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Jennifer Naftel,1,* Heena Mistry,1– 5,* Frances Ann Mitchell,4 Jane Belson,4 Mohammed Aref Kyyaly,2,4 Clair Barber,1,2 Hans Michael Haitchi,1– 3,6 Paddy Dennison,1– 3 Ratko Djukanovic,1– 3,6 Gregory Seumois,5 Pandurangan Vijayanand,2,5 Syed Hasan Arshad,1– 4,6 Ramesh J Kurukulaaratchy1– 4 1National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK; 2Clinical and Experimental Sciences Department, Faculty of Medicine, University of Southampton, Southampton, UK; 3Asthma, Allergy and Clinical Immunology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK; 4The David Hide Asthma & Allergy Research Centre, St Mary’s Hospital, Newport, Isle of Wight, UK; 5Vijayanand Laboratory, La Jolla Institute of Immunology, San Diego, CA, 92037, USA; 6Institute for Life Sciences, University of Southampton, Southampton, UK*These authors contributed equally to this workCorrespondence: Ramesh J Kurukulaaratchy, Respiratory Medicine & Allergy, Clinical Experimental Sciences, Mailpoint 810, F-Level, South Academic Block, Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD, United Kingdom, Tel +442381 208790, Email Rjk1s07@soton.ac.ukBackground: Despite most of the asthma population having mild disease, the mild asthma phenotype is poorly understood. Here, we aim to address this gap in knowledge by extensively characterising the mild asthma phenotype and comparing this with difficult-to-treat asthma.Methods: We assessed two real-world adult cohorts from the South of England using an identical methodology: the Wessex AsThma CoHort of difficult asthma (WATCH) (n=498) and a mild asthma cohort from the comparator arm of the Epigenetics Of Severe Asthma (EOSA) study (n=67). Data acquisition included detailed clinical, health and disease-related questionnaires, anthropometry, allergy and lung function testing, plus biological samples (blood and sputum) in a subset.Results: Mild asthma is predominantly early-onset and is associated with type-2 (T2) inflammation (atopy, raised fractional exhaled nitric oxide (FeNO), blood/sputum eosinophilia) plus preserved lung function. A high prevalence of comorbidities and multimorbidity was observed in mild asthma, particularly depression (58.2%) and anxiety (56.7%). In comparison to difficult asthma, mild disease showed similar female predominance (> 60%), T2-high inflammation and atopy prevalence, but lower peripheral blood/airway neutrophil counts and preserved lung function. Mild asthma was also associated with a greater prevalence of current smokers (20.9%). A multi-component T2-high inflammatory measure was comparable between the cohorts; T2-high status 88.1% in mild asthma and 93.5% in difficult asthma.Conclusion: Phenotypic characterisation of mild asthma identified early-onset disease with high prevalence of current smokers, T2-high inflammation and significant multimorbidity burden. Early comprehensive assessment of mild asthma patients could help prevent potential later progression to more complex severe disease.Keywords: mild asthma, difficult asthma, multimorbidity, type 2 inflammation

Hongmei Zhang1,*, Wilfried Karmaus1,*, Jianjun Gan2, Weichao Bao1,*, Yan D Zhao3, Dewi Rahardja3, John W Holloway5, Martha Scott4,5, Syed Hasan Arshad4,51Department of Epidemiology and Biostatistics, The University of South Carolina, Columbia, SC, USA; 2GlaxoSmithKline, Research Triangle Park, NC, USA; 3Department of Clinical Science and Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA; 4The David Hide Asthma and Allergy Research Center, St Mary’s Hospital, Newport, Isle of Wight, UK; 5School of Medicine, University of Southampton, Southampton, UK *These authors contributed equally to this articlePurpose: Skin prick testing (SPT) is fundamental to the practice of clinical allergy identifying relevant allergens and predicting the clinical expression of disease. Wheal sizes on SPT are used to identify atopic cases, and the cut-off value for a positive test is commonly set at 3 mm. However, the measured wheal sizes do not solely reflect the magnitude of skin reaction to allergens, but also skin reactivity (reflected in the size of histamine reaction) and other random or non-random factors. We sought to estimate wheal sizes exclusively due to skin response to allergens and propose gender-specific cutoff points of atopy.Methods: We developed a Bayesian method to adjust observed wheal sizes by excluding histamine and other factor effects, based on which revised cutoff points are proposed for males and females, respectively. The method is then applied to and intensively evaluated using a study population aged 18, at a location on the Isle of Wight in the United Kingdom. To evaluate the proposed approach, two sample t-tests for population means and proportion tests are applied.Results: Four common aeroallergens, house dust mite (HDM), grass pollen, dog dander, and alternaria are considered in the study. Based on 3 mm cutoff, males tend to be more atopic than females (P-values are between 0.00087 and 0.062). After applying the proposed methods to adjust wheal sizes, our findings suggest that misclassifications of atopy occur more often in males. Revised allergen-specific cutoff values are proposed for each gender.Conclusion: To reduce the gender discrepancy, we may have two potentially convenient solutions. One way is to apply allergen-specific and gender-specific cutoff values following the proposed method. Alternatively, we can revise the concentration of allergens in the SPT solutions but keep the cutoff values unchanged, which may be more convenient to clinicians.Keywords: SPT, atopy, Bayesian method, joint modeling, misclassification

