We report for the first time the case of allergy to egusi seeds in an atopic child of Nigerian origin with allergy to other seeds and nuts. This case highlights the need to know and explore less common foods as potential allergens, the importance of modified skin prick testing and the basophil activation test to support the diagnosis of rare food allergies and of awareness about world cuisine and exotic foods as potential allergens.

This spring, instructors moved their courses online in an emergency fashion as campuses were closed due to the pandemic. As colleges prepare for the next academic year, there is a need to provide flexible instruction that is more intentional for quality online learning. We taught two undergraduate courses online for the first time this spring and surveyed our students’ reactions to the course experiences. From our experiences and student feedback we identified design elements and activities that were beneficial in promoting student engagement, sense of connectivity, and learning. We describe four qualities for a successful transition to online learning: 1) big questions and core concepts; 2) peer groups including reflective writing; 3) outreach to broader scientific community; and 4) instructor’s social presence in the class. Our experience gives us confidence that courses can be redesigned for online without compromising rigor or essential learning goals.

Background: Asthma is a leading cause of pediatric hospitalization in the United States. Children hospitalized with asthma are often cared for in different care settings during a single hospitalization. Our objective was to study the reliability and safety of a new pediatric hospital-wide asthma severity score (HASS) across different care units within a single tertiary-care pediatric center. Methods. 150 patients between the ages of 2 and 18 years hospitalized with a principal diagnosis of status asthmaticus were included. Study patients were followed from initial triage in the emergency department until the time of medical readiness for discharge. Rates of medical errors, early transfers to a higher level of care and medically indicated hospital length of stay (LOS) were compared between 75 patients prior to and 75 patients after implementation of the HASS using retrospective chart review. Inter-rater reliability was determined by collecting independent HASS scores from blinded staff members after tandem or simultaneous patient assessment. Results. Inter-rater reliability among untrained staff members using the HASS was high. Rates of preventable adverse events and medical errors were low and not significantly different before and after implementation of the HASS. LOS was shorter after implementation of the HASS but without statistical significance. Rates of early transfer to a higher level of care were unchanged between study years. Conclusion. The HASS is a reliable asthma severity tool that can be used throughout hospitalization and also among multiple clinical providers to trend clinical progress and optimize communication, particularly during times of care handoffs.

To contain transmission of COVID-19, lockdown or strict restriction of people’s mobility outside their residence was imposed worldwide. In Nepal, the first phase of nationwide lockdown was observed from March 24 to July 21, 2020. This sudden halt in human activities brought positive and negative impacts on forests and wildlife. We undertook a study was undertaken to know the impact of the CoViD-19 lockdown on wildlife and forests in the protected areas (PAs) of Nepal. The study was carried in July and September 2020, data of illegal activities recorded by the PAs and also those reported by media were obtained and analyzed. Key Informant Interview (KII) was done with the park officers and security personnel by virtual communication that included telephone, messenger app, and ZOOM video meeting to collect detailed information and for verification. The collected data were categorized into four groups: i) wildlife killed, ii) wildlife injured, iii) arrest incidents related to forest crime, and iv) arrest incidents related to wildlife crime. Data from the fiscal year 2019-2020 were analyzed, comparing before lockdown and after. The study found trends of substantial increases in. wildlife death in two PAs, Banke National Park and Bardia National Park out of 20 during the lockdown. Similarly, Chitwan National Park (CNP) and Shivapuri Nagarjun National Park (SNNP) witnessed a rise in wildlife poaching. CNP and SNNP are located close to highly populated cities and also having human settlements in their peripheries. Interestingly, wildlife was easily sighted inside PAs during the lockdown, presumably because the absence of visitors and human activities during the lockdown decreased disturbance. Thus, a paradoxical situation was observed with the wildlife enjoying the freedom of movement on the one hand, but with poachers, many of them laid off from other activities, taking advantage of the lapse in security.

