A Review of International Recommendations for the Diagnosis and Management of Chronic Urticaria

Both spontaneous and inducible forms of chronic urticaria pose a significant economic burden and have an adverse effect on patients’ quality of life. The international guidelines and US practice parameters for the diagnosis and management of chronic urticaria both recommend performing a thorough patient history and physical examination, conducting limited routine laboratory testing, and taking a stepwise approach to treatment. These documents differ in several areas, such as the order of diagnostic procedures and the treatment for patients non-responsive to standard dose H1-antihistamines. Patients with chronic urticaria who visit a specialist have typically been treated with second-generation H1-antihistamines – the recommended first-line treatments. The advantages and disadvantages of each treatment option should be taken into consideration when selecting therapies beyond H1-antihistamines. Greater awareness of the international guidelines and US practice parameters will likely improve the quality of care for patients with chronic urticaria

Technology for the Future: In-Space Technology Experiments Program, part 2

The purpose of the Office of Aeronautics and Space Technology (OAST) In-Space Technology Experiments Program In-STEP 1988 Workshop was to identify and prioritize technologies that are critical for future national space programs and require validation in the space environment, and review current NASA (In-Reach) and industry/ university (Out-Reach) experiments. A prioritized list of the critical technology needs was developed for the following eight disciplines: structures; environmental effects; power systems and thermal management; fluid management and propulsion systems; automation and robotics; sensors and information systems; in-space systems; and humans in space. This is part two of two parts and contains the critical technology presentations for the eight theme elements and a summary listing of critical space technology needs for each theme

Technology for the Future: In-Space Technology Experiments Program, part 1

The purpose of the Office of Aeronautics and Space Technology (OAST) In-Space Technology Experiment Program (In-STEP) 1988 Workshop was to identify and prioritize technologies that are critical for future national space programs and require validation in the space environment, and review current NASA (In-Reach) and industry/university (Out-Reach) experiments. A prioritized list of the critical technology needs was developed for the following eight disciplines: structures; environmental effects; power systems and thermal management; fluid management and propulsion systems; automation and robotics; sensors and information systems; in-space systems; and humans in space. This is part one of two parts and is the executive summary and experiment description. The executive summary portion contains keynote addresses, strategic planning information, and the critical technology needs summaries for each theme. The experiment description portion contains brief overviews of the objectives, technology needs and backgrounds, descriptions, and development schedules for current industry, university, and NASA space flight technology experiments

Quality of Water from Tile Drains in Fields Treated with Poultry Litter in McLean County, Kentucky

Poultry litter (a mixture of feed, manure, and bedding material) is commonly used as a soil amendment to row-crop fields in western Kentucky. Because of feed additives, litter typically has elevated concentrations of contaminants, including metals and anions. These metals and anions can accumulate in the soil and therefore could be transported to surface water through drainage tiles. In order to assess water quality in tile drains, a pilot study was conducted in 2008 in McLean County, Kentucky, in which 10 tile drains and six drainage ditches were sampled for total metals and anions. Seven of the tile-drained fields were amended with poultry litter and three tile-drained fields were not amended. Drainage ditches received discharge from the tile drains. Acidified and unacidified samples were collected for laboratory analysis, and the acidified samples were analyzed for total major and trace metals (aluminum, arsenic, calcium, cadmium, copper, iron, mercury, magnesium, manganese, nickel, lead, and zinc). To determine the association of major and trace metals to suspended material in the water, the unacidified samples were filtered using 0.45- and 0.20-µm filters, and each filtered sample was analyzed for major and trace metals. Mean concentrations for total calcium and magnesium were similar for the amended and unamended field samples. Total aluminum, iron, and manganese concentrations were higher in the amended-field samples than in the unamended-field samples. Total arsenic, cadmium, and mercury concentrations were below the method detection limits for all samples. Total copper and nickel concentrations were higher in the amended-field samples than in the unamended-field samples. Calcium, magnesium, and manganese concentrations did not decrease after samples were filtered. Aluminum and iron concentrations decreased, indicating that these metals are associated with suspended sediment in the tile discharge water. Copper and nickel concentrations did not decrease after the samples were filtered. Chloride, sulfate, and nitrate concentrations were higher in amended-field samples than in unamended-field samples. The mean nitrate concentration for the tile-drain samples from amended fields was above the U.S. Environmental Protection Agency maximum contaminant level of 10 ppm. All phosphate concentrations were below the MDL. Additional sampling is needed to more thoroughly document concentrations and evaluate the impact of potential contaminants associated with poultry litter on the quality of tile-drain water in Kentucky

Toll-like receptor 3 activation is required for normal skin barrier repair following UV damage.

UV damage to the skin leads to the release of noncoding RNA (ncRNA) from necrotic keratinocytes that activates Toll-like receptor 3 (TLR3). This release of ncRNA triggers inflammation in the skin following UV damage. Recently, TLR3 activation was also shown to aid wound repair and increase the expression of genes associated with permeability barrier repair. Here, we sought to test whether skin barrier repair after UVB damage is dependent on the activation of TLR3. We observed that multiple ncRNAs induced expression of skin barrier repair genes, that the TLR3 ligand Poly (I:C) also induced expression and function of tight junctions, and that the ncRNA U1 acts in a TLR3-dependent manner to induce expression of skin barrier repair genes. These observations were shown to have functional relevance as Tlr3-/- mice displayed a delay in skin barrier repair following UVB damage. Combined, these data further validate the conclusion that recognition of endogenous RNA by TLR3 is an important step in the program of skin barrier repair

Simplified Paper Format for Detecting HIV Drug Resistance in Clinical Specimens by Oligonucleotide Ligation

