Methodologies for the Development of the Management of Cough: CHEST Guideline and Expert Panel Report

BACKGROUND: This series of guidance documents on cough, which will be published over time, is a hybrid of two processes: (1) evidence-based guidelines and (2) trustworthy consensus statements based on a robust and transparent process.

METHODS: The CHEST Guidelines Oversight Committee selected a nonconflicted Panel Chair and jointly assembled an international panel of experts in each clinical area with few, if any, conflicts of interest. PICO (population, intervention, comparator, outcome)-based key questions and parameters of eligibility were developed for each clinical topic to inform the comprehensive literature search. Existing guidelines, systematic reviews, and primary studies were assessed for relevance and quality. Data elements were extracted into evidence tables and synthesized to provide summary statistics. These, in turn, are presented to support the evidence-based graded recommendations. A highly structured consensus-based Delphi approach was used to provide expert advice on all guidance statements. Transparency of process was documented.

RESULTS: Evidence-based guideline recommendations and consensus-based suggestions were carefully crafted to provide direction to health-care providers and investigators who treat and/or study patients with cough. Manuscripts and tables summarize the evidence in each clinical area supporting the recommendations and suggestions.

CONCLUSIONS: The resulting guidance statements are based on a rigorous methodology and transparency of process. Unless otherwise stated, the recommendations and suggestions meet the guidelines for trustworthiness developed by the Institute of Medicine and can be applied with confidence by physicians, nurses, other health-care providers, investigators, and patients.

Ectomycorrhizas - Extending the capabilities of rhizosphere remediation?

The potential of ectomycorrhizal (ECM) associations to facilitate clean-up of soil contaminated with persistent organic pollutants (POPs) is considered. Most ECM fungi screened for degradation of POPs (e.g. polyhalogenated biphenyls, polyaromatic hydrocarbons, chlorinated phenols, and pesticides) are able to transform these compounds. Mineralization of toluene, tetrachloroethylene and 2,4-dichlorophenol in intact ECM-association rhizospheres has also been demonstrated. We review and consider the likely mechanisms by which ECM fungi can transform pollutants, the extent to which these capabilities may be utilized practically in bioremediation, along with the potential advantages and disadvantages of using ECM associations in bioremediation. (C) 2000 Elsevier Science Ltd.

5.9-keV Mn K-shell X-ray luminosity from the decay of 55Fe in Type Ia supernova models

We show that the X-ray line flux of the Mn Kα line at 5.9 keV from the decay of 55Fe is a promising diagnostic to distinguish between Type Ia supernova (SN Ia) explosion models. Using radiation transport calculations, we compute the line flux for two three-dimensional explosion models: a near-Chandrasekhar mass delayed detonation and a violent merger of two (1.1 and 0.9 M⊙) white dwarfs. Both models are based on solar metallicity zero-age main-sequence progenitors. Due to explosive nuclear burning at higher density, the delayed-detonation model synthesizes ˜3.5 times more radioactive 55Fe than the merger model. As a result, we find that the peak Mn Kα line flux of the delayed-detonation model exceeds that of the merger model by a factor of ˜4.5. Since in both models the 5.9-keV X-ray flux peaks five to six years after the explosion, a single measurement of the X-ray line emission at this time can place a constraint on the explosion physics that is complementary to those derived from earlier phase optical spectra or light curves. We perform detector simulations of current and future X-ray telescopes to investigate the possibilities of detecting the X-ray line at 5.9 keV. Of the currently existing telescopes, XMM-Newton/pn is the best instrument for close (≲1-2 Mpc), non-background limited SNe Ia because of its large effective area. Due to its low instrumental background, Chandra/ACIS is currently the best choice for SNe Ia at distances above ˜2 Mpc. For the delayed-detonation scenario, a line detection is feasible with Chandra up to ˜3 Mpc for an exposure time of 106 s. We find that it should be possible with currently existing X-ray instruments (with exposure times ≲5 × 105 s) to detect both of our models at sufficiently high S/N to distinguish between them for hypothetical events within the Local Group. The prospects for detection will be better with future missions. For example, the proposed Athena/X-IFU instrument could detect our delayed-detonation model out to a distance of ˜5 Mpc. This would make it possible to study future events occurring during its operational life at distances comparable to those of the recent supernovae SN 2011fe (˜6.4 Mpc) and SN 2014J (˜3.5 Mpc).

An Irish eclipse prediction of AD 754: the earliest in the Latin West

This note announces the discovery of a tract on eclipse prediction in Paris, BnF, lat. 6400b, composed by an Irish scholar in ad 754. It is the earliest such text in the early middle ages and it is here placed in its scientific context.

