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Dodd A, Turner PJ, Soar J, Savic L. Emergency treatment of peri-operative anaphylaxis: Resuscitation Council UK algorithm for anaesthetists. Anaesthesia 2024; 79:535-541. [PMID: 38205901 DOI: 10.1111/anae.16206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 01/12/2024]
Abstract
Peri-operative anaphylaxis is a rare but potentially catastrophic event which must be considered whenever unexpected and significant cardiovascular or respiratory compromise occurs during anaesthesia. The Resuscitation Council UK algorithm for peri-operative anaphylaxis highlights the importance of early intravenous adrenaline and fluid resuscitation and provides guidance on the treatment of refractory anaphylaxis and immediate follow-up. This algorithm is endorsed by the Royal College of Anaesthetists, Association of Anaesthetists, British Society of Allergy and Clinical Immunology and Clinical Immunology Professional Network of the British Society for Immunology. This document was produced by the Perioperative Allergy Network steering committee in collaboration with the Resuscitation Council UK.
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Affiliation(s)
- A Dodd
- Department of Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - P J Turner
- Department of Paediatric Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College, London, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - L Savic
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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2
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Cole ME, Kundu R, Abdulla AF, Andrews N, Hoschler K, Southern J, Jackson D, Miller E, Zambon M, Turner PJ, Tregoning JS. Pre-existing influenza-specific nasal IgA or nasal viral infection does not affect live attenuated influenza vaccine immunogenicity in children. Clin Exp Immunol 2021; 204:125-133. [PMID: 33314126 PMCID: PMC7944357 DOI: 10.1111/cei.13564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
The United Kingdom has a national immunization programme which includes annual influenza vaccination in school-aged children, using live attenuated influenza vaccine (LAIV). LAIV is given annually, and it is unclear whether repeat administration can affect immunogenicity. Because LAIV is delivered intranasally, pre-existing local antibody might be important. In this study, we analysed banked samples from a study performed during the 2017/18 influenza season to investigate the role of pre-existing influenza-specific nasal immunoglobulin (Ig)A in children aged 6-14 years. Nasopharyngeal swabs were collected prior to LAIV immunization to measure pre-existing IgA levels and test for concurrent upper respiratory tract viral infections (URTI). Oral fluid samples were taken at baseline and 21-28 days after LAIV to measure IgG as a surrogate of immunogenicity. Antibody levels at baseline were compared with a pre-existing data set of LAIV shedding from the same individuals, measured by reverse transcription-polymerase chain reaction. There was detectable nasal IgA specific to all four strains in the vaccine at baseline. However, baseline nasal IgA did not correlate with the fold change in IgG response to the vaccine. Baseline nasal IgA also did not have an impact upon whether vaccine virus RNA was detectable after immunization. There was no difference in fold change of antibody between individuals with and without an URTI at the time of immunization. Overall, we observed no effect of pre-existing influenza-specific nasal antibody levels on immunogenicity, supporting annual immunization with LAIV in children.
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MESH Headings
- Administration, Intranasal
- Adolescent
- Antibodies, Viral/immunology
- Child
- Female
- Humans
- Immunogenicity, Vaccine/immunology
- Immunoglobulin A/immunology
- Immunoglobulin G/immunology
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/immunology
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Male
- Nasal Cavity/immunology
- Nasal Cavity/virology
- Vaccination/methods
- Vaccines, Attenuated/administration & dosage
- Vaccines, Attenuated/immunology
- Virus Shedding/immunology
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Affiliation(s)
- M. E. Cole
- Department of Infectious DiseaseImperial College London (St Mary’s Campus)LondonUK
- Present address:
MEC – The Pirbright InstitutePirbrightUK
| | - R. Kundu
- Health Protection Research Unit in Respiratory InfectionsImperial College LondonLondonUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - A. F. Abdulla
- Department of Infectious DiseaseImperial College London (St Mary’s Campus)LondonUK
| | - N. Andrews
- Public Health England (Colindale)LondonUK
| | | | | | - D. Jackson
- Public Health England (Colindale)LondonUK
| | - E. Miller
- Public Health England (Colindale)LondonUK
| | - M. Zambon
- Public Health England (Colindale)LondonUK
| | - P. J. Turner
- Health Protection Research Unit in Respiratory InfectionsImperial College LondonLondonUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - J. S. Tregoning
- Department of Infectious DiseaseImperial College London (St Mary’s Campus)LondonUK
- Health Protection Research Unit in Respiratory InfectionsImperial College LondonLondonUK
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3
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McCarthy S, Murphy M, Turner PJ, Hourihane OB. Comment on 'Four-year data from use of the nut and soya allergy testing protocol before treatment with isotretinoin and alitretinoin'. Clin Exp Dermatol 2020; 45:1071. [PMID: 32686162 DOI: 10.1111/ced.14391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
- S McCarthy
- Department of Paediatric Dermatology, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - M Murphy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - P J Turner
- National Heart and Lung Institute, Imperial College London, London, UK
| | - O B Hourihane
- Paediatrics and Child Health and RCSI and Children's Health Ireland, Temple Street, Dublin, Ireland
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4
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Stowe J, Andrews NJ, Turner PJ, Miller E. The risk of Kawasaki disease after pneumococcal conjugate & meningococcal B vaccine in England: A self-controlled case-series analysis. Vaccine 2020; 38:4935-4939. [PMID: 32536544 DOI: 10.1016/j.vaccine.2020.05.089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
Kawasaki disease (KD) is an uncommon condition occasionally reported after childhood vaccination. Admissions with a KD-compatible diagnosis identified from a national database in England were linked to immunisation records to investigate the risk after pneumococcal conjugate (PCV) or meningococcal B (MenB) vaccines. Both are given at 2/4/12 months of age but were introduced sequentially, allowing their effects to be separately assessed. A total of 553 linked admissions in 512 individuals were validated as KD. The relative incidence (RI) within 28 days of PCV doses 1 or 2 measured by the self-controlled case-series method was 0.62 (95% confidence interval (CI) 0.38-1.00) with a significantly decreased risk after dose 3 (RI 0.30 (95% CI 0.11-0.77)). For MenB vaccine, the RI after doses 1 or 2 was 1.03 (95% CI 0.51-2.05) and 0.64 (95% CI 0.08-5.26) after dose 3. This study shows no evidence of an increased risk of KD after either vaccine.
