Asthma Severity and Prevalence: An Ongoing Interaction between Exposure, Hygiene, and Lifestyle

Why are the prevalence and severity of asthma increasing? Platts-Mills looks at the key studies that can help to anwer this important questio

Challenging Payday Lenders by Opening up the Market for Small-Dollar Loans

“Why hasn’t someone else stepped in to lend at lower interest rates?” is the question frequently asked in discussions of payday loans. The average payday loan carries an Annual Percentage Rate (APR) of over 300%. Given the strength of th e payday lenders lobby at the federal and state level, one way to help low- and moderate-income households escape the financial harms of pa yday loans is to encourage other lenders to enter the small-dollar loan market and offer more affordable products. Over the past ten years, an array of affordable small-dollar loan programs offered by banks, credit unions, non-profit organizations, and for-profit fintech compan ies have entered the market to provide borrowers with alternatives to payday loans. These lenders are offering small-dollar loans at rates and on terms that are more manageable for low- and moderate-income consumers than payday loans, while maintaining the features of payday loans that consumers like—namely quick and easy access to credit. This paper w ill desc ribe these affordable small-dollar loan programs and explain what is needed from regulators, financial institutions and foundations, and consumer advocates for the programs to serve more borrowers and take over more of the market space curren tly occupied by payday lenders. Banks, with support from t he ir regulators, can offer affordable small-dollar loans to their customers and should continue to provide low-in terest loan capital to non-profit small-dollar lenders. Credit unions can continue to offer small-dollar loan programs like the Payday Alte rnative Loan product and the Employer Sponsored Small-Dollar Loan product and should be encouraged to do so by their regulators. Non-profit organizations can continue to offer affordable loans in partnership with employers or other lenders and should be provided with grants and low-interest loan capital and pro-bono support from la wyers and marketing companies. For-profit, fintech lenders can continue to enter this space and should be supported by consumer advocates and regulators as long as their products meet certain guidelines: compliance with all federal and state laws, affordable payments, and features such as credit bureau reporting, transparent fees, and flexible repayment terms. Finally, recent efforts in Congress to encourage the U. S. Postal Service to offer affordable small-dollar loans should also be supported. The short-term small-dollar credit needs of low- and moderateincome households should not be met primarily by payday lenders whose high fees and short repayment terms too often trap borrowers in a cycle of debt. Low-and moderate-income consumers deserve better options. With support, the affordable small-dollar loan programs described in this paper can be expanded to make the market for smalldollar credit more competitive, helping borrowers across the country

Thinking Like Entrepreneurs: Qlegal’s Experience of Teaching Law Students to have an Entrepreneurial Mindset

To advise a client you need to understand what they do. To provide truly innovative, client-centred advice, you also need to understand how they think. These observations are especially true when working with entrepreneurs who may be otherwise inclined to move forward with their business with or without legal guidance. Entrepreneurs are distinguished by their growth mindset and resilience, appetite for innovation and comfort with taking risks and doing things themselves. As the legal marketplace in the UK becomes increasingly competitive (due to legal technology and the growing number of alternative legal service providers), law students need to adopt an entrepreneurial mindset themselves, both to navigate the legal marketplacefor their own careers and to provide commercially aware legal services to their clients. Law schools need to teach law students to think like entrepreneurs, and commercial law clinics provide the natural setting. This paper adopts a qualitative case study approach to examine how qLegal, the pro bono commercial law clinic within the Centre for Commercial Law Studies (“CCLS”) at Queen Mary, University of London (“QMUL”) teaches students to develop an entrepreneurial mindset. We reflect on the importance of students learning about and developing this mindset, for their own professional development and to service the unmet legal needs of the start-up community. This paper will also highlight the challenges faced by qLegal staff, including our own legal training and experience, our obligations to real clients and our students’ expectations. We conclude by sharing examples of how we are currently teaching our students to have an entrepreneurial mindset and our ideas for overcoming our institutional challenges and improving our offering even more

Giardia: a pathogen or commensal for children in high-prevalence settings?

Giardia is a common intestinal parasite worldwide, and infection can be associated with clear and sometimes persistent symptomatology. However, in children in high prevalence settings, it is not associated with or is perhaps even protective against acute diarrhea, and the association with long-term outcomes has been difficult to discern

The use of machine learning to understand the relationship between IgE to specific allergens and asthma

In a study recently published in PLOS Medicine, Custovic and colleagues report an elegant analysis of the results of specific Immunoglobulin E (IgE) assays on sera from a birth cohort that they have studied in detail over the last 15 years. The IgE assays used a microchip with >100 purified allergens, and their machine learning approach used a hypothesis-free statistical approach to group children with similar allergen sensitization profiles. The primary objective was to evaluate the relationship of the results to the diagnosis of current asthma. The goal of employing a “machine learning” approach is both as a form of data reduction to avoid spuriously identified associations resulting from multiple comparisons and to identify biologically relevant groupings that may not be recognized with conventional approaches. The use of “hypothesis free” clustering methods with individual allergen components in itself is not novel. However, the authors have employed a new network analysis method, which is improved over previous methods because it can capture nonlinear relationships and does not rely on assumption of a parametric probability. As the authors show, this approach can lead to improved sensitivity and specificity. With this model, they were able to show that pairings of allergens (e.g., the cat allergen Fel d 1 and the peanut allergen Ara h 1) were more predictive of the child having asthma than individual components, although we must be cautious in the generalizability of the specific patterns identified, in this single cohort in the United Kingdom, because the pairing may represent host susceptibility to making an IgE response or common co-exposures, which could be allergens or adjuvants. Still, the concept of complicated connections between individual allergenic proteins and allergic disease are likely to apply more broadly and are important to consider in future studies

Differences in both prevalence and titre of specific immunoglobulin E among children with asthma in affluent and poor communities within a large town in Ghana.