Victorius vs Dionysius: the Irish Easter controversy of AD 689

Over the past few decades, the early medieval Easter controversy has increasingly been portrayed as a conflict between the ‘Celtic’ and the ‘Roman’ churches, limiting the geographical extent of this most vibrant debate to Britain and Ireland (with the exception of the disputes caused by Columbanus’ appearance on the Continent). Both are not the case. Before c.AD 800, there was no unanimity within the ‘Roman’ cause. Two ‘Roman’ Easter reckonings existed, which could not be reconciled, one invented by Victorius of Aquitaine in AD 457, the other being the Alexandrian system as translated into Latin by Dionysius Exiguus in AD 525. The conflict between followers of Victorius and adherents of Dionysius occurred in Visigothic Spain first, reached Ireland in the second half of the 7th century, and finally dominated the intellectual debate in Francia in the 8th century. This article will focus on the Irish dimension of this controversy. It is argued that the southern Irish clergy introduced the Victorian reckoning in the AD 630s and strictly adhered to that system until the end of the 7th century. When Adomnan, the abbot of Iona, converted to Dionysius in the late AD 680s and convinced most of the northern Irish churches to follow his example, this caused considerable tension with southern Irish followers of Victorius, as is impressively witnessed by the computistical literature of the time, especially the texts produced in AD 689. From this literature, the issues debated at the time are reconstructed. This analysis has serious consequences for how we read Irish history towards the end of the 7th century; rather than bringing the formerly ‘Celtic’ northern Irish clergy in line with southern Irish ‘Roman’ practise, Adomnan added a new dimension to the conflict.

Dificuldades de síntese na escrita de alunos do ensino superior politécnico

O presente estudo teve como objectivo analisar o desempenho de alunos de primeiro ano dos cursos de Engenharia e de Ecoturismo da Escola Superior Agrária (ESAC) do Instituto Politécnico de Coimbra (IPC) no que respeita à realização de uma síntese da informação escrita a partir de várias fontes. O estudo compreendeu duas partes, constituídas em dois estudos de caso: no primeiro, realizado no ano lectivo de 2003/2004, participaram 123 alunos; no segundo, realizado no ano lectivo de 2006/2007, participaram 60 alunos, constituindo estes a totalidade de alunos de primeiro ano que estudaram a língua nacional sob as orientações do novo “Programa de Língua Portuguesa” vigente no Ensino Secundário a partir de 2003. Em ambos os estudos de caso, procurou-se conhecer o que pensavam os alunos sobre a sua relação com a escrita em contexto escolar e sobre os seus procedimentos e dificuldades relativos à selecção e síntese da informação. Foram analisados os seus procedimentos preliminares à produção de um texto a partir de várias fontes através de eventuais sublinhados, apontamentos e rascunhos e, em seguida, através do trabalho de revisão e qualidade do texto final, que pressupunha o domínio ao nível da explicitação do conhecimento. A análise comparativa a partir dos estudos e os resultados finais revelaram dificuldades de selecção, organização e conexão da informação, bem como dificuldades relativas a uma construção discursiva própria a partir da situação de comunicação proposta, tanto ao nível da superfície do texto quanto ao nível da sua estrutura profunda. Assim, considerando que os participantes no estudo apresentaram dificuldades ao nível da explicitação do conhecimento, considerando a pouca ou nenhuma abordagem do assunto no Ensino Secundário em Portugal, considerando ainda que, em contexto académico, a competência de escrita a partir de várias fontes com vista à explicitação do conhecimento é uma condição básica e necessária para uma escrita de transformação do conhecimento e consequente literacia crítica, torna-se imperativo reflectir sobre o problema para buscar soluções. A inclusão de uma disciplina no primeiro ano do Ensino Superior (cujos conteúdos básicos são aqui sugeridos) - que contemple o ensino explícito da escrita para o desenvolvimento das competências de explicitação e transformação do conhecimento - poderá ser uma interessante solução para promover a melhoria do desempenho escritural dos alunos na difícil transição do Ensino Secundário para o Superior, tornando-os mais auto-confiantes, afastando-os da prática do plágio e contribuindo para o seu sucesso escolar.

Perioperative antiplatelet therapy.

