Disruption Rate Research Articles

Ultrasound-Activated Nanodroplet Disruption of the Enterococcus faecalis Biofilm in Dental Root Canal.

Conventional methods used to control bacterial biofilm infection in root canals have poor efficacy, causing repeated and chronic infections, which pose a great challenge to clinical treatment. Microbubbles, due to their small size and ultrasound (US)-enhanced cavitation effects, have attracted considerable clinical attention. They possess the potential for therapeutic application in restricted spaces. We address the above problem with a strategy for the restricted space of root canals. Herein, phase-change nanodroplets (P-NDs) exposed to US are combined with common antibacterial drugs to disrupt a 7 day Enterococcus faecalis biofilm in an in vitro human tooth model. Specifically, the preparation of P-NDs is based on secondary cavitation. Their average particle size is ∼144 nm, and the stability is favorable. The clearance effect for the biofilm is notable (the disruption rate of P-NDs + US is 63.1%, P < 0.01), while the effect of an antibacterial in conjunction with 2% chlorhexidine (Chx) is significant (the antibiofilm rate of P-NDs@2% Chx + US is 96.2%, P < 0.001). Furthermore, biocompatibility testing on human periodontal ligament fibroblasts demonstrated that P-NDs are safe. In summary, the strategy that we have proposed is suitable for the removal of biofilms in root canals. Notably, it also has great potential for application in the treatment of bacterial infections in restricted spaces.

The temperature induced disruption process of amylopectin under ultrasonic treatments.

In this study, amylopectin was ultrasonicated at different temperatures to explore its disruption process. Results showed a significant decrease in amylopectin Mw after ultrasonic treatments and a retarded effect was detected with the increase of temperatures. The amylopectin disruption process fitted to the second order kinetic model (1/Mwt-1/Mw0=kt) and its disruption rate coefficient decreased from 2.203×10-8 to 0.986×10-8mol/gmin as the temperatures increased from 20 to 80°C. This was ascribed to the higher vapour pressure and the lower viscosity of the solution at higher temperatures. Ultrasound induced break points preferentially occurred to B3 chains of amylopectin at higher temperatures which contributed to an increase of A chains, which because that amylopectin would be more extended at higher temperatures. The activation energy of amylopectin disruption was negative (-11.6 KJ/mol), which indicated that its scission process by ultrasound was essentially a mechanical action.

Healthcare Disruptions and Use of Telehealth Services Among People With Multiple Sclerosis During the COVID-19 Pandemic

ObjectiveThe current study examined health care disruptions and use of telehealth services among people with multiple sclerosis (pwMS) during the COVID-19 pandemic. DesignCross-sectional survey. SettingGeneral community. ParticipantsParticipants (N=163) included 70 pwMS and 93 healthy controls (HCs). The majority of respondents were from the United States (88%). InterventionsNot applicable. Main Outcome MeasuresRates of health care disruptions (eg, missing/canceling appointments, experiencing delays) and telehealth use for MS and non-MS medical care and mental health care. ResultsIn this U.S. majority, predominantly White, and high socioeconomic status sample, 38% to 50% of pwMS reported experiencing disruptions in their MS and non-MS medical care and 20% to 33% reported disruptions in their mental health care; this was significantly lower than the rates observed among HCs. Compared with HCs, pwMS were more likely to use telehealth than in-person services, especially for mental health care. The majority of pwMS and HCs reported being satisfied with telehealth services. Individuals with higher degrees of functional limitation experienced more health care disruptions and were more likely to use telehealth services than individuals with lower degrees of functional limitation. ConclusionsDespite high health care disruption rates, pwMS frequently used and were highly satisfied with telehealth services during the COVID-19 pandemic. Due to physical limitations commonly observed in the MS population that may preclude travel, telehealth services should be continued even after resolution of the pandemic to expand access and reduce health care disparities.

Assessment of hand hygiene strategies on skin barrier function during COVID-19 pandemic: A randomized clinical trial.

