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Plain language summary Comprehensive biomarker testing is a crucial requirement for the optimal treatment of advanced‐stage non–small cell lung cancer (NSCLC), with emerging relevance in the adjuvant treatment setting. To advance its goal of ensuring optimal therapy for persons diagnosed with lung cancer, the American Cancer Society National Lung Cancer Roundtable (ACS NLCRT) held The Summit on Optimizing Lung Cancer Biomarkers in Practice in September 2020 to align its partners toward the goal of ensuring comprehensive biomarker testing for all eligible patients with NSCLC. The ACS NLCRT's Strategic Plan for Advancing Comprehensive Biomarker Testing in NSCLC, a product of the summit, comprises actions to promote comprehensive biomarker testing for all eligible patients. The approach is multifaceted, including policy‐level advocacy and the development and dissemination of targeted educational materials, clinical decision tools, and guides to patients, physicians, and payers aimed at ameliorating barriers to testing experienced by each of these groups. The ACS NLCRT works to improve care for patients with lung cancer. The ACS NLCRT supports comprehensive biomarker testing as essential to determine treatment options for all eligible patients with non–small cell lung cancer. Many factors lead to some patients not receiving optimal biomarker testing. The ACS NLCRT held a collaborative summit and developed a strategic plan to achieve and promote comprehensive biomarker testing for all patients. These plans include developing educational materials and physician tools and advocating for national policies in support of biomarker testing. The ACS NLCRT works to improve care for patients with lung cancer.The ACS NLCRT supports comprehensive biomarker testing as essential to determine treatment options for all eligible patients with non–small cell lung cancer.Many factors lead to some patients not receiving optimal biomarker testing.The ACS NLCRT held a collaborative summit and developed a strategic plan to achieve and promote comprehensive biomarker testing for all patients.These plans include developing educational materials and physician tools and advocating for national policies in support of biomarker testing. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to estimate the population size and annual recruitment of Shortnose Sturgeon Accipenser brevirostrum in the Altamaha River estuary in Georgia, United States, during an 11‐year period. The Shortnose Sturgeon is an endangered fish species that occupies rivers on the east coast of North America. Previous studies have suggested that the Altamaha River supports the largest population of Shortnose Sturgeon in the southern United States; however, the status of the population has not been assessed in 11 years. Methods: We used entanglement gears to capture Shortnose Sturgeon in the Altamaha River estuary, marked them, and used an established statistical method (closed‐population capture–mark–recapture models) to annually estimate total population size and age‐1 recruitment from 2012 to 2022. Result: We were able to estimate the size of age‐1 cohorts in 7 of the 11 years of data collection. Point estimates of annual age‐1 recruitment varied between 113 and 1021 individuals, and total population size varied between 452 (95% confidence interval [CI]: 116–2277) and 5054 individuals (95% CI: 2155–13,267). Conclusion: Recruitment of age‐1 juveniles was variable, suggesting that reproduction success is inconsistent between years in the Altamaha River. The results of this study, in combination with previous work, do not show any clear trends in Altamaha River Shortnose Sturgeon population abundance or recruitment. The population seems to be stable, but in the absence of historical population numbers, it is unclear whether the population should be considered recovered or is stagnated in its recovery. Impact statementEleven years of data indicate that the Altamaha River population of Shortnose Sturgeon appears stable but reproduction is not successful every year. In the absence of historical data, it is unclear whether the population is recovered or stagnated in its recovery. [ABSTRACT FROM AUTHOR]

Background: Anaphylaxis is a sudden multisystem allergic reaction which may result in a fatal outcome if not treated promptly. Guidelines worldwide suggest intramuscular adrenaline as the first‐line treatment for anaphylaxis outside a perioperative reaction. Adrenaline autoinjectors (AAIs) are widely used self‐administrable devices, especially in community settings. Different commercial AAIs have been authorized to be marketed in Europe. For an AAI to be efficacious, a rapid adrenaline delivery in patients, including those who are overweight or obese, resulting in an optimal cardiovascular (CV) response, is a key feature. AAIs are designed to achieve this requirement, which is reflected in their differing functional properties such as primary container selection, drug delivery mechanism (cartridge‐or syringe‐based), needle length, needle gauge, and adrenaline dose (150 μg, 300 μg, or 500 μg). However, the differences in functional properties across these devices may play a critical role in achieving these requirements as well as the differences in ergonomics in the handling of these devices. The purpose of this review: Considering the dynamic pharmacokinetic/pharmacodynamic (PK/PD) profiles of different AAIs marketed in Europe and their effect on adrenaline delivery, the expert panel, also serving as author for this paper have carried out a detailed analysis of the PK/PD profiles of four AAIs, namely, Anapen, Emerade, EpiPen, and Jext, to delineate the adrenaline delivery and their subsequent physiological effects on the backdrop of device characteristics, dose strength, and the skin‐to‐muscle distances of the participants. [ABSTRACT FROM AUTHOR]

