Endotypes of allergic diseases and asthma: An important step in building blocks for the future of precision medicine

Discoveries from basic science research in the last decade have brought significant progress in knowledge of pathophysiologic processes of allergic diseases, with a compelling impact on understanding of the natural history, risk prediction, treatment selection or mechanism-specific prevention strategies. The view of the pathophysiology of allergic diseases developed from a mechanistic approach, with a focus on symptoms and organ function, to the recognition of a complex network of immunological pathways. Several subtypes of inflammation and complex immune-regulatory networks and the reasons for their failure are now described, that open the way for the development of new diagnostic tools and innovative targeted-treatments. An endotype is a subtype of a disease condition, which is defined by a distinct pathophysiological mechanism, whereas a disease phenotype defines any observable characteristic of a disease without any implication of a mechanism. Another key word linked to disease endotyping is biomarker that is measured and evaluated to examine any biological or pathogenic processes, including response to a therapeutic intervention. These three keywords will be discussed more and more in the future with the upcoming efforts to revolutionize patient care in the direction of precision medicine and precision health. The understanding of disease endotypes based on pathophysiological principles and their validation across clinically meaningful outcomes in asthma, allergic rhinitis, chronic rhinosinusitis, atopic dermatitis and food allergy will be crucial for the success of precision medicine as a new approach to patient management

ARIA 2016 : Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

European Innovation Partnership on Active and Healthy Ageing Reference Site MACVIA-France, EU Structural and Development Fund Languedoc-Roussillon, ARIA.Peer reviewedPublisher PD

Classroom composition, classroom quality and German skills of very young dual language learners and German-only learners

This study examined associations between the classroom percentage of dual language learners (DLLs), observed classroom quality, and children's German majority language skills. The cross-sectional sample of 2.5 years olds (n = 93 immigrant DLLs and n = 363 monolingual German-only learners) was clustered within n = 197 classrooms. Classrooms with higher percentages of DLLs demonstrated slightly lower levels of overall classroom process quality. DLLs scored about 1 SD below monolingual children on German language skills when adjusting for family and classroom covariates. Moderation analyses revealed that this difference did not depend on the percentage of DLLs in a classroom. In fact, the classroom percentage of DLLs was related to children's German skills only when omitting the child level language status (DLL vs. monolingual) from the analyses. However, classroom quality moderated the difference between DLLs’ and monolingual children's German skills. This difference was estimated as about only 0.5 SD for DLLs and monolingual children experiencing higher classroom quality, but as about 1.5 SD for those experiencing lower quality. We conclude that high quality classrooms may promote the majority language skills of DLLs

Impact of retrograde transillumination while securing the airway in obese patients undergoing bariatric surgery

Video laryngoscopy (VL) is a well-established technique used in anaesthetising obese patients who present with higher risks of airway-related difficulties and desaturations due to shorter safe apnoea periods. However, VL has certain limitations and may fail. We present the Infrared Red Intubation System (IRRIS), a new technique facilitating glottis identification in severely obese patients undergoing anaesthesia for bariatric surgery. This single-centre, prospective trial assessed the efficacy of the IRRIS for VL tracheal intubation in 20 severely obese adult patients undergoing elective bariatric surgery under general anaesthesia. We assessed the ability of the IRRIS to differentiate the transilluminated glottis from the oesophagus and laryngeal folds and evaluated the ease of intubation. The average weight in the investigated patient cohort was 145 ± 29 kg, the suprasternal tissue thickness was 12 ± 4 mm. The median IQR [range] larynx recognition time was 10 [2–50] s, which was similar to that of lean patients. The degree of obesity correlated with the duration to achieve optimal laryngoscopic view and complete the intubation procedure. We achieved successful VL insertion on the first attempt in 13 of 20 cases (65%), and on the second attempt in 7 cases (35%), emphasising the increased probability of successful intubation on the first attempt. Tracheal intubation with the IRRIS lasted 50 [IQR 20–100] s. The lowest SpO2 during intubation was 98 [IQR 83–100] %. Addition of IRRIS to VL insertion facilitated the intubation of difficult airways in severely obese patients. IRRIS improves the visualization of the intubation pathway by selectively highlighting the airway entrance and shortens the time to successfully conclude the intubation procedure

Alteration of superconductivity of suspended carbon nanotubes by deposition of organic molecules

We have altered the superconductivity of a suspended rope of single walled carbon nanotubes, by coating it with organic polymers. Upon coating, the normal state resistance of the rope changes by less than 20 percent. But superconductivity, which on the bare rope shows up as a substantial resistance decrease below 300 mK, is gradualy suppressed. We correlate this to the suppression of radial breathing modes, measured with Raman Spectroscopy on suspended Single and Double-walled carbon nanotubes. This points to the breathing phonon modes as being responsible for superconductivity in carbon nanotubes

ARIA-EAACI care pathways for allergen immunotherapy in respiratory allergy

Rinitis al·lèrgica; Asma; ImmunoteràpiaRinitis alérgica; Asma; InmunoterapiaAllergic rhinitis; Asthma; ImmunotherapyARIA, Grant/Award Number: N/

Allergen immunotherapy for asthma prevention: A systematic review and meta-analysis of randomized and non-randomized controlled studies

