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Allergy Electronic Health Record Documentation: A 2022 Work Group Report of the AAAAI Adverse Reactions to Drugs, Biologicals, and Latex Committee
No full textThe allergy section of the electronic health record (EHR) is ideally reviewed and updated by health care workers during routine outpatient visits, emergency room visits, inpatient hospitalizations, and surgical procedures. This EHR section has the potential to help proactively and comprehensively avoid exposures to drugs, contact irritants, foods, and other agents for which, based on an individual’s medical history and/or genetics, there is increased risk for adverse outcomes with future exposures. Because clinical decisions are made and clinical decision support is triggered based on allergy details from the EHR, the allergy module needs to provide meaningful, accurate, timely, and comprehensive allergy information. Although the allergy section of the EHR must meet these requirements to guide appropriate clinical decisions and treatment plans, current EHR allergy modules have not achieved this standard. We urge EHR vendors to collaborate with allergists to optimize and modernize allergy documentation. A work group within the Adverse Reactions to Drugs, Biologicals, and Latex Committee of the American Academy of Allergy, Asthma & Immunology was formed to create recommendations for allergy documentation in the EHR. Whereas it is recognized that the term “allergy” is often used incorrectly because most adverse drug reactions (ADRs) are not true immune-mediated hypersensitivity reactions, “allergy” in this article includes allergies and hypersensitivities as well as side effects and intolerances. Our primary objective is to provide guidance for the current state of allergy documentation in the EHR. This guidance includes clarification of the definition of specific ADR types, reconciliation of confirmed ADRs, and removal of disproved or erroneous ADRs. This document includes a proposal for the creation, education, and implementation of a drug allergy labeling system that may allow for more accurate EHR documentation for improved patient safety
Fire interval and post-fire climate effects on serotinous forest resilience
Get PDFBackground
Climate change is eroding forest resilience to disturbance directly through warming climate and indirectly through increasing disturbance activity. Forests characterized by stand-replacing fire regimes and dominated by serotinous species are at risk when the inter-fire period is insufficient for canopy seed bank development and climate conditions for recruitment in the post-fire growing season are unsuitable. Although both factors are critical to serotinous forest persistence, their relative importance for post-fire regeneration in serotinous forests remains poorly understood. To assess the relative effects of each factor, we established plots in severely burned knobcone pine (Pinus attenuata Lemmon) forests in Oregon and California, USA, representing a range of past fire intervals (6 to 31+ years). Specifically, we evaluated effects of fire interval and pre-fire canopy seed bank (proxies for seed supply) and post-fire climate on three metrics of post-fire tree regeneration (seedling density, probability of self-replacement, percent population recovery).
Results
Seed supply consistently had the strongest effect on post-fire regeneration. Between 6- and 31-year fire intervals, post-fire seedling density increased from 1000 to 100,000 seedlings ha−1, while probability of self-replacement increased from ~ 0 to ~ 100% and percent population recovery increased from 20 to 2000% of the pre-fire population, respectively. Similarly, increasing the canopy seed bank by two orders of magnitude increased seedling density and percent population recovery by two orders and one order of magnitude, respectively, and increased the probability of self-replacement by > 50%. Greater post-fire climatic moisture deficit exacerbated the effect of seed supply; an additional 4–6 years between fires was required under high moisture stress conditions to reach similar regeneration levels as under low moisture stress conditions.
Conclusion
The overriding effect of seed supply—strongly driven by pre-fire stand age—on post-fire regeneration suggests that altered fire frequency (an indirect effect of climate change) will have a profound impact on serotinous forests. Although direct effects of hot and dry climate are lower in magnitude, they can alter forest recovery where seed supply nears a threshold. These findings reveal how fire interval and climate combine to determine changes in forest cover in the future, informing management and vulnerability mapping
Financial risk protection against noncommunicable diseases: trends and patterns in Bangladesh
No full textBackground
Demographic and epidemiological transitions are changing the disease burden from infectious to noncommunicable diseases (NCDs) in low- and middle-income countries, including Bangladesh. Given the rising NCD-related health burdens and growing share of household out-of-pocket (OOP) spending in total health expenditure in Bangladesh, we compared the country’s trends and socioeconomic disparities in financial risk protection (FRP) among households with and without NCDs.
Methods
We used data from three recent waves of the Bangladesh Household Income and Expenditure Survey (2005, 2010, and 2016) and employed the normative food, housing (rent), and utilities method to measure the levels and distributions of catastrophic health expenditure (CHE) and impoverishing effects of OOP health expenditure among households without NCDs (i.e. non-NCDs only) and with NCDs (i.e. NCDs only, and both NCDs and non-NCDs). Additionally, we examined the incidence of forgone care for financial reasons at the household and individual levels.
