A systematic review and economic evaluation of subcutaneous and sublingual allergen immunotherapy in adults and children with seasonal allergic rhinitis

© Queen’s Printer and Controller of HMSO 2013Severe allergic rhinitis uncontrolled by conventional medication can substantially affect quality of life. Immunotherapy involves administering increasing doses of a specific allergen, with the aim of reducing sensitivity and symptomatic reactions. Recent meta-analyses have concluded that both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are more effective than placebo in reducing symptoms. It is uncertain which route of administration is more effective and whether or not treatment is cost-effective.National Institute for Health Research Health Technology Assessment programm

Is there a role for telemedicine in adult allergy services?

Telemedicine refers to the application of telecommunication and information technology (IT) in the delivery of health and clinical care at a distance or remotely and can be broadly considered in two modalities: store-and-forward and real-time interactive services. Preliminary studies have shown promising results in radiology, dermatology, intensive care, diabetes, rheumatology and primary care. However, the evidence is limited and hampered by small sample sizes, paucity of randomised controlled studies and lack of data relating to cost-effectiveness, health related quality of life and patient and clinician satisfaction. This review appraises the evidence from studies that have employed telemedicine tools in other disciplines and makes suggestions for its potential applications in specific clinical scenarios in adult allergy services. Possible examples include: triaging patients to determine the need for allergy tests; pre-assessment for specialised treatments such as allergen immunotherapy; follow up to assess treatment response and side effects; and education in self-management plan including training updates for self-injectable adrenaline and nasal spray use. This approach might improve access for those with limited mobility or living far away from regional centres, as well as bringing convenience and cost savings for the patient and service provider. These potential benefits need to be carefully weighed against evidence of service safety and quality. Keys to success include delineation of appropriate clinical scenarios, patient selection, training, IT support and robust information governance framework. Well-designed prospective studies are needed to evaluate its role. This article is protected by copyright. All rights reserved

A systematic review of the clinical effectiveness of acupuncture for allergic rhinitis

BACKGROUND: Allergies cause a considerable burden to both sufferers and the National Health Service. There is growing interest in acupuncture as a treatment for a range of conditions. Since acupuncture may modulate the immune system it could be a useful treatment for allergic rhinitis (AR) sufferers. We therefore assessed the evidence for the clinical effectiveness of acupuncture in patients with AR by performing a systematic review of the literature. METHODS: Searches (to 2007) were conducted in all major databases for randomised controlled trials (RCTs) evaluating the clinical effectiveness of acupuncture in the treatment of AR. No limits were placed on language. Studies were included if they compared acupuncture to a sham or inactive acupuncture treatment (placebo) with or without standard care. Meta-analysis was performed where feasible. RESULTS: Seven relevant RCTs were included after screening and application of inclusion and exclusion criteria. The trials were generally of poor quality as assessed by a modified Jadad scale, with the exception of two studies which scored highly. A wide variety of outcomes was measured but most assessed symptom severity on a visual analogue scale. A meta-analysis failed to show any summary benefits of acupuncture treatment for symptom severity scores or serum IgE measures which could not have been accounted for by chance alone. Acupuncture was not associated with any additional adverse events in the trials. CONCLUSION: There is currently insufficient evidence to support or refute the use of acupuncture in patients with AR. A large well conducted RCT, which overcomes identified methodological problems in the existing RCTs, would be required to resolve this question.West Midlands purchasers levy to the Department of Public Health and Epidemiology, University of Birmingha

Effect of induced hypothermia on respiratory parameters in mechanically ventilated patients

Aim: Mild hypothermia is increasingly applied in the intensive care unit. Knowledge on the effects of hypothermia on respiratory parameters during mechanical ventilation is limited. In this retrospective study, we describe the effect of hypothermia on gas exchange in patients cooled for 24 h after a cardiac arrest. Methods: Respiratory parameters were derived from electronic patient files from 65 patients at the start and end of the hypothermic phase and at every centigrade increase in body temperature until normo-temperature, including tidal volume, positive end expiratory pressure (PEEP), plateau pressure, respiratory rate, exhaled CO2 concentrations (etCO(2)) and FIO2. Static compliance was calculated as V-T/P-plateau - PEEP. Dead space ventilation was calculated as (PaCO2-etCO(2))/PaCO2. Results: During hypothermia, PaCO2 decreased, at unchanged PaCO2-etCO(2) gap and minute ventilation. During rewarming, PaCO2 did not change, while etCO(2) increased at unchanged minute ventilation. Dead space ventilation did not change during hypothermia, but lowered during rewarming. During hypothermia, PaO2/FIO2 ratio increased at unchanged PEEP levels. Respiratory static compliance did not change during hypothermia, nor during rewarming. Conclusion: Hypothermia possibly improves oxygenation and ventilation in mechanically ventilated patients. Results may accord with the hypothesis that reducing metabolism with applied hypothermia may be beneficial in patients with acute lung injury, in whom low minute ventilation results in severe hypercapnia. (C) 2010 Elsevier Ireland Ltd. All rights reserve

Development of a Microscopic Traffic Simulator for Inter-Vehicle Communication Application Research

This paper describes the development of a microscopic traffic simulator purposely designed for ITS researchers studying inter-vehicle communication (IVC) concepts and applications in large traffic networks. The simulator can represent real life vehicles within the simulation by using data from vehicle Global Positioning System (GPS) receivers, enabling validation of theories with real vehicle data. The software is developed on top of the existing microscopic traffic simulator VISSIM with the added flexibility of modelling and efficiently handling communication between large numbers of vehicles. This along with the software architecture was discussed in detail

