Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis

BACKGROUND: Food allergy is a common cause of anaphylaxis, but the incidence of fatal food anaphylaxis is not known. The aim of this study was to estimate the incidence of fatal food anaphylaxis for people with food allergy and relate this to other mortality risks in the general population. METHODS: We undertook a systematic review and meta-analysis, using the generic inverse variance method. Two authors selected studies by consensus, independently extracted data and assessed the quality of included studies using the Newcastle-Ottawa assessment scale. We searched Medline, Embase, PsychInfo, CINAHL, Web of Science, LILACS or AMED, between January 1946 and September 2012, and recent conference abstracts. We included registries, databases or cohort studies which described the number of fatal food anaphylaxis cases in a defined population and time period and applied an assumed population prevalence rate of food allergy. RESULTS: We included data from 13 studies describing 240 fatal food anaphylaxis episodes over an estimated 165 million food-allergic person-years. Study quality was mixed, and there was high heterogeneity between study results, possibly due to variation in food allergy prevalence and data collection methods. In food-allergic people, fatal food anaphylaxis has an incidence rate of 1.81 per million person-years (95%CI 0.94, 3.45; range 0.63, 6.68). In sensitivity analysis with different estimated food allergy prevalence, the incidence varied from 1.35 to 2.71 per million person-years. At age 0–19, the incidence rate is 3.25 (1.73, 6.10; range 0.94, 15.75; sensitivity analysis 1.18–6.13). The incidence of fatal food anaphylaxis in food-allergic people is lower than accidental death in the general European population. CONCLUSION: Fatal food anaphylaxis for a food-allergic person is rarer than accidental death in the general population

The Practitioner Perspective on Access to Justice for Social Rights: Addressing the Accountability Gap

First paragraph: This report examines access to justice for social rights across the UK drawing on legal and empirical data across each of the UK’s jurisdictions. Social rights form part of the international human rights framework, including the right to housing, the right to food and fuel and the right to social security. State parties who have signed up to the international framework are under an obligation to protect these rights in the domestic context, this includes the UK. As part of its international obligations the UK is required to provide access to an effective remedy if there is a failure to meet these obligations. We adopt a conceptualisation of access to justice using this international human rights law lens (that remedies are “accessible, affordable, timely and effective”). The research therefore examines whether people in the UK who experience a violation of the rights to housing, food, fuel or social security are able to access effective remedies to address that violation. We interviewed practitioners in each of the UK’s jurisdictions to better understand the access to justice journey for social rights. As this report demonstrates, it became clear that the UK and its devolved jurisdictions consists of a complex (legal) framework that intersects with international and domestic laws and institutions, politics, public services and the third sector, e.g. non-governmental agencies (NGOs) that serve and work with rights holders seeking to access justice. Our report recognises that the research we undertook barely touches the surface of access to justice for social rights violations and we hope this report serves as the basis for numerous future studies to enquire further and deeper into an increasingly emergent field of innovative interdisciplinary study. Ultimately, the aim of the research and the report seeks to better equip those who support rights holders accessing justice for social rights claims – there is a significant accountability gap in this respect across the UK and a pressing need to address this gap

The Practitioner Perspective on Access to Justice for Social Rights: Addressing the Accountability Gap

First paragraph: This report examines access to justice for social rights across the UK drawing on legal and empirical data across each of the UK’s jurisdictions. Social rights form part of the international human rights framework, including the right to housing, the right to food and fuel and the right to social security. State parties who have signed up to the international framework are under an obligation to protect these rights in the domestic context, this includes the UK. As part of its international obligations the UK is required to provide access to an effective remedy if there is a failure to meet these obligations. We adopt a conceptualisation of access to justice using this international human rights law lens (that remedies are “accessible, affordable, timely and effective”). The research therefore examines whether people in the UK who experience a violation of the rights to housing, food, fuel or social security are able to access effective remedies to address that violation. We interviewed practitioners in each of the UK’s jurisdictions to better understand the access to justice journey for social rights. As this report demonstrates, it became clear that the UK and its devolved jurisdictions consists of a complex (legal) framework that intersects with international and domestic laws and institutions, politics, public services and the third sector, e.g. non-governmental agencies (NGOs) that serve and work with rights holders seeking to access justice. Our report recognises that the research we undertook barely touches the surface of access to justice for social rights violations and we hope this report serves as the basis for numerous future studies to enquire further and deeper into an increasingly emergent field of innovative interdisciplinary study. Ultimately, the aim of the research and the report seeks to better equip those who support rights holders accessing justice for social rights claims – there is a significant accountability gap in this respect across the UK and a pressing need to address this gap

