bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental studies of the reusable steel deck forms for concrete slabs
Authors: Tuan Nguyen Canh , Tung Dang Dang
Published: August 2023

Recently, many flyover steel bridges have been built due to high demand of transportation development mega cities in Vietnam, especially in Ho Chi Minh City and Ha Noi City. The steel bridges are selected as effective solutions in urban area because of their advantages such as rapid construction, aesthetic design, high performance. For the construction method of concrete deck slab, wood panels, plastic panels, and precast concrete panels are often used to reduce construction costs. From actual construction projects, these form solutions may not be suitable for large span over 2.0 meters and take more time to install and to dismantle. This study aims to develop an improved solution with reusable steel deck forms for bridge slabs which has been used as permanent deck forms in buildings. Experimental studies are conducted to investigate the frequency of reusability and to verify the bending capacity of the steel deck after many times of reuse. The experiments are separated into two phases including concrete casting stage and strength tests in laboratory. Bending strengths of reused forms are compared with that of new one. Results shows that steel deck forms are still in good condition and provide sufficient bending capacity after 10 times of concrete casting comparing. Therefore, reusable steel deck forms can be effectively applied in the construction of bridge slabs to optimize the construction time and cost.
Interface horizontal shear strength requirement in Ultra-thin whitetopping (UTW) pavement.
Authors: NguyenDinh Nen
Published: August 2023

Ultra-thin whitetopping (UTW) is a thin (5-10 cm) layer of concrete overlaying over an existing asphalt pavement. This concrete layer is bonded on the asphalt surface. Although UTW has been successful in strengthening asphalt pavement, in some cases, the composite pavement may debond at the interface under the concrete slab due to high shear stress. This paper aims to determine the interface shear strength required for UTW pavement systems using theoretical methods and calibrated numerical models (FEMs). The study analysed 432 pavement scenarios with different slab sizes, thicknesses, and material properties. The results show that higher shear stress occurs when the asphalt modulus is stiffer. The size of the slab, the modulus of the supporting layer, and the asphalt thickness have only a minor effect on the shear stress value. However, the thickness of the concrete slab significantly affects the maximum shear stress in the UTW, with an increase of up to 36.6% when reducing the slab thickness from 100mm to 50 mm. The FEM calculations can be used to determine the required interface horizontal shear strength for UTW.
Use of glass waste as granular material in pavement layers
Authors: Doukani Abderrahmane , Bekki Hadj , Hariche Lazhar , Belkacem Abdelillah , Ammari Hafsa
Published: August 2023

The valorisation of waste glass is part of a sustainable development plan. It presents several challenges, starting with the elimination of the various types of waste sent to landfill and the related costs, the reduction of the inconveniences associated with glass (shards, landfill fires), the development of new economic sectors and raw material saving (aggregate quarries). Several research works have previously been carried out to highlight the interest of using waste glass as a partial replacement for unbound granular aggregate in pavement structure. Nevertheless, industrialists remain reluctant to apply such a technique, which encourages researchers to extend their studies in order to properly control the behaviour of granular materials containing glass grains and consequently give more confidence to companies to enforce this technical solution. The present work consists in studying the influence of the shape of glass grains less than 5 mm (rounded and sub-rounded) on the mechanical behaviour of granular pavement materials. The study consists in making a comparison, from a behaviour point of view, between the two forms of glass grains obtained from two different grinding processes. As a result, the Proctor test clearly shows that there is no significant difference between rounded and sub-rounded shape in terms of compactabiliy. It was noted that the addition of particles of recycled glass makes the mixture more insensitive to water. It has been also found that the limiting percentage of addition of glass particles is situated between 20% and 30% reported to the total mass of the mixture.
Properties of pervious concrete made with different types of waste aggregate-A literature review
Authors: Sohel Kazi Md Abu , Al-Jabri Khalifa , Al-Hashami Anwar
Published: August 2023

Pervious concrete, also known as porous concrete, contains interconnected pores that allow water from various sources to pass through. This type of concrete is generally used for pavement construction to protect the environment. Pervious concrete contains only coarse aggregate and sometime very small amount of fine aggregate. Many researches were conducted to develop an efficient type of pervious concrete with different types and combination of aggregates. In many studies, along with natural stone aggregate, other types of waste materials were also tried to use as a coarse aggregate in the mix design of pervious concrete. Some of waste materials showed very promising characteristics which can be effectively used in the mix design of pervious concrete with double environmental benefits. This review article provides an overview of some of the earlier investigations on pervious concrete made from waste and industrial by-product materials. The relationships between crushing strength, porosity and water permeability of the pervious concrete with different types of aggregate are presented in this paper. Steel slag, recycled aggregate, and palm oil clicker were among the waste materials utilized as aggregate in pervious concrete, showed comparable performance; even in some instances, better performance was achieved than pervious concrete made with conventional natural aggregate. The shape of waste aggregate, described by the elongation and flakiness indices, greatly affects the strength properties and water infiltration rate of pervious concrete. If these indices are high, the strength properties of the pervious concrete are significantly reduced, but the water permeability is significantly increased.
The Effect of Baghouse Dust from Secondary Aluminum Processing Waste on Cement Hydration and Mechanical Properties
Authors: Torfin Brysson , Byrd Ben , Huynh Linh , Lowry Michael , Tran Thien Q , Brand Alexander S
Published: August 2023