Coronavirus disease 2019 (COVID-19) has increased the frequency of handwashing. There is scarce evidence regarding the impact of different hand hygiene procedures on skin barrier function in clinical practice. To compare the impact on skin barrier function of different hand hygiene measures in healthcare workers in daily practice. A randomized controlled clinical trial was conducted. Participants were randomized to sanitize their hands with water and soap, alcohol-based hand sanitizers (ABHSs), or disinfectant wipes during their 8-hour working shift. Epidermal barrier functional parameters, such as transepidermal water loss (TEWL), and the microbial load were assessed before and immediately after the working day. Tolerance and acceptability of each product were recorded after work. Sixty-two participants were included and 20, 21, and 21 were randomized to use water and soap, ABHS, and disinfectant wipes, respectively. After the 8-hour shift, TEWL increase was higher with disinfectant wipes than with soaps or ABHS (+5.45 vs +3.87 vs -1.46 g h-1 m-2 , respectively; P=.023). Bacteria and fungi colony-forming unit (CFU) count reductions were lower for the water and soap group than for ABHS and disinfectant wipes. Disinfectant wipes were considered more difficult to use (P=.013) compared with water and soap and ABHS. Daily hand hygiene with ABHS showed the lowest rates of skin barrier disruption and the highest reduction of CFU.

CRISPR-surfaceome: An online tool for designing highly efficient sgRNAs targeting cell surface proteins

CRISPR-based genome-editing tools have emerged as an efficient tool for functional genomics studies. Online tools and databases have been developed to facilitate the design and selection of CRISPR single guide RNA (sgRNA) for gene modifications. However, to the best of our knowledge, none of these tools or database are designated to cell surface proteins. In a previous study, we described the development and application of surfaceome CRISPR libraries targeting to cell surface proteins on human cells. Here, we present the design and construction of an online tool and database (https://crispr-surfaceome.siais.shanghaitech.edu.cn/home), named CRISPR-Surfaceome, for the design of highly efficient sgRNA targeting to the surface proteins on human cells. To show case and validate the efficiencies of sgRNAs designed by this online tool, we chose ICAM-1 gene for knockout studies and found that all the 10 designed ICAM-1 sgRNAs could efficiently generate knockout cells, with more than 80% gene disruption rates. These ICAM-1 knockout cells were found to be resistant to the infection of rhinovirus (RV), which utilizes ICAM-1 as the receptor. Therefore, CRISPR-Surfaceome can serve the research community for the functional genomics studies on cell surface proteins, such as identification of pathogen receptors and discovery of drug targets.

Suboptimal Uptake, Retention, and Adherence of Daily Oral Prexposure Prophylaxis Among People With Opioid Use Disorder Receiving Hepatitis C Virus Treatment.

BackgroundDaily oral preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) prevents human immunodeficiency (HIV) among people who inject drugs (PWID). Despite rising HIV incidence and injection drug use (IDU), PrEP use remains low and there is limited research about uptake, adherence, and retention among PWID.MethodsThe ANCHOR investigation evaluated a community-based care model collocating hepatitis C virus (HCV) treatment, medication for opioid use disorder (OUD), and PrEP in individuals in Washington, DC, and Baltimore, Maryland. PrEP counseling was conducted from HCV treatment day 0 until week 24. Subjects could start any time during this window, were followed for 48 weeks, and were assessed for adherence by self-report and dried blood spot TDF analysis.ResultsOne hundred ninety-eight participants were enrolled, of whom 185 (93%) were HIV negative. Twenty-nine individuals (15.7% of HIV-negative cohort) initiated PrEP. One hundred sixteen participants (62.7%) met 2014 Centers for Disease Control and Prevention (CDC) PrEP criteria due to IDU (82 [44.3%]), sex (9 [4.9%]), or both practices (25 [13.5%]). Providers recommended PrEP to 94 individuals (50.8%), and recommendation was associated with PrEP uptake. Median treatment duration was 104 days (interquartile range, 28–276 days), with 8 participants retained through week 48. Adherence was variable over time by self-report and declined by TDF analysis. No HIV seroconversions occurred.ConclusionsThis cohort of people with HCV and OUD experienced low uptake of PrEP despite the majority meeting CDC criteria. High rates of disruption and discontinuation, compounded by variable adherence, made TDF/FTC a suboptimal prevention strategy. Emerging modalities like long-acting formulations may address these barriers, but PWID have been excluded from their development to date.