Thermal management in laminated die system

This is an Accepted Manuscript of an article published by Taylor & Francis in International Journal of Control, Automation and Systems on August 2014, available online: http://dx.doi.org/10.1007/s12555-013-0348-6The thermal control of a die is crucial for the development of high efficiency injection moulds. For an effective thermal management, this research provides a strategy to identify a thermal dynamic model and to design a controller. The neural network techniques and finite element analysis enable modeling to deal with various cycle-times for moulding process and uncertain dynamics of a die. Based on the system identification which is experimentally validated using a real system, controllers are designed using fuzzy-logic and self-tuning PID methods with backpropagation and radial basis function neural networks to tune control parameters. Through a comparative study, each controller’s performance is verified in terms of response time and tracking accuracy under different moulding processes with multiple cycle-times

A silicone-based soft matrix nanocomposite strain-like sensor fabricated using Graphene and Silly Putty®

Off-the-shelf planar strain gauges are ubiquitous and are generally designed for materials with a large elastic modulus such as steel or aluminum. Correspondingly, the strain gauges themselves are stiff and do not deform substantially under applied stress. Pairs of this type of strain gauge are typically used in a Wheatstone bridge circuit allowing the measurement of very small changes in resistance due to the changes in sensing element cross-sectional area to be measured. However, their use with softer low-modulus materials is limited due to the larger elastic deformations involved. The conductive property of graphene is leveraged to produce a different type of strain sensor that is sensitive yet also capable of significant elastic deformation. The graphene is dispersed in a silicone-based polymer matrix such that the deformation induces a change in resistance that can be measured using a voltage divider circuit. The target application for which this sensor is developed is to measure strain in a pressurized length of soft Tygon® tubing which is often used in pumping fluids through microfluidic devices. However, the silicone-based graphene polymer can easily be applied to a variety of other shapes and soft materials. © 2020 Elsevier B.V

A quantitative study of the dynamic response of compliant microfluidic chips in a microfluidics context

Polydimethylsiloxane (PDMS) is a widely used material for microfluidic devices due to its low cost, superior optical properties and fast iterative design process. Its softness however creates challenges for the device design and operation because part of the applied pressures contributes to deform chips instead of controlling the flow. The resulting dynamic behaviour is often ignored in passive microfluidic that focuses on the static behaviour of the chip, however, can cause low accuracy to active microfluidic that actuates flow frequently. Therefore, understanding the dynamic behaviour of microfluidic devices due to material compliance is of fundamental and practical importance. In this study, the microfluidic chip compliance is carefully considered by separating it from the sample tubing compliance. The capacitance is retrieved by assuming a symmetric RC circuit based on the experimentally determined time constant and chip resistance. The experimental capacitance is compared to a theoretical formula for chip designs with different height-to-width ratios and height-to-length ratios and for various fluids. The accuracy is within one order of magnitude that is much closer than previous approximations. © 2022 The Author(s). Published by IOP Publishing Ltd

A Quantitative study of the dynamic response of soft tubing for pressure-driven flow in a microfluidics context

Microfluidics typically uses either a syringe pump that regulates the flow rate in microchannels or a pressure pump that controls the inlet pressures to drive the flow. In the context of pressure-driven flow, a reservoir holder containing liquid samples is normally used to interface the pressure pump with the microfluidic chip via soft tubing. The tubing connecting the pump and holder transports the pressurized air while the tubing connecting the holder and chip transports the liquid samples. The pressure output from the pump is usually assumed to be stable and the same as that applied to the liquid in the chip; however, in practice this assumption is often incorrect and may negatively impact chip performance. This assumption is critically challenged when applied to microfluidic chips involving dynamic control of fluids since the pressures are constantly varied (at > 10 Hz). This study presents a method for investigating, quantifying and modelling the pump stability and the dynamics of the air tubing using two pressure sensors. The relationship between the pressure output from the pump and the reservoir holder pressure is generalized as a first-order linear system. This relationship allows the software that controls the pressure pump to output the required pressure to the reservoir holder and thus to the microfluidic chip. These results should significantly improve the performance of microfluidic chips using active fluid control, and may also benefit passive fluid control applications. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature

µPump: An open-source pressure pump for precision fluid handling in microfluidics

An open-source precision pressure pump system and control software is presented, primarily designed for the experimental microfluidics community, although others may find additional uses for this precision pressure source. This mechatronic system is coined ‘µPump,’ and its performance rivals that of commercially available systems, at a fraction of the cost. The pressure accuracy, stability, and resolution are 0.09%, 0.02%, and 0.02% of the full span, respectively. The settling time to reach 2 bar from zero and stabilize is less than 2 s. Material for building a four-channel µPump (approx. $3000 USD) or an eight-channel µPump (approx.$5000 USD) is approximately a quarter, or a third of the cost of buying a high-end commercial system, respectively. The design rationale is presented, together with documented design details and software, so that the system may be replicated or customized to particular applications. µPump can be used for two-phase droplet microfluidics, single-phase microfluidics, gaseous flow microfluidics and any other applications requiring precise fluid handling. µPump provides researchers, students, and startups with a cost-effective solution for precise fluid control. © 202