Background: Anatomy of the hip must be taken into account to perform the various surgical procedures like reconstruction of the acetabulum in patients with significant acetabular bone deficiency. It remains a major challenge in total hip arthroplasty. Appropriate anatomic concepts for surgery to treat femoroacetabular impingement require a precise appreciation of the native acetabular anatomy. Since the acetabulum is not always of the same shape, width or depth, joint congruence is frequent with minor anatomical variations in the shape of the acetabulum. Hence, the present study was undertaken as controversies still exist on the importance of these variations and to prevent problems following surgical procedures such as acetabular reconstruction and femoroacetabular impingement. Method: 81 dry human hip bones of unknown sex were taken for observation from departments of anatomy at Dr SCGMC Nanded and SRTRGMC Ambajogai. All hip bones were adult-type. The exact age and sex of hip bones were not known. Measurements were taken in millimeters using a sliding digital vernier calliper. The mean and standard deviation of the acetabulum in various dimensions were calculated. Parameters of acetabulum depth and diameter were measured. Result: The overall goal of this study was to generate data that would be useful to the orthopaedics for geometric modelling. The study would also help the forensic experts. It would also be valuable for the anthropologists in their racial and population studies. The mean SD value of the depth of acetabulum on the right side is 27.121.02mm and on the left side is 27.021.03. The mean S.D. value of the diameter of the acetabulum on the right side is 47.501.27mm and on the left side is 47.451.33. Conclusion: Morphological study on adult hip bone is useful for anatomists, anthropologists, experts in forensic medicine and orthopaedics for performing surgical procedures in this area.

Abstract Studies exploring the transcriptome of stress and its effects on meat quality are very limited, particularly in goats. Fifty-four male Spanish goats (8-mo old; BW = 29.7 ± 2.03 kg) were randomly subjected to one of three treatments (TRT; n = 18 goats/treatment): (1) transported for 180 min, (2) transported for 30 min, or (3) held in pens (control) to analyze the transcriptome of stress and meat quality in goats using RNA-seq technology. Blood samples were collected before and after treatment, and meat samples were collected after humane slaughter for stress hormone, meat quality (Longissimus dorsi), and transcriptomic analysis. Plasma epinephrine concentrations were higher (P

Objective: To evaluate the visual outcome of ocular trauma and its medicolegal interpretation in a tertiary care hospital, Karachi. Methods: This was a prospective, cross-sectional observational study conducted at Abbasi Shaheed Hospital, Karachi. Data was collected through nonprobability consecutive sampling technique. The study duration was 12 months, from 14 September 2014 to 15 September 2015. Inclusion criteria were patients of both genders aged between 18 - 60 years, presenting with ocular trauma in the outpatient department or admitted through an emergency in the department of Ophthalmology. The exclusion criterion was patients suffering from all extraocular injuries. Patients were followed up for a period of 6 months. Statistical analysis was done through SPSS version 20.0 Results: There were 99 patients, with a mean age of 31.6 ± 18.5 SD years. Males were 74.7% and 82 (82.2 %) were unskilled. Closed globe injury was seen in 54 (54.5%) and the open globe in 45 (45.5%). Nine percent of the patients were assault cases and 90.9% cases were accidental. The corneal injury was seen in 43 (71.6%) and scleral injury in 5 (8.3%) of the patients. At the time of trauma 39.4% of patients presented with 6/60 visual acuity, in the early post-op period 50.5% were 6/6, whereas at six-month follow-up 90.9% patients were with 6/6 visual acuity. Wilcoxon Signed Ranks Test showed P-value less than 0.01. Conclusion: It was concluded that the major outcome of ocular trauma was impaired visual acuity, which improved significantly on regular follow-ups. Medicolegal interpretation of ocular trauma is imperative and should be accounted for properly. It should be exercised by the medicolegal officer, to not give the final report before at least 6 months of follow-up in case of poor visual outcome. Moreover, educate the person to demand compensation during this period.

