Food allergy can result in considerable morbidity, impairment of quality of life, and healthcare expenditure. There is therefore interest in novel strategies for its treatment, particularly food ...allergen immunotherapy (FA‐AIT) through the oral (OIT), sublingual (SLIT), or epicutaneous (EPIT) routes. This Guideline, prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Task Force on Allergen Immunotherapy for IgE‐mediated Food Allergy, aims to provide evidence‐based recommendations for active treatment of IgE‐mediated food allergy with FA‐AIT. Immunotherapy relies on the delivery of gradually increasing doses of specific allergen to increase the threshold of reaction while on therapy (also known as desensitization) and ultimately to achieve post‐discontinuation effectiveness (also known as tolerance or sustained unresponsiveness). Oral FA‐AIT has most frequently been assessed: here, the allergen is either immediately swallowed (OIT) or held under the tongue for a period of time (SLIT). Overall, trials have found substantial benefit for patients undergoing either OIT or SLIT with respect to efficacy during treatment, particularly for cow's milk, hen's egg, and peanut allergies. A benefit post‐discontinuation is also suggested, but not confirmed. Adverse events during FA‐AIT have been frequently reported, but few subjects discontinue FA‐AIT as a result of these. Taking into account the current evidence, FA‐AIT should only be performed in research centers or in clinical centers with an extensive experience in FA‐AIT. Patients and their families should be provided with information about the use of FA‐AIT for IgE‐mediated food allergy to allow them to make an informed decision about the therapy.
•A stochastic hybrid blade tip timing approach is proposed and demonstrated.•Turbomachine blade damage is identified and classified using this approach.•Probabilistic damage identification is ...achieved through natural frequency tracking.•Damage classification utilises a K-means clustering approach.•The proactive scheduling of a turbomachine outage is thus demonstrated.
Blade Tip Timing (BTT) has been in existence for many decades as an attractive vibration based condition monitoring technique for turbomachine blades. The technique is non-intrusive and online monitoring is possible. For these reasons, BTT may be regarded as a feasible technique to track the condition of turbomachine blades, thus preventing unexpected and catastrophic failures. The processing of BTT data to find the associated vibration characteristics is however non-trivial. In addition, these vibration characteristics are difficult to validate, therefore resulting in great uncertainty of the reliability of BTT techniques. This article therefore proposes a hybrid approach comprising a stochastic Finite Element Model (FEM) based modal analysis and Bayesian Linear Regression (BLR) based BTT technique. The use of this stochastic hybrid approach is demonstrated for the identification and classification of turbomachine blade damage. For the purposes of this demonstration, discrete damage is incrementally introduced to a simplified test blade of an experimental rotor setup. The damage identification and classification processes are further used to determine whether a damage threshold has been reached, therefore providing sufficient evidence to schedule a turbomachine outage. It is shown that the proposed stochastic hybrid approach may offer many short- and long-term benefits for practical implementation.
Abstract
The inner ∼200 pc region of the Galaxy contains a 4 million M
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supermassive black hole (SMBH), significant quantities of molecular gas, and star formation and cosmic-ray energy densities ...that are roughly two orders of magnitude higher than the corresponding levels in the Galactic disk. At a distance of only 8.2 kpc, the region presents astronomers with a unique opportunity to study a diverse range of energetic astrophysical phenomena, from stellar objects in extreme environments, to the SMBH and star-formation-driven feedback processes that are known to influence the evolution of galaxies as a whole. We present a new survey of the Galactic center conducted with the South African MeerKAT radio telescope. Radio imaging offers a view that is unaffected by the large quantities of dust that obscure the region at other wavelengths, and a scene of striking complexity is revealed. We produce total-intensity and spectral-index mosaics of the region from 20 pointings (144 hr on-target in total), covering 6.5 square degrees with an angular resolution of 4″ at a central frequency of 1.28 GHz. Many new features are revealed for the first time due to a combination of MeerKAT’s high sensitivity, exceptional
u
,
v
-plane coverage, and geographical vantage point. We highlight some initial survey results, including new supernova remnant candidates, many new nonthermal filament complexes, and enhanced views of the Radio Arc bubble, Sagittarius A, and Sagittarius B regions. This project is a South African Radio Astronomy Observatory public legacy survey, and the image products are made available with this article.