Background: Allergen immunotherapy (AIT) is a disease-modifying treatment for IgE-mediated diseases. Randomized controlled trials (RCTs) support AIT's potential role in asthma prevention but evidence from non-randomized studies of interventions (NRSI) and longitudinal observational studies has been poorly addressed. Therefore, we aimed to conduct a systematic review and meta-analysis to assess clinical data from all study types to evaluate quantitatively the preventive role of AIT in asthma onset. Methods: We search three databases. Studies were screened, selected and evaluated for quality using risk-of-bias (ROB) tools. Data were descriptively summarized and meta-analysed using random effects. We performed a sensitivity, influence and subgroup analyses. Publication bias and heterogeneity were assessed. Results: From the 4549 identified studies, 24 (12 RCTs and 12 NRSI) were included in the qualitative synthesis and 18 underwent meta-analysis. One study was at low ROB, seven had moderate ROB, and 15 were proven of high ROB. Random-effects analysis showed a significant decrease in the risk of developing asthma following AIT by 25% (RR, 95% CI: 0.75, 0.64–0.88). This effect was not significant in the sensitivity analysis. Publication bias raised concerns, together with the moderate heterogeneity between studies (I2 = 58%). Subgroup analysis showed a remarkable preventive effect of AIT in children (RR, 95% CI: 0.71, 0.53–0.96), when completing 3 years of therapy (RR, 95% CI: 0.64, 0.47–0.88), and in mono-sensitized patients (RR, 95% CI: 0.49, 0.39–0.61). Conclusions: Our findings support a possible preventive effect of AIT in asthma onset and suggest an enhanced effect when administered in children, mono-sensitized, and for at least 3 years, independently of allergen type. © 2022 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.Funding text 1: Mariana Farraia is funded by Fundação para a Ciência e Tecnologia through the PhD Grant number SFRH/BD/145168/2019. João Cavaleiro Rufo is funded by Fundação para a Ciência e Tecnologia through the Stimulus for Scientific Employment Individual Support (2020.01350.CEECIND).; Funding text 2: Mariana Farraia is funded by Fundação para a Ciência e Tecnologia through the PhD Grant number SFRH/BD/145168/2019. João Cavaleiro Rufo is funded by Fundação para a Ciência e Tecnologia through the Stimulus for Scientific Employment Individual Support (2020.01350.CEECIND)

Investigation of photoplethysmographic signals and blood oxygen saturation values on healthy volunteers during cuff-induced hypoperfusion using a multimode PPG/SpO2 sensor

Photoplethysmography (PPG) is a technique widely used to monitor volumetric blood changes induced by cardiac pulsations. Pulse oximetry uses the technique of PPG to estimate arterial oxygen saturation values (SpO2). In poorly perfused tissues, SpO2 readings may be compromised due to the poor quality of the PPG signals. A multimode finger PPG probe that operates simultaneously in reflectance, transmittance and a combined mode called “transreflectance”’ was developed, in an effort to improve the quality of the PPG signals in states of hypoperfusion. Experiments on 20 volunteers were conducted to evaluate the performance of the multimode PPG sensor and compare the results with a commercial transmittance pulse oximeter. A brachial blood pressure cuff was used to induce artificial hypoperfusion. Results showed that the amplitude of the transreflectance AC PPG signals were significantly different (p\0.05) than the AC PPG signals obtained from the other two conventional PPG sensors (reflectance and transmittance). At induced brachial pressures between 90 and 135 mmHg, the reflectance finger pulse oximeter failed 25 times (failure rate 42.2 %) to estimate SpO2 values, whereas the transmittance pulse oximeter failed 8 times (failure rate 15.5 %). The transreflectance pulse oximeter failed only 3 times (failure rate 6.8 %) and the commercial pulse oximeter failed 17 times (failure rate 29.4 %)

A Stochastic Search on the Line-Based Solution to Discretized Estimation

Recently, Oommen and Rueda [11] presented a strategy by which the parameters of a binomial/multinomial distribution can be estimated when the underlying distribution is nonstationary. The method has been referred to as the Stochastic Learning Weak Estimator (SLWE), and is based on the principles of continuous stochastic Learning Automata (LA). In this paper, we consider a new family of stochastic discretized weak estimators pertinent to tracking time-varying binomial distributions. As opposed to the SLWE, our proposed estimator is discretized , i.e., the estimate can assume only a finite number of values. It is well known in the field of LA that discretized schemes achieve faster convergence speed than their corresponding continuous counterparts. By virtue of discretization, our estimator realizes extremely fast adjustments of the running estimates by jumps, and it is thus able to robustly, and very quickly, track changes in the parameters of the distribution after a switch has occurred in the environment. The design principle of our strategy is based on a solution, pioneered by Oommen [7], for the Stochastic Search on the Line (SSL) problem. The SSL solution proposed in [7], assumes the existence of an Oracle which informs the LA whether to go “right” or “left”. In our application domain, in order to achieve efficient estimation, we have to first infer (or rather simulate ) such an Oracle. In order to overcome this difficulty, we rather intelligently construct an “Artificial Oracle” that suggests whether we are to increase the current estimate or to decrease it. The paper briefly reports conclusive experimental results that demonstrate the ability of the proposed estimator to cope with non-stationary environments with a high adaptation rate, and with an accuracy that depends on its resolution. The results which we present are, to the best of our knowledge, the first reported results that resolve the problem of discretized weak estimation using a SSL-based solution

Re-architecting datacenter networks and stacks for low latency and high performance

Modern datacenter networks provide very high capacity via redundant Clos topologies and low switch latency, but transport protocols rarely deliver matching performance. We present NDP, a novel data-center transport architecture that achieves near-optimal completion times for short transfers and high flow throughput in a wide range of scenarios, including incast. NDP switch buffers are very shallow and when they fill the switches trim packets to headers and priority forward the headers. This gives receivers a full view of instantaneous demand from all senders, and is the basis for our novel, high-performance, multipath-aware transport protocol that can deal gracefully with massive incast events and prioritize traffic from different senders on RTT timescales. We implemented NDP in Linux hosts with DPDK, in a software switch, in a NetFPGA-based hardware switch, and in P4. We evaluate NDP's performance in our implementations and in large-scale simulations, simultaneously demonstrating support for very low-latency and high throughput