Background Reports from several African countries have noted an increasing prevalence of asthma in areas of extensive urbanization. Objective To investigate the relevance of allergen-specific sensitization and body mass index (BMI) to asthma/wheezing and exercise-induced bronchospasm (EIB) among children from affluent and poorer communities within a large town in Ghana. Methods Children with physician-diagnosed asthma and/or current wheezing aged 9-16 years (n=99; cases) from three schools with differing socio-economic backgrounds [urban affluent (UA), urban poor (UP) or suburban/rural (SR)] were recruited from a cross-sectional study (n=1848) in Kumasi, Ghana, and matched according to age, sex and area of residence with non-asthmatic/non-wheezy controls. We assayed sera for IgE antibodies to mite, cat, dog, cockroach, Ascaris and galactose-α-1,3-galactose. Results Children from the UA school had the lowest total serum IgE. However, cases from the UA school had a higher prevalence and mean titre of sIgE to mite (71.4%, 21.2IU/mL) when compared with controls (14.3%, 0.8IU/mL) or cases from UP (30%, 0.8IU/mL) and SR community (47.8%, 1.6IU/mL). While similar findings were observed with EIB in the whole population, among cases there was no difference in IgE antibody prevalence or titre between children with or without EIB. BMI was higher among UA children with and without asthma; in UP and SR communities, children with EIB (n=14) had a significantly higher BMI compared with children with asthma/wheezing without EIB (n=38) (18.2 vs. 16.4, respectively, P<0.01). Conclusions and Clinical Relevance In the relatively affluent school, asthma/wheezing and EIB were associated with high titre IgE antibodies to mite, decreased total IgE, and increased BMI. This contrasted with children in the urban poor school and suggests that changes relevant to a Western model of childhood asthma can occur within a short geographical distance within a large city in Africa. © 2011 Blackwell Publishing Ltd

Effect of urban vs. rural residence on the association between atopy and wheeze in Latin America: findings from a case-control analysis.

BACKGROUND: The association between atopy and asthma is attenuated in non-affluent populations, an effect that may be explained by childhood infections such as geohelminths. OBJECTIVE: To investigate the association between atopy and wheeze in schoolchildren living in urban and rural areas of Ecuador and examine the effects of geohelminths on this association. METHODS: We performed nested case-control studies among comparable populations of schoolchildren living in rural communities and urban neighbourhoods in the Province of Esmeraldas, Ecuador. We detected geohelminths in stool samples, measured recent wheeze and environmental exposures by parental questionnaire, and atopy by specific IgE (sIgE) and skin prick test (SPT) reactivity to aeroallergens. RESULTS: Atopy, particularly sIgE to house dust mite (HDM), was more strongly associated with recent wheeze in urban than rural schoolchildren: (urban, adj. OR 5.19, 95% CI 3.37-8.00, P < 0.0001; rural, adj. OR 1.81, 95%CI 1.09-2.99, P = 0.02; interaction, P < 0.001). The population fractions of wheeze attributable to atopy were approximately two-fold greater in urban schoolchildren: SPT to any allergen (urban 23.5% vs. rural 10.1%), SPT to HDM (urban 18.5% vs. rural 9.6%), and anti-HDM IgE (urban 26.5% vs. rural 10.5%), while anti-Ascaris IgE was related to wheeze in a high proportion of rural (49.7%) and urban (35.4%) children. The association between atopy and recent wheeze was attenuated by markers of geohelminth infections. CONCLUSIONS: Our data suggest that urban residence modifies the association between HDM atopy and recent wheeze, and this effect is explained partly by geohelminth infections

Identifying Elder Abuse in the Emergency Department: Toward a Multidisciplinary Team-Based Approach

Elder abuse and neglect are defined as action or negligence against a vulnerable older adult that causes harm or risk of harm, either committed by a person in a relationship with an expectation of trust or when an older person is targeted based on age or disability. This mistreatment may include physical abuse, sexual abuse, neglect, psychological abuse, or financial exploitation; many victims experience multiple types of abuse. Elder abuse is both common and costly. It has an estimated prevalence of 5% to 10% and has been linked to major adverse health outcomes, including dementia, depression, and mortality. Although not easily quantified, elder abuse is estimated to cost many billions of dollars annually. In addition to community-dwelling older adults, residents of skilled nursing facilities may also be victims of mistreatment by staff members or other residents

Diagnosis of Elder Abuse in U.S. Emergency Departments

To estimate the proportion of visits to United States emergency departments (EDs) receiving a diagnosis of elder abuse using two nationally representative datasets