bluuebunny/crossref_metadata_2025 huggingface dataset:
Higher rates of skin clearance and efficacy in challenging body areas are associated with better health‐related quality of life following ixekizumab maintenance treatment in pediatric patients with plaque psoriasis
Authors: Hebert Adelaide A. , Bobonich Margaret A. , Rodriguez Capriles Claudia , Gallo Gaia , Li Lingnan , Somani Najwa , Ridenour Terri , Wang Yan , Edson‐Heredia Emily , Becker Emily M.
Published: December 2021

Background/Objectives

Information is limited on the relationship between skin clearance, resolution of challenging body areas, and improvement of patient‐reported outcomes (PROs) in pediatric psoriasis. Ixekizumab, a high‐affinity monoclonal antibody that selectively targets interleukin‐17A, is approved for the treatment of moderate‐to‐severe psoriasis in patients aged 6 to <18 years. This study examines improvement in psoriasis clearance in challenging body areas in pediatric patients relative to health‐related quality of life.

Methods

Data from the IXORA‐PEDS trial (NCT03073200) were analyzed, and changes from baseline were measured for overall Psoriasis Area and Severity Index (PASI), static Physicians' Global Assessment of psoriasis (sPGA), Psoriasis Scalp Severity Index (PSSI), Palmoplantar Psoriasis Area and Severity Index (PPASI), and Nail Psoriasis Severity Index. Rates of Dermatology Life Quality Index (DLQI), or Children's DLQI (CDLQI), scores of 0 or 1 were evaluated using the Cochran‐Armitage trend test.

Results

Higher rates of DLQI/CDLQI (0,1) scores were significantly associated with greater PASI and PSSI responses at both Week 12 and Week 48 (p < .0001). A significant association was also observed between DLQI/CDLQI (0,1) and sPGA scores (p < .0001). Significantly higher rates of DLQI/CDLQI (0,1) scores were achieved in patients with greater levels of palmoplantar clearance as measured by PPASI at Week 12 (p = .0139), but significance was not sustained at Week 48 (p = .0896).

Conclusions

Greater skin clearance and scalp resolution are associated with better PROs over a short‐term (12‐week) and long‐term (48‐week) period. This demonstrates that greater improvement of skin clearance and scalp resolution may benefit quality of life in pediatric patients with psoriasis.
Optimal queue length information disclosure when service quality is uncertain
Authors: Guo Pengfei , Haviv Moshe , Luo Zhenwei , Wang Yulan
Published: December 2021

We investigate a server's best queue disclosure strategy in a single‐server service system with an uncertain quality level (which is assumed to be binary). We consider this problem from the perspective of a Bayesian persuasion game. The server first commits to a possibly mixed strategy stating the probability that the queue length will be revealed to customers on their arrival given a realized quality level. The service quality level is then realized, and the server's corresponding queue‐disclosure action is observed by customers, who then update their beliefs regarding service quality and decide whether to join the service system. We reformulate the server's decision problem as looking for the best Bayes‐plausible distribution of posterior beliefs regarding service quality. We demonstrate that the maximal expected effective arrival rate, as a function of the prior belief, can be graphed as the upper envelope of all convex combinations of any two arbitrary points on the two effective arrival rate functions of the revealed and concealed queues. We show that when the market size is sufficiently small (large), the server always conceals (reveals) the queue, regardless of the realized service quality. Numerically, we find that in a medium‐sized market, the server's optimal commitment strategy is often hybrid or mixed, that is, randomizing queue concealment and revelation. We also extend our analysis to a situation in which the server aims to maximize social welfare. We show that under certain conditions, it is always beneficial for the welfare‐maximizing social planner to randomize queue concealment and revelation, regardless of the market size.
Out of sight, Out of mind — but not Out of scope: the need to consider ozone (O3) in restoration science, policy, and practice
Authors: Perring Michael P. , Bullock James M. , Alison Jamie , Holder Amanda J. , Hayes Felicity
Published: December 2021

Restoration ecologists have local‐ to global‐scale ambitions in a policy framework of sustainable development goals and reversing biodiversity loss. Emphasis is given to environmental alteration, typically considering land degradation and climate change. Other related environmental drivers, such as pollution, receive less attention. Here we emphasize that terrestrial restoration discourse needs to consider tropospheric ozone (O3) pollution. O3's pervasive influence on plants and other ecosystem components provides for the possibility of consequences at community and ecosystem levels. The precursor chemicals that lead to O3 formation are increasing, precipitously so in rapidly industrializing regions of the world. Yet, a review of critical restoration guidance and journals suggests that because O3 is out of sight, it remains out of mind. Based on a narrative cross‐discipline literature review, we examine: (1) How O3 could affect the achievement of restoration goals and (2) How restoration interventions could feedback on tropospheric O3. Evidence, currently limited, suggests that O3 could impair the achievement of restoration goals to as great an extent as other drivers, but, in general, we lack direct quantification. Restoration interventions (e.g. tree planting) that may be considered successful can actually exacerbate O3 pollution with negative consequences for food security and human health. These wide‐ranging effects, across multiple goals, mean that O3 is not out of scope for restoration science, policy, and practice. In detailing a strategic ozone‐aware restoration agenda, we suggest how restoration science and policy can quantify O3's influence, while outlining steps practitioners can take to adapt to/mitigate the impacts of O3 pollution.
Remembering the Victims of the Gulag: Images of Dokhodiagi in Solzhenitsyn's The Gulag Archipelago and Shalamov's Kolyma Stories
Authors: HUSIEVA OKSANA
Published: December 2021

