Incomplete Evidence Research Articles

Infection epidemiological effects of school closures during the second COVID-19 pandemic wave-an exemplary analysis within alower Bavarian region

The rapid global spread of the SARS-CoV‑2 virus during the COVID-19 pandemic led to widespread non-pharmaceutical interventions, such as school closures, to curb infections. This study investigates the influence of school closures on the number of new infections to reduce the existing knowledge gap in this area. The effect of school closures starting on 16December 2020, was quantified using COVID-19 infection data from the district and city of Landshut in Bavaria between November 2020 and January 2021. An interrupted time series (ITS) analysis was performed to analyze daily new infections among 6-18 year olds and the entire population in the region before and after the school closures using anegative binomial regression model. The analysis showed that the trend of daily new COVID-19 infections among 6-18 year olds significantly decreased after the school closures (incidence rate ratio (IRR) 0.93; 95% confidence interval (CI): 0.89-0.96; p < 0.001). This was also true for the entire study population (IRR 0.95; 95% CI: 0.93-0.97; p < 0.001). In the context of various concurrent measures to contain the COVID-19 pandemic, the study provides evidence for asignificant association between school closures and reduced COVID-19 infections. By optimizing the existing incomplete evidence base on the role of school closures in pandemic control, this finding can support involved stakeholders and contribute to strengthening future approaches to pandemic prevention.

Trust Mechanism-Based Multi-Tier Computing System for Service-Oriented Edge-Cloud Networks

Edge-cloud networks face security threats during data collection, data routing, and service construction, resulting in data tampering, stealing, and communication interruption. Trust mechanism can predict data quality and cooperation probability of nodes before purchasing data or establishing cooperation, so as to select trusted participants for data perception and interaction. However, there are some problems with existing trust methods, such as limited evaluation scope, incomplete trust evidence, and inaccurate evaluation results. To address these issues, a Trust mechanism-based Multi-Tier Computing system (TMTC) is proposed in this paper. Specifically, we propose a two-tier trust evaluation model. At the data collection layer, it conducts trust evaluation on data reporters based on data submission and communication interactions. At the network layer, it evaluates trust of routers through path backtracking verification, multi-service analysis and coincident path analysis. Then, based on evaluation results, a differentiated trust detection is initiated for normal and abnormal nodes. And high-frequency detection tasks are initiated for malicious nodes to improve accuracy, sparse detection tasks are initiated for normal nodes to reduce costs. Finally, extensive experiments conducted on the synthetic and real-world datasets demonstrate that, TMTC can resist data tampering and good-bad mouth attacks effectively. And whether in a dense or uniform scene, it outperforms two benchmark methods by increasing malicious node detection rate by 13.37%-21.87% and reducing cost by 18.8%-50.32%.

Sepsis Order Set Use Associated With Increased Care Value

BackgroundSepsis is common and expensive and there is evidence that sepsis order sets may help improve care. There is very incomplete evidence of the effects of sepsis order sets on the value of care produced by hospitals or the societal costs of sepsis care. Research QuestionIn patients hospitalized for sepsis, is the receipt a of a sepsis order set vs. no order set associated with improved value of care, defined as decreased hospital mortality, decreased hospital direct variable costs and decreased societal spending on hospitalizations? Study Design and MethodsRetrospective cohort study of patients discharged with sepsis ICD-10 codes over two years from a large integrated delivery system. Using a propensity score, sepsis order set users were matched to non-users to study the association between sepsis order set use and the value of care from the hospital and societal perspective. The association between order set receipt and hospital mortality, direct variable cost, and hospital revenue were also examined in a priori defined subgroups of sepsis severity and hospital mortality. Results97,249 patients were included in the study with 52,793 (54%) receiving the sepsis order set. 55,542 patients were included in the propensity score match analysis, 27,771 in each group. Recipients of the sepsis order set had a 3.3% lower hospital mortality rate, a $1487 lower median direct variable total cost (P < 0.01 for both). Median payer neutral reimbursement (PNR), a proxy for hospital revenue and thus societal costs, was $465 lower for sepsis order set users (P < 0.01). Receipt of the sepsis order set was associated with an $1022 increase in contribution margin, the difference between direct variable costs and PNR per patient. InterpretationReceipt of the sepsis order set was associated with improved value of care, from both a hospital and societal perspective.