Differential Impact of the COVID-19 Pandemic on Health Care Utilization Disruption for Community-Dwelling Individuals With and Without Acquired Brain Injury

To delineate health care disruption for individuals with acquired brain injury (ABI) during the peak of the pandemic and to understand the impact of health care disruption on health-related quality of life (HRQoL). Cross-sectional survey. General community. Volunteer sample of adults with traumatic brain injury (TBI; n=33), adults with stroke (n=66), and adults without TBI or stroke (n=108) with access to the internet and personal technology (N=207). Not applicable. Not applicable. Participants with TBI and stroke reported high rates of disruption in care specific to their diagnosis (53%-54.5%), while participants across all groups reported disruption for major medical care (range, 68.2%-80%), general health care (range, 60.3%-72.4%), and mental health care (range, 31.8%-83.3%). During the pandemic, participants with TBI and stroke used telehealth for care specific to their diagnosis (40.9%-42.4%), whereas all participants used telehealth for major medical care (range, 50%-86.7%), general health care (range, 31.2%-53.3%), and mental health care (range, 53.8%-72.7%). Disruption in TBI or stroke care and type of ABI explained 27.1% of the variance in HRQoL scores (F2,95=16.82, P<.001, R 2=0.262), and disruption in mental health care explained 14.8% of the variance (F1,51=8.86, P=.004, R 2=0.148). Individuals with and without ABI experienced pronounced disruption in health care utilization overall. However, individuals who experienced a disruption in care specific to TBI or mental health care were most vulnerable to decreased HRQoL. Telehealth was a viable alternative to in-person visits for individuals with and without ABI, but limitations included difficulty with technology, difficulty with comprehensive examination, and decreased rapport with providers.

A Concern for Intraoperative Distractions and Interference: An Observational Study Identifying, Measuring, and Quantifying Both within the Operating Theatre.

Background Modern surgical research has broadened to include an interest into the investigation of surgical workflow. Rigorous analysis of the surgical process has a particular focus on distractions. Operating theatres are inherently full of distractions, many not pertinent to the surgical process. Distractions have the potential to increase surgeon stress, operative time, and complications. Our study aims to objectively identify, classify, and quantify distractions during the surgical process. Methods 46 general surgical procedures were observed within a tertiary Irish hospital between June 2019 and October 2019. An established observational tool was used to apply a structured observation to all operations. Additionally, a nine-point ordinal behaviourally anchor scoring scale was used to assign an interference level to each distraction. Results The total operative observation time was 4605 minutes (mean = 100.11 minutes, std. deviation: 45.6 minutes). Overall, 855 intraoperative distractions were coded. On average, 18.58 distractions were coded per operation (std. deviation: 6.649; range: 5–34), with 11.14 distractions occurring per hour. Entering/exiting (n = 380, 42.88%) and case irrelevant communication (n = 251, 28.32%) occurred most frequently. Disruption rate was highest within the first (n = 275, 32%) and fourth operative quartiles (n = 342, 41%). Highest interference rates were observed from equipment issue and procedural interruptions. Anaesthetists initiated CIC more frequently (2.72 per operation), compared to nurses (1.57) and surgeons (1.17). Conclusion Our results confirm that distractions are prevalent within the operating theatre. Distractions contribute to significant interferences of surgical workflow. Steps can be taken to reduce overall prevalence and interference level by drawing upon a systems-based perspective. However, due to the ubiquitous nature of distractions, surgeons may need to develop skills to help them resume interrupted primary tasks so as to negate the effects distraction has on surgical outcomes. Data for the above have been presented as conference abstract in 28th International Congress of the European Association for Endoscopic Surgery (EAES) Virtual Congress, 23–26 June 2020.

