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Definitions of elementary ultrasound lesions in Takayasu arteritis: a study from the OMERACT Ultrasound Working Group
Get PDFObjective: To systematically assess the evidence on the use of ultrasonography (US) for the detection of vascular inflammation in Takayasu arteritis (TAK), with a focus on evaluating existing scoring systems and identifying elementary sonographic lesions for diagnosis, disease monitoring and outcome prediction.
Methods: A systematic literature review (SLR) was conducted using PubMed, EMBASE, the Cochrane Library and Epistemonikos from their inception until 15 March 2024. Only original research articles evaluating the diagnostic accuracy, outcome prediction or monitoring ability of US in TAK, with a minimum sample size of 15 patients, were included. Data extraction was performed independently by two reviewers. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool for diagnostic studies and the Quality In Prognosis Studies tool for prognostic studies.
Results: 21 studies met the inclusion criteria. Three of them proposed a US scoring system for TAK, while the remainder focused on reporting elementary lesions. The common findings included increased intima-media thickness (IMT), stenosis, occlusion, aneurysm and increased contrast enhancement. All studies evaluated the common carotid arteries, with less frequent assessment of other vascular territories such as the subclavian and common femoral arteries and the abdominal aorta. Although increased IMT and contrast enhancement of the arterial wall correlated with clinical measures of disease activity, heterogeneity of lesion definitions and measurement thresholds, along with small sample sizes and moderate-to-high risk of bias, limits the generalisability of the findings.
Conclusions: This SLR highlights the current lack of a fully validated US scoring system for TAK and underscores the need for standardised definitions of elementary sonographic lesions
Native soil microbes buffer savanna trees against nutrient limitation but are drought sensitive
No full text1. Below-ground microbial communities are vital to ecosystem nutrient cycling,
plant health, and resource acquisition, yet below-ground plant–soil interactions
in savannas remain understudied, especially in their responses to environmental
stressors like drought and nutrient limitation.
2. Here, we evaluate if native soil microbiomes have positive or negative effects
on tree growth and if these effects are dependent on the level of resource
availability. We grew 6 tree species from Kruger National Park, South Africa,
for 8 weeks under factorial soil inoculant, water stress, and nitrogen-limitation
treatments (i.e. sterile/inoculated soils, droughted/non-droughted water supply,
and low/high rate of nitrogen supply).
3. In all resource treatments, inoculated plants grew significantly more than sterile
plants. Under low nitrogen, trees increased investment in nitrogen-fixing nodules
and mycorrhizal associations, leading to increased mass gain. Soil inoculant was
most beneficial in non-droughted water conditions, indicating that microbial
symbiont effects decreased under drought.
4. Synthesis. Below-ground microbial symbionts increased savanna tree growth
in limited resource environments and could be critical for plant growth in the
field. However, drought substantially affected both tree growth and the effects
of native soil microbes on tree growth, indicating that extreme droughts could
create lasting consequences for both above-ground tree growth and belowground beneficial microbial communities
On providing a Blockchain-based reverse supply chain traceability of agrochemicals [Sobre o fornecimento de rastreabilidade da cadeia de suprimentos reversa de agroquímicos com base em Blockchain]
Get PDFAgrochemicals are often used to produce higher crop production rates; however, malicious misuse could cause environmental damage and health problems for both consumers and farmers. Furthermore, despite the increased control of agrochemicals through a regulated reverse supply chain, these products are also vulnerable to theft due to their high financial value. Today, no initiatives in the literature securely approach the problem of tracing agrochemicals along with the stakeholders, joining actions done by manufacturers, farmers, government, and return centers. This article presents the design, architecture, and prototype evaluation of a Blockchain based system for pervasive agrochemical traceability within reverse logistics chains (Agrochemicals Pervasive Traceability Model - APTM), keeping up with agrochemicals along their route on the reverse logistic chain. APTM uses Blockchain technology to monitor eventual illegal activities, generating value for producers that operate strictly within the law. Our contributions are: (i) a gamification mechanism for producers that play the APTM rules; (ii) an architecture composed of modules, functionalities, interconnections, and rules to manage the agrochemical flow. APTM comprises five parts: authentication, route control, Blockchain recording, statistics, notification, and gamification. At the prototype level, our solution achieved a rate of 4,6 transactions per second and a monthly operating cost of approximately US 40,00. Os resultados experimentais obtidos a partir de simulações de protótipos demonstraram a capacidade do sistema de manter 4,6 transações por segundo (TPS), validar permissões de atores e gerenciar a persistência de dados no Blockchain, além de fornecer uma visualização on-line de dados agroquímicos ao longo da cadeia de suprimentos reversa
