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Anaphylaxis is an acute systemic and potentially fatal allergic reaction. We evaluated trends in yearly rates of anaphylaxis in a pediatric Emergency Department (ED) in Montreal, Canada. A prospective and retrospective recruitment process was used to find families of children who had presented with anaphylaxis at the Montreal Children's Hospital between April 2011 and April 2021. Using a uniform recruitment form, data were collected. Anaphylaxis patterns were compared to clinical triggers using descriptive analysis. Among 830,382 ED visits during the study period, 2726 (26% recruited prospectively) presented with anaphylaxis. The median age was 6 years (IQR: 0.2, 12.00), and 58.7% were males. The relative frequency of anaphylaxis cases doubled between 2011–2015, from 0.22% (95% CI, 0.19, 0.26) to 0.42 March 2020, the total absolute number of anaphylaxis cases and relative frequency declined by 24 cases per month (p < 0.05) and by 0.5% of ED visits (p < 0.05). The rate of anaphylaxis has changed over the years, representing modifications in food introduction strategies or lifestyle changes. The decrease in the frequency of anaphylaxis presenting to the ED during the COVID pandemic may reflect decreased accidental exposures with reduced social gatherings, closed school, and reluctance to present to ED. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is characterized by autoantibody expression and aberrant autoreactive B cells contribute to disease progression; therefore, B cell inhibition has been an attractive target for novel therapies. However, after more than two decades of research and over 40 randomized clinical trials, only one such therapy, belimumab, has been approved for use in SLE. In this review, we discuss the evidence for B cell-targeted therapies in SLE and lupus nephritis. Belimumab has been successful in several large clinical trials and is approved in several countries for use in SLE and lupus nephritis. Despite a lack of supporting phase III evidence, rituximab is used off-label in SLE. Several other B cell-targeted therapies have failed to meet their end points in late-stage clinical trials. Successful phase II trials have recently been reported for obinutuzumab and telitacicept with larger confirmatory trials currently underway. Refinements in pharmaceutical mechanisms of action, trial design, and patient selection have resulted in recent preliminary successes, offering renewed optimism for B-cell targeted therapeutics in SLE management. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is an autoimmune disorder that affects almost every organ system and it is treated with immunomodulation and immunosuppression. SLE patients have an intrinsically dysfunctional immune system which is exacerbated by disease activity and leaves them vulnerable to infection. Treatment with immunosuppression increases susceptibility to infection, while hydroxychloroquine use decreases this risk. Infectious diseases are a leading cause of hospitalization and death. This narrative review provides an overview of recent epidemiology and predictors of infections in SLE, delineates the risk of infection by therapeutic agent, and provides suggestions for risk mitigation. Articles were selected from Pubmed searches conducted between September 2019 and January 2020. Despite the large burden of infection, effective and safe preventative care such as universal hydroxychloroquine use and vaccination are underutilized. Future efforts should be directed to quality improvement, glucocorticoid reduction, and validation of risk indices that identify patients at the highest risk of infection. [ABSTRACT FROM AUTHOR]

Introduction: Systemic lupus erythematosus (SLE)-related thrombocytopenia during pregnancy and the postpartum period have been associated with adverse pregnancy outcomes and perinatal complications. In this case report, we present two SLE patients with thrombocytopenia emergencies secondary to HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome and thrombotic thrombocytopenic purpura (TTP). Areas covered: The first case involved a 26-year-old woman, G1P0 at 26 weeks gestation (GA), with high-titer antiphospholipid antibodies (aPL) (positive lupus anticoagulant, anti-beta 2 glycoprotein-1 (aβ2GP1), anti-cardiolipin) and non-criteria aPL to phosphatidylserine/prothrombin complex and anti-domain 1 β2GP1. This case highlights the risks associated with aPL in pregnancy, considers management issues relating to anticoagulation during pregnancy and highlights the importance of maintaining a high index of suspicion for diagnosis of HELLP in SLE patients. The second case was a 36-year-old female, G3P2 at 32 weeks GA, with class III lupus nephritis (LN) who developed severe pre-eclampsia, which included mild thrombocytopenia. This case illustrates the challenges in identifying and differentiating between three pregnancy emergencies that can be seen in SLE patients (pre-eclampsia, LN, and TTP) and presents the management of TTP in peripartum SLE. Expert opinion: These two cases remind us of the importance of timely diagnosis and management of thrombocytopenia in this population. [ABSTRACT FROM AUTHOR]