859. Suboptimal Uptake, Retention, and Adherence of Daily Oral PrEP Among People with OUD Receiving HCV Treatment

BackgroundDaily oral pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) effectively prevents HIV among people who use drugs (PWUD). Despite rising rates of HIV incidence and injection drug use, PrEP use remains low and limited research exists on PrEP adherence and retention in this population.MethodsBased in Washington, DC and Baltimore, the ANCHOR investigation evaluated a community-based model of care collocating hepatitis C (HCV) therapy, medication for opioid use disorder (OUD), and PrEP in people with chronic HCV, OUD, and drug use within 1 year. PrEP counseling was offered from HCV treatment Day 0 until Week 24 and subjects could start any time during this window. PrEP patients were followed for 48 weeks and assessed for adherence by self-report and dried blood spot analysis of TDF. ANCHOR PrEP study enrollment and participant retention along the PrEP continuum.Results198 participants enrolled in ANCHOR, of whom 185 (93%) were HIV-negative. 29 subjects (16% of HIV-negative group) initiated PrEP. 116 subjects (63%) met 2014 CDC criteria for PrEP initiation due to IDU (82, 44%), sex (9, 5%), or both (25, 14%). Those who initiated were more likely to meet both CDC sexual and IDU risk criteria than those who declined PrEP (P=0.006). Providers recommended PrEP to 94 subjects (51%), which was associated with uptake (P=0.02). While median treatment duration was 104 days (IQR 28, 276), only 8 subjects were retained through Week 48. The most common reason for discontinuation was side effects in 7 subjects or 24% of PrEP subgroup. Treatment interruptions occurred in one-third of the PrEP subgroup. Adherence of 4 to 7 pills per week was variable over time by self-report and declined by TDF analysis. No HIV seroconversions occurred. Demographic and epidemiological background of the ANCHOR study population. Total duration, in days, on PrEP in the ANCHOR study. Discontinued participants are grouped by reason for cessation of therapy.PrEP Adherence Adherence to PrEP by ANCHOR study timepoint, assessed via self-report (above) and dried bloodspot analysis of tenofovir level (below).ConclusionIn this cohort of people with OUD and HCV, 16% of subjects started PrEP. While clinical recommendation was associated with uptake, high rates of disruption and discontinuation, compounded by variable pill adherence, made daily oral TDF/FTC a suboptimal preventive strategy in this cohort. Emerging PrEP modalities like long-acting injectables have potential to address these barriers, but PWUD have been excluded from their research and development to date. Additional work to identify vulnerable individuals and to promote use, adherence, and retention will be critical in implementing PrEP more effectively in this key population.Disclosures Sarah Kattakuzhy, MD, Gilead Sciences (Scientific Research Study Investigator, Research Grant or Support) Elana S. Rosenthal, MD, Gilead Sciences (Research Grant or Support)Merck (Research Grant or Support)

Erosion Resistance and Fertility of Frost-Resistant Ecological Substrate in Alpine Region

This research was conducted to quantitatively evaluate the application effect of the frost-resistant ecological substrate in the rock slope of the hydropower station. Field sampling and laboratory tests were conducted to determine the erosion resistance and fertility of frost-resistant ecological substrate, and the test results were compared with those of natural soils with similar site conditions. The research conclusions were as follows. Compared with the natural soil, the content of &gt; 0.25 mm mechanical-stable aggregates, &gt; 0.25 mm water-stable aggregates, average weight diameter, geometric average diameter, organic matter, available nitrogen, available phosphorus, and available potassium of frost-resistant ecological substrate, significantly increased. On the contrary, erodibility factor, percentage aggregate disruption, aggregate degree, and dispersion rate decreased evidently. These results showed that erosion resistance and fertility of the frost-resistant ecological substrate have a better prospect in the engineering application of alpine regions. In addition, the principal component analysis showed that the principal component value of frost-resistant ecological substrate increased by 1.9 times that of natural soil. According to the correlation study, the increase in the amount of &gt; 0.25 mm macro-aggregates and organic matter is the primary reason that ecological substrate has greater stability and fertility than natural soil. In conclusion, the frost-resistant ecological substrate was a suitable soil to create a suitable vegetation growth environment on the surface of rock slope in the alpine region.

Selection of Culture Conditions and Cell Morphology for Biocompatible Extraction of β-Carotene from Dunaliella salina.