This work studies the mechanical and chemical effects of utilizing baghouse dust (BHD) from secondary aluminum processing waste as a cement additive for potential use in concrete materials. The baghouse dust was added to cement pastes at replacements of 4 % and 8 % by cement mass. In addition, a combination of BHD and silica fume at different blended ratios were added to the cement mixture as a combined additive. Some reference proportions were also prepared for a comprehensive comparison. Unconfined compressive strength and the chemical composition of the extracted pore solution of the abovementioned hardened cement pastes were investigated. In addition, the effect of BHD on the hydration characteristics of the cement paste was also observed through isothermal calorimetry. It was found that an 8 % substitution of cement by BHD resulted in increased compressive strength after 1 day and 3 days of curing and a reduction of less than 2 % at 7 days of curing. Comparatively, samples with 8 % silica fume resulted in a strength increase of 17 %. As such, it was concluded that BHD addition of up to 8 % was not detrimental to concrete strength but did not improve performance either. This finding was supported by isothermal calorimetry data, which showed that the addition of BHD and the addition of silica fume both increased the initial peak of hydration and accelerated the hydration process but did not significantly impact the total energy of hydration over a period of 7 days. Finally, the high chloride content in BHD may promote corrosion in steel bars and increase concrete scaling potential.
Effects of the cross-sectional shape of drain pipes on seepage of rainwater
Authors: Kawai K , Nakashima K , Yasutomi K , Otaka N
Published: August 2023

Road and railway embankments are earth structures that lose stability under rainfall, and accumulation of rainfall causes an elevation of the phreatic surface within an embankment. For these reasons, drainage systems are needed when constructing an earth structure. Drain pipes are one type of drainage system applicable even for an existing earth structure. However, it is difficult to estimate the effects of the drain pipe quantitatively, and design and construction of drain pipes proceed according to past experience. In this study, the authors succeeded in expressing the drainage effects of drain pipes using an existing soil/water/air coupled analysis framework. This study specifically focused on the cross-sectional shape of drain pipes. Five kinds of cross-sectional drain pipe shapes were created, and rainfall infiltration series was simulated using the same procedure for each case. Consequently, the simulations determined that seepage behavior is dependent on the cross-sectional shape of the drain pipe. Furthermore, this analysis found that infiltrated rainwater does not drain when the phreatic surface is located below the drain pipe.
Ultimate bearing capacity of rigid strip footings on c-ϕ soil subjected to combined eccentric and inclined loading
Authors: Pham Ngoc Quang , Ohtsuka Satoru , Isobe Koichi , Hoang Phuong Hoa
Published: August 2023

The present study calculated the maximum bearing capacity of a strip footing against eccentrically inclined coupled loading on c-ϕ soil, by means of the plane strain rigid plastic finite element method (RPFEM). The influence of soil strengths and footing width on the V-H and H-M failure envelopes (presenting the vertical load V, horizontal load H, and moment M) was thoroughly surveyed to assess the uniqueness of the V-H-M failure envelope. Based on the obtained results, the V-H-M failure envelope was found to be distinct for each value of normalized cohesion c/γB and internal friction angle ϕ. A novel equation, which is a function of c/γB and ϕ, was achieved to predict the failure envelope of the V-H-M limit load space.
Linking dynamics between anchors and granular materials
Authors: Vo Thanh-Trung , Nguyen Trung-Kien
Published: August 2023

The research quantitatively explores the linking properties between the circular plate anchor and the granular assembly during the failure process under the subject of a specified pullout force given to the anchor using three-dimensional discrete particle simulations. This circular anchor is created as a hard cluster of spherical grains and is initially buried at a depth in the granular assembly. The numerical method is constructed based on the frictional interaction force law. The linking dynamic is characterized by the variation of the drag force acting on such anchor due to interaction with grains at the bottom of the frustum which is formed during the uplifting movement of the anchor. The results show that the drag force acting on the anchor first reaches a nearly constant value corresponding to the loading phenomenon at small anchor movement, reflecting the plastic deformation of granular bed as a result of particle rearrangement, and then fluctuates in a wide range, this range increases with increasing the anchor movement as a result of the unloading/reloading events. These loading/unloading/reloading events provide evidence for the linking properties between the anchor movement and granular assembly, which are highlighted by the density and intensity of force network within the frustum.
Bidirectional load test in HoChiMinh City: a case history and lessons learned
Authors: Nguyen Tan , Shiau Jim
Published: August 2023

Bidirectional static load tests to evaluate the axial load-bearing capacity of large cross-sectional bored piles are indispensable. Nonetheless, this test is complicated, costly, and easy to fail. A case history of a bidirectional static load test conducted in HoChiMinh City is reported and analyzed. In particular, a bored pile with 1.8m in diameter and ∼60m in embedment length, located in Tan Binh district, HoChiMinh City, is tested using the bidirectional static load test. The testing load is close to 48MN. The state-of-the-art methods to analyze the data of bidirectional load tests such as back-calculation, constructing equivalent load-displacement curve as head-down static load test, will be adopted then the lessons learned from the case history are elucidated. A guideline to carry out a bidirectional load test is presented. In essence, this study could facilitate the success of bidirectional load tests conducted on large cross-section bored piles.
Reclamation analysis to evaluate measures to increase an acceptable capacity of dredged clay disposal pond
Authors: Nishizono Katsuhide , Kitahara Masahiro , Katagiri Masaaki , Watabe Yoichi
Published: August 2023