Objectives: To study the epidemiology of dengue with reference to serological, demographic profile, spatio-temporal distribution, vectors, circulating serotypes and coinfections. Methods: Demographic data and presenting symptoms of fever cases reporting to the clinic were recorded. Suspected patients were tested for dengue, chikungunya and malaria. Dengue specific RT-PCR was performed to detect circulating DENV serotypes. Vector surveys were carried out to detect Aedes breeding. Results: Of the 5536 fever patients tested during 2012 to 2015, 1536 (27.7%) had confirmed dengue. The peak in dengue positivity was observed during September and October. Of the 60 samples analysed, 10 (16.7%) had concurrent infection with multiple dengue serotypes; one of them had all the four serotypes. Coinfection of dengue with malaria and chikungunya was also observed. The occurrence of dengue and malaria was inversely related. Seven percent of the dengue patients required hospitalization. Vector surveys in the draining area revealed Aedes breeding with a high house index. Conclusion: Delhi being hyperendemic, the occurrence of concurrent infections with multiple DENV serotypes has become a frequent finding. The study emphasizes the need of epidemiological and entomological surveillance to monitor trends in dengue distribution, seasonal patterns and circulating serotypes to guide dengue control activities. Keywords: Dengue, Epidemiology, India, Serotypes

In this paper, we propose a Q-Learning based efficient and balanced energy consumption data gathering routing protocol (QLEEBDG) for underwater sensor networks (USNs). We set an optimal next hop forwarder for each node to transmit its the sensed data. This helps to reduce distance between sender and receiver. The energy consumption is minimum. Furthermore, a node is considered an eligible forwarder node only if its next hop neighbour exists. We incorporate this mechanism to avoid void hole problem. Our technique minimizes energy consumption in the network, hence, lifespan increases. The performance of our proposed technique is validated through extensive simulations.

UWSNs are frequency selective and energy-hungry due to the underwater acoustic communication links. We propose adaptive transmission based geographic and opportunistic routing (ATGOR) for efficient and reliable communication. Opportunistic routing is utilized along with geographic routing to select a set of forwarders from the neighboring nodes instead of a single forwarder. We propose a 3D network model logically divided into small cubes of equal volume with a goal that the sensed data is transmitted by the unit of small cubes.

Underwater sensor networks (USNs) are getting popular for the purpose of monitoring and exploration of undersea terrain. However, underwater communication channel characteristics limits data gathering capacity and duration of monitoring. Efficient routing protocols can improve performance of USNs having dynamic topology and localization errors. This paper presents LETR; a geo-opportunistic routing protocol that considers localization errors and communication void regions. LETR considers transmission range levels for finding neighbor nodes. Sensor nodes search for neighbors by adapting different transmission range levels. The performance of our proposed protocol is evaluated against different parameters through simulations. The simulation results show that LETR significantly improves network performance in terms of energy consumption, packet loss ratio, fraction of void nodes and the total amount of depth adjustment performed by sensor nodes.

Energy is a unique characteristic of Underwater Acoustic Sensor Networks (UASNs) which is limited in features and a basic point on which the whole network depends. On the basis of efficient energy utilization, we propose a routing protocol Enhanced and Efficient Balance energy consumption in Data Gathering (EEBDG) for UASNs. This routing scheme EEBDG, works for large scale area networks efficiently and effectively by balanced energy consumption. EEBDG removes the deficiency of previous routing scheme in which mixed routing performs all over the network which is not possible in real world when network size increases. By the increase in area of a network, we avoid the direct transmission mode using only hop by hop transmission. The contribution of our work is to extend network lifetime with large scale in the form of increased nodes and dimension, minimize energy utilization by balanced energy consumption, increased number of packets transfer. Our trade-off is packet drop ratio when number of nodes is small in sparse networks, but when the number of nodes increases our packets drop is also improved.