Contaminants derived from consumables, reagents, and sample handling often negatively affect LC-MS data acquisition. In proteomics experiments, they can markedly reduce identification performance, reproducibility, and quantitative robustness. Here, we introduce a data analysis workflow combining MS1 feature extraction in Skyline with HowDirty, an R-markdown-based tool, that automatically generates an interactive report on the molecular contaminant level in LC-MS data sets. To facilitate the interpretation of the results, the HTML report is self-contained and self-explanatory, including plots that can be easily interpreted. The R package HowDirty is available from https://github.com/DavidGZ1/HowDirty. To demonstrate a showcase scenario for the application of HowDirty, we assessed the impact of ultrafiltration units from different providers on sample purity after filter-assisted sample preparation (FASP) digestion. This allowed us to select the filter units with the lowest contamination risk. Notably, the filter units with the lowest contaminant levels showed higher reproducibility regarding the number of peptides and proteins identified. Overall, HowDirty enables the efficient evaluation of sample quality covering a wide range of common contaminant groups that typically impair LC-MS analyses, facilitating taking corrective or preventive actions to minimize instrument downtime.

Abstract: Background: The European Academy of Allergy and Clinical Immunology’s (EAACI) is updating the Guidelines on Food Allergy Diagnosis. We aimed to undertake a systematic review of the literature with meta-analyses to assess the accuracy of diagnostic tests for IgE-mediated food allergy. Methods: We searched three databases (Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase (OVID)) for diagnostic test accuracy studies published between 1 st October 2012 and 30 th June 2021 according to a previously published protocol (CRD42021259186). We independently screened abstracts, extracted data from full-texts, and assessed risk of bias with QUADRAS 2 tool in duplicate. Meta analyses were undertaken for food-test combination where 3 or more studies were available. Results: 149 studies comprising 24,489 patients met the inclusion criteria and were generally heterogeneous. 60.4% of studies were in children ≤12 years of age, 54.3% undertaken in Europe, ≥95% conducted in a specialized pediatric or allergy clinical setting and all included oral food challenge in at least a percentage of enrolled patients, in 21.5% DBPCFC. Skin prick test (SPT) with fresh cow’s milk and raw egg had high sensitivity (90% and 94%) for milk and cooked egg allergies. Specific IgE to individual components had high specificity: Ara h 2 had 92%, Cor a 14 95%, Ana o 3 94%, casein 93%, ovomucoid 92/91% for the diagnosis of peanut, hazelnut, cashew, cow’s milk and raw/cooked egg allergies, respectively. BAT was highly specific for the diagnosis of peanut (90%) and sesame (93%) allergies. Conclusions: SPT and specific IgE to extracts had high sensitivity whereas specific IgE to components and BAT had high specificity to support the diagnosis of individual food allergies. PROSPERO registration: CRD42021259186 Funding: European Academy of Allergy (EAACI).

Introduction: Although prolonged respiratory symptoms following SARS-CoV-2 infection have been reported in adults, there is a paucity of literature describing post-acute symptoms in pediatric patients following COVID-19. In this study we describe health data and respiratory findings in pediatric patients presenting with complaints of persistent respiratory symptoms following acute COVID-19 infection. Methods: This study included patients referred to Pulmonary Clinic at the Children’s Hospital of Philadelphia between December 2020 and April 2021 (n=29). Inclusion criteria included a history of SARS-CoV-2 RNA positivity or confirmed close household contact. A retrospective chart review was performed and demographic, clinical, imaging, and functional test data were collected. Results: The mean age at presentation to clinic was 13.1 years (range: 4-19 years). Patients had persistent respiratory symptoms ranging from 1.3 to 6.7 months post-acute infection. Persistent dyspnea and/or exertional dyspnea were present in nearly all (96.6%) of the patients at the time of clinic presentation. Other reported chronic symptoms included cough (51.7%) and exercise intolerance (48.3%). Fatigue was reported in 13.7% of subjects. Many subjects were overweight or obese (62.1%) and eleven subjects had a prior history of asthma. Lung function was normal in most patients. The six-minute walk test (6MWT) revealed exercise intolerance and significant tachycardia in two-thirds of children tested. Conclusion: Exertional dyspnea, cough and exercise intolerance were the most common respiratory symptoms in children with post-acute COVID-19 respiratory symptoms seen in an outpatient pulmonary clinic. Lung function, however, was mostly normal, and exertional intolerance was frequently demonstrated using the 6MWT.