Biocompatible extraction emerges recently as a means to reduce costs of biotechnology processing of microalgae. In this frame, this study aimed at determining how specific culture conditions and the associated cell morphology impact the biocompatibility and the extraction yield of β-carotene from the green microalga Dunaliella salina using n-decane. The results highlight the relationship between the cell disruption yield and cell volume, the circularity and the relative abundance of naturally permeabilized cells. The disruption rate increased with both the cell volume and circularity. This was particularly obvious for volume and circularity exceeding 1500 µm3 and 0.7, respectively. The extraction of β-carotene was the most biocompatible with small (600 µm3) and circular cells (0.7) stressed in photobioreactor (30% of carotenoids recovery with 15% cell disruption). The naturally permeabilized cells were disrupted first; the remaining cells seems to follow a gradual permeabilization process: reversibility (up to 20 s) then irreversibility and cell disruption. This opens new carotenoid production schemes based on growing robust β-carotene enriched cells to ensure biocompatible extraction.

One Bony Morphology, Two Pathologic Entities: Sex-Based Differences in Patients With Borderline Hip Dysplasia Undergoing Hip Arthroscopy

Background: Sex-based differences have been largely uncharacterized for patients with borderline hip dysplasia (BHD) undergoing hip arthroscopy. Purpose: To evaluate for sex-based differences in clinical and pathologic characteristics as well as surgical outcomes in patients with BHD undergoing hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2011 and December 2018, data were prospectively collected on all patients with BHD undergoing primary hip arthroscopy. Patients were included if they had preoperative and minimum 2-year postoperative scores for the modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale for pain. Patients with previous ipsilateral hip conditions or surgery, Tönnis grade >1, lateral center-edge angle <18° or >25°, or workers’ compensation status were excluded. Patients were then divided by sex and propensity score matched in a 1:1 ratio for body mass index, age, and Tönnis grade. The rates of patients who achieved the minimal clinically important difference were recorded for the mHHS and NAHS. The rates of achieving the patient acceptable symptomatic state for the mHHS were calculated. Results: A total of 344 hips met the inclusion criteria, and 317 hips (92%) had adequate follow-up. Propensity score matching created cohorts of 109 male and 109 female patients. Male patients had significantly higher preoperative average alpha angles (69.79° vs 58.17°, P < .001), more often requiring a femoroplasty (97.2% vs 83.5%, P < .001), and had higher rates of complex labral tearing (50.5% vs 33.0%, P < .001). Male patients also had higher rates of grade 3 and 4 acetabular labral articular disruption (62.4% vs 19.3%, P < .001) and higher rates of grade 3 and 4 acetabular cartilage injury (59.6% vs 20.2%, P < .001) requiring a microfracture more frequently (32.1% vs 7.3%, P < .001). Female patients more typically had painful internal snapping requiring iliopsoas fractional lengthening (60.6% vs 32.1%, P < .001). Female patients also underwent capsular plication more regularly to address hip instability (79.8% vs 45.9%, P < .001). Male and female patients showed significant improvements in all outcome scores after surgery (P < .001). Female patients achieved the minimal clinically important difference for the NAHS at higher rates (85.3% vs 71.6%, P = .020). Conclusion: Female and male patients with BHD who underwent hip arthroscopy achieved favorable outcomes but had notably dissimilar pathology. Hence, although they share similar acetabular bony morphology, male and female patients with BHD may represent 2 very different pathologic entities.

Implementing an Application Programming Interface for PROMIS Measures at Three Medical Centers.

Background There is an increasing body of literature advocating for the collection of patient-reported outcomes (PROs) in clinical care. Unfortunately, there are many barriers to integrating PRO measures, particularly computer adaptive tests (CATs), within electronic health records (EHRs), thereby limiting access to advances in PRO measures in clinical care settings. Objective To address this obstacle, we created and evaluated a software integration of an Application Programming Interface (API) service for administering and scoring Patient-Reported Outcomes Measurement Information System (PROMIS) measures with the EHR system. Methods We created a RESTful API and evaluated the technical feasibility and impact on clinical workflow at three academic medical centers. Results Collaborative teams (i.e., clinical, information technology [IT] and administrative staff) performed these integration efforts addressing issues such as software integration as well as impact on clinical workflow. All centers considered their implementation successful based on the high rate of completed PROMIS assessments (between January 2016 and January 2021) and minimal workflow disruptions. Conclusion These case studies demonstrate not only the feasibility but also the pathway for the integration of PROMIS CATs into the EHR and routine clinical care. All sites utilized diverse teams with support and commitment from institutional leadership, initial implementation in a single clinic, a process for monitoring and optimization, and use of custom software to minimize staff burden and error.

