Diagnosis and management of eosinophilic asthma: a US perspective.

Eosinophilic asthma is now recognized as an important subphenotype of asthma based on the pattern of inflammatory cellular infiltrate in the airway. Eosinophilic asthma can be associated with increased asthma severity, atopy, late-onset disease, and steroid refractoriness. Induced sputum cell count is the gold standard for identifying eosinophilic inflammation in asthma although several noninvasive biomarkers, including fractional exhaled nitric oxide and periostin, are emerging as potential surrogates. As novel therapies and biologic agents become increasingly available, there is an increased need for specific phenotype-directed treatment strategies. Greater recognition and understanding of the unique immunopathology of this asthma phenotype has important implications for management of the disease and the potential to improve patient outcomes. The present review provides a summary of the clinical features, pathogenesis, diagnosis, and management of eosinophilic asthma

Type 2 Innate Lymphoid Cells in Allergic Disease.

Type II innate lymphoid cells (ILC2) are a novel population of lineage-negative cells that produce high levels of Th2 cytokines IL-5 and IL-13. ILC2 are found in human respiratory and gastrointestinal tissue as well as in skin. Studies from mouse models of asthma and atopic dermatitis suggest a role for ILC2 in promoting allergic inflammation. The epithelial cytokines IL-25, IL-33, and TSLP, as well as the lipid mediator leukotriene D4, have been shown to potently activate ILC2 under specific conditions and supporting the notion that many separate pathways in allergic disease may result in stimulation of ILC2. Ongoing investigations are required to better characterize the relative contribution of ILC2 in allergic inflammation as well as mechanisms by which other cell types including conventional T cells regulate ILC2 survival, proliferation, and cytokine production. Importantly, therapeutic strategies to target ILC2 may reduce allergic inflammation in afflicted individuals. This review summarizes the development, surface marker profile, cytokine production, and upstream regulation of ILC2, and focuses on the role of ILC2 in common allergic diseases

Imitation, Intertextuality and the Minerva Press Novel

Jane Austen’s famous reference to Ann Radcliffe and 'all her imitators' in Northanger Abbey can be understood both as a satirical characterisation of popular gothic novels and as a record of a historical mode of describing those same texts. This article provides a new reading of fictional 'imitation' in the Romantic period arguing that, as it was practised by Minerva Press novelists, it became a crucial fulcrum in the ongoing Romantic debate over the literary status of the novel. While charges of 'imitation' are often understood as derogatory, and were frequently deployed against the Minerva Press’s fiction by critics, looking closely at the novels in question suggests that many novelists used imitation quite deliberately as a literary strategy. This essay suggests that the fiction produced by Minerva's novelists is deeply entwined with the press’s status as England’s highest-producing novel publisher, in that the form and function of Minerva novels stems from their collective identity: each novel is produced and consumed specifically as one of many—one of many narratives, but also one of many physical, circulating objects, lent, sold and exchanged between readers. Using allusions, parodic inversions, self-referential prefaces and a multitude of other narrative strategies, the novelists exploit the creative potential of their imitative parameters

The Effect of Income on Healthy Food Options

This paper explores the effect of income per capita on the number of grocery stores and fast-food franchises in an area. Using a panel dataset to allow for the inclusion of every county in the United States across a period of three years, the results suggest that the income per capita of a county significantly impacts the number of grocery stores and fast-food restaurants in the area. Other factors such as education, age, and attributes regarding time constraints also play an important role in determining the number of grocery stores and fast-food franchises in a location

Helping children think: Gaze aversion and teaching

Looking away from an interlocutor's face during demanding cognitive activity can help adults answer challenging arithmetic and verbal-reasoning questions (Glenberg, Schroeder, & Robertson, 1998). However, such `gaze aversion' (GA) is poorly applied by 5-year-old school children (Doherty-Sneddon, Bruce, Bonner, Longbotham, & Doyle, 2002). In Experiment 1 we trained ten 5-year-old children to use GA while thinking about answers to questions. This trained group performed significantly better on challenging questions compared with 10 controls given no GA training. In Experiment 2 we found significant and monotonic age-related increments in spontaneous use of GA across three cohorts of ten 5-year-old school children (mean ages: 5;02, 5;06 and 5;08). Teaching and encouraging GA during challenging cognitive activity promises to be invaluable in promoting learning, particularly during early primary years

Communication skills training in undergraduate medicine.

Good communication with patients is now recognised as the cornerstone in effective medical practice. Medical students do not automatically acquire the art of good communication through clinical training. A new course to promote the development of communication skills at undergraduate level is described. The course was provided at the juncture between pre-clinical and clinical training. Course evaluation illustrated the value of the course as perceived by students themselves and highlighted the areas of greatest need for students in communication skills training

Promoting Healthy Behaviour Choices: Understanding Patient Challenges by Undertaking a Personal Behaviour Change Task

INTRODUCTION: Unhealthy behaviours such as poor diet, smoking and physical inactivity contribute significantly to chronic disease. Our first year medical school project aims to increase student awareness of: the importance of these behaviours and their systematic measurement; recommended behaviour targets in health professional guidelines; challenges in achieving patient behaviour change; and psychological theories which aid behaviour change. METHODS: Students are provided with evidence-based health behaviour guidelines for prevention of heart disease. Students select whichever behaviour they would personally like to achieve improvement in, systematically record behaviour for one week (baseline), and then try to implement (healthy) behaviour change for the next two weeks, using psychological theory as an aide. Students report their results and discuss outcomes reflecting on explanations for the success or otherwise of their behaviour attempts. A virtual learning environment (Moodle) ensures project engagement and completion during the relevant timeframes. RESULTS: This assignment has been successfully completed by students over previous academic years. The use of deadlines for uploading sections of coursework to Moodle (e.g. baseline data) has increased the quality and completeness of the projects. Students learn to use standard instruments such as the Fagerstrom Test for Nicotine Dependence and also learn recommended professional guidelines on diet and physical activity at an early point in a medical training. Also, self-reported health behaviours improved over the course of the assignment. CONCLUSIONS: This project allows students to test the difficulty of adhering to professional advice they themselves will give to future patients. The assignment combines knowledge (e.g. education on chronic conditions, on the role of behaviour change and on professional guidelines), skills (e.g. documenting behaviours, planning and implementing change) and attitudes (e.g. on understanding the difficulties encountered by individuals when making and sustaining recommended behaviour change). The novel use of a virtual learning environment ensures high participation

Communication skills training in undergraduate medicine: attitudes and attitude change.

The importance of communication skills training in undergraduate medical education is now widely accepted. However little is known about student attitudes towards their own communication skills and whether their attitudes changes as a result of participating in communication skills courses. The aim of the present study was to identify these attitudes prior to commencing such a course and to further evaluate changes in these attitudes on completion of the course. Results demonstrated an improvement in perceived confidence regarding a number of specific communication skills. The study provides further evidence of the value of such courses in undergraduate medical training