A survey of the treatment and management of patients with severe chronic spontaneous urticaria.

Chronic spontaneous urticaria (CSU) is characterized by the recurrent appearance of weals, angio‐oedema or both, occurring at least twice weekly for longer than 6 weeks.1 It is often managed with antihistamines, but occasionally requires other systemic agents in recalcitrant cases. A cross‐sectional survey was conducted by means of an internet‐based survey tool (Typeform; https://www.typeform.com). Participating consultants with a specialist interest in urticaria were identified through the specialist registers of the British Society of Allergy and Clinical Immunology (BSACI), the Improving Quality in Allergy Services (IQAS) Group and the British Association of Dermatologists (BAD), and invited to take part. The survey content was based on current CSU treatment guidelines from EAACI/GA2LEN/EDF/WAO1 and the British Society for Allergy and Clinical Immunology (BSACI).2 The EAACI/GA2LEN/EDF/WAO guidelines are a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA2LEN) (a European Union‐funded network of excellence), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO). To standardize responses, all participants were presented with a case of recalcitrant CSU (failed on maximum dose of nonsedating antihistamines and montelukast), requiring alternative systemic treatment. Questions covered usage of systemic treatments, routine disease severity assessments, adherence to treatment guidelines and perceived barriers to prescribing. Responses (Table 1) were received from 19 UK consultants (26 surveys sent; completion rate 73%), 15 of whom had > 10 years’ experience in the treatment of CSU. The majority were allergy (58%) and dermatology consultants (37%). Of the 19 consultants, 56% provide a dedicated urticaria service, 37% treat both adult and paediatric patients, and the majority (79%) use systemic medications other than antihistamines and montelukast. Omalizumab and ciclosporin were the most commonly used first‐line agents (47% and 27% respectively) (Fig. 1). The majority (84%) of consultants use validated measures to assess disease severity, including the weekly Urticaria Activity Score (UAS‐7, 63%), the Physician Global Assessment (63%), the Patient Global Assessment (44%) and the Dermatology Quality of Life Index (DLQI) (38%). Guidelines are used by 89% to direct their management of CSU, with 50% using the EAACI/GA2LEN/EDF/WAO guideline,1 compared with 31% primarily using the BSACI guideline.2 The main perceived barriers to prescribing systemic medications were potential adverse effects (AEs) (32% strongly agreed), potential long‐term toxicity (26% strongly agreed), cost of treatment (42% strongly agreed), and views expressed by the patient and their family (37% agreed)

Renal tumor leading to acute respiratory distress syndrome – A rare occurrence

Adult respiratory distress syndrome (ARDS) generally develops in the setting of sepsis, aspiration, shock or some other identifiable cause. Pulmonary involvement with neoplastic disease is an unusual but recognized cause of ARDS and has been rarely reported. Here we report a case of ARDS due to renal tumor most probably renal cell carcinoma (RCC).KEY WORDS: ARDS; Renal tumor; Adult respiratory distress syndrom

Aspiration of mediastinal hydatid cyst – A case report

Mediastinal hydatid cyst is very rare and has been only anecdotally reported in the literature. Because of surrounding vital structures, the cyst should be treated without delay, surgery being the mainstay of treatment. Here we report a case of hydatid cyst of the mediastinum which was managed by trans-thoracic aspiration followed by albendazole therapy

Subsystem symmetry enriched topological order in three dimensions

We introduce a model of three-dimensional (3D) topological order enriched by planar subsystem symmetries. The model is constructed starting from the 3D toric code, whose ground state can be viewed as an equal-weight superposition of two-dimensional (2D) membrane coverings. We then decorate those membranes with 2D cluster states possessing symmetry-protected topological order under line-like subsystem symmetries. This endows the decorated model with planar subsystem symmetries under which the loop-like excitations of the toric code fractionalize, resulting in an extensive degeneracy per unit length of the excitation. We also show that the value of the topological entanglement entropy is larger than that of the toric code for certain bipartitions due to the subsystem symmetry enrichment. Our model can be obtained by gauging the global symmetry of a short-range entangled model which has symmetry-protected topological order coming from an interplay of global and subsystem symmetries. We study the non-trivial action of the symmetries on boundary of this model, uncovering a mixed boundary anomaly between global and subsystem symmetries. To further study this interplay, we consider gauging several different subgroups of the total symmetry. The resulting network of models, which includes models with fracton topological order, showcases more of the possible types of subsystem symmetry enrichment that can occur in 3D.Comment: 21 pages. v2: Published version. Updated Section IV with new figure and tabl