Visualized Multigene Editing System for Aspergillus niger.

The resistance markers could ensure the entry of the CRISPR/Cas9 system into Aspergillus niger cells instead of gene editing. To increase the efficiency of positive colony screening on the primary transformation plates, we designed a visualized multigene editing system (VMS) via a unique tRNA-guide RNA (gRNA) array containing the gRNAs of a pigment gene albA and target genes. Disruption of albA produces white colonies, and the sequences of the endogenous tRNAAla, tRNAPhe, tRNAArg, tRNAIle, and tRNALeu enhance gRNA release. The disruption efficiencies of multigene were analyzed in the A. niger strain AG11 using ammA, amyA, prtT, kusA, and glaA as reporters. In white colonies on the primary transformation plates, the disruption rates of one-, two-, three-, four-, and five-target genes reached 89.2, 70.91, 50, 22.41, and 4.17%, respectively. The VMS developed here provides an effective method for screening homokaryotic multigene editing strains of A. niger.

Extraction of microalgal starch and pigments by using different cell disruption methods and aqueous two‐phase system

AbstractBACKGROUNDMicroalgae can synthesize starch with productivity higher than conventional terrestrial crops, without the need for arable land. However, little is known about processes to extract starch from microalgae. Here, a biorefinery process is described including microalgal cell disruption followed by extraction of starch and pigments with aqueous two‐phase system (ATPS) using choline chloride and polypropylene glycol 400. Sonication and bead milling were compared for cell disruption rate and starch extraction efficiency.RESULTSA first order kinetic model described well the cell disruption for both the methods, with a rate 2.6 times higher for bead milling than sonication. By applying ATPS on samples with comparable cell disruption (&gt;93%), starch was separated better after sonication (67% recovery in the pellet) than after bead milling, for which it remained equally distributed between pellet (40%) and choline chloride phase. Pigments were extracted with 42–66% yield irrespective of the cell disruption method. Microalgal starch granules had a normal and narrow distribution for size (0.93 ± 0.14 μm) and a gelatinization temperature between 45–55 °C.CONCLUSIONFor the same cell disruption yield, different starch separation efficiencies can be achieved, depending on the cell disruption method applied. Although bead milling was faster than sonication in disrupting cells, it gave worst starch separation efficiency. The properties of the extracted microalgal starch indicate potential technical advantages, with respect to conventional starch sources, for applications in the bioplastic and food sector. © 2021 The Authors. Journal of Chemical Technology and Biotechnology published by John Wiley &amp; Sons Ltd on behalf of Society of Chemical Industry (SCI).

Defining a Slurry Phase Map for Gas Hydrate Management in Multiphase Flow Systems

This study proposes a criterion for the safe transportability of gas hydrate slurries in oil-dominant flowlines. Fluids chemistry plays a role in how the particles agglomerate, which occurs in the time window the particles take to decrease their porosity because of crystallization in the capillary walls or to seal the water within the pores by the action of chemical additives, completely preventing any water in the outer surface of the particle and avoiding liquid bridge formation (agglomeration). Hydrodynamic aspects come from the lift vs buoyancy/weight forces that tend to suspend/settle the particles, as well as the collision and disruption rates of particles that play a role in the agglomeration process. The criterion is rather simple and shows the importance of the subcooling of crystallization, water cut, mixture velocity, and oil–water interfacial tension that can be lowered by the use of additives. A simple chart for assuring safe, fully suspended slurry flow (low plugging risk) is proposed, called hydrate slurry phase map, and directives of its use for flowline design and management are discussed. Discussion is also given on how to scale up laboratory measurements into field conditions by the proposal of a new dimensionless group, called the Bassani number.