Concussion management in pediatric patients – ethical concerns

ABSTRACT Collision sports pose a high risk of concussion. How to respond to this risk is more ethically complex when considering children and adolescents due to a) incomplete evidence regarding the impact of concussion on developing brains, b) physiological and social vulnerability, and c) the young person’s reliance on proxy decision-makers, usually parents. There is also a lack of clear definitions of (a) collision sport (vs. contact sport) and (b) what constitutes a child or adolescent. We consider whether parents should be free to allow their children/adolescents to play contact or collision sport. The article analyses the harms and benefits of collision sport and methods of determining risk, before outlining our support for the precautionary principle. We then consider whether the ‘best interests’ or ‘right to an open future’ framework ought to be applied to the issue of childhood participation in collision sport. Rather than supporting a ban of child/adolescent participation in collision sport, we argue that permissibility should be decided on a sport-by-sport basis. Moreover, we apply the ‘Accountability of Reasonableness’ framework to ensure that sound ethical values guide and support protections for this vulnerable group in the absence of high-quality evidence.

Habitat type modulates sharp body mass oscillations in cyclic common vole populations

Cyclic rodent populations exhibit pronounced changes in body mass associated with the population cycle phase, long-known as Chitty effect. Although Chitty effect is a common epiphenomenon in both America and Europe, there is still incomplete evidence about the generality of these patterns across the entire range of most species. Moreover, despite decades of research, the underlying factors driving Chitty effect remains poorly understood. Here, we examined the influence of intrinsic and extrinsic factors that may underlie observed patterns in vole size variation in the Iberian common vole Microtus arvalis asturianus. We weighed and measured 2816 adult voles that were captured during 6 trapping periods. Vole numbers and body mass showed strong period- and phase-related variation both in females and males, demonstrating marked Chitty effect in the studied population. Body mass of adult males correlated with body length, evidencing that heavier males are also structurally larger. Statistical models showed that probability of occurrence of large-sized vole (> 37 g) was significantly more likely in reproductive males, during increase and peak phases, and it was modulated by habitat, with crop fields and field margins between crops showing an increased likelihood. We suggest an effect of the habitat on vole body mass mediated by predation.

The cyclical cascade of HIV care: Temporal care engagement trends within a population-wide cohort.

The traditional HIV treatment cascade aims to visualise the journey of each person living with HIV from diagnosis, through initiation on antiretroviral therapy (ART) to treatment success, represented by virological suppression. This representation has been a pivotal tool in highlighting and quantifying sequential gaps along the care continuum. There is longstanding recognition, however, that this may oversimplify the complexity of real-world engagement with HIV services in settings with mature high-burden HIV epidemics. A complementary "cyclical" cascade has been proposed to represent the processes of disengagement at different points on the care continuum, with multiple pathways to re-engagement, although the feasibility of implementing this at scale has been uncertain. This study aimed to populate, refine, and explore the utility of a cyclical representation of the HIV cascade, using routine data from a high-burden HIV setting. This observational cohort study leveraged person-level data on all people living with HIV in the Western Cape (WC), South Africa, who accessed public health services in the 2 years prior to 31 December 2023. Programme data from disease registers were complemented by data from pharmacy and laboratory systems. At study closure, 494 370 people were included, constituting 93% of those of those estimated to be living with HIV in the province, of whom 355 104 were on ART. Substantial disengagement from HIV care was evident at every point on the cascade. Early treatment emerged as a period of higher risk of disengagement, but it did not account for the majority of disengagement. Almost all those currently disengaged had prior experience of treatment. While re-engagement was also common, overall treatment coverage had increased slowly over 5 years. The transition to dolutegravir-based regimens was dramatic with good virological outcomes for those in care, notwithstanding a clearly discernible impact of the Coronavirus Disease 2019 (COVID-19) pandemic on viral load (VL) testing. People currently engaged and disengaged in care are similar with respect to age and gender. Those who died or disengaged recently were previously distributed across a range of cascade statuses, and a substantial proportion of those newly initiating and re-initiating treatment were no longer on treatment 6 months later. The main limitation of this study was incomplete evidence of HIV testing, linkage to HIV-specific services, and out-of-facility mortality. Using routine data, it was possible to populate and automate a cyclical cascade of HIV care that continuously captured the nonlinear care journeys of individuals living with HIV. In this generalised mature HIV epidemic, most people are treatment experienced. Disengagement is common and occurs at various points along the cascade, making it challenging to identify high-impact intervention opportunities. While historical HIV cascades remain valuable for target setting and service monitoring, they can be complemented with insights from more detailed cyclical cascades.