Shipping plays an important role in Japan surrounded by the sea and navigation channel must be dredged to accommodate the increasing size of vessels. Most of the dredged soil is usually discharged into a disposal pond. Since it is not easy to secure a new disposal pond, it is necessary to make effective use of the pond currently in use. Therefore, measures to accurately predict the amount of consolidation settlement of dredged soil discharged into the disposal pond are being studied. In this paper, regarding the Shinmoji-Oki disposal pond (S-3 area), which currently accepts dredged soil from the Kanmon waterway, we reported the way to discharge the dredged soil to the pond and the annual accumulated soil volume in it. Then, through the distribution chart of mud surface elevation in S-3 area and elapsed time, we clarified the effects of different way to discharge the dredged soil. Furthermore, to accurately estimate the future acceptable capacity of the pond, the prediction model identified by back analysis is also proposed.
Estimating Unconfined Compression Strength of Fly Ash and Cement Stabilised Clayey Soil using Artificial intelligence Techniques
Authors: Pham Van-Ngoc , Oh Erwin , Ong Dominic E. L. , Nguyen Hong-Hai
Published: August 2023

The study aims to develop proposed predictive formulas for determining the unconfined compression strength (UCS) of fly ash and cement stabilised clayey soil based on Multi-Gene Genetic Programming (MGGP) and Artificial Neural Network (ANN) techniques. Thirteen parameters, including the soil characteristics, the binder types, the binder contents, the curing period, the mixing method, and the fly ash characteristics, such as calcium oxide (CaO) content, CaO/SiO2 ratio, loss of ignition, were considered as the independent variables in the model. The results show that the selected optimal ANN and MGGP models can predict the target values with high correlation coefficients (R-value approximately 0.994 and 0.973, respectively), and low errors. The performances of the MGGP and ANN models were compared based on statistical parameters and several external criteria. The study finds that both models show their generalisation capabilities with robust, powerful, and accurate prediction ability; however, the ANN model slightly outperforms the MGGP model. The proposed predictive equations formulated from the selected optimal MGGP and ANN models could help engineers and consultants to choose the suitable binder and a reasonable amount of fly ash in the pre-planning and pre-design period.
Potential impacts of rapidly changing european use of fossil fuels on global warming
Authors: Huntingford Chris , Lowe Jason , Gohar Laila K , Mathison Camilla
Published: August 2023

The balance of primary energy sources for Europe has been changing rapidly over recent decades, shifting towards more renewables and using fossil fuels with lower carbon emissions. However, the latter is being impacted by the Russia-Ukraine conflict. Here, we determine the potential bounds of how this may affect global warming, based on whether the European use of Russian gas and oil is replaced with either less efficient burning of coal (with and without the gas and oil then used in new markets elsewhere) or with renewables. We perform calculations as perturbations from a baseline carbon dioxide (CO2) trajectory associated with ‘middle range’ and ‘low’ Shared Socioeconomic Pathways (SSP), SSP2-45 and SSP1-26. We calculate the CO2 perturbations as a simulated step change in emissions for the year 2023, which then decays linearly to zero by 2043. The emission profiles drive the FaIR simple climate model. FaIR links greenhouse gas emissions to global warming levels and includes a representation of warming uncertainty based on projections made using more complex Earth system models. We find that the direct impact of the conflict on the global mean temperature is likely to be relatively small, amounting to the worst case of nearly one-hundredth of a degree. This warming is equivalent to approximately an extra half year of current global CO2 emissions. However, we suggest that it is important to consider the implications of the precedents set by the European response to the reduced availability of Russian gas and oil. Such action may reveal the potential for faster uptake of low-carbon energy sources or the converse of backtracking on current Nationally Determined Contributions (NDCs).
Gate-mesa trench enables enhanced β-Ga2O3 MOSFET with higher power figure of merit
Authors: Zhang Yunfei , Luan Suzhen
Published: August 2023

In this article, a gate-mesa trench (GMT) β-Ga2O3 metal-oxide-semiconductor field-effect transistor (MOSFET) device with enhanced performance and breakdown voltage improvement is proposed. Compared with the gate-field plate trench (GFPT), the breakdown voltage and power figure of merit (PFOM) of the GMT device are 2566 V and 680.53 MW cm−2 respectively, which are 1.56 times and 2.25 times higher than those of the GFPT, demonstrating excellent device performance. When the etch depth is 200 nm, the specific on-resistance of the GFPT and the GMT is 8.84 mΩ cm−2 and 9.76 mΩ cm−2, respectively, with the peak transconductance of the GFPT being 61.56 mS mm−1 when the epitaxial layer doping concentration is 3 × 1017 cm-3, which is 1.22 times that of the GMT. The high dielectric constant HfO2 dielectric can significantly improve the PFOM of the device, while the gate oxide Al2O3 drifts the threshold voltage to the right. This article presents a novel approach for designing high-performance enhanced β-Ga2O3 MOSFETs.
Smallworldness in hypergraphs
Authors: Raghav Tanu , Boccaletti Stefano , Jalan Sarika
Published: August 2023

