Recycling in teaching english as a major

This article examines the role of recycling in teaching foreign languages as a major. The author specifies its characteristics by comparing recycling and revision. To highlight the importance of recycling at the advanced level of foreign language teaching and learning, the author provides the results of an empirical study. In conclusion, a few ways of promoting recycling at the advanced level are described

Reducing recurrent care proceedings: initial evidence from new interventions

The English family justice system faces a crisis of recurrence. As many as one in four birth mothers involved in public law care proceedings in English family courts are likely to reappear in a subsequent set of proceedings within seven years. These mothers are involved in up to one-third of total care applications, as they are – by definition – linked to more than one child . Few birth mothers experiencing the removal of a child to care are offered any follow-up support, despite often facing multiple challenges including poverty, addiction, domestic violence and mental health problems. Since 2011, however, a number of new services have been established to begin to address their unmet needs. This article summarises the findings of the first academic-led evaluation of two of these initiatives. Presenting evidence from a mixed-methods evaluative study, it concludes that the new services were able to foster relationships that ‘worked’ in reducing recurrent proceedings. None of the women engaging with the services went on to experience what could be described as a ‘rapid repeat pregnancy’ within the evaluation window. Just as significantly, a number of clients reported some improvement in their psychological functioning, and the practitioners involved reported positively on their experience of delivering and managing innovative services. The article closes with a discussion of the challenges of evaluating personalised, strengths-based interventions and the possibilities of evidencing empowerment in these cases

Neo-liberal racism: Excision, ethnicity and the Children and Families Act 2014

This article focuses on the removal in the Children and Families Act 2014 of the so-called ‘ethnicity clause’ relating to adoption. Reviewing the background to the contentious issue of adoption for Black, Asian and Minority Ethnic children and the coalition’s drive to increase its scale, the article analyses the discursive resources deployed – especially during the Bill’s passage through Parliament – to justify, oppose or modify the legal change. It is argued that the emergent government policy can be seen as incoherent, even contradictory in relation to ethnicity and its significance and that this can be understood through the competing aims of striking a populist blow against ‘political correctness’ while staving off accusations of being ‘naïve’ (or worse) about race and ethnicity. These developments and debates are also analysed in the context of the growing power of racial neo-liberalism in shaping debates on child welfare

BASOPHILE ACTIVATION TEST FOR THE DIAGNOSTICS OF FUNGAL SENSITIZATION IN THE PATIENTS WITH CYSTIC FIBROSIS

Aspergillus fumigatus colonization in the patients with cystic fibrosis (CF) may cause sensitization against A. fumigatus and/or allergic bronchopulmonary aspergillosis (ABPA), which significantly worsens the course of underlying disease. At the present time, new diagnostic tests are searched for detection of fungal sensitization in these patients. The aim of this work was to evaluate an opportunity of application of basophile activation test with A. fumigatus allergen in vitro using flow cytometry, aiming for identification of fungal sensitization in the CF patients. The study included 190 patients with CF aged 1 to 37 years. All the patients underwent common allergy screening (skin tests with fungal allergens, determination of serum levels of total IgE and specific IgE for the fungal allergens), and mycological examination (microscopy and culture of respiratory substrates). Computed tomography of the chest was performed upon clinical indications. The basophil activation test with the A. fumigatus allergen was performed in 10 CF patients with ABPA, and 10 CF patients without ABPA, in addition to the standard allergological examination. Frequency of sensitization to A. fumigatus in the patients with cystic fibrosis was 27%, the incidence of allergic bronchopulmonary aspergillosis was 5.7%. The number of eosinophils, total IgE and specific IgE levels in CF patients with ABPA were significantly higher than in CF patients without ABPA. In blood of the ABPA patients we have identified 68.5 (52.5-81.5%) of basophilic leukocytes activated by A. fumigatus allergen, with a stimulation index of 17.07 (10.30-27.70). In appropriate comparison group, the stimulation index did not exceed 1.5 (p = 0.000). Direct positive correlation between the levels of specific IgE to A. fumigatus and the number of basophils activated by A. fumigatus allergens was revealed (r = 0.77; р < 0.05). FVC values and the body mass index in CF patients with ABPA were significantly lower when compared with the patients without fungal sensitization. Introduction of the basophil activation test, along with standard techniques, may enable a more differentiated assessment of ABPA development in CF patients. Timely detection of associations between A. fumigatus sensitization and clinical status of CF patients will facilitate early and effective administration of specific therapy

