An algorithm for diagnosing IgE-mediated food allergy in study participants who do not undergo food challenge.

BACKGROUND: Food allergy diagnosis in clinical studies can be challenging. Oral food challenges (OFC) are time-consuming, carry some risk and may, therefore, not be acceptable to all study participants. OBJECTIVE: To design and evaluate an algorithm for detecting IgE-mediated food allergy in clinical study participants who do not undergo OFC. METHODS: An algorithm for trial participants in the Barrier Enhancement for Eczema Prevention (BEEP) study who were unwilling or unable to attend OFC was developed. BEEP is a pragmatic, multi-centre, randomized-controlled trial of daily emollient for the first year of life for primary prevention of eczema and food allergy in high-risk infants (ISRCTN21528841). We built on the European iFAAM consensus guidance to develop a novel food allergy diagnosis algorithm using available information on previous allergenic food ingestion, food reaction(s) and sensitization status. This was implemented by a panel of food allergy experts blind to treatment allocation and OFC outcome. We then evaluated the algorithm's performance in both BEEP and Enquiring About Tolerance (EAT) study participants who did undergo OFC. RESULTS: In 31/69 (45%) BEEP and 44/55 (80%) EAT study control group participants who had an OFC the panel felt confident enough to categorize children as "probable food allergy" or "probable no food allergy". Algorithm-derived panel decisions showed high sensitivity 94% (95%CI 68, 100) BEEP; 90% (95%CI 72, 97) EAT and moderate specificity 67% (95%CI 39, 87) BEEP; 67% (95%CI 39, 87) EAT. Sensitivity and specificity were similar when all BEEP and EAT participants with OFC outcome were included. CONCLUSION: We describe a new algorithm with high sensitivity for IgE-mediated food allergy in clinical study participants who do not undergo OFC. CLINICAL RELEVANCE: This may be a useful tool for excluding food allergy in future clinical studies where OFC is not conducted

Full Thermoelectric Characterization of Stoichiometric Electrodeposited Thin Film Tin Selenide (SnSe)

Tin selenide (SnSe) has attracted much attention in the thermoelectric community since the discovery of the record figure of merit (ZT) of 2.6 in single crystal tin selenide in 2014. There have been many reports since of the thermoelectric characterization of SnSe synthesized or manufactured by several methods, but so far none of these have concerned the electrodeposition of SnSe. In this work, stoichiometric SnSe was successfully electrodeposited at −0.50 V vs SCE as shown by EDX, XPS, UPS, and XRD. The full ZT of the electrodeposits were then measured. This was done by both a delamination technique to measure the Seebeck coefficient and electrical conductivity which showed a peak power factor of 4.2 and 5.8 μW m–1 K–2 for the as deposited and heat-treated films, respectively. A novel modified transient 3ω method was used to measure the thermal conductivity of the deposited films on the deposition substrate. This revealed the thermal conductivity to be similar to the ultralow thermal conductivity of single crystal SnSe, with a value of 0.34 W m–1 K–1 being observed at 313 K

Screening and Audit as Service-Level Strategies to Support Implementation of Australian Guidelines for Cancer Pain Management in Adults: A Feasibility Study

© 2019 Background: Pain in people with cancer is common but often under-recognized and under-treated. Guidelines can improve the quality of pain care, but need targeted strategies to support implementation. Aim: To test the feasibility of two service-level strategies for supporting guideline implementation: a screening system and medical record audit. Design: Multimethods. Setting: One oncology outpatient service, and one palliative care outpatient and inpatient service. Participants: Patients with advanced cancer. Methods: Patients were screened in the waiting room with a modified version of the Edmonton Symptom Assessment System-revised either electronically or in paper-based format. Feasibility indicated the percentage of patients successfully screened from the total number attending the services. An audit assessed adherence to key indicators of pain assessment and management. Feasibility thresholds were set at 75% incidence for screening and a median of 30 minutes per patient for audit. Results: Of 452 patient visits, 95% (n = 429)were successfully screened, 34% (n = 155)electronically and 61% (n = 274)paper-based. Electronic pain screening was technically challenging and time-intensive for nurses. Thirty-one patients consented to have their records audited. The median audit time was 37.5 minutes (range 10-120 minutes). Variability arose from the number and type of record (outpatient or inpatient). Adherence to indicators varied from 63% (pain assessment at first presentation)to 94% (regular pain assessment and medication prescribed at regular intervals). Conclusions: This study confirmed the need to implement evidence-based guidelines for cancer pain and generated useful insights into the feasibility of pain screening and audit