Most real-world networks are endowed with the small-world property, by means of which the maximal distance between any two of their nodes scales logarithmically rather than linearly with their size. The evidence sparkled a wealth of studies trying to reveal possible mechanisms through which the pairwise interactions amongst the units of a network are structured in a way to determine such observed regularity. Here we show that smallworldness occurs also when interactions are of higher order. Namely, by considering Q-uniform hypergraphs and a process through which connections can be randomly rewired with given probability p, we find that such systems may exhibit prominent clustering properties in connection with small average path lengths for a wide range of p values, in analogy to the case of dyadic interactions. The nature of small-world transition remains the same at different orders Q (

=

2
,
3
,
4
,
5
,

and 6) of the interactions, however, the increase in the hyperedge order reduces the range of rewiring probability for which smallworldness emerge.
Herbicide exposure during occupational knapsack spraying in French gardeners and municipal workers
Authors: Boulanger Mathilde , de Graaf Lucie , Pons Romain , Bouchart Valérie , Bureau Mathilde , Lecluse Yannick , Meryet-Figuiere Matthieu , Tual Séverine , Baldi Isabelle , Lebailly Pierre
Published: August 2023

Context

There is a lack of data on pesticide exposure levels during spraying with a knapsack, while it could have important implications for their users’ health.

Methods

We assessed levels and determinants of exposure in 24 male private landscapers/gardeners and municipal workers in France in 2011. Actual dermal exposure to glyphosate was assessed with cotton undergarments and gloves, and a cotton coverall changed between mixing and spraying to assess the contribution of each phase and body area to overall contamination. A field monitor observed the whole workshift and filled in a standardized observation grid.

Results

The median actual contamination was 5,256 µg for the body, and 4,620 µg for hands. Spraying was more exposing than mixing/loading for all body parts except hands, which contributed to nearly 90% of body exposure during mixing/loading, and 30% during spraying, followed by back (14%). In the most exposed quartile, levels were close to some observations in agriculture.

Conclusion

Our study provides new data on pesticide exposure levels of knapsack sprayer users; it should lead to a reinforced prevention, in order to make exposures as low as possible and lessen the risk of chronic diseases.
Antiseptic Techniques in Breast Implant Surgery: Insights From Plastic Surgeons in Saudi Arabia
Authors: Mortada Hatan , Almutairi Faisal Falah , Alrobaiea Saad , Helmi Ayman M , Kattan Abdullah E , Gelidan Adnan G , Arab Khalid
Published: August 2023

Background

Breast implant surgery is a popular procedure worldwide, and the same holds true for Saudi Arabia. Ensuring a sterile surgical environment is crucial to avert postoperative infections. This study explores the various antiseptic techniques adopted by Saudi plastic surgeons during breast implant procedures.

Objectives

This study aims to assess Saudi plastic surgeons’ adherence to antiseptic measures in breast implant surgery, and determine what types of antiseptic measures are most commonly used among Saudi plastic surgeons.

Methods

The authors conducted a cross-sectional survey among board-certified plastic surgeons in Saudi Arabia, collecting data through a self-administered online questionnaire. This questionnaire, which covered their demographic information and their antiseptic practices during breast implant surgery, was disseminated via a WhatsApp (Menlo Park, CA) broadcast message from May 15 to June 27, 2023.

Results

Of the 52 Saudi plastic surgeons who completed the questionnaire, all reported employing preoperative antibiotics and skin disinfection. Other measures included pocket irrigation (86.5%), implant irrigation (92.3%), sleeve/funnel usage (65.4%), nipple shield usage (51.9%), and glove change during the procedure (96.2%). Nearly, all respondents used only a surgical cap for head cover (96.2%) and postoperative antibiotics as prophylaxis (98.1%). However, more than half of them did not minimize door movement during the procedure (51.9%).

Conclusions

This study offers a valuable insight into the antiseptic practices during breast implant surgery in Saudi Arabia. The findings underline the need for further research to establish evidence-based guidelines for antiseptic practices in this field.

Level of Evidence: 5
Expression of trematode-induced zombie-ant behavior is strongly associated with temperature
Authors: Gasque Simone Nordstrand , Fredensborg Brian Lund
Published: August 2023