The current article contributes to the emerging literature on dokhodiagi–the Gulag's most vulnerable, famished, and exhausted prisoners, whose deaths were a common occurrence in the harsh conditions of the Soviet forced labor camps. I explore the literary representation of dokhodiagi in the two major works authored by Gulag survivors–Aleksandr Solzhenitsyn's The Gulag Archipelago and Varlam Shalamov's Kolyma Stories. Both Solzhenitsyn and Shalamov dedicate their works to the memory of victims who perished in Stalinist camps, which suggests their intention to commemorate dokhodiagi. Yet, a close examination of Solzhenitsyn's and Shalamov's texts shows marked differences in how the two authors engage in the process of memorializing the Gulag's victims. By focusing on the selected passages from The Gulag Archipelago and Kolyma Stories, I juxtapose the narrative strategies that Solzhenitsyn and Shalamov use to describe dokhodiagi, as well as address the larger ethical issues that underlie the two authors' written testimonies of the Soviet forced labor camps.
Identification of the novel HLA‐B*42:28 allele by next‐generation sequencing
Authors: Ward Jessica , Guthrie Pamela , Keen Leigh , Poles Anthony , Wroe Elizabeth
Published: December 2021

HLA‐B*42:28 differs from HLA‐B*42:01:01 by a single base substitution in exon 4 at codon 267.2.
COVID‐19 worries, concerns and mitigation behaviours: A snapshot of Nepal during the first wave
Authors: Askari Melanie S. , Treleaven Emily , Ghimire Dirgha , Axinn William , Hermosilla Sabrina
Published: December 2021

Objectives

To understand COVID‐19 worries and how they influence COVID‐19 mitigation behaviours, especially in communities prior to case surges, in Nepal.

Methods

Data related to COVID‐19 impacts on life disruptions were collected from households in the Chitwan Valley Family Study, a 25‐year community panel study, during February–April 2021. COVID‐19 worry was measured by the extent of respondent concern for themselves or household members getting COVID‐19 in the prior 2 weeks. 11 items examined COVID‐19 mitigation behaviours. Logistic regression models assessed associations between socio‐demographic characteristics and COVID‐19 worry and then the influence of worry on any mitigation behaviour and behaviour type adjusting for age, education, sex, ethnicity and COVID‐19 exposure, accounting for neighbourhood clustering.

Results

Of 2,678 households with a responding adult, ages 18–88, 394 (14.7%) reported moderate‐to‐extreme COVID‐19 worry and 1,214 (45.3%) engaged in three or more mitigation behaviours. Prevalence of mitigation behaviours was higher among those with COVID‐19 worry (e.g. avoided crowds: 62.7% versus 40.5% in those with minimal worry). Respondents self‐reporting COVID‐19 had higher odds of worry (adjusted odds ratio [aOR]: 2.73, 95% confidence interval [CI]: 1.13, 6.57). Odds of any mitigation behaviour were higher among those with COVID‐19 worry compared to those with minimal worry (aOR: 6.19, 95% CI = 1.88, 20.35).

Conclusions

COVID‐19 mitigation behaviours were more common in people with COVID‐19 worry. To address current and potential future waves of the pandemic, public health efforts should include informational campaigns about mitigation behaviours particularly for those unconcerned with COVID‐19 risks.
Precise estimation of chlorophyll a, b and carotenoid content by deconvolution of the absorption spectrum and new simultaneous equations for Chl determination
Authors: Chazaux Marie , Schiphorst Christo , Lazzari Gioele , Caffarri Stefano
Published: December 2021

The precise determination of photosynthetic pigment content in green organisms, chlorophylls (Chls) and carotenoids (Cars), is important to investigate many photosynthetic processes such as responses to environmental fluctuations or to gene mutations, as well as to interpret biochemical and structural results obtained on purified membranes and photosynthetic complexes. The most utilized methods for determination by spectrophotometry of Chl content in solution, usually 80% acetone, are based on the use of simultaneous equations. The advantages are the easiness and speed over chromatography, which also requires less common equipment. The disadvantage is that issues in sample preparation or in the measurement are not detectable, which could lead to wrong results. Here we propose a fast, accurate and (almost) error‐proof method to measure Chl a, Chl b and also total Car content in a solution of pigments extracted from tissue, membranes or purified complexes. The method is based on the fit of the absorption spectrum of the acetone extract using the spectra of purified pigments as references. We show how this method allows a more precise and accurate estimation of pigment content as compared to classical equations, even in incorrectly prepared acetone solutions. Moreover, the method allows the discovery of artifacts in sample preparation or measurement and thus drastically reduces the risk of mistakes. Examples obtained on purified complexes are also discussed. Based on newly acquired Chl spectra, we also propose a new set of improved simultaneous equations that provide slightly different but more reliable results in comparison with the currently used equations.
Phenomenological Analysis of the Combustion of Gaseous Fuels to Measure the Fuel's Energy Quality and Availability to Produce Work in Spark Ignition Engines, Part 2
Authors: Gómez Montoya Juan Pablo , Amell Arrieta Andrés
Published: December 2021