Results
Between 2005 and 2016, OOP expenses increased by more than 50% across all households (NCD-only: USD 95.6 to 149.3; NCD-and-non-NCD: USD 89.5 to 167.7; non-NCD-only: USD 45.3 to 73.0), with NCD-affected families consistently spending over double that of non-affected households. Concurrently, CHE incidence grew among NCD-only families (13.5% to 14.4%) while declining (with fluctuations) among non-NCD-only (14.4% to 11.6%) and NCD-and-non-NCD households (12.9% to 12.2%). Additionally, OOP-induced impoverishment increased among NCD-only and non-NCD-only households from 1.4 to 2.0% and 1.1 to 1.5%, respectively, affecting the former more. Also, despite falling over time, NCD-affected individuals more frequently mentioned prohibiting treatment costs as the reason for forgoing care than the non-affected (37.9% vs. 13.0% in 2016). The lowest quintile households, particularly those with NCDs, consistently experienced many-fold higher CHE and impoverishment than the highest quintile. Notably, CHE and impoverishment effects were more pronounced among NCD-affected families if NCD-afflicted household members were female rather than male, older people, or children instead of working-age adults.
Conclusions
The lack of FRP is more pronounced among households with NCDs than those without NCDs. Concerted efforts are required to ensure FRP for all families, particularly those with NCDs
Correction to: Doping sodium tungsten Bronze-Like (Na5W14O44) Near-Infrared shielding functional units in bulk Borosilicate glasses for Energy-Saving window applications
No full textIn the version of this article initially published, there was an error in the period of 2021–2022 in “the Chinese–Ukrainian International Exchange Project for the Period of 2021–2022 of Ministry of Science and Technology of China” in the Acknowledgments section, which should be 2022–2023 in the form of “the Chinese–Ukrainian International Exchange Project for the Period of 2022–2023 of Ministry of Science and Technology of China”
Serum amino acid ratios as proxies to mechanisms contributing to improved metabolic health after bariatric surgery: Basic science and research in bariatric surgery
No full textAbstract taken from 25th IFSO World Congress Silver Anniversary #O-35
Understanding the role, quality of life and strategies used by older carers of older people to maintain their own health and Well-Being: A national Australian survey
Get PDFIntroduction: Carers play a critical role in supporting older people with health problems to remain living at home. This study aimed to understand the role and quality of life of older carers of older people and identify strategies used to manage their own health and well-being.
Methods: Older carers (aged ≥ 50 years) of older people (aged ≥ 65 years) in Australia participated in a cross-sectional survey focused on carer roles, self-rated health, information and activities used to maintain their carer role and health, barriers to accessing health care, and assessment of quality of life (QoL) using the Dementia Quality of Life Scale for Older Family Carers. Multiple regression analysis examined relationships between variables and the QoL outcome.
Results: The survey was completed by 189 older carers (mean age: 68 years; SD = 9.3). Most were female (83.5%), 80.2% providing care daily and 47.8% provided ≥six hours care daily. Almost half (45.1%) self-reported their health as average or below. Despite rating ensuring personal health as very important (mean importance 8/10), only 46.3% reported receiving support from their general practitioner for their carer role. The most common barrier to accessing care for themselves was “not having enough time”. Factors independently associated with poorer carer QoL were living with the care-recipient, caring for someone with depression/anxiety and poor care-recipient health. Factors independently associated with higher carer QoL were placing high importance on personal health, receiving assistance from a specialist clinic as a carer, and older age.
Conclusion: Older carers of older people provide high levels of care and experience reduced quality of life. Innovative approaches that provide integrated care and support for older carers to promote their QoL are urgently needed
Comparisons between sequenced and re-sequenced genomes of historical subterranean clover mottle virus isolates
Get PDFWe report comparisons between the complete genomic sequences of five historical Western Australian isolates of subterranean clover mottle virus (SCMoV) from 1989–2000, and an infectious clone of its 1989 isolate. Sanger Sequencing (SS) and High Throughput Sequencing (HTS), or both, were used to obtain these genomes. Four of the SCMoV isolates were sequenced by SS in 1999–2002, but re-sequenced again by HTS in 2020. The pairs of sequences obtained from these four isolates differed by only 18–59 nucleotides. This small difference resulted from the different sequencing methods, the < 1–5 years each isolate was host passaged before freeze-drying prior to HTS sequencing, or a combination of both. Since SCMoV has not been reported outside Australia, this similarity suggests the population sequenced represents the progeny of either an indigenous virus that spread from a native legume to subterranean clover after its introduction or a recent seed-borne incursion from elsewhere. The ORF1 was the most variable, and the phylogenetic tree constructed with ORF1s showed the isolates grouped according to their symptom severity in subterranean clover, indicating the probability that ORF1-encoded P1 protein is a symptom determinant. A satellite RNA was associated with all SCMoV genomes obtained by HTS but none derived by SS
A systematic review of optimal planning and deployment of distributed generation and energy storage systems in power networks
