Crude Estimates Research Articles

Interaction between subclinical carotid atherosclerosis endotype and biological sex: a study from IMPROVE cohort

Abstract Background Carotid-intima media thickness (c-IMT) is a measure of subclinical carotid atherosclerosis and a predictor of future atherosclerotic cardiovascular events (ASCVD). We have recently generated, using an artificial intelligence approach, four endotypes (E) of subclinical atherosclerosis, i.e. subgroups of individuals predisposed to both c-IMT progression and ASCVD. Each E is defined by a set of demographic, clinical, and molecular data and characterize individuals with a low (E1), intermendiate (E2), high (E3) and very high (E4) cardiovascular risk profile. We observed an unbalanced distribution of males and females across the 4 endotypes, with a higher prevalence of female in the low risk E1. Purpose To estimate the interaction between biological sex and the 4 endotypes on measures of c-IMT progression and ASCVD risk. Methods We performed our study on 3121 individuals from the IMPROVE cohort, which includes participants with at least three ASCVD risk factors. We estimated the interaction between biological sex and the endotypes generated in the IMPROVE on (1) c-IMT and carotid plaque measurements after 30 months of follow-up (c-IMTfastest-progr, Area of plaquesbulb-progr) by linear regression (β, SE) and (2) with the 3-year ASCVD risk by Cox [hazard ratio (HR), 95% confidence interval (CI)] regression model. Crude estimates were adjusted by batch effect for biomarker measurement, geographical region and/or baseline ultrasonographic measures. Adjusted models further included ASCVD common risk factors. Results As shown in Figure 1, we did not observe any significant interaction between endotypes and biological sex on 30-month carotid ultrasound progression measures, and 3-year-ASCVD risk. In both the crude and adjusted models on c-IMTfastest-progr, Area of plaquesbulb-progr, and 3-year ASCVD, the p-value for interaction ranged from 0.18 to 0.98. While E4 was associated with the strongest cardiovascular risk profile in both males and females. Conclusions Our results indicate that the association between endotypes and progression of subclinical atherosclerosis and ASCVD risk mirrors a specific risk profile not entirely explained by differences in biological sex.

First trimester maternal infections and offspring congenital heart defects: a systematic review and meta-analysis

Abstract Background Maternal infections early in pregnancy have been proposed as playing a role in the development of congenital heart defects. We aimed to summarise contemporary evidence regarding the association between first-trimester maternal infection and risk of offspring congenital heart defects. Methods For this systematic review and meta-analysis, we searched Medline and Embase for studies reporting associations of at least one measure of maternal infection during pregnancy and offspring congenital heart disease in humans and published in English between January 1, 1990 and February 13, 2024. Studies were eligible for inclusion if they reported rates of offspring congenital heart defects among both infected and non-infected mothers, and included a minimum of 50 offspring with congenital heart defects. We stratified associations by type of infection and type of heart defect when data from at least two studies were available. We used inverse variance weighted random-effect meta-analyses to pool the estimates. In main analyses, we pooled crude estimates from studies reporting maternal infections during the first trimester of pregnancy. We performed sensitivity analyses to include studies that i) investigated infections later in pregnancy or at unspecified time-points, and ii) adjusted for potential confounders such as maternal age, socioeconomic status, or ethnicity. Findings: We identified 11 studies (7 case control studies, 4 cohort studies) with data from 1,805,115 pregnancies. Nine of these studies assessed maternal infectious status through self-reported questionnaires or medical records, two used laboratory antibody testing and three reported on specific infectious pathogens. Studies reported on various types of bacterial and viral infections, including influenza, urinary tract infections, cytomegalovirus, herpes simplex virus, or chlamydia, with varying effect sizes. Ten studies reported a positive association between maternal infection variables and offspring congenital heart defects, with a pooled odds ratio (OR) and 95% confidence interval of 1.56 (1.27, 1.91) across all types of infections. Associations differed by individual subtype of congenital heart defects, with ORs ranging from 1.28 (0.89, 1.85) for pulmonary atresia to 1.75 (1.23, 2.49) for ventricular septal defects. Sensitivity analyses that included infections measured later in pregnancy, or adjusted rates for potential confounders, showed broadly similar trends but attenuated effect sizes. Interpretation: First trimester maternal infections are associated with increased risk of congenital heart defects. Associations appear to vary by type of infection and type of congenital heart defect, and to extend beyond infections commonly tested for during routine pregnancy screening. Larger-scale studies are warranted to confirm these findings using laboratory antibody testing and investigating how these associations vary by specific pathogens and subtypes of congenital heart defects.