1. Understanding the effects of disease is critical to determining appropriate management responses, but estimating those effects in wildlife species is challenging. We used bovine tuberculosis (BTB) ...in the African buffalo Syncerus caffer population of Kruger National Park, South Africa, as a case study to highlight the issues associated with estimating chronic disease effects in a long-lived host. 2. We used known and radiocollared buffalo, aerial census data, and a natural gradient in pathogen prevalence to investigate if: (i) at the individual level, BTB infection reduces reproduction; (ii) BTB infection increases vulnerability to predation; and (iii) at the population level, increased BTB prevalence causes reduced population growth. 3. There was only a marginal reduction in calving success associated with BTB infection, as indexed by the probability of sighting a known adult female with or without a calf (P = 0·065). 4. Since 1991, BTB prevalence increased from 27 to 45% in the southern region and from 4 to 28% in the central region of Kruger National Park. The prevalence in the northern regions was only 1·5% in 1998. Buffalo population growth rates, however, were neither statistically different among regions nor declining over time. 5. Lions Panthera leo did not appear to preferentially kill test-positive buffalo. The best (Akaike's Information Criterion corrected for small sample size) AICc model with BTB as a covariate exp(β) = 0·49; 95% CI = (0·24-1·02) suggested that the mortality hazard for positive individuals was no greater than for test-negative individuals. 6. Synthesis and applications. Test accuracy, time-varying disease status, and movement among populations are some of the issues that make the detection of chronic disease impacts challenging. For these reasons, the demographic impacts of bovine tuberculosis in the Kruger National Park remain undetectable despite 6 years of study on known individuals and 40 years of population counts. However, the rainfall and forage conditions during this study were relatively good and the impacts of many chronic diseases may be a non-linear function of environmental conditions such that they are only detectable in stressful periods.
No approved treatment for peanut allergy exists for children younger than 4 years of age, and the efficacy and safety of epicutaneous immunotherapy with a peanut patch in toddlers with peanut allergy ...are unknown.
We conducted this phase 3, multicenter, double-blind, randomized, placebo-controlled trial involving children 1 to 3 years of age with peanut allergy confirmed by a double-blind, placebo-controlled food challenge. Patients who had an eliciting dose (the dose necessary to elicit an allergic reaction) of 300 mg or less of peanut protein were assigned in a 2:1 ratio to receive epicutaneous immunotherapy delivered by means of a peanut patch (intervention group) or to receive placebo administered daily for 12 months. The primary end point was a treatment response as measured by the eliciting dose of peanut protein at 12 months. Safety was assessed according to the occurrence of adverse events during the use of the peanut patch or placebo.
Of the 362 patients who underwent randomization, 84.8% completed the trial. The primary efficacy end point result was observed in 67.0% of children in the intervention group as compared with 33.5% of those in the placebo group (risk difference, 33.4 percentage points; 95% confidence interval, 22.4 to 44.5; P<0.001). Adverse events that occurred during the use of the intervention or placebo, irrespective of relatedness, were observed in 100% of the patients in the intervention group and 99.2% in the placebo group. Serious adverse events occurred in 8.6% of the patients in the intervention group and 2.5% of those in the placebo group; anaphylaxis occurred in 7.8% and 3.4%, respectively. Serious treatment-related adverse events occurred in 0.4% of patients in the intervention group and none in the placebo group. Treatment-related anaphylaxis occurred in 1.6% in the intervention group and none in the placebo group.
In this trial involving children 1 to 3 years of age with peanut allergy, epicutaneous immunotherapy for 12 months was superior to placebo in desensitizing children to peanuts and increasing the peanut dose that triggered allergic symptoms. (Funded by DBV Technologies; EPITOPE ClinicalTrials.gov number, NCT03211247.).