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Affiliation(s)
- J Stowe
- Immunisation & Countermeasures, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
| | - N J Andrews
- Statistics and Modelling Economics Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
| | - P J Turner
- Section of Inflammation, Repair & Development, National Heart & Lung Institute, Imperial College London, United Kingdom.
| | - E Miller
- Prof. Elizabeth Miller, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
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5
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Turner PJ, Abdulla AF, Cole ME, Javan RR, Gould V, O'Driscoll ME, Southern J, Zambon M, Miller E, Andrews NJ, Höschler K, Tregoning JS. Differences in nasal immunoglobulin A responses to influenza vaccine strains after live attenuated influenza vaccine (LAIV) immunization in children. Clin Exp Immunol 2020; 199:109-118. [PMID: 31670841 PMCID: PMC6954673 DOI: 10.1111/cei.13395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 11/28/2022] Open
Abstract
Different vaccine strains included in the live attenuated influenza vaccine (LAIV) have variable efficacy. The reasons for this are not clear and may include differences in immunogenicity. We report a Phase IV open-label study on the immunogenicity of a single dose of quadrivalent LAIV (Fluenz™ Tetra) in children during the 2015/16 season, to investigate the antibody responses to different strains. Eligible children were enrolled to receive LAIV; nasal samples were collected before and approximately 4 weeks after immunization. There was a significant increase in nasal immunoglobulin (Ig)A to the H3N2, B/Victoria lineage (B/Brisbane) and B/Yamagata lineage (B/Phuket) components, but not to the H1N1 component. The fold change in nasal IgA response was inversely proportional to the baseline nasal IgA titre for H1N1, H3N2 and B/Brisbane. We investigated possible associations that may explain baseline nasal IgA, including age and prior vaccination status, but found different patterns for different antigens, suggesting that the response is multi-factorial. Overall, we observed differences in immune responses to different viral strains included in the vaccine; the reasons for this require further investigation.
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Affiliation(s)
- P. J. Turner
- National Heart and Lung InstituteImperial College LondonLondonUK
- Public Health England (Colindale)LondonUK
| | - A. F. Abdulla
- Department of Infectious DiseaseSt Mary's CampusImperial College LondonLondonUK
| | - M. E. Cole
- Department of Infectious DiseaseSt Mary's CampusImperial College LondonLondonUK
| | - R. R. Javan
- Department of Infectious DiseaseSt Mary's CampusImperial College LondonLondonUK
| | - V. Gould
- Department of Infectious DiseaseSt Mary's CampusImperial College LondonLondonUK
| | - M. E. O'Driscoll
- Infectious Diseases EpidemiologySt Mary's CampusImperial College LondonLondonUK
| | | | - M. Zambon
- Public Health England (Colindale)LondonUK
| | - E. Miller
- Public Health England (Colindale)LondonUK
| | | | | | - J. S. Tregoning
- Department of Infectious DiseaseSt Mary's CampusImperial College LondonLondonUK
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6
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Zhou X, Peets DC, Morgan B, Huttema WA, Murphy NC, Thewalt E, Truncik CJS, Turner PJ, Koenig AJ, Waldram JR, Hosseini A, Liang R, Bonn DA, Hardy WN, Broun DM. Logarithmic Upturn in Low-Temperature Electronic Transport as a Signature of d-Wave Order in Cuprate Superconductors. Phys Rev Lett 2018; 121:267004. [PMID: 30636125 DOI: 10.1103/physrevlett.121.267004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 09/13/2018] [Indexed: 06/09/2023]
Abstract
In cuprate superconductors, high magnetic fields have been used extensively to suppress superconductivity and expose the underlying normal state. Early measurements revealed insulatinglike behavior in underdoped material versus temperature T, in which resistivity increases on cooling with a puzzling log(1/T) form. We instead use microwave measurements of flux-flow resistivity in YBa_{2}Cu_{3}O_{6+y} and Tl_{2}Ba_{2}CuO_{6+δ} to study charge transport deep inside the superconducting phase, in the low-temperature and low-field regime. Here, the transition from metallic low-temperature resistivity (dρ/dT>0) to a log(1/T) upturn persists throughout the superconducting doping range, including a regime at high carrier dopings in which the field-revealed normal-state resistivity is Fermi-liquid-like. The log(1/T) form is thus likely a signature of d-wave superconducting order, and the field-revealed normal state's log(1/T) resistivity may indicate the free-flux-flow regime of a phase-disordered d-wave superconductor.
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Affiliation(s)
- Xiaoqing Zhou
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
- Department of Physics, University of Colorado, Boulder, Colorado 80309-0390, USA
| | - D C Peets
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
- State Key Laboratory of Surface Physics, Department of Physics, and Advanced Materials Laboratory, Fudan University, Shanghai 200438, People's Republic of China
| | - Benjamin Morgan
- Cavendish Laboratory, Madingley Road, Cambridge CB3 0HE, United Kingdom
| | - W A Huttema
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - N C Murphy
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - E Thewalt
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - C J S Truncik
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - P J Turner
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - A J Koenig
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - J R Waldram
- Cavendish Laboratory, Madingley Road, Cambridge CB3 0HE, United Kingdom
| | - A Hosseini
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - Ruixing Liang
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
- Canadian Institute for Advanced Research, Toronto, Ontario MG5 1Z8, Canada
| | - D A Bonn
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
- Canadian Institute for Advanced Research, Toronto, Ontario MG5 1Z8, Canada
| | - W N Hardy
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
- Canadian Institute for Advanced Research, Toronto, Ontario MG5 1Z8, Canada
| | - D M Broun
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
- Canadian Institute for Advanced Research, Toronto, Ontario MG5 1Z8, Canada
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7
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Dubois AEJ, Turner PJ, Hourihane J, Ballmer-Weber B, Beyer K, Chan CH, Gowland MH, O'Hagan S, Regent L, Remington B, Schnadt S, Stroheker T, Crevel RWR. How does dose impact on the severity of food-induced allergic reactions, and can this improve risk assessment for allergenic foods?: Report from an ILSI Europe Food Allergy Task Force Expert Group and Workshop. Allergy 2018; 73:1383-1392. [PMID: 29331070 PMCID: PMC6032860 DOI: 10.1111/all.13405] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
Abstract
Quantitative risk assessment (QRA) for food allergens has made considerable progress in recent years, yet acceptability of its outcomes remains stymied because of the limited extent to which it has been possible to incorporate severity as a variable. Reaction severity, particularly following accidental exposure, depends on multiple factors, related to the allergen, the host and any treatments, which might be administered. Some of these factors are plausibly still unknown. Quantitative risk assessment shows that limiting exposure through control of dose reduces the rates of reactions in allergic populations, but its impact on the relative frequency of severe reactions at different doses is unclear. Food challenge studies suggest that the relationship between dose of allergenic food and reaction severity is complex even under relatively controlled conditions. Because of these complexities, epidemiological studies provide very limited insight into this aspect of the dose-response relationship. Emerging data from single-dose challenges suggest that graded food challenges may overestimate the rate of severe reactions. It may be necessary to generate new data (such as those from single-dose challenges) to reliably identify the effect of dose on severity for use in QRA. Success will reduce uncertainty in the susceptible population and improve consumer choice.