Prevalence of schizophrenia spectrum disorders in the Lazio region, Italy: use of an algorithm based on health administrative databases

BackgroundMental healthcare provision is undergoing substantial reconfiguration in many regions of the world. Such changes require a broad, evidence-based approach incorporating epidemiological data and information on local needs. The objective of this study was to estimate the prevalence of schizophrenia spectrum disorders (SSD) in the Lazio region and its geographical distribution using regional administrative healthcare databases.MethodsCases of SSD (15–64 years old) were identified using an algorithm based on data from the hospital discharge registry (ICD IX CM: 295, 297, 298 [excl. 298.0], 299) and the ticket exemption database [code 044], between 2006 and 2019. We calculated crude, age- and gender-specific prevalence estimates on December 31, 2019. We also calculated age- and gender-adjusted prevalence to compare prevalence in different regional areas.ResultsWe identified 18,371 cases. The overall prevalence was 5.03 per 1000 population (95% CI 4.96–5.10). Age-adjusted prevalence estimates were 4.18 (95% CI 4.09–4.27) per 1000 for women and 5.92 (95% CI 5.81–6.04) per 1000 for men. The prevalence was higher among older age groups, in both genders. There were differences in prevalence within the region, ranging from 4.25/1000 in the province of Viterbo to 5.42/1000 in Rome and 6.02/1000 in the province of Frosinone. When we analysed the subcategories of SSD, the three most frequent conditions were schizophrenia, schizoaffective disorder, and psychosis NOS. In general, the prevalence was higher in men for all the conditions but delusional disorders and brief psychosis.ConclusionsOur results show that the overall prevalence of SSD among adults in the Lazio region is similar to those published in previous reviews, but an uneven regional distribution was observed. While possible underestimation must be considered, administrative databases represent a valuable source of information for epidemiological surveillance and healthcare planning.

Temporal changes in characteristics, incidence, and mortality in patients undergoing surgical intervention for mitral stenosis

To examine temporal changes in patient characteristics, the incidence rate of surgical intervention, and the three-year mortality rate for patients undergoing surgical intervention for mitral valve stenosis (MS) from 2001 to 2021 in Denmark. Utilizing Danish nationwide registries, we identified all adult patients undergoing first-time surgical intervention for MS (2001–2021). Temporal changes in the incidence rate of surgical intervention across calendar periods were investigated (2001–2005, 2006–2010, 2011–2015, and 2016–2021). Using Kaplan-Meier estimates, we computed temporal changes in three-year all-cause mortality across calendar periods. With multivariable Cox regression analysis, we assessed the adjusted rates of mortality. We included 256 patients (median age 60.3 years, 31.3% males). A stepwise decrease in the burden of chronic heart failure was identified (2001–2005: 54%, and 2016–2021: 20%, p-value < 0.001 for trend), while the burden of atrial fibrillation seemed stable (2001–2005: 51%, and 2016–2021: 46%, p-value = 0.27 for trend). The proportion of patients with rheumatic MS was 64% in 2001–2005 and 33% in 2016–2021, p-value < 0.001 for trend. 28 patients (10.9%) had mitral valve surgery prior to the first-time surgical intervention for MS. A stepwise decrease in the incidence rate of surgical intervention was observed: 3.3 cases per million person-years in 2001–2005 and 2.2 in 2016–2021. The incidence of patients diagnosed with first-time MS remained stable over calendar periods (2001–2005: 54.5 incidences per million person-years, and 2016–2021: 41.9, p-value = 0.46 for trend). The in-hospital mortality was 8.6% and the three-year mortality after surgical discharge was 9.0%, and we found no difference over calendar periods in either crude estimates or adjusted analysis. From nationwide data across three decades, we identified that the incidence of surgical interventiondecreased significantly within the past 20 years, while all-cause mortality remained stable. The burden of heart failure decreased, while the burden of atrial fibrillation remained stable over the study period.