A novel methodology is proposed to evaluate fuel’s performance in spark ignition (SI) engines based on the fuel’s energy quality and availability to produce work. Experiments used a diesel engine with a high compression ratio (CR), modified by SI operation, and using interchangeable pistons. The interchangeable pistons allowed for the generation of varying degrees of turbulence during combustion, ranging from middle to high turbulence. The generating efficiency (ηq), and the maximum electrical energy (EEmax) were measured at the knocking threshold (KT). A cooperative fuel research (CFR) engine operating at the KT was also used to measure the methane number (MN), and critical compression ratio (CCR) for gaseous fuels. Fuels with MNs ranging from 37 to 140 were used: two biogases, methane, propane, and five fuel blends of biogas with methane/propane and hydrogen. Results from both engines are linked at the KT to determine correlations between fuel’s physicochemical properties and the knocking phenomenon. Certain correlations between knocking and fuel properties were experimentally determined: energy density (ED), laminar flame speed (SL), adiabatic flame temperature (Tad), heat capacity ratio (γ), and hydrogen/carbon (H/C) ratio. Based on the results, a mathematical methodology for estimating EEmax and ηq in terms of ED, SL, Tad, γ, H/C, and MN is presented. These equations were derived from the classical maximum thermal efficiency for SI engines given by the Otto cycle efficiency (ηOtto). Fuels with MN > 97 got higher EEmax, and ηq than propane, and diesel fuels.
Automated and Adaptive Geometry Preparation for AR/VR-Applications
Authors: Dammann Maximilian Peter , Steger Wolfgang , Stelzer Ralph
Published: December 2021

Product visualization in AR/VR applications requires a largely manual process of data preparation. Previous publications focus on error-free triangulation or transformation of product structure data and display attributes for AR/VR applications. This paper focuses on the preparation of the required geometry data. In this context, a significant reduction in effort can be achieved through automation. The steps of geometry preparation are identified and examined concerning their automation potential. In addition, possible couplings of sub-steps are discussed. Based on these explanations, a structure for the geometry preparation process is proposed. With this structured preparation process, it becomes possible to consider the available computing power of the target platform during the geometry preparation. The number of objects to be rendered, the tessellation quality, and the level of detail (LOD) can be controlled by the automated choice of transformation parameters. Through this approach, tedious preparation tasks and iterative performance optimization can be avoided in the future, which also simplifies the integration of AR/VR applications into product development and use. A software tool is presented in which partial steps of the automatic preparation are already implemented. After an analysis of the product structure of a CAD file, the transformation is executed for each component. Functions implemented so far allow, for example, the selection of assemblies and parts based on filter options, the transformation of geometries in batch mode, the removal of certain details, and the creation of UV maps. Flexibility, transformation quality, and timesavings are described and discussed.
Verification of a Specialized Hydrodynamic Simulation Code for Modeling Deflagration and Detonation of High Explosives
Authors: Andrews Stephen A. , Aslam Tariq D.
Published: December 2021

A specialized hydrodynamic simulation code has been developed and verified for the simulation of one-dimensional unsteady problems involving the detonation and deflagration of high explosives. To model all the relevant physical processes in these problems, a code is required to simulate compressible hydrodynamics, unsteady thermal conduction, and chemical reactions with complex rate laws. Several verification exercises are presented which test the implementation of these capabilities. The code also requires models for physics processes such as equations of state and conductivity for pure materials and mixtures as well as rate laws for chemical reactions. Additional verification tests are required to ensure that these models are implemented correctly. Though this code is limited in the types of problems it can simulate, its computationally efficient formulation allows it to be used in calibration studies for reactive burn models for high explosives. This study demonstrates how a series of verification tests can be used to ensure that the various physics processes needed to simulate complex phenomenon can be tested to ensure that they are correctly implemented.
MoS2 by XPS using monochromatic Ag Lα x rays
Authors: Counsell Jonathan D. P. , Coultas Sarah J. , Gerrard Nikki
Published: December 2021

XPS spectra of molybdenum disulfide mineral were obtained using monochromatic Ag Lα radiation. Spectra include Mo 2p, Mo 3d, Mo 3s, S 1s, S 2p, and S 2s. A flake was mechanically exfoliated from a MoS2 bulk single crystal for the study. Quantitative comparison was performed using Cant sensitivity factors.
Comparison of AlF3 thin films grown by thermal and plasma enhanced atomic layer deposition
Authors: Messina Daniel C. , Eller Brianna S. , Scowen Paul A. , Nemanich Robert J.
Published: December 2021

Films of aluminum fluoride (AlF3) deposited by thermal and plasma enhanced atomic layer deposition (PEALD) have been compared using in situ multiwavelength ellipsometry (MWE) and monochromatic x-ray photoelectron spectroscopy (XPS). The AlF3 films were grown using cyclic exposures of trimethylaluminum, hydrogen fluoride, and H radicals from a remote H2 inductively coupled plasma. Films were characterized in situ using MWE and XPS for growth rate, film composition, and impurity incorporation. The MWE showed a growth rate of 1.1 and 0.7 Å per cycle, at 100 °C, for thermal and plasma enhanced ALD AlF3 films, respectively. Carbon incorporation was below the XPS detection limit. The plasma enhanced ALD AlF3 film showed the presence of Al-Al chemical states, in the Al 2p scans, suggesting the presence of Al-rich clusters with a concentration of 14%. The Al-rich clusters are thought to originate during the hydrogen plasma step of the PEALD process. The Al-rich clusters were not detected in thermal ALD AlF3 films using the same precursors and substrate temperature.
Engineering ordered arrangements of oxygen vacancies at the surface of superconducting La2CuO4 thin films
Authors: Suyolcu Y. Eren , Christiani Georg , Gemperline Patrick T. , Provence Sydney R. , Bussmann-Holder Annette , Comes Ryan B. , van Aken Peter A. , Logvenov Gennady
Published: December 2021

