Skin Prick Tests and Allergy Diagnosis

Skin testing remains an essential diagnostic tool in modern allergy practice. A signifi cant variability has been reported regarding technical procedures, interpretation of results and documentation. This review has the aim of consolidating methodological recommendations through a critical analysis on past and recent data. This will allow a better understanding on skin prick test (SPT) history; technique; (contra-) indications; interpretation of results; diagnostic pitfalls; adverse reactions; and variability factors

Tourism Culture: Nexus, Characteristics, Context and Sustainability

This article makes the case for tourism culture; the new cultural expressions, practises and identities, influenced by hosts, guests and industry context, which may develop in destinations, as a useful perspective with which to draw together various conceptual narratives within the tourism studies literature. Research in three small islands finds evidence of a distinctive cultural landscape which emerges from the interaction of host and guest cultures, and the exchange, change and creativity that results. Tourism industry dynamics are found to facilitate or undermine this process, as in turn they may be influenced by. This tourism culture has implications for the continuation and evolution of indigenous culture, as it does for the absorption of elements of tourist cultures. The emergent fusion may be symptomatic of a richer cultural landscape and might be considered as an indicator of more sustainable communities and forms of tourism development

From Cleanroom to Desktop: Emerging Micro-Nanofabrication Technology for Biomedical Applications

This review is motivated by the growing demand for low-cost, easy-to-use, compact-size yet powerful micro-nanofabrication technology to address emerging challenges of fundamental biology and translational medicine in regular laboratory settings. Recent advancements in the field benefit considerably from rapidly expanding material selections, ranging from inorganics to organics and from nanoparticles to self-assembled molecules. Meanwhile a great number of novel methodologies, employing off-the-shelf consumer electronics, intriguing interfacial phenomena, bottom-up self-assembly principles, etc., have been implemented to transit micro-nanofabrication from a cleanroom environment to a desktop setup. Furthermore, the latest application of micro-nanofabrication to emerging biomedical research will be presented in detail, which includes point-of-care diagnostics, on-chip cell culture as well as bio-manipulation. While significant progresses have been made in the rapidly growing field, both apparent and unrevealed roadblocks will need to be addressed in the future. We conclude this review by offering our perspectives on the current technical challenges and future research opportunities

Pan-cancer analysis of whole genomes

Cancer is driven by genetic change, and the advent of massively parallel sequencing has enabled systematic documentation of this variation at the whole-genome scale(1-3). Here we report the integrative analysis of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA). We describe the generation of the PCAWG resource, facilitated by international data sharing using compute clouds. On average, cancer genomes contained 4-5 driver mutations when combining coding and non-coding genomic elements; however, in around 5% of cases no drivers were identified, suggesting that cancer driver discovery is not yet complete. Chromothripsis, in which many clustered structural variants arise in a single catastrophic event, is frequently an early event in tumour evolution; in acral melanoma, for example, these events precede most somatic point mutations and affect several cancer-associated genes simultaneously. Cancers with abnormal telomere maintenance often originate from tissues with low replicative activity and show several mechanisms of preventing telomere attrition to critical levels. Common and rare germline variants affect patterns of somatic mutation, including point mutations, structural variants and somatic retrotransposition. A collection of papers from the PCAWG Consortium describes non-coding mutations that drive cancer beyond those in the TERT promoter(4); identifies new signatures of mutational processes that cause base substitutions, small insertions and deletions and structural variation(5,6); analyses timings and patterns of tumour evolution(7); describes the diverse transcriptional consequences of somatic mutation on splicing, expression levels, fusion genes and promoter activity(8,9); and evaluates a range of more-specialized features of cancer genomes(8,10-18).Peer reviewe

Colonial lives of the carceral archipelago: rethinking the neoliberal security state