A scoping review of the existing evidence linking school food procurement contract type with school food provision
Get PDFAbstract Objective School food and catering constitutes the largest area of public sector food spend in the UK, with the potential to influence health on a population scale. This review sought to understand and map the existing evidence linking school meals contracts for food procurement with the quality of food provided and health and academic outcomes for school children. Design A scoping review of the peer reviewed and grey literature published between 1988 and 2023 was conducted. The strategy searched in Medline, Web of Science, Scopus, ERIC and Google, using key words related to population, exposure and outcomes. Setting UK and International. Participants School meal services. Results Thirty documents were included representing 16 papers, 3 books and 11 reports. Documents revealed a complex and fragmented school meal provision system and inconsistent evidence relating to the outcomes of interest. Most studies focused on sustainability or nutrition/ guideline compliance and the main types of food providers discussed were commercial contractors, local authorities and in house catering. However, there was a lack of clarity in contract specifications and definitions of quality and concerns over compliance monitoring and financial viability impacting quality. We found no substantial body of peer reviewed research linking school food procurement contract type with food quality or outcomes of interest. Conclusions The lack of research in this area (and conflicting findings) meant that it was impossible to draw robust conclusions on the benefits of using any particular contract provision type over another. Given the magnitude of public sector spending and the need for urgent improvements to the dietary health of the nation, this presents a significant gap in our knowledge
Expert consensus recommendations for the diagnosis and treatment of chronic non-bacterial osteitis (CNO) in adults
Get PDFBackground
There is considerable practice variation in labelling, diagnosis and treatment of adults with sterile bone inflammation. We developed a expert consensus recommendations on the disease definition, diagnosis and treatment of this rare condition.
Methods
Systematic literature review and Grading of Recommendations, Assessment, Development and Evaluations-based appraisal of evidence, two Delphi surveys and three digital and in-person consensus meetings with a multidisciplinary expert panel and patient representatives.
Results
A consensus disease definition was developed and the term ’chronic non-bacterial osteitis’ (CNO) is proposed to describe adults with sterile bone inflammation. For initial imaging evaluation of adults with suspected CNO, the panel recommends MRI or otherwise CT combined with nuclear imaging. Whole-body imaging at initial evaluation can be considered for diagnostic and prognostic purposes. Suggested first-line treatment in adults with active CNO includes nonsteroidal anti-inflammatory drugs/cyclooxygenase 2-inhibitors. Second-line treatment preferably consists of intravenous bisphosphonates, and otherwise tumour necrosis factor-α inhibitors. Choice between them should be individualised, considering the presence of additional inflammatory features. The panel further discusses outcome measures, follow-up and management of adverse events and complications.
Conclusions and future perspectives
These expert consensus recommendations are intended to support healthcare professionals worldwide in their care for adults with CNO. They also lay the groundwork for establishing international patient registries, translational research lines and multicentre trials, all of which are urgently required
11 Cross-Cultural Adaptation and External Validation of the Locally Recurrent Rectal Cancer – Quality of Life (LRRC-QoL) Measure
No full textCompeting types in preferential attachment graphs with community structure
Get PDFWe extend the two-type preferential attachment model of Antunović, Mossel and Rácz, where each new vertex takes its type according to a defined rule based on the types of its neighbours, to incorporate community structure, and investigate whether the proportions of vertices of each type synchronise between communities. The behaviour depends both on the choice of community structure and on the type assignment rule.