Parasite-induced modification of host behavior increasing transmission to a next host is a common phenomenon. However, field-based studies are rare, and the role of environmental factors in eliciting host behavioral modification is often not considered. We examined the effects of temperature, relative humidity (RH), time of day, date, and an irradiation proxy on behavioral modification of the ant Formica polyctena (Förster, 1850) by the brain-encysting lancet liver fluke Dicrocoelium dendriticum (Rudolphi, 1819). This fluke induces ants to climb and bite to vegetation by the mandibles in a state of temporary tetany. A total of 1264 individual ants expressing the modified behavior were observed over 13 non-consecutive days during one year in the Bidstrup Forests, Denmark. A sub-set of those ants (N = 172) was individually marked to track the attachment and release of infected ants in relation to variation in temperature. Infected ants primarily attached to vegetation early and late in the day, corresponding to low temperature and high RH, presumably coinciding with the grazing activity of potential herbivorous definitive hosts. Temperature was the single most important determinant for the induced phenotypic change. On warm days, infected ants altered between the manipulated and non-manipulated state multiple times, while on cool days, many infected ants remained attached to the vegetation all day. Our results suggest that the temperature sensitivity of the infected ants serves the dual purpose of exposing infected ants to the next host at an opportune time, while protecting them from exposure to high temperatures, which might increase host (and parasite) mortality.
O05 Management of acute desloughing of the oesophageal lining in patients with dystrophic epidermolysis bullosa: a case series of six paediatric patients
Authors: Bageta Maria , Balboa Pablo Lopez , Yerlett Natalie , Rybak Anna , Petrof Gabriela , Martinez Anna
Published: August 2023

Dystrophic epidermolysis bullosa (DEB) is a subtype of inherited skin disorders characterized by skin and mucosal fragility due to collagen VII (COL7A1) gene mutations. Desloughing of the lining of the oesophagus has not been reported before. We retrospectively reviewed the hospital electronic patient records between 2008 and 2021 with regard to acute treatment and long-term management. Six patients with recessive DEB (RDEB) severe (n = 4), RDEB intermediate (n = 1) and dominant DEB (DDEB) were identified. The mean age at the time of the episode was 29.6 months. Most of the patients (n = 5) suffered from severe gastro-oesophageal reflux at the time of onset. Clinically, they presented with a coughing episode (n = 6), haematemesis (n = 6), vomiting (n = 6) and choking (n = 3) with a piece of mucosae coughed up. Four patients recovered with medical management including immediate hospitalization, no oral intake (nil by mouth, NBM), pain relief and optimization of the dose of proton-pump inhibitors. Due to severe persistent dysphagia, two patients required gastrostomy insertions for feeding; one also required a Nissen's fundoplication due to severe reflux. One patient had an aspiration pneumonia. Desloughing of varying lengths of segments of the oesophagus is an emergency. The lining coughed up needs to be cut at the mouth not pulled and the emergency services called immediately. On arrival, an urgent assessment and chest X-ray should be performed to rule out any signs of perforation. The patient should be kept NBM with intravenous fluids and pain relief. Expert multidisciplinary care is needed to manage this rare but extremely serious condition.
O06 Novel multispectral imaging vs. clinical assessment to assess disease activity in paediatric morphoea
Authors: O’Connor Cathal , McCarthy Siobhan , McCauliffe Michael , Bennett Mary
Published: August 2023

The assessment of disease activity in paediatric morphoea is challenging. Clinical examination and the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) are subjective. Thermography is the monitoring tool of choice but has a high rate of false-positive results, with low specificity. Multispectral imaging (measuring depth, volume, haemoglobin and melanin) may provide a noninvasive objective assessment of disease activity. The aim of this study was to compare activity assessment with multispectral imaging vs. clinical assessment in children with morphoea. 3D images of site-matched affected and unaffected skin were obtained using a handheld portable Antera 3D camera (Miravex Ltd). Analysis of depth, volume, haemoglobin and melanin was performed using the Antera Clinical Studies software. Objective and subjective clinical assessment was performed using LoSCAT and Children's Dermatology Life Quality Index (CDLQI). To date, 17 children (age range 7–18 years) have been recruited. Two-thirds (65%) had linear morphoea and 58% were treated with systemic agents (pulsed methylprednisolone, methotrexate, mycophenolate mofetil, abatacept). Average LoSCAT scores were 20.6 (range 5–73), and average CDLQI scores were 3.7 (range 0–14). The average haemoglobin gradient between affected and unaffected skin was 0.3 in children with active disease and 0.08 in those who had persistent disease remission (P < 0.0001). The sensitivity of multispectral imaging in paediatric morphoea is 90% with specificity of 100%, giving a positive predictive value of 100%, and a negative predictive value of 95%. Multispectral imaging of affected skin may aid activity detection in paediatric morphoea and is particularly useful in darkly pigmented skin.
O10 Cohort study of paradoxical psoriasis in an adolescent population receiving anti-tumour necrosis factor-α for inflammatory bowel disease in a large teaching hospital with specialist dermatology and paediatric gastroenterology services
Authors: Shareef Narin , Price Josephina , Ferguson Leila , Abdul-Wahab Alya
Published: August 2023