Тяжелый грипп как фактор риска развития инвазивного аспергиллёза лёгких (клинический случай)

During  last  years  the  frequency  of  invasive  pulmonary aspergillosis  (IPA)  in  immunocompetent  patients  has  increased. Clinical case report of successful treatment invasive aspergillosis  with  influenza  A(H1N1)  presented  in  the  article. We analyzed the special literature of patients with IPA following influenza infection. The timely identification and treatment of these patients are necessary.В последние годы увеличилась частота инвазивного аспергиллеза у больных без типичных факторов риска. В статье представлен случай успешного лечения инвазивного аспергиллёза лёгких, возникшего на фоне гриппа A(H1N1), и обзор литературы. Показана необходимость своевременной диагностики и адекватной антимикотической терапии у больных тяжелым гриппом

Invasive aspergillosis in patients with COVID-19 in intensive care units: results of a multicenter study

Objective. To study risk factors, clinical and radiological features and effectiveness of the treatment of invasive aspergillosis (IA) in adult patients with COVID-19 (COVID-IA) in intensive care units (ICU). Materials and Methods. A total of 60 patients with COVID-IA treated in ICU (median age 62 years, male – 58%) were included in this multicenter prospective study. The comparison group included 34 patients with COVID-IA outside the ICU (median age 62 years, male – 68%). ECMM/ISHAM 2020 criteria were used for diagnosis of CAPA, and EORTC/MSGERC 2020 criteria were used for evaluation of the treatment efficacy. A case-control study (one patient of the main group per two patients of the control group) was conducted to study risk factors for the development and features of CAPA. The control group included 120 adult COVID-19 patients without IA in the ICU, similar in demographic characteristics and background conditions. The median age of patients in the control group was 63 years, male – 67%. Results. 64% of patients with COVID-IA stayed in the ICU. Risk factors for the COVID-IA development in the ICU: chronic obstructive pulmonary disease (OR = 3.538 [1.104–11.337], p = 0.02), and prolonged (> 10 days) lymphopenia (OR = 8.770 [4.177–18.415], p = 0.00001). The main location of COVID-IA in the ICU was lungs (98%). Typical clinical signs were fever (97%), cough (92%), severe respiratory failure (72%), ARDS (64%) and haemoptysis (23%). Typical CT features were areas of consolidation (97%), hydrothorax (63%), and foci of destruction (53%). The effective methods of laboratory diagnosis of COVID-IA were test for galactomannan in BAL (62%), culture (33%) and microscopy (22%) of BAL. The main causative agents of COVID-IA are A. fumigatus (61%), A. niger (26%) and A. flavus (4%). The overall 12-week survival rate of patients with COVID-IA in the ICU was 42%, negative predictive factors were severe respiratory failure (27.5% vs 81%, p = 0.003), ARDS (14% vs 69%, p = 0.001), mechanical ventilation (25% vs 60%, p = 0.01), and foci of destruction in the lung tissue on CT scan (23% vs 59%, p = 0.01). Conclusions. IA affects predominantly ICU patients with COVID-19 who have concomitant medical conditions, such as diabetes mellitus, hematological malignancies, cancer, and COPD. Risk factors for COVID-IA in ICU patients are prolonged lymphopenia and COPD. The majority of patients with COVID-IA have their lungs affected, but clinical signs of IA are non-specific (fever, cough, progressive respiratory failure). The overall 12-week survival in ICU patients with COVID-IA is low. Prognostic factors of poor outcome in adult ICU patients are severe respiratory failure, ARDS, mechanical ventilation as well as CT signs of lung tissue destruction