Background Protecting the skin barrier in early infancy may prevent atopic dermatitis (AD). We investigated if daily emollient use from birth to 2 months reduced AD incidence in high risk infants at 12 months. Methods This was a single-center, two-armed, investigator-blinded, randomized controlled clinical trial (NCT03871998). Term infants identified as high risk for AD (parental history of AD, asthma or allergic rhinitis) were recruited within 4 days of birth and randomised 1:1 to either twice-daily emollient application for the first 8 weeks of life (intervention group), using an emollient specifically formulated for very dry, AD-prone skin, or to standard routine skin care (control group). The primary outcome was cumulative AD incidence at 12 months. AD <6 months was diagnosed based on clinical presence of AD. The UK Working Party Diagnostic Criteria were applied when diagnosing AD between 6 and 12 months. Results 321 infants were randomised (161 intervention and 160 control), with 61 withdrawals (41 intervention, 20 control). The cumulative incidence of AD at 12 months was 32.8% in the intervention group vs. 46.4% in the control group, p = 0.036 [Relative risk (95%CI): 0.707 (0.516, 0.965)]. One infant in the intervention group was withdrawn from the study following development of a rash that had a potential relationship with the emollient. There was no significant difference in the incidence of skin infections between the intervention and control groups during the intervention period (5.0% vs. 5.7%, P>0.05). Conclusions This study has demonstrated that early initiation of daily specialized emollient use until 2 months reduces the incidence of AD in the first year of life in high-risk infants.

Changing and moving toward online shopping has made it necessary to customize customers' needs and provide them more selective options. The buyers search the products' features before deciding to purchase items. The recommender systems facilitate the searching task for customers via narrowing down the search space within the specific products that align the customer needs. Clustering, as a typical machine learning approach, is applied in recommender systems. As an information filtering method, a recommender system clusters user's data to indicate the required factors for more accurate predictions by calculating the similarity between members of a cluster. In this study, using the Gaussian mixture model clustering and considering the scores distance and the value of scores in the Pearson correlation coefficient, a new method is introduced for predicting scores in machine learning recommender systems. To study the proposed method's performance, a Movie Lens data set is evaluated, and the results are compared to some other recommender systems, including the Pearson correlation coefficients similarity criteria, K-means, and fuzzy C-means algorithms. The simulation results indicate that our method has less error than others by increasing the number of neighbors. The results also illustrate that when the number of users increases, the proposed method's accuracy will increase. The reason is that the Gaussian mixture clustering chooses similar users and considers the scores distance in choosing similar neighbors to the active user.

Spatial and temporal heterogeneity, or messiness, is a broadly desirable characteristic of river corridors and an indicator of many of the geomorphic processes that sustain fluvial ecosystems. However, quantifying geomorphic heterogeneity is complicated by a lack of consistent metrics, classification schemas for dividing the river corridor into the patches that form the basis for those metrics, and guidance on interpreting metrics. Drawing from both geomorphic and landscape ecology concepts, we offer ideas and guidance intended to help investigators, from researchers to restoration practitioners, more effectively and reliably use heterogeneity to describe river corridor processes and characteristics. We define geomorphic heterogeneity both spatially and temporally. Spatially, heterogeneity can be described by diversity, or the evenness and richness of geomorphic units, and spatial configuration, or the arrangement and shape of geomorphic units. Temporally, heterogeneity can be described by turnover rate, or the rate of change of geomorphic units. Interpretation of heterogeneity metrics depends integrally on the definition of the geomorphic unit schema on which metrics are based. Contextual information, such as measurements of process space (i.e., how much room a river has to move), disturbance frequency, and geomorphic trajectory, can also be key to interpreting measurements of heterogeneity. Geomorphic applications of heterogeneity require carefully defined geomorphic unit schemas that reflect processes and characteristics of interest, robust metrics of heterogeneity whose meaning is appropriate to the question at hand, and interpretation of those metrics based on the context of expected geomorphic processes and the disturbance regime.