In this work, we propose a positivity-preserving scheme for solving two-dimensional advection–diffusion equations including mixed derivative terms, in order to improve the accuracy of lower-order ...methods. The solution of these equations, in the absence of mixed derivatives, has been studied in detail, while positivity-preserving schemes for mixed derivative terms have received much less attention. A two-dimensional diffusion equation, for which the analytical solution is known, is solved numerically to show the applicability of the scheme. It is further applied to the Fokker–Planck collision operator in two-dimensional cylindrical coordinates under the assumption of local thermal equilibrium. For a thermal equilibration problem, it is shown that the scheme conserves particle number and energy, while the preservation of positivity is ensured and the steady-state solution is the Maxwellian distribution.
MeerKAT’s large number (64) of 13.5 m diameter antennas, spanning 8 km with a densely packed 1 km core, create a powerful instrument for wide-area surveys, with high sensitivity over a wide range of ...angular scales. The MeerKAT Galaxy Cluster Legacy Survey (MGCLS) is a programme of long-track MeerKAT L-band (900−1670 MHz) observations of 115 galaxy clusters, observed for ∼6−10 h each in full polarisation. The first legacy product data release (DR1), made available with this paper, includes the MeerKAT visibilities, basic image cubes at ∼8″ resolution, and enhanced spectral and polarisation image cubes at ∼8″ and 15″ resolutions. Typical sensitivities for the full-resolution MGCLS image products range from ∼3−5 μJy beam−1. The basic cubes are full-field and span 2° × 2°. The enhanced products consist of the inner 1.2° × 1.2° field of view, corrected for the primary beam. The survey is fully sensitive to structures up to ∼10′ scales, and the wide bandwidth allows spectral and Faraday rotation mapping. Relatively narrow frequency channels (209 kHz) are also used to provide H I mapping in windows of 0 < z < 0.09 and 0.19 < z < 0.48. In this paper, we provide an overview of the survey and the DR1 products, including caveats for usage. We present some initial results from the survey, both for their intrinsic scientific value and to highlight the capabilities for further exploration with these data. These include a primary-beam-corrected compact source catalogue of ∼626 000 sources for the full survey and an optical and infrared cross-matched catalogue for compact sources in the primary-beam-corrected areas of Abell 209 and Abell S295. We examine dust unbiased star-formation rates as a function of cluster-centric radius in Abell 209, extending out to 3.5 R 200. We find no dependence of the star-formation rate on distance from the cluster centre, and we observe a small excess of the radio-to-100 μm flux ratio towards the centre of Abell 209 that may reflect a ram pressure enhancement in the denser environment. We detect diffuse cluster radio emission in 62 of the surveyed systems and present a catalogue of the 99 diffuse cluster emission structures, of which 56 are new. These include mini-halos, halos, relics, and other diffuse structures for which no suitable characterisation currently exists. We highlight some of the radio galaxies that challenge current paradigms, such as trident-shaped structures, jets that remain well collimated far beyond their bending radius, and filamentary features linked to radio galaxies that likely illuminate magnetic flux tubes in the intracluster medium. We also present early results from the H I analysis of four clusters, which show a wide variety of H I mass distributions that reflect both sensitivity and intrinsic cluster effects, and the serendipitous discovery of a group in the foreground of Abell 3365.
Background
The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE‐mediated Food Allergy. To inform the development of ...clinical recommendations, we sought to critically assess evidence on the effectiveness, safety and cost‐effectiveness of AIT in the management of food allergy.
Methods
We undertook a systematic review and meta‐analysis that involved searching nine international electronic databases for randomized controlled trials (RCTs) and nonrandomized studies (NRS). Eligible studies were independently assessed by two reviewers against predefined eligibility criteria. The quality of studies was assessed using the Cochrane Risk of Bias tool for RCTs and the Cochrane ACROBAT‐NRS tool for quasi‐RCTs. Random‐effects meta‐analyses were undertaken, with planned subgroup and sensitivity analyses.