Audio on the go: The effect of audio cues on memory in driving

An inability to recall details from an otherwise uneventful drive on a familiar route is a common experience to many. Whether this amnesia for everyday driving is because we don't actually form strong memories when we are driving on autopilot or whether this is because we simply can't find those memories when we try to later is an interesting question, not only for driving, but for memory and skilled performance more generally. The present study sought to determine whether recall could be aided by reinstating an auditory cue that was present during the drive. Twenty-five participants drove three 9 km routes on familiar roads and then were asked a series of questions about the details of the drives. Three auditory cues (music, radio documentary, or periodic verbal markers) and a visual cue were used as contextual stimuli during the drives and as post-drive recall cues. The music and verbal markers produced better recall than the radio documentary. Although proceduralised driving on a familiar road may make incidental details of the drive difficult to recall, those details are recoverable with a sufficiently robust recall cue

Eccentric lamellar keratolimbal grafts harvested with a manually guided microkeratome

Background: To perform lamellar keratolimbal allograft transplantation in a one- step procedure with a single graft, we investigated the feasibility of harvesting eccentric lamellar keratolimbal grafts from conventionally processed corneoscleral buttons using a manually guided microkeratome in conjunction with an artificial anterior chamber system. Methods: We used the Moria LSK- One microkeratome and the automated lamellar therapeutic keratoplasty ( ALTK) system ( Antony, France). Ten human donor eyes were used to obtain single- piece lamellar keratolimbal grafts. Specimens were processed for light and electron microscopy. Results: Eccentric keratolimbal grafts could be obtained from all human donor buttons. Grafts include a crescent- shaped limbal and a large corneal portion. No visible damage to the limbal region was discernible. Conclusion: Our data show that the LSK- One microkeratome in conjunction with the ALTK system allows harvesting eccentric keratolimbal grafts from donor corneoscleral buttons. Copyright (c) 2007 S. Karger AG, Basel

Pauli topological subsystem codes from Abelian anyon theories

We construct Pauli topological subsystem codes characterized by arbitrary two-dimensional Abelian anyon theories--this includes anyon theories with degenerate braiding relations and those without a gapped boundary to the vacuum. Our work both extends the classification of two-dimensional Pauli topological subsystem codes to systems of composite-dimensional qudits and establishes that the classification is at least as rich as that of Abelian anyon theories. We exemplify the construction with topological subsystem codes defined on four-dimensional qudits based on the $\mathbb{Z}_4^{(1)}$ anyon theory with degenerate braiding relations and the chiral semion theory--both of which cannot be captured by topological stabilizer codes. The construction proceeds by "gauging out" certain anyon types of a topological stabilizer code. This amounts to defining a gauge group generated by the stabilizer group of the topological stabilizer code and a set of anyonic string operators for the anyon types that are gauged out. The resulting topological subsystem code is characterized by an anyon theory containing a proper subset of the anyons of the topological stabilizer code. We thereby show that every Abelian anyon theory is a subtheory of a stack of toric codes and a certain family of twisted quantum doubles that generalize the double semion anyon theory. We further prove a number of general statements about the logical operators of translation invariant topological subsystem codes and define their associated anyon theories in terms of higher-form symmetries.Comment: 67 + 35 pages, single column forma

Comparison of hierarchical temporal memories and artificial neural networks under noisy data

The ability of two different machine learning approaches to map non-linear problems from experimental data is evaluated under controlled experiments. A well-known machine learning algorithm (Artificial Neural Network) is compared against a new computing paradigm (Hierarchical Temporal Memory) under a controlled scenario. The chosen scenario is the detection of impacts in a cantilever beam under vibration instrumented with fiber Bragg gratings. The main characteristics of both of the machine learning approaches are analyzed while varying environmental parameters such as the number of sensing points and their location. From the achieved results some clues can be extracted regarding dealing with noisy or partial data using different machine learning approaches