Advances in biomarker‐driven therapies for patients with nonsmall cell lung cancer (NSCLC) both provide opportunities to improve the treatment (and thus outcomes) for patients and pose new challenges for equitable care delivery. Over the last decade, the continuing development of new biomarker‐driven therapies and evolving indications for their use have intensified the importance of interdisciplinary communication and coordination for patients with or suspected to have lung cancer. Multidisciplinary teams are challenged with completing comprehensive and timely biomarker testing and navigating the constantly evolving evidence base for a complex and time‐sensitive disease. This guide provides context for the current state of comprehensive biomarker testing for NSCLC, reviews how biomarker testing integrates within the diagnostic continuum for patients, and illustrates best practices and common pitfalls that influence the success and timeliness of biomarker testing using a series of case scenarios. [ABSTRACT FROM AUTHOR]

Attention‐deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that often presents with abnormal time perception and increased impulsive choice behavior. The spontaneously hypertensive rat (SHR) is the most widely used preclinical model of the ADHD‐Combined and ADHD‐Hyperactive/Impulsive subtypes of the disorder. However, when testing the spontaneously hypertensive rat from Charles River (SHR/NCrl) on timing and impulsive choice tasks, the appropriate control strain is not clear, and it is possible that one of the possible control strains, the Wistar Kyoto from Charles River (WKY/NCrl), is an appropriate model for ADHD‐Predominately Inattentive. Our goals were to test the SHR/NCrl, WKY/NCrl, and Wistar (WI; the progenitor strain for the SHR/NCrl and WKY/NCrl) strains on time perception and impulsive choice tasks to assess the validity of SHR/NCrl and WKY/NCrl as models of ADHD, and the validity of the WI strain as a control. We also sought to assess impulsive choice behavior in humans diagnosed with the three subtypes of ADHD and compare them with our findings from the preclinical models. We found SHR/NCrl rats timed faster and were more impulsive than WKY/NCrl and WI rats, and human participants diagnosed with ADHD were more impulsive compared to controls, but there were no differences between the three ADHD subtypes. [ABSTRACT FROM AUTHOR]

Background: Cow's milk allergy (CMA) is one of the most common food allergies world‐wide. The emergence of online CMA symptom questionnaires, aimed at parents and/or healthcare professionals (HCP), may raise awareness about the possible diagnosis of CMA, but also increases the risk for overdiagnosis leading to unnecessary dietary restriction impacting on growth and nutrition. This publication sets out to establish the availability of these CMA symptom questionnaires and critically assesses the development and validity. Methods: Thirteen HCP working in the field of CMA, from different countries, were recruited to participate. A combination of a Pubmed and CINAHL literature and online review using the Google search engine in English language was used. Symptoms in the questionnaires were assessed, using the European Academy for Allergy and Clinical Immunology guidelines for food allergy. Following the assessment of both the questionnaires and literature, the authors followed the modified Delphi approach to generate consensus statements. Results: Six hundred and fifty‐one publications were identified, of which 29 were suitable for inclusion, with 26 being associated with the Cow's Milk‐Related Symptoms Score. The online search yielded 10 available questionnaires: 7/10 were sponsored by formula milk companies and 7/10 were aimed at parents and three at HCP. Following the assessment of data, 19 statements were generated in two rounds of anonymous voting reaching 100% agreement. Conclusions: Online CMA questionnaires, available to parents and HCP's, are varied in symptoms, and most were not validated. The overarching consensus generated from authors is that these questionnaires should not be used without the involvement of HCP. [ABSTRACT FROM AUTHOR]

Objective: Gulf Sturgeon Acipenser oxyrinchus desotoi populations have undergone substantial declines since the start of the 20th century due to overfishing and habitat loss. A predicted increase in the frequency of major hurricanes, driven by climate change, presents an additional but poorly characterized threat to Gulf Sturgeon populations. In October 2018, category 5 Hurricane Michael made landfall 40 km west of the Apalachicola River, causing a hypoxic event and an ensuing fish kill that included Gulf Sturgeon. Methods: We used acoustic telemetry, mark–recapture, and side‐scan sonar data to examine migration behavior and estimate Gulf Sturgeon abundance, mortality, and annual recruitment in the system before and after the storm. Result: Within 2 days of landfall, we observed an early and rapid emigration response among tagged adults residing in lower portions of the river system, coinciding with declining dissolved oxygen levels; migration behavior returned to normal by the subsequent spring. The hurricane caused an acute mass mortality event: mortality of Gulf Sturgeon in October 2018 was four to five times greater than that in previous years. Several other independent metrics also indicate a major decline in Gulf Sturgeon abundance after the hurricane. Juvenile recruitment to age 1 after the storm was >5 of the previous 6 years, indicating the hurricane did not cause a year‐class failure. Conclusion: These findings suggest that major hurricanes can impact the structure and abundance of Gulf Sturgeon populations, yet elements of resiliency, including survival (facilitated by early emigration and refugia) and enhanced recruitment, may aid in population recovery following such disturbances. [ABSTRACT FROM AUTHOR]