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Affiliation(s)
- A. E. J. Dubois
- University Medical Centre Groningen; Groningen The Netherlands
| | | | | | | | - K. Beyer
- Charité Universitätsmedizin Berlin; Berlin Germany
| | | | | | | | - L. Regent
- Anaphylaxis Campaign; Farnborough UK
| | - B. Remington
- The Netherlands Organisation for Applied Scientific Research (TNO); Zeist The Netherlands
| | - S. Schnadt
- German Allergy and Asthma Association (DAAB); Mönchengladbach DE
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8
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Patel N, Vazquez-Ortiz M, Lindsley S, Campbell DE, Turner PJ. Low frequency of soya allergy in peanut-allergic children: Relevance to allergen labelling on medicines. Allergy 2018; 73:1348-1350. [PMID: 29575021 DOI: 10.1111/all.13442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- N Patel
- Section of Paediatrics, Imperial College London, London, UK
| | | | - S Lindsley
- Section of Paediatrics, Imperial College London, London, UK
| | - D E Campbell
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
| | - P J Turner
- Section of Paediatrics, Imperial College London, London, UK
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
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9
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Korošec P, Gibbs BF, Rijavec M, Custovic A, Turner PJ. Cover Image. Clin Exp Allergy 2018. [DOI: 10.1111/cea.13152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Abstract
IgE‐mediated allergic reactions involve the activation of effector cells, predominantly through the high‐affinity IgE receptor (FcεRI) on mast cells and basophils. Although the mast cell is considered the major effector cell during acute allergic reactions, more recent studies indicate a potentially important and specific role for basophils and their migration which occurs rapidly upon allergen challenge in humans undergoing anaphylaxis. We review the evidence for a role of basophils in contributing to clinical symptoms of anaphylaxis and discuss the possibility that basophil trafficking during anaphylaxis might be a pathogenic (to target organs) or protective (preventing degranulation in circulation) response. Finally, we examine the potential role of basophils in asthma exacerbations. Understanding the factors that regulate basophil trafficking and activation might lead to new diagnostic and therapeutic strategies in anaphylaxis and asthma.
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Affiliation(s)
- P Korošec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - B F Gibbs
- Department of Dermatology and Allergology, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - M Rijavec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - A Custovic
- Section of Paediatrics and MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - P J Turner
- Section of Paediatrics and MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
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11
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Remington BC, Westerhout J, Campbell DE, Turner PJ. Minimal impact of extensive heating of hen's egg and cow's milk in a food matrix on threshold dose-distribution curves. Allergy 2017; 72:1816-1819. [PMID: 28474471 PMCID: PMC5655912 DOI: 10.1111/all.13198] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 11/28/2022]
Abstract
We analyzed reaction threshold data from 352 children undergoing open food challenges to hen's egg or cow's milk, either fresh or extensively heated into a muffin. There was no significant shift in dose-distribution curves due to the baking process, implying that existing threshold data for these allergens can be applied to allergen risk management, even when these allergens are heat-processed into baked foods.
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Affiliation(s)
| | | | - D. E. Campbell
- Department of Allergy & Immunology Children's Hospital at Westmead Sydney Australia
- Discipline of Child and Adolescent Health University of Sydney Sydney Australia
| | - P. J. Turner
- Discipline of Child and Adolescent Health University of Sydney Sydney Australia
- Section of Paediatrics (Allergy and Infectious Diseases) & MRC and Asthma UK Centre in Allergic Mechanisms of Asthma Imperial College London London UK
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12
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Affiliation(s)
- P. J. Turner
- Section of Paediatrics (Allergy and Infectious Diseases) & MRC and Asthma UK Centre in Allergic Mechanisms of Asthma; Imperial College London; London UK
- Discipline of Child and Adolescent Health; Sydney Medical School; University of Sydney; Australia
| | - B. K. Wainstein
- Department of Immunology and Infectious Diseases; Sydney Children's Hospital; Sydney NSW Australia
- School of Women's and Children's Health; University of New South Wales; Sydney NSW Australia
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13
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Affiliation(s)
- P. J. Turner
- Section of Paediatrics (Allergy and Infectious Diseases) & MRC and Asthma UK Centre in Allergic Mechanisms of Asthma; Imperial College London; London UK
- University of Sydney; Sydney NSW Australia
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14
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Turner PJ, Baumert JL, Beyer K, Boyle RJ, Chan CH, Clark AT, Crevel RWR, DunnGalvin A, Fernández-Rivas M, Gowland MH, Grabenhenrich L, Hardy S, Houben GF, O'B Hourihane J, Muraro A, Poulsen LK, Pyrz K, Remington BC, Schnadt S, van Ree R, Venter C, Worm M, Mills ENC, Roberts G, Ballmer-Weber BK. Can we identify patients at risk of life-threatening allergic reactions to food? Allergy 2016; 71:1241-55. [PMID: 27138061 DOI: 10.1111/all.12924] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 12/31/2022]
Abstract
Anaphylaxis has been defined as a 'severe, life-threatening generalized or systemic hypersensitivity reaction'. However, data indicate that the vast majority of food-triggered anaphylactic reactions are not life-threatening. Nonetheless, severe life-threatening reactions do occur and are unpredictable. We discuss the concepts surrounding perceptions of severe, life-threatening allergic reactions to food by different stakeholders, with particular reference to the inclusion of clinical severity as a factor in allergy and allergen risk management. We review the evidence regarding factors that might be used to identify those at most risk of severe allergic reactions to food, and the consequences of misinformation in this regard. For example, a significant proportion of food-allergic children also have asthma, yet almost none will experience a fatal food-allergic reaction; asthma is not, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergen exposure and symptom severity is unclear. While dose appears to be a risk factor in at least a subgroup of patients, studies report that individuals with prior anaphylaxis do not have a lower eliciting dose than those reporting previous mild reactions. It is therefore important to consider severity and sensitivity as separate factors, as a highly sensitive individual will not necessarily experience severe symptoms during an allergic reaction. We identify the knowledge gaps that need to be addressed to improve our ability to better identify those most at risk of severe food-induced allergic reactions.
