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Growing numbers of American students are travelling overseas to study abroad and enroll in full degree programs. Despite this trend, relatively little is known about the experiences of United States (U.S.) students abroad. The aim of this research was to examine the experiences of American international students in Ireland. Findings suggest that while U.S. students experience some adaptation problems, overall, they adapt well to studying in Ireland. Subtle differences in long-term and short-term international students' levels of social support and academic satisfaction were also detected. This research has important practical implications for facilitating the adaption of U.S. students abroad. At a time when many governments and academic institutions are devising strategies to attract international students, this research is timely and necessary.

Although numerous studies have explored international students' experiences, there is a dearth of research exploring the perspectives of professionals who have contact with international students. The present study addresses this gap in the literature by providing an analysis of higher educational professionals' ("n"=11) perspectives of international students' experiences and analysing the challenges which arise when working with international students. In this study, semi-structured interviews were conducted with staff from a large Irish Higher Education Institution. Participants described a range of difficulties experienced by international students, including sociocultural and psychological difficulties, and outlined a number of challenges which exist when dealing with international students, most of which relate to cultural differences and lack of interest in internationalisation. The findings have important policy and practical implications for higher education service provision and point to the need to consider internationalisation as a process which can be enriching for international students, host students and staff members alike.

This article reports on an empirical study of the psychosocial adaptation of international students in Ireland. Using measures of social support, loneliness, stress, psychological well-being, and sociocultural adaptation, data were obtained from international students and a comparison sample of Irish students. The study found that, although international students had high levels of social support and low levels of loneliness and stress, students were experiencing high levels of sociocultural adjustment difficulties and psychological distress. Significant differences invariables were reported across time, whereas differences between international and Irish students were also discovered. Suggestions for further research and for individuals working with international students are proposed. (Contains 3 tables.)

There is uncertainty about the role of hormonal replacement therapy (HRT) in the development of asthma. We investigated whether use of HRT and duration of use was associated with risk of development of asthma in perimenopausal and postmenopausal women. We constructed a 17-year (from January 1, 2000, to December 31, 2016) open cohort of 353,173 women (aged 46-70 years) from the Optimum Patient Care Database, a longitudinal primary care database from across the United Kingdom. HRT use, subtypes, and duration of use; confounding variables; and asthma onset were defined by using the Read Clinical Classification System. We fitted multilevel Cox regression models to estimate hazard ratios (HRs) with 95% CIs. During the 17-year follow-up (1,340,423 person years), 7,614 new asthma cases occurred, giving an incidence rate of 5.7 (95% CI = 5.5-5.8) per 1,000 person years. Compared with nonuse of HRT, previous use of any (HR = 0.83; 95% CI = 0.76-0.88), estrogen-only (HR = 0.89; 95% CI = 0.84-0.95), or combined estrogen and progestogen (HR = 0.82; 95% CI = 0.76-0.88) HRT was associated with a reduced risk of asthma onset. This was also the case with current use of any (HR = 0.79; 95% CI = 0.74-0.85), estrogen-only (HR = 0.80; 95% CI = 0.73-0.87), and combined estrogen and progestogen (HR = 0.78; 95% CI = 0.70-0.87) HRT. Longer duration of HRT use (1-2 years [HR = 0.93; 95% CI = 0.87-0.99]; 3-4 years [HR = 0.77; 95% CI = 0.70-0.84]; and ≥5 years [HR = 0.71; 95% CI = 0.64-0.78]) was associated with a dose-response reduced risk of asthma onset. We found that HRT was associated with a reduced risk of development of late onset asthma in menopausal women. Further cohort studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Longitudinal studies investigating impact of exogenous sex steroids on clinical outcomes of asthma in women are lacking. We investigated the association between use of hormonal contraceptives and risk of severe asthma exacerbation in reproductive-age women with asthma.Methods: We used the Optimum Patient Care Research Database, a population-based, longitudinal, anonymised primary care database in the UK, to construct a 17-year (1 January 2000-31 December 2016) retrospective cohort of reproductive-age (16-45 years, n=83 084) women with asthma. Using Read codes, we defined use, subtypes and duration of use of hormonal contraceptives. Severe asthma exacerbation was defined according to recommendations of the European Respiratory Society/American Thoracic Society as asthma-related hospitalisation, accident and emergency department visits due to asthma and/or oral corticosteroid prescriptions. Analyses were done using multilevel mixed-effects Poisson regression with QR decomposition.Results: The 17-year follow-up resulted in 456 803 person-years of follow-up time. At baseline, 34% of women were using any hormonal contraceptives, 25% combined (oestrogen/progestogen) and 9% progestogen-only contraceptives. Previous (incidence rate ratio (IRR) 0.94, 95% CI 0.92 to 0.97) and current (IRR 0.96, 95% CI 0.94 to 0.98) use of any, previous (IRR 0.92, 95% CI 0.87 to 0.97) and current use of combined (IRR 0.93, 95% CI 0.91 to 0.96) and longer duration of use (3-4 years: IRR 0.94, 95% CI 0.92 to 0.97; 5+ years: IRR 0.91, 95% CI 0.89 to 0.93) of hormonal contraceptives, but not progestogen-only contraceptives, were associated with reduced risk of severe asthma exacerbation compared with non-use.Conclusions: Use of hormonal contraceptives may reduce the risk of severe asthma exacerbation in reproductive-age women. Mechanistic studies investigating the biological basis for the influence of hormonal contraceptives on clinical outcomes of asthma in women are required.Protocol Registration Number: European Union electronic Register of Post-Authorisation Studies (EUPAS22967). [ABSTRACT FROM AUTHOR]