Global particle buildup simulations with gas puff scan: application to WEST discharge

This paper deals with the distribution of sources, transport, and exhaust of particles in a tokamak. Knowledge and understanding of all the physical phenomena involved in the global particle buildup are necessary to study and predict density regimes and subsequently to develop optimized scenarios for tokamak operation in order to control heat and particle exhaust. Neutral particles and their interactions with plasma are central in this perspective. This paper discusses the impact of varying the intensity of particle fueling in 2D transport simulations of a WEST discharge. Simulations are performed with an updated version of SOLEDGE-HDG that allows a more realistic transport of neutrals using a self-consistent diffusive model based on charge exchange and ionization processes. New code capabilities allow the entire WEST poloidal cross section to be simulated in a realistic configuration for both geometry and the range of control parameters. A gas puff scan illustrates the main features of the sheath-limited, high-recycling, and detached regimes, such as the buildup of the temperature gradient and the pressure drop in the scrape-off layer (SOL), the target temperature falling to 1 eV, and the ionization source moving away from the targets, as well as the particle flux rollover. A crude estimate of wall erosion is also provided, showing the respective role of each plasma wall component in each of these regimes.

Predicting Unfavorable Pregnancy Outcomes in Polycystic Ovary Syndrome (PCOS) Patients Using Machine Learning Algorithms.

Background and Objectives: Polycystic ovary syndrome (PCOS) is a complex disorder that can negatively impact the obstetrical outcomes. The aim of this study was to determine the predictive performance of four machine learning (ML)-based algorithms for the prediction of adverse pregnancy outcomes in pregnant patients diagnosed with PCOS. Materials and Methods: A total of 174 patients equally divided into 2 groups depending on the PCOS diagnosis were included in this prospective study. We used the Mantel-Haenszel test to evaluate the risk of adverse pregnancy outcomes for the PCOS patients and reported the results as a crude and adjusted odds ratio (OR) with a 95% confidence interval (CI). A generalized linear model was used to identify the predictors of adverse pregnancy outcomes in PCOS patients, quantifying their impact as risk ratios (RR) with 95% CIs. Significant predictors were included in four machine learning-based algorithms and a sensitivity analysis was employed to quantify their performance. Results: Our crude estimates suggested that PCOS patients had a higher risk of developing gestational diabetes and had a higher chance of giving birth prematurely or through cesarean section in comparison to patients without PCOS. When adjusting for confounders, only the odds of delivery via cesarean section remained significantly higher for PCOS patients. Obesity was outlined as a significant predictor for gestational diabetes and fetal macrosomia, while a personal history of diabetes demonstrated a significant impact on the occurrence of all evaluated outcomes. Random forest (RF) performed the best when used to predict the occurrence of gestational diabetes (area under the curve, AUC value: 0.782), fetal macrosomia (AUC value: 0.897), and preterm birth (AUC value: 0.901) in PCOS patients. Conclusions: Complex ML algorithms could be used to predict adverse obstetrical outcomes in PCOS patients, but larger datasets should be analyzed for their validation.