Nutrition means how the food substances interact with each to maintain, health, disease and growth of an organism. Nutrition starts from food intake and involves absorption, assimilation, biosynthesis, catabolism, till excretion1. The human diet is largely dependent on its availability and whether it is palatable or not. A healthy diet depends on hygienic preparation of food and safe storage to reduce the risk of food borne dieases1. Good and proper nutrition plays an important role for providing a healthy diet. Both physical activity and diet can help you to live a healthy life and reduce the risk of heart disease and cancer and promote an overall good health2. Food choices every day can affect your health,the epidemic of obesity in the United States is the result of unhealthy eating habits. Almost one-third of U.S adults (33.8%) are obese and about 12.5 million (17%) of children and adolescents aged 2-19 years are obese2. Association between good nutrition and health is too important and cannot be ignored. If you take healthy food, you can maintain your heath. By increasing your exercise and by making minute changes in your diet you can live a long healthy life2. Unhealthy diet and weight gain are major risk factors for diabetes and hypertension in young age. Dietary habits developed during childhood continue in adulthood, so children should be taught to take a healthy diet at young age to live a healthy life2. Food is a gift from Allah Almighty. Many types of food are available in solid and liquid form. Many types are taken in raw form like vegetables and fruits. When cooking food, heat can be transferred by conduction, or convection, radiation (microwave cooking). During conduction heat flows to the food stuff. For better and equal conduction bottom of the pan should be flat and thick as for example in steaming and poaching. Baking takes place by convection. In radiation heat only reaches the surface of food and the rest of the food is cooked by conduction and convection as for example in boiling or toasting3. Cooking can be carried out in various medias as air, water, steam and fat or combination of these medias may be used. Grilling, roasting and baking take place in air. Boiling, simmering or stirring involves cooking in water. Steam is another medium for cooking. It is of three types. In steaming food is cooked by steam formation by added water. Whereas in waterless cooking steam originates from food itself. In pressure cooking time is reduced by increasing the pressure so that boiling point is quickly reached and food is cooked by condensation of steam over the food. Fats can be used as a medium for instant cooking. Shallow and deep frying can be used to cook food by this method3. The methods of cooking include boiling, grilling, frying baking, deep frying, pressure cooking and cooking on charcoal. Majority of the methods used destroy proteins and vitamins at high temperatures. Frying has little effect on the protein and mineral content of fried food. The increased temperature and less cooking time of the frying process cause least damage to heat labile vitamins than other types of cooking. The nutritional value of the frying material should also be considered. Some fat is added to the food when fried which increases its energy and makes the food more palatable. Frying adds taste to the food and benefits of healthy oils can be utilized which are used for frying4. It has been reported that microwave cooking results in higher losses of moisture from food but overall effects of microwave on protein, lipid and minerals is minimal5. Less cooking time and decreased exposure to heat can preserve the nutrients of food when cooked in microwave6. Grilling and boiling increase the flavour but also decrease B vitamins but grilling increases carcinogenic substances7. Boiling, simmering and poaching are all methods of water-based cooking. They only differ by water temperature to which the food is exposed: Poaching: Less than 180°F/82°C. Simmering: 185-200°F/85-93°C. Boiling: 212°F/100°C. Vegetables are an important source of vitamin C, but most of it is wasted when cooked in water. Maximum conservation of vitamin C is by microwaving8 Roasting or baking mostly effect B vitamins. Sautéing and stir-frying increase the absorption of fat-soluble vitamins and some of the plant compounds, but most of the vitamin C is wasted in vegetables9. Steaming is one of the best cooking methods to preserve nutrients and water-soluble vitamins10. It is also important to understand that when food is subjected to heat certain destructive changes in proteins and carbohydrates are beneficial. For example, due to effect of heat on proteins deamination takes place which helps in destruction of microorganisms. In addition, cooking deactivates certain enzymes and toxic substances in food that may have serious effects on health. Carbohydrates when cooked in water make the starch molecules in it to swell and break and increase the digestibility of carbohydrates3. It's important to choose proper methods of cooking to get maximum nutritional value of meal. However, there is no perfect cooking method. Generally, less cooking time at a low temperature with minimum water will produce good results. The nutrients in your food should not be wasted. Adequate and proper nutrition is important for a healthy life. Awareness is needed to educate parents, teachers so that they can communicate to the students and children about healthy food. Many of the educated people are unaware of the nutritional deficiencies especially calcium and vitamin D. They live for taste alone, health through education is needed. It is important to promote an awareness about the nutritional value of foods and their importance for maintaining body growth, reproduction, health, and disease prevention in humans. Proper nutrition is important for normal cardiovascular function, muscle strength, respiratory ventilation, protection of infection, wound healing, and psychological wellbeing11. The World Health Organization (WHO) reported that almost 60% of all deaths, and 43% of global burden of disease are caused by nutritional diseases and by 2020, the burden of nutrition-related diseases is expected to increase to 73% of all deaths and 60% of the global burden of disease12. WHO reports that the factors that lead to unhealthy eating habits among individuals include lack of knowledge about nutrition and dangers to health, and getting wrong information about health and nutrition matters3. when foods are not consumed in quantities required for individual’s body need, it compels towards taking junk food so malnutrition or over-nutrition may result. Thus taking in consideration the roles played by nutrients in promoting health and optimal functioning in humans counselling and education about diet and nutrition is required to be on priority by all relevant professionals, including nutritional counsellors, home economists and dieticians10.

