Nasal lysine aspirin challenge in the diagnosis of aspirin - exacerbated respiratory disease

Background Aspirin-exacerbated respiratory disease is under-diagnosed and therefore effective and inexpensive therapy with aspirin desensitization is rarely performed. Methods We present an audit of 150 patients with difficult to treat nasal polyposis, 132 of whom also had asthma, 131 of whom underwent challenge with the only soluble form of aspirin, lysine aspirin (LAS), to confirm or exclude the diagnosis of aspirin-exacerbated respiratory disease (AERD). Results One hundred patients proved positive on nasal challenge, 31 who were negative went onto oral LAS challenge and a further 14 gave positive results, leaving 17 who were negative to a dose equivalent to over 375 mg of aspirin. Nineteen were not challenged because of contraindications. With the exception of one patient who developed facial angioedema and two patients with > 20% drop in FEV1 (following nasal plus oral challenge) no other severe adverse events occurred. No hospitalization was required for these three patients. Nasal inspiratory peak flow monitoring was less sensitive to obstruction caused by aspirin than was acoustic rhinometry – which should be employed when aspirin challenge is an outpatient procedure. Conclusions Provided patients are carefully chosen and monitored LAS challenge is suitable for ENT day case practice where respiratory physician help with asthma is available and should reduce the under-diagnosis of this condition

The Institute of Archaeology & Siegfried H. Horn Museum Newsletter Volume 29.4

Tall al-\u27Umayri 2008, Larry G. Herr and Douglas R. Clark Vaughn Lecture, Owen Chesnut Egypt Tour, Constance E. Gane NEH Summer Institute for School Teachers Random Surveyhttps://digitalcommons.andrews.edu/iaham-news/1036/thumbnail.jp

Evolving information systems: meeting the ever-changing environment

To meet the demands of organizations and their ever-changing environment, information systems are required which are able to evolve to the same extent as organizations do. Such a system has to support changes in all time-and application-dependent aspects. In this paper, requirements and a conceptual framework for evolving information systems are presented. This framework includes an architecture for such systems and a revision of the traditional notion of update. Based on this evolutionary notion of update (recording, correction and forgetting) a state transition-oriented model on three levels of abstraction (event level, recording level, correction level) is introduced. Examples are provided to illustrate the conceptual framework for evolving information systems

Dangerous liaisons: A ‘Big Four’ framework that provides a ‘hint’ to understanding an adversary’s strategy for influence.

Beliefs, attitudes and behaviour can be influenced in myriad ways. History has consistently demonstrated the struggle between protagonist and antagonist to win over ‘the people’, often through the simultaneous promotion and destruction of places, icons, myths, symbols and stories. Neil Verrall, Mark Dunkley and Toby Gane, three army reserve officers, and Richard Byrne, an independent geographer, describe four interconnected ways in which hostile state actors or non-state terrorist groups might attempt to influence their target audiences as part of strategy