bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and sociodemographic correlates of antinuclear antibody testing by indirect immunofluorescence or solid-phase assays in a Spanish population: the Camargo Cohort
Authors: Irure-Ventura Juan , Martínez-Revuelta Daniel , López-Hoyos Marcos , Martín-Millán Marta , Nan Daniel , Pariente Emilio , Pardo-Lledías Javier , Comins-Boo Alejandra , Olmos José Manuel , Martínez-Taboada Víctor Manuel , Hernández José Luis
Published: November 2023

Autoantibodies are the hallmark of autoimmunity, and specifically, antinuclear antibodies (ANA) are one of the most relevant antibodies present in systemic autoimmune diseases (AID). In the present study, we evaluate the relationship between ANA and sociodemographic and biobehavioral factors in a population with a low pre-test probability for systemic AID. ANA were determined in serum samples at baseline visit from 2997 participants from the Camargo Cohort using indirect immunofluorescence assay, and two solid phase assays (SPA), addressable laser bead immunoassay, and fluorescence enzyme immunoassay. Sociodemographic and biobehavioral features of the subjects were obtained at baseline visit using a structured questionnaire. The prevalence of ANA positive results was significantly higher when indirect immunofluorescence assay was used as screening method in comparison with SPAs, being higher in females, older subjects, and those with higher C-reactive protein levels. Considering biobehavioral features, the prevalence was higher in those individuals with a sedentary lifestyle, and in ex- and non-alcohol users. Moreover, considering the relevance of the antibody load using ANA Screen, the prevalence of the antibody load also increased with age, especially in females. In conclusion, the prevalence of ANA varies depending on sociodemographic and biobehavioral features of the subjects, which could be relevant specifically in a population with a low pre-test probability for systemic AIDs.
A Novel Truncating Mutation in PAX1 Gene Causes Otofaciocervical Syndrome Without Immunodeficiency
Authors: Elbagoury Nagham M. , Abdel-Aleem Asmaa F. , Sharaf-Eldin Wessam E. , Ashaat Engy A. , Esswai Mona L.
Published: November 2023

Otofaciocervical syndrome (OTFCS) is a rare genetic disorder of both autosomal recessive and autosomal dominant patterns of inheritance. It is caused by biallelic or monoallelic mutations in PAX1 or EYA1 genes, respectively. Here, we report an OTFCS2 female patient of 1st consanguineous healthy parents. She manifested facial dysmorphism, hearing loss, intellectual disability (ID), and delayed language development (DLD) as the main clinical phenotype. The novel homozygous variant c.1212dup (p.Gly405Argfs*51) in the PAX1 gene was identified by whole exome sequencing (WES), and family segregation confirmed the heterozygous status of the mutation in the parents using the Sanger sequencing. The study recorded a novel PAX1 variant representing the sixth report of OTFCS2 worldwide and the first Egyptian study expanding the geographic area where the disorder was confined.
Thin shell foundations: Quantification of embodied carbon reduction through materially efficient geometry
Authors: Feickert Kiley , Mueller Caitlin T.
Published: November 2023

Building foundation systems are a significant but understudied contributor to embodied carbon emissions of the built environment, and typically use excess material in prismatic, bending-dominated typologies. This paper identifies and characterizes a promising pathway for reducing the embodied carbon associated with reinforced concrete shallow foundations through an alternative typology, thin shell foundations. The main focus is a quantification and comparison of the environmental impact of typical spread footings and materially efficient shell foundations. Validated analytical engineering equations are applied in a parametric design workflow for the same design load and soil bearing capacity. By iterating through this workflow systematically, insights are gained regarding the applicability of shell foundations to various building typologies and site conditions. Results show that for small column loads and weak soils, shells reduce embodied carbon by about half compared to spread footings. For high applied loads, shells significantly outperform their prismatic counterparts, reducing the environmental impact by almost two-thirds. Foundations are then considered within the context of a whole building structural frame to determine the potential downstream savings when multiple systems are optimized to reduce material use and mass. When floor slabs are shape-optimized in addition to using shell foundations, a building structural system can be constructed for nearly one-quarter of the embodied carbon of a typical system. To take advantage of these potential savings, a method for fabricating thin shell foundations, where earth is compacted and milled to create the formwork, is presented following a review of digital fabrication methods.
Humans Have Boosted Atmospheric Mercury Concentrations Sevenfold
Authors: Dzombak Rebecca
Published: November 2023

A new baseline of volcanic contributions to the global mercury cycle reveals how drastically human activities have increased the element’s concentration in the atmosphere.
Compound Continental Risk of Multiple Extreme Floods in the United States
Authors: Najibi Nasser , Devineni Naresh , Lall Upmanu
Published: November 2023