We demonstrate how ordered arrangements of oxygen vacancies can be engineered during the growth of superconducting La2CuO4 films by oxide molecular-beam epitaxy. These arrangements are seen using in situ reflection high-energy electron diffraction. Based on qualitative real-time observations, we propose a surface reconstruction mechanism emphasizing the active role of dopants and oxygen vacancies at the film surface. Due to the specific atomic arrangement induced by dopant positions, characteristic surface “stripes” are generated, and they determine the intrinsically heterogeneous structure characterized by distorted checkerboard patterns on the surface. Not only can the surface motif during growth be monitored via characteristic surface reconstructions, but it can also be customized by altering strain, doping, and oxygen activity.
Disclosing the response of the surface electronic structure in SrTiO3 (001) to strain
Authors: Bonini Guedes Eduardo , Willemoes Jensen Tobias , Naamneh Muntaser , Chikina Alla , T. Dahm Ramus , Yun Shinhee , Chiabrera Francesco M. , Plumb Nicholas C. , Dil J. Hugo , Shi Ming , Valbjørn Christensen Dennis , Hugo Brito Walber , Pryds Nini , Radović Milan
Published: December 2021

Combining angle-resolved photoemission spectroscopy and density functional theory calculations, we addressed the surface electronic structure of bent SrTiO3 (STO) (001) wafers. Using a custom-made device, we observe that the low-dimensional states that emerge at the STO (001) surface are robust to an external tensile strain of about 0.1%. Our results show that this value of strain is too small to sensibly alter the surface conduction band of STO, but, surprisingly, it is enough to shift the energy of the in-gap states. In order to access higher strain values of around 2%, standard for STO-based heterostructures, we performed density functional theory calculations of STO slabs under different strain configurations. The simulations predict that such levels of both compressive and tensile strain significantly alter the orbital splitting of the surface conduction band. Our study indicates that the strain generated in STO can tailor the electronic properties of its bare surface and of STO-based interfaces.
Vertical quasistatic Poiseuille flow: Theory and experiment
Authors: Lemons Don S. , Lipsombe Trevor C. , Faehl Rickey J.
Published: December 2021

As a viscous fluid drains from the bottom of a wide-mouthed reservoir through a narrow vertical tube, the symmetric flow within the tube, known as Poiseuille flow, is quickly established. Since the pressure provided by the fluid in the reservoir changes slowly in time, the flow is quasistatically time dependent. Our theoretical model of this process relates the time dependence of the height of the fluid in the reservoir to the dimensions of the tube and the kinetic viscosity of the fluid. We construct an apparatus from inexpensive and easily procured materials (plastic containers, steel straws, glue, adhesive putty, and a supply of pure glycerin) in order to test our model and find good agreement between the theory and the experiment.
Gravitational lens effect revisited through membrane waves
Authors: Catheline Stefan , Delattre Victor , Laloy-Borgna Gabrielle , Faure Fréderic , Fink Mathias
Published: December 2021

By means of experiments and curved manifold simulations, we show that wave propagation past a topological deviation on a two-dimensional flat fabric membrane is analogous to gravitational lensing. Using an ultrafast camera, we track a membrane plane wave as it crosses a local warped depression. Finite difference simulation, based on the scalar wave equation in a Schwarzschild metric, fully describes the experimental wavefront shape. Comparison between the theoretical and experimental deviation of wave geodesics from straight lines shows that (i) the nonlinear behavior of fabrics due to stretching induces second order effects only and (ii) the experimental depression is closely approximated by the Schwarzschild metric of a gravity well. The experiment demonstrates, in a simple way, how wave propagation is influenced by the topology of the transmission medium.
Spatial reconstruction of sound fields using local and data-driven functions
Authors: Hahmann Manuel , Verburg Samuel A. , Fernandez-Grande Efren
Published: December 2021

Sound field analysis methods make it possible to characterize and reconstruct a sound field from a limited set of observations. Classical approaches rely on the use of analytical basis functions to model the sound field throughout the observed domain. When the complexity of the sound field is high, for example, in a room at mid and high frequencies, propagating wave representations can be suboptimal due to model discrepancy. We examine the use of local representations to alleviate this model discrepancy and explore data-driven approaches to obtain suitable models. Specifically, local representations are used to reconstruct the sound field over a large spatial aperture in a room. The performance of local models is compared against conventional plane wave reconstructions and the use of data-driven local functions is examined. Dictionary learning and principal component analysis are used to obtain functions from extensive spatial measurements in an empty room. The results indicate that local partitioning models conform to fields of high spatial complexity. Dictionary learning generalizes across different rooms and frequencies—conferring potential for modelling complex sound fields based on their local and statistical properties.
Distinguishing Characteristics Between High and Low Adherence Patients Following Anterior Cruciate Ligament Reconstruction: A Qualitative Examination
Authors: Williams Tom , Evans Lynne , Robertson Angus , Hardy Lew , Roy Stuart , Lewis Daniel
Published: December 2021