Ultimately, we need to have high-quality, appropriate allergy education available to all those who need it so that gaps in knowledge can be filled, and patients with allergy can be safe, supported and cared for wherever they may be. Keywords: adult; anaphylaxis; asthma; atopic dermatitis; drug allergy; education; food allergy; HCP; healthcare; national strategy; paediatric; quality improvement; training; workforce EN adult anaphylaxis asthma atopic dermatitis drug allergy education food allergy HCP healthcare national strategy paediatric quality improvement training workforce 481 484 4 04/04/22 20220401 NES 220401 ADDRESSING GAPS IN PRACTICE If we are to meaningfully improve the lives of people who suffer from allergic disease, then significant action is required. Promoting and achieving excellence in the delivery of integrated allergy care: the European academy of allergy & clinical immunology competencies for allied health professionals working in allergy. [Extracted from the article]

Introduction: Food hypersensitivity (FHS), including food allergy, coeliac disease and food intolerance, is a major public health issue. The Food Standards Agency (FSA), an independent UK Government department working to protect public health and consumers' wider interests in food, sought to identify research priorities in the area of FHS. Methods: A priority setting exercise was undertaken, using a methodology adapted from the James Lind Alliance—the first such exercise with respect to food hypersensitivity. A UK‐wide public consultation was held to identify unanswered research questions. After excluding diagnostics, desensitization treatment and other questions which were out of scope for FSA or where FSA was already commissioning research, 15 indicative questions were identified and prioritized by a range of stakeholders, representing food businesses, patient groups, health care and academia, local authorities and the FSA. Results: 295 responses were received during the public consultation, which were categorized into 70 sub‐questions and used to define 15 key evidence uncertainties ('indicative questions') for prioritization. Using the JLA prioritization framework, this resulted in 10 priority uncertainties in evidence, from which 16 research questions were developed. These could be summarized under the following 5 themes: communication of allergens both within the food supply chain and then to the end consumer (ensuring trust in allergen communication); the impact of socio‐economic factors on consumers with FHS; drivers of severe reactions; mechanism(s) underlying loss of tolerance in FHS; and the risks posed by novel allergens/processing. Discussion: In this first research prioritization exercise for food allergy and FHS, key priorities identified to protect the food‐allergic public were strategies to help allergic consumers to make confident food choices, prevention of FHS and increasing understanding of socio‐economic impacts. Diagnosis and treatment of FHS was not considered in this prioritization. [ABSTRACT FROM AUTHOR]

Comprehensive biomarker testing for patients with non–small cell lung cancer is critical for selecting appropriate targeted therapy or immunotherapy. Ensuring timely ordering, processing, and reporting is key to optimizing patient outcomes. However, various factors can prevent or delay patients from being offered the option of treatment selection based on comprehensive biomarker testing. These factors include problems with access to testing, tissue adequacy, turnaround time, and health insurance coverage and billing practices. Turnaround time depends on several logistical and tissue handling factors, which involve institutional policies, processes, resources, testing methodology, and testing algorithms that vary across different practices. In this article, the authors identify key factors that prolong biomarker testing turnaround time, propose strategies to reduce it, and present a process map to aid physicians and key organizational stakeholders in improving testing efficiency. [ABSTRACT FROM AUTHOR]

The introduction of personalized medicine (PM) has been a milestone in the history of medical therapy, because it has revolutionized the previous approach of treating the disease with that of treating the patient. It is known today that diseases can occur in different genetic variants, making specific treatments of proven efficacy necessary for a given endotype. Allergic diseases are particularly suitable for PM, because they meet the therapeutic success requirements, including a known molecular mechanism of the disease, a diagnostic tool for such disease, and a treatment blocking the mechanism. The stakes of PM in allergic patients are molecular diagnostics, to detect specific IgE to single‐allergen molecules and to distinguish the causative molecules from those merely cross‐reactive, pursuit of patient's treatable traits addressing genetic, phenotypic, and psychosocial features, and omics, such as proteomics, epi‐genomics, metabolomics, and breathomics, to forecast patient's responsiveness to therapies, to detect biomarker and mediators, and to verify the disease control. This new approach has already improved the precision of allergy diagnosis and is likely to significantly increase, through the higher performance achieved with the personalized treatment, the effectiveness of allergen immunotherapy by enhancing its already known and unique characteristics of treatment that acts on the causes. [ABSTRACT FROM AUTHOR]

Basophil activation test, egusi seed, egusi seed allergy, food allergy, seed allergy Keywords: basophil activation test; egusi seed; egusi seed allergy; food allergy; seed allergy EN basophil activation test egusi seed egusi seed allergy food allergy seed allergy 1 3 3 01/05/22 20220101 NES 220101 The vast majority of food allergies in children are caused by few foods, namely cow's milk, egg, wheat, soya, peanut, tree nuts, fish, and shellfish.1 However, as a practicing allergist, one needs to have an open mind as allergy can be caused by virtually any food. [Extracted from the article]

The UK takes great pride for its National Health Service (NHS) which is free at the point of delivery and cares for a diverse multi-racial and multi-cultural society. In a study from a London clinic, UK, ethnic minorities were over-represented in terms of the number of children with food allergy, number of food allergies per child, presenting at an earlier age with food allergy, and possibly having a greater variety of food allergies compared with Caucasians. [Extracted from the article]