Rapid reviews methods series: assessing the appropriateness of conducting a rapid review

This paper, part of the Cochrane Rapid Review Methods Group series, offers guidance on determining when to conduct a rapid review (RR) instead of a full systematic review (SR). While...

Sentiment interpretability analysis on Chinese texts employing multi-task and knowledge base.

With the rapid development of deep learning techniques, the applications have become increasingly widespread in various domains. However, traditional deep learning methods are often referred to as "black box" models with low interpretability of their results, posing challenges for their application in certain critical domains. In this study, we propose a comprehensive method for the interpretability analysis of sentiment models. The proposed method encompasses two main aspects: attention-based analysis and external knowledge integration. First, we train the model within sentiment classification and generation tasks to capture attention scores from multiple perspectives. This multi-angle approach reduces bias and provides a more comprehensive understanding of the underlying sentiment. Second, we incorporate an external knowledge base to improve evidence extraction. By leveraging character scores, we retrieve complete sentiment evidence phrases, addressing the challenge of incomplete evidence extraction in Chinese texts. Experimental results on a sentiment interpretability evaluation dataset demonstrate the effectiveness of our method. We observe a notable increase in accuracy by 1.3%, Macro-F1 by 13%, and MAP by 23%. Overall, our approach offers a robust solution for enhancing the interpretability of sentiment models by combining attention-based analysis and the integration of external knowledge.

Assessing the completeness of patient-reported outcomes reporting in congestive heart failure clinical trials.

We aim to evaluate the quality of patient-reported outcomes included in randomized control trials for the treatment of congestive heart failure using the International Society for Quality of Life Research (ISOQOL) checklist, a validated tool for critically appraising the quality of patient-reported outcomes. We performed a cross-sectional analysis of 65 randomized control trials with patient-reported outcomes for drug intervention trials for treating congestive heart failure. N/A. N/A. The primary outcome of this study was to evaluate the reporting completeness of patient-reported outcomes in congestive heart failure clinical trials with drug interventions according to the ISOQOL checklist. Our search returned 1114 studies, of which, 65 are included in the analysis. The average completion of the ISOQOL reporting standards was 44.51%. Higher completion of the ISOQOL patient-reported outcome standards was observed in the clinical trials with patient-reported outcomes as primary endpoints compared to the clinical trials with patient-reported outcomes as a secondary endpoint. The multivariable regression model showed that clinical trials with patient-reported outcomes as a primary endpoint had a 21.46% better completion percentage (t = 4.45, p ⩽ 0.001) when controlling for PRO recording duration and trial registration. Eight (8/65, 12.31%) of the clinical trials met the satisfaction criteria of completing two-thirds of the ISOQOL patient-reported outcomes reporting standards. All of these RCTs had a patient-reported outcome as a primary endpoint. Our analysis of the reporting of patient-reported outcomes in congestive heart failure clinical trials with drug interventions suggests that the quality of reporting is suboptimal. This evidence of substandard reporting of patient-reported outcomes is disconcerting as it reduces the transparency of randomized control trials, which are considered the foundation of evidenced-based medicine. Inadequate reporting may result in clinicians implementing misrepresented or incomplete evidence into clinical practice. Validated reporting tools, such as the ISOQOL, can be used by trialists and clinicians alike to improve and critically appraise the reporting of patient-reported outcomes in randomized control trials. N/A.

