Pragmatic randomised controlled trial of an allergy intervention for children aged 6 to 16 with asthma and rhinitis in general practice

Background: It is widely believed that for allergic rhinitis and asthma, avoidance of specific triggers can improve symptom control. Whilst many children with asthma or rhinitis are sensitised to airborne allergens, primary care diagnostic and management decisions are often made without a detailed history of the allergic triggers or allergy testing. Thus, treatment decisions are empirical and allergen avoidance advice is either not given or, if given, not tailored to the child’s sensitivities. Objective: To ascertain whether allergy assessment and tailored advice in General Practice enhances outcomes of children with asthma and rhinitis. Method: Pragmatic RCT of allergy intervention (structured allergy history, skin prick testing and appropriate allergy avoidance advice) versus usual care in children with asthma and/or rhino-conjunctivitis. A blinded observer assessed outcomes at 12 months. Main outcome measures were symptom scores and disease-specific health-related QoL. Secondary outcomes were health care utilisation, days unable to pursue usual activities, and self-rated improvement. Results: 335 participants were randomised to formal allergy assessment or normal care. There were no differences in participants’ demographic or clinical characteristics at baseline (all p>.05). At 12 months, participants receiving the allergy intervention had fewer rhinitis symptoms (MD -3.14, 95% CI -6.01, -0.81) and an improvement in QoL (MD -0.50, 95% CI 0.32, 0.68). There were no significant changes in asthma symptoms, health care utilisation or number of days unable to pursue usual activities. Conclusion: Amongst children with known asthma and/or rhinitis in primary care, taking a structured allergy history with skin prick testing and tailored advice on allergy avoidance resulted in reduced symptoms of rhinitis and improved QoL

The sources and dynamics of fine-grained sediment degrading the Freshwater Pearl Mussel (Margaritifera margaritifera) beds of the River Torridge, Devon, UK

The Freshwater Pearl Mussel (Margaritifera margaritifera) is an endangered organism across its entire range. It has a complex life cycle and stringent habitat requirements and is therefore an indicator species for the general ecosystem health of host rivers. Whereas historical intensive pearl fishing contributed to population declines, excess nutrient and sediment loss associated with current land use pressures in host river catchments, including modern intensive farming practices, are now highlighted as primary contributory factors. Accordingly, this study investigated the sources and dynamics of fine-grained sediment sampled in the mussel beds of the River Torridge, SW England. Sediment source fingerprinting using a combination of colorimetric and radiometric tracers to construct different composite signatures revealed the importance of roads both as a sediment source and delivery pathway for fine-grained sediment mobilised from fields predominantly supporting lowland livestock farming. Grassland fields with evidence of soil poaching were highlighted as important sediment sources, but equally, riparian woodland was also identified as important, especially during the latter stages of consecutive runoff events when its rainfall buffering capacity was exceeded. Bed sediment storage levels (median up to 393 g m−2) were found to be low (41st percentile) compared to typical values reported by a recent strategic scale survey across England and Wales, whereas elevated turbidity peaks were shown to be long duration (days) in conjunction with consecutive days of rainfall and corresponding runoff events. Hysteresis patterns varied but were generally clockwise during the largest runoff events associated with consecutive rain days; again, suggesting mobilisation of sediment from proximal woodland sources following exceedance of rainfall buffering capacity. In combination, the data assembled by this study provides a basis for planning sediment control measures for protecting the Freshwater Pearl Mussel (FPM) beds from excessive fine-grained sediment inputs associated with the intensive use of primarily grazing land

Quantum Zakharov Model in a Bounded Domain

We consider an initial boundary value problem for a quantum version of the Zakharov system arising in plasma physics. We prove the global well-posedness of this problem in some Sobolev type classes and study properties of solutions. This result confirms the conclusion recently made in physical literature concerning the absence of collapse in the quantum Langmuir waves. In the dissipative case the existence of a finite dimensional global attractor is established and regularity properties of this attractor are studied. For this we use the recently developed method of quasi-stability estimates. In the case when external loads are $C^\infty$ functions we show that every trajectory from the attractor is $C^\infty$ both in time and spatial variables. This can be interpret as the absence of sharp coherent structures in the limiting dynamics.Comment: 27 page

Travelling waves for the Gross-Pitaevskii equation II

The purpose of this paper is to provide a rigorous mathematical proof of the existence of travelling wave solutions to the Gross-Pitaevskii equation in dimensions two and three. Our arguments, based on minimization under constraints, yield a full branch of solutions, and extend earlier results, where only a part of the branch was built. In dimension three, we also show that there are no travelling wave solutions of small energy.Comment: Final version accepted for publication in Communications in Mathematical Physics with a few minor corrections and added remark