Paradoxical psoriasis is well recognized in adults receiving anti-tumour necrosis factor-(TNF)-α therapy for inflammatory bowel disease (IBD) [Bucalo A, Rega F, Zangrilli A et al. Paradoxical psoriasis induced by anti-TNFα treatment: evaluation of disease-specific clinical genetic markers. Int J Mol Sci 2020; 21: 7873. https://doi.org/10.3390/ijms21217873]. Biologics are increasingly being initiated earlier in the treatment ladder for IBD in the paediatric population, who are also vulnerable to paradoxical psoriasis. This observational study aimed to describe the clinical features and management in this group, as there are limited data on how paradoxical psoriasis differs in children. Eight patients with paradoxical psoriasis were referred between 2019 and 2022: five females and three males; age range 12–19 years (mean 15.4 years). They all had Crohn disease and were receiving infliximab (7/8 patients) or adalimumab (1/8). The onset of symptoms following anti-TNF-α initiation was 3 months to 3 years (mean 12.75 months). Involvement included scalp (7), flexural areas (3), trunk (4) limb (3) and face (1). In adults, palmoplantar and pustular forms were commonly reported whereas our cohort demonstrated eczematous forms requiring antibacterial agents, rarely seen in adults. Management included switching from infliximab to ustekinumab in three patients; and the addition of methotrexate (two). Topical treatments alone were sufficient in three patients. There were florid presentations in our cohort and the scalp was predominantly affected (7/8). Five of eight patients required a switch of their anti-TNF-α therapy or an additional systemic treatment. It is crucial for physicians to be aware of this phenomenon and work collaboratively to recognize this early to optimize patients’ symptoms and quality of life [Bucalo et al.].
P07 Quality improvement project of acute referrals to the on-call dermatology service
Authors: Jayaprakash Sindoora , Millette Dijon , Khan Farishta
Published: August 2023

With dermatology services now integrating neural networks and artificial intelligence into departments, the importance of technology to streamline services has been timely in light of the increased influx of referrals needing remote reviews from both community and secondary care. We performed a department quality improvement project to compare referrals made to the on-call dermatology service, Dudley Group NHS trust, during September 2019 and September 2020 against the ‘COVID-19: Clinical guidelines for the management of dermatology patients remotely’. Data were collected from telephone, paper and email referrals made in September 2019 and 2020. Referral data including patient demographics, nature and urgency of referrals, diagnosis, availability of medical photography and follow-up arrangements was collated on a Microsoft Excel Proforma. Of 74 total referrals (35 in 2019; 39 in 2020), hospital referrals in September 2020 (92%, n = 36) largely outweighed GP referrals (8%, n = 3). Urgent referrals made by hospital departments rose from 17% (n = 5 of 29) in September 2019 to 53% (n = 19 of 36) in September 2020. Medical photography, often essential for triage and diagnosis, was available only at the time of referral in 8.6% (n = 3) of cases in 2019 and 48.7% (n = 19) in 2020. The rise may be explained by an increased dependence on remote services. With current pressures placing greater demand on resources, there is a need for online referral systems. Moving away from emails, letters and phone calls ensures a less user-dependent interface. Medical photography can be implemented as an integral feature of referral. Online systems facilitate triage and remote management in keeping with dermatological guidelines.
P20 Job syndrome: hyper IgE syndrome in a young girl with an acneiform rash
Authors: Hefferon Tom , Byrne Berbie , Leahy Marion , Murphy Annette
Published: August 2023

Hyper IgE syndrome (HIES1) is a rare, autosomal dominant, primary immunodeficiency characterized by eczema, recurrent staphylococcal skin infections, pneumonia, increased serum IgE and eosinophilia. It is caused by a heterozygous mutation in the STAT3 gene on chromosome 17q21 with variable expressivity. Nonimmunological findings including characteristic facies, hyperextensibility, long-bone fractures, aneurysms, craniosynostosis and dental abnormalities. We present the case of an 11-year-old girl referred to dermatology with an acneiform facial rash. Examination was consistent with papulo-pustular scarring acne of the face and back. Her history was also significant for recurrent MSSA bacterial lymphadenitis requiring incision and drainage over the proceeding 3 years. Her past medical history was significant for the development of moderate-severity infantile acne at 2 weeks of age, mild childhood eczema, recurrent childhood otitis media Staphylococcus infections resulting in grommet insertion, primary tooth retention requiring extraction and a fractured wrist at age 9 years. Because of the burden of infection the patient was referred to immunology in Crumlin. Investigations revealed mild neutropenia, marginally elevated IgA and IgM, normal eosinophils, marginally elevated IgE, normal lymphocyte subsets, intact complement pathways and normal oxidative burst test. Next-generation sequencing was significant for STAT3 gene mutation consistent with HIES. As there is no family history this likely represents a de novo mutation. The patient is currently on prophylactic azithromycin and low-dose isotretinoin with good effect. This case represents a patient with both immunological and nonimmunological features of HIES1, marginally elevated IgE, absence of eosinophils and negative family history.
P22 Life-threatening bleeding is a serious potential complication of ulcerated congenital haemangiomas: three case reports
Authors: Alenezi Hadi , Solman Lea
Published: August 2023

