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Annette Carlisle, Jay Lieberman Department of Pediatrics, Division of Pediatric Pulmonary, Sleep, Allergy & Immunology, The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN, USACorrespondence: Annette CarlisleDepartment of Pediatrics, Division of Pediatric Pulmonary, Sleep, Allergy & Immunology, The University of Tennessee Health Science Center/Le Bonheur Children’s Hospital, Faculty Office Building 49 N. Dunlap #217, Memphis, TN, 38103, USATel +1 901-287-5590Fax +1 901-287-7450Email acarlis3@uthsc.eduAbstract: Anaphylaxis is a condition that is likely increasing in prevalence and commonly treated by allergists as well as other first responders and emergency room providers. Although a relatively rare event, anaphylaxis can occur in infants, with the most common cause attributed to foods. Infant anaphylaxis can present with unique diagnostic challenges and treatment considerations. While infants can present with classic signs and symptoms of anaphylaxis (eg, urticaria, angioedema, dyspnea, wheeze, and vomiting) they can also present with non-classical signs. Non-classical signs of infant anaphylaxis can include ear pulling, tongue thrusting, fussiness, and increase clinginess to the caregiver. These non-classic signs of infant anaphylaxis can often mimic normal infant behavior further complicating the diagnosis. Additionally, when treating infant anaphylaxis, there are special considerations regarding the use of epinephrine. These include determining appropriate needle length, dosages appropriate to administer depending on the weight of the infant, and the availability of different epinephrine auto-injectors. In this article, we aim to review the clinical management of infant anaphylaxis including diagnosis, recognition, treatment, strategies for follow-up and special considerations regarding epinephrine administration in this demographics.Keywords: infant anaphylaxis, epinephrine

The promise of identity-based systems is that they maintain the functionality of public key cryptography while eliminating the need for public key certificates. The first efficient identity-based encryption (IBE) scheme was proposed by Boneh and Franklin in 2001; variations have been proposed by many researchers since then. However, a common drawback is the requirement for a private key generator (PKG) that uses its own master private key to compute private keys for end users. Thus, the PKG can potentially decrypt all ciphertext in the environment (regardless of who the intended recipient is), which can have undesirable privacy implications. This has led to limited adoption and deployment of IBE technology. There have been numerous proposals to address this situation (which are often characterized as methods to reduce trust in the PKG). These typically involve threshold mechanisms or separation-of-duty architectures, but unfortunately often rely on non-collusion assumptions that cannot be guaranteed in real-world settings. This paper proposes a separation architecture that instantiates several intermediate CAs (ICAs), rather than one (as in previous work). We employ digital credentials (containing a specially-designed attribute based on bilinear maps) as the blind tokens issued by the ICAs, which allows a user to easily obtain multiple layers of pseudonymization prior to interacting with the PKG. As a result, our proposed architecture does not rely on unrealistic non-collusion assumptions and allows a user to reduce the probability of a privacy breach to an arbitrarily small value.

This paper extends previous work to strengthen the enforcement portion of a comprehensive architecture for enforcing privacy when a user needs to submit personal data to an Internet website in order to obtain goods or services. Our extension proposes to use a website's P3P privacy policy (derived in an automated way from its internal XACML access control policy) as a public key to encrypt the user's data using IBE (identity-based encryption) technology. The website will only acquire the corresponding private key to decrypt this data if a trusted 3rd-party auditor (acting as an IBE private key generator) has verified that the P3P policy is an accurate statement of the site's internal privacy practices. We discuss all the components of this model and describe our proof-of-concept implementation which demonstrates that such an architecture is feasible in real-world scenarios.

Multiple primary cancers, although uncommon, have been increasing in incidence in recent years. This trend is likely due to advances in factors such as diagnostic imaging, life expectancy, and interventional modalities with associated adverse effects. The patient presented in this case report is a 59-year-old Caucasian female with an extensive medical history who developed multiple primary cancers of the breast, mouth, gastrointestinal system, and lung in the span of four years. We attempted to elucidate the possible etiologies and risk factors that may have contributed. Given the patient’s complex medical and social history, interventions, environmental, and genetic predispositions, it is impossible to pinpoint a single etiology. Rather, it is more likely that the interplay of multiple factors contributed to the findings of this case.