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Affiliation(s)
- P. J. Turner
- Section of Paediatrics (Allergy and Infectious Diseases) & MRC and Asthma UK Centre in Allergic Mechanisms of Asthma; Imperial College London; London UK
| | - J. L. Baumert
- Food Allergy Research and Resource Program; Department of Food Science and Technology; University of Nebraska; Lincoln NE USA
| | - K. Beyer
- Department of Pediatric Pneumology and Immunology; Charité Universitätsmedizin; Berlin Germany
| | - R. J. Boyle
- Section of Paediatrics (Allergy and Infectious Diseases) & MRC and Asthma UK Centre in Allergic Mechanisms of Asthma; Imperial College London; London UK
| | | | - A. T. Clark
- Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - R. W. R. Crevel
- Safety and Environmental Assurance Centre; Unilever; Colworth Science Park; Sharnbrook Bedford UK
| | - A. DunnGalvin
- Applied Psychology and Paediatrics and Child Health; University College Cork; Cork Ireland
| | | | | | - L. Grabenhenrich
- Institute for Social Medicine; Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. Hardy
- Food Standards Agency; London UK
| | | | - J. O'B Hourihane
- Paediatrics and Child Health; University College Cork; Cork Ireland
| | - A. Muraro
- Department of Paediatrics; Centre for Food Allergy Diagnosis and Treatment; University of Padua; Veneto Italy
| | - L. K. Poulsen
- Allergy Clinic; Copenhagen University Hospital at Gentofte; Copenhagen Denmark
| | - K. Pyrz
- Applied Psychology and Paediatrics and Child Health; University College Cork; Cork Ireland
| | | | - S. Schnadt
- German Allergy and Asthma Association (Deutscher Allergie- und Asthmabund (DAAB)); Mönchengladbach Germany
| | - R. van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - C. Venter
- School of Health Sciences and Social Work; University of Portsmouth; Portsmouth UK
- The David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
| | - M. Worm
- Allergy-Center Charité; Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - E. N. C. Mills
- Institute of Inflammation and Repair; Manchester Academic Health Science Centre; Manchester Institute of Biotechnology; The University of Manchester; Manchester UK
| | - G. Roberts
- The David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
- NIHR Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust and Human Development and Health Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
| | - B. K. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital; University Zürich; Zürich Switzerland
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15
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Umasunthar T, Leonardi-Bee J, Turner PJ, Hodes M, Gore C, Warner JO, Boyle RJ. Incidence of food anaphylaxis in people with food allergy: a systematic review and meta-analysis. Clin Exp Allergy 2016; 45:1621-36. [PMID: 25495886 DOI: 10.1111/cea.12477] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 08/04/2014] [Accepted: 10/15/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Food allergy is a common cause of anaphylaxis, but the incidence of anaphylaxis in food allergic people is unknown. METHODS We undertook a systematic review and meta-analysis, using the inverse variance method. Two authors selected studies by consensus, independently extracted data and assessed study quality using the Newcastle-Ottawa assessment scale. We searched Medline, Embase, PsychInfo, CINAHL, Web of Science, LILACS and AMED between January 1946 and September 2012 and recent conference abstracts. We included registries, databases or cohort studies which described the number of food anaphylaxis cases in a defined population and time period and applied an assumed population prevalence of food allergy. RESULTS We included data from 34 studies. There was high heterogeneity between study results, possibly due to variation in study populations, anaphylaxis definition and data collection methods. In food allergic people, medically coded food anaphylaxis had an incidence rate of 0.14 per 100 person-years (95% CI 0.05, 0.35; range 0.01, 1.28). In sensitivity analysis using different estimated food allergy prevalence, the incidence varied from 0.11 to 0.21 per 100 person-years. At age 0-19, the incidence rate for anaphylaxis in food allergic people was 0.20 (95% CI 0.09, 0.43; range 0.01, 2.55; sensitivity analysis 0.08, 0.39). At age 0-4, an incidence rate of up to 7.00 per 100 person-years has been reported. In food allergic people, hospital admission due to food anaphylaxis had an incidence rate of 0.09 (95% CI 0.01, 0.67; range 0.02, 0.81) per 1000 person-years; 0.20 (95% CI 0.10, 0.43; range 0.04, 2.25) at age 0-19 and 0.50 (0.26, 0.93; range 0.08, 2.82) at age 0-4. CONCLUSION In food allergic people, the incidence of food allergic reactions which are coded as anaphylaxis by healthcare systems is low at all ages, but appears to be highest in young children.
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Affiliation(s)
- T Umasunthar
- Department of Paediatrics, Imperial College, London, UK.,Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - J Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - P J Turner
- Department of Paediatrics, Imperial College, London, UK.,Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - M Hodes
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.,Centre for Mental Health, Imperial College, London, UK
| | - C Gore
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - J O Warner
- Department of Paediatrics, Imperial College, London, UK.,Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - R J Boyle
- Department of Paediatrics, Imperial College, London, UK.,Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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Ullah R, Turner PJ, Khambay BS. Accuracy of three-dimensional soft tissue predictions in orthognathic surgery after Le Fort I advancement osteotomies. Br J Oral Maxillofac Surg 2016; 53:153-7. [PMID: 25432431 DOI: 10.1016/j.bjoms.2014.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 11/01/2014] [Indexed: 11/17/2022]
Abstract
Prediction of postoperative facial appearance after orthognathic surgery can be used for communication, managing patients' expectations,avoiding postoperative dissatisfaction and exploring different treatment options. We have assessed the accuracy of 3dMD Vultus in predicting the final 3-dimensional soft tissue facial morphology after Le Fort I advancement osteotomy. We retrospectively studied 13 patients who were treated with a Le Fort I advancement osteotomy alone. We used routine cone-beam computed tomographic (CT) images taken immediately before and a minimum of 6 months after operation, and 3dMD Vultus to virtually reposition the preoperative maxilla and mandible in their post operative positions to generate a prediction of what the soft tissue would look like. Segmented anatomical areas of the predicted mesh were then compared with the actual soft tissue. The means of the absolute distance between the 90th percentile of the mesh points for each region were calculated, and a one-sample Student's t test was used to calculate if the difference differed significantly from 3 mm.The differences in the mean absolute distances between the actual soft tissue and the prediction were significantly below 3 mm for all segmented anatomical areas (p < 0.001), and ranged from 0.65 mm (chin) to 1.17 mm (upper lip). 3dMD Vultus produces clinically satisfactory 3-dimensional facial soft tissue predictions after Le Fort I advancement osteotomy. The mass-spring model for prediction seems to be able to predict the position of the lip and chin, but its ability to predict nasal and paranasal areas could be improved.
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Brough HA, Turner PJ, Wright T, Fox AT, Taylor SL, Warner JO, Lack G. Dietary management of peanut and tree nut allergy: what exactly should patients avoid? Clin Exp Allergy 2016; 45:859-871. [PMID: 25443673 DOI: 10.1111/cea.12466] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Peanut and tree nut allergies are the commonest cause of life-threatening food-allergic reactions and significantly affect quality of life in children and their families. Dietary nut avoidance and provision of emergency medication is currently the mainstay of treatment. Nut avoidance has consequences on both quality of life and nutrition. We review the terminology that may cause confusion and lead to unnecessary dietary restrictions. In peanut or tree nut-allergic children, introduction of specific nuts to which the child is not allergic may improve quality of life and should be considered in patients with multiple foods allergies, vegan or ethnic-specific diets, in whom nuts are an important source of protein. Nut-allergic consumers do not just need to avoid foods containing nuts as an ingredient, but also contend with pre-packed foods which frequently have precautionary allergen labelling (PAL) referring to possible nut contamination. Although the published rate of peanut contamination in 'snack' foods with PAL (see Box ) ranges from 0.9-32.4%, peanut contamination in non-snack items with PAL is far less common. We propose that in some peanut-allergic patients (depending on history of reactivity to trace levels of peanut, reaction severity, other medical conditions, willingness to always carry adrenaline, etc.), consideration may be given to allow the consumption of non-snack foods containing PAL following discussion with the patient's (and their family's) specialist. More work is needed to provide consumers with clearer information on the risk of potential nut contamination in pre-packed food. We also draw attention to the change in legislation in December 2014 that require mandatory disclosure of allergens in non-pre-packed foods.
