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Insurers pay for the test. Misunderstanding of how to interpret food sensitization tests is widespread among physicians (Photo: AFP) New York: Primary care doctors often use the wrong test to diagnose food allergies in children, new research shows. Costs for testing were about $400 per patient with primary care physicians, compared to about $200 for allergists.2 percent of allergists’ orders.“This is where true harm shower niche Manufacturers is coming from,” he said.Known as food allergy panels, these blood tests check for sensitization to several different allergens at once. The practice can lead to overdiagnosis, with potentially harmful effects, including stunted growth due to unnecessary dietary restrictions, Dr.”Stukus, of Nationwide Children’s Hospital in Columbus, Ohio, and his colleagues had observed that primary care doctors seemed much more likely than allergists to order food allergy panels. Andrew Bird, director of the Food Allergy Center at Children’s Health in Dallas and associate professor at UT Southwestern Medical Center, who wasn't involved in the study.

 To investigate, they looked at one year’s worth of data on food allergy testing at their hospital.”“The article underscores the importance of directed testing and understanding what tests you’re ordering and really not ordering a panel of food allergy tests for any reason,” said Dr. But allergists agree that children should be tested for sensitization to allergens one at a time, and only if there’s strong evidence for a true food allergy. “However, there are rare if any instances where the use of such panels would offer any useful information for patients.The results, published in Pediatrics, confirmed their suspicions: panel tests accounted for 45. “If you’re misdiagnosed with cow’s milk allergy, then you are at increased risk of having poor growth parameters compared to your peers who are on cow’s milk or a fortified formula,” he noted.Choosing Wisely, a public health campaign focused on reducing unnecessary and potentially harmful medical tests, specifically advises against using food allergy panels. In addition to putting children at risk of nutritional deficiency, Stukus noted, unnecessary dietary restrictions can actually increase a child’s likelihood of developing a true allergy down the road.Overdiagnosis of food allergy can have lasting ill effects, Bird said in a phone interview.1 percent of the food allergy tests ordered by primary care doctors, compared to 1.

These panels are marketed as convenient tools for physicians to obtain information about their patients regarding multiple allergens all at once,” Stukus said. “That’s what scares me as an allergist, and I’ve seen this in practice.Misunderstanding of how to interpret food sensitization tests is widespread among physicians and patients, Stukus said, often leading to children being misdiagnosed with food allergies and put on unnecessarily restricted diets.”. David Stukus, an author of the new study, told Reuters Health by phone. J.Known as food allergy panels, these blood tests check for sensitization to several different allergens at once, including many foods that don’t provoke allergic reactions, such as fruits, vegetables and different types of meat. “It’s really the long-term consequences of unnecessary avoidance that we worry about in terms of the kids’ growth

The Supreme Court, in 2013 had come down heavily on the CBI in a case related to the coal block scam, calling it a ‘caged parrot’. The Act is a clear violation of the safeguards laid down in the Vineet Narain case and the CVC Act. The report submitted by the Committee prefaced with the following words: “In the past several years, there has been progressive increase in allegation of corruption involving public servants. The report recommended better training, more manpower, greater powers of search and seizure, more insulation from political action, and more funding to enable better investigation.The recent events at the Central Bureau of Investigation involving the director and deputy director and the allegations of corruption and political obstruction that they have levied against each other, have yet again demonstrated that the premier investigative agency continues to be a political tool of the Central government.

The decisions of higher courts to directly monitor investigations in certain cases have added to the aforesaid belief. Precipitating the matter, the director filed an FIR against Mr Asthana and another officer Devender Kumar, for bribery and corruption.Background on the lawThe government of India set up an Independent Review Committee (IRC) way back in 1997 to monitor the functioning of the CBI, the ED, and related agencies and give recommendations to ensure that investigations against powerful persons happen freely and without any outside interference. Several U-turns taken by the CBI in politically sensitive cases such as those relating to Mayawati, Mulayam Singh Yadav, Tulsiram Prajapati, Vijay Mallya, Bofors, and the like, are well documented.The Supreme Court, in 2013 had come down heavily on the CBI in a case related to the coal block scam, calling it a ‘caged parrot’. Senior IPS officers such as the CBI director should have the legal wherewithal to refer the charges to the CVC or to another unbiased and independent agency.Subsequently, a standing committee of the Rajya Sabha, vide its report tabled in March 2008, found that the legal fabric underpinning the CBI was not robust and needed urgent intervention to enable the agency to have a stronger sanction of law, to enable it to investigate offences from the first instance, without fear or favour, in a time-bound manner.


This is contrary to the law declared by the apex court and legislation passed by Parliament.  Over the last few months, the director CBI and his deputy have been trading allegations of corruption against each other.In a bid to contain the disaster, the government, on the recommendation of the CVC summarily sent these two seniormost officers of the CBI on indefinite leave, in clear violation of the two-year security of tenure for the director laid down in law.On xps shower tray Factory further recommendation of the CVC, the government appointed the number three person in the CBI, Nageshwar Rao, as an interim director. Franklin?” He replied: “A republic, if you can keep it. The CVC failed to appreciate that while there was no process for appointment of interim director in the Act, the appointment must bear the review of the same process, which is approval from the joint committee. The bad blood between the officers led to the Mr Asthana filing detailed complaints against the director with the CVC for interfering in probes and accepting bribes in several politically sensitive cases, in August 2018.