64 The Biomarker-Based Etiological Diagnosis of Neurocognitive Disorders: the European Inter-Societal Delphi Consensus

Objective:In the field of neurocognitive disorders, the perspective offered by new disease-modifying therapy increases the importance of etiological diagnosis. The prescription of cerebrospinal fluid analysis (CSF) and imaging biomarkers is a common practice in the clinic but is often driven more by personal expertise and local availability of diagnostic tools than by evidence of efficacy and cost-effectiveness analysis. This leads to a widely heterogeneous dementia care across Europe. Therefore, a European initiative is currently being conducted to establish a consensus for biomarker-based diagnosis of patients with mild cognitive impairment (MCI) and mild dementia.Participants and Methods:Since November 2020, a European multidisciplinary task force of 22 experts from 11 scientific societies have been defining a diagnostic workflow for the efficient use of biomarkers. The Delphi consensus procedure was used to bridge the gaps of incomplete scientific evidence on biomarker prioritization. The project has been in two phases. During Phase 1, we conducted a literature review on the accuracy of imaging, CSF, neurophysiological and blood biomarkers in predicting the clinical progression or in defining the underpinning aetiology of main neurocognitive disorders. Evidence was provided to support the panelists’ decisions. In phase 2, a modified Delphi procedure was implemented, and consensus was reached at a threshold of 70% agreement, or 50%+1 when a question required rediscussion.Results:In phase 1, 167 out of 2,200 screened papers provided validated measures of biomarker diagnostic accuracy compared with a gold standard or in predicting progression or conversion of MCI to the dementia stage (i.e., MRI, CSF, FDG-PET, DaT-imaging, amyloid-PET, tau-PET, and myocardial MIBG-scintigraphy and EEG). During phase 2, panelists agreed on the clinical workspace of the workflow, the stage of application, and the patient age window. The workflow is patient-centered and features three levels of assessment (W): W1 defines eleven clinical profiles based on integrated results of neuropsychology, MRI atrophy patterns, and blood tests; W2 describes the first-line biomarkers according to W1 versus clinical suspicion; and W3 suggests the second-line biomarkers when the results of first-line biomarkers are inconsistent with the diagnostic hypothesis, uninformative or inconclusive. CSF biomarkers are first-line in the suspect of Alzheimer’s disease (AD) and when inconsistent neuropsychological and MRI findings hinder a clear diagnostic hypothesis; dopamine SPECT/PET for those leading to suspect Lewy body spectrum. FDG-PET is first-line for the clinical profiles leading to suspect frontotemporal lobar degeneration and motor tauopathies and is followed by CSF biomarkers in the case of atypical metabolic patterns, when an underlying AD etiology is conceivable.Conclusions:The workflow will promote consistency in diagnosing neurocognitive disorders across countries and rational use of resources. The initiative has some limitations, mainly linked to the Delphi procedure (e.g., kickoff questions were driven by the moderators, answers are driven by the Delphi panel composition, a subtle phrasing of the questions may drive answers, and 70% threshold for convergence is conventional). However, the diagnostic workflow will be able to help clinicians achieve an early and sustainable etiological diagnosis and enable the use of disease-modifying drugs as soon as they become available.

Motor neurone disease: A point-prevalence study of patient reported symptom prevalence, severity and palliative care needs.