Despite well-described sex differences in asthma incidence, there remains uncertainty about the role of female sex hormones in the development of asthma. We sought to investigate whether hormonal contraceptive use, its subtypes, and duration of use were associated with new-onset asthma in reproductive-age women. Using the Optimum Patient Care Research Database, a UK national primary care database, we constructed an open cohort of 16- to 45-year-old women (N = 564,896) followed for up to 17 years (ie, January 1, 2000, to December 31, 2016). We fitted multilevel Cox regression models to analyze the data. At baseline, 26% of women were using any hormonal contraceptives. During follow-up (3,597,146 person-years), 25,288 women developed asthma, an incidence rate of 7.0 (95% CI, 6.9-7.1) per 1000 person-years. Compared with nonuse, previous use of any hormonal contraceptives (hazard ratio [HR], 0.70; 95% CI, 0.68-0.72), combined (HR, 0.70; 95% CI, 0.68-0.72), and progestogen-only therapy (HR, 0.70; 95% CI, 0.67-0.74) was associated with reduced risk of new-onset asthma. For current use, the estimates were as follows: any (HR, 0.63; 95% CI, 0.61-0.65), combined (HR, 0.65; 95% CI, 0.62-0.67), and progestogen-only therapy (HR, 0.59; 95% CI, 0.56-0.62). Longer duration of use (1-2 years: HR, 0.83; 95% CI, 0.81-0.86; 3-4 years: HR, 0.64; 95% CI, 0.61-0.67; 5+ years: HR, 0.46; 95% CI, 0.44-0.49) was associated with a lower risk of asthma onset than nonuse. Hormonal contraceptive use was associated with reduced risk of new-onset asthma in women of reproductive age. Mechanistic investigations to uncover the biological processes for these observations are required. Clinical trials investigating the safety and effectiveness of hormonal contraceptives for primary prevention of asthma will be helpful to confirm these results. [ABSTRACT FROM AUTHOR]

