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The probability hypothesis density (PHD) filter, which is used for multi-target tracking based on sensor measurements, relies on the propagation of the first-order moment, or intensity function, of a point process. This algorithm assumes that targets behave independently, an hypothesis which may not hold in practice due to potential target interactions. In this paper, we construct a second-order PHD filter based on determinantal point processes which are able to model repulsion between targets. Such processes are characterized by their first- and second-order moments, which allows the algorithm to propagate variance and covariance information in addition to first-order target count estimates. Our approach relies on posterior moment formulas for the estimation of a general hidden point process after a thinning operation and a superposition with a Poisson point process, and on suitable approximation formulas in the determinantal point process setting. The repulsive properties of determinantal point processes apply to the modeling of negative correlation between distinct measurement domains. Monte Carlo simulations with correlation estimates are provided.

Objectives Cow’s milk is a commonly implicated trigger in eosinophilic esophagitis (EoE). Exclusive cow’s milk avoidance has been reported previously, but the degree of elimination required for remission is unclear. Strict food avoidance may confer a risk of developing immunoglobulin E (IgE)-mediated allergy. The goal of this study was to evaluate the effectiveness of cow’s milk elimination (CME) in children with EoE and compare responses of strict and liberalized CME diets. Methods Children (≤16 years) diagnosed with EoE who were treated with exclusive CME diets were evaluated clinically and histologically. Strict diets eliminated all milk products, including ‘may-contain’ and baked milk goods. Liberalized diets eliminated obvious sources including milk, cheese, yogurt, cream-based products but permitted foods with traces of milk and baked goods. Results Cow’s milk elimination induced histological remission of

We report on a case of an F-16 pilot who suffered a compression fracture of the L5 vertebral body during centrifuge training. The pilot sustained the injury during a rapid onset to 6 G run. He was subsequently diagnosed to have osteopenia with a bone mineral density T-score of -1.95. This report discusses the medical and operational management of the pilot with this rare condition. The pilot has since returned to flying duties, albeit in a transport platform.

After a few years of difficulty swallowing solids and feeling like food was getting stuck, a 13-year-old boy in my practice with peanut allergy and asthma was recently diagnosed with eosinophilic esophagitis (EoE). What is EoE and how is it diagnosed and managed?Eosinophilic esophagitis is an immune-mediated disease resulting in inflammation of the esophagus. It is increasing in prevalence and incidence in countries like Canada, and frequently occurs in children with other allergic conditions. Unexplained feeding difficulties, vomiting, and solid-food dysphagia, especially in boys with atopy, supports the possibility of having EoE. A formal diagnosis is obtained by reviewing esophageal biopsies obtained through upper endoscopy performed while the patient is taking a proton pump inhibitor. Once EoE has been established, management should involve working collaboratively with gastroenterology and allergy specialists. Medical or dietary treatments are acceptable therapeutic approaches.