Estuaries include some of the most productive yet anthropogenically impacted marine ecosystems on the planet, and provide critical habitat to many ecologically and economically important marine species. In order to elucidate ecological function in estuaries, we must understand what factors drive community dynamics. Delaware Bay is the third largest estuary in the United States and hosts over 200 species of migrant and resident fishes and invertebrates. The Delaware Division of Fish and Wildlife has conducted two long-term trawl surveys at monthly intervals in Delaware Bay since 1966. The two surveys collect data on environmental conditions, species composition, and number of fishes and macroinvertebrates across different size classes and life histories. Using a suite of multivariate approaches including hierarchical cluster analysis, canonical correlation analysis, and permutational multivariate analysis of variance, we characterized the fish and macroinvertebrate community in Delaware Bay and found that community composition and environmental conditions varied across spatial and seasonal scales. We identified four distinct biogeographic regions, based on environmental conditions and community composition, which were consistent across surveys. We found that the community was driven primarily by gradients in temperature and salinity and that abundant, frequently occurring species in the Bay have well-defined environmental associations. Our work represents the first attempt to use an existing historical survey to better understand how environmental parameters influence diversity and distribution of macrofauna within Delaware Bay, providing insight into how abiotic variables, influenced by climate, may impact the Delaware Bay ecosystem and similar estuarine ecosystems worldwide.

BackgroundEffective therapies for reducing cardiovascular disease (CVD) risk in people with elevated lipoprotein(a) are lacking, especially for primary prevention. Because of the potential association of lipoprotein(a) with thrombosis, we evaluated the relationship between aspirin use and CVD events in people with elevated lipoprotein(a).Methods and resultsWe used data from the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of individuals free of baseline cardiovascular disease. Due to potential confounding by indication, we matched aspirin users to nonusers using a propensity score based on CVD risk factors. We then evaluated the association between aspirin use and coronary heart disease (CHD) events (CHD death, nonfatal myocardial infarction) stratified by baseline lipoprotein(a) level (threshold of 50 mg/dL) using Cox proportional hazards models with adjustment for CVD risk factors. After propensity matching, the study cohort included 2183 participants, including 1234 (57%) with baseline aspirin use and 423 (19%) with lipoprotein(a) >50 mg/dL. Participants with lipoprotein(a) >50 mg/dL had a higher burden of CVD risk factors, more frequent aspirin use (61.7% versus 55.3%, P=0.02), and higher rate of incident CHD events (13.7% versus 8.9%, P50 mg/dL and aspirin use had similar CHD risk as those with lipoprotein(a) ≤50 mg/dL regardless of aspirin use.ConclusionsAspirin use was associated with a significantly lower risk for CHD events in participants with lipoprotein(a) >50 mg/dL without baseline CVD. The results of this observational propensity-matched study require confirmation in studies with randomization of aspirin use.

Across internally fertilising species, males transfer ejaculate proteins that trigger wide-ranging changes in female behaviour and physiology. Much theory has been developed to explore the drivers of ejaculate protein evolution. The accelerating availability of high-quality genomes now allows us to test how these proteins are evolving at fine taxonomic scales. Here, we use genomes from 264 species to chart the evolutionary history of Sex Peptide (SP), a potent regulator of female post-mating responses in Drosophila melanogaster. We infer that SP first evolved in the Drosophilinae subfamily and has since followed markedly different evolutionary trajectories in different lineages. Outside of the Sophophora-Lordiphosa, SP exists largely as a single-copy gene with independent losses in several lineages. Within the Sophophora-Lordiphosa, the SP gene family has repeatedly and independently expanded. Up to seven copies, collectively displaying extensive sequence variation, are present in some species. Despite these changes, SP expression remains restricted to the male reproductive tract. Alongside, we document considerable interspecific variation in the presence and morphology of seminal microcarriers that, despite the critical role SP plays in microcarrier assembly in D. melanogaster, appears to be independent of changes in the presence/absence or sequence of SP. We end by providing evidence that SP's evolution is decoupled from that of its receptor, Sex Peptide Receptor, in which we detect no evidence of correlated diversifying selection. Collectively, our work describes the divergent evolutionary trajectories that a novel gene has taken following its origin and finds a surprisingly weak coevolutionary signal between a supposedly sexually antagonistic protein and its receptor.

Vocabulary instruction is a critical component of language and literacy lessons, yet few studies have examined the nature and extent of vocabulary activities in early elementary classrooms. We explored vocabulary activities during reading lessons using video observations in a sample of 2nd- and 3rd-grade students (n = 228) and their teachers (n = 38). Teachers spent more time in vocabulary activities than has been previously observed. In the fall, 28% of their literacy block was devoted to vocabulary in 2nd grade and 38% in 3rd grade. Our findings suggest that vocabulary activities were most likely to take place prior to reading a text—teachers rarely followed-up initial vocabulary activities after text reading. Analysis of teachers’ discourse moves showed more instructional comments and short-answer questions than other moves; students most frequently engaged in participating talk, such as providing short, simple answers to questions. Students engaged in significantly more talk during vocabulary activities (including generative talk such as initiating an idea) in the spring of 3rd grade than the spring of 2rd grade. These data contribute descriptive information about how teachers engage their students in vocabulary learning during the early elementary years. We discuss implications for practice and future research directions.