The purpose of this study was to identify factors that distinguished between injured athletes who displayed high compared with low levels of rehabilitation adherence following anterior cruciate ligament reconstructive surgery. In order to gain an in-depth understanding of these factors, semistructured qualitative interviews were conducted with six high adherers, six matched low adherers and for each injured athlete, a significant other. Thematic analysis was used to identify the themes that distinguished between high and low adherers. Three themes were generated based on the findings: (a) preparation for postoperative rehabilitation, (b) an active versus passive approach to rehabilitation, and (c) the threat of a poor outcome. Each theme comprised a number of subthemes that further elucidated the participants’ rehabilitation experiences and adherence behaviors. The findings have important implications for medical professionals, sport psychology consultants, coaches, and athletes with a vested interest in expediting recovery following anterior cruciate ligament reconstructive surgery.
Apramycin Overcomes the Inherent Lack of Antimicrobial Bactericidal Activity in Mycobacterium abscessus
Authors: Selchow Petra , Ordway Diane J. , Verma Deepshikha , Whittel Nicholas , Petrig Aline , Hobbie Sven N. , Böttger Erik C. , Sander Peter
Published: December 2021

Antibiotic therapy of infections caused by the emerging pathogen
Mycobacterium abscessus
is challenging due to the organism’s inherent resistance to clinically available antimicrobials. The low bactericidal potency of currently available treatment regimens is of concern and testifies to the poor therapeutic outcomes for pulmonary
M. abscessus
infections.
Quinolone Resistance Is Transferred Horizontally via Uptake Signal Sequence Recognition in Haemophilus influenzae
Authors: Tanaka Emi , Wajima Takeaki , Uchiya Kei-ichi , Nakaminami Hidemasa
Published: December 2021

The presence of
Haemophilus influenzae
strains with low susceptibility to quinolones has been reported worldwide. However, the emergence and dissemination mechanisms remain unclear.
Selection of AmpC β-Lactamase Variants and Metallo-β-Lactamases Leading to Ceftolozane/Tazobactam and Ceftazidime/Avibactam Resistance during Treatment of MDR/XDR Pseudomonas aeruginosa Infections
Authors: Ruedas-López Alba , Alonso-García Isaac , Lasarte-Monterrubio Cristina , Guijarro-Sánchez Paula , Gato Eva , Vázquez-Ucha Juan Carlos , Vallejo Juan Andrés , Fraile-Ribot Pablo Arturo , Fernández-Pérez Begoña , Velasco David , Gutiérrez-Urbón José María , Oviaño Marina , Beceiro Alejandro , González-Bello Concepción , Oliver Antonio , Arca-Suárez Jorge , Bou Germán
Published: December 2021

Infections caused by ceftolozane-tazobactam and ceftazidime-avibactam-resistant
P. aeruginosa
infections are an emerging concern. We aimed to analyze the underlying ceftolozane-tazobactam and ceftazidime-avibactam resistance mechanisms in all multidrug-resistant or extensively drug-resistant (MDR/XDR)
P. aeruginosa
isolates recovered during 1 year (2020) from patients with a documented
P. aeruginosa
infection.
Pharmacodynamics of Moxifloxacin, Meropenem, Caspofungin, and Their Combinations against
In Vitro
Polymicrobial Interkingdom Biofilms
Authors: Ruiz-Sorribas Albert , Poilvache Hervé , Van Bambeke Françoise
Published: December 2021

Biofilms colonize medical devices and are often recalcitrant to antibiotics. Interkingdom biofilms, where at least a bacterium and a fungus are present, increase the likelihood of therapeutic failures.
Early Secretory Pathway-Associated Proteins SsEmp24 and SsErv25 Are Involved in Morphogenesis and Pathogenicity in a Filamentous Phytopathogenic Fungus
Authors: Xie Chong , Shang Qingna , Mo Chenmi , Xiao Yannong , Wang Gaofeng , Xie Jiatao , Jiang Daohong , Xiao Xueqiong
Published: December 2021

Understanding the reproduction and pathogenesis mechanism of phytopathogens could provide new opinions to effectively control fungal diseases. Although it has been known that effectors and extracellular hydrolytic enzymes secreted by phytopathogenic fungi play important roles in fungus-host interactions, the secretion system for the delivery of virulence factors to the host is still largely undescribed.
Syrinx reduction due to spontaneous spinal cord tear: demonstration on 3 T MRI and review of the literature
Authors: Staglianó Serena , Prodi Elena , Goeggel Simonetti Barbara , Cianfoni Alessandro
Published: December 2021

A holocord syringomyelia due to Chiari 1.5 malformation (CM) in a 12-year-old girl was serially imaged with 3 T MRI over 4 years. The serial MRI showed reduction in size of the syrinx, without any surgical intervention or CM improvement, but rather due to spontaneous spinal cord tear. The tear was clearly demonstrated by evidence of flow signal across the tear between syrinx and subarachnoid space at the upper thoracic level. The tear showed spontaneous closure at follow-up. A medullary tear has been described in the adult population as one of the putative causes of spontaneous syringomyelia reduction, but its clear demonstration with modern high-resolution MRI has not been reported in the paediatric population. Moreover, this is the first reported case of syrinx reduction due to spontaneous fissuration in a paediatric patient.
Long-term reproducibility of optical coherence tomography angiography in healthy and stable glaucomatous eyes
Authors: Nishida Takashi , Moghimi Sasan , Hou Huiyuan , Proudfoot James A , Chang Aimee C , David Ryan Caezar C , Kamalipour Alireza , El-Nimri Nevin , Rezapour Jasmin , Bowd Christopher , Zangwill Linda M , Weinreb Robert N
Published: December 2021

Background/aims

To assess and compare long-term reproducibility of optic nerve head (ONH) and macula optical coherence tomography angiography (OCTA) vascular parameters and optical coherence tomography (OCT) thickness parameters in stable primary open-angle glaucoma (POAG), glaucoma suspect and healthy eyes.