Introduction: Numerous studies have clearly demonstrated that there is an altered cancer risk profile in patients with systemic lupus erythematous (SLE) versus the general population. This includes a higher risk of certain cancers (e.g. hematologic, lung) and a decreased risk of others (e.g. breast cancer). Several determinants could be behind this altered risk; these include immunosuppressant drugs, viral exposures, genetic factors, and other variables. Area covered: We review what is known regarding specific risk profiles and risk factors for some key cancers in SLE, including hematologic malignancies and lung cancers. In light of this, we examine current guidelines and practices regarding cancer screening, and propose ways that patients and physicians might help manage cancer risk in SLE. Expert commentary: Despite significant progress over the past decade, not many risk factors have been precisely identified. A better understanding of the elements that drive malignancy risk in systemic autoimmune rheumatic diseases may permit the further development of guidelines (regarding. cancer screening) for SLE patients. Abbreviations: AbTG: Anti-thyroglobulin antibodies; AbTPO: Anti-peroxydase antibodies; AML: Acute myeloid leukemia; APRIL: A proliferating-inducing ligand; BAFF: B-cell activating factor; CAPA: Canadian Arthritis Patient Alliance; CI: Confidence interval; CIN: Cervical intraepithelial neoplasia; CT: Computed tomography; DLBCL: Diffuse large B cell lymphoma; dsDNA: Double-stranded DNA; EBV: Epstein-Barr virus; EULAR European League Against Rheumatism; IBD: Inflammatory bowel disease; HBV: Hepatitis B virus; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus; HR: Hazard ratio; HSIL: High-grade cervical squamous intraepithelial lesions; HSV: Herpes simplex virus; HL: Hodgkin lymphoma; HPV: Human papillomavirus; MALT: Mucosa-associated lymphoid tissue; MDS: Myelodysplastic syndrome; MESNA: 2-mercaptoethane sodium sulfonate; NHL: Non-Hodgkin lymphoma; OR: Odds ratio; Pap: Papanicolaou; RA: Rheumatoid arthritis; SLE: Systemic Lupus erythematous; SLICC: Systemic International Collaborating Clinics; SNPs: Single-nucleotide polymorphisms; SOGC: Society of Obstetricians and Gynaecologists of Canada. [ABSTRACT FROM AUTHOR]

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with systemic manifestations and multiorgan involvement. Although primarily diagnosed, and managed in the outpatient setting, it can occasionally present with life-threatening complications that require rapid assessment and urgent aggressive therapy. Areas covered: In our review, we explore three organ systems that are often affected in SLE, but have the potential to present as medical emergencies; these are the kidney, the central nervous system, and the hematologic system. We take a case-based approach to each clinical scenario, with information given sequentially in order to reflect “real-life” situations where management decisions need to be made with limited information. We review the acute management, pathophysiology, diagnostic approach, and treatment along with a review of the literature, for lupus nephritis presenting as rapidly progressive glomerulonephritis, acute lupus transverse myelitis, and refractory antiphospholipid syndrome. Expert commentary: At the conclusion of each section, we provide an expert commentary regarding each issue, relating to diagnosis, early management, and current evidence behind treatment recommendations. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore experiences and coping strategies of low-income families affected by food allergies. Of particular interest were experiences of allergy-related stigma within the context of poverty stigma. A secondary objective was to offer suggestions for refining a conceptual model of disease stigma. In-depth interviews with 23 individuals (10 key informants and 13 low-income adults affected by food allergies in southwestern Ontario, Canada) were conducted in 2012–2013. Participants reported feeling forced to adopt income-related stigmatized behaviors to obtain food and perceived difficulty in obtaining medication. Participants adopted cognitive distancing strategies to separate themselves from other low-income families affected by food allergies. Key informants frequently perceived low-income allergic individuals to be less vigilant than higher income individuals and attributed higher rates of allergy among higher income individuals to fewer unhygienic exposures and infections in early childhood. Both low-income participants and key informants perceived that inadequate education was a barrier to allergy management: key informants perceived a lack of education as an individual-level failure, while low-income participants perceived the lack of education as a system-level failure. Our findings revealed intersections between allergy stigma and poverty stigma. Results can be used to suggest additions to a conceptual model of disease stigma. Differing perspectives between key informants and low-income individuals have implications for strategies to improve access to education, safe food, and medication for low-income families affected by food allergies. [ABSTRACT FROM PUBLISHER]