Effective emergency (such as a hurricane, a building on fire, and so on) response requires accurate, relevant, timely, and location-aware information (e.g., environmental information, health records, and so on). Acquiring information in such critical situations encounters substantial challenges, such as large volume of data processing, unstructured data, privacy, authorized data access, and so forth. Among the issues, access authorization has received little attention. Existing solutions for data authorization either do not scale well or merely consider a Break-the-Glass concept in which a master key is provided to the first responders (FRs) to decrypt the corresponding ciphertext. This may not only enable unauthorized users to access information, but it may also overwhelm FRs by the large volume of accessible data. To jointly address the aforementioned issues, this paper proposes a location-aware authorization scheme that enables FRs to access information provided that they are within a predefined distance from data owners at the time of an emergency. We innovatively integrate attribute-based encryption with broadcast encryption to incorporate dynamic attributes (i.e., location and time) into an access policy. Such attributes act as filters to eliminate data irrelevant to an ongoing emergency. As a result, our scheme provides authorized access to accurate, relevant, timely, and location-aware information. We provide extensive security analysis and performance evaluations to demonstrate the effectiveness of our scheme. The analysis shows that the scheme imposes constant communication and decryption computation overheads. Furthermore, the proposed scheme is proven chosen plain-text attack selectively secure based on m-bilinear Diffie-Hellman exponent assumption. It also addresses the key escrow problem.

Attention allows us to focus on relevant information while ignoring distractions. Effective suppression of distracting information is crucial for efficient visual search. Recent studies have developed two paradigms to investigate attentional suppression: cued-suppression which is based on top-down control, and learned-suppression which is based on selection history. While both types of suppression reportedly engage proactive control, it remains unclear whether they rely on shared mechanisms. This study aimed to determine the relationship between cued- and learned-suppression. In a within-subjects design, 54 participants performed a cued-suppression task where pre-cues indicated upcoming target or distractor colors, and a learned-suppression task where a salient color distractor was present or absent. No significant correlation emerged between performance in the two tasks, suggesting distinct suppression mechanisms. Cued-suppression correlated with visual working memory capacity, indicating reliance on explicit control. In contrast, learned-suppression correlated with everyday distractibility, suggesting implicit control based on regularities. These results provide evidence for heterogeneous proactive control mechanisms underlying cued- and learned-suppression. While both engage inhibition, cued-suppression relies on deliberate top-down control modulated by working memory, whereas learned-suppression involves implicit suppression shaped by selection history and distractibility traits.

The authors explored how art centers for people with disabilities -- a form of day program -- could collaborate with art museums to create inclusive and integrated programming with artists from the broader community. Museums are in a particularly salient period of a paradigm shift, becoming more socially responsive and considering audience engagement in terms of inclusion and diversity rather than simply numbers of visitors. Art centers for people with disabilities, which provide mentorship and exhibition opportunities, are often positioned within outsider art discourse. Critical pedagogy, Universal Design for Learning (UDL), and constructivism undergirded the theoretical framework of the research project. Transformative possibilities abound when visitors with disabilities are centered in the design phase of art museum education programs.

An abundance of academic resources exists for supporting college students enrolled in science, technology, engineering, and mathematics (STEM) majors. However, the dearth of research on supporting STEM students' mental health is concerning, as STEM students face unique risks for mental health distress and utilize mental health services at lower rates than their counterparts. To begin addressing this gap in the literature, we found statistically significant structural links from STEM students' perceived social support from friends and family to increases in their mental health. Results also revealed that male STEM students self-reported higher levels of mental health than female students. Findings are discussed in terms of implications for practice, including how college counselors and psychotherapists can use social support as one method for supporting STEM students' mental health.

All teachers need ongoing coaching that helps them recognize areas of strength and need for teaching students with disabilities. Unfortunately, the amount, quality, and speed with which teachers receive feedback from coaches, administrators, mentors, or other instructional leaders on their academic and behavior management practices is limited. In this article, we describe a multimedia professional development option for documenting teacher practice, generating feedback, and delivering targeted instruction.

This study examined several possible factors determining the profitability of small scale crop farmers in Trinidad and Tobago in the Caribbean. Industrial/urban influence on profit efficiency was tested by the creation of a special variable (IFOUR). This variable along with farming and socio-economic variables were incorporated into a translog augmented stochastic profit frontier. The significance of coefficients was tested as well as the calculation of the elasticity of profit with respect to the wage rate. The study found a significant negative impact of wage rates on profitability. Also the age of the farmer negatively affected profitability, while the number of years farming had a positive effect. This latter variable also significantly influenced both the one-sided error and idiosyncratic error terms. However IFOUR measuring industrial/urban influence did not significantly affect the profitability. The farmers had a mean profit efficiency of 48.4%, which was low in international comparisons.