Congenital haemangiomas (CH) are rare vascular tumours that can be complicated by high-output heart failure (HOHF), transient thrombocytopaenia and ulceration. We present three patients who had life-threatening bleeding from the ulcerated CH, which was fatal for one of the patients. The first patient was born with a large CH of his left thigh, causing thrombocytopaenia and HOHF, requiring ventilation. He was discharged home after 3 weeks, but subsequently developed an ulceration and had a profuse bleeding following a dressing change at home. He required admission to PICU and ventilation support. The second patient was born with a large segmental CH of his right scalp with two ulcerated areas, without HOHF or thrombocytopaenia. He developed a massive bleeding from the ulcerated area at 6 weeks of age, was admitted to PICU with cardiac arrest, but died a few hours later due to multiorgan failure. The third patient was born at 29 weeks’ gestation with a large CH of her right thigh which was ulcerated. She had a profuse arterial bleeding after the dressing was removed in the hospital, requiring emergency surgery and admission to PICU. Although it is a rare complication, neonates/infants with ulcerated CH are at risk for severe, life-threatening arterial bleeding. If an ulceration is present, it needs to be protected with a suitable dressing, until it heals completely. Parents need to be educated on appropriate dressing changing technique, have the support of local tissue viability nurses and learn basic CPR techniques should arterial bleeding occur and necessitate CPR.
Failure of scabies treatment: a systematic review and meta-analysis
Authors: Mbuagbaw Lawrence , Sadeghirad Behnam , Morgan Rebecca L , Mertz Dominik , Motaghi Shahrzad , Ghadimi Maryam , Babatunde Ifeoluwa , Zani Babalwa , Pasumarthi Tejanth , Derby McKenzie , Kothapudi Venkata N , Palmer Nicole R , Aebischer Anton , Harder Thomas , Reichert Felix
Published: August 2023

Background

Treatment failure is considered to be an important factor in relation to the increase in scabies incidence over the last decade. However, the regional and temporal differences, in addition to the predictors of therapy failure, are unclear.

Objectives

We aimed to conduct a systematic review of the prevalence of treatment failure in patients with scabies and investigation of associated factors.

Methods

We searched MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, Global Health and the Cochrane Central Register of Controlled Trials from inception to August 2021 for randomized and quasi-randomized trials, in addition to observational studies that enrolled children or adults diagnosed with confirmed or clinical scabies treated with permethrin, ivermectin, crotamiton, benzyl benzoate, malathion, sulfur or lindane, and measured treatment failure or factors associated with treatment failure. We performed a random effects meta-analysis for all outcomes reported by at least two studies.

Results

A total of 147 studies were eligible for inclusion in the systematic review. The overall prevalence of treatment failure was 15.2% [95% confidence interval (CI) 12.9–17.6; I2 = 95.3%, moderate-certainty evidence] with regional differences between World Health Organization regions (P = 0.003) being highest in the Western Pacific region (26.9%, 95% CI 14.5–41.2). Oral ivermectin (11.8%, 95% CI 8.4–15.4), topical ivermectin (9.3%, 95% CI 5.1–14.3) and permethrin (10.8%, 95% CI 7.5–14.5) had relatively lower failure prevalence compared with the overall prevalence. Failure prevalence was lower in patients treated with two doses of oral ivermectin (7.1%, 95% CI 3.1–12.3) compared with those treated with one dose (15.2%, 95% CI 10.8–20.2; P = 0.021). Overall and permethrin treatment failure prevalence in the included studies (1983–2021) increased by 0.27% and 0.58% per year, respectively. Only three studies conducted a multivariable risk factor analysis; no studies assessed resistance.

Conclusions

A second dose of ivermectin showed lower failure prevalence than single-dose ivermectin, which should be considered in all guidelines. The increase in treatment failure over time hints at decreasing mite susceptibility for several drugs, but reasons for failure are rarely assessed. Ideally, scabicide susceptibility testing should be implemented in future studies.
SUN1 facilitates CHMP7 nuclear influx and injury cascades in sporadic amyotrophic lateral sclerosis
Authors: Baskerville Victoria , Rapuri Sampath , Mehlhop Emma , Coyne Alyssa N
Published: August 2023

We have recently identified the aberrant nuclear accumulation of the ESCRT-III protein CHMP7 as an initiating event that leads to a significant injury to the nuclear pore complex (NPC) characterized by the reduction of specific nucleoporins from the neuronal NPC in sporadic amyotrophic lateral sclerosis (sALS) and C9orf72 ALS/frontotemporal dementia (FTD)-induced pluripotent stem cell-derived neurons (iPSNs), a phenomenon also observed in post-mortem patient tissues. Importantly, this NPC injury is sufficient to contribute to TDP-43 dysfunction and mislocalization, a common pathological hallmark of neurodegenerative diseases. However, the molecular mechanisms and events that give rise to increased nuclear translocation and/or retention of CHMP7 to initiate this pathophysiological cascade remain largely unknown. Here, using an iPSN model of sALS, we demonstrate that impaired NPC permeability barrier integrity and interactions with the LINC complex protein SUN1 facilitate CHMP7 nuclear localization and the subsequent ‘activation’ of NPC injury cascades. Collectively, our data provide mechanistic insights in the pathophysiological underpinnings of ALS/FTD and highlight SUN1 as a potent contributor to and modifier of CHMP7-mediated toxicity in sALS pathogenesis.
Depression and HIV: a scoping review in search of neuroimmune biomarkers
Authors: Mudra Rakshasa-Loots Arish
Published: August 2023