RepAtt: Achieving Swarm Coordination through Chemotaxis

Swarm foraging is a common test case application for multi-robot systems. In this paper we present a novel algorithm for improving coordination of a robot swarm by selectively broadcasting repulsion and attraction signals. Robots use a chemotaxis-inspired search behaviour based on the temporal gradients of these signals in order to navigate towards more advantageous areas. Hardware experiments were used to model and validate realistic, noisy sound communication. We then show through extensive simulation studies that our chemotaxis-based coordination algorithm significantly improves swarm foraging time and robot efficiency

Modelling phosphorus fluxes in Loweswater

1. This is the final report to the Loweswater Care Project (in support of the Catchment Restoration Fund for England) ECRC-ENSIS Project 298, 'Loweswater 12-13'. The study was concerned with the spatial and temporal concentrations of sediment phosphorus (P) in the lake and the use of P measurements from the water column and inflow and outflow samples to derive a simple mass balance model for P in the lake. 2. A review of published and unpublished literature on Loweswater highlighted trends in water chemistry since the mid-eighteenth century. Land use and farming practises have changed over the past 200 years which have led to increased nutrient loading to the lake with significant increases occurring in the mid part of the last century. Agricultural intensification is likely to be a significant cause of the problem as well as inadequate septic tank management. Local management efforts, led by the Loweswater Care Project, has sought to reduce the primary sources of nutrients reaching the lake, but total phosphorus (TP) concentrations in the lake remain higher than desired. 3. Temperature and dissolved oxygen (DO) profiling confirmed that the site stratified in summer with major changes in DO occurring below a depth of 8 m. The deeper waters were almost entirely anoxic. During stratification the maximum TP value was recorded at the lake bottom. This is a clear indication that P is being released from the lake bed during summer stratification. 4. Analysis of the stream water from the Dub Beck inflow (data for 2013), shows that P influx remains high enough to explain the elevated lake water P concentrations, despite considerable efforts to reduce catchment P sources. 5. Analysis of the water column P profiles shows that P release from the sediment is only a minor contribution to the P load. While the sediment core data reveals a substantial pool of P in the sediment very little of this should be released each year to the water column. In 2013 it is estimated that more than 90% of the P came from the catchment and only ~10% from the sediment. 6. As with all modelling exercises there are uncertainties inherent in the approach. In this case the model output is based on a single year of input data for the inflow P flux calculations and it would be preferable to have a longer data series to inform the modelling. Inflow fluxes are highly dependent on flow conditions and here, in the absence of flow data from Dub Beck, we used data from a nearby stream. Further, the monthly sampling has resulted in most samples being taken in low flow conditions, thus missing potential storm flow conditions. Finally, stream input information is restricted to Dub Beck, and contributions from the other stream is unknown. 7. Nevertheless, the results from the modelling are clear and on that basis we conclude that the priority is for P loading to the lake to be reduced by better catchment management and that lake manipulation is not warranted. Integrated catchment management supported by modelling together with local stakeholder engagement should provide the most effective means of improving the condition of the lake

Detecting the signatures of helium in type Iax supernovae

Recent studies have argued that the progenitor system of type Iax supernovae must consist of a carbon-oxygen white dwarf accreting from a helium star companion. Based on existing explosion models invoking the pure deflagration of carbon-oxygen white dwarfs, we investigate the likelihood of producing spectral features due to helium in type Iax supernovae. From this scenario, we select those explosion models producing ejecta and Ni-56 masses that are broadly consistent with those estimated for type Iax supernovae (0.014-0.478M(circle dot) and similar to 0.003-0.183 M-circle dot, respectively). To this end, we present a series of models of varying luminosities (-18.4 less than or similar to M-V less than or similar to -14.5 mag) with helium abundances accounting for up to similar to 36% of the ejecta mass, and covering a range of epochs beginning a few days before B-band maximum to approximately two weeks after maximum. We find that the best opportunity for detecting He (I) features is at near-infrared wavelengths, and in the post-maximum spectra of the fainter members of this class. We show that the optical spectrum of SN 2007J is potentially consistent with a large helium content (a few 10(-2) M-circle dot), but argue that current models of accretion and material stripping from a companion struggle to produce compatible scenarios. We also investigate the presence of helium in all objects with near-infrared spectra. We show that SNe 2005hk, 2012Z, and 2015H contain either no helium or their helium abundances are constrained to much lower values (less than or similar to 10(-3) M-circle dot). For the faint type Iax supernova, SN 2010ae, we tentatively identify a small helium abundance from its near-infrared spectrum. Our results demonstrate the differences in helium content among type Iax supernovae, perhaps pointing to different progenitor channels. Either SN 2007J is an outlier in terms of its progenitor system, or it is not a true member of the type Iax supernova class

Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial.

