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\"This is the only Jordan guide with Arabic script next to every place name and with expanded coverage of adventure pursuits including trekking by horse or camal, hiking, canyoning and ecotourism opportunities.\"--Publisher's description.

Common variable immunodeficiency disorders (CVIDs) are the most frequent symptomatic primary immune deficiency condition in adults. The genetic basis for the condition is not known and no single clinical feature or laboratory test can establish the diagnosis; it has been a diagnosis of exclusion. In areas of uncertainty, diagnostic criteria can provide valuable clinical information. Here, we compare the revised European society of immune deficiencies (ESID) registry (2014) criteria with the diagnostic criteria of Ameratunga et al. (2013) and the original ESID/pan American group for immune deficiency (ESID/PAGID 1999) criteria. The ESID/PAGID (1999) criteria either require absent isohemagglutinins or impaired vaccine responses to establish the diagnosis in patients with primary hypogammaglobulinemia. Although commonly encountered, infective and autoimmune sequelae of CVID were not part of the original ESID/PAGID (1999) criteria. Also excluded were a series of characteristic laboratory and histological abnormalities, which are useful when making the diagnosis. The diagnostic criteria of Ameratunga et al. (2013) for CVID are based on these markers. The revised ESID registry (2014) criteria for CVID require the presence of symptoms as well as laboratory abnormalities to establish the diagnosis. Once validated, criteria for CVID will improve diagnostic precision and will result in more equitable and judicious use of intravenous or subcutaneous immunoglobulin therapy.

Contains magic tricks that are based in important physics concepts such as gravity, inertia, magnetism, sound vibrations, and more.

Hereditary angioedema (HAE) is a rare genetic disorder characterized by recurrent episodes of skin and mucosal edema. The main treatment goal is to enable a “normal life” for all patients. However, due to high costs, there are limited options for the management of HAE in most developing and low-income countries. As a result, most of the recommended first-line treatments are not available. In this review, we attempt to highlight the disparities in health-care resources for the management of patients with HAE amongst different countries. Data was collected from HAE experts in countries who provide tabulated information regarding management and availability of HAE treatments in their countries. We reviewed the two most recent international HAE guidelines. Using India, the world’s second most populous country, as a paradigm for HAE management in lower-income countries, we reviewed the evidence for second-line and non-recommended practices reported by HAE experts. Results suggest significant inequities in provision of HAE services and treatments. HAE patients in low-income countries do not have access to life-saving acute drugs or recently developed highly effective prophylactic medications. Most low-income countries do not have specialized HAE services or diagnostic facilities, resulting in consequent long delays in diagnosis. Suggestions for optimizing the use of limited resources as a basis for future discussion and reaching a global consensus are provided. There is an urgent need to improve HAE services, diagnostics and treatments currently available to lower-income countries. We recommend that all HAE stakeholders support the need for global equity and access to these essential measures.

The mRNA COVID vaccines are only licensed for intramuscular injection but it is unclear whether successful intramuscular administration is required for immunogenicity. In this observational study, eligible adults receiving their first ComirnatyTM/BNT162b2 dose had their skin to deltoid muscle distance (SDMD) measured by ultrasound. The relationship between SDMD and height, weight, body mass index, and arm circumference was assessed. Three needle length groups were identified: ‘clearly sufficient’ (needle exceeding SDMD by >5 mm), ‘probably sufficient’ (needle exceeding SDMD by ≤ 5 mm), and ‘insufficient’ (needle length ≤ SDMD). Baseline and follow-up finger prick blood samples were collected and the primary outcome variable was mean spike antibody levels in the three needle length groups. Participants (n = 402) had a mean age of 34.7 years, BMI 29.1 kg/m2, arm circumference 37.5 cm, and SDMD 13.3 mm. The SDMD was >25 mm in 23/402 (5.7%) and >20 mm in 61/402 (15.2%) participants. Both arm circumference (≥40 cm) and BMI (≥33 kg/m2) were able to identify those with a SDMD of >25 mm, the length of a standard injection needle, with a sensitivity of 100% and specificities of 71.2 and 79.9%, respectively. Of 249/402 (62%) participants with paired blood samples, there was no significant difference in spike antibody titres between needle length groups. The mean (SD) spike BAU/mL was 464.5 (677.1) in 'clearly sufficient needle length' (n = 217) compared with 506.4 (265.1) in 'probably sufficient' (n = 21, p = 0.09), and 489.4 (452.3) in 'insufficient needle length' (n = 11, p = 0.65). A 25 mm needle length is likely to be inadequate to ensure vaccine deposition within the deltoid muscle in a small proportion of adults. Vaccine-induced spike antibody titres were comparable in those vaccinated with a needle of sufficient versus insufficient length suggesting deltoid muscle deposition may not be required for an adequate antibody response to mRNA vaccines.

Common variable immunodeficiency (CVID) is a primary immunodeficiency disease. We present a case of a patient with CVID complicated by rhinosinusitis with granulomatous inflammation. Treatment for this patient was challenging with regards recognition of the granulomatous manifestation as well as treatment in the setting immunodeficiency and was ultimately unsuccessful. Granulomatous inflammation affecting the sinonasal mucosa should be considered in patients with CVID and recalcitrant chronic rhinosinusitis. Appropriate treatment is challenging, balancing immune suppression with an existing immune defect.