Northeast Arctic haddock (Melanogrammus aeglefinus) spawning grounds and drift to nursery areas in the Barents Sea

AbstractThe Northeast Arctic stock of haddock (Melanogrammus aeglefinus) is the most northerly stock of the species. It is one of the largest haddock stocks but not the most studied. Similar to the more extensively studied sympatric cod (Gadus morhua) and herring (Clupea harengus) stocks, it relies on Atlantic currents for egg and larvae transportation from spawning grounds to nursery areas in the Barents Sea. The exact locations of the spawning grounds have not been known and the maps that have been published differ substantially. Here, we present results from the first survey dedicated to exploring the spawning habitat of Northeast Arctic (NEA) haddock, and a particle drift and larvae growth model with physical forcing from a high‐resolution ocean model. Gadoid eggs, later identified as haddock by DNA analyses, as well as spawning individuals were sampled at the survey. Spawning haddock was found in Atlantic water in temperatures 3.6–6.2°C and depths of 240–560 m. Sampled eggs were mostly in early development stages, suggesting that they were largely spawned in the surveyed area. Using the drift model, we found that most of the modelled particles released as eggs at our surveyed area ended up in the nursery area in the Barents Sea. A crude estimate of the spawning stock biomass based on the survey suggests that the most updated spawning ground map of NEA haddock might be too restricted in its extent. Particle drift and growth with physical forcing for the years 2012–2022 indicated small interannual variation in aberrant drift, and that growth driven by ambient temperature could be important in explaining interannual variation in haddock recruitment.

Mass incarceration as a driver of the tuberculosis epidemic in Latin America and projected impacts of policy alternatives: A mathematical modeling study.

Tuberculosis incidence is increasing in Latin America, where the incarcerated population has nearly quadrupled since 1990. The full impact of incarceration on the tuberculosis epidemic, accounting for effects beyond prisons, has never been quantified. We calibrated dynamic compartmental transmission models to historical and contemporary data from Argentina, Brazil, Colombia, El Salvador, Mexico, and Peru, which comprise approximately 80% of the region's incarcerated population and tuberculosis burden. Using historical counterfactual scenarios, we estimated the transmission population attributable fraction (tPAF) for incarceration and the excess population-level burden attributable to increasing incarceration prevalence since 1990. We additionally projected the impact of alternative incarceration policies on future population tuberculosis incidence. Population tuberculosis incidence in 2019 was 29.4% (95% UI, 23.9-36.8) higher than expected without the rise in incarceration since 1990, corresponding to 34,393 (95% UI, 28,295-42,579) excess incident cases across countries. The incarceration tPAF in 2019 was 27.2% (95% UI, 20.9-35.8), exceeding estimates for other risk factors like HIV, alcohol use disorder, and undernutrition. Compared to a scenario where incarceration rates remain stable at current levels, a gradual 50% reduction in prison admissions and duration of incarceration by 2034 would reduce population tuberculosis incidence by over 10% in all countries except Mexico. The historical rise in incarceration in Latin America has resulted in a large excess tuberculosis burden that has been under-recognized to-date. International health agencies, ministries of justice, and national tuberculosis programs should collaborate to address this health crisis with comprehensive strategies, including decarceration. National Institutes of Health.

Dielectric Properties of a Ferroelectric Nematic Material: Quantitative Test of the Polarization-Capacitance Goldstone Mode.

The recently discovered ferroelectric nematic (N_{F}) liquid crystals (LC) have been reported to show an extraordinarily large value of the real part of the dielectric constant (ϵ^{'}>10^{3}) at low frequencies. However, it was argued by Clark etal. in Phys. Rev. Res. 6, 013195 (2024)PPRHAI2643-156410.1103/PhysRevResearch.6.013195 that what was measured was the capacitance of the insulating layer at LC or electrode surface and not that of the liquid crystal. Here we describe the results of dielectric spectroscopy measurements of an N_{F} material in cells with variable thickness of the insulating layers. Our measurements quantitatively verify the model by Clark etal. Additionally, our measurements in cells with bare conducting indium tin oxide surface provide a crude estimate of ϵ_{⊥}∼10^{2} in the N_{F} phase.