Effects of emergency department crowding on the delivery of timely care in an inner-city hospital in the Netherlands

Background The impact of delays in emergency department (ED) care has not been described in European countries where ED crowding is not universally recognized. The aim of this study was to determine the relationship of ED crowding with delays in triage and treatment, and 24-h mortality in patients admitted to the ED. Methods Five years of data from adults admitted to the hospital were

The protein kinase C inhibitor, Ro-31-7459, is a potent activator of ERK and JNK MAP kinases in HUVECs and yet inhibits cyclic AMP-stimulated <i>SOCS-3</i> gene induction through inactivation of the transcription factor c-Jun

Induction of the suppressor of cytokine signalling 3 (SOCS-3) gene is vital to the normal control of inflammatory signalling. In order to understand these processes we investigated the role of the proto-oncogene component of the AP-1 transcription factor complex, c-Jun, in the regulation of SOCS-3 gene induction. We found that cyclic AMP stimulation of HUVECs promoted phosphorylation and activation of JNK MAP kinase and its substrate c-Jun. The JNK responsive element of the human SOCS-3 promoter mapped to a putative AP-1 site within 1000 bp of the transcription start site. The PKC inhibitors, GF-109203X, Gö-6983 and Ro-317549, were all found to inhibit AP-1 transcriptional activity, transcriptional activation of this minimal SOCS-3 promoter and SOCS-3 gene induction in HUVECs. Interestingly, Ro-317549 treatment was also found to promote PKC-dependent activation of ERK and JNK MAP kinases and promote JNK-dependent hyper-phosphorylation of c-Jun, whereas GF-109203X and Gö-6983 had little effect. Despite this, all three PKC inhibitors were found to be effective inhibitors of c-Jun DNA-binding activity. The JNK-dependent hyper-phosphorylation of c-Jun in response to Ro-317549 treatment of HUVECs does therefore not interfere with its ability to inhibit c-Jun activity and acts as an effective inhibitor of c-Jun-dependent SOCS-3 gene induction

A Geography of Cohabitation in the Americas, 1970-2010

In this chapter, we trace the geography of unmarried cohabitation in the Americas on an unprecedented geographical scale in family demography. We present the percentage of partnered women aged 25-29 in cohabitation across more than 19,000 local units of 39 countries, from Canada to Argentina, at two points in time, 2000 and 2010. The local geography is supplemented by a regional geography of cohabitation that covers five decades of data from 1960 to 2010. Our data derive primarily from the rich collection of census microdata amassed by the Centro Latinoamericano y Caribeño de Demografía (CELADE) of the United Nations and from the IPUMS-international collection of harmonized census microdata samples (Minnesota Population Center, Integrated public use microdata series, international: Version 6.3 [Machine-readable database]. University of Minnesota, Minneapolis, 2014). Our analyses unveil a substantial amount of spatial heterogeneity both within and across countries. Despite the spectacular rise in cohabitation, its regional patterning has remained relatively unchanged over the last decades, which points to the presence of geo-historical legacies in the present patterns of unmarried cohabitation

Validation of the children's sleep habits questionnaire in a sample of Greek children with allergic rhinitis