Understanding spatially correlated floods and modeling joint hazard associated with threshold exceedances across multiple locations is crucial for accurate estimation of continental‐scale portfolio risk. This work uses a non‐parametric copula‐based spatial simulator to analyze peak floods across the United States to derive the first‐of‐its‐kind continental portfolio risk estimates at the 10‐ and 100‐year return levels. We find significant interdependence in floods across the nation, revealing the recurring pattern of extreme events affecting the Northeast, Central, West, and Northwest United States in the same year. The stochastic simulator effectively manages high‐dimensional data and offers reliable uncertainty estimates for both spatially dependent floods and the aggregated flood losses at the continental level. El Niño‐Southern Oscillation and Atlantic Multidecadal Oscillation are identified as statistically significant tele‐connectors of aggregate loss. This research aims to advance the understanding of compound continental flood hazard and the potential large‐scale climate teleconnections that lead to such compound floods.
How Exceptional Was the 2015–2019 Central American Drought?
Authors: Anderson Talia G. , McKinnon Karen A. , Pons Diego , Anchukaitis Kevin J.
Published: November 2023

The Central American Dry Corridor experienced five consecutive years of drought from 2015 to 2019. Here, we find that the severity of this drought was driven primarily by rainfall deficits in July–August. To determine if the magnitude of this event was outside the range of natural variability, we apply a statistical resampling method to observations that emulates internal climate variability. Our analyses show that droughts similar to the 2015–2019 event are possible, although extremely rare, even without anthropogenic influences. Persistent droughts in our ensemble are consistently linked to stronger easterly winds associated with the Caribbean Low‐Level Jet. We also examine the effects of temperature on soil moisture during this drought using the Palmer Drought Severity Index and show that anthropogenic warming increases the likelihood of severe deficits. Multi‐year droughts are likely to worsen by the end of the 21st century due to the compound effects of anthropogenic climate change.
Treosulfan vs busulfan conditioning for allogeneic bmt in children with nonmalignant disease: a randomized phase 2 trial
Authors: Sykora Karl-Walter , Beier Rita , Schulz Ansgar , Cesaro Simone , Greil Johann , Gozdzik Jolanta , Sedlacek Petr , Bader Peter , Schulte Johannes , Zecca Marco , Locatelli Franco , Gruhn Bernd , Reinhardt Dirk , Styczynski Jan , Piras Simona , Fagioli Franca , Bonanomi Sonia , Caniglia Maurizio , Li Xieran , Baumgart Joachim , Kehne Jochen , Mielcarek-Siedziuk Monika , Kalwak Krzysztof
Published: November 2023

Optimal conditioning prior to allogeneic hematopoietic stem cell transplantation for children with non-malignant diseases is subject of ongoing research. This prospective, randomized, phase 2 trial compared safety and efficacy of busulfan with treosulfan based preparative regimens. Children with non-malignant diseases received fludarabine and either intravenous (IV) busulfan (4.8 to 3.2 mg/kg/day) or IV treosulfan (10, 12, or 14 g/m2/day). Thiotepa administration (2 × 5 mg/kg) was at the investigator’s discretion. Primary endpoint was freedom from transplantation (treatment)-related mortality (freedom from TRM), defined as death between Days -7 and +100. Overall, 101 patients (busulfan 50, treosulfan 51) with at least 12 months follow-up were analyzed. Freedom from TRM was 90.0% (95% CI: 78.2%, 96.7%) after busulfan and 100.0% (95% CI: 93.0%, 100.0%) after treosulfan. Secondary outcomes (transplantation-related mortality [12.0% versus 3.9%]) and overall survival (88.0% versus 96.1%) favored treosulfan. Graft failure was more common after treosulfan (n = 11), than after busulfan (n = 2) while all patients were rescued by second procedures except one busulfan patient. CTCAE Grade III adverse events were similar in both groups. This study confirmed treosulfan to be an excellent alternative to busulfan and can be safely used for conditioning treatment in children with non-malignant disease.
Tissue-resident B cells orchestrate macrophage polarisation and function
Authors: Suchanek Ondrej , Ferdinand John R. , Tuong Zewen K. , Wijeyesinghe Sathi , Chandra Anita , Clauder Ann-Katrin , Almeida Larissa N. , Clare Simon , Harcourt Katherine , Ward Christopher J. , Bashford-Rogers Rachael , Lawley Trevor , Manz Rudolf A. , Okkenhaug Klaus , Masopust David , Clatworthy Menna R.
Published: November 2023

B cells play a central role in humoral immunity but also have antibody-independent functions. Studies to date have focused on B cells in blood and secondary lymphoid organs but whether B cells reside in non-lymphoid organs (NLO) in homeostasis is unknown. Here we identify, using intravenous labeling and parabiosis, a bona-fide tissue-resident B cell population in lung, liver, kidney and urinary bladder, a substantial proportion of which are B-1a cells. Tissue-resident B cells are present in neonatal tissues and also in germ-free mice NLOs, albeit in lower numbers than in specific pathogen-free mice and following co-housing with ‘pet-store’ mice. They spatially co-localise with macrophages and regulate their polarization and function, promoting an anti-inflammatory phenotype, in-part via interleukin-10 production, with effects on bacterial clearance during urinary tract infection. Thus, our data reveal a critical role for tissue-resident B cells in determining the homeostatic ‘inflammatory set-point’ of myeloid cells, with important consequences for tissue immunity.
Quantum noise and its evasion in feedback oscillators
Authors: Loughlin Hudson A. , Sudhir Vivishek
Published: November 2023