Considering pregnancies as repeated vs independent events: an empirical comparison of common approaches across selected perinatal outcomes

BackgroundIn population-based research, pregnancy may be a repeated event. Despite published guidance on how to address repeated pregnancies to the same individual, a variety of approaches are observed in perinatal epidemiological studies. While some of these approaches are supported by the chosen research question, others are consequences of constraints inherent to a given dataset (eg, missing parity information). These decisions determine how appropriately a given research question can be answered and overall generalizability. ObjectiveTo compare common cohort selection and analytic approaches used for perinatal epidemiological research by assessing the prevalence of two perinatal outcomes and their association with a clinical and a social independent variable. Study DesignUsing vital records linked to maternal hospital discharge records for singleton births, we created four cohorts: (1) all-births (2) randomly selected one birth per individual (3) first-observed birth per individual (4) primiparous-births (parity 1). Sampling of births was not conditional on cluster (ie, we did not sample all births by a given mother, but rather sampled individual births). Study outcomes were severe maternal morbidity (SMM) and preeclampsia/eclampsia, and the independent variables were self-reported race/ethnicity (as a social factor) and systemic lupus erythematosus. Comparing the four cohorts, we assessed the distribution of maternal characteristics, the prevalence of outcomes, overall and stratified by parity, and risk ratios (RR) for the associations of outcomes with independent variables. Among all-births, we then compared RR from three analytic strategies: with standard inference that assumes independently sampled births to the same mother in the model, with cluster-robust inference, and adjusting for parity. ResultsWe observed minor differences in the population characteristics between the all-birth (N=2736,693), random-selection, and first-observed birth cohorts (both N=2284,660), with more substantial differences between these cohorts and the primiparous-births cohort (N=1054,684). Outcome prevalence was consistently lowest among all-births and highest among primiparous-births (eg, SMM 18.9 per 1000 births among primiparous-births vs 16.6 per 1000 births among all-births). When stratified by parity, outcome prevalence was always the lowest in births of parity 2 and highest among births of parity 1 for both outcomes. RR differed for study outcomes across all four cohorts, with the most pronounced differences between the primiparous-birth cohort and other cohorts. Among all-births, robust inference minimally impacted the confidence bounds of estimates, compared to the standard inference, that is, crude estimates (eg, lupus-SMM association: 4.01, 95% confidence intervals [CI] 3.54–4.55 vs 4.01, 95% CI 3.53–4.56 for crude estimate), while adjusting for parity slightly shifted estimates, toward the null for SMM and away from the null for preeclampsia/eclampsia. ConclusionResearchers should consider the alignment between the methods they use, their sampling strategy, and their research question. This could include refining the research question to better match inference possible for available data, considering alternative data sources, and appropriately noting data limitations and resulting bias, as well as the generalizability of findings. If parity is an established effect modifier, stratified results should be presented.

Over 14-year survival of pressed e.max lithium disilicate glass-ceramic complete and partial coverage restorations in patients with severe wear: A prospective clinical study

Statement of problemLong-term clinical data are lacking on the comparative survival of adhesively luted lithium disilicate glass-ceramic complete and partial coverage restorations in patients with severe wear and the effect that different clinical variables have on their survival. PurposeThe purpose of this study was to examine the 14-year survival of pressed e.max lithium disilicate glass-ceramic complete and partial coverage restorations in patients with severe wear and to evaluate associated clinical parameters. Material and methodsPatients demonstrating severe wear and requiring single unit defect-specific partial or complete coverage restorations were recruited in a clinical private practice and received lithium disilicate restorations. The effect of various clinical parameters was evaluated using Kaplan-Meier survival curves to account for attrition bias and other causes of failure. The statistical significance of differences between parameters was determined by using the log rank test (α=.05). ResultsA total of 53 participants (24 men and 29 women) requiring 662 lithium disilicate restorations were evaluated. The mean age of the participants at the time of restoration placement was 60 (range 25 to 85 years). Of 662 units, 551 were anterior and posterior complete and 111 were posterior partial coverage restorations. Six failures (bulk fracture or large chip) requiring replacement occurred with the average time to failure of 4.5 (range 2 to 8) years, yielding a crude estimate of annual failure of 0.1% (cumulative monitoring period of 4650 years, overall survival rate of 98.6%). Of the 551 complete coverage restorations, 4 failed (0 anterior, 4 posterior), yielding a crude estimate of 0.1% annual failure with the survival function time at 14 years. Of the 111 partial coverage restorations, 2 failed, yielding a crude estimate of 0.4% annual failure with the survival function time at 12 years. The only statistically significant difference was seen between anterior crowns and posterior onlays, with no failures in anterior crowns (P<.001). Other clinical variables had no significant effect on survival (P>.05). ConclusionsPressed e.max lithium disilicate partial and complete coverage restorations both showed high survival rates in patients with severe wear over 14 years with an overall yearly failure rate of 0.1%. Risk of failure at any age was minimal for both men and women. All anterior crowns survived. The highest annual failure rate (0.4%) was for posterior onlay partial coverage restorations.