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Affiliation(s)
- H A Brough
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Division of Asthma, Allergy and Lung Biology & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - P J Turner
- Section of Paediatrics (Allergy & Immunology) & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust / NIHR Biomedical Research Unit.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - T Wright
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - A T Fox
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Division of Asthma, Allergy and Lung Biology & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - S L Taylor
- Food Allergy Research & Resource Program, Department of Food Science & Technology, University of Nebraska, Lincoln, NE, USA
| | - J O Warner
- Section of Paediatrics (Allergy & Immunology) & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust / NIHR Biomedical Research Unit
| | - G Lack
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Division of Asthma, Allergy and Lung Biology & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
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Affiliation(s)
- P J Turner
- Section of Paediatrics (Allergy and Infectious Diseases) and MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK; Division of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
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Umasunthar T, Procktor A, Hodes M, Smith JG, Gore C, Cox HE, Marrs T, Hanna H, Phillips K, Pinto C, Turner PJ, Warner JO, Boyle RJ. Patients' ability to treat anaphylaxis using adrenaline autoinjectors: a randomized controlled trial. Allergy 2015; 70:855-63. [PMID: 25850463 PMCID: PMC4654245 DOI: 10.1111/all.12628] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2015] [Indexed: 11/28/2022]
Abstract
Background Previous work has shown patients commonly misuse adrenaline autoinjectors (AAI). It is unclear whether this is due to inadequate training, or poor device design. We undertook a prospective randomized controlled trial to evaluate ability to administer adrenaline using different AAI devices. Methods We allocated mothers of food‐allergic children prescribed an AAI for the first time to Anapen or EpiPen using a computer‐generated randomization list, with optimal training according to manufacturer's instructions. After one year, participants were randomly allocated a new device (EpiPen, Anapen, new EpiPen, JEXT or Auvi‐Q), without device‐specific training. We assessed ability to deliver adrenaline using their AAI in a simulated anaphylaxis scenario six weeks and one year after initial training, and following device switch. Primary outcome was successful adrenaline administration at six weeks, assessed by an independent expert. Secondary outcomes were success at one year, success after switching device, and adverse events. Results We randomized 158 participants. At six weeks, 30 of 71 (42%) participants allocated to Anapen and 31 of 73 (43%) participants allocated to EpiPen were successful – RR 1.00 (95% CI 0.68–1.46). Success rates at one year were also similar, but digital injection was more common at one year with EpiPen (8/59, 14%) than Anapen (0/51, 0%, P = 0.007). When switched to a new device without specific training, success rates were higher with Auvi‐Q (26/28, 93%) than other devices (39/80, 49%; P < 0.001). Conclusions AAI device design is a major determinant of successful adrenaline administration. Success rates were low with several devices, but were high using the audio‐prompt device Auvi‐Q.
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Affiliation(s)
- T. Umasunthar
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - A. Procktor
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - M. Hodes
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
- Academic Unit of Child and Adolescent Psychiatry Imperial College LondonLondon UK
| | - J. G. Smith
- Population Health Research Institute St. George's, University of LondonLondon UK
| | - C. Gore
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - H. E. Cox
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - T. Marrs
- Department of Paediatric Allergy Division of Asthma, Allergy and Lung Biology King's College London London UK
| | - H. Hanna
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - K. Phillips
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - C. Pinto
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - P. J. Turner
- Section of Paediatrics Imperial College LondonLondon UK
| | - J. O. Warner
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
| | - R. J. Boyle
- Section of Paediatrics Imperial College LondonLondon UK
- Imperial College Healthcare NHS Trust St. Mary's HospitalLondon UK
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Turner PJ, Kumar K, Fox AT. Skin testing with raw egg does not predict tolerance to baked egg in egg-allergic children. Pediatr Allergy Immunol 2014; 25:657-61. [PMID: 25298203 DOI: 10.1111/pai.12291] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most children with egg allergy tolerate egg in baked foods, such as cake, but tolerance cannot be predicted with conventional allergy testing. We hypothesized that the skin prick test (SPT) wheal to unprocessed raw egg might predict tolerance of baked egg at formal oral food challenge (OFC). METHODS We conducted a retrospective chart review to assess the utility of SPT wheal to egg extract (EE), raw egg (RE), and the ratio of EE:RE in predicting outcome of baked-egg OFC in children presenting to our tertiary referral centers with a physician diagnosis of egg allergy and following complete egg avoidance in their diet, between 2009 and 2013. OFC were performed following a standardized protocol using baked egg in cake, to a total dose equivalent to 3g egg protein. RESULTS Data were analyzed from 186 completed challenges: OFC was positive in 64 (34%) children and negative in 122 (66%). Six children experienced anaphylaxis at OFC. Children tolerant to baked egg were more likely to have a lower SPT to egg extract/raw egg and EE:RE (median 0.56) than their allergic counterparts (0.70, p < 0.05). However, ROC curve analysis demonstrated poor predictivity of challenge outcome, with AUC for SPT to egg extract, raw egg and EE:ER equal to 0.71, 0.63 and 0.60, respectively. CONCLUSION EE:RE was not helpful in predicting outcome of baked-egg OFC. Indeed, SPT to egg extract was slightly better at predicting outcome than either SPT to raw egg or EE:RE. Unfortunately, tolerance to baked egg can only be predicted from previous history or through controlled exposure.
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Affiliation(s)
- P J Turner
- Section of Paediatrics and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
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Umasunthar T, Leonardi-Bee J, Hodes M, Turner PJ, Gore C, Habibi P, Warner JO, Boyle RJ. Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis. Clin Exp Allergy 2014; 43:1333-41. [PMID: 24118190 PMCID: PMC4165304 DOI: 10.1111/cea.12211] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/24/2013] [Indexed: 01/12/2023]
Abstract
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.
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Affiliation(s)
- T Umasunthar
- Department of Paediatrics, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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22
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Tan JWL, Campbell DE, Turner PJ, Kakakios A, Wong M, Mehr S, Joshi P. Baked egg food challenges - clinical utility of skin test to baked egg and ovomucoid in children with egg allergy. Clin Exp Allergy 2014; 43:1189-95. [PMID: 24074337 DOI: 10.1111/cea.12153] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 05/07/2013] [Accepted: 06/02/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many children with IgE-mediated egg allergy can tolerate products containing extensively heated (baked) egg. Aside from food challenge, there are no tests which reliably predict tolerance to baked egg in egg-allergic individuals. OBJECTIVES To determine if skin prick test (SPT) to baked egg (muffin) and ovomucoid can predict the outcome of baked egg challenges in egg allergic patients. METHODS In this prospective study, children with a recent history of immediate allergic reactions to egg [and corroborative positive SPT or serum-specific IgE (ssIgE) to egg] or those with SPT/ssIgE > 95% PPV for egg allergy were invited to undergo an open standardized baked egg (muffin) challenge. SPT to egg white, ovomucoid, and fresh muffin were performed immediately prior to challenge. RESULTS One hundred and forty-three egg allergic children underwent baked egg challenge and of these, 90 (63%) tolerated 1 g of egg protein in a baked muffin. Of the 53 positive challenges, eight (15%) had respiratory and/or cardiovascular symptoms. The median SPT diameters in positive challenges compared with negative challenges were baked muffin - 6.0 mm/4.0 mm and ovomucoid 7.5 mm/5.0 mm respectively. Receiver operating characteristic (ROC) curves were generated for SPT to baked egg and ovomucoid. The area under the curve was 0.68 for baked egg, and 0.67 for ovomucoid. A muffin SPT of < 2 mm had a negative predictive value of 88% and an ovomucoid SPT ≥ 11 mm had a positive predictive value of 100%. CONCLUSIONS AND CLINICAL RELEVANCE A SPT of < 2 mm to muffin had a high negative predictive value to baked egg challenge. Ovomucoid SPT ≥ 11 mm was very likely to predict a reaction to baked egg. In these children, deferring the challenge would be appropriate.