Mean throughput rate in restart-upon-failure systems subject to random disruptions

We model a manufacturing or service system processing a fixed number of tasks subject to random disruptions generated by a renewal process, such that a task has to start over from scratch if it is interrupted. We study the impact of an increase in disruption rate on the mean throughput of the system, using tools from stochastic ordering. We show that a system that is stochastically better than another does not necessarily have a higher mean throughput - the deciding factor is the hazard rate of the underlying disruption process. We prove that a system that is better than another in the sense of hazard rate ordering of time between disruptions is guaranteed to enjoy a higher average throughput.

STRUCTURAL PATHOLOGY AFTER RETINAL DETACHMENT: Multicolor Confocal Scanning Laser Ophthalmoscopy Versus Color Fundus Photography.

To compare pathology detection using multicolor confocal scanning laser ophthalmoscopy with color fundus photography following macula-off rhegmatogenous retinal detachment. Postsurgery multicolor confocal scanning laser ophthalmoscopy and color fundus photography images from 30 rhegmatogenous retinal detachment patients were examined by 10 masked graders. Imaging was performed with the Heidelberg Spectralis HRA and the digital retinal camera Basler acA2500-14gc GigE. Swept-source optical coherence tomography was used as verification modality. Detection rates of ellipsoid zone disruption, foveal ellipsoid zone rosette, outer retinal folds, intraretinal cysts, subretinal fluid layer, subretinal fluid blebs, retinal striae, and retinal detachment line were compared. Intermodality and intergrader agreement were estimated. Overall pathology detection was significantly higher for multicolor confocal scanning laser ophthalmoscopy multicolor confocal scanning laser ophthalmoscopy (adjusted odds ratio = 7.39; 95% confidence interval, 1.64-33.30; P = 0.009). The intermodality and intergrader agreement on overall pathology detection were moderate. The intermodality agreement was 0.49 (95% confidence interval, 0.48-0.51; P < 0.0001) (Gwet's AC1). Intergrader agreement was 0.53 (95% confidence interval, 0.52-0.54; P < 0.0001) for multicolor confocal scanning laser ophthalmoscopy and 0.58 (95% confidence interval, 0.57-0.59; P < 0.0001) (Fleiss kappa) for color fundus photography. Multicolor confocal scanning laser ophthalmoscopy imaging is superior to color fundus photography in detecting and delineating structural retinal abnormalities following rhegmatogenous retinal detachment and can be a helpful tool in the visualization of retinal remodeling processes in patients recovering from rhegmatogenous retinal detachment surgery.

Charting a course for the management of long COVID

It is difficult to think beyond the immediate crisis, when wave after wave of the COVID-19 pandemic has repeatedly overwhelmed health systems and resulted in high rates of mortality and severe disruption to normal life. However, the recognition of a syndrome of prolonged, multisystem disability in survivors of COVID-191–3—commonly referred to as long COVID or the post-COVID-19 condition—has made obtaining knowledge of its pathogenesis, prognosis, and management an important competing priority. A comprehensive, coordinated global research strategy for the post-acute sequelae of COVID-19, rather than a piecemeal approach, is clearly required, although difficult to achieve in the midst of a pandemic.

The impact of fuelling and W radiation on the performance of high-power, ITER-baseline scenario plasmas in JET-ILW

Sustained operation of high-performance, ITER-baseline scenario plasmas at the high levels of input power () required to achieve ∼15 MW of D-T fusion power in JET-ILW requires careful optimisation of the fuelling to avoid an unacceptable disruption rate due to excessive radiation, primarily from W impurities, which are sputtered by edge-localised modes (ELMs) from the divertor targets. By using a train of ELM-pacing pellets from a high-frequency pellet injector to promote regular ELMs, which flush W and other impurities from the confined plasma, such high-performance plasmas can be sustained (for ∼5 s) while maintaining a high normalised confinement factor H 98,y2 ∼ 1, which would otherwise be degraded by reducing the pedestal confinement if a higher rate of D2 gas fuelling were used instead of the pellets to mitigate the W contamination. The causes underlying the improved performance and energy confinement obtained using this combined, gas and pellet fuelling scheme is investigated here in some detail.