Improving prevalence estimates of mental health and well-being indicators among sexual minority men: a propensity-weighting approach

Abstract The prevalence and relative disparities of mental health outcomes and well-being indicators are often inconsistent across studies of sexual minority men (SMM) due to selection biases in community-based surveys (nonprobability sample), as well as misclassification biases in population-based surveys where some SMM often conceal their sexual orientation identities. The present study estimated the prevalence of mental health related outcomes (depressive symptoms, mental health service use, anxiety) and well-being indicators (loneliness and self-rated mental health) among SMM, broken down by sexual orientation using the adjusted logistic propensity score (ALP) weighting. We applied the ALP to correct for selection biases in the 2019 Sex Now data (a community-based survey of SMMs in Canada) by reweighting it to the 2015-2018 Canadian Community Health Survey (a population survey from Statistics Canada). For all SMMs, the ALP-weighted prevalence of depressive symptoms was 15.96% (95% CI, 11.36%-23.83%), while for mental health service use, it was 32.13% (95% CI, 26.09%-41.20%). The ALP estimates lie in between the crude estimates from the two surveys. This method was successful in providing a more accurate estimate than relying on results from one survey alone. We recommend to the use of ALP on other minority populations under certain assumptions. This article is part of a Special Collection on Mental Health.

Incidence and prevalence of eating disorders among U.S. military service members, 2016-2021.

Despite unique experiences that may increase eating disorder risk, U.S. military service members are an understudied population. The current study examined incidence and prevalence of eating disorder diagnoses in U.S. military personnel. This retrospective cohort study utilized Military Health System Data Repository (MDR) data on eating disorder diagnoses (2016-2021). Active duty, Reserve, and National Guard U.S. military service members who received care via TRICARE Prime insurance were identified by ICD-10 eating disorder diagnostic codes. During the 6-year surveillance period, 5189 Service members received incident eating disorders diagnoses, with a crude overall incidence rate of 6.2 cases per 10,000 person-years. The most common diagnosis was other/unspecified specified eating disorders, followed by binge-eating disorder, bulimia nervosa, and anorexia nervosa. There was an 18.5% overall rise in total incident cases across the surveillance period, but this trend was not statistically significant (p = 0.09). Point prevalence significantly increased across the 6-year timeframe for total eating disorders (p < 0.001). Period prevalence for 6-year surveillance period was 0.244% for total eating disorders, 0.149% for other/unspecified eating disorder, 0.043% for bulimia nervosa, 0.038% for binge-eating disorder, and 0.013% for anorexia nervosa. Overall crude incidence estimates for total eating disorders were higher than reported in prior research that included only active duty Service members and required an eating disorder diagnosis code in the first or second diagnostic position of the medical record. Comprehensive and confidential studies are needed to more thoroughly characterize the nature and scope of eating disorder symptomatology within U.S. military personnel. U.S. military service members are a vulnerable population with regard to eating disorder symptoms. Previously reported incidence and prevalence estimates using data from the Military Health System may have been underestimated due to overly stringent case definitions. Given personal and occupational barriers (e.g., career consequences), confidential studies of military personnel may provide more complete data on the scope of eating disorders to inform screening and clinical practice guidelines for military populations.