Summary Background Chronic non-specific respiratory symptoms are difficult to manage. This trial aimed to evaluate the association between baseline fractional exhaled nitric oxide (F e NO) and the response to inhaled corticosteroids in patients with non-specific respiratory symptoms. Methods In this double-blind randomised placebo-controlled trial, we enrolled undiagnosed patients, aged 18–80 years, with cough, wheeze, or dyspnoea and less than 20% bronchodilator reversibility across 26 primary care centres and hospitals in the UK and Singapore. Patients were assessed for 2 weeks before being randomly assigned (1:1) to 4 weeks of treatment with extrafine inhaled corticosteroids (QVAR 80 μg, two puffs twice per day, equivalent to 800 μg per day beclomethasone dipropionate) or placebo. Randomisation was stratified by baseline F e NO measurement: normal (≤25 parts per billion [ppb]), intermediate (>25 tp <40 ppb), and high (≥40 ppb). The primary endpoint was change in Asthma Control Questionnaire (ACQ7) mean score. We used generalised linear modelling to assess F e NO as a predictor of response, estimating an interaction effect between F e NO and treatment on change in ACQ7. We did our primary and secondary analyses in the per-protocol set, which excluded patients with non-completion of the primary endpoint, non-compliance to treatment (ascertained by patient report), and study visits made outside the predefined visit windows. This study is registered on ClinicalTrials.gov , number NCT02294279 . Findings Between Feb 4, 2015, and July 12, 2016, we randomly assigned 294 patients to extrafine inhaled corticosteroid treatment (n=148) or placebo (n=146). Following exclusions due to protocol violations, we analysed 214 patients (114 extrafine inhaled corticosteroids and 100 placebo). We observed a significant interaction between baseline F e NO and treatment group for every 10 ppb increase in baseline F e NO, with the change in ACQ7 greater in the extrafine inhaled corticosteroids group than in the placebo group (difference between groups 0·071, 95% CI 0·002 to 0·139; p=0·044). The most common adverse events were nasopharyngitis (18 [12%] patients in the treatment group vs 13 [9%] in the placebo group), infections and infestations (25 [17%] vs 21 [14%]), and respiratory, thoracic, and mediastinal disorders (13 [9%] vs 17 [12%]). Interpretation F e NO measurement is an easy and non-invasive tool to use in clinical practice in patients with non-specific respiratory symptoms to predict response to inhaled corticosteroids. Further research is needed to examine its role in patients with evidence of other airway diseases, such as chronic obstructive pulmonary disease. Funding Sponsored by OPRI with partial funding by Circassia and study drugs provided by TEVA. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is a common disorder which has a major impact on the lives of sufferers and families. Although currently there is no cure for this disease, a variety of therapeutic interventions can alleviate the symptoms. It is important that nurses are able to differentiate allergic and non-allergic rhinitis (NAR) from viral upper respiratory tract infections (URTIs) in order to best manage their patients. It is also necessary to ask appropriate questions of those patients attending for asthma review, as they may have unrecognised and untreated disease. Familiarity with the range of medications and their administration is advocated. Patients with troublesome, non-responding symptoms need to be referred, as do those with red flag signs. [ABSTRACT FROM AUTHOR]