Human immunodeficiency virus (HIV) is a chronic infection that can be managed by antiretroviral treatment (ART). However, periods of suboptimal viral suppression during lifelong ART can select for HIV drug resistant (DR) variants. Transmission of drug resistant virus can lessen or abrogate ART efficacy. Therefore, testing of individuals for drug resistance prior to initiation of treatment is recommended to ensure effective ART. Sensitive and inexpensive HIV genotyping methods are needed in low-resource settings where most HIV infections occur. The oligonucleotide ligation assay (OLA) is a sensitive point mutation assay for detection of drug resistance mutations in HIV pol. The current OLA involves four main steps from sample to analysis: (1) lysis and/or nucleic acid extraction, (2) amplification of HIV RNA or DNA, (3) ligation of oligonucleotide probes designed to detect single nucleotide mutations that confer HIV drug resistance, and (4) analysis via oligonucleotide surface capture, denaturation, and detection (CDD). The relative complexity of these steps has limited its adoption in resource-limited laboratories. Here we describe a simplification of the 2.5-hour plate-format CDD to a 45-minute paper-format CDD that eliminates the need for a plate reader. Analysis of mutations at four HIV-1 DR codons (K103N, Y181C, M184V, and G190A) in 26 blood specimens showed a strong correlation of the ratios of mutant signal to total signal between the paper CDD and the plate CDD. The assay described makes the OLA easier to perform in low resource laboratories

Mannan-Binding Lectin Levels and Activity Are Not Altered in Atopic Dermatitis Patients with a History of Eczema Herpeticum

Background. Eczema herpeticum (EH) is a potentially serious, systemic complication in subjects with atopic dermatitis (AD) caused by herpes simplex virus (HSV). The innate immune dysregulation that predisposes these subjects to cutaneous viral infections is not well understood. We tested the hypothesis that defects in mannan-binding lectin (MBL) may be associated with an increased risk of EH. Methods. We evaluated serum MBL levels and functional activity in 13 AD subjects with a history of EH (EH+) and 21 AD subjects with no history of EH (EH−). MBL levels were detected by enzyme immunoassay. MBL pathway functional activity was evaluated by determining MBL C4b deposition capacity. Results. We found no statistical difference in MBL serum levels or function between EH+ and EH− groups. Conclusion. Considering the limitations of this study (e.g., small samples size) our findings suggest that MBL defects do not play a role in EH

Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis.

Epidural electrical stimulation (EES) of the spinal cord has been shown to restore function after spinal cord injury (SCI). Characterization of EES-evoked motor responses has provided a basic understanding of spinal sensorimotor network activity related to EES-enabled motor activity of the lower extremities. However, the use of EES-evoked motor responses to guide EES system implantation over the spinal cord and their relation to post-operative EES-enabled function in humans with chronic paralysis attributed to SCI has yet to be described. Herein, we describe the surgical and intraoperative electrophysiological approach used, followed by initial EES-enabled results observed in 2 human subjects with motor complete paralysis who were enrolled in a clinical trial investigating the use of EES to enable motor functions after SCI. The 16-contact electrode array was initially positioned under fluoroscopic guidance. Then, EES-evoked motor responses were recorded from select leg muscles and displayed in real time to determine electrode array proximity to spinal cord regions associated with motor activity of the lower extremities. Acceptable array positioning was determined based on achievement of selective proximal or distal leg muscle activity, as well as bilateral muscle activation. Motor response latencies were not significantly different between intraoperative recordings and post-operative recordings, indicating that array positioning remained stable. Additionally, EES enabled intentional control of step-like activity in both subjects within the first 5 days of testing. These results suggest that the use of EES-evoked motor responses may guide intraoperative positioning of epidural electrodes to target spinal cord circuitry to enable motor functions after SCI

Suicide & Supervision: Issues for Probation Practice

Suicides by offenders in the community have been relatively under-researched in comparison with prison suicides. This study examined in-depth the events and experiences of 28 service users under probation supervision, based on continuous records from the start of their sentence to their death by suicide. The study presents novel findings through mapping suicidal behaviour on to the probation supervision process, and demonstrates the complex pathways leading to suicide in this population.Key issues identified include missed appointments, the impact of legal proceedings,changes in supervision, and the importance of recording risk

Ortho-semantic learning of novel words: An event-related potential study of grade 3 children

Introduction: As children become independent readers, they regularly encounter new words whose meanings they must infer from context, and whose spellings must be learned for future recognition. The self-teaching hypothesis proposes orthographic learning skills are critical in the transition to fluent reading, while the lexical quality hypothesis further emphasizes the importance of semantics. Event-related potential (ERP) studies of reading development have focused on effects related to the N170 component—print tuning (letters vs. symbols) and lexical tuning (real words vs. consonant strings)—as well as the N400 reflecting semantic processing, but have not investigated the relationship of these components to word learning during independent reading. Methods: In this study, children in grade 3 independently read short stories that introduced novel words, then completed a lexical decision task from which ERPs were derived. Results: Like real words, newly-learned novel words evoked a lexical tuning effect, indicating rapid establishment of orthographic representations. Both real and novel words elicited significantly smaller N400s than pseudowords, suggesting that semantic representations of the novel words were established. Further, N170 print tuning predicted accuracy on identifying the spellings of the novel words, while the N400 effect for novel words was associated with reading comprehension. Discussion: Exposure to novel words during self-directed reading rapidly establishes neural markers of orthographic and semantic processing. Furthermore, the ability to rapidly filter letter strings from symbols is predictive of orthographic learning, while rapid establishment of semantic representations of novel words is associated with stronger reading comprehension