In this article, to monitor the fields with square and circular geometries, three energy-efficient routing protocols are proposed for underwater wireless sensor networks. First one is sparsity-aware energy-efficient clustering, second one is circular sparsity-aware energy-efficient clustering, and the third one is circular depth–based sparsity-aware energy-efficient clustering routing protocol. All three protocols are proposed to minimize the energy consumption of sparse regions, whereas sparsity search algorithm is proposed to find sparse regions and density search algorithm is used to find dense regions of the network field. Moreover, clustering is performed in dense regions to minimize redundant transmissions of a data packet, while sink mobility is exploited to collect data from sensor nodes with an objective of minimum energy consumption. A depth threshold ( d th ) value is also used to minimize number of hops between source and destination for less energy consumption. Simulation results show that our schemes perform better than their counter-part schemes (depth-based routing and energy-efficient depth-based routing) in terms of energy efficiency.

Aim: To identify and analyze the clinical presentation, etiopathology, management and outcome of patients with acute mechanical small bowel obstruction. Materials and methods: This is a prospective study of patients admitted with acute mechanical small bowel obstruction between 2001 and 2006. Results: Of the 300 patients included in the study, 296 (98.66%) patients presented with abdominal pain, while distention of the abdomen was the most common physical finding on clinical examination, which was present in 236 (78.66%) patients. Ascaris lumbricoides (44.60%) and adhesions (34.0%) were the most frequent causes of obstruction. 86 patients (28.66%) were managed conservatively and 214 (71.33%) patients were operated on. Simple obstruction was present in 190 (63.33%) patients, while strangulation was present in 110 (36%) patients. Intussusception was the most common etiology associated with non-viable strangulation, which was present in 12/14 patients (85.71%). Enterotomy and adhesiolysis were the most commonly performed operative procedures (28.97% and 14.95% respectively). Superficial surgical site infection was the most frequently noted complication and ndash; 84/300 (28.0%). Septicemia was the commonest cause of mortality in our series and ndash; 4/300 (1.33%). Conclusion: Abdominal pain and distention of the abdomen are the most common symptoms and physical findings in patients presenting with acute mechanical small bowel obstruction (SBO). Worm (ascaridial) obstruction is the most common cause of obstruction followed by postoperative adhesions. Although all patients were managed conservatively to start with, the operative rate in our series remained very high because it is very difficult to distinguish simple from strangulation obstruction on clinical, biochemical and/or radiological grounds with certainty. [Arch Clin Exp Surg 2013; 2(3.000): 154-160]

The study is based on hypothesis that whether continuous entomological surveillance of Ae. aegypti and simultaneous appropriate interventions in key containers during non-transmission (December-May) months would have any impact on breeding of Aedes and dengue cases during the following transmission months (June-November). The impact of the surveillance and intervention measures undertaken during non-transmission months were assessed by entomological indicators namely container index (CI), house index (HI), pupal index (PI) and breteau index (BI).A total of 28 localities of West Zone of Delhi with persistent dengue endemicity were selected for the study. Out of these localities, 20 were included in study group while other 8 localities were in control group. IEC and various Aedes breeding control activities were carried out in study group in both non-transmission and transmission season whereas control group did not have any such interventions during non-transmission months as per guidelines of MCD. These activities were undertaken by a team of investigators from NIMR and SDMC, Delhi. In control group, investigators from NIMR carried out surveillance activity to monitor the breeding of Aedes mosquito in localities.Comparison of baseline data revealed that all indices in control and study group of localities were comparable and statistically non-significant (p>0.05). In both study and control groups, indices were calculated after pooling data on seasonal basis, i.e., transmission and non-transmission months for both years. The test of significance conducted on all the four indices, i.e., HI, PI, CI, and BI, revealed a significant difference (p