Eosinophilic esophagitis (EoE) is an allergic condition resulting from esophageal infiltration by eosinophils, with subsequent inflammation and possible narrowing of the esophagus. EoE is more common in whites, but a variable presentation has been recently documented in blacks in the United States. Canada’s ethnic population varies significantly from that of the United States, and in particular South Asians (defined according to criteria used by Statistics Canada, and included the following ethnic origins: Bangladeshi, Bengali, East Indian, Goan, Gujarati, Kashmiri, Nepali, Pakistani, Punjabi, Sinhalese, Sri Lankan, and Tamil) and East Asians (defined according to criteria used by Statistics Canada: people of Burmese, Cambodian, Chinese, Filipino, Indonesian, Japanese, Korean, Laotian, Malaysian, Mongolian, Singaporean, Taiwanese, Thai, Tibetan, and Vietnamese origins) comprise the largest visible minority groups in the province of British Columbia (BC). There is a lack of data for EoE among Asians living in North America. This letter describes the unique ethnic distribution of children with EoE in BC. The University of British Columbia Children’s Research Ethics Board approved this study. We reviewed all patients younger than 18 years in the multidisciplinary EoE Clinic at BC Children’s Hospital (BCCH) who prospectively consented to inclusion in our EoE registry over a 2-year period. BCCH is the only pediatric tertiary care facility in BC, making the EoE Clinic the only referral center for children with EoE in the province. Information was obtained by chart review, including variables examined in previous ethnic studies of EoE: age at diagnosis, sex, ethnicity, biopsy counts at diagnosis, history of atopy, symptoms, and treatment. Ethnicity was reported by the patient’s parent/ guardian. All endoscopies were performed at the BCCH. Histological findings were identified from pathology reports containing eosinophil counts. All recruited patients were symptomatic with 15 or more eosinophils/hpf from at least 1 biopsy, despite a trial of proton pump inhibitors. Shapiro-Wilk tests for normality, 2-tailed Mann-Whitney U tests (continuous variables), and Pearson c analyses (noncontinuous variables) were performed (SPSS, version 22.0, IBM Corp, Armonk, NY). The registry was created using REDCap software. Two individuals out of 65 had mixed ancestries and were excluded, limiting our analysis to 63 patients. Our cohort’s ethnic distribution was 71% (45) whites, 29% (18) South Asians, and no East Asians. Overall, 81% (51) were boys. South Asians were diagnosed at a significantly younger age than whites (mean age, South Asians vs whites 1⁄4 4.1 vs. 6.5 years; P 1⁄4 .005). Overall, differences in symptoms were not significant between ethnic groups. Vomiting was the most common symptom, experienced by 49% (31) of all patients, followed by dysphagia (37% [23]). Abdominal pain (22% [4]) was the least reported symptom. Children presented with vomiting at a mean age of 4.0 years (95% CI, 2.9-5.2), whereas dysphagia or odynophagia was experienced at a mean age of 9.4 years (95% CI, 7.4-11.4). Thirty-nine percent (7) of South Asians and 47% (21) of whites were atopic. Asthma was the most common allergic condition in South Asians (28% [5]); in whites, this was allergic rhinitis (31% [14]). On diagnosis, South Asians and whites presented with similar mean counts of eosinophils (South Asians vs whites 1⁄4 35.8 [95% CI, 26.8-44.8] vs 43.5 eosinophils/hpf [95% CI, 36.8-50.3]; P 1⁄4 nonsignificant). Treatment preferences varied significantly between ethnic groups. Medical treatment was used more frequently by whites than by South Asians (whites vs South Asians 1⁄4 51% [23] vs 22% [4]; P < .05). Conversely, dietary interventions were more favored by South Asians, including elimination and elemental diets (whites vs South Asians 1⁄4 49% [22] vs 78% [14]; P < .05). A similar study reporting a higher incidence of inflammatory bowel disease in South Asian pediatric patients led us to initially hypothesize a clustering of immune-based gastrointestinal disorders (eg, EoE) in South Asian children in BC. Instead, we observed a lack of East Asians in our registry (Figure 1). This is unexpected because there are more East Asian children than South Asian children in BC. Our findings contrast with other allergic conditions such as peanut allergy, which, for the BC population seen in our hospital, favors East Asian (41%) and white (52%) children compared with South Asians (7%) (E.S. Chan, unpublished raw data, 2015). It is worthwhile to note that despite a global distribution of EoE, there is a paucity of data on the prevalence of EoE in East Asians. There was also a lack of black Canadian children in our study; however, this is likely due to their small representation in the BC population (

Sibutramine is a serotonin and norepinephrine reuptake intake inhibitor approved for the management of obesity. It has various CNS adverse effects and a few case reports of psychiatric manifestations. Here, we report a case of severe catatonic and psychotic symptoms associated with sibutramine overuse in the patient who had no prior psychiatric history. The symptoms subsequently resolved completely with cessation. Given the widespread use of sibutramine, this case would be of interest to practitioners of internal medicine and psychiatry. Moreover, as sibutramine may be used for weight management in patients on antipsychotic medications, the implications on psychotic symptoms need to be explored further. We also discuss possible pathophysiologic underpinnings.

A tandem, proline-catalyzed α-chlorination/aldol reaction is described that involves a dynamic kinetic resolution of α-chloroaldehyde intermediates. The resulting syn-chlorohydrins are produced with good to excellent diastereoselectivity in high enantiopurity and provide new opportunities for the synthesis of carbohydrates.

Background Barriers to administering epinephrine auto injectors include failure to recognize signs and symptoms of anaphylaxis, administering oral antihistamines or asthma inhalers due to lack of education, failing to administer epinephrine correctly, fear of giving a needle, auto injector misplaced, and past experiences with spontaneous recovery. The aim of this study is to assess the impact of supervised auto injector administration by parents/patients on confidence, knowledge and skill for future treatment of severe allergic reactions. Methods