People with HIV are at increased risk for depression, though the neurobiological mechanisms underlying this are unclear. In the last decade, there has been a substantial rise in interest in the contribution of (neuro)inflammation to depression, coupled with rapid advancements in the resolution and sensitivity of biomarker assays such as Luminex, single molecular array and newly developed positron emission tomography radioligands. Numerous pre-clinical and clinical studies have recently leveraged these next-generation immunoassays to identify biomarkers that may be associated with HIV and depression (separately), though few studies have explored these biomarkers in co-occurring HIV and depression. Using a systematic search, we detected 33 publications involving a cumulative N = 10 590 participants which tested for associations between depressive symptoms and 55 biomarkers of inflammation and related processes in participants living with HIV. Formal meta-analyses were not possible as statistical reporting in the field was highly variable; future studies must fully report test statistics and effect size estimates. The majority of included studies were carried out in the United States, with samples that were primarily older and primarily men. Substantial further work is necessary to diversify the geographical, age, and sex distribution of samples in the field. This review finds that alterations in concentrations of certain biomarkers of neuroinflammation (interleukin-6, tumour necrosis factor-α, neopterin) may influence the association between HIV and depression. Equally, the chemokines monocyte chemoattractant protein-1 (MCP-1) and interleukin-8 (IL-8) or the metabolic index kynurenine:tryptophan (Kyn:Trp), which have been the focus of several studies, do not appear to be associated with depressive symptoms amongst people living with HIV, as all (MCP-1) or most (IL-8 and Kyn:Trp) available studies of these biomarkers reported non-significant associations. We propose a biomarker-driven hypothesis of the neuroimmunometabolic mechanisms that may precipitate the increased risk of depression among people with HIV. Chronically activated microglia, which trigger key neuroinflammatory cascades shown to be upregulated in people with HIV, may be the central link connecting HIV infection in the central nervous system with depressive symptoms. Findings from this review may inform research design in future studies of HIV-associated depression and enable concerted efforts towards biomarker discovery.
‘Guidelines are not the issue, access to support and advice is the problem’: a cross-sectional survey of general practitioners referring to paediatric dermatology
Authors: Fagan Nicole , Browne Fiona , Dvorakova Veronika , Carroll Áine , Irvine Alan D
Published: August 2023

This study describes the findings from a cross-sectional survey of 206 general practitioners (GPs), investigates the factors affecting the referral process to secondary care and highlights challenges faced. The results showed that most GPs are interested in caring for children with skin diseases locally, given sufficient support and training. However, GPs reported challenges because of limited access to resources and advice, high demand on dermatology services, and the need for better collaboration between generalists and specialists. We suggest sharing knowledge and lessons learned from quality improvement exercises to create a more effective and connected care system.
Comparing the number-needed-to-biopsy ratio for melanoma diagnosis between teledermatology and face-to-face models of care
Authors: Hussain Khawar , Khalil Nada , Amini Amir , Patel Neil P
Published: August 2023

The UK elective recovery plan has advocated that teledermatology (TD) should be available in every service receiving urgent suspected skin cancer referrals. Currently, TD plays an important role in some NHS dermatology services in triaging referrals on the skin cancer 2-week-wait (2WW) pathway, given the necessity for rapid lesion assessment and the ever-increasing volume of 2WW referrals received. However, evidence supporting the effectiveness of TD for the accurate diagnosis and triage of skin lesions remains insufficient, with further prospective and pragmatic evaluation required.
Cost-effectiveness of Low-complexity Screening Tests in Community-based Case-finding for Tuberculosis
Authors: Brümmer Lukas E , Thompson Ryan R , Malhotra Akash , Shrestha Sourya , Kendall Emily A , Andrews Jason R , Phillips Patrick , Nahid Payam , Cattamanchi Adithya , Marx Florian M , Denkinger Claudia M , Dowdy David W
Published: August 2023

Introduction

In high-burden settings, low-complexity screening tests for tuberculosis (TB) could expand the reach of community-based case-finding efforts. The potential costs and cost-effectiveness of approaches incorporating these tests are poorly understood.

Methods

We developed a microsimulation model assessing 3 approaches to community-based case-finding in hypothetical populations (India-, South Africa-, The Philippines-, Uganda-, and Vietnam-like settings) with TB prevalence 4 times that of national estimates: (1) screening with a point-of-care C-reactive protein (CRP) test, (2) screening with a more sensitive “Hypothetical Screening test” (95% sensitive for Xpert Ultra-positive TB, 70% specificity; equipment/labor costs similar to Xpert Ultra, but using a $2 cartridge) followed by sputum Xpert Ultra if positive, or (3) testing all individuals with sputum Xpert Ultra. Costs are expressed in 2023 US dollars and include treatment costs.

Results

Universal Xpert Ultra was estimated to cost a mean $4.0 million (95% uncertainty range: $3.5 to $4.6 million) and avert 3200 (2600 to 3900) TB-related disability-adjusted life years (DALYs) per 100 000 people screened ($670 [The Philippines] to $2000 [Vietnam] per DALY averted). CRP was projected to cost $550 (The Philippines) to $1500 (Vietnam) per DALY averted but with 44% fewer DALYs averted. The Hypothetical Screening test showed minimal benefit compared to universal Xpert Ultra, but if specificity were improved to 95% and per-test cost to $4.5 (all-inclusive), this strategy could cost $390 (The Philippines) to $940 (Vietnam) per DALY averted.

Conclusions

Screening tests can meaningfully improve the cost-effectiveness of community-based case-finding for TB but only if they are sensitive, specific, and inexpensive.