Results
We identified 1814 potentially relevant papers from which we selected 31 eligible studies, comprising of 25 RCTs and six NRS, studying a total of 1259 patients. Twenty‐five trials evaluated oral immunotherapy (OIT), five studies investigated sublingual immunotherapy, and one study evaluated epicutaneous immunotherapy. The majority of these studies were in children. Twenty‐seven studies assessed desensitization, and eight studies investigated sustained unresponsiveness postdiscontinuation of AIT. Meta‐analyses demonstrated a substantial benefit in terms of desensitization (risk ratio (RR) = 0.16, 95% CI 0.10, 0.26) and suggested, but did not confirm sustained unresponsiveness (RR = 0.29, 95% CI 0.08, 1.13). Only one study reported on disease‐specific quality of life (QoL), which reported no comparative results between OIT and control group. Meta‐analyses revealed that the risk of experiencing a systemic adverse reaction was higher in those receiving AIT, with a more marked increase in the risk of local adverse reactions. Sensitivity analysis excluding those studies judged to be at high risk of bias demonstrated the robustness of summary estimates of effectiveness and safety of AIT for food allergy. None of the studies reported data on health economic analyses.
Conclusions
AIT may be effective in raising the threshold of reactivity to a range of foods in children with IgE‐mediated food allergy whilst receiving (i.e. desensitization) and post‐discontinuation of AIT. It is, however, associated with a modest increased risk in serious systemic adverse reactions and a substantial increase in minor local adverse reactions. More data are needed in relation to adults, long term effects, the impact on QoL and the cost‐effectiveness of AIT.
Objectives
To determine the prevalence of myocardial injury (MInj) in systemic lupus erythematosus (SLE) according to cardiac magnetic resonance (CMR) criteria. To compare clinical and ...echocardiographic features of patients with and without MInj and identify predictors of myocardial tissue characteristics according to CMR.
Methods
SLE inpatients underwent CMR screening for MInj based on the Lake Louise Criteria (LLC). Tissue characteristics included inflammation (increased T2-weighted signal or early gadolinium enhancement ratio (EGEr)) and necrosis or fibrosis (late gadolinium enhancement (LGE)). Echocardiographic parameters included left (left ventricular ejection fraction (LVEF)) and right ventricular function (tricuspid annular plane systolic excursion (TAPSE)), global longitudinal strain (GLS), wall motion score (WMSi) and left ventricular internal diameter index (LVIDi). Variables were compared with regards to the presence/absence of CMR criteria. Logistic regression identified variables predictive of CMR tissue characteristics.
Results
A hundred and six SLE patients were screened of whom 49 patients were included. Fifty-seven patients were excluded due to intolerance of or contraindication to CMR (27/57 due to renal impairment). Twenty-three patients had CMR evidence of MInj, of which 60.9% was subclinical. Inflammation occurred in 16/23 and necrosis/fibrosis in 12/23 patients. Patients with any evidence of MInj were more frequently anti-dsDNA positive (p = 0.026) and patients fulfilling LLC for myocarditis had higher SLE disease activity (p = 0.022). The LVIDi (p = 0.005), LVEF (p = 0.005) and TAPSE (p = 0.011) were more abnormal in patients with an increased EGEr, whereas WMSi (p = 0.002) and GLS (0.020) were more impaired in patients with LGE. On multivariable logistic regression analyses, TAPSE predicted inflammation (OR: 0.045, p = 0.006, CI: 0.005–0.415) and GLS predicted necrosis/fibrosis (OR: 1.329, p = 0.031, CI: 1.026–1.722). A model including lymphocyte count, TAPSE and LVIDi predicted an increased EGEr on CMR (receiver operating characteristic-curve analyses: area under the curve: 0.901, p < 0.001, sensitivity: 88.9%, specificity: 76.3%).
Conclusions
CMR evidence of MInj frequently occurs in SLE and is often subclinical. The utility of CMR in SLE is limited by a high exclusion rate, mainly due to renal involvement. Models including echocardiographic parameters (TAPSE, LVIDi and GLS) are predictive of CMR myocardial injury. Echocardiography can be used as a cost-effective screening tool with a high negative predictive value, in particular when CMR is contraindicated or unavailable.
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