Feedback oscillators, consisting of an amplifier whose output is partially fed back to its input, provide stable references for standardization and synchronization. Notably, the laser is such an oscillator whose performance can be limited by quantum fluctuations. The resulting frequency instability, quantified by the Schawlow-Townes formula, sets a limit to laser linewidth. Here, we show that the Schawlow-Townes formula applies universally to feedback oscillators beyond lasers. This is because it arises from quantum noise added by the amplifier and out-coupler in the feedback loop. Tracing the precise origin of quantum noise in an oscillator informs techniques to systematically evade it: we show how squeezing and entanglement can enable sub-Schawlow-Townes linewidth feedback oscillators. Our analysis clarifies the quantum limits to the stability of feedback oscillators in general, derives a standard quantum limit (SQL) for all such devices, and quantifies the efficacy of quantum strategies in realizing sub-SQL oscillators.
Deciphering triterpenoid saponin biosynthesis by leveraging transcriptome response to methyl jasmonate elicitation in Saponaria vaccaria
Authors: Chen Xiaoyue , Hudson Graham A. , Mineo Charlotte , Amer Bashar , Baidoo Edward E. K. , Crowe Samantha A. , Liu Yuzhong , Keasling Jay D. , Scheller Henrik V.
Published: November 2023

Methyl jasmonate (MeJA) is a known elicitor of plant specialized metabolism, including triterpenoid saponins. Saponaria vaccaria is an annual herb used in traditional Chinese medicine, containing large quantities of oleanane-type triterpenoid saponins with anticancer properties and structural similarities to the vaccine adjuvant QS-21. Leveraging the MeJA-elicited saponin biosynthesis, we identify multiple enzymes catalyzing the oxidation and glycosylation of triterpenoids in S. vaccaria. This exploration is aided by Pacbio full-length transcriptome sequencing and gene expression analysis. A cellulose synthase-like enzyme can not only glucuronidate triterpenoid aglycones but also alter the product profile of a cytochrome P450 monooxygenase via preference for the aldehyde intermediate. Furthermore, the discovery of a UDP-glucose 4,6-dehydratase and a UDP-4-keto-6-deoxy-glucose reductase reveals the biosynthetic pathway for the rare nucleotide sugar UDP-d-fucose, a likely sugar donor for fucosylation of plant natural products. Our work enables the production and optimization of high-value saponins in microorganisms and plants through synthetic biology approaches.
Greater wax moth control in apiaries can be improved by combining Bacillus thuringiensis and entrapments
Authors: Han Bo , Zhang Li , Geng Lili , Jia Huiru , Wang Jian , Ke Li , Li Airui , Gao Jing , Wu Tong , Lu Ying , Liu Feng , Song Huailei , Wei Xiaoping , Ma Shilong , Zhan Hongping , Wu Yanyan , Liu Yongjun , Wang Qiang , Diao Qingyun , Zhang Jie , Dai Pingli
Published: November 2023

The greater wax moth (GWM), Galleria mellonella (Lepidoptera: Pyralidae), is a major bee pest that causes significant damage to beehives and results in economic losses. Bacillus thuringiensis (Bt) appears as a potential sustainable solution to control this pest. Here, we develop a novel Bt strain (designated BiotGm) that exhibits insecticidal activity against GWM larvae with a LC50 value lower than 2 μg/g, and low toxicity levels to honey bee with a LC50 = 20598.78 μg/mL for larvae and no observed adverse effect concentration = 100 μg/mL for adults. We design an entrapment method consisting of a lure for GWM larvae, BiotGm, and a trapping device that prevents bees from contacting the lure. We find that this method reduces the population of GWM larvae in both laboratory and field trials. Overall, these results provide a promising direction for the application of Bt-based biological control of GWM in beehives, although further optimization remain necessary.
Training large-scale optoelectronic neural networks with dual-neuron optical-artificial learning
Authors: Yuan Xiaoyun , Wang Yong , Xu Zhihao , Zhou Tiankuang , Fang Lu
Published: November 2023

Optoelectronic neural networks (ONN) are a promising avenue in AI computing due to their potential for parallelization, power efficiency, and speed. Diffractive neural networks, which process information by propagating encoded light through trained optical elements, have garnered interest. However, training large-scale diffractive networks faces challenges due to the computational and memory costs of optical diffraction modeling. Here, we present DANTE, a dual-neuron optical-artificial learning architecture. Optical neurons model the optical diffraction, while artificial neurons approximate the intensive optical-diffraction computations with lightweight functions. DANTE also improves convergence by employing iterative global artificial-learning steps and local optical-learning steps. In simulation experiments, DANTE successfully trains large-scale ONNs with 150 million neurons on ImageNet, previously unattainable, and accelerates training speeds significantly on the CIFAR-10 benchmark compared to single-neuron learning. In physical experiments, we develop a two-layer ONN system based on DANTE, which can effectively extract features to improve the classification of natural images.
FAIR EVA: Bringing institutional multidisciplinary repositories into the FAIR picture
Authors: Aguilar Gómez Fernando , Bernal Isabel
Published: November 2023