АСПЕРГИЛЛЕЗ ЛЕГКИХ У БОЛЬНЫХ МУКОВИСЦИДОЗОМ В РОССИЙСКОЙ ФЕДЕРАЦИИ

The aim: to assess the incidence of various forms of pulmonary aspergillosis in patients with cystic fibrosis.Materials and methods. In 2014-2017 yy. in prospective study in  different regions of Russia were included 190 patients with cystic  fibrosis aged 1 to 37 years. Children – 130, adults – 60. All patients  underwent allergy (skin tests with fungal allergens, total IgE level,  specific IgE to fungal allergens) and mycology (microscopy and  cultural investigations of respiratory biomaterials) testing. Chest  computed tomography was performed according to the indications.Results. The incidence of fungal sensitization in patients with cystic  fibrosis was 57%, to Aspergillus spp. – 27%. The incidence of  allergic bronchopulmonary aspergillosis was 5,7%, chronic lung  aspergillosis – 4,2%, invasive aspergillosis developed in one patient  (0,5%) during immunosuppressive therapy after liver transplantation.Conclusion. The incidence of pulmonary aspergillosis in patients  with cystic fibrosis in the Russian Federation was first determined  (10.5%). Mycology testing is indicated for patients with cystic  fibrosis for early treatment of different variants of pulmonary aspergillosis.Цель. Оценить частоту развития различных форм аспергиллеза легких у больных муковисцидозом.Материалы и методы. В 2014–2017 гг. в проспективное исследование в разных регионах  РФ включили 190 больных муковисцидозом в возрасте от 1 до 37 лет (130 детей, 60  взрослых). Всем пациентам провели аллергологическое обследование (кожные тесты с  грибковыми аллергенами, определение уровня общего IgE и специфических IgE к  грибковым аллергенам) и микологическое обселедование (микроскопия и посев  респираторных субстратов). По показаниям выполняли компьютерную томографию органов грудной клетки.Результаты. У больных муковисцидозом частота микогенной сенсибилизации составила  57%, к Aspergillus spp. – 27%. Аллергический бронхолегочный аспергиллез выявили у 5,7%  пациентов, хронический аспергиллез легких – у 4,2%, инвазивный аспергиллез развился у  одного пациента (0,5%) на фоне иммунодепрессивной терапии после трансплантации печени.Заключение. Впервые определена частота развития аспергиллеза легких у больных  муковисцидозом в Российской Федерации (10,5%). Больным муковисцидозом показано  микологическое обследование для своевременного лечения различных вариантов аспергиллеза легких