Autoinflammatory syndromes result from a defective innate immune system. They are characterised by unexplained fever and systemic inflammation involving the skin, muscle, joints, serosa and eyes, along with elevated acute phase reactants. Autoinflammatory syndromes are increasingly recognised as a cause of neurological disease with a diverse range of manifestations. Corticosteroids, colchicine and targeted therapies are effective if started early, and hence the importance of recognising these syndromes. Here, we review the neurological features of specific autoinflammatory syndromes and our approach (as adult neurologists) to their diagnosis.

LEARNING POINTS In acute angio-oedema a detailed history may show that a food, drug, or sting triggers acute angio-oedema Stop angiotensin converting enzyme (ACE) inhibitors in any patient who develops angio-oedema In recurrent angio-oedema without urticaria, consider conditions including angio-oedema induced by ACE inhibitors and C1 inhibitor deficiency. Screen for C1 inhibitor deficiency in these patients (including those taking ACE inhibitors) by measuring C4 levels, and if levels are low refer for confirmation of diagnosis Chronic spontaneous urticaria associated with angio-oedema is unlikely to be IgE mediated, and investigation for the presence of specific IgE is rarely indicated

All university faculty pursuing scholarly goals tackle complex tasks over long periods, yet some must overcome additional adversity and challenges to succeed. Recent studies have measured faculty research success according to their self-reported accomplishments in research activities, publications, and grant writing, and motivation was a predictor of success (Stupnisky, BrckaLorenz, et al., 2019; Stupnisky et al., 2023). This dissertation describes a three-study program of research that examined how faculty navigated barriers to research success through the lens of different theories of motivation.Faculty face barriers in completing research because it often involves a lengthy and emotion filled process, from research design to literature review, sampling, data collection, analysis, and writing; thus, Study 1 examined faculty grit, or passion and perseverance toward long-term goals (Duckworth et al., 2007) as well as the Control-Value Theory of Emotions (Pekrun & Perry, 2014). Counseling psychology faculty were recruited (N = 131) and two structural equation models tested if grit and emotions predicted perceived teaching (Model 1) and research success (Model 2). Results showed that grit predicted control and value, which in turn predicted emotions, and then perceived research success. Grit, however, did not predict control and value for teaching. Study 2 used an Exploratory Mixed-Methods design to examine how a major societal event that created significant work and life barriers for faculty, the COVID-19 pandemic, impacted research motivation and success. Researchers conducted 12 focus groups of (N = 57) and collected survey data (N = 611) from Science, Technology, Engineering, and Mathematics (STEM) faculty, with both methods asking participants about the level of impact COVID-19 had on their research success. The qualitative phase yielded five themes of how COVID-19 impacted faculty research: dependent status, marital status, STEM field, and tenure status. Next, in the quantitative phase the Protection Motivation Theory (Norman et al., 2015) was applied to examine research value, control, competency, COVID-19 research impacts, and research success. Integration of the qualitative and quantitative analyses showed that faculty who had dependents and who were on the tenure track but not tenured experienced the most negative impact from COVID-19. Further, these impacts may have been due to a decreased level of control over their research, as research control was a strong predictor for research success among STEM faculty. Study 3 (N = 504) examined how a potential cognitive barrier, the symptomology of Attention Deficit/Hyperactivity Disorder (ADHD), impacts faculty self-determined motivation (Deci & Ryan, 2021) and research success. In an online survey of 504 faculty, ADHD symptomology was measured using the Adult ADHD Self-Report Scale (ASRS, v1.1 Screener, Kessler et al., 2005), which included two subscales measuring the inattentive and hyperactive/impulsive ADHD subtypes. Two structural equation models were tested that examined the ADHD symptomology using the whole scale and, separately, the two subtypes. Findings from the first model showed that the ASRS predicted basic psychological needs, motivation, and, in turn, research success.; however, when ADHD symptoms were separated into two subscales only inattentiveness predicted basic needs, motivation, and research success. These three studies in the current program of research examined a range of barriers that are associated with faculty motivation and research success. Faculty members who identify with each of these barriers (long-term tasks, COVID-19, ADHD symptoms) will find this valuable information as they navigate their research. First, when struggling to complete long-term tasks, STEM faculty can use the findings from the current research to understand how grit influences motivation and start to think about ways to improve their grit, which may ultimately improve their motivation and research success. Second, although future STEM faculty members may not experience a global pandemic in their careers, this research highlights how factors such as staying home with dependents, losing access to data collection, and threats toward career development are associated with research success. Factors such as these can occur at any time in STEM faculty careers so studying them during a pandemic will help prepare faculty and administration when these factors occur outside of a pandemic. Finally, examining the barrier of unmanaged ADHD symptoms will highlight how important it may be to identify STEM faculty experiencing these symptoms and how these symptoms are associated with decreased psychological needs toward their research. Further, this research could help identify a public health need for STEM faculty in diagnosis and treatment of ADHD by first examining how the elevated symptoms could be associated with decreased productivity.

Proposes a decoy strategy to reduce morbidity and mortality amongst groups at high risk of COVID-19, using inhaled modified recombinant human cell surface angiotensin converting enzyme 2 (ACE2), which may bind the virus and mitigate lung damage. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.