Motor neurone disease is a rare but debilitating illness with incomplete evidence regarding patients' symptom burden. Palliative care and generalist clinicians are often in-experienced in caring for these patients and assessing their needs. To identify the symptom prevalence and severity experienced by patients with motor neurone disease. Secondary objectives were to examine differences in symptom burden and clusters according to phenotype, functional status, palliative care provision and those in their last months of life. A point prevalence study assessing patient-reported symptoms using a modified IPOS-Neuro assessment tool, incorporating 41 symptom items. Patients with motor neurone disease attending the State-wide Progressive Neurological Disease Service or inpatient unit at Calvary Health Care Bethlehem, Melbourne Australia, from March to December 2021. A total of 102 patients participated, the majority diagnosed with lumber-onset (30.4%), bulbar-onset (28.4%) and cervical-onset (25.5%) phenotypes. Patients experienced a median of 17 symptoms (range 2-32) with a median of 3 symptoms rated as severe/overwhelming (range 0-13). Motor and functional symptoms predominated, with differences in symptom clusters present according to phenotype. Patients had a higher number of severe/overwhelming symptoms if they were accessing palliative care services (p = 0.005), in their last 6 months of life (p = 0.003) and experiencing moderate or severe functional impairment (p < 0.001). Patients with motor neurone disease report high symptom burden. A validated motor neurone disease-specific symptom assessment tool is needed to accurately assess patients, including important variations in symptom clusters according to phenotype. Further research must focus on evidence-based treatment guidelines for symptoms experienced commonly and severely.

Authentication of milk thistle commercial products using UHPLC-QTOF-ESI + MS metabolomics and DNA metabarcoding

BackgroundMilk thistle is one of the most popular hepatoprotectants, and is often sold in combination with other ingredients. Botanical supplements are known to be vulnerable to contamination and adulteration, and emerging technologies show promise to improve their quality control.MethodsUntargeted and semi-targeted metabolomics based on UHPLC-QTOF-ESI+MS techniques, UV spectrometry, and DNA metabarcoding using Illumina MiSeq were used to authenticate eighteen milk thistle botanical formulations (teas, capsules, tablets, emulsion).ResultsUntargeted metabolomics separated 217 molecules and by multivariate analysis the discrimination between the different preparations was established. The semi-targeted metabolomics focused on 63 phytochemicals, mainly silymarin flavonolignans and flavonoids, that may be considered as putative biomarkers of authenticity. All formulations contained molecules from silymarin complexes at different levels. The quantitative evaluation of silybins was done using in parallel UV spectrometry and UHPLC-QTOF-ESI+MS and their correlations were compared. DNA metabarcoding detected milk thistle in eleven out of sixteen retained preparations, whereas two others had incomplete evidence of milk thistle despite metabolomics validating specific metabolites, e.g., silymarin complex, identified and quantified in all samples. Meanwhile, the DNA metabarcoding provided insights into the total species composition allowing the interpretation of the results in a broad context.ConclusionOur study emphasizes that combining spectroscopic, chromatographic, and genetic techniques bring complementary information to guarantee the quality of the botanical formulations.

European Inter‐Societal Delphi Consensus for the biomarker‐based etiological diagnosis of neurocognitive disorders in the mild stage