Sparse node deployment and dynamic network topology in underwater wireless sensor networks (UWSNs) result in void hole problem. In this paper, we present two interference-aware routing protocols for UWSNs (Intar: interference-aware routing; and Re-Intar: reliable and interference-aware routing). In proposed protocols, we use sender based approach to avoid the void hole. The beauty of the proposed schemes is that they not only avoid void hole but also reduce the probability of collision. The proposed Re-Intar also uses one-hop backward transmission at the source node to further improve the packet delivery ratio of the network. Simulation results verify the effectiveness of the proposed schemes in terms of end-to-end delay, packet delivery ratio and energy consumption.

Due to the limited availability of battery power of the acoustic node, an efficient utilization is desired. Additionally, the aquatic environment is harsh; therefore, the battery cannot be replaced, which leaves the network prone to sudden failures. Thus, an efficient node battery dissipation is required to prolong the network lifespan and optimize the available resources. In this paper, we propose four schemes: Adaptive transmission range in WDFAD-Depth-Based Routing (DBR) (A-DBR), Cluster-based WDFAD-DBR (C-DBR), Backward transmission-based WDFAD-DBR (B-DBR) and Collision Avoidance-based WDFAD-DBR (CA-DBR) for Internet of Things-enabled Underwater Wireless Sensor Networks (IoT, UWSNs). A-DBR adaptively adjusts its transmission range to avoid the void node for forwarding data packets at the sink, while C-DBR minimizes end-to-end delay along with energy consumption by making small clusters of nodes gather data. In continuous transmission range adjustment, energy consumption increases exponentially; thus, in B-DBR, a fall back recovery mechanism is used to find an alternative route to deliver the data packet at the destination node with minimal energy dissipation; whereas, CA-DBR uses a fall back mechanism along with the selection of the potential node that has the minimum number of neighbors to minimize collision on the acoustic channel. Simulation results show that our schemes outperform the baseline solution in terms of average packet delivery ratio, energy tax, end-to-end delay and accumulated propagation distance.

The energy-efficient and reliable delivery of data packets in resource constraint underwater wireless sensor networks (UWSNs) is one of the key considerations to enhance the network lifetime. The traditional re-transmissions approach consumes the node battery and increases the communication overhead, which results in congestion and affects the reliable data packet delivery in the network. To ensure the reliability and conserve the node battery, in this paper, we propose adaptive forwarding layer multipath power control routing protocol to reduce the energy dissipation, achieve the data reliability and avoid the energy hole problem. In order to achieve the reliability, tree based topology is exploited to direct multiple copies of the data packet towards the surface through cross nodes in the network. The energy dissipation is reduced by a substantial amount with the selection of low noise path between the source and the destination including the information of neighbors of the potential forwarder node. Extensive simulation results show that our proposed work outperforms the compared existing scheme in terms of energy efficiency and packet received ratio (PRR).

In this paper, three opportunistic pressure based routing techniques for underwater wireless sensor networks (UWSNs) are proposed. The first one is the cooperative opportunistic pressure based routing protocol (Co-Hydrocast), second technique is the improved Hydrocast (improved-Hydrocast), and third one is the cooperative improved Hydrocast (Co-improved Hydrocast). In order to minimize lengthy routing paths between the source and the destination and to avoid void holes at the sparse networks, sensor nodes are deployed at different strategic locations. The deployment of sensor nodes at strategic locations assure the maximum monitoring of the network field. To conserve the energy consumption and minimize the number of hops, greedy algorithm is used to transmit data packets from the source to the destination. Moreover, the opportunistic routing is also exploited to avoid void regions by making backward transmissions to find reliable path towards the destination in the network. The relay cooperation mechanism is used for reliable data packet delivery, when signal to noise ratio (SNR) of the received signal is not within the predefined threshold then the maximal ratio combining (MRC) is used as a diversity technique to improve the SNR of the received signals at the destination. Extensive simulations validate that our schemes perform better in terms of packet delivery ratio and energy consumption than the existing technique; Hydrocast.