The court gave supervisory status of the CBI to the Chief Vigilance Commission, provided for appointment of an independent Chief Vigilance Commissioner, and also created structure and fetters to the post, power and discretion of the CBI director. A general impression appears to have gained ground that the concerned Central investigating agencies are subject to extraneous pressures and have been indulging in dilatory tactics in not bringing the guilty to book. By passing these directions, the court has ensured that the procedure envisioned in the CVC Act and the Vineet Narain case does not become redundant, and that no precedent is created for a similar course of action in the future. The feud appears to have started when the director Alok Verma filed a complaint with the CVC opposing the appointment of Rakesh Asthana as special director CBI, a year ago in October 2017, on grounds of corruption and that Mr Asthana was himself under investigation. The recent public spat between the director and the deputy director is a sad ode to the fact that that the bureau continues to be completely political, thus, undermining its credibility. There is great expectation that this crisis will be the inflection point for the SC to pass stringent directions to insulate the CBI from political interference. Without the legal sanction of the committee, the order is suspect and would not bear the scrutiny of law. Understandably, cases of this nature have attracted heightened media and public attention.”That is the institution we, the people, have today — A premier, independent investigative agency, if we can keep it.ConclusionHow the court and government proceed on the matter will certainly have great bearing on the future of the bureau. No action was taken on the said report.By monitoring the preliminary inquiry against the director, the Supreme Court has attempted to make the situation transparent, in a clear departure from the closed door midnight removals and appointments being undertaken by the executive and has brought the investigation into the judicial fold.The Supreme Court, in the case of Vineet Narain, while noting the above comment and the inaction of the government to act on the recommendations contained in the report, proceeded to pass a slew of directions aimed at better governance through fair and proper investigation of all accused, regardless of their stature and influence. The court further directed the interim director to not take any major policy decisions in the mean time and directed that all policy decisions made by him till then be placed before it in a sealed cover for review. The court also provided for a minimum two-year term for the CBI director CBI, to ensure that he has security of tenure during service, in a bid to insulate him from pressure from the powers that be. While no change came from those words, they did prove well reasoned. If the CBI director himself does not appreciate the need for an impartial unbiased investigation in an internal case, there is nothing to suggest a more legally sound approach would prevail in the regular external cases of the CBI. This hasty act, done at midnight, unwittingly destroyed any assumptions on who actually controls personnel and transfers in the CBI. It does not help that bad blood has existed between the director and his deputy since the appointment of the latter, which shows the existence of a presupposition, which in itself is fatal to an impartial investigation.

The restriction on the powers of the interim director are a clear action on the point that his appointment itself has not gone through the procedure laid down in law and thus his power to take substantial policy decisions is still suspect. There is great expectation from the court that this case, which has seriously dented and damaged the reputation of the CBI, would be the inflection point before the court to pass stringent directions to insulate the CBI from political interference, making a stronger and more robust investigative agency that is above reproach. Now, a unique and rare opportunity has come about from this unfortunate saga. In the past, the Supreme Court has used cases like these to pass wide ranging directions to avoid future conflict, improve and rigidify existing systems, and create better processes for the future.

This procedure, laid down in the CVC Act, is to avoid political appointees to this sensitive post. Over the last few months, the director CBI and his deputy have been trading allegations of corruption against each other.On the legal side, an agency certainly cannot investigate its own officer in this manner. Chief Justice Lodha, in his widely reported comment, had added that the “agency must know how to stand up against pulls and pressures” while discharging its duty.The appointment of the CBI director is done through a joint committee meeting, constituting the Prime Minister, the Chief Justice of India, and the leader of the Opposition. The court, passing unprecedented orders to take control of the extraordinary situation, proceeded to bring in place an interim arrangement, whereby a retired judge of the Supreme Court would supervise the investigation to be conducted against the CBI director, and conclude the same within two weeks.Supreme Court’s rescue actAggrieved by his removal, the CBI director challenged the order of the CVC before the Supreme Court, on the very ground that his tenure could not be altered through such orders. The efficacy of such investigation shall remain suspect, and stymies the fundamental principles of having investigations done by an impartial, independent agency (which, ironically, is the whole objective of the CBI!).

