Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis CHEST Guideline and Expert Panel Report

BACKGROUND: Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews related to the management of chronic wet cough in children (aged METHODS: We used the CHEST expert cough panel\u27s protocol for systematic reviews and the American College of Chest Physicians (CHEST) methodologic guidelines and GRADE framework (the Grading of Recommendations Assessment, Development and Evaluation). Data from the systematic reviews in conjunction with patients\u27 values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain consensus for the recommendations/suggestions made. RESULTS: Combining data from the systematic reviews, we found high-quality evidence in children aged 4 weeks\u27 duration) wet/productive cough that using appropriate antibiotics improves cough resolution, and further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be undertaken when specific cough pointers (eg, digital clubbing) are present. When the wet cough does not improve following 4 weeks of antibiotic treatment, there is moderate-quality evidence that further investigations should be considered to look for an underlying disease. New recommendations include the recognition of the clinical diagnostic entity of protracted bacterial bronchitis. CONCLUSIONS: Compared with the 2006 Cough Guidelines, there is now high-quality evidence for some, but not all, aspects of the management of chronic wet cough in specialist settings. However, further studies (particularly in primary health) are required

Going beyond defining: Preschool educators\u27 use of knowledge in their pedagogical reasoning about vocabulary instruction

Previous research investigating both the knowledge of early childhood educators and the support for vocabulary development present in early childhood settings has indicated that both educator knowledge and enacted practice are less than optimal, which has grave implications for children\u27s early vocabulary learning and later reading achievement. Further, the nature of the relationship between educators\u27 knowledge and practice is unclear, making it difficult to discern the best path towards improved knowledge, practice, and children\u27s vocabulary outcomes. The purpose of the present study was to add to the existing literature by using stimulated recall interviews and a grounded approach to examine how 10 preschool educators used their knowledge to made decisions about their moment-to-moment instruction in support of children\u27s vocabulary development. Results indicate that educators were thinking in highly context-specific ways about their goals and strategies for supporting vocabulary learning, taking into account important knowledge of their instructional history with children and of the children themselves to inform their decision making in the moment. In addition, they reported thinking about research-based goals and strategies for supporting vocabulary learning that went beyond simply defining words for children. Implications for research and professional development are discussed

EPUAP classification system for pressure ulcers: European reliability study

‘The definitive version is available at www3.interscience.wiley.com .' Copyright Blackwell PublishingPeer reviewe

Tidal energy machines: A comparative life cycle assessment

Marine energy in the UK is currently undergoing a period of exponential growth in terms of development and implementation. The current installed tidal energy capacity of around 4MW is expected to rise to provide up to 20% of the UK’s electricity demand by 2050 [5]. With this in mind, there is a huge range of energy devices, all seemingly promoted by their developers as the best method of extracting power from the ocean. Embodied energy is an important aspect of any power producing device or process, and is used to describe the amount of energy required to begin and maintain the process of energy generation. Until a device or process has generated this amount of energy it cannot be said to be a net contributor of energy. This work used Life Cycle Assessment to study four tidal energy devices, representing a cross section of the existing designs, and compares their embodied energy and carbon dioxide emissions. In order to ensure a fair comparison, a hypothetical installation site is used, with conditions typical of those found at potential array installation sites in the UK. The designs studied include a multi-blade turbine, two three blade horizontal axis turbine machines, and an Archimedes’ screw device. These machines were chosen to represent a cross section of device, foundation, installation and operation designs. They have all been developed to prototype stage, meaning that actual manufacturing data is available. Embodied energy is considered over the entire lifetime of each device, beginning with extraction of raw materials. Energy use from fabrication, transport, installation, lifetime maintenance, end-of-life decommissioning and recycling are all calculated, and compared to the energy generation from each device at the test site. Finally, the embodied energy; CO2 intensity; and energy payback periods are compared to those of conventional power generating systems as well as other renewable energy sources. A range of data sources are used. Embodied energy of steel has been provided by the World Steel Association. Of the four devices studied, all were found to achieve CO2 and energy payback within the first 12 years of their lifetime, and exhibited CO2 intensity of between 18 and 35 gCO2/kWh. This compares favourably to many current energy sources, and is likely to fall as technology improves, array size increases and industry experience progresses

Antiviral Combination Therapy with Interferon/Peginterferon Plus Ribavirin for Patients with Chronic Hepatitis C in Germany: A Health Technology Assessment Commissioned by the German Agency for Health Technology Assessment

Objective: The purpose of this health technology assessment (HTA), commissioned by the German Agency for HTA at the German Federal Ministry of Health and Social Security, was to systematically review the evidence on effectiveness and cost-effectiveness of antiviral treatment (AVT) for initial chronic hepatitis C (CHC) and to apply these data in the context of the German health care system. Methods: A systematic literature search was conducted to identify randomised controlled trials (RCTs), meta-analyses, and HTAs that evaluated initial AVT for CHC. A modified version of the German Hepatitis C Model (GEHMO) -- a decision-analytic Markov model -- was used to determine long-term morbidity, life expectancy, quality of life, costs and cost-effectiveness of different treatment strategies. Model parameters were derived from German databases, international RCTs, and a Cochrane Review. Results: Overall, 9 RCTs, 2 HTA reports, 1 Cochrane review, and 2 meta-analyses examining medical effectiveness of antiviral combination therapy, as well as 7 economic evaluations, met the inclusion criteria. These studies indicate that combination therapy with peginterferon plus ribavirin produced the highest sustained virological response rates (54-61%), followed by interferon plus ribavirin with 38-54%, and interferon monotherapy with 11-21%. Based on international cost-effectiveness studies, interferon plus ribavirin is cost-effective compared to interferon monotherapy. No published articles were available regarding cost-effectiveness of peginterferon plus ribavirin. In our decision analysis, these findings were confirmed and the discounted incremental cost-effectiveness ratio for peginterferon plus ribavirin was € 9,800 per quality-adjusted life-year gained compared to interferon monotherapy (as the next best non-dominated strategy). Sensitivity analyses showed robust results across a wide range of model parameters. Conclusions: This HTA suggests that initial combination therapy prolongs life, improves quality of life, and is cost-effective in patients with CHC. Combination of peginterferon and ribavirin is the most effective and efficient treatment strategy among the examined options

