The value of pimecrolimus in improving quality of life of children with severe eczema – an open non-randomised study

Background: Atopic eczema is a common skin condition. It has the potential to severely impair quality of life in affected children. Pimecrolimus is currently registered for mild-moderate eczema but in clinical practice children with more severe disease are often treated with this therapy in an attempt to find a safe addition to long-term topical corticosteroid usage. The aim of this study was to test the value of pimecrolimus in improving quality of life in children with severe atopic eczema.Methods: This a single site, phase 4, non-randomised, open label trial of pimecrolimus use in children aged 4 months to 12 years living withmoderate to very severe atopic eczema. The study was conducted at Steve Biko Academic Hospital. Patients with unsatisfactorily controlled disease despite conventional topical therapy, adequate use of emollients, allergen avoidance and non-pharmacological skin hygiene were enrolled. A ParentIndex Quality of Life Questionnaire was completed by parents before and three months after using pimecrolimus.Results: A total of 24 patients were recruited, 20 of whom completed the study. Ninety per cent of patients had co-morbid asthma and allergicrhinitis. The Parent Index Quality of Life demonstrated a mean 33% score improvement after the use of pimecrolimus. There was an attendant reduction in cost of therapy to these patients.Conclusions: Pimecrolimus usage should be extended to patients with more severe atopic eczema as the improvement in quality of life is important and demonstrable.Keywords: severe eczema; topical steroids; calcineurin inhibitors; pimecrolimus; quality of lif

Asthma control - Practical suggestions for practicing doctors in family practice

Many surveys of asthma care suggest that only 5% of asthmatics are meeting the ‘Goals of asthma management' as set out in the Global Initiative for Asthma (GINA) guidelines. Despite the availability of useful asthma therapies and treatment strategies, the morbidity from asthma has remained significant. This review includes practical suggestions on optimal asthma control for the family practitioner. South African Family Practice Vol. 50 (2) 2008: pp. 26-3

Atopy in HIV-infected children in Pretoria

Introduction. The development or aggravation of a pre-existingatopic state in patients with human immunodeficiency virus(HIV) has not been thoroughly investigated in South Africa.HIV-infected adults have been shown to have a higherprevalence of atopy in some international studies, but this hasnot been documented in children.Methods. A prospective convenience sample of 50 childrenaged between 3 months and 12 years attending the TshwaneDistrict Hospital Paediatric HIV clinic in Pretoria wasrecruited. Their personal and family histories of atopy, WorldHealth Organization (WHO) HIV clinical staging and Centersfor Disease Control (CDC) immunological staging with CD4counts were documented. An age- and sex-matched controlgroup of 50 HIV-negative children was included. Skin pricktests (SPTs) to identify common aeroallergens were conductedon all patients.Results. One hundred children were enrolled, with 50 in eachgroup. Ten per cent of the HIV-infected patients comparedwith 16% of controls had positive SPTs to aeroallergens. Ahigher percentage of the HIV-infected patients had chronicrhinitis and eczema (60% and 68%, respectively). Therewas no relationship between CD4 count and positive SPTs(p=0.61), mean log CD4 count and presence of reportedasthma (p=0.71), and CD4 count and presence of reporteddermatitis (p=0.84). The CD4 count was not statisticallydifferent between children with and without a family historyof atopy (p=0.68).Conclusion. It appears that the stage of HIV disease does notinfluence the development or expression of allergy. There is a high prevalence of dermatitis and chronic rhinitis in HIVinfectedchildren, probably not atopic in origin

Urban Megatrends: Towards a European Research Agenda

The report presents the urban megatrends both worlwide and in Europe

Roadmaps to Utopia: Tales of the Smart City

Notions of the Smart City are pervasive in urban development discourses. Various frameworks for the development of smart cities, often conceptualized as roadmaps, make a number of implicit claims about how smart city projects proceed but the legitimacy of those claims is unclear. This paper begins to address this gap in knowledge. We explore the development of a smart transport application, MotionMap, in the context of a £16M smart city programme taking place in Milton Keynes, UK. We examine how the idealized smart city narrative was locally inflected, and discuss the differences between the narrative and the processes and outcomes observed in Milton Keynes. The research shows that the vision of data-driven efficiency outlined in the roadmaps is not universally compelling, and that different approaches to the sensing and optimization of urban flows have potential for empowering or disempowering different actors. Roadmaps tend to emphasize the importance of delivering quick practical results. However, the benefits observed in Milton Keynes did not come from quick technical fixes but from a smart city narrative that reinforced existing city branding, mobilizing a growing network of actors towards the development of a smart region. Further research is needed to investigate this and other smart city developments, the significance of different smart city narratives, and how power relationships are reinforced and constructed through them

Role of Strain and Ligand Effects in the Modification of the Electronic and Chemical Properties of Bimetallic Surfaces

Periodic density functional calculations are used to illustrate how the combination of strain and ligand effects modify the electronic and surface chemical properties of Ni, Pd, and Pt monolayers supported on other transition metals. Strain and the ligand effects are shown to change the width of the surface d band, which subsequently moves up or down in energy to maintain a constant band filling. Chemical properties such as the dissociative adsorption energy of hydrogen are controlled by changes induced in the average energy of the d band by modification of the d-band width

The diagnosis of asthma in children: An evidence-based approach to a common clinical dilemma

Background. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The diagnosis of asthma in young children is limited by the inability to perform objective lung function testing in this group of patients and the wide variety of conditions that can phenotypically present with asthma-like symptoms.Objectives. To provide an evidence-based approach for clinicians to accurately diagnose asthma in young children and to assess the level of control to guide therapeutic decisions.Methods. The South African Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The asthma diagnosis and control task groups reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system, providing recommendations based on current evidence.Conclusions. Asthma in young children should only be diagnosed if all other causes of wheezing have been considered and excluded, and if there is a response to a therapeutic trial and worsening with withdrawal of asthma medication. Asthma control should be assessed at each visit to guide therapeutic decisions.

Developing ethical geography students? The impact and effectiveness of a tutorial based approach

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Geography in Higher Education on 17/02/2016, available online: doi 10.1080/03098265.2016.1141396This paper explores the effectiveness of a tutorial based approach in supporting the development of geography undergraduates’ ethical thinking. It was found that overall the intervention had a statistically significant impact on students’ ethical thinking scores as assessed using Clarkeburn et al.’s (2003) Meta-Ethical Questionnaire (MEQ). The initiative led to a convergence of scores, having a bigger impact on those who had a relatively low score prior to the intervention. Interestingly the approach had the biggest impact on students who self-identified as physical geographers. Unlike some previous research there was little evidence of difference between male and female students