The FAIR Principles are a set of good practices to improve the reproducibility and quality of data in an Open Science context. Different sets of indicators have been proposed to evaluate the FAIRness of digital objects, including datasets that are usually stored in repositories or data portals. However, indicators like those proposed by the Research Data Alliance are provided from a high-level perspective that can be interpreted and they are not always realistic to particular environments like multidisciplinary repositories. This paper describes FAIR EVA, a new tool developed within the European Open Science Cloud context that is oriented to particular data management systems like open repositories, which can be customized to a specific case in a scalable and automatic environment. It aims to be adaptive enough to work for different environments, repository software and disciplines, taking into account the flexibility of the FAIR Principles. As an example, we present DIGITAL.CSIC repository as the first target of the tool, gathering the particular needs of a multidisciplinary institution as well as its institutional repository.
On the $$(k,\ell )$$-anonymity of networks via their k-metric antidimension
Authors: Fernández Elena , Kuziak Dorota , Munoz-Marquez Manuel , Yero Ismael G.
Published: November 2023

This work focuses on the $$(k,\ell )$$

(
k
,
ℓ
)

-anonymity of some networks as a measure of their privacy against active attacks. Two different types of networks are considered. The first one consists of graphs with a predetermined structure, namely cylinders, toruses, and 2-dimensional Hamming graphs, whereas the second one is formed by randomly generated graphs. In order to evaluate the $$(k,\ell )$$

(
k
,
ℓ
)

-anonymity of the considered graphs, we have computed their k-metric antidimension. To this end, we have taken a combinatorial approach for the graphs with a predetermined structure, whereas for randomly generated graphs we have developed an integer programming formulation and computationally tested its implementation. The results of the combinatorial approach, as well as those from the implementations indicate that, according to the $$(k,\ell )$$

(
k
,
ℓ
)

-anonymity measure, only the 2-dimensional Hamming graphs and some general random dense graphs are achieving some higher privacy properties.
Long-term safety and decrease of pill burden by tenapanor therapy: a phase 3 open-label study in hemodialysis patients with hyperphosphatemia
Authors: Koiwa Fumihiko , Sato Yu , Ohara Meiko , Nakanishi Kaoru , Fukagawa Masafumi , Akizawa Tadao
Published: November 2023

Phosphate binders (PBs) generally have a high pill burden. Tenapanor selectively inhibits sodium/hydrogen exchanger isoform 3, reducing intestinal phosphate absorption. Tenapanor is a novel drug administered as a small tablet, twice daily. This multicenter, open-label, single-arm, phase 3 study aimed to evaluate the long-term safety of tenapanor and its efficacy in decreasing PB pill burden. Tenapanor 5 mg twice daily was administered to hemodialysis patients with serum phosphorus level 3.5–7.0 mg/dl at baseline; the dose could be increased up to 30 mg twice daily. Patients could also switch from PBs. The primary endpoint was safety during 52-week administration. The key secondary endpoint was a ≥ 30% reduction in the total pill number of daily PBs and tenapanor from baseline. Of 212 patients starting treatment, 154 completed the study. Diarrhea was the most frequent adverse event, occurring in 135 patients (63.7%); most events were classified as mild (74.8%). No clinically significant changes occurred other than serum phosphorus level. At Week 52/discontinuation, 158/204 patients (77.5%) achieved the key secondary endpoint. Complete switching from PBs to tenapanor was achieved in 50–76 patients (26.7%–41.5%), and 80 patients (51.9%) at Week 8–12 and Week 50, respectively. Serum phosphorus remained generally stable within the target range (3.5–6.0 mg/dl). These findings suggest the long-term safety and tolerability of tenapanor. Tenapanor could reduce or eliminate PB pill burden while controlling serum phosphorus levels.

Trial registration: NCT04771780
Changes in the skin characteristics of Nellore steers during the rearing phase in hot climate pasture supplemented with protein sources
Authors: Nonato Lucimara Modesto , Ítavo Luis Carlos Vinhas , Brandão Ferreira Ítavo Camila Celeste , Longhini Vanessa Zirondi , Dias Alexandre Menezes , dos Santos Difante Gelson , de Moraes Gabriella Jorgetti , Pupin Rayane Chitolina , de Affonseca Jardim Paulo Henrique , dos Santos Viviane Maria Oliveira , Gurgel Antonio Leandro Chaves , Araujo Carolina Marques Costa
Published: November 2023

We hypothesized that the protein source in supplements and the insolation and ambient temperature changes in different seasons could cause changes in the skin of Nellore steers during the rearing phase on warm-climate pasture. The objective of this study was to evaluate the effects of replacing true protein (soybean meal) with NPN (extruded urea) in the supplement on the skin characteristics of steers grazing on Marandu grass pastures. Thirty-six Nellore steers with an average initial weight of 250.0 kg and 15 months of age were used. Skin biopsies were performed at three different times: summer, autumn, and winter. The protein source has effects on the length of the glandular portion, number of follicles, and gland area in steers during the rearing phase at different seasons of the year. In the summer, the skin presented a higher compact structure, while in the autumn and winter, the skin presented a sparser arrangement. Skin from steers that received soybean meal in supplement had a more significant number of follicles in the summer and a smaller area and length of sweat glands. The dermis thickness of steers supplemented with soybean meal was greater than that of urea supplemented. The epidermis thickness and dermis of the steers' skin were greater at the autumn (April). Sweat gland depth was greater in autumn (April) and winter (July) than in summer (December). The protein source in the supplement alters the skin characteristics by increasing of dermis thickness of Nellore steers during the growth phase. The insolation and ambient temperature changes in different seasons alter the skin structure by increasing the epidermis and dermis thickness, sweat glands depth, and glands area of the skin of steers during the growth phase.
Unravelling the secrets of lesser florican: a study of their home range and habitat use in Gujarat, India
Authors: Ram Mohan , Gadhavi Devesh , Sahu Aradhana , Srivastava Nityanand , Rather Tahir Ali , Bhatia Kapil , Jhala Lahar , Zala Yashpal , Gadhvi Indra , Modi Vidhi , Jhala Dushyantsinh , Patel Akshita , Baraiya Sneha , Devaliya Dhaval
Published: November 2023