Overcoming the risk of inaction from emissions uncertainty in smallholder agriculture

The potential for improving productivity and increasing the resilience of smallholder agriculture, while also contributing to climate change mitigation, has recently received considerable political attention (Beddington et al 2012). Financial support for improving smallholder agriculture could come from performance-based funding including sale of carbon credits or certified commodities, payments for ecosystem services, and nationally appropriate mitigation action (NAMA) budgets, as well as more traditional sources of development and environment finance. Monitoring the greenhouse gas fluxes associated with changes to agricultural practice is needed for performance-based mitigation funding, and efforts are underway to develop tools to quantify mitigation achieved and assess trade-offs and synergies between mitigation and other livelihood and environmental priorities (Olander 2012)

Sources of Value Gains in Minority Equity Investments by Private Equity Funds: Evidence from Block Share Acquisitions

Using a large sample of block share acquisitions made by private equity (PE) funds over the 1990 to 2006 period, we examine the sources of value gains in PE minority equity investments. We find that compared to non-PE acquirers, PE acquirers are more likely to place representatives with finance experience on a target’s board, particularly when the target performs poorly or when it has more pronounced agency problems. PE acquirers are also more likely to place representatives with experience in the target’s industry on the target’s board when the target has more complex operations (e.g., multiple segments or higher R&D intensity). The targets in PE acquisitions, particularly those whose boards have representatives from PE acquirers, realize both higher abnormal announcement returns and better post-acquisition operating performance than do targets in other types of acquisitions. Target announcement abnormal returns and post-acquisition operating performance are also higher when PE-appointed directors have expertise in the target’s industry, when they sit on the boards of poorly performing targets, or when they sit on the boards of targets with higher R&D intensity. Thes

Serum selenium concentrations and diabetes in U.S. adults : National Health and Nutrition Examination Survey (NHANES) 2003–2004

Background: Increasing evidence suggests that high selenium levels are associated with diabetes and other cardiometabolic risk factors. Objectives: We evaluated the association of serum selenium concentrations with fasting plasma glucose, glycosylated hemoglobin levels, and diabetes in the most recently available representative sample of the U.S. population. Methods: We used a cross-sectional analysis of 917 adults ≥ 40 years of age who had a fasting morning blood sample in the National Health and Nutrition Examination Survey 2003–2004. We evaluated the association of serum selenium, measured by inductively coupled plasma-dynamic reaction cell-mass spectrometry, and diabetes, defined as a self-report of current use of hypoglycemic agents or insulin or as fasting plasma glucose ≥ 126 mg/dL. Results: Mean serum selenium was 137.1 μg/L. The multivariable adjusted odds ratio [95% confidence interval (CI)] for diabetes comparing the highest quartile of serum selenium (≥ 147 μg/L) with the lowest (< 124 μg/L) was 7.64 (3.34–17.46). The corresponding average differences (95% CI) in fasting plasma glucose and glycosylated hemoglobin were 9.5 mg/dL (3.4–15.6 mg/dL) and 0.30% (0.14–0.46%), respectively. In spline regression models, the prevalence of diabetes as well as glucose and glycosylated hemoglobin levels increased with increasing selenium concentrations up to 160 μg/L. Conclusions: In U.S. adults, high serum selenium concentrations were associated with higher prevalence of diabetes and higher fasting plasma glucose and glycosylated hemoglobin levels. Given high selenium intake in the U.S. population, further research is needed to determine the role of excess selenium levels in the development or the progression of diabetes

Aerodynamics of aero-engine installation

This paper describes current progress in the development of methods to assess aero-engine airframe installation effects. The aerodynamic characteristics of isolated intakes, a typical transonic transport aircraft as well as a combination of a through-flow nacelle and aircraft configuration have been evaluated. The validation task for an isolated engine nacelle is carried out with concern for the accuracy in the assessment of intake performance descriptors such as mass flow capture ratio and drag rise Mach number. The necessary mesh and modelling requirements to simulate the nacelle aerodynamics are determined. Furthermore, the validation of the numerical model for the aircraft is performed as an extension of work that has been carried out under previous drag prediction research programmes. The validation of the aircraft model has been extended to include the geometry with through flow nacelles. Finally, the assessment of the mutual impact of the through flow nacelle and aircraft aerodynamics was performed. The drag and lift coefficient breakdown has been presented in order to identify the component sources of the drag associated with the engine installation. The paper concludes with an assessment of installation drag for through-flow nacelles and the determination of aerodynamic interference between the nacelle and the aircraft