Immunoglobulin E (IgE)-mediated food allergies are the most common type of food allergy, often causing rapid symptoms after exposure to allergens posing a serious health risk and a high impact on patient's and caregiver's quality of life. Omalizumab, a humanized anti-IgE monoclonal antibody, reduces allergic reactions by binding to circulating IgE. Omalizumab has been successfully used in allergic asthma, chronic rhinosinusitis with nasal polyps, and chronic urticaria, and was recently approved for treating IgE-mediated food allergies by the US Food and Drug Administration (FDA). This GA 2 LEN ANACARE Consensus Statement presents our position on the use of omalizumab for treating IgE-mediated food allergies, based on a systematic review and meta-analysis, experience with use for other conditions, and expert consensus achieved via an eDelphi process. Following publication of the recent OUtMATCH study (stage 1) results and subsequent FDA approval, we propose that there is now sufficient evidence to recommend omalizumab as the only drug currently available that can mechanistically reduce IgE-mediated food allergic reactions. We acknowledge that the evidence does not reach the highest level of evidence which would be needed for a guideline recommendation., (© 2024 The Author(s). Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.)

Background: Chronic obstructive pulmonary disease (COPD) is caused by interactions between many factors across the life course, including genetics. A proportion of COPD may be due to reduced lung growth in childhood. We hypothesized that a polygenic risk score (PRS) for COPD is associated with lower lung function already in childhood and up to adulthood., Methods: A weighted PRS was calculated based on the 82 association signals ( p  ≤ 5 × 10 -8 ) revealed by the largest GWAS of airflow limitation (defined as COPD) to date. This PRS was tested in association with lung function measures (FEV 1 , FVC, and FEV 1 /FVC) in subjects aged 4-50 years from 16 independent cohorts participating in the Chronic Airway Diseases Early Stratification (CADSET) Clinical Research Collaboration. Age-stratified meta-analyses were conducted combining the results from each cohort (n = 45,406). These findings were validated in subjects >50 years old., Findings: We found significant associations between the PRS for airflow limitation and: (1) lower pre-bronchodilator FEV 1 /FVC from school age (7-10 years; β: -0.13 z-scores per one PRS z-score increase [-0.15, -0.11], q -value = 7.04 × 10 -53 ) to adulthood (41-50 years; β: -0.16 [-0.19, -0.13], q -value = 1.31 × 10 -24 ); and (2) lower FEV 1 (from school age: 7-10 years; β: -0.07 [-0.09, -0.05], q -value = 1.65 × 10 -9 , to adulthood: 41-50 years; β: -0.17 [-0.20, -0.13], q -value = 4.48 x 10 -20 ). No effect modification by smoking, sex, or a diagnosis of asthma was observed., Interpretation: We provide evidence that a higher genetic risk for COPD is linked to lower lung function from childhood onwards., Funding: This study was supported by CADSET, a Clinical Research Collaboration of the European Respiratory Society., Competing Interests: NH-P was supported with a Medium-Term Research Fellowship by the European Academy of Allergy and Clinical Immunology (EAACI) and a Long-Term Research Fellowship by the European Respiratory Society (ERS) (LTRF202101-00861), and lecture honoraria from OMNIPREX, S.L (outside of the submitted work). LLa was supported by the Fund for Scientific Research Flanders (Grant 3G037618), lecture honoraria from IPSA vzw, a non-profit organization facilitating lifelong learning for health care providers, and Chiesi; and consulting fees from AstraZeneca, all paid to the institution. LLa also declares unpaid membership of faculty board and faculty committees of the European Respiratory Society and Belgian Respiratory Society. LB received support from the K.G. Jebsen Center for Genetic Epidemiology funded by Stiftelsen Kristian Gerhard Jebsen; Faculty of Medicine and Health Sciences, NTNU; The Liaison Committee for Education, Research and Innovation in Central Norway; and the Joint Research Committee between St Olavs Hospital and the Faculty of Medicine and Health Sciences, NTNU. YS was supported by a grant from the China Scholarship Council. AL declares consulting fees regarding presentation of spirometry from Diagnostica Ltb and lecture honoraria from AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline. AC reports research grants funded by MRC, EPSRC, and Wellcome Trust; consulting fees from Worg Pharmaceuticals; lecture honoraria from GlaxoSmithKline, AstraZeneca, Stallergens-Greer, and Sanofi; and unpaid membership of a board of officers of the World Allergy Organization. GK was supported by grants from ZON-MW, Lung Foundation of the Netherlands, UBBO EMMIUS Foundation, GSK, Vertex, European Union (H2020 program), TEVA the Netherlands; consulting fees from AstraZeneca and PURE IMS; lecture fees from AstraZeneca, Boehringer Ingelheim and Sanofi; and participation as a chair at the exquAIro foundation (AI education for medicine and pharma). RF received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation program (grant agreement No. 101044387), Instituto de Salud Carlos III (PI18/00018, PI21/00735), SEPAR and Serra Hunter Program. AA reports research grants, consulting fees, and lecture honoraria by GlaxoSmithKline, AstraZeneca, Menarini, Chiesi, and Sanofi; and unpaid roles as Chair Board of Directors of GOLD and Co-chair of CADSET. MS received funding from ERC under the European Union's Horizon 2020 research and innovation program (grant agreement No. 949906). EM is supported by grants from the EU (ERC, TRIBAL No 757919). EM also declares advisory board and lecture fees from ALK, AstraZeneca, and Chiesi outside the submitted work. The rest of the authors declare no conflicts of interest that might be perceived to influence the interpretation of this article., (© 2024 The Author(s).)