AbstractBackgroundCSF and imaging biomarkers are needed for the etiological diagnosis of neurocognitive disorders, but evidence is incomplete on their rational use in the clinic. Since October 2020, a European task force has been defining an evidence‐based diagnostic workflow, where incomplete evidence is filled by the opinion of experts. Herein, we report the preliminary results through January 2022.MethodA Delphi method was used to reach consensus. Eleven pertinent European scientific societies delegated two panelists each to join Delphi rounds and voting. Consensus was set at 70% of consistent responses.ResultIn the 5 voting rounds completed so far, panelists defined clinical setting (specialist outpatient service) and stage of application (prodromal and mild dementia) of the workflow, patients’ age window of biomarkers use (strongly encouraged below 70 years and of limited usefulness over 85). Workflow is configurated to be patient‐centered and structured on three levels of assessment (W): W1, definition of clinical profiles based on the combined results of MRI, neuropsychology, blood tests; W2, choice of first‐line biomarkers according to the main clinical suspicion (i.e., FDG‐PET for frontotemporal lobar degeneration and motor tauopathies, dopamine SPECT/PET for Lewy body spectrum disorders, and CSF biomarkers either for Alzheimer’s disease or in cases with inconclusive neuropsychological and/or MRI findings, whereas no biomarker was indicated in suspected vascular cognitive impairment); W3, selection of a second‐line biomarker when results of first‐line biomarkers are inconsistent with diagnostic hypothesis (i.e., not typical FDG‐PET pattern) or uninformative (i.e., borderline CSF amyloid results) or not sufficient to rule out other etiologies (i.e., amyloid‐positive and tau‐negative CSF results) or when a diagnosis remains possible despite a negative first‐line biomarker (e.g., normal dopamine SPECT/PET in suspected prodromal dementia with Lewy bodies).ConclusionThe task force is currently defining the second‐line biomarkers of W3 and the project it set to deliver the final algorithm by June 2022. The workflow will promote consistency in diagnosing neurocognitive disorders across countries, and rational use of resources. The initiative has an impact in preparing clinicians to work in the upcoming clinical space where etiological disease‐modifying drugs are expected to be available.

Nutzenbewertung von Diagnostik – Umgang mit unvollständiger Evidenz

Incomplete evidence in diagnostic studies results from missing or too few randomised test-treatment studies or from studies of too low quality. In order to be able to carry out a benefit assessment, it is helpful in the first step to design a hypothetical randomised test-treatment study. In the second step, the linked evidence approach can be used to link the evidence of the individual components of the test-treatment pathway and to assess the potential benefits and risks. In the third step, based on the linked evidence approach, decision analytic models can be used to quantify the benefit-risk ratio. In the case of incomplete evidence, the assessment can thus be made by linking the individual components of the test-treatment pathway, provided that their evidence is sufficient.

Multi-agent multi-criteria decision framework with interactive explanation tools

In this paper, we present the formalization and implementation of a decision framework in which a group of agents can express their preferences among a set of alternatives by using several comparison criteria. We define special kind of argument to support agents’ preferences, and the set of generated arguments is used both to obtain the set of selected alternatives and to explain why they were selected. We introduce a software application that implements our proposed approach and provides interactive tools for obtaining different kinds of explanations for the computed results. Also, we formally study the proposed argumentation process and we prove that the set of warranted conclusions, which support the obtained results, is consistent. We also show that our framework works properly on choice scenarios with incomplete evidence, and we propose how to optimize the computation process for dynamic environments.

The history of global strain and geodynamics on Mars

The tectonic record of Mars is dominated by compressional wrinkle ridges on volcanic surfaces, and these structures have been widely used as a record of tectonic and geodynamic evolution. This study analyzes the density of compressional tectonic structures and inferred strain as functions of time, using the lengths and heights of compressional ridges together with geologic estimates of surface age. Our analyses confirm an apparent peak in compressional strain in the late Noachian and early Hesperian, and comparatively lower values before and after. The lower tectonic strain in the early and middle Noachian relative to the early Hesperian reflects the incompleteness of the ancient compressional tectonic record of strain, as older surfaces should accumulate more strain than younger surfaces. This strain deficit necessitates other means of accommodating contractional strain in the ancient crust, including distributed strain and small-scale faulting. The abrupt decrease in the accumulated tectonic strain and strain rate after the early Hesperian reflects a rapid episode of global contraction followed by much lower rates, in conflict with models of steady-state mantle evolution. The decreasing strain rate may be explained by a changing mantle rheology due to volcanic outgassing. Alternatively, the strain history may be explained by the dominance of mantle plumes in the late Noachian and early Hesperian associated with the formation of Tharsis and the early Hesperian volcanic provinces, which could have led to a pulse of rapid contraction caused by disequilibrium cooling and volcanic outpourings. The tectonic record of strain on Mars – including the incomplete ancient record and evidence for strong departures from steady-state models – may have implications for the interpretation of the tectonic record and thermal evolution of other bodies as well.