Инвазивный аспергиллез у взрослых пациентов с ревматическими заболеваниями

Objective: to study risk factors for invasive aspergillosis (IA), its etiology, clinical manifestations, and treatment efficiency in patients with rheumatic diseases (RD).Patients and methods. The first study of proven and probable IA (EORT/MSGERC, 2019) was conducted in 18 patients with RD, who accounted for 3% of all adult IA patients (n=699) included in the 1998–2020 registry of the Department of Clinical Mycology, Allergology, and Immunology, I.I. Mechnikov North-Western State Medical University (Group 1). This group comprised 56% women; the median age was 59 [21; 75] years. Group 2 (a comparison group) included 610 adult hematology patients with IA (median age, 45 [18; 79] years; 42% women). A prospective case-control study was conducted to identify risk factors for IA in patients with RD: 36 rheumatic patients without IA (median age, 58 (18–79) years; 61% women) (a control group).Results and discussion. Patients with RD were found to often develop IA in the presence of anti-neutrophilic cytoplasmic antibody-associated vasculitis (granulomatosis with polyangiitis and microscopic polyangiitis) and systemic lupus erythematosus (50 and 16%, respectively). It was shown for the first time that the likelihood of IA in patients with RD increases with prolonged (median 14 days) lymphocytopenia during RD treatment (odds ratio 13.0; 95% confidence interval, 3.3–50.3). The main causative agents of IA were A. fumigatus (50%) and A. niger (29%). IA was more severe in Group 1 than in Group 2: in the resuscitation and intensive care units, there were 44 and 18%, respectively (p=0.01). Group 1 versus Group 2 more frequently had respiratory failure (61 and 37%, respectively; p=0.03), hemoptysis (28 and 7%; p=0.0001), chest pain (17 and 7%; p=0.04), and cardiac involvement (11 and 1%; p=0.0001), and less frequently had fever (67 and 85%; p=0.01). The common site of IA was the lung (83%); the characteristic feature detected by computed tomography (CT) is pulmonary cavitation (44%). Antifungal therapy was used in 89% of Group 1 patients; the overall 12-week survival was 69%.Conclusion. In patients with RD, it is difficult to differentiate between the progression of the underlying disease, adverse drug reactions, infectious complications, or a combination of these disorders due to the similarity of their clinical manifestations. When RD patients with infectious syndrome and respiratory failure develop prolonged lymphocytopenia during combination therapy, AI should be suspected and lung CT, bronchoscopy, and mycological examination of the material obtained by bronchoalveolar lavage be done.Цель исследования – изучение факторов риска развития, этиологии, особенностей клинических проявлений и эффективности лечения инвазивного аспергиллеза (ИА) у пациентов с ревматическими заболеваниями (РЗ).Пациенты и методы. Проведено первое исследование «доказанного» и «вероятного» (EORTС/MSGERC, 2019) ИА у 18 пациентов с РЗ, которые составили 3% всех взрослых больных ИА (n=699), включенных в регистр, созданный на базе кафедры клинической микологии, аллергологии и иммунологии ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» (1998–2020 гг.) – 1-я группа. В этой группе было 56% женщин, медиана возраста – 59 [21; 75] лет. Во 2-ю группу (группа сравнения) вошли 610 взрослых пациентов с гематологическими заболеваниями, страдающих ИА (медиана возраста – 45 [18; 79] лет, женщины – 42%). Для изучения факторов риска ИА у пациентов с РЗ было проведено проспективное исследование случай-контроль, в которое включили 36 взрослых пациентов с РЗ без ИА (медиана возраста – 58 [18; 79] лет, женщины – 61%) – контрольная группа.Результаты и обсуждение. Установлено, что у пациентов с РЗ ИА чаще развивается на фоне васкулитов, ассоциированных c антинейтрофильными цитоплазматическими антителами (гранулематоз с полиангиитом и микроскопический полиангиит), и системной красной волчанки (соответственно в 50 и 16% случаев). Впервые было показано, что вероятность возникновения ИА у пациентов с РЗ повышается при длительной (медиана – 14 дней) лимфоцитопении на фоне лечения РЗ (отношение шансов 13,0; 95% доверительный интервал 3,3–50,3). Основными возбудителями ИА были A. fumigatus (50% случаев) и A. niger (29%). В 1-й группе ИА протекал более тяжело, чем во 2-й: в отделениях реанимации и интенсивной терапии находились 44 и 18% больных соответственно (p=0,01). В 1-й группе чаще, чем во 2-й, отмечались дыхательная недостаточность (61 и 37% соответственно; p=0,03), кровохарканье (28 и 7%; p=0,0001), боль в грудной клетке (17 и 7%; p=0,04), поражение сердца (11 и 1%; p=0,0001), реже – лихорадка (67 и 85%; p=0,01). Основной локализацией ИА были легкие (у 83% больных), характерный признак, определяемый при компьютерной томографии (КТ), – наличие полостей деструкции (44% случаев). Антифунгальную терапию получали 89% больных 1-й группы, общая выживаемость в течение 12 нед составила 69%.Заключение. У пациентов с РЗ сложно провести дифференциальную диагностику между прогрессированием основного заболевания, неблагоприятными реакциями лекарственной терапии, инфекционным осложнением или комбинацией этих нарушений из-за сходства их клинических проявлений. При развитии длительной лимфоцитопении на фоне комплексной терапии у пациентов с РЗ, имеющих инфекционный синдром и дыхательную недостаточность, следует заподозрить ИА и провести обследование: КТ легких, бронхоскопию и микологическое исследование материала, полученного при бронхоальвеолярном лаваже.