It has long been recognised that given the high prevalence and considerable impact of allergic disease globally, there needs to be a focus on appropriate training for clinical professionals. The health‐economic consequences of allergic disease are significant, with both direct healthcare costs (doctor, nurse and dietitian consultations, hospital admissions and prescribed medications) and indirect costs (lost school and work time, reduced productivity and over‐the‐counter medications). There is also a well‐recognised impairment of quality of life, with less tangible costs including anxiety, distress, discomfort, disability and, occasionally, death. To help to mitigate these effects, there is a need to upskill the professional workforce at all levels, and also to equip those trained with the skills to become future healthare professional trainers. Upskilling the workforce from the grass‐roots of undergraduate study in Medical, Nursing and Allied Health Professionals (AHP) through the entirety of training to senior consultant levels could have a major beneficial impact on the patient and their families, lead to a reduction in emergency use of clinical service, and help increase economic productivity. [ABSTRACT FROM AUTHOR]

Atlantic Sturgeon Acipenser oxyrinchus, a federally endangered anadromous fish, persist along the East Coast of North America. Despite two decades of federal protection, many populations have yet to fully recover and major knowledge gaps remain, especially in the southern portion of the species' range. The seasonal movement patterns of river‐resident juveniles (RRJs) are not well understood, and little is known about the transition from the RRJ life stage to the marine‐migratory juvenile (MMJ) life stage. During the summers of 2014–2016 we captured and acoustically tagged age‐1 RRJ Atlantic Sturgeon in the Ogeechee, Altamaha, and Satilla rivers, Georgia, to (1) describe and quantify seasonal movements of RRJ Atlantic Sturgeon in order to identify important estuarine nursery areas and (2) examined temporal patterns of out‐migration in order to better understand the critical transition from RRJ to MMJ in Georgia rivers. Movements of 79 fish were monitored using an array of stationary receivers deployed downstream from the heads of tide in each river system. During the summer months in each river, the fish congregated in upriver, freshwater reaches, but during the winter months they moved downriver and became more broadly distributed. Some fish (36.7%; n = 29) migrated back up their natal river in the spring and remained there as age‐2 RRJs. We observed the out‐migration of 30.4% (n = 24) of age‐2 MMJs only during December–March, based on detections outside their natal river. The results of this study support the assumption of the closure of age‐1 populations that underpins recent quantitative studies of Atlantic Sturgeon recruitment. [ABSTRACT FROM AUTHOR]

The rise in food allergy has been described as the "second wave" of the allergy epidemic, with some developed countries reporting a prevalence of 10% of challenge‐proven food allergies. Recognition of the Allergic March has played a crucial role in identifying causality in allergic conditions, linking atopic dermatitis to food allergy and food allergy to other atopic disorders, thereby highlighting opportunities in prevention and the importance of early intervention. This publication will establish the value of weaving the less well‐understood, non‐IgE‐mediated food allergy into the Allergic March and mapping its progression through childhood and its associated co‐morbidities. The proposed non‐IgE‐mediated Allergic March highlights the concomitant presentation of gastrointestinal symptoms and atopic dermatitis as early presenting symptoms in confirmed non‐IgE‐mediated allergies and the later development of atopic co‐morbidities, including asthma and allergic rhinitis, similar to the IgE‐mediated Allergic March. This publication highlights recent observations of a link between non‐IgE‐mediated food allergy in early childhood and functional gastrointestinal disorders in later life and also the reported occurrence of extra‐intestinal manifestations at later ages. Although significant limitations exist in regard to the proposed evolution of the Allergic March model, the authors hope that this publication will influence the management of non‐IgE‐mediated gastrointestinal allergies and inform future research and interventions. [ABSTRACT FROM AUTHOR]

Background: Cows 'milk protein allergy (CMPA) is the most common food allergy in infants in the United Kingdom. Infants with CMPA who are not exclusively breastfed require a substitute hypoallergenic formula, which are perceived as having a poor palatability. This study compares the palatability of different extensively hydrolysed formulas (EHFs) and explores healthcare professional (HCP) expectations of how palatability impacts infants and their families. Methods: Healthcare professional with experience of CMPA were recruited to take part in a home palatability test of four EHFs [Aptamil Pepti 1, Nutricia Ltd. (EHF W1); Althera, Nestle Health Science (EHF W2); Similac Alimentum, Abbott (EHF C1); Nutramigen LGG 1, Mead Johnson (EHF C2)] using a blind taste procedure. A randomised, complete block design was used to minimise order and carry‐over biases. Participants completed a questionnaire about the impact of formula palatability on infants and their families. Results: A total of 100 HCPs took part (51 dietitians and 49 general practitioners). Overall, whey‐based lactose‐containing EHFs were ranked the most palatable: EHF W1 by 77% of participants and EHF W2 by 20%. EHF W1 was liked significantly more (P < 0.0001) than the other formulas. The vast majority of participants agreed that better palatability would result in an increased chance of non‐rejection (96%), more content families (92%) and decreased healthcare costs (90%). Conclusion: Amongst HCPs who manage infants with CMPA, whey‐based lactose‐containing EHFs were ranked the most palatable. HCPs expected that good palatability would result in better acceptance, more content infants and families, alongside decreased wastage and healthcare costs. [ABSTRACT FROM AUTHOR]