Reconstructing ecological niche evolution can provide insight into the biogeography and diversification of evolving lineages. However, comparative phylogenetic methods can infer the history of ecological niche evolution inaccurately because (1) species’ niches are often poorly characterized; and (2) phylogenetic comparative methods rely on niche summary statistics rather than full estimates of species’ environmental tolerances. Here we propose a new framework for coding ecological niches and reconstructing their evolution that explicitly acknowledges and incorporates the uncertainty introduced by incomplete niche characterization. Then, we modify existing ancestral state inference methods to leverage full estimates of environmental tolerances. We provide a worked empirical example of our method, investigating ecological niche evolution in the New World orioles (Aves: Passeriformes: Icterus spp.). Temperature and precipitation tolerances were generally broad and conserved among orioles, with niche reduction and specialization limited to a few terminal branches. Tools for performing these reconstructions are available in a new R package called nichevol.

Background and Purpose: In recent decades, a focus on the most critical and fundamental concepts has proven highly advantageous to students and educators in many science disciplines. Pharmacology, unlike microbiology, biochemistry or physiology, lacks a consensus list of such core concepts. Experimental approach: We sought to develop a research-based, globally relevant list of core concepts that all students completing a foundational pharmacology course should master. This two-part project consisted of exploratory and refinement phases. The exploratory phase involved empirical data mining of the introductory sections of five key textbooks, in parallel with an online survey of over 200 pharmacology educators from 17 countries across six continents. The refinement phase involved three Delphi rounds involving 24 experts from 15 countries across six continents. Key Results: The exploratory phase resulted in a consolidated list of 74 candidate core concepts. In the refinement phase, the expert group produced a consensus list of 25 core concepts of pharmacology. Conclusion and Implications: This list will allow pharmacology educators everywhere to focus their efforts on the conceptual knowledge perceived to matter most by experts within the discipline. Next steps for this project include defining and unpacking each core concept and developing resources to help pharmacology educators globally teach and assess these concepts within their educational contexts.

Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in profound health challenges across the globe. Pharmacists’ readiness to cope with the pandemic is critical in supporting and sustaining the healthcare workforce to meet the challenges.Objective This study aims to examine community pharmacists’ views on their work environment, policies, and preparedness for safe retail patronage to prevent the transmission of COVID-19 and assess the variables influencing coping strategies during the pandemic.Setting An online survey of pharmacists practicing in community pharmacy setting in Malaysia.Method A questionnaire-based, cross-sectional study was conducted in Malaysia to evaluate coping strategies of community pharmacists and pharmaceutical services provided during COVID-19 pandemic. Between May 1 and July 31, 2020, the questionnaire was distributed to pharmacists working in community setting nationwide utilizing a snowball sampling method. Main outcome measure Community pharmacists’ perceptions on safety, resilience, organizational support, and pharmaceutical services offered during COVID-19 pandemic.Results A total of 217 pharmacists participated in the study. The vast majority of community pharmacists reported a positive outlook and were able to balance working with self-care during this period. Most reported to have access to personal protective equipment such as gloves and hand sanitizers. A large proportion of community pharmacies also installed physical barriers in doorways or in front of the counter, put markings on the ground to section areas to ensure physical distancing, and controlled the number of customers who could access the pharmacy during this period. Innovations reported to be implemented included teleconsultations and providing curb-side or drive-through delivery and pickup services.  Conclusion The findings suggest the frontline and essential roles of community pharmacists in delivering pandemic responses, creating the opportunity to determine areas where community pharmacy services can be incorporated to strengthen the public health system and improve patient health outcomes.