Reliable event rates for disease mapping.

When analyzing spatially referenced event data, the criteria for declaring rates as "reliable" is still a matter of dispute. What these varying criteria have in common, however, is that they are rarely satisfied for crude estimates in small area analysis settings, prompting the use of spatial models to improve reliability. While reasonable, recent work has quantified the extent to which popular models from the spatial statistics literature can overwhelm the information contained in the data, leading to oversmoothing. Here, we begin by providing a definition for a "reliable" estimate for event rates that can be used for crude and model-based estimates and allows for discrete and continuous statements of reliability. We then construct a spatial Bayesian framework that allows users to infuse prior information into their models to improve reliability while also guarding against oversmoothing. We apply our approach to county-level birth data from Pennsylvania, highlighting the effect of oversmoothing in spatial models and how our approach can allow users to better focus their attention to areas where sufficient data exists to drive inferential decisions. We then conclude with a brief discussion of how this definition of reliability can be used in the design of small area studies.

Spin interaction of nonrelativistic neutrons with an ultrashort laser pulse

The nonrelativistic Pauli equation is used to study the interaction of slow neutrons with an ultrashort laser pulse. In the extreme limit, the pulse is acting on the magnetic moment of the neutron only at one instant of time. We obtain the scattering amplitude by deriving the junction conditions for the Pauli wave function across the pulse. Explicit expressions are given for a beam of polarized plane wave neutrons subjected to a pulse of spatially constant magnetic field strength. Finally we provide crude numerical estimates for pulses with the highest intensity available today.

Association between COVID-19 severity and tobacco smoking status: a retrospective cohort study using propensity score matching weights analysis

IntroductionThe COVID-19 pandemic continues to be a global threat to public health, with over 766 million confirmed cases and more than 6 million reported deaths. Patients with a smoking history...

Ticks - public health risks in urban green spaces

BackgroundUrban green spaces are important for human health, but they may expose visitors to tick-borne diseases. This not only presents a potential public health challenge but also undermines the expected public health gains from urban green spaces. The aim of this study is to assess the public health risk of tick-borne diseases in an urban green space used for recreation in Stockholm, Sweden.MethodsWe used a mixed method approach identifying both the magnitude of the tick hazard and the extent of the human exposure to tick-borne diseases. At six entry points to an urban green space, we sampled ticks and documented microhabitat conditions from five randomly assigned 2 m × 2 m plots. Surrounding habitat data was analyzed using geographical information system (GIS). Nymphs and adult ticks were tested for Borrelia burgdorferi sensu lato and Anaplasma phagocytophilum using TaqMan qPCR. Positive B. burgdorferi (s.l.) ticks were further analyzed by nested PCR amplification and sequence analysis. Population census data and visitor count data were used to estimate the degree of human exposure to tick-borne diseases. To further understand the degree to which visitors get in contact with infected ticks we also conducted interviews with visitors to green spaces.ResultsHigh tick densities were commonly found in humid broadleaved forest with low field vegetation. High pathogen prevalence was significantly correlated with increasing proportions of artificial areas. Integrating the tick hazard with human exposure we found that the public health risk of tick-borne diseases was moderate to high at most of the studied entry points. Many of the visitors frequently used urban green spaces. Walking was the most common activity, but visitors also engaged in activities with higher risk for tick encounters. Individual protective measures were connected to specific recreational activities such as picking berries or mushrooms.ConclusionsThe number of visitors can be combined with tick inventory data and molecular analyses of pathogen prevalence to make crude estimations of the public health risk of tick-borne diseases in urban green spaces. The risk of encountering infected ticks is omnipresent during recreational activities in urban green spaces, highlighting the need for public health campaigns to reduce the risk of tick-borne diseases.

Environmental risk factors analysis in paediatric oral health: a cross-sectional study.