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Affiliation(s)
- J W-L Tan
- Children's Hospital at Westmead, Sydney, Australia; University of Sydney, Sydney, Australia
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Abstract
This commentary will discuss the use of the "stroke window" settings in the evaluation of CT head examinations and advocate their more widespread use in patients who present with neurological symptoms in addition to patients with suspected stroke. We present examples of the use of stroke windows, which revealed subtle abnormalities that were not readily apparent on default brain window settings and were subsequently confirmed on MRI or follow-up CT. As a result we suggest that stroke windows should be routine in the review of all CT head examinations.
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Affiliation(s)
- P J Turner
- Radiology Department, The Mid Yorkshire Hospitals NHS Trust, Pinderfields General Hospital, Wakefield, UK.
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Gervai J, Turner PJ, Hinde RA. Parents' and teachers' perceptions of personality traits of young children: Sex differences1, cross-cultural comparisons and relations with observed behaviour. British Journal of Developmental Psychology 2011. [DOI: 10.1111/j.2044-835x.1993.tb00608.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Turner PJ, Gervai J, Hinde RA. Gender-typing1 in young children: Preferences, behaviour and cultural differences. British Journal of Developmental Psychology 2011. [DOI: 10.1111/j.2044-835x.1993.tb00607.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Matthews R, Turner PJ, McDonald NJ, Ermolaev K, Manus T, Shelby RA, Steindorf M. Real time workload classification from an ambulatory wireless EEG system using hybrid EEG electrodes. Annu Int Conf IEEE Eng Med Biol Soc 2009; 2008:5871-5. [PMID: 19164053 DOI: 10.1109/iembs.2008.4650550] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper describes a compact, lightweight and ultra-low power ambulatory wireless EEG system based upon QUASAR's innovative noninvasive bioelectric sensor technologies. The sensors operate through hair without skin preparation or conductive gels. Mechanical isolation built into the harness permits the recording of high quality EEG data during ambulation. Advanced algorithms developed for this system permit real time classification of workload during subject motion. Measurements made using the EEG system during ambulation are presented, including results for real time classification of subject workload.
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Constantinides J, Chhabra P, Turner PJ, Richard B. A Comparison of Shepard's Osteotome versus Trapdoor Flap Technique to Harvest Iliac Crest Bone for Secondary Alveolar Bone Grafting. Cleft Palate Craniofac J 2008; 45:347-52. [DOI: 10.1597/06-235.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To compare the postoperative donor site morbidity and alveolar bone graft results following two different techniques for iliac crest bone graft harvest: a closed (Shepard's osteotome) and an open (trapdoor flap) technique. Design: A retrospective review of two cohorts of alveolar bone grafts performed from 1998 to 2004 in Birmingham Children's Hospital by two surgeons using different harvest techniques. Medical and nursing anesthetic notes and medication charts were reviewed. Alveolar bone graft results were assessed using preoperative and postoperative radiographic studies. Patients: A total of 137 patients underwent an operation. Of these, 109 patients were compatible with the inclusion criteria (data available, first operation, no multiple comorbidities). Sixty-four patients had iliac bone harvested using the open trapdoor technique, while 45 had the same procedure using the closed osteotomy technique. Results: Maximum bone graft volumes harvested were similar with both techniques. The mean length of hospital stay was 50.9 hours for the osteotome and 75.5 hours for the open technique group (p < .0001). The postoperative analgesia requirement was higher and the postoperative mobilization was delayed and more difficult for the open technique patients (p < .0005). Kindelan scores performed by two independent orthodontists were similar for both techniques. Conclusion: The findings demonstrate that harvesting bone from the iliac crest using an osteotome technique reduces time in hospital, analgesia requirements, and postoperative donor site morbidity with no detrimental outcome.
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Affiliation(s)
| | - P. Chhabra
- Birmingham Dental Hospital, Birmingham, UK
| | | | - B. Richard
- Dr. Richard is Consultant in Plastic Surgery, Birmingham Children's Hospital, Birmingham, UK
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Broun DM, Huttema WA, Turner PJ, Ozcan S, Morgan B, Liang R, Hardy WN, Bonn DA. Superfluid density in a highly underdoped YBa_{2}Cu_{3}O_{6+y} superconductor. Phys Rev Lett 2007; 99:237003. [PMID: 18233402 DOI: 10.1103/physrevlett.99.237003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2007] [Indexed: 05/25/2023]
Abstract
The superfluid density rho_{s}(T) identical with1/lambda;{2}(T) has been measured at 2.64 GHz in highly underdoped YBa_{2}Cu_{3}O_{6+y}, at 37 dopings with T_{c} between 3 and 17 K. Within limits set by the transition width DeltaT_{c} approximately 0.4 K, rho_{s}(T) shows no evidence of critical fluctuations as T-->T_{c}, with a mean-field-like transition and no indication of vortex unbinding. Instead, we propose that rho_{s} displays the behavior expected for a quantum phase transition in the (3+1)-dimensional XY universality class, with rho_{s0} proportional, variant(p-p_{c}), T_{c} proportional, variant(p-p_{c});{1/2}, and rho_{s}(T) proportional, variant(T_{c}-T);{1} as T-->T_{c}.
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Affiliation(s)
- D M Broun
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada V5A 1S6
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Broun DM, Turner PJ, Huttema WA, Özcan S, Morgan B, Liang R, Hardy WN, Bonn DA. In-Plane Superfluid Density of Highly Underdoped YBa2Cu3O6+x. ACTA ACUST UNITED AC 2006. [DOI: 10.1063/1.2354775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Hansma PK, Fantner GE, Kindt JH, Thurner PJ, Schitter G, Turner PJ, Udwin SF, Finch MM. Sacrificial bonds in the interfibrillar matrix of bone. J Musculoskelet Neuronal Interact 2005; 5:313-5. [PMID: 16340118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- P K Hansma
- Department of Physics, University of California, Santa Barbara, Santa Barbara, CA 93106, USA.
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Abstract
We report 12 cases of transient osteoporosis in 10 patients. The presenting symptoms, diagnostic investigations and management are considered here as well as a discussion on the aetiology and the pathology. Arthroscopic surgery was carried out in some of the patients to exclude intraarticular pathology. Resolution of symptoms occurred in all patients within 6 months and the MRI findings returned to normal.
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Affiliation(s)
- G Vardi
- Droitwich Knee Clinic, St Andrews Road, Droitwich Spa, Worcestershire WR9 8YX, UK.