The home range of a species is determined by a complex interplay of extrinsic and intrinsic factors, which can have profound impacts on the species’ resource use. Understanding these dynamics is especially important for conserving critically endangered species. In this study, we used satellite telemetry to investigate the home range of the critically endangered lesser florican (Sypheotides indicus) in Gujarat, India. We analysed GPS locations from 10 lesser floricans deployed with GPS/GSM transmitters between 2020 and 2022. The average home range size (95% KDE) was 10.73 ± 10.70 km2 (mean ± SD), while the average core area (50% KDE) was 1.95 ± 1.56 km2 (mean ± SD). The monthly and daily distances covered were 286.29 ± 599.42 km and 10.11 ± 19.78 km, respectively. Our analysis indicated that suitable habitats and movement patterns were the most important factors explaining the variation in home range size. Specifically, our results suggest that lesser floricans prefer multi-use agro-grassland habitat systems with heterogeneous structures to accommodate different life history requirements. This preference may reflect the depletion and degradation of grasslands across the species’ range. Therefore, managing grassland habitats amidst croplands should be one of the key conservation strategies for the lesser florican.
Push–pull [7]helicene diimide: excited-state charge transfer and solvatochromic circularly polarised luminescence
Authors: Saal Fridolin , Swain Asim , Schmiedel Alexander , Holzapfel Marco , Lambert Christoph , Ravat Prince
Published: November 2023

Herein we describe a helically chiral push–pull molecule named 9,10-dimethoxy-[7]helicene diimide, displaying fluorescence and CPL over nearly the entire visible spectrum dependent on solvent polarity along with high dissymmetry factors.
Effect of the oxygen vacancy electronic state on Ni migration in Li0.5(Ni0.8Mn0.1Co0.1)O2 cathode material
Authors: Komalig Ravanny W. M. , Shukri Ganes , Agusta Mohammad Kemal , Mahyuddin Muhammad Haris , Sumboja Afriyanti , Saputro Adhitya Gandaryus , Maezono Ryo , Nuruddin Ahmad , Dipojono Hermawan Kresno
Published: November 2023

The presence of oxygen vacancies thermodynamically and kinetically induces Ni in Li0.5NMC811 to migrate to the empty lithium site.
Reaction of methionine with chlorine: kinetics, product formation, and potential use as a scavenger in chlorine dioxide-based systems
Authors: Jütte Mischa , Heyns Josephine , Abdighahroudi Mohammad Sajjad , Schüth Christoph , Lutze Holger V.
Published: November 2023

The present study investigates the reaction of methionine with free available chlorine (FAC) and estimates the usability of methionine as a selective scavenger for intrinsically formed FAC in chlorine dioxide (ClO2)-based reactions.
Particle and DBP removal efficiency and toxicity evaluation of polypropylene cotton filters in household drinking water purification systems
Authors: Pan Linlin , Zhuang Yuan , Chen Ruya , He Yitian , Shi Baoyou
Published: November 2023

PCF could efficiently remove iron particles and DBPs to reduce toxicity risks.
Outcomes of Ultrasound or Physical Examination-Indicated Cerclage according to the Degree of Cervical Dilation
Authors: Binsted Alyssa C. Savelli , Nehme Lea , Abuhamad Alfred Z. , Kawakita Tetsuya
Published: November 2023

Objective Pregnancy outcomes of individuals receiving cervical cerclage when the cervix is dilated are not well known. We sought to examine preterm birth rates after ultrasound or physical examination-indicated cerclage placement according to the degree of cervical dilation.

Study Design This was a retrospective cohort study of individuals with singleton pregnancies undergoing ultrasound or physical examination-indicated cerclage before 240/7 weeks of gestation from 2004 to 2018. Individuals were categorized based on the degree of cervical dilation at the time of cerclage. Our primary outcome was preterm delivery at less than 37 weeks of gestation. Multivariable logistic regression was performed to calculate adjusted odds ratios (aOR) with 95th confidence intervals (95% CI), controlling for predefined covariates.