Methods

Eighty-eight eyes (15 healthy, 38 glaucoma suspect and 35 non-progressing POAG) of 68 subjects who had at least three visits within 1–1.5 years with OCTA and OCT imaging (Angiovue; Optovue, Fremont, California, USA) on the same day were included. A series of vascular and thickness parameters were measured including macular parafoveal vessel density (pfVD), ONH circumpapillary capillary density (cpCD), macular parafoveal ganglion cell complex (pfGCC) and ONH circumpapillary retinal nerve fibre layer (cpRNFL). A random effects analysis of variance model was used to estimate intraclass correlation (ICC) coefficients and long-term variability estimates.

Results

ICC was lower for OCTA (pfVD 0.823 (95% CI 0.736 to 0.888) and cpCD 0.871 (0.818 to 0.912)) compared with OCT (pfGCC 0.995 (0.993 to 0.997) and cpRNFL 0.975 (0.964 to 0.984)). Within-subject test–retest SD was 1.17% and 1.22% for pfVD and cpCD, and 0.57 and 1.22 µm for pfGCC and cpRNFL. Older age and lower signal strength index were associated with decreasing long-term variability of vessel densities.

Conclusions

OCTA-measured macula and ONH vascular parameters have good long-term reproducibility, supporting the use of this instrument for longitudinal analysis. OCTA long-term reproducibility is less than OCT-measured thickness reproducibility. This needs to be taken into consideration when serial OCTA images are evaluated for change.

Trial registration number

NCT00221897.
Prevalence, ethnic differences and risk factors of primary angle-closure glaucoma in a multiethnic Chinese adult population: the Yunnan Minority Eye Study
Authors: Wang Ying , Cun Qing , Li Jun , Shen Wei , Yang Wen-Yan , Tao Yi-Jin , Niu Zhi-Qiang , Zhang Ying , Zhong Hua , Pan Chen-Wei
Published: December 2021

Purpose

To describe the prevalence and risk factors of primary angle-closure glaucoma (PACG) and to explore nationality difference in Chinese.

Methods

The Yunnan Minority Eye Study was conducted in a rural multiethnic area in Yunnan province and included 6546 participants aged over 50 years. PACG was diagnosed based on International Society of Geographical and Epidemiologic Ophthalmology criteria by experienced ophthalmologists. Multivariate regression modelling was conducted to examine risk factors for PACG. Principal component analyis (PCA) was performed to evaluate the effects of ethnicity on PACG.

Results

The overall prevalence of PACG was 0.7% (95% CIs: 0.5% to 0.9%). PCA indicated that ethnicity is significantly related to the presence of PACG (p<0.001) after controlling for other risk factors. In addition, higher PACG prevalence was also correlated with older age (60–69 years group (OR: 3.47; 95% CI: 1.11 to 10.84; p<0.05) and 70–79 years group (OR: 4.71; 95% CI: 1.40 to 15.86; p<0.05) as compared with 50–59 years group), higher intraocular pressures (OR: 1.26; 95% CI: 1.17 to 1.36; p<0.001), shorter axial lengths (OR: 0.42; 95% CI: 0.32 to 0.56; p<0.001) and thinner central corneal thicknesses (OR: 0.89; 95% CI: 0.81 to 0.99; p<0.05).

Conclusions

This multiethnic study on Chinese adults living in the same geographical location indicated that ethnicity is a significant risk factor for PACG. However, there were still some of the effects of ethnic differences on the prevalence of PACG that could not be explained and further studies should take culture and lifestyle factors into account.
Respiratory tract infection and risk of bleeding in oral anticoagulant users: self-controlled case series
Authors: Ahmed Haroon , Whitaker Heather , Farewell Daniel , Hippisley-Cox Julia , Noble Simon
Published: December 2021

Objective

To estimate the association between untreated, community acquired, respiratory tract infections and bleeding in oral anticoagulant users.

Design

Self-controlled case series.

Setting

General practices in England contributing data to the Clinical Practice Research Datalink GOLD.

Participants

1208 adult users of warfarin or direct oral anticoagulants with a general practice or hospital admission record of a bleeding event between January 2010 and December 2019, and a general practice record of a consultation for a community acquired respiratory tract infection for which immediate antibiotics were not prescribed (that is, untreated).

Main outcome measures

Relative incidence of major bleeding and clinically relevant non-major bleeding in the 0-14 days after an untreated respiratory tract infection, compared to unexposed time periods.