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Wookey A, Turner PJ, Greenhalgh JM, Eastwood M, Clarke J, Sefton C. AZD2563, a novel oxazolidinone: definition of antibacterial spectrum, assessment of bactericidal potential and the impact of miscellaneous factors on activity in vitro. Clin Microbiol Infect 2004; 10:247-54. [PMID: 15008947 DOI: 10.1111/j.1198-743x.2004.00770.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AZD2563, a new oxazolidinone targeted at Gram-positive bacteria, was evaluated and compared with linezolid and other agents against 802 aerobic bacterial isolates for spectrum of activity, bactericidal activity, and the effect of miscellaneous factors upon activity in vitro. At a concentration of 2 mg/L, AZD2563 inhibited 98% of all Gram-positive bacteria tested (100% at 4 mg/L), including susceptible and resistant isolates of Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp., Streptococcus pneumoniae, other Streptococcus spp. and Corynebacterium spp. Conversely, all Enterobacteriaceae and non-fermenting Gram-negative bacteria had MICs > 128 mg/L, and only a few Haemophilus or Moraxella spp. had MICs < 8 mg/L. By conventional laboratory definition, AZD2563 and linezolid were bacteriostatic against staphylococci and enterococci, with variable bactericidal activity against Strep. pneumoniae. The in-vitro activity of AZD2563 was essentially unaffected by altering pH, inoculum size, the type of testing medium, or the inclusion of human serum up to 25% v/v.
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Affiliation(s)
- A Wookey
- Antibiotic Development and Technical Support Group, AstraZeneca, Alderley Park, Macclesfield, Cheshire, UK
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Turner PJ, Harris R, Kamal S, Hayden ME, Broun DM, Morgan DC, Hosseini A, Dosanjh P, Mullins GK, Preston JS, Liang R, Bonn DA, Hardy WN. Observation of weak-limit quasiparticle scattering via broadband microwave spectroscopy of a d-wave superconductor. Phys Rev Lett 2003; 90:237005. [PMID: 12857284 DOI: 10.1103/physrevlett.90.237005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2002] [Indexed: 05/24/2023]
Abstract
There has long been a discrepancy between microwave conductivity measurements in high temperature superconductors and the conductivity spectrum expected in the simplest models for impurity scattering in a d-wave superconductor. Here we present a new type of broadband measurement of microwave surface resistance that finally shows some of the spectral features expected for a d(x2-y2) pairing state. Cusp-shaped conductivity spectra, consistent with weak impurity scattering of nodal quasiparticles, were obtained in the 0.6-21 GHz frequency range in highly ordered crystals of YBa2Cu3O6.50 and YBa2Cu3O6.99.
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Affiliation(s)
- P J Turner
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada V6T 1Z1
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Abstract
In vitro susceptibilities to meropenem and comparators of Acinetobacter strains isolated from serious infections in 37 European hospital centers participating in the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program (1997-2000) were tested. There were 635 Acinetobacter strains collected: 490 A. baumannii; 51 A. calcoaceticus var. lwoffii; and 94 other Acinetobacter strains. Overall, meropenem and imipenem were the most effective agents tested. Resistance to the antimicrobials was: 14%, meropenem; 16%, imipenem; 39%, piperacillin-tazobactam; 41%, tobramycin; 45%, ceftazidime; and 53%, ciprofloxacin. Thus, the carbapenems have useful activity against Acinetobacter spp. and represent a viable choice for treating infections caused by these organisms.
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Affiliation(s)
- P J Turner
- Antibiotic Development and Technical Support Group, AstraZeneca, Alderley House, Alderley Park, Macclesfield, Cheshire, SK10 4TF, UK.
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Mutnick AH, Turner PJ, Jones RN. Emerging antimicrobial resistances among Proteus mirabilis in Europe: report from the MYSTIC Program (1997-2001). Meropenem Yearly Susceptibility Test Information Collection. J Chemother 2002; 14:253-8. [PMID: 12120879 DOI: 10.1179/joc.2002.14.3.253] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Resistance patterns that are currently problematic in Europe can vary greatly within the same species over time, among various patient populations and among geographic regions on the same continent. The results from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program, which monitors carbapenem resistance rates in institutions using meropenem, were used to determine resistance differences among Proteus mirabilis. MIC results from 688 P. mirabilis strains were classified into 4 patient care groups: ICU (n=426), neutropenia patients (NP; n=145), general wards (n=97) and cystic fibrosis patients (CF; n=20). A total of 40 centers from 12 European countries have participated since 1997, divided into 3 geographic regions (East, North, South). All testing was performed by NCCLS reference methods and interpretive criteria, including screening of extended-spectrum beta-lactamase (ESBL) phenotypes. Over the monitored interval the resistance rates varied for each agent without a clear trend toward a greater rate. Rank order of susceptibility was: meropenem (99%) > piperacillin/tazobactam (TAZ; 96%) > cefepime (95%) > ceftazidime (CAZ; 94%) > imipenem (IPM; 92%). Ciprofloxacin (CIP) was the least active agent tested (MIC90 4 microg/ml; 86% susceptible). Unexpectedly, 3.6% of P. mirabilis were imipenem-resistant (MIC, > or = 16 microg/ml). Greater rates of resistance were found for strains from NP and CF patients, and from eastern or southern European sites, usually associated with epidemic clusters. Generally susceptible species such as P. mirabilis have recently emerged as therapeutic problems in European medical centers following mutations that compromise CIP, CAZ and aminoglycoside use. Imipenem also showed decreased susceptibility of greater than 7% compared to less than 1% for meropenem. Continued surveillance by the MYSTIC Program appears to be a prudent practice to focus effective empiric treatment regimens.
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Affiliation(s)
- A H Mutnick
- The JONES Group/JMI Laboratories, North Liberty, Iowa 52317, USA.
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Turner PJ, Cartwright P, Southon MJ, Oostrom AV, Manley BW. Use of a channelled image intensifier in the field-ion microscope. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0022-3735/2/8/332] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program is a longitudinal global antimicrobial surveillance study that compares the activity of meropenem and comparator antimicrobial agents against pathogens isolated from intensive care, neutropenic or cystic fibrosis patients, and general wards. Data from the different European MYSTIC Program units (1997-2000) showed that the most prevalent isolates tested overall were methicillin-susceptible Staphylococcus aureus (MSSA; in accordance with study design methicillin-resistant S. aureus was not tested), Pseudomonas aeruginosa and Escherichia coli. In all the unit types, E. coli (approximately 20% having an extended spectrum beta-lactamase phenotype) and MSSA were highly susceptible to meropenem (97-99% susceptibility). Isolates of MSSA showed lower levels of susceptibility to ciprofloxacin (61-77% susceptibility) in both cystic fibrosis and neutropenia patients, and particularly high levels of resistance to ceftazidime (38% susceptibility) in cystic fibrosis units. Ciprofloxacin (54% susceptibility) and gentamicin (46% susceptibility) demonstrated low levels of activity against P. aeruginosa (frequently encountered in cystic fibrosis units). Meropenem and piperacillin/tazobactam were the most active agents against P. aeruginosa in all the unit types. Carbapenems and piperacillin/tazobactam have sustained > 90% susceptibility rates overall against the most frequently isolated pathogens. The analysis of specific units that house patients with a high-risk of contracting antimicrobial-resistant pathogens remains very important for the optimal selection of empiric regimens.
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Affiliation(s)
- C Mendes
- Laboratório Fleury, São Paulo, Brazil
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Abstract
This article discusses the use of speech recognition software by means of reviewing two leading packages. Both programs require considerable training before they can be used effectively, but are then able to convert continuous speech into text with varying degrees of success.
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Turner PJ, Weerakone S. Internet service providers: choosing the right one. Dent Update 2001; 28:404-10. [PMID: 11764614 DOI: 10.12968/denu.2001.28.8.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In order to access the Internet it is necessary to open an account with an Internet Service Provider. This article describes the typical services provided by these companies so that the new subscriber will be in a better position to make an informed choice.