Background: Peanut allergy is classically managed by food avoidance. Immunotherapy programs are available at some academic centers for selected patients reacting to small amounts of peanut during food challenge. We aimed to determine and compare reaction thresholds and prevalence of anaphylaxis during peanut oral challenges at multiple specialist allergy centers. Methods: A retrospective, international survey of anonymized case records from seven specialist pediatric allergy centers from the UK and Ireland, as well as the Australian HealthNuts study. Demographic information, allergy test results, reaction severity and threshold during open oral peanut challenges were collated and analyzed. Results: Of the 1634 children aged 1‐18 years old included, 525 (32%) failed their peanut challenge. Twenty‐eight percent reacted to 25 mg, while 38% only reacted after consuming 1 g or more of whole peanut. Anaphylaxis (55 [11%]) was 3 times more common in teenagers than younger children and the likelihood increased at all ages as children consuming more peanut at the challenge. Children who developed anaphylaxis to 25‐200 mg of whole peanut were significantly older. Previous history of reaction did not predict reaction threshold or severity. Conclusions: More than a third of the children in this large international cohort tolerated the equivalent of one peanut in an oral challenge. Anaphylaxis, particularly to small amounts of peanut, was more common in older children. Tailored immunotherapy programs might be considered not only for children with low, but also higher reaction thresholds. Whether these programs could prevent heightened sensitivity and anaphylaxis to peanut with age also deserves further study. [ABSTRACT FROM AUTHOR]

The article reports that the British Society for Allergy & Clinical Immunology (BSACI) has published guidance for healthcare professionals of Great Britain to prevent food allergy in higher risk infants. Also discussed are suggestions for introducing potential allergenic foods into the infant diet reducing food allergy risks and an accompanying information sheet for parents.

Allergic rhinitis is a very common disease of childhood, and its impact on quality of life is often underestimated. This article discusses the diagnosis of allergic rhinitis in children and the management options that can be tried, including allergen avoidance, pharmacological therapies and allergen immunotherapy. [ABSTRACT FROM AUTHOR]

Verbal rules or instructions often exert obvious and meaningful control over human behavior. Sometimes instructions benefit the individual by enabling faster acquisition of a skill or by obviating an aversive consequence. However, research has also suggested a clear disadvantage: 'insensitivity' to changing underlying contingencies. The two experiments described here investigated the variables that control initial rule-following behavior and rule-following insensitivity. When the initial rule was inaccurate, behavior was consistent with the rule for approximately half of participants and all participants' behavior was mostly insensitive to changing contingencies. When the initial rule was accurate, behavior of all participants was consistent with it and behavior for nearly all participants was insensitive to changes in underlying contingencies. These findings have implications for how best to establish and maintain rule-following behavior in applied settings when deviant behavior would be more reinforcing to the individual. [ABSTRACT FROM AUTHOR]

Cow's milk allergy (CMA) is one of the most common presentations of food allergy seen in early childhood. It is also one of the most complex food allergies, being implicated in IgE-mediated food allergy as well as diverse manifestations of non-IgE-mediated food allergy. For example, gastrointestinal CMA may present as food protein induced enteropathy, enterocolitis or proctocolitis. Concerns regarding the early and timely diagnosis of CMA have been highlighted over the years. In response to these, guideline papers from the United Kingdom (UK), Australia, Europe, the Americas and the World Allergy Organisation have been published. The UK guideline, 'Diagnosis and management of non-IgE-mediated cow's milk allergy in infancy-a UK primary care practical guide' was published in this journal in 2013. This Milk Allergy in Primary Care (MAP) guideline outlines in simple algorithmic form, both the varying presentations of cow's milk allergy and also focuses on the practical management of the most common presentation, namely mild-to-moderate non-IgE-mediated allergy. Based on the international uptake of the MAP guideline, it became clear that there was a need for practical guidance beyond the UK. Consequently, this paper presents an international interpretation of the MAP guideline to help practitioners in primary care settings around the world. It incorporates further published UK guidance, feedback from UK healthcare professionals and affected families and, importantly, also international guidance and expertise. [ABSTRACT FROM AUTHOR]

The authors discuss the findings of the first in-depth study into patient experiences in accessing paediatric allergy services in Great Britain. The study was based around two clinics in the West Midlands. The study authors assumed that many of the themes identified are generalizable across Great Britain. The findings seem to point to an openness by patients to consult a specialist nurse.

Behavior and events distributed in time can serve as markers that signal delays to future events. The majority of timing research has focused on how behavior changes as the time to some event, usually food availability, decreases. The primary objective of the two experiments presented here was to assess how behavior changes as time passes between two time markers when the first time marker was manipulated but the second, food delivery, was held constant. Pigeons were exposed to fixed-interval, response-initiated fixed-interval, and signaled response-initiated fixed-interval 15- and 30-s schedules of reinforcement. In Experiment 1, first-response latencies were systematically shorter in the signaled response-initiated schedules than response-initiated schedules, suggesting that the first response was a more effective time marker when it was signaled. In Experiment 2, responding in no-food (i.e. 'peak') trials indicated that timing accuracy was equivalent in the three schedule types. Compared to fixed interval schedules, timing precision was reduced in the signaled response-initiated schedules and was lowest in response-initiated schedules. Results from Experiments 1 and 2 coupled with previous research suggest that the overall 'informativeness' of a time marker relative to other events and behaviors in the environment may determine its efficacy. [ABSTRACT FROM AUTHOR]