For essentially all cases where the single community model has more than one possible limit, communities may fail to synchronise for weakly interacting communities. Even when the single community model almost surely converges to a deterministic limit, synchronisation is not guaranteed. However, we give natural conditions on the assignment rule and, for two communities, on the structure, either of which will imply synchronisation to this limit, and each of which is essentially best possible.
We also give an example where the proportions of types almost surely do not converge, which is impossible in the single community model
Clinical effectiveness and cost-effectiveness of the rehabilitation enablement in chronic heart failure facilitated self-care rehabilitation intervention for people with heart failure with preserved ejection fraction and their caregivers:rationale and protocol for a multicentre randomised controlled trial - REACH-HFpEF trial
Get PDFINTRODUCTION: Heart failure with preserved ejection fraction (HFpEF) is common and causes functional limitation, poor health-related quality of life (HRQoL) and impairs prognosis. Exercise-based cardiac rehabilitation is a promising intervention for HFpEF, but there is currently insufficient evidence to support its routine use. This trial will assess the clinical and cost-effectiveness of a 12-week health professional-facilitated, home-based rehabilitation intervention (REACH-HF), in people with HFpEF, for participants and their caregivers. METHODS AND ANALYSIS: REACH-HFpEF is a parallel two group multicentre randomised controlled trial with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention group) or usual care alone (control group) with a target sample size of 372 participants with HFpEF and their caregivers recruited from secondary care centres in United Kingdom. Outcome assessment and statistical analysis will be performed blinded; outcomes will be assessed at baseline and 4-month and 12-month follow-up. The primary outcome measure will be patients' disease-specific HRQoL, measured using the Minnesota Living with Heart Failure questionnaire, at 12 months. Secondary outcomes include patient's exercise capacity, psychological well-being, level of physical activity, generic HRQoL, self-management, frailty, blood biomarkers, mortality, hospitalisations, and serious adverse events, and caregiver's HRQoL and burden. A process evaluation and substudy will assess the fidelity of intervention delivery and adherence to the home-based exercise regime and explore potential mediators and moderators of changes in HRQoL with the intervention. Qualitative studies will describe facilitators' experiences of delivery of the intervention. A cost-effectiveness analysis (CEA) of the REACH-HF intervention in participants with HFpEF will estimate incremental cost per quality-adjusted life year at 12 months. The CEA will be conducted from a UK NHS and Personal Social Services perspective and a wider societal perspective. The adequacy of trial recruitment in an initial 6-month internal pilot period will also be checked. ETHICS AND DISSEMINATION: The study is approved by the West of Scotland Research Ethics Committee (ref 21/WS/0085). Results will be disseminated via peer-reviewed journal publication and conference presentations to researchers, service users and policymakers. TRIAL REGISTRATION NUMBER: ISRCTN47894539
Hedge fund performance, classification with machine learning, and managerial implications
Get PDFPrior academic research on hedge funds focuses predominately on fund strategies in relation to market timing, stock picking, and performance persistence, among others. However, the hedge fund industry lacks a universal classification scheme for strategies, leading to potentially biased fund classifications and inaccurate expectations of hedge fund performance. This paper uses machine learning techniques to address this issue. First, it examines whether the reported fund strategies are consistent with their performance. Second, it examines the potential impact of hedge fund classification on managerial decision making. Our results suggest that for most reported strategies there is no alignment with fund performance. Classification matters in terms of abnormal returns and risk exposures, although the market factor remains consistently the most important exposure for most clusters and strategies. An important policy implication of our study is that the classification of hedge funds affects asset and portfolio allocation decisions, and the construction of the benchmarks against which performance is judged
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