Lung Clearance Index in cystic fibrosis subjects treated for Pulmonary Exacerbations

Pulmonary exacerbations are important clinical events for cystic fibrosis (CF) patients. Studies assessing the ability of the lung clearance index (LCI) to detect treatment response for pulmonary exacerbations have yielded heterogeneous results. Here, we conduct a retrospective analysis of pooled LCI data to assess treatment with intravenous antibiotics for pulmonary exacerbations and to understand factors explaining the heterogeneous response.

A systematic literature search was performed to identify prospective observational studies. Factors predicting the relative change in LCI and spirometry were evaluated while adjusting for within-study clustering.

Six previously reported studies and one unpublished study, which included 176 pulmonary exacerbations in both paediatric and adult patients, were included. Overall, LCI significantly decreased by 0.40 units (95% CI -0.60 -0.19, p=0.004) or 2.5% following treatment. The relative change in LCI was significantly correlated with the relative change in forced expiratory volume in 1 s (FEV1), but results were discordant in 42.5% of subjects (80 out of 188). Higher (worse) baseline LCI was associated with a greater improvement in LCI (slope: -0.9%, 95% CI -1.0- -0.4%).

LCI response to therapy for pulmonary exacerbations is heterogeneous in CF patients; the overall effect size is small and results are often discordant with FEV1.

Repply to: Brito, A.C., Brotas, V., Caetano, M., Coutinho, T.P., Bordalo, A.A., Icely, J., Neto, J.M., Serôdio, J., Moita, T. (2012) "Defining phytoplankton class boundaries in Portuguese transitional waters: an evaluation of the ecological quality status according to the Water Framework Directive" [Ecological Indicators 19, 5-14]

We write to comment on the recently published paper “Defining phytoplankton class boundaries in Portuguese transitional waters: an evaluation of the ecological quality status according to the Water Framework Directive” (Brito et al., 2012). This paper presents an integrated methodology to analyse the ecological quality status of several Portuguese transitional waters, using phytoplanktonrelated metrics. One of the systems analysed, the Guadiana estuary in southern Portugal, is considered the most problematic estuary, with its upstream water bodies classified as Poor in terms of ecological status. We strongly disagree with this conclusion and we would like to raise awareness to some methodological constraints that, in our opinion, are the basis of such deceptive conclusions and should therefore not be neglected when using phytoplankton to assess the ecological status of natural waters.

Arbeitszeit und Sonntagsruhe : Stellungnahmen zur Sonntagsarbeit als Beitrag kirchlicher Sozialkritik im 19. Jahrhundert

Mit der Forderung nach einem arbeitsfreien Sonntag haben die Kirchen im 19. Jahrhundert in die Diskussion um die Wochenarbeitszeit eingegriffen. Auch wenn das Thema der menschlichen Arbeit in der evangelischen Theologie des vergangenen Jahrhunderts nicht in dem Maße bedacht worden ist, wie es die neuzeitliche Veränderung im Verständnis der Arbeit und die Industrialisierung erfordert hätten, so lässt sie die bekannte Formel vom "Versagen der Kirche gegenüber der sozialen Frage" nicht aufrechterhalten. Die vorliegende Untersuchung fragt nach der Begründung der Sonntagsruhe für die Arbeit: Kann Sonntagsruhe im Gegensatz zu Freizeit als ein Begriff bestimmt werden, der in keinem komplementären Verhältnis zur Arbeit steht, nicht im Sinn eines Primats der Ruhe, sondern in dem Sinn, daß der Sonntag Kontrapost ist gegen den Primat der Arbeit in der Gegenwart?