Results

Of 1208 study participants, 58% (n=701) were male, median age at time of first bleed was 79 years (interquartile range 72-85), with a median observation period of 2.4 years (interquartile range 1.3-3.8). 292 major bleeds occurred during unexposed time periods and 41 in the 0-14 days after consultation for a respiratory tract infection. 1003 clinically relevant non-major bleeds occurred during unexposed time periods and 81 in the 0-14 days after consultation for a respiratory tract infection. After adjustment for age, season, and calendar year, the relative incidence of major bleeding (incidence rate ratio 2.68, 95% confidence interval 1.83 to 3.93) and clinically relevant non-major bleeding (2.32, 1.82 to 2.94) increased in the 0-14 days after an untreated respiratory tract infection. Findings were robust to several sensitivity analyses and did not differ by sex or type of oral anticoagulant.

Conclusions

This study observed a greater than twofold increase in the risk of bleeding during the 0-14 days after an untreated respiratory tract infection. These findings have potential implications for how patients and clinicians manage oral anticoagulant use during an acute intercurrent illness and warrant further investigation into the potential risks and how they might be mitigated.
Density strips: visualisation of uncertainty in clinical data summaries and research findings
Authors: Weir Christopher J , Bowman Adrian W
Published: December 2021

The disproportionate focus on statistical significance in reporting and interpreting clinical research studies contributes to publication bias and encourages selective reporting. This highlights a need for alternative approaches that clearly communicate the uncertainty in the data, enabling researchers to provide a more nuanced interpretation of clinical research findings.

Our purpose in this article is to introduce the density strip method as one potential approach that might act as a bridge between data visualisation for descriptive purposes and formal statistical inference. We build on existing theory, translating it to the applied research context to illustrate its utility to clinical researchers.

We achieve this by considering an exemplar clinical trial, Multiple Sclerosis-Secondary Progressive Multi-Arm Randomisation Trial (MS-SMART). MS-SMART was a multiarm randomised placebo-controlled trial of three potentially neuroprotective drugs in secondary progressive MS. We illustrate through MS-SMART the potential of the density strip as an effective visualisation of the distribution of clinical trial outcomes and as a complementary approach to aid the interpretation of formal, inferential, statistical analysis.

We conclude by summarising the advantages and disadvantages of the density strip methodology and provide suggestions for its potential extensions and possible further uses.
Balancing benefits and potential risks of vaccination: the precautionary principle and the law of unintended consequences
Authors: Grimes David Robert
Published: December 2021

Vaccination is a life-saving endeavour, yet risk and uncertainty are unavoidable in science and medicine. Vaccination remains contentious in the public mind, and vaccine hesitancy is a serious public health issue. This has recently been reignited in the discussion over potential side effects of COVID-19 vaccines, and the decision by several countries to suspend measures such as the AstraZeneca vaccine. In these instances, the precautionary principle has often been invoked as a rationale, yet such heuristics do not adequately weigh potential harms against real benefits. How we analyse, communicate and react to potential harms is absolutely paramount to ensure the best decisions and outcomes for societal health, and maintaining public confidence. While balancing benefits and risks is an essential undertaking, it cannot be achieved without due consideration of several other pertinent factors, especially in the context of vaccination, where misguided or exaggerated fears have in the past imperilled public health. While well meaning, over reactions to potential hazards of vaccination and other health interventions can have unintended consequences, and cause lingering damage to public trust. In this analysis, we explore the challenges of assessing risk and benefit, and the limitations of the precautionary principle in these endeavours. When risk is unclear, cautious vigilance might be a more pragmatic and useful policy than reactionary suspensions.
Registration of health and medical research
Authors: Cashin Aidan G , Richards Georgia C , DeVito Nicholas J , Mellor David T , Lee Hopin
Published: December 2021

Registration of health and medical research is an effective way of improving the transparency and credibility of evidence. Registration involves pre-specifying the research objectives, design, methods and analytic plan on a publicly accessible repository before conducting the study. Registration can reduce bias and improve the transparency and credibility of research findings. Registration is mandated for clinical trials, but it is also relevant to systematic reviews, observational and preclinical experimental research. This paper describes how researchers can register their research and outlines possible barriers and challenges in doing so. Widespread adoption of research registration can reduce research waste and improve evidence-informed clinical and policy decision making.
Risk factors associated with preterm birth in the Dominican Republic: a case-control study
Authors: Díaz-Rodríguez Agustín , Feliz-Matos Leandro , Ruiz Matuk Carlos Bienvenido
Published: December 2021

Objectives

This study aimed to identify the risk factors associated with preterm birth, and to determine the prevalence of preterm births in the Dominican Republic.

Design

Case-control study.

Settings

Seven National Reference Hospitals from different regions of the Dominican Republic.

Participants

A probabilistic sampling of both cases and controls was performed with a ratio of 2.92:1, and a power analysis was performed with α=0.05,P1=0.5,P2=0.6, and β=0.08, to yield a distribution of 394 cases and 1150 controls. Estimation of gestational age was based on neonatologist reports.

Primary outcome measures

A protocol was created to obtain maternal and obstetric information.

Results

The main risk factors were a family history of premature births (p<0.001, OR: 14.95, 95% CI 8.50 to 26.29), previous preterm birth (p=0.005, OR: 20.00; 95% CI 12.13 to 32.96), advanced maternal age (over 35 years; p<0.001, OR: 2.21; 95% CI 1.57 to 3.09), smoking (p<0.001, OR: 6.65, 95% CI 3.13 to 13.46), drug consumption (p=0.004, OR: 2.43, 95% CI 1.37 to 4.30), premature rupture of membranes (p<0.001, OR: 2.5) and reduced attendance at prenatal consultations (95% CI 6 to 7, Z=−10.294, p<0.001).