The authors are advocates at the Supreme Court of India.An anecdote seems to cover the situation succinctly: At the close of the Constitutional Convention of the United States, on September 17, 1787, as Benjamin Franklin left the hall in Philadelphia, he was asked, “What kind of government have you given us, Dr. The matter was however, not referred to the committee. If the government or the CVC wished to send the director on indefinite leave, it was this committee that had the ultimate jurisdiction to take a call and pass necessary orders. Despite the objections raised, Mr  Asthana was brought in.”Sadly, this has not changed till date.Supreme Court of India (Photo: PTI)Recent eventsThough envisioned as an apolitical, independent, unbiased, premier investigative agency to take on the biggest and most contentious cases of the country, the CBI has been reduced to a poll issue and a contentious point of controversy with the potential to make or break governments

Dense building construction can amplify the winds and cause gusts to blow much faster than they would out in the open. This wind tunnel effect can cause serious damage, blowing out windows, knocking down trees, and sending dangerous debris hurtling toward the busy streets below.

The urban heat island effect is most noticeable during winter storms when air temperatures are hovering right around freezing, putting you right on the line between wet snow, an icy mix, or a cold rain. Nuclear power plants release large amounts of steam during the course of their operations, and on cold mornings when there’s enough moisture in the air, locations immediately downwind of a power plant’s steam stacks can experience “nuclear-effect snow,” which forms through similar means as lake effect snow. The hot water vapour produced by the engine exhaust of a high-flying jet aircraft leave contrails, short for condensation trails, in their wake. This is also why you should never take shelter underneath a bridge during a tornado.A 2011 study published in the Journal of Applied Meteorology and Climatology also found that the urban heat island effect can have a pronounced impact on thunderstorms that form over cities. This human-made insulation, called the urban heat island effect, keeps city centers a tad hotter on hot days and a little less cool on cold days. PAVING INCREASES THE INTENSITY OF FLOODSOur obsession with construction doesn’t stop at influencing temperatures.The principle is the same as holding your thumb over the end of a garden hose to make the water spray out faster— the wind speeds up dramatically as it presses between the buildings. Compare that to a muggy day, which has a dew point around 70°F, or a comfortably dry day with a dew point in the low 50s.URBAN DENSITY CAN AMPLIFY WINDSIf you’ve ever walked down a city street on a windy day, you’ve probably noticed that it sometimes feels like you’re being buffeted by air shot out of an industrial fan instead of a regular windstorm.

The researchers studied 91 summertime thunderstorms that formed over Indianapolis, Indiana, and found that their research models could not replicate those thunderstorms without the influence of the urban area beneath the storms. The phenomenon isn’t limited to just nuclear power plants, but they produce enough steam that it’s noticeable over a large area.While we don’t have the capability to control the weather outside of the movies, we humans and our everyday activities really are able to indirectly influence the weather in ways that go far beyond our addiction to greenhouse gases. Contrails can dissipate right away or linger for hours depending on upper-level humidity and winds.jpg While we don’t have the capability to control the weather outside of the movies, we humans and our everyday activities really are able to indirectly influence the weather in ways that go far beyond our addiction to greenhouse gases.

The artificial warmth from cities can influence the precipitation type in these storms, potentially lowering a city’s snow accumulations compared to its suburbs. The state’s Mesonet, a network of weather stations, found that the newly harvested areas were hotter and had a lower dew point than their cooler but muggier surroundings. NUCLEAR POWER PLANTS CAN TRIGGER NUCLEAR-EFFECT SNOWLake effect snow is a yearly phenomenon across North America’s Great Lakes, where bitterly cold air flows over the warm lake water, triggering convection that blows ashore as heavy bands of snow. The dense web of asphalt roads, concrete sidewalks, brick facades, and tar roofs are able to China underfloor heating Factory absorb a significant amount of heat from the daytime sun, even in the dead of winter. These man-made cirrus clouds are most common at high cruising altitudes, but places like Arctic and Antarctic get cold enough that contrails can form at or near ground level.JETS CREATE CIRRUS CLOUDSThe act of flying can create intricate patterns of clouds in the sky that wouldn’t have formed had we not perfected the art of air travel. It’s not only bodies of water that can cause this phenomenon. Paving over porous earth with relatively impervious materials like asphalt and concrete has also had a major impact on flooding during heavy rain events.

CROPS JACK UP THE HUMIDITYIf cities can absorb the heat of the day and make it even hotter, you can imagine how the vast swaths of crops that blanket the countryside can also affect our daily weather. CITIES FORM HEAT ISLANDSThey’re not exactly wrong when they call the capital of Georgia “Hotlanta.” Most populated areas generate heat simply by existing. Instead of making it hotter, crops can make a humid day unbearable by sending moisture levels almost off the charts on a putrid summer’s day. The bands of snow are so intense that communities can see many feet of snow in one day, sometimes accompanied by thunder and lightning. LIGHTNING_THUNDER_SYDNEY_UHD. Fewer places for rainwater to escape means that the sudden influx of water builds up in urban areas or runs off and inundates places that had never seen flooding before.The harvest can have the opposite effect, as seen in northern Oklahoma this summer when farmers harvested their winter wheat crops.. Corn crops are notorious for pushing dew points — the temperature at which the air reaches 100 per cent humidity — up above 80°F in the middle of the summer, creating a heat index that soars far above 100°F