BACKGROUND: Skin barrier dysfunction precedes eczema development. We tested whether daily use of emollient in the first year could prevent eczema in high-risk children. METHODS: We did a multicentre, pragmatic, parallel-group, randomised controlled trial in 12 hospitals and four primary care sites across the UK. Families were approached via antenatal or postnatal services for recruitment of term infants (at least 37 weeks' gestation) at high risk of developing eczema (ie, at least one first-degree relative with parent-reported eczema, allergic rhinitis, or asthma, diagnosed by a doctor). Term newborns with a family history of atopic disease were randomly assigned (1:1) to application of emollient daily (either Diprobase cream or DoubleBase gel) for the first year plus standard skin-care advice (emollient group) or standard skin-care advice only (control group). The randomisation schedule was created using computer-generated code (stratified by recruiting centre and number of first-degree relatives with atopic disease) and participants were assigned to groups using an internet-based randomisation system. The primary outcome was eczema at age 2 years (defined by UK working party criteria) with analysis as randomised regardless of adherence to allocation for participants with outcome data collected, and adjusting for stratification variables. This trial is registered with ISRCTN, ISRCTN21528841. Data collection for long-term follow-up is ongoing, but the trial is closed to recruitment. FINDINGS: 1394 newborns were randomly assigned to study groups between Nov 19, 2014, and Nov 18, 2016; 693 were assigned to the emollient group and 701 to the control group. Adherence in the emollient group was 88% (466 of 532) at 3 months, 82% (427 of 519) at 6 months, and 74% (375 of 506) at 12 months in those with complete questionnaire data. At age 2 years, eczema was present in 139 (23%) of 598 infants with outcome data collected in the emollient group and 150 (25%) of 612 infants in the control group (adjusted relative risk 0·95 [95% CI 0·78 to 1·16], p=0·61; adjusted risk difference -1·2% [-5·9 to 3·6]). Other eczema definitions supported the results of the primary analysis. Mean number of skin infections per child in year 1 was 0·23 (SD 0·68) in the emollient group versus 0·15 (0·46) in the control group; adjusted incidence rate ratio 1·55 (95% CI 1·15 to 2·09). INTERPRETATION: We found no evidence that daily emollient during the first year of life prevents eczema in high-risk children and some evidence to suggest an increased risk of skin infections. Our study shows that families with eczema, asthma, or allergic rhinitis should not use daily emollients to try and prevent eczema in their newborn. FUNDING: National Institute for Health Research Health Technology Assessment

Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial.

BACKGROUND: Skin barrier dysfunction precedes eczema development. We tested whether daily use of emollient in the first year could prevent eczema in high-risk children. METHODS: We did a multicentre, pragmatic, parallel-group, randomised controlled trial in 12 hospitals and four primary care sites across the UK. Families were approached via antenatal or postnatal services for recruitment of term infants (at least 37 weeks' gestation) at high risk of developing eczema (ie, at least one first-degree relative with parent-reported eczema, allergic rhinitis, or asthma, diagnosed by a doctor). Term newborns with a family history of atopic disease were randomly assigned (1:1) to application of emollient daily (either Diprobase cream or DoubleBase gel) for the first year plus standard skin-care advice (emollient group) or standard skin-care advice only (control group). The randomisation schedule was created using computer-generated code (stratified by recruiting centre and number of first-degree relatives with atopic disease) and participants were assigned to groups using an internet-based randomisation system. The primary outcome was eczema at age 2 years (defined by UK working party criteria) with analysis as randomised regardless of adherence to allocation for participants with outcome data collected, and adjusting for stratification variables. This trial is registered with ISRCTN, ISRCTN21528841. Data collection for long-term follow-up is ongoing, but the trial is closed to recruitment. FINDINGS: 1394 newborns were randomly assigned to study groups between Nov 19, 2014, and Nov 18, 2016; 693 were assigned to the emollient group and 701 to the control group. Adherence in the emollient group was 88% (466 of 532) at 3 months, 82% (427 of 519) at 6 months, and 74% (375 of 506) at 12 months in those with complete questionnaire data. At age 2 years, eczema was present in 139 (23%) of 598 infants with outcome data collected in the emollient group and 150 (25%) of 612 infants in the control group (adjusted relative risk 0·95 [95% CI 0·78 to 1·16], p=0·61; adjusted risk difference -1·2% [-5·9 to 3·6]). Other eczema definitions supported the results of the primary analysis. Mean number of skin infections per child in year 1 was 0·23 (SD 0·68) in the emollient group versus 0·15 (0·46) in the control group; adjusted incidence rate ratio 1·55 (95% CI 1·15 to 2·09). INTERPRETATION: We found no evidence that daily emollient during the first year of life prevents eczema in high-risk children and some evidence to suggest an increased risk of skin infections. Our study shows that families with eczema, asthma, or allergic rhinitis should not use daily emollients to try and prevent eczema in their newborn. FUNDING: National Institute for Health Research Health Technology Assessment