No full textClimate change is encouraging a growing interest worldwide to increase renewable distributed generation (DG) integration into the power grid. DG is free from greenhouse gas emissions and can assist in mitigating the energy crisis and reducing energy costs. However, due to its variable nature and bidirectional power flows, high penetration of such DGs, particularly solar and wind, might create significant problems. Some of the issues could be related to reduced power quality, excessive power loss, and low utilization rate of power equipment. Optimal DG allocation can effectively alleviate these challenges by enhancing voltage stability, relieving the overloads of feeders, and improving the reliability of the power grid. Introducing energy storage systems (ESSs) in the network provide another possible approach to solve the above problems by stabilizing voltage and frequency. Therefore, it is essential to allocate distributed ESSs optimally on the distribution network to fully exploit their advantages. Enormous research effort has been put into these areas over the last decade by industries, utilities, and research communities. This paper presents an extensive review on the optimal planning and deployment of DGs, ESSs, and coordinated DGs and ESSs. This paper also will look at their strengths and weaknesses, the barriers to their implementation, and the associated technologies used in their implementation. Finally, this paper reviews the methods of uncertainty modelling in DG and ESS planning and their merits and drawbacks. This review includes a survey of the deployment planning approaches and investigates challenges with recommendations for future deployment. This review will be beneficial for use by utilities, researchers, investors, and stakeholders when considering the future deployment of DGs and ESSs in distribution networks to ensure a reliable and sustainable power system
Actuators and sensors for application in agricultural robots: A review
Get PDFIn recent years, with the rapid development of science and technology, agricultural robots have gradually begun to replace humans, to complete various agricultural operations, changing traditional agricultural production methods. Not only is the labor input reduced, but also the production efficiency can be improved, which invariably contributes to the development of smart agriculture. This paper reviews the core technologies used for agricultural robots in non-structural environments. In addition, we review the technological progress of drive systems, control strategies, end-effectors, robotic arms, environmental perception, and other related systems. This research shows that in a non-structured agricultural environment, using cameras and light detection and ranging (LiDAR), as well as ultrasonic and satellite navigation equipment, and by integrating sensing, transmission, control, and operation, different types of actuators can be innovatively designed and developed to drive the advance of agricultural robots, to meet the delicate and complex requirements of agricultural products as operational objects, such that better productivity and standardization of agriculture can be achieved. In summary, agricultural production is developing toward a data-driven, standardized, and unmanned approach, with smart agriculture supported by actuator-driven-based agricultural robots. This paper concludes with a summary of the main existing technologies and challenges in the development of actuators for applications in agricultural robots, and the outlook regarding the primary development directions of agricultural robots in the near future
289.1 Evaluation of a rapid screening test as an effective tool in decentralizing ADAMTS13 activity testing - report from the rapid assessment of plasma in microangiopathic thrombocytopenia (RAPMAT) study
No full textBackground: Thrombotic thrombocytopenia purpura (TTP) is a rare life-threatening disease and timely diagnosis is critical. An ADAMTS13 activity level of < 10 IU/dl is used to differentiate TTP from other thrombotic microangiopathic thrombocytopenia (TMAT) diagnosis. Current test iterations based on FRET, ELISA or chemiluminescence assays are time consuming, have long turnaround times or are not readily available.
Aims: To evaluate and compare a rapid flow through screening test (Technoclone, Vienna) against a VWF73 ADAMTS13 activity ELISA (Technoclone, Vienna) and an ADAMTS13 automated chemiluminescence method (Acustar - Werfen).
Methods: De- identified suspect and confirmed TTP plasmas (n = 120) from 6 diagnostic laboratories in Australia and New Zealand were collected. Study was approved by MU HREC for assay development and calibration (Permit No. 2013/131). Local and central measurement of ADAMTS13 activity level comparison was made with the flow through test and functional ELISA assay. Additionally, the central study site also included a chemiluminescence method. The semi quantitative screening test assigns ADAMTS13 to one of four level indicator guides: 0, 10, 40 and 80 IU/dl.
Results: ADAMTS13 activity levels from local and central study sites were comparable, (r2 = 0.78) as was the correlation with the chemiluminescence and ELISA methods (r2 = 0.86). All but 1 of the rapid flow through results confirmed the quantitative ELISA results of <10 IU/dl, the TTP diagnostic threshold. There were 2 results of 40 IU/dl that were <10 IU/dl by the ELISA assay and no results at 80 IU/dl resulted in activity levels less than <10 IU/dl by the ELISA assay.
Conclusion(s): The rapid flow through test provides an initial time critical semi-quantitative ADAMTS13 evaluation. A semi quantitative value of 80 IU/dl does not require an urgent ADAMTS13 assay. The point of care test makes it suitable for all laboratories, especially regional laboratories where quantitative levels are not performed