of 23 studies reported training, and zero of 23 reported the use of an intervention manual; and for the area of delivery of treatment, when assessing the treatment of gastroesophageal reflux disease, three of 23 studies appeared consistent with the most recent guideline/protocol referenced by the authors. For receipt of treatment, zero of 23 studies mentioned measuring concordance of patient-interventionist understanding of the treatment recommended, and zero of 23 mentioned measuring enactment of treatment, with three of 23 measuring side effects and two of 23 measuring adherence. The overall average intervention fidelity score for all 23 studies was poor (20.74 out of 48).

CONCLUSIONS: Only low-quality evidence supports that intervention fidelity strategies were used when conducting primary research in diagnosing and managing chronic cough in adults. This supports the contention that some of the variability in the reporting of patients with unexplained or unresolved chronic cough may be due to lack of intervention fidelity. By following the recommendations and suggestions in this article, researchers will likely be better able to incorporate strategies to address intervention fidelity, thereby strengthening the validity and generalizability of their results that provide the basis for the development of trustworthy guidelines.

On the structure and dynamics of ionic liquids

The structure and dynamics of the ionic liquid 1-ethyl-3-methylimidazolium nitrate is studied by molecular dynamics simulations. We find long-range spatial correlations between the ions and a three-dimensional local structure that reflects the asymmetry of the cations. The main contribution to the configurational energy comes from the electrostatic interactions which leads to charge-ordering effects. Radial screening and threedimensional distribution of charge are also analyzed. The motion of a single ion is studied via velocity and reorientational correlation functions. It is found that ions "rattle" in a long-lived cage, while the orientational structure relaxes on a time scale longer than 200 ps. As in a supercooled liquid, the mean square displacements reveal a subdiffusive dynamics. In addition, the presence of dynamic heterogeneities can be detected by analyzing the non-Gaussian behavior of the van Hove correlation function and the spatial arrangement of the most mobile ions. The short-time collective dynamics is also studied through the electric current time correlation function.