This study compares the U.S. National Water Model (NWM) reanalysis snow outputs to observed snow water equivalent (SWE) and snow-covered area fraction (SCAF) at SNOTEL sites across the Western U.S. SWE was obtained from SNOTEL sites, while SCAF was obtained from MODIS observations at a nominal 500 m grid scale. Retrospective NWM results were at a 1000 m grid scale. We compared results for SNOTEL sites to gridded NWM and MODIS outputs for the grid cells encompassing each SNOTEL site. Differences between modeled and observed SWE were attributed to both model errors, as well as errors in inputs, notably precipitation and temperature. The NWM generally under-predicted SWE, partly due to precipitation input differences. There was also a slight general bias for model input temperature to be cooler than observed, counter to the direction expected to lead to under-modeling of SWE. There was also under-modeling of SWE for a subset of sites where precipitation inputs were good. Furthermore, the NWM generally tends to melt snow early. There was considerable variability between modeled and observed SCAF as well as the binary comparison of snow cover presence that hampered useful interpretation of SCAF comparisons. This is in part due to the shortcomings associated with both model SCAF parameterization and MODIS observations, particularly in vegetated regions. However, when SCAF was aggregated across all sites and years, modeled SCAF tended to be more than observed using MODIS. These differences are regional with generally better SWE and SCAF results in the Central Basin and Range and differences tending to become larger the further away regions are from this region. These findings identify areas where predictions from the NWM involving snow may be better or worse, and suggest opportunities for research directed towards model improvements.

Vaccination is a critical tool in the prevention of COVID-19 infection for individuals and for communities. The mRNA vaccines contain polyethylene glycol (PEG) as a stabilizer. Currently in North America only the BNT162b2 (Pfizer-BioNTech) mRNA vaccine is approved individuals 12 to 17 years of age. Most patients treated with contemporary regimens for acute lymphoblastic leukemia receive Peg-asparaginase and 10-30% will develop allergic reactions. Optimizing access and safety for vaccine administration for these patients critical. This report describes a process developed to support COVID vaccination in a cohort of adolescents and young adults with a history of PEG-asparaginase allergy.

BACKGROUND/OBJECTIVES: Survivors of pediatric brain tumors (BT) are at increased risk for difficulties with social competence, including poor social information processing (SIP) and peer relationships. Due to improved survival rates among BT, there is a need to better understand these challenges and if they are specific to BT versus other survivors of childhood cancer. METHODS: 51 BT and 34 survivors of pediatric solid tumors (ST) completed evaluations of SIP and peer relationship quality within 6 months of completing treatment and at one year follow-up. Caregivers also completed a measure of social skills. Linear mixed models evaluated (1) differences between BT and ST on SIP and social skills and (2) how indices of SIP were associated with peer relationships over time for ST and BT. RESULTS: BT did not differ from ST on indices of SIP or social skills over time. There was a three-way interaction between measures of SIP, group, and time to predict peer relationships. ST showed a positive association between baseline social skills and theory of mind and peer relationships over time, whereas BT showed an inverse association between baseline social skills and theory of mind and peer relationships over time. CONCLUSION: Baseline SIP and social skills affected the trajectory of BT peer relationships. BT social functioning should be monitored regularly after the completion of treatment to determine if and when intervention services would be beneficial.

The manifestations of COVID-19 as outlined by echocardiography, lung ultrasound (LUS) and cardiac magnetic resonance (CMR) imaging are yet to be fully described. We conducted a systematic review of the current literature and included studies that described cardiovascular manifestations of COVID-19 using echocardiography, LUS and CMR. We queried PubMed, EMBASE and Web of Science for relevant articles. Original studies and case series were included. This review describes the most common abnormalities encountered on echocardiography, LUS and CMR in patients infected with COVID-19.

We described eleven patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The younger age and female gender seem to contribute to poor outcomes possibly. Furthermore, the left ventricle ejection fraction and pro-BNP improvement within the first week of treatment might indicate a good prognosis.