Prior to COVID-19, there were already increasing rates of youth with mental health concerns, including an increase in youth presenting to medical emergency departments (EDs) with mental health chief complaints and limited access to treatment. This trend worsened during the pandemic, and rates of youth presenting to medical EDs with suicidal ideation and self-harm increased 50% from 2019 to 2022. This resulted in a "boarding" crisis, in part, due to a lack of inpatient psychiatric hospitalization beds, and many youth were left without access to adequate treatment. Additional study of innovations in health care delivery will be paramount in meeting this need., Competing Interests: Disclosure Drs J. Close and J. Lewis have no disclosures or conflicts to report. Dr S.H. Arshad has no conflicts, also receives funding from UC Irvine’s Train New Trainer’s program. Dr S.L. Soffer: Guilford Press (author). Dr T.D. Benton is on the AFSP Board, Friends Central School Board, and Juvenile Law Center Board, serves as AACAP President, and recieves NIH/PCORI funding., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Rationale: Lung function in early adulthood is associated with subsequent adverse health outcomes., Objectives: To ascertain whether stable and reproducible lung function trajectories can be derived in different populations and investigate their association with objective measures of cardiovascular structure and function., Methods: Using latent profile modelling, we studied three population-based birth cohorts with repeat spirometry data from childhood into early adulthood to identify trajectories of forced expiratory volume in 1 s (FEV 1 )/forced vital capacity (FVC). We used multinomial logistic regression models to investigate early-life predictors of the derived trajectories. We then ascertained the extent of the association between the derived FEV 1 /FVC trajectories and blood pressure and echocardiographic markers of increased cardiovascular risk and stroke in ~3200 participants at age 24 years in one of our cohorts., Results: We identified four FEV 1 /FVC trajectories with strikingly similar latent profiles across cohorts (pooled N=6377): above average (49.5%); average (38.3%); below average (10.6%); and persistently low (1.7%). Male sex, wheeze, asthma diagnosis/medication and allergic sensitisation were associated with trajectories with diminished lung function in all cohorts. We found evidence of an increase in cardiovascular risk markers ascertained by echocardiography (including left ventricular mass indexed to height and carotid intima-media thickness) with decreasing FEV 1 /FVC (with p values for the mean crude effects per-trajectory ranging from 0.10 to p<0.001). In this analysis, we considered trajectories as a pseudo-continuous variable; we confirmed the assumption of linearity in all the regression models., Conclusions: Childhood lung function trajectories may serve as predictors in the development of not only future lung disease, but also the cardiovascular disease and multimorbidity in adulthood., Competing Interests: Competing interests: RG, SH, MD, AU, OM, SF, LL, AS, CP, CSM and GR declare no conflicts of interest. AS has received research grants. JWD has received research and charity grants and declares pharmaceutical support for lectures and attending conferences/meetings. AH has received support from Research Institutions and declares an unpaid fiduciary role. JWH has received research grant and support for travel to congress. AC has received research grants, consulting fees, honoraria for lectures and declares unpaid fiduciary role., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)