Summary: Background: Patterns of health-care use and comorbidities present in patients in the period before diagnosis of chronic obstructive pulmonary disease (COPD) are unknown. We investigated these factors to inform future case-finding strategies. Methods: We did a retrospective analysis of a clinical cohort in the UK with data from Jan 1, 1990 to Dec 31, 2009 (General Practice Research Database and Optimum Patient Care Research Database). We assessed patients aged 40 years or older who had an electronically coded diagnosis of COPD in their primary care records and had a minimum of 3 years of continuous practice data for COPD (2 years before diagnosis up to a maximum of 20 years, and 1 year after diagnosis) and at least two prescriptions for COPD since diagnosis. We identified missed opportunites to diagnose COPD from routinely collected patient data by reviewing patterns of health-care use and comorbidities present before diagnosis. We assessed patterns of health-care use in terms of lower respiratory consultations (infective and non-infective), lower respiratory consultations with a course of antibiotics or oral steroids, and chest radiography. If these events did not lead to a diagnosis of COPD, they were deemed to be missed opportunities. This study is registered with ClinicalTrials.gov, number NCT01655667. Findings: We assessed data for 38 859 patients. Opportunities for diagnosis were missed in 32 900 (85%) of 38 859 patients in the 5 years immediately preceding diagnosis of COPD; in 12 856 (58%) of 22 286 in the 6–10 years before diagnosis, in 3943 (42%) of 9351 in the 11–15 years before diagnosis; and in 95 (8%) of 1167 in the 16–20 years before diagnosis. Between 1990 and 2009, we noted decreases in the age at diagnosis (0·05 years of age per year, 95% CI 0·03–0·07) and yearly frequency of lower respiratory prescribing consultations (rate ratio 0·982 opportunities per year, 95% CI 0·979–0·985). Prevalence of all comorbidities present at COPD diagnosis increased except for asthma and bronchiectasis, which decreased between 1990 and 2007, from 281 (33·4%) of 842 patients to 451 of 1465 (30·8%) for asthma, and from 53 of 842 (6·3%) to 53 of 1465 (3·6%) for bronchiectasis. In the 2 years before diagnosis, of 6897 patients who had had a chest radiography, only 2296 (33%) also had spirometry. Interpretation: Opportunities to diagnose COPD at an earlier stage are being missed, and could be improved by case-finding in patients with lower respiratory tract symptoms and concordant long-term comorbidities. Funding: UK Department of Health, Research in Real Life. [ABSTRACT FROM AUTHOR]

Aim: Achieving target recruitment in randomized controlled trials (RCTs) is challenging. This paper compares our experience of recruiting for an RCT with the predictions made in our proposal. Methods: Participating UK primary care practices searched their computer databases to identify patients (12 years and over) with asthma who may be poorly controlled. Postal invitations were sent to all patients identified. Respondees were prescreened by phone, to assess their asthma control and establish their mobile phone suitability. Potentially eligible patients were booked for a trial recruitment visit.Results: We recruited 288 patients (2.4% of those invited) across 32 practices, with a total list size of 311,926 patients. This compares to our predicted recruitment of 312 patients from a population of 72,000 patients in six to eight practices. In addition to the recognized problem of poor response rates, the major challenges were insufficiently discriminating computer searches and incompatibilities between mobile phone handsets, networks and the asthma application. Conclusion: Our data have implications for clinicians, managers, and researchers in primary care. Researchers in this area may wish to consider our data when designing their recruitment strategies. Improved coding of asthma morbidity data in clinical practice would ease identification of poorly controlled patients, both for clinical interventions and recruitment to trials. If telehealth is to become mainstream, there needs to be standardization of applications, operating platforms, and network capabilities [ABSTRACT FROM AUTHOR]

The article presents the 2009 issue of the "World Allergy Organization." It discusses the use of sub-lingual immunotherapy (SLIT) in medical care particularly its clinical application for physicains who are focusing on the development of immune system resistance. Moreover, it also provides an overview on the functions of subcutaneous immunotherapy and other routes of immunotherapy administration in treating severe diseases due to allergens.

This article explores The Queen's Case (1820) 2 Brod & B 284; 129 ER 976. As well as being a sensational episode in English history, The Queen's Case is authority for the basic rule of the common law that a witness cannot be asked any question about the contents of a document, unless the document is first shown to the witness and put in evidence as part of the case of the party represented by the cross-examiner. An undesirable consequence of this rule was that the party represented by the cross-examiner was forced into evidence, with consequential effects on the order of final address. This article provides some highlights of Queen Caroline's trial for adultery, in particular the sometimes questionable conduct and tactics of her legal team, before turning to the significant implications of the rule and its descendants for the conduct of modern litigation. [ABSTRACT FROM AUTHOR]

Discusses forest use and management in Europe from ancient times until the present. Evolution of forest management and its influence on the present-day sustainability of forests; Move beyond regulation of exploitation towards wood production; Paradigm shifts and the development of scientific forest management; Human impact on the sustainability of forest ecosystems; Concepts in sustainability.