Background The concept of a general practitioner with special interest (GPwSI) was first proposed in the 2000 National Health Service Plan, as a way of providing specialized treatment closer to the patient's home and reducing hospital waiting times. Given the patchy and inadequate provision of paediatric allergy services in the UK, the introduction of GPwSIs might reduce pressure on existing specialist services. Methods A total of 100 consecutive referrals to a specialist paediatric allergy clinic were reviewed to assess what proportion could be managed by a GPwSI allergy service with a predefined range of facilities and expertise (accurate diagnosis and management of allergy; skin prick testing; provision of allergen avoidance advice; ability to assess suitability for desensitization). Each referral was reviewed independently by three allergy specialists. Cases were initially judged on the referral letter and then, to determine whether appropriate triage decisions could be made prospectively, cases were re-assessed with information summarized in the clinic letter. The proportion of referrals suitable for a GPwSI was calculated and their characteristics identified. Results At least 42% and up to 75% were suitable for management by a GPwSI in allergy based on unanimous and majority agreement, respectively. The appropriateness of 79% referrals could be identified based on the information in the referral letter. A total of 19% referrals were unsuitable for a GPwSI service because of complex or multisystem disease, need for specialist knowledge or facilities or patient's young age. Conclusions At least two-fifths of paediatric allergy referrals to our hospital-based service could be dealt with in a GPwSI clinic, thereby diversifying the patient pathway, allowing specialist services to focus on complex cases and reducing waiting times for appointments. [ABSTRACT FROM AUTHOR]

Background There is limited information regarding the onset and sensitization patterns of pollen food syndrome ( PFS) in children. The aim was to explore this within children referred to a specialist allergy clinic at a London Tertiary Hospital. Methods A total of 54 patients with seasonal allergic rhinitis ( SAR) were enrolled in equal numbers in three age groups; 0-5, 6-10, 11-15 years. Families completed a questionnaire on rhinitis, food symptoms and quality of life. Children underwent skin prick testing ( SPT) to fresh fruits, nuts and a blood test for microarray analysis. Results Clinical diagnosis of PFS was made in 26/54 (48%), increasing with age (group 1 = 3 (17%), group 2 = 9 (50%), group 3 = 14 (78%) (p = 0.03)). Microarray demonstrates children aged 2.8 years sensitized to pan-allergens and 4.5 years symptomatic to pan-allergens. Peach, cherry, carrot and strawberry SPT had the highest sensitivity and NPV at 100%. The sensitivity of PR10 molecules on microarray was 92%, PPV 62% and NPV 87%. Microarray confirmed 69% of allergens on clinical history compared to 61% by SPT. Microarray and SPT had a 19% false-negative rate. The quality-of-life data showed moderate impact across all domains, and patients with PFS were significantly more likely to have increased anxiety over time spent preparing food (p = 0.029). Conclusions We demonstrate that SAR occurs in children from 1.4 years and PFS from 4.5 years with a changing pattern of pan-allergen sensitization. Microarray and SPT have moderate concordance in confirming allergens. PFS impacts negatively on quality of life and should be assessed in all paediatric allergy patients. [ABSTRACT FROM AUTHOR]

Background This study aimed to assess the efficacy of MP-AzeFlu (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in a single spray) in children with seasonal allergic rhinitis ( SAR) and explore the importance of child symptom severity assessment in paediatric allergic rhinitis ( AR) trials. Methods A total of 348 children (4-11 years) with moderate/severe SAR were randomized into a double-blind, placebo-controlled, 14-day, parallel-group trial. Efficacy was assessed by changes from baseline in reflective total nasal symptom score ( rTNSS), reflective total ocular symptom score ( rTOSS) and individual symptom scores over 14 days (children 6-11 years; n = 304), recorded by either children or caregivers. To determine whether a by-proxy effect existed, efficacy outcomes were assessed according to degree of child/caregiver rating. Moreover, total Paediatric Rhinitis Quality of Life Questionnaire ( PRQLQ) score was compared between the groups. Results A statistically superior, clinically relevant efficacy signal of MP-AzeFlu versus placebo was apparent for PRQLQ overall score (diff: −0.29, 95% CI −0.55, −0.03; p = 0.027), but not for rTNSS (diff: −0.80; 95% CI: −1.75; 0.15; p = 0.099). However, as the extent of children's self-rating increased, so too did the treatment difference between MP-AzeFlu and placebo; MP-AzeFlu provided significantly better relief than placebo for rTNSS (p = 0.002), rTOSS (p = 0.009) and each individual nasal and ocular symptom assessed (except rhinorrhoea; p = 0.064) when children mostly rated their own symptoms. Conclusions MP-AzeFlu is an effective treatment for AR in childhood. Caregivers are less able than children to accurately assess response to treatment with available tools. A simple paediatric-specific tool to assess efficacy in AR trials in children is needed. [ABSTRACT FROM AUTHOR]