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Turner PJ, Weerakone S. What, when and how to back up your data. Dent Update 2001; 28:351-6, 358. [PMID: 11575249 DOI: 10.12968/denu.2001.28.7.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article defines and describes the process of backing up data files, which should be undertaken by anyone who routinely uses a computer. The important points to be considered when developing a backup strategy are explained and a résumé given of the backup devices currently available.
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Abstract
OBJECTIVE A method of cephalometric analysis is described in which cephalometric x-rays were scanned using a flat-bed scanner and transparency hood. Then the image was displayed on a computer monitor for point identification and subsequent cephalometric analysis using dedicated software. The reproducibility of point identification using this method was compared with two other, commonly used, methods. MATERIAL AND METHODS The study material comprised 25 lateral skull x-rays taken as part of routine orthodontic assessment. Repeat cephalometric point identification was carried out on each x-ray using 3 methods: 1. On-screen digitization of the scanned bitmap image (Screenceph method). 2. Tracing followed by digitization of the identified points and 3. Direct digitization. RESULTS For the 8 angular and 4 linear cephalometric measurements examined the Screenceph method compared favourably with the two conventional methods. The median difference between methods was 0.5 degrees and 0.2 mm. Using constructed Cartesian axes to examine the x, y discrepancy between repeat measurements and comparing Screenceph to tracing followed by digitization, there were significant differences in 3 instances at the 5% level and 2 instances at the 1% level. These differences represented median scores of 0.14 to 0.32 mm greater for Screenceph. Comparing Screenceph to direct digitization 15 significant differences out of the 28 measurements were noted: six at the 5% level and 9 at the 1% level. The actual difference in median scores ranged from 0.2 mm to 0.53 mm. CONCLUSION The results demonstrated that Screenceph is sufficiently accurate to use in a clinical setting but is not yet sufficiently exact for use in research projects owing to hardware limitations.
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Affiliation(s)
- P J Turner
- Department of Orthodontics, Warwick Hospital, Lakin Road, Warwick, CV34 5BW, UK
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Zehr JP, Waterbury JB, Turner PJ, Montoya JP, Omoregie E, Steward GF, Hansen A, Karl DM. Unicellular cyanobacteria fix N2 in the subtropical North Pacific Ocean. Nature 2001; 412:635-8. [PMID: 11493920 DOI: 10.1038/35088063] [Citation(s) in RCA: 536] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fixed nitrogen (N) often limits the growth of organisms in terrestrial and aquatic biomes, and N availability has been important in controlling the CO2 balance of modern and ancient oceans. The fixation of atmospheric dinitrogen gas (N2) to ammonia is catalysed by nitrogenase and provides a fixed N for N-limited environments. The filamentous cyanobacterium Trichodesmium has been assumed to be the predominant oceanic N2-fixing microorganism since the discovery of N2 fixation in Trichodesmium in 1961 (ref. 6). Attention has recently focused on oceanic N2 fixation because nitrogen availability is generally limiting in many oceans, and attempts to constrain the global atmosphere-ocean fluxes of CO2 are based on basin-scale N balances. Biogeochemical studies and models have suggested that total N2-fixation rates may be substantially greater than previously believed but cannot be reconciled with observed Trichodesmium abundances. It is curious that there are so few known N2-fixing microorganisms in oligotrophic oceans when it is clearly ecologically advantageous. Here we show that there are unicellular cyanobacteria in the open ocean that are expressing nitrogenase, and are abundant enough to potentially have a significant role in N dynamics.
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Affiliation(s)
- J P Zehr
- Department of Ocean Sciences and Institute of Marine Sciences, University of California, Santa Cruz, California 95064, USA.
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Turner PJ, Maggs JRL, Foreman JC. Induction by inhibitors of nitric oxide synthase of hyperresponsiveness in the human nasal airway. Br J Pharmacol 2000; 131:363-9. [PMID: 10991932 PMCID: PMC1572316 DOI: 10.1038/sj.bjp.0703561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2000] [Accepted: 06/26/2000] [Indexed: 11/09/2022] Open
Abstract
1. The effects of inhibitors of nitric oxide synthase (NOS) on the responsiveness of the human nasal airway were investigated, by measuring the nasal response to histamine and bradykinin. 2. Repeated intranasal administration of N(G)-nitro-L-arginine methyl ester (L-NAME) or N(G)-monomethyl-L-arginine (L-NMMA), 1 micromol per nostril every 30 min for 6 h, increased the nasal obstruction induced by histamine, 50 - 500 microg, and bradykinin, 200 microg per nostril. A single administration of L-NAME, 1 micromol per nostril did not induce hyperresponsiveness to histamine. 3. Pretreatment with L-arginine, 30 micromol, abolished the hyperresponsiveness to histamine caused by L-NAME, 1 micromol. Pretreatment with N(G)-nitro-D-arginine methyl ester (D-NAME), 1 micromol, did not induce hyperresponsiveness to histamine. 4. Repeated administration of L-NAME, 1 micromol, caused a significant reduction in the amount of nitric oxide measured in the nasal cavity. 5. Neither L-NMMA, 1 micromol, nor L-arginine, 30 micromol, altered the nasal hyperresponsiveness induced by platelet activating factor (PAF), 60 microg. PAF did not alter the levels of nitric oxide in the nasal cavity. 6. The results suggest that inhibition of nitric oxide synthase induces a hyperresponsiveness in the human nasal airway, and that this occurs by a mechanism different from that involved in PAF-induced hyperresponsiveness.
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Affiliation(s)
- P J Turner
- Department of Pharmacology, University College London, Gower Street, London WC1E 6BT
| | - J R L Maggs
- Department of Pharmacology, University College London, Gower Street, London WC1E 6BT
| | - J C Foreman
- Department of Pharmacology, University College London, Gower Street, London WC1E 6BT
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Turner PJ. MYSTIC (Meropenem Yearly Susceptibility Test Information Collection): a global overview. J Antimicrob Chemother 2000; 46 Suppl T2:9-23. [PMID: 11065145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) is a global, multicentre surveillance study that compares the activity of meropenem in centres that are prescribers with that of imipenem, ceftazidime, piperacillin/tazobactam, ciprofloxacin and gentamicin. Of the 46 centres (intensive care units, cystic fibrosis units, neutropenia units and general wards) contributing to this study, 29 were in Europe, 14 in the Americas and three in the Middle East and Asia. The results for the most common isolates obtained in the first year of the study from these three regions show that meropenem has a broad spectrum of activity and potency in these centres, with 89% of the 6890 strains tested having an MIC < or = 4 mg/L. The overall susceptibility was lower for the comparator antibiotics. There was evidence in all regions of strains producing beta-lactamases and other resistance mechanisms against the other beta-lactams tested, fluoroquinolones and aminoglycosides. Future years' results from this surveillance study will show whether meropenem will continue to exhibit such activity.
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Affiliation(s)
- P J Turner
- Antibiotic Development and Technical Support Group, AstraZeneca, Macclesfield, Cheshire, UK.
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