The aim is to investigate how stakeholders can participate in the early phases of construction projects and how relevant insights can be gathered from stakeholders with very different backgrounds and interests. To gain these insights, it is important to understand how a space can be created to facilitate communication between professionals and stakeholders. The research draws on the literature of design and user-driven innovation in order to get a richer understanding of stakeholders’ involvement in construction. The method applied is research based on three stakeholder workshops, interviews and observations from a single case study. The findings provide valuable information on six aspects of who the stakeholders are in construction, what these stakeholders can do in construction when involved, how to involve these stakeholders in a construction project, how a space can be staged and facilitated for the meeting of stakeholders, and what kind of information can be collected from the stakeholders to influence the development process. The findings show how creating and facilitating a workshop as a socio-technical space across boundaries can overcome barriers and improve stakeholders’ involvement and thus provide better insights into their needs, values and concerns. [ABSTRACT FROM PUBLISHER]

Several contributions to understanding the emotional aspects of everyday lives have been made by geographers. What we undertake in this research is to focus that lens on the emotional context of experiences ofchildren at riskand in particular on anaphylactic risk-scapes, particularly within the school environment. This research attempts to go beyond the policy response by privileging the voices of the affected children (and their parents) in order to understand the emotionality of their risk experience; how it is articulated and negotiated in place, and how bodily boundaries are interrupted. Qualitative methods were used to explore children's perceptions of, and experiences with, anaphylactic allergy in the school environment. In-depth interviews were conducted with 10 children (aged 8–12 years) and 10 adolescents (aged 13–17 years) and their parents. Children were also asked to draw a picture of ‘what it was like to live with a severe food allergy’ and to then explain their illustration. Results revealed how the spaces of children at risk of anaphylaxis were interrupted; social spaces were interrupted through their bodily experiences of risk as they negotiated in and through school environments. These findings suggest allergic children contest school and policy constructions of ‘safe place’ through the interrupted spaces and bodily disruptions of emotion. [ABSTRACT FROM PUBLISHER]