Aversive control is a common method to reduce undesirable behavior in horses. However, it often results in unintended negative side effects, including potential abuse of the animal. Procedures based on positive reinforcement, such as differential reinforcement of other behavior (DRO), may reduce undesirable behaviors with fewer negative consequences. The current study used DRO schedules to reduce pawing using a multiple baseline design across 3 horses. Results indicated that DRO schedules were effective at reducing pawing. However, individual differences in sensitivity to DRO and reinforcer efficacy may be important considerations. [ABSTRACT FROM AUTHOR]

Ebola virus disease ( EVD) has been the subject of recent attention due to the current outbreak in West Africa, as well as the appearance of a number of cases within the United States. The presence of EVD patients in the United States required health care systems to prepare for the identification and management of both patients under investigation and patients with confirmed EVD infection. This article discusses the development and use of a mobile containment unit in an extended treatment area as a novel approach to isolation and screening of potential EVD patients. [ABSTRACT FROM AUTHOR]

Different events can serve as time markers that initiate intervals in schedules of reinforcement. Pigeons were exposed to fixed-interval (FI) schedules in which the onset of the interval was signaled by the illumination of a key light or initiated by a peck to a lighted key. Food was delivered following the first response after the interval elapsed. In Experiment 1, three pigeons were exposed to a multiple schedule. One component was a standard FI schedule: Key light illumination signaled the onset of the interval. The other component was a response-initiated fixed-interval (RIFI) schedule: The first key-peck response determined the onset of the interval. In Experiment 2, three pigeons were exposed to a multiple FI-RIFI schedule of reinforcement and on occasional trials food was not delivered (i.e. "no-food" or "peak trials"). A yoking procedure equated reinforcement rates between the schedule types in both experiments. Absolute response rates early in the intervals were higher in the RIFI schedules of both experiments. Normalized response-rate gradients, ogive fits of normalized response gradients, and breakpoints were not systematically different for the schedule types in Experiment 1, indicating similar patterns of responding between interval onset and food delivery. However, during peak trials in Experiment 2 the duration of responding at a high rate was longer for RIFI schedules than FI schedules. This suggests that timing precision was reduced in the RIFI schedules and that relative "distinctiveness" of a time marker may determine its efficacy. [ABSTRACT FROM AUTHOR]

To the Editor, In 2020, the BSACI's policy on how it interacts with industry1 was ratified at the annual general meeting by members. One of the principles of the policy is that the BSACI will not have commercial relationships with companies that directly manufacture infant milk formula. In line with our industrial policy, in October, the British Society of Allergy and Clinical Immunology (BSACI) held a very successful annual meeting without funding from infant milk formula companies. [Extracted from the article]

In fixed-interval (FI) and response-initiated fixed-interval (RIFI) schedules of reinforcement, a response is required after an interval has elapsed for delivery of reinforcement. In RIFI schedules, a response is required to initiate each interval as well. The objective of this experiment was a systematic comparison of performance in the two schedule types over a range of interval durations. Four pigeons were exposed to FI and RIFI schedules of 15, 30, 60, 120 and 240 s. Interfood intervals were longer and more variable in RIFI than corresponding FI schedules. In addition, response rates early in the RIFI schedules were higher than in corresponding FI schedules. However, the distribution of first-response latencies, mean breakpoints, and normalized response gradients suggest that temporal discrimination was equivalent in the two schedules. [ABSTRACT FROM AUTHOR]

The present study investigated the effects of punishing responses inconsistent with rules on instructional control during a choice task. In a procedure modeled after Hackenberg and Joker (1994), 7 adults were presented with repeated choices between progressive- and fixed-time schedules of reinforcement and were given instructions (rules) for how to respond to maximize earnings. Across sessions, the progressive-time schedule step size was manipulated so that the instructions became increasingly inaccurate, and deviating from the instructions produced greater earnings. The experiment consisted of two phases, Penalty and No Penalty. During the Penalty phase, deviating from the instructions produced a money-loss penalty (response-cost punishment). Two participants showed persistent instructional control and therefore completed only one phase (Penalty or No Penalty), and 1 participant showed little instructional control during the Penalty phase until the punishment magnitude was increased. In all 4 participants who experienced both Penalty and No Penalty phases, punishment increased the consistency of choices with the instructions, and in 2 of these participants punishment increased the progressive-schedule step size at which choices began to systematically deviate from the instructions. These results show that monetary penalties for breaking with rules may enhance instructional control, but that deviations from rules still occur under punishment when such deviations produce greater reinforcement than rule following. [ABSTRACT FROM AUTHOR]

To cite this article: Meyer R, Venter C, Fox AT, Shah N. Practical dietary management of protein energy malnutrition in young children with cow's milk protein allergy. Pediatric Allergy Immunology 2012: 23: 307-314. Abstract Cow's milk protein allergy (CMPA) affects between 1.9 and 4.9% of infants and young children. This food allergy requires the complete elimination of cow's milk and its derivatives, impacting on nutritional status. The risk of having protein energy malnutrition (PEM) in children with CMPA has been well documented. In 2007, the World Health Organisation published guidelines on the dietary management of PEM, which has impacted on the recommendations and composition on specialist feeds for many chronic diseases, but not on CMPA. The main change in management of the child with PEM is the protein energy ratio and energy requirements. The ideal protein energy ratio lies between 8.9 and 11.5%, which would ensure a deposition of about 70% lean and 30% fat mass. In addition, for optimal catch-up growth between 5 and 10 g/kg/day, energy requirements should be between 105 and 126 kcal/kg/day. Although most current hypoallergenic formulas fall well within the recommendation for protein, there is a problem in achieving energy requirements. As a result, modular additions are often made, disturbing the protein energy ratio or feeds are concentrated, which impacts on osmolality. We therefore aimed to review current guidelines on PEM and how these can be applied in the management of the malnourished child with CMPA. [ABSTRACT FROM AUTHOR]