Immune responses during COVID-19 infection

Over the past 16 years, three coronaviruses (CoVs), severe acute respiratory syndrome CoV (SARS-CoV) in 2002, Middle East respiratory syndrome CoV (MERS-CoV) in 2012 and 2015, and SARS-CoV-2 in 2020, have been causing severe and fatal human epidemics. The unpredictability of coronavirus disease-19 (COVID-19) poses a major burden on health care and economic systems across the world. This is caused by the paucity of in-depth knowledge of the risk factors for severe COVID-19, insufficient diagnostic tools for the detection of SARS-CoV-2, as well as the absence of specific and effective drug treatments. While protective humoral and cellular immune responses are usually mounted against these betacoronaviruses, immune responses to SARS-CoV2 sometimes derail towards inflammatory tissue damage, leading to rapid admissions to intensive care units. The lack of knowledge on mechanisms that tilt the balance between these two opposite outcomes poses major threats to many ongoing clinical trials dealing with immunostimulatory or immunoregulatory therapeutics. This review will discuss innate and cognate immune responses underlying protective or deleterious immune reactions against these pathogenic coronaviruses

The Gel'fand problem for the biharmonic operator

We study stable solutions of a fourth order nonlinear elliptic equation, both in entire space and in bounded domains

Nearly inviscid Faraday waves

Many powerful techniques from Hamiltonian mechanics are available for the study of ideal hydrodynamics. This article explores some of the consequences of including small viscosity in a study of surface gravity-capillary waves excited by the vertical vibration of a container. It is shown that in this system, as in others, the addition of small viscosity provides a singular perturbation of the ideal fluid system, and that as a result its effects are nontrivial. The relevance of existing studies of ideal fluid problems is discussed from this point of view

Fingerprinting of hydroxyl radical-attacked polysaccharides by N-isopropyl-2-aminoacridone labelling

Hydroxyl radicals ((•)OH) cause non-enzymic scission of polysaccharides in diverse biological systems. Such reactions can be detrimental (e.g. causing rheumatic and arthritic diseases in mammals) or beneficial (e.g. promoting the softening of ripening fruit, and biomass saccharification). Here we present a method for documenting (•)OH action, based on fluorescent labelling of the oxo groups that are introduced as glycosulose residues when (•)OH attacks polysaccharides. The method was tested on several polysaccharides, especially pectin, after treatment with Fenton reagents. 2-Aminoacridone plus cyanoborohydride reductively aminated the oxo groups in treated polysaccharides; the product was then reacted with acetone plus cyanoborohydride, forming a stable tertiary amine with the carbohydrate linked to N-isopropyl-2-aminoacridone (pAMAC). Digestion of labelled pectin with ‘Driselase’ yielded several fluorescent products which on electrophoresis and HPLC provided a useful ‘fingerprint’ indicating (•)OH attack. The most diagnostic product was a disaccharide conjugate of the type pAMAC·UA-GalA (UA=unspecified uronic acid), whose UA-GalA bond was Driselase-resistant (product 2A). 2A was clearly distinguishable from GalA-GalA–pAMAC (disaccharide labelled at its reducing end), which was digestible to GalA–pAMAC. The methodology is applicable, with appropriate enzymes in place of Driselase, for detecting natural and artificial (•)OH attack in diverse plant, animal and microbial polysaccharides

Co-bedding as a Comfort measure For Twins undergoing painful procedures (CComForT Trial)

<p>Abstract</p> <p>Background</p> <p>Co-bedding, a developmental care strategy, is the practice of caring for diaper clad twins in one incubator (versus separating and caring for each infant in separate incubators), thus creating the opportunity for skin-to-skin contact and touch between the twins. In studies of mothers and their infants, maternal skin-to-skin contact has been shown to decrease procedural pain response according to both behavioral and physiological indicators in very preterm neonates. It is uncertain if this comfort is derived solely from maternal presence or from stabilization of regulatory processes from direct skin contact. The intent of this study is to compare the comfort effect of co-bedding (between twin infants who are co-bedding and those who are not) on infant pain response and physiologic stability during a tissue breaking procedure (heelstick).</p> <p>Methods/Design</p> <p>Medically stable preterm twin infants admitted to the Neonatal Intensive Care Unit will be randomly assigned to a co-bedding group or a standard care group. Pain response will be measured by physiological and videotaped facial reaction using the Premature Infant Pain Profile scale (PIPP). Recovery from the tissue breaking procedure will be determined by the length of time for heart rate and oxygen saturation to return to baseline. Sixty four sets of twins (n = 128) will be recruited into the study. Analysis and inference will be based on the intention-to-treat principle.</p> <p>Discussion</p> <p>If twin contact while co-bedding is determined to have a comforting effect for painful procedures, then changes in current neonatal care practices to include co-bedding may be an inexpensive, non invasive method to help maintain physiologic stability and decrease the long term psychological impact of procedural pain in this high risk population. Knowledge obtained from this study will also add to existing theoretical models with respect to the exact mechanism of comfort through touch.</p> <p>Trial registration</p> <p>NCT00917631</p