Results Of 147 individuals undergoing ultrasound or physical examination-indicated cerclage, 90/147 (61%) had a closed or 0.5 cm dilated cervix at the time of cerclage placement, 45/147 (31%) had a cervical dilation of 1 to 2.5 cm, and 12/147 (8%) had a cervical dilation of 3 to 4 cm at the time of placement. Individuals with a cervical dilation of 1 to 2.5 cm compared with those who had a closed cervix did not have increased odds of preterm delivery (58 vs. 42%; aOR: 1.95; 95% CI: 0.93–4.07). However, individuals with a cervical dilation of 3 to 4 cm compared with individuals who had a closed cervix had significantly increased odds of preterm delivery (75 vs. 42%; aOR: 4.33; 95% CI: 1.05–17.77).

Conclusion The rate of preterm birth increases with increasing cervical dilation at the time of cerclage placement. However, individuals who have a cerclage placed when the cervix is 1 to 2.5 cm can achieve an outcome that is not significantly different from those who had a cerclage placed when the cervix is closed.

Key Points
Free Thoracodorsal Artery Perforator Flap for Head and Neck Reconstruction: An Indian Experience
Authors: Jaffar Samreen , Jaiswal Dushyant , Shankhdhar Vinay Kant , Bindu Ameya , Mathews Saumya , Mantri Mayur , Kumar Vineet , Yadav Prabha Subhash
Published: November 2023

Background We describe our experience with use of free thoracodorsal artery perforator (TDAP) flap for head and neck (H&N) cancer reconstruction, with respect to the patient and disease profile, suitable defect characteristics, the reconstructive technique, and complications.

Methods Consecutive patients (N = 26) undergoing free TDAP flap for H&N onco-reconstruction, in a single center, were included from January 2015 to December 2018 and the data were analyzed.

Results Perforator(s) were reliably predicted preoperatively, using handheld Doppler. Lateral position was comfortable for the harvest. Twenty flaps were harvested on a single perforator, more commonly musculocutaneous (n = 16). The thoracodorsal nerve and latissimus dorsi muscle could be preserved, completely in almost all cases. The skin paddle was horizontally (n = 5) or vertically (n = 21) oriented, both giving a satisfactory scar. The flap was used as a single island or two islands by de-epithelializing intervening skin. Pedicle length was sufficient in all cases. Four cases were explored for suspected venous insufficiency. Two had thrombosis, of which one was salvaged, while the other necrosed. One flap had minimal partial necrosis, which was managed with secondary suturing. The 5-year follow-up showed good oral competence, mouth opening, and cosmetic satisfaction among patients.

Conclusion TDAP flap provides all the advantages of a perforator-based free flap and of back as a donor site with close color match to the face, relatively hairless, and thickness in between the thigh and the forearm. It can be a useful tool to provide an ideal functional and aesthetic outcome, with a hidden donor site and minimal donor site morbidity in selected cases.
Peoples of the Covenant
Authors: Smith Anthony D
Published: November 2023

The belief in ethnic election was developed in various ways by different communities across the ages, and covered a wide range of ideas and concerns. Some of them adhered, more or less strictly, to the prototypical elements of divine choice, promise, collective sanctification, conditional privilege, witness, and sacred law. In other cases, these elements are attenuated or altered, and other ideas are grafted onto the original beliefs. In this chapter, I shall look at four covenanted peoples-the medieval Gregorian Armenians and Amharic Ethiopians, and the modern Afrikaners and Zionist Jews. In the next chapter, I consider a wider field of ‘missionary’ chosen peoples within the monotheistic traditions. In Christian doctrine, closeness is transferred from a particular ethnic community to the universal Church of believers, verus Israel.Yet, in historical fact, we often find some tension between this universalism and the profession of Christian faith and practice of particular communities. Such was the case of Armenia from the fourth century. Despite many attempts by the Gregorian Apostolic Church to convert the heathen, and with considerable success, the Armenian kingdom’s geographical location and political circumstance, between Sasanid
Morality without the Idea that Humans are Special
Authors: Rachels James
Published: November 2023

IF the idea of human dignity is abandoned, what sort of moral view should be adopted in its place? This is not an easy question. Like Asa Gray, we are pulled in one way by the thought that we are kin to the animals, but we are pulled in a different direction by the conviction that, when all is said and done, we remain quite different from them. Anyone who attempts to formulate an adequate post-Darwinian ethic must feel this tension. The conflicting pulls are evident in the remarks of the distinguished evolutionary biologist Ernst Mayr:

The shockwaves of the ‘dethroning’ of man have not yet abated. Depriving man of his privileged position, necessitated by the theory of common descent, was the first Darwinian revolution. Like most revolutions, it went at first too far, as reflected in the claim made by some extremists that man is ‘nothing but’ an animal. This is, of course, not true. To be sure, man is, zoologically speaking, an animal. Yet, he is a unique animal, differing from all others in so many fundamental ways that a separate science for man is well-justified. When recognizing this, one must not forget in how many, often unsuspected, ways man reveals his ancestry. At the same time, man’s uniqueness justifies, up to a point, a man directed value system and man-centered ethics. In this sense a severely modified anthropocentrism continues to be legitimate.
Economic aspects of the production and use of pharmaceuticals: evidence and gaps in research
Authors: Foster Susan D
Published: November 2023