This paper offers a reassessment of the origins and derivation of many of Sir William Petty's economic ideas, based on an analysis of his unpublished papers. Petty's archive makes clear what a large part Ireland played in his writings, and it is suggested that this preoccupation is essential to an appreciation of him as an economist. It also demonstrates the point that Petty was not principally a theorist but rather a practical political economist whose schemes for the enrichment of the king's dominions were inspired by the underdevelopment which he experienced at first hand in Ireland. [ABSTRACT FROM AUTHOR]

In December 2019, a novel coronavirus (SARS-CoV-2) emerged in China and subsequently spread globally, with a pandemic of the disease (COVID-19) being declared by the World Health Organization in March 2020.1 The first confirmed cases in the UK were reported in January 2020, and over the next few months, restrictions were placed on individuals and businesses to limit spread of the virus. COVID-19 continues to circulate in healthcare facilities and the community, and patients are still fearful of attending hospitals. Staff had to adjust rapidly to scale down services, cancel or defer patient appointments and procedures, and field calls from concerned patients. [Extracted from the article]

Children have a right to be safe in school: schools, in turn, have a statutory responsibility to provide a safe environment for children.[1] Schools are required to have policies to support pupils with any medical condition - including food allergies - which must be developed in the context of statutory guidance from the Department of Education.[1] However, this guidance is wholly generic and does not provide detail about specific medical conditions. Schools already have a statutory duty to provide for children with medical needs (which includes food allergy); the Department for Education should recommend schools do so by adhering to the (currently non-mandatory) guidance published by DHSC in 2017.[9] Analysis of value-based costs of undesignated school stock epinephrine policies for peanut anaphylaxis. [Extracted from the article]

To improve the quality of outpatient letters used as communication between hospital and primary care doctors. On 2 separate occasions, 15 unselected outpatient letters written by each of 7 hospital practitioners were rated by another hospital doctor and a general practitioner (GP) using the Sheffield Assessment Instrument for Letters (SAIL). Individualised feedback was provided to participants following the rating of the first set of letters. The audit cycle was completed 3 months later without forewarning by repeat assessment by the same hospital and GP assessors using the SAIL tool to see if there was any improvement in correspondence. Single centre: general paediatric outpatient department in a large district general hospital. All 7 doctors available for reassessment completed the audit loop, each providing 15 outpatient letters per assessment. The mean of the quality scores, derived for each letter from the summation of a 20-point checklist and a global score, improved from 23.3 (95% CI 22.1–24.4) to 26.6 (95% CI 25.8–27.4) ( P = 0.001). The SAIL provides a feasible and reliable method of assessing the quality and content of outpatient clinic letters. This study demonstrates that it can also provide feedback with a powerful educational impact. This approach holds real potential for appraisal and revalidation, providing an effective means for the quality improvement required by clinical governance. [ABSTRACT FROM AUTHOR]

Presents several books on British history in the sixteenth century. `The Oxford Illustrated History of Tudor and Stuart Britain,' edited by John Morrrill; `The Stations of the Sun: A History of the Ritual Year in Britain,' by Ronald Hutton; `The British Problem c.1534-1707: State Formation in the Atlantic Archipelago,' edited by Brendan Bradshaw and John Morrill; `Henry VIII,' by J.J. Scarisbrick.

A letter to the editor is presented in response to the article "Advice provided by Health Professionals regarding precautionary allergen labelling," that was published in a previous issue.

The Milk Allergy in Primary (MAP) Care guideline was first published in 2013 in this journal. MAP aimed to provide simple and accessible algorithms for UK clinicians in primary care, detailing all the steps between initial presentation, through diagnosis, management and tolerance development. Despite its UK focus, it soon became clear that MAP was being accessed internationally and thus an updated International Milk Allergy in Primary Care (iMAP) guideline was published in 2017. Both guidelines used existing international consensus guidelines to develop accessible algorithms accompanied by patient information leaflets. In 2018, the guidelines were criticised for 3 distinct reasons: promoting the overdiagnosis of cow's milk allergy (CMA), negatively impacting breastfeeding and the possibility of industry influence on the guidelines. The authors address these criticisms using available evidence and, in the context of this and in consultation with patient groups, members of the General Practice Infant Feeding Network and other infant feeding healthcare leads, have collaboratively produced updated algorithms and an information leaflet to support breastfeeding. We believe iMAP is now closer to its original aim of facilitating early and accurate diagnosis of CMA, whilst minimising, as far as possible, any concerns around overdiagnosis or a risk to breastfeeding rates. We continue to welcome open and constructive engagement about how best to achieve these aims to provide evidence-based, practical guidelines for the primary care practitioner. [ABSTRACT FROM AUTHOR]