The aim of the present study was to evaluate the association between environmental risk factors [adherence to the Mediterranean diet (MD), eating habits, hygiene habits, body mass index (BMI)] with the presence of caries in a university-based cohort of paediatric patients. A total of 118 paediatric patients were included in the study. In addition to the evaluation of clinical (vitality test, percussion test) and radiographic (X-ray bitewing, OPT) parameters, patients' lifestyle was investigated through validated questionnaries. Data regarding decayed, missing, filled teeth index were recorded for both permanent (DMFT) and deciduous teeth (dmft). Logistic/linear regression models (crude estimates) and multiple regression models (logistic/linear) adjusted for confounding factors were built to evaluate the association between lifestyle habits and caries. The results were reported as Odds Ratio (OR - con 95% CI) for logistic regression models and Mean Difference (MD - con 95% CI) for linear models. The present study confirmed the role of nutritional habits in caries development in the paediatric population, especially for deciduous dentition. Further clinical studies are needed to improve the quality of administered questionnaires and evaluate the cause/effect relationship between environmental risk factors and caries.

Discovery of Merging Twin Quasars at z = 6.05

Abstract We report the discovery of two quasars at a redshift of z = 6.05 in the process of merging. They were serendipitously discovered from the deep multiband imaging data collected by the Hyper Suprime-Cam (HSC) Subaru Strategic Program survey. The quasars, HSC J121503.42−014858.7 (C1) and HSC J121503.55−014859.3 (C2), both have luminous (&gt;1043 erg s−1) Lyα emission with a clear broad component (full width at half maximum &gt;1000 km s−1). The rest-frame ultraviolet (UV) absolute magnitudes are M 1450 = − 23.106 ± 0.017 (C1) and −22.662 ± 0.024 (C2). Our crude estimates of the black hole masses provide log ( M BH / M ⊙ ) = 8.1 ± 0.3 in both sources. The two quasars are separated by 12 kpc in projected proper distance, bridged by a structure in the rest-UV light suggesting that they are undergoing a merger. This pair is one of the most distant merging quasars reported to date, providing crucial insight into galaxy and black hole build-up in the hierarchical structure formation scenario. A companion paper will present the gas and dust properties captured by Atacama Large Millimeter/submillimeter Array observations, which provide additional evidence for and detailed measurements of the merger, and also demonstrate that the two sources are not gravitationally lensed images of a single quasar.

Are biomarkers expression and clinical-pathological factors predictive markers of the efficacy of neoadjuvant chemotherapy for locally advanced cervical cancer?

IntroductionTo predict the overall pathologic response to neoadjuvant chemotherapy (NACT) of patients with locally advanced cervical cancer (LACC) creating a prediction model based on clinical-pathological factors and biomarkers (p53, Bcl1 and Bcl2) and to evaluate the prognostic outcomes of NACT. Materials and methodsThis is a retrospective study of 88 consecutive patients with LACC who underwent NACT followed by nerve sparing surgery with retroperitoneal lymphadenectomy at National Cancer Institute of Milan, between January 2000 and June 2013. Clinical pathologic data were retrieved from the institutional database. Biomarkers (p53, Bcl1 and Bcl2) were evaluated before and after NACT in the specimen. To investigate their role as predictors of response, we tried several statistical machine learning algorithms. ResultsResponders to NACT showed a 5-years survival between 100%(CR) and 85.7%(PR). Clinical factors were the most important predictor of response. Age, BMI and grade represented the most important predictors of response at random forest analysis. Tree-based boosting revealed that after adjusting for other prognostic factors, age, grade, BMI and tumor size were independent predictors of response to NACT, while p53 was moderately related to response to NACT. Area under the curve (crude estimate): 0.871. Whereas Bcl1 and Bcl2, were not predictors for response to NACT. The final logistic regression reported that grade was the only significant predictor of response to NACT. ConclusionCombined model that included clinical pathologic variables plus p53 cannot predict response to NACT. Despite this, NACT remain a safe treatment in chemosensitive patients avoiding collateral sequelae related to chemo-radiotherapy.