Conclusion

Maternal age greater than 35 years, previous preterm birth, family history of preterm births and prelabour rupture of membranes were independent risk factors for preterm birth. Adolescence, pregnancy weight gain and prenatal consultations, on the other hand, were protective factors for preterm birth. Although the prevalence of premature births in this study was 25%, this could have been biased.
Accuracy and usability of AcuPebble SA100 for automated diagnosis of obstructive sleep apnoea in the home environment setting: an evaluation study
Authors: Devani Nikesh , Pramono Renard Xaviero Adhi , Imtiaz Syed Anas , Bowyer Stuart , Rodriguez-Villegas Esther , Mandal Swapna
Published: December 2021

Objectives

Obstructive sleep apnoea (OSA) is a heavily underdiagnosed condition, which can lead to significant multimorbidity. Underdiagnosis is often secondary to limitations in existing diagnostic methods. We conducted a diagnostic accuracy and usability study, to evaluate the efficacy of a novel, low-cost, small, wearable medical device, AcuPebble_SA100, for automated diagnosis of OSA in the home environment.

Settings

Patients were recruited to a standard OSA diagnostic pathway in an UK hospital. They were trained on the use of type-III-cardiorespiratory polygraphy, which they took to use at home. They were also given AcuPebble_SA100; but they were not trained on how to use it.

Participants

182 consecutive patients had been referred for OSA diagnosis in which 150 successfully completed the study.

Primary outcome measures

Efficacy of AcuPebble_SA100 for automated diagnosis of moderate–severe-OSA against cardiorespiratory polygraphy (sensitivity/specificity/likelihood ratios/predictive values) and validation of usability by patients themselves in their home environment.

Results

After returning the systems, two expert clinicians, blinded to AcuPebble_SA100’s output, manually scored the cardiorespiratory polygraphy signals to reach a diagnosis. AcuPebble_SA100 generated automated diagnosis corresponding to four, typically followed, diagnostic criteria: Apnoea Hypopnoea Index (AHI) using 3% as criteria for oxygen desaturation; Oxygen Desaturation Index (ODI) for 3% and 4% desaturation criteria and AHI using 4% as desaturation criteria. In all cases, AcuPebble_SA100 matched the experts’ diagnosis with positive and negative likelihood ratios over 10 and below 0.1, respectively. Comparing against the current American Academy of Sleep Medicine’s AHI-based criteria demonstrated 95.33% accuracy (95% CI (90·62% to 98·10%)), 96.84% specificity (95% CI (91·05% to 99·34%)), 92.73% sensitivity (95% CI (82·41% to 97·98%)), 94.4% positive-predictive value (95% CI (84·78% to 98·11%)) and 95.83% negative-predictive value (95% CI (89·94% to 98·34%)). All patients used AcuPebble_SA100 correctly. Over 97% reported a strong preference for AcuPebble_SA100 over cardiorespiratory polygraphy.

Conclusions

These results validate the efficacy of AcuPebble_SA100 as an automated diagnosis alternative to cardiorespiratory polygraphy; also demonstrating that AcuPebble_SA100 can be used by patients without requiring human training/assistance. This opens the doors for more efficient patient pathways for OSA diagnosis.

Trial registration number

NCT03544086; ClinicalTrials.gov.
Barriers to increase surgical productivity in Sierra Leone: a qualitative study
Authors: Bakker Juul , van Duinen A J , Nolet Wouter W E , Mboma Peter , Sam Tamba , van den Broek Ankie , Flinkenflögel Maaike , Gjøra Andreas , Lindheim-Minde Barbro , Kamanda Samuel , Koroma Alimamy P , Bolkan H A
Published: December 2021

Objective

To explore factors influencing surgical provider productivity and identify barriers against and opportunities to increase individual surgical productivity in Sierra Leone, in order to explain the observed increase in unmet surgical need from 92.2% to 92.7% and the decrease in surgical productivity to 1.7 surgical procedures per provider per week between 2012 and 2017.

Design and methods

This explanatory qualitative study consisted of in-depth interviews about factors influencing surgical productivity in Sierra Leone. Interviews were analysed with a thematic network analysis and used to develop a conceptual framework.

Participants and setting

21 surgical providers and hospital managers working in 12 public and private non-profit hospitals in all regions in Sierra Leone.

Results

Surgical providers in Sierra Leone experience a broad range of factors within and outside the health system that influence their productivity. The main barriers involve both patient and facility financial constraints, lack of equipment and supplies, weak regulation of providers and facilities and a small surgical workforce, which experiences a lack of recognition. Initiation of a Free Health Care Initiative for obstetric and paediatric care, collaborations with partners or non-governmental organisations, and increased training opportunities for highly motivated surgical providers are identified as opportunities to increase productivity.

Discussion

Broader nationwide health system strengthening is required to facilitate an increase in surgical productivity and meet surgical needs in Sierra Leone. Development of a national strategy for surgery, obstetrics and anaesthesia, including methods to reduce financial barriers for patients, improve supply-mechanisms and expand training opportunities for new and established surgical providers can increase surgical capacity. Establishment of legal frameworks and appropriate remuneration are crucial for sustainability and retention of surgical health workers.