BACKGROUND: Obstructive respiratory disorders, such as allergic rhinitis and asthma may impair sleep quality. The aim of this study is to validate the Children's Sleep Habits Questionnaire (CSHQ) for Greek children from 6 to 14 years of age. No validated tool has been developed so far to assess sleep disturbances in Greek school-aged children. METHODS: We examined the reliability and validity of the CSHQ in a sample of children with allergic rhinitis (AR) and a non-clinical population of parents of these children as a proxy measure of children's AR quality of life (QoL) as evaluated by the Pediatric Allergic Rhinitis Quality of Life (PedARQoL) questionnaire. RESULTS: The CSHQ questionnaire Child's Form (CF) had a moderate internal consistency with a Cronbach's alpha 0.671 and Guttman split-half coefficient of 0.563 when correlated with the PedARQoL (CF). There was also a moderate intraclass correlation of ICC=0.505 between the responses to both questionnaires in the two visits. The CSHQ Parent's Form (PF) had a very good internal consistency with a Cronbach's alpha of 0.928 and Guttman split-half coefficient of 0.798. There was a high intraclass correlation of 0.643 between the responses in the two visits. CONCLUSIONS: The Greek version of the CSHQ CF, but particularly the PF has proved to be a very reliable clinical instrument, which can be used in clinical trials for assessing sleep quality in school-aged children with sleep disturbances because of obstructive airway disorders, such as AR

Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration

Background Codesign has the potential to transform health and other public services. To avoid unintentionally reinforcing existing inequities, better understanding is needed of how to facilitate involvement of vulnerable populations in acceptable, ethical and effective codesign. Objective To explore citizens’ involvement in codesigning public services for vulnerable groups, identify challenges and suggest improvements. Design A modified case study approach. Pattern matching was used to compare reported challenges with a priori theoretical propositions. Setting and participants A two‐day international symposium involved 28 practitioners, academics and service users from seven countries to reflect on challenges and to codesign improved processes for involving vulnerable populations. Intervention studied Eight case studies working with vulnerable and disadvantaged populations in three countries. Results We identified five shared challenges to meaningful, sustained participation of vulnerable populations: engagement; power differentials; health concerns; funding; and other economic/social circumstances. In response, a focus on relationships and flexibility is essential. We encourage codesign projects to enact a set of principles or heuristics rather than following pre‐specified steps. We identify a set of principles and tactics, relating to challenges outlined in our case studies, which may help in codesigning public services with vulnerable populations. Discussion and conclusions Codesign facilitators must consider how meaningful engagement will be achieved and how power differentials will be managed when working with services for vulnerable populations. The need for flexibility and responsiveness to service user needs may challenge expectations about timelines and outcomes. User‐centred evaluations of codesigned public services are needed

Spectroscopic Target Selection in the Sloan Digital Sky Survey: The Quasar Sample

We describe the algorithm for selecting quasar candidates for optical spectroscopy in the Sloan Digital Sky Survey. Quasar candidates are selected via their non-stellar colors in "ugriz" broad-band photometry, and by matching unresolved sources to the FIRST radio catalogs. The automated algorithm is sensitive to quasars at all redshifts lower than z=5.8. Extended sources are also targeted as low-redshift quasar candidates in order to investigate the evolution of Active Galactic Nuclei (AGN) at the faint end of the luminosity function. Nearly 95% of previously known quasars are recovered (based on 1540 quasars in 446 square degrees). The overall completeness, estimated from simulated quasars, is expected to be over 90%, whereas the overall efficiency (quasars:quasar candidates) is better than 65%. The selection algorithm targets ultraviolet excess quasars to i^*=19.1 and higher-redshift (z>3) quasars to i^*=20.2, yielding approximately 18 candidates per square degree. In addition to selecting ``normal'' quasars, the design of the algorithm makes it sensitive to atypical AGN such as Broad Absorption Line quasars and heavily reddened quasars.Comment: 62 pages, 15 figures (8 color), 8 tables. Accepted by AJ. For a version with higher quality color figures, see http://archive.stsci.edu/sdss/quasartarget/RichardsGT_qsotarget.preprint.p