Most developing countries do not have enough of the right drugs in the right places to meet the health needs of their populations. A WHO report estimated that some 2 billion people, nearly half the world’s population, have no access to even essential basic drugs (WHO 1988a). The problem is as much one of poor economic and political choices as one of scarcity. Most countries are already spending significant amounts on drugs; but for a number of reasons the shortages persist. That the issue of pharmaceuticals has become highly politicized is not surprising, given that the international market for pharmaceuticals was estimated to be worth $100 billion in 1987, and the pharmaceutical industry is one of the world’s most profitable (Wyke 1987). Political considerations often spill over into the economics of pharmaceuticals, and economic analysis is often pressed into the service of political or commercial interests, or used to defend a point of view. The characteristics of the research are sometimes closely linked to the source of its financing. Interest groups which have a stake in any move towards more rational use of drugs in developing countries include the government and ministry of health; the medical profession; the political é lite; the pharmaceutical industry; and the industrialized countries (Yudkin 1980).
Encouraging efficiency through programme and functional budgeting: lessons from experience in Ghana and The Gambia
Authors: Issaka-Tinorgah Abdulai , Waddington Catriona
Published: November 2023

Encouraging health services to operate more efficiently lies at the heart of health economics. Thus efficiency has been a recurring theme in this volume. In the absence of competitive markets for health care − and hence in the absence of prices acting as signals for efficient behaviour − institutional procedures determine the extent to which efficient resource-allocation occurs. If they are to behave efficiently, decision-makers ideally need a reliable flow of information about the costs and benefits of health programmes. Planners and managers should combine data on health needs and the effectiveness of alternative interventions with the relevant cost profiles. In reality, this link between benefits and costs − in effect between the objectives of plans and accounts information − is often absent.
Smoking habits: by social class
Authors: Wald Nicholas , Nicolaides-Bouman Ans
Published: November 2023

This section is concerned with current smokers only. Information on ex-smokers and persons who have never smoked, classified according to social class, is given in Section 6. Details of the TAC classification by social class, and the GHS classification by socio¬ economic group are given on page xxxi. In the text, little mention is made of trends in smoking habits among men and women in social class VI (TAC data), whose members are described as unoccupied (including for example, persons unemployed for more than two months, married women with unemployed husbands, and divorcees and widows with no occupation). Social class VI is therefore a heterogenous group, and the composition of its members is likely to have changed during the period of the surveys. It cannot appropriately be considered in the social classes I to V ‘gradient’ described below.
Age at starting to smoke
Authors: Wald Nicholas , Nicolaides-Bouman Ans
Published: November 2023

Data on age at starting to smoke are available from surveys commissioned by the TAC between 1965 and 1987. Data are available for men and women for all ages combined; they are also stratified according to age at the time of the survey. In the tabulations the data relate to all persons who have ever smoked any form of tobacco, and therefore include ex-smokers as well as current smokers at the time of the survey.
Tobacco tax and price
Authors: Wald Nicholas , Nicolaides-Bouman Ans
Published: November 2023

This section contains tables of the rates of duty on tobacco, and total receipts from duty and taxes on tobacco from 1900 to 1988. Duties on tobacco appeared on the statute book in 1660; preferential rates were allowed to the Colonies and, after 1787, to the United States of America as well. In 1789 the duties were subdivided into two portions, Customs and Excise. In 1825 the Customs and Excise duties were consolidated into a single Customs duty, and the following year the differential duty on foreign tobacco was abolished. No distinction was made between raw and manufactured tobacco until 1823, when foreign cigars and manufactured tobacco were dutied separately. From 1863 the rate for raw tobacco was graduated according to the moisture content. From 1904, imported manufactured cigarettes were rated for duty separately.
Use of records, diaries, and proxy respondents
Authors: Armstrong Bruce k. , White Emily , Saracci Rodolfo
Published: November 2023

In this chapter we consider the use of records, diaries, and proxy respondents, all of which are important methods of measurement of exposure in epidemiology.
Basic information on health system performance
Authors: Cumper George E
Published: November 2023

It is a common complaint among health planners and administrators concerned with developing countries that their job is made difficult or (in pessimistic moods) impossible by lack of information. There is something of a paradox here; for the volume and range of data collected by the health authorities and other national agencies is often enormous. In Jamaica, for example, the administrative process gathers data, for all or part of the system, under the following heads:
Evaluation: Process, priorities, techniques
Authors: Cumper George E
Published: November 2023

The comparison of standards with performance provides the formal logical structure of health, as of other kinds of evaluation. It is therefore analogous with the comparison of experience with hypothesis which gives the structure of an experiment in the natural science –at least in its published form. But it has now become a commonplace that the testing of hypotheses against experience through experiment is only a small part of the process of science, telling us little about the choice of field for investigation, the emergence of hypotheses or the way experiments grow from rough conceptions to their final form. Similarly the process of evaluation is more complex and approximate than the formal structure would suggest. If it were not so, the task of evaluating a national health care system would be a daunting one, involving the comparison of performance and standards item by innumerable item, and we should have no useful answer to the first-time investigator who says ‘But how do I set about this?’
The future of national health system evaluation
Authors: Cumper George E
Published: November 2023

