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Summary: For the past half-century, β2-agonists have been the mainstay of treatment of the bronchoconstriction associated with asthma. Although their usefulness in reversing acute bronchospasm remains undiminished, there is increasing evidence that chronic use may lead to development of tolerance and thus, potentially increasing morbidity and even mortality. In addition, genetic studies have shown that certain individuals carrying specific mutations may be prone to developing resistance to β2-agonists regardless of the duration of treatment. This article reviews the current evidence regarding the underlying mechanisms that cause or contribute to the development of the resistance, as well as the strategies for the evaluation and management of patients who are at risk for or have developed tolerance to β2-agonists. [Copyright &y& Elsevier]

This article is a personal interpretation of how The Discipline has re-formulated the pastoral identity, practice, and theology of a board certified chaplain providing ministry to patients in the heart sciences. His reflections take into account his history as an ordained priest and as a professionally trained chaplain. The article reflects his struggles and theological transformations, demonstrating how a theological base may emerge from the interpretative reflection on The Discipline. The article describes the uneasy internal and external processes that occurred in and around him during that transformation. His story also attests to growth made “from the inside out” as a chaplain within a generative multi-faith department. [ABSTRACT FROM PUBLISHER]

After the chaplain is well acquainted with The Discipline and has begun to implement it in daily pastoral practice, half of the work is done. The further work concerns how and what to communicate to the care team regarding the chaplain's observations. This article begins by offering a pastoral reflection on the chaplain's identity and pastoral practice within a multi-disciplinary care team. The pastoral reflection highlights key theological assertions used by The Discipline. The author then identifies the particular problems facing care teams and their communication that the chaplain can anticipate when using The Discipline. Thirdly, the author suggests work able, the ologically based tools for the resolution of these problems. Lastly, through the case study of “Jerry,” the author illustrates both the “how” and “what” components of care team communication using the working elements of The Discipline. The “how” component describes the informal and formal relational processes that have contributed to a working partnership. The case study also illustrates the “what” part of care team communication-the structure and delivery of observable and discernible content to physicians and nurses. These materials can ease the transition towards effective pastoral presence on the interdisciplinary care team regarding patient and family/support partner care. [ABSTRACT FROM PUBLISHER]

Reports of clinical manifestations of West Nile virus (WNV) infections in children have been relatively rare. Four cases of WNV infection in children are described: the first report of prolonged encephalitis and fulminant hepatitis caused by WNV, and 3 other presentations of WNV, including the first report of ocular involvement in a child. [ABSTRACT FROM AUTHOR]