Dublin's Hoccleve: James Yonge, scribe, author, and bureaucrat, and the literary world of late medieval Dublin

James Yonge, known for his Hiberno-English translation of the Secreta secretorum, was a legal scribe and notary in early fifteenth-century Dublin. This thesis explores Yonge's literary works, identifies his handwriting, and uses over eighty newly-discovered documents to reconstruct his career and socio-professional circle. In 1422, Yonge completed an English translation of Jofroi of Waterford's Secreta secretorum under the patronage of James Butler, 4th Earl of Ormond. The author vacillates between slavish translation and radical alteration of his exemplar, re-shaping the text to appeal to Butler, King Henry V and his court, and an Anglo-Irish audience that included the nobility, government officials, and members of the mercantile class. One outcome of English intervention in Ireland was the dissemination of tales regarding Saint Patrick's Purgatory, where pilgrims enclosed in a small cave experienced visions of purgatory. Treatises detailing these visions circulated in England and on the Continent. Yonge was the author of the first such narrative written in Ireland. Yonge's 1412 Latin account of the visit to the Purgatory of Laurence Rathold, a retainer of Sigismund I of Hungary, incorporates traditional elements of earlier works such as H. of Saltrey's Tractatus de Purgatorio Sancti Patricii and the anonymous Visiones Georgii, and offers new literary innovations. Yonge uses the narrative to market Ireland as a pilgrimage destination and frames his work as part literary text and part notarial instrument, pitching it to a pan-European audience. The patterns of employment and social relationships of Yonge and his circle echo those of Yonge's contemporaries in London, especially Geoffrey Chaucer, John Carpenter, and Thomas Hoccleve. The training and careers of Yonge's two students reveal much about scribal training in Anglo-Ireland while providing a model for scribal education applicable to other English cities. This thesis augments the canon of late medieval Anglo-Irish authors and texts by demonstrating that several texts once considered English were written in the Dublin area by Yonge's student Nicholas Bellewe. This exploration of Yonge and his circle is supported with editions of literary and legal documents that will further research into medieval Anglo-Ireland

Growth of preschool children at high risk for asthma 2 years after discontinuation of fluticasone

BACKGROUND: The effect on linear growth of daily long-term inhaled corticosteroid (ICS) therapy in preschool-aged children with recurrent wheezing is controversial. OBJECTIVE: To determine the effect of daily ICS given for 2 years on linear growth in preschool children with recurrent wheezing. METHODS: Children ages 2 and 3 years with recurrent wheezing and positive modified asthma predictive indices were randomized to a two-year treatment period of fluticasone propionate CFC (176 mcg/day) or masked-placebo delivered by valved chamber with mask and then followed 2 years off study medication. Height growth determined by stadiometry was compared between treatment groups. RESULTS: In the study cohort as a whole, the fluticasone group did not have significantly less linear growth than the placebo-group [change in height from baseline difference (ΔHt) of −0.2 cm (95% CI, −1.1, 0.6)] two years after discontinuation of study treatment. In post-hoc analyses, children 2 years old and who weighed < 15 kg at enrollment treated with fluticasone had less linear growth compared to placebo [ΔHt of −1.6 cm (95% CI, −2.8, −0.4), p=0.009]. CONCLUSION: Linear growth was not significantly different in high-risk, recurrent wheezing preschool age children treated with CFC fluticasone 176 mcg/day compared to placebo 2 years after fluticasone is discontinued. However, post-hoc subgroup analyses revealed that children who are younger in age and of lesser weight relative to the entire study cohort had significantly less linear growth, possibly due to a higher relative fluticasone exposure

Questions in Mild Asthma: An Official American Thoracic Society Research Statement

Background: Patients with mild asthma are believed to represent the majority of patients with asthma. Disease-associated risks such as exacerbations, lung function decline, and death have been understudied in this patient population. There have been no prior efforts from major societies to describe research needs in mild asthma. Methods: A multidisciplinary, diverse group of 24 international experts reviewed the literature, identified knowledge gaps, and provided research recommendations relating to mild asthma definition, pathophysiology, and management across all age groups. Research needs were also investigated from a patient perspective, generated in conjunction with patients with asthma, caregivers, and stakeholders. Of note, this project is not a systematic review of the evidence and is not a clinical practice guideline. Results: There are multiple unmet needs in research on mild asthma driven by large knowledge gaps in all areas. Specifically, there is an immediate need for a robust mild asthma definition and an improved understanding of its pathophysiology and management strategies across all age groups. Future research must factor in patient perspectives. Conclusions: Despite significant advances in severe asthma, there remain innumerable research areas requiring urgent attention in mild asthma. An important first step is to determine a better definition that will accurately reflect the heterogeneity and risks noted in this group. This research statement highlights the topics of research that are of the highest priority. Furthermore, it firmly advocates the need for engagement with patient groups and for more support for research in this field