A former member of Who’s staff liked to tell how his little son, entertaining an early visitor, had been asked what was his father’s job. ‘A doctor, eh? If I am sick he will make me better?’ ‘Oh no, he is a talking doctor.’ Suppose the young surgeon who was left in Chapter 2 in transition to international consultancy has arrived, a few years later, at the status of the talking doctor, and even conducted a number of evaluations of the national health systems of developing countries. Picture him resting between assignments, perhaps in the Hotel Cornavin (‘pas de bruit, jour et nuit’). Outside his windows, if he could only hear it, is the decorous nightlife of Geneva. But he has decided to eat quietly and well in the Buffet Premiere Classe and retire to his room. Tomorrow he may have to set out again on his missionary rounds, praising rice to the Sikhs, yam to the Bengalis, and vegetarianism to the Masai. But tonight he is among the people of one of the richest and healthiest nations in the world, indistinguishable from them so long as he does not open his mouth to speak.
Introduction
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel
Published: November 2023

Several definitions of epidemiology have been suggested. The simplest is that epidemiology is the study of the occurrence o( disease or other health-related characteristics in human populations. Quite often epidemiologists study not only the frequency of disease but why the frequency differs in different groups of people. Diseases do not occur at random; they have causes, quite often man-made causes, which are avoidable. Thus, many diseases may be prevented if the causes are known. Many people are affected by the occurrence of diseases and their causes. Epidemiology is, therefore, not a discipline used only by professional researchers. The principles of epidemiological research are used by many people who do not even consider themselves epidemiologists. Modern epidemiology is a broad discipline which deals with determinants or risk indicators of a variety of health-related events in human populations. Much of our present knowledge in occupational medicine is drawn from epidemiological studies.
Problems and Possible Solutions
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel
Published: November 2023

An epidemiological study is often begun because a health problem exists and a solution is needed. The best solution would be to prevent diseases from occurring at the work place and sometimes that is possible. New chemicals or processes should ideally be tested before being used. However, no test based upon cells, bacteria, or animals will guarantee that the actual exposure is harmless for man. Chemical compounds can lead to very complex exposures and the damaging effect of this on health is difficult to predict or even document. The second best solution to work site health problems is to try to detect them as soon as they appear; but to implement a monitoring system, good company records are needed. Even if the concern is not about a current problem, proper record systems should be maintained. These data may turn out to be the essential clues if something goes wrong.
Important considerations
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel
Published: November 2023

Comparing the occurrence of disease among exposed and nonexposed might be a reasonable starting point, but often the study design can be strengthened by comparing groups with different degrees of exposure. If the risk of getting the disease does increase with an increasing degree of exposure, it speaks in favour of a causal relationship between exposure and disease, Table 3. When epidemiologists speak about risk or risk indicators, they are not necessarily speaking about causal relationship. Red haired people are at risk from skin cancer in sunny Australia, for example, not because of their red hair, but because they often lack skin protection against sunlight. The fact that people with yellow fingers run a much higher risk of lung cancer than others does not indicate that yellow fingers cause lung cancer. It is a statistical association of no causal importance. However, tobacco stained fingers are risk indicators. Risk indicators are not necessarily causes. Why do we say then that smoking is one of the causes of lung cancer as well as the cause of yellow fingers?
Case study in a power plant
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel
Published: November 2023

In March 1979 the factory inspectorate received a letter from a group of unions who had received by mail a number of reports from several power plants. These reports gave details of premature deaths from cardiovascular disease among union workers. In two plants, employing about 250 union members, there had been 20 deaths in a 12 year period. The average age of the deceased was 60 years and the average length of employment was 14-16 years. In another plant there had been 28 deaths in the period 1968-78 and 70 per cent of the deceased were union members. Union members, however, only accounted for one-third of the total employed at the power plant.
Ascertainment, registration, and assessment of exposure
Authors: Little Julian
Published: November 2023

The descriptive epidemiology of congenital anomalies is influenced not only by true variations in the occurrence of anomalies by time, place, and person but also by variations in the completeness of case finding and recording. In theory, it should be sufficient that there is no bias in ascertainment; in practice, this requires demonstration that ascertainment is as complete as possible. In analytical studies, the problems of interpretation posed by incomplete ascertainment differ between case-control and cohort studies. In case-control studies, the opportunity for bias of ascertainment is minimized as presence or absence of the anomaly under consideration is the characteristic defining the study groups, and incomplete ascertainment poses questions mainly about the external validity of the study. By contrast, in cohort studies ascertainment may be influenced by knowledge of the exposure status of the mother of the infant being examined. This is more likely to be a problem for minor malformations than for serious malformations such as neural tube defects, but even for these the issue is relevant for data on fetuses from pregnancies terminated after pre-natal diagnosis of a malformation, records of which are more difficult to obtain than for births.
Secular trends
Authors: Elwood Mark , Little Julian
Published: November 2023

Changes in the prevalence rate at birth of neural tube defects with time have been reported in almost all well-studied areas. These include long-term trends over 10 or more years and short-term changes over a few years. Seasonal variations are considered separately, in Chapter 7. Secular trends have been greatly affected by antenatal diagnosis and therapeutic abortion, making the trends since the late 1970s more difficult to interpret. It is therefore useful to consider separately trends in the period up to the mid-1970s, and trends in more recent years, although some repetition is unavoidable.