Mass incarceration, police brutality, and border controls are part and parcel of the everyday experiences of marginalized and racialized communities across the world. Recent scholarship in international relations, sociology, and geography has examined the prevalence of these coercive practices through the prism of “disciplinary,” “penal,” or “authoritarian” neoliberalism. In this collective discussion, we argue that although this literature has brought to the fore neoliberalism's reliance on state violence, it has yet to interrogate how these carceral measures are linked to previous forms of global racial ordering. To rectify this moment of “colonial unknowing,” the collective discussion draws on decolonial approaches, Indigenous studies, and theories of racial capitalism. It demonstrates that “new” and “neoliberal” forms of domestic control must be situated within the global longue durée of racialized and colonial accumulation by dispossession. By mapping contemporary modes of policing, incarceration, migration control, and surveillance onto earlier forms of racial–colonial subjugation, we argue that countering the violence of neoliberalism requires more than nostalgic appeals for a return to Keynesianism. What is needed is abolition—not just of the carceral archipelago, but of the very system of racial capitalism that produces and depends on these global vectors of organized violence and abandonment. L'incarcération de masse, la brutalité policière et les contrôles aux frontières constituent une partie intégrante des expériences quotidiennes des communautés marginalisées et racialisées du monde entier. Des études récentes en relations internationales, en sociologie et en géographie ont examiné la prévalence de ces pratiques coercitives par le prisme du néolibéralisme « disciplinaire », « pénal » ou « autoritaire ». Dans cet article, nous soutenons que bien que cette littérature ait mis en évidence la dépendance du néolibéralisme à la violence étatique, elle ne s'est pas encore interrogée sur le lien entre ces mesures carcérales et les formes précédentes d'ordre racial mondial. Cet article s'appuie sur le féminisme noir, les approches décoloniales, les études indigènes et les théories de capitalisme racial pour rectifier cette « ignorance coloniale » marquante. Il démontre que les formes « nouvelles » et « néolibérales » de contrôle national doivent se situer dans la longue durée globale de l'accumulation racialisée et coloniale par dépossession. Nous associons les modes contemporains de maintien de l'ordre, d'incarcération, de contrôle migratoire et de surveillance à des formes antérieures d'assujettissement racial/colonial pour soutenir que contrer la violence du néolibéralisme exige davantage que des appels nostalgiques au retour du keynésianisme. Ce qu'il faut, c'est une abolition : non seulement de l'archipel carcéral, mais aussi du système de capitalisme racial en lui-même qui produit et dépend de ces vecteurs globaux de violence organisée et d'abandon. El encarcelamiento masivo, la brutalidad policial y los controles fronterizos forman parte de las experiencias cotidianas de las comunidades marginadas y racializadas de todo el mundo. Estudios recientes en RI, Sociología y Geografía han examinado la prevalencia de estas prácticas coercitivas a través del prisma del neoliberalismo “disciplinario,” “penal” o “autoritario.” En este artículo, sostenemos que, si bien esta literatura puso en primer plano la dependencia del neoliberalismo de la violencia estatal, aún tiene que cuestionar la manera en que estas medidas carcelarias se vinculan a formas anteriores de ordenamiento racial global. Para rectificar este momento de “desconocimiento colonial,” el artículo recurre al feminismo negro, a los abordajes descoloniales, a los estudios indígenas y a las teorías del capitalismo racial. Demuestra que las formas “nuevas” y “neoliberales” de control interno se deben situar dentro de la longue durée global de la acumulación por desposesión racializada y colonial. Al trazar un mapa de los modos contemporáneos de vigilancia policial, encarcelamiento, control de la migración y vigilancia sobre las formas anteriores de subyugación racial-colonial, sostenemos que contrarrestar la violencia del neoliberalismo requiere algo más que apelaciones nostálgicas de retorno al keynesianismo. Lo que se necesita es la abolición, no solo del archipiélago carcelario, sino también del propio sistema de capitalismo racial que produce y depende de estos vectores globales de violencia y abandono organizados

Occupational advice for Patients undergoing Arthroplasty of the Lower limb: An intervention development and feasibility study (The OPAL Study)

Background Hip and knee replacements are regularly performed for patients who work. There is little evidence about these patients’ needs and the factors influencing their return to work. There is a paucity of guidance to help patients return to work after surgery and a need for structured occupational advice to enable them to return to work safely and effectively. Objective(s) To develop an occupational advice intervention to support early recovery to usual activities including work which is tailored to the requirements of patients undergoing hip and knee replacements. To test the acceptability, practicality and feasibility of this intervention within current care frameworks Design An intervention mapping (IM) approach was used to develop the intervention. The research methods employed were: rapid evidence synthesis; qualitative interviews with patients and stakeholders; prospective cohort study; survey of clinical practice; modified Delphi consensus process. The developed intervention was implemented and assessed during the final feasibility stage of the IM process. Setting Orthopaedic departments within NHS secondary care. Participants Patients in work, and intending to return to work following primary elective hip and knee replacement surgery; healthcare professionals and employers. Interventions Occupational advice intervention. Main outcome measures Development of an occupational advice intervention. Fidelity of the developed intervention when delivered in a clinical setting. Patient and clinician perspectives of the intervention. Preliminary assessments of intervention effectiveness and cost. Results A cohort study (154 patients), 110 stakeholder interviews, survey of practice (152 respondents) and evidence synthesis provided the necessary information to develop the intervention. The intervention included information resources, personalized return to work plan and co-ordination from the healthcare team to support the delivery of 13 patient and 20 staff performance objectives (POs). To support delivery, a range of tools (e.g. occupational checklists, patient workbooks, employer information), roles (e.g. return-to-work coordinator) and training resources were created. Feasibility was assessed in 21 of the 26 patients recruited from 3 NHS trusts. Adherence with the defined performance objectives was 75% for patient POs and 74% for staff POs. The intervention was generally well received although the short timeframe available for implementation and concurrent research evaluation led to some confusion amongst patients and those delivering the intervention regarding its purpose and the roles and responsibilities of key staff. Limitations Implementation and uptake of the intervention was not standardized and was limited by the study timeframe. Evaluation of the intervention involved a small number of patients which limited the ability to assess it. Conclusions The developed occupational advice intervention supports best practice. Evaluation demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues require further attention Future work The intervention warrants a randomised controlled trial to assess its clinical and cost effectiveness to improve rates and timing of sustained return to work after surgery. This research should include the development of a robust implementation strategy to ensure adoption is sustained. Funding This project was funded by the NIHR Health Technology Assessment programme (project number 15/28/02) Trial Registrations International Standard Randomised Controlled Trials Number Trial ID: ISRCTN27426982 International prospective register of systematic reviews (PROSPERO) Registration: CRD4201604523