Aspirin is recommended as a lifelong therapy that should never be interrupted for patients with cardiovascular dis- ease. Clopidogrel therapy is mandatory for six weeks after placement of bare-metal stents, three to six months after myocardial infarction, and at least 12 months after placement of drug-eluting stents. Because of the hypercoagulable state induced by surgery, early withdrawal of antiplatelet therapy for secondary prevention of cardiovascular disease increases the risk of postoperative myocardial infarction and death five- to 10-fold in stented patients who are on continuous dual antiplatelet therapy. The shorter the time between revascularization and surgery, the higher the risk of adverse cardiac events. Elective surgery should be postponed beyond these periods, whereas vital, semiurgent, or urgent operations should be performed under continued dual antiplatelet therapy. The risk of surgical hemorrhage is increased approximately 20 percent by aspirin or clopidogrel alone, and 50 percent by dual antiplatelet therapy. The present clinical data suggest that the risk of a cardiovascular event when stopping antiplatelet agents preoperatively is higher than the risk of surgical bleeding when continuing these drugs, except during surgery in a closed space (e.g., intracranial, posterior eye chamber) or surgeries associated with massive bleeding and difficult hemostasis.

L'Evangile du Sauveur, He 5,7 et la prière de supplication: en quête d'autres traditions sur la prière au Mont des Oliviers

L'Évangile du Sauveur 45-59 rapporte une interprétation peu connue de la prière de Jésus au Mont des Oliviers, comme prière d'intercession pour le peuple d'Israël. Cette interprètation est connue d'Origène, Jérôme et Epiphane. Cet article souhaite montrer que la prise en compte d'une telle tradition permet de reprendre sur une base nouvelle la question de la signification des prières et supplications, avec grand cri et larmes d'He 5,7. En amont de ces deux passages se tient en effet le topos d'une intense prière de supplication, efficace et faisant place aux motions. Evoquée par Justin Martyr et Origène comme d'origine hébraïque, cette prière reçoit dans le cadre du judaïsme hellénistique une tournure caractéristique, quand elle y est associée à la terminologie grecque du suppliant : elle témoigne alors d'un point de contact entre cultures juive et hellénistique. La conclusion souligne que l'Evangile du Sauveur est vecteur à la fois de la mémoire et de l'oubli culturels de la prière de supplication évoquée en He 5,7.

Breviarium totius juris canonici ([Reprod.]) / Paulus Florentinus

Collection : French books before 1601 ; 134.2

L'Écho de Paris

1888/04/14 (Numéro 1484).

Dialogue des créatures moralisé

[Dialogus creaturarum (français moyen). 1482]

Armoriaux et copies de pièces concernant spécialement les Flandres. (XIVe-XVIe siècle).

Blasons coloriés des chanoines de Cologne en 1569 (fol. 1) et des chevaliers ayant pris part au tournoi de Bruges entre Jean de La Gruthuse et Jean de Ghistelle, 1392 (fol. 3). — « Du voiage de Luxembourg, » 1484 (fol. 10). — Traité de Cambrai et autres traités ou lettres de Charles-Quint concernant particulièrement les Flandres (fol. 53), copies.

« Les ordonnances des roys de France sur le reiglement du faict du sel, debitement d'icelluy, jurisdiction et pouvoyr de messieurs les visiteurs generaulx des gabelles à sel, ses lieutenantz et aultres officiers, avec les privilleges desd. officiers et aultres y nommez ».

Contient : 1 Confirmation par CHARLES VIII (Pontoise, mars 1484-5) d'une ordonnance de CHARLES VII (S. Amand en Berry, oct. 1429) confirmant et augmentant celle de CHARLES VI (Paris, juillet 1411) ratificative de celle de son oncle JEAN, duc DE BERRY (Mehun-sur-Yèvre, 23 juin 1411) lieutenant de ce dernier roi ès pays de Languedoc et duché d'Aquitaine, le tout concernant le fait du sel en Languedoc, au duché d'Aquitaine, au bailliage de Mâcon et dans la sénéchaussée de Lyon ; 2 « La teneur de la virifficaction de nosd. seigneurs les generaulx conseilliers sur le fait et gouvernement des finances » de l'ordonnance ci-dessus. 15 juin 1485. — « La teneur de certaines lettres patentes dud. seigneur [CHARLES VIII] atachées » à ladite ordonnance « soubz ung contreseel de sa chancellerie », et adressées aux « generaulx conseilliers sur le fait de la justice » des « aydes à Paris », dont la vérification suit. Paris, 16-18 juin 1485 ; 3 Mandement de CHARLES VIII au « visiteur general des gabelles à sel ès pays de Lyonnois..., Charroloys et leurs ressors » pour l'exercice de son droit de visite. Paris, 22 juin 1485 ; 4 « Lettres du roy [CHARLES VIII] touchant la jurisdiction du faict du sel par les visiteurs ». Paris. 14 février 1484-1485 ; 5 « Aultres lettres patentes du roy [CHARLES VIII] du deuxiesme mars » 1483-4 « pour exercer la visitation ès pays de Lyonnois, Forestz, Beaujolloys, Masconnois, Roannoys, Charrolloys et ressortz, non osbtant opposicions et appellacions »