Food allergies are emerging health risks in much of the Western world, and some evidence suggests prevalence is increasing. Despite lacking scientific consensus around prevalence and management, policies and regulations are being implemented in public spaces (e.g., schools). These policies have been criticized as extreme in the literature, in the media, and by the non-allergic population. Backlash appears to be resulting from different perceptions of risk between different groups. This article uses a recently assembled national dataset (n = 3,666) to explore how Canadians perceive the risks of food allergy. Analyses revealed that almost 20% self-report having an allergic person in the household, while the average respondent estimated the prevalence of food allergies in Canada to be 30%. Both of these measures overestimate the true clinically defined prevalence (7.5%), indicating an inflated public understanding of the risks of food allergies. Seventy percent reported food allergies to be substantial risks to the Canadian population. Multivariate logistic regression models revealed important determinants of risk perception including demographic, experience-based, attitudinal, and regional predictors. Results are discussed in terms of understanding emerging health risks in the post-industrial era, and implications for both policy and risk communication. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is a complex, multisystem disease that is characterized by variable and unpredictable manifestations that are often life-threatening. Although the prognosis has improved dramatically over the past 50 years, individuals with SLE still experience considerable morbidity and undue mortality. Furthermore, since SLE affects a predominantly young population at a critical time in their lives when they are establishing careers and starting families, the economic burden to society can be immense. Only three medications have ever received US FDA approval for use in the treatment of SLE and none have received FDA approval for over 25 years. Currently used therapies may have improved the prognosis but often have undesirable side effects, such as infertility, bone-marrow suppression and infection. Recent advances in our understanding of the disease pathogenesis, coupled with progress in drug development, have led to new therapeutic strategies that will potentially offer an improved side-effect profile and improved efficacy, but will almost certainly be much more expensive than current treatments. [ABSTRACT FROM AUTHOR]

This paper reports the results of the excavation of an Early Bronze Age cist cemetery on the mid-Northumberland coast of Howick. The Bronze age site was discovered during the investigation of a Mesolithic hut site, the latter having been published separately as a monograph. A total of five cist were found with the only being adult-sized, the rest presumably for infants. Due to the acidic conditions on the site, only a few fragments of a small skull were found in Cist 2. Other small finds included a small sherd of Food Vessel urn in an area of disturbance next to Cist 5, smoothed limestone cobbles and some nodules of yellow ochre. Flints were found in most of the feature fills, but these are considered to be residual as they are directly comparable to the narrow blade materials found within the Mesolithic hut and its environs. The sitting of early Bronze Age cist burial in coastal locations is thought to reflect contemporary settlement in the coastal margin and its hinterland. With no Bronze Age dwelling site known from this area, these cemeteries have an added significance as they provide indirect evidence for Bronze Age settlement on the North-East coastal plain. [ABSTRACT FROM AUTHOR]

Assessing the British Library's contribution to the national economy is a complex matter, requiring consideration of a number of different dimensions. First, the value added by the Library takes many forms--economic, cultural, social and intellectual. Second, the British Library adds value both to those who use our products and services directly, and to the wider UK population who benefit indirectly from the Library's existence and the services it provides. Traditionally, attempts to assess these benefits have taken the form of qualitative case studies--telling good stories, but failing to provide a comprehensive evaluation. But now a technique supported by the Nobel Prize winning economists, Kenneth Arrow and Robert Solow, permits a coherent quantitative evaluation of the total benefit to the nation of publicly funded institutions and programmes. Recognising the value of this technique, the British Library commissioned a groundbreaking research study to estimate the impact of the Library on the UK economy. The study demonstrates that the Library generates value of around 44 times the level of its annual public funding of £83m. To the best of our knowledge, this study represents the first time the `Contingent Valuation' technique has been used to derive a figure for the overall economic impact of a national or major research library. [ABSTRACT FROM AUTHOR]

To argue that anything as complex as human behaviour has multifactorial origins demanding a systems analysis is today almost a statement of the obvious. This does not, however, mean that a search for significant main effects in populations is unwarranted, provided that these can be shown in replicated studies across place and time. In this article two such effects will be examined. In both cases there is a massive amount of data available, much of it recent, and some of it based on sophisticated research designs. [ABSTRACT FROM PUBLISHER]

Two groups of eight Junior High School pupils listened to a tape‐recorded prose passage. Interspersed questions designed to direct attention to either the factual content (Surface Level) or arguments and principles (Deep Level) resulted in superior retention by the DL group on tests combining both types of question administered immediately and three days later. [ABSTRACT FROM PUBLISHER]

Analyzes the contribution of psychology to educational theory. Research on a range of educational problems within a developing conceptual context; Process model of development concerned to account for cognitive changes from infancy to adult life; Disparities in educational attainment across social classes and ethnic groups in terms of genetically determined differences in intelligence quotient.