Kinetics and pulses of zircon growth in migmatites beneath a volcanic arc: An example from the high‐T Ryoke Complex, southwest Japan

AbstractWe present an analysis of kinetics and pulses of zircon growth in migmatites formed at middle to lower crustal depths beneath a volcanic arc. Migmatites in high‐T metamorphic complexes at active continental margins, such as in the Ryoke Complex of southwest Japan, are thought to have been produced beneath volcanic arcs. Thermal models suggest that melt advection supplies the heat to form such high‐T complexes. We found that zircons in the migmatites of the Ryoke Complex grew in multiple discrete stages by rapid diffusion‐controlled growth. The individual growth pulses can be distinguished using a Gaussian mixture model when the duration of each growth pulse is shorter than 1σ of the analytical error of the zircon age dating, and where the interval between each growth pulse is larger than 2σ of them. This method allows extraction of the growth pulses even when the zircon exhibits incomplete textural evidence for multiple stages of growth. Application of the method to the Ryoke Complex revealed three and four pulses of zircon growth with 3–10 Myr intervals for two migmatite samples respectively in the Mikawa area and three pulses with 2–4 Myr intervals from one migmatite sample in the Yanai area. The detected zircon growth pulses are consistent with previously reported pulses of plutonic activity in the two areas, with the exception of the oldest growth pulse in the Mikawa area. Therefore, the growth pulses are interpreted to be the result of thermal pulses because of melt flux events at lower to middle crustal levels. The inferred intervals of pulsed melt fluxes are similar to those of individual caldera formation in coeval caldera clusters at the surface.

Using Belief Function Theory to Assist Pavement Maintenance and Rehabilitation Activities

Abstract Several information technology approaches have been applied to life cycle analyses to improve decision-making performance and prolong infrastructure life spans. Belief function theory (BFT), also known as the Dempster-Shafer theory of evidence, is a method of representing uncertain, incomplete, and imprecise evidence of a system’s knowledge base. BFT has rarely been applied to pavement management until now. For pavement management decision-making, pavement engineers must formulate relationships between various objectives, incorporate subjective judgment, and pool evidence from various sources. These issues are not adequately addressed in the existing analytical tools used in pavement management. This paper conducts a study of pavement maintenance and rehabilitation (M&amp;R) activities using BFT. Questionnaires are carried out to establish an evidential tree, which is used to quantify the level of uncertainty associated with M&amp;R activities. With respect to the given evidence in the case study, the belief interval of (0.222, 0.778) with uncertainty for the M&amp;R activities can be obtained by using Dempster’s rule of combination. BFT provides a more rigorous but straightforward approach to assisting pavement engineers with M&amp;R decision-making.

Remembering St. Louis Individual—structural violence and acute bacterial infections in a historical anatomical collection

Incomplete documentary evidence, variable biomolecular preservation, and limited skeletal responses have hindered assessment of acute infections in the past. This study was initially developed to explore the diagnostic potential of dental calculus to identify infectious diseases, however, the breadth and depth of information gained from a particular individual, St. Louis Individual (St.LI), enabled an individualized assessment and demanded broader disciplinary introspection of ethical research conduct. Here, we document the embodiment of structural violence in a 23-year-old Black and/or African American male, who died of lobar pneumonia in 1930s St. Louis, Missouri. St.LI exhibits evidence of systemic poor health, including chronic oral infections and a probable tuberculosis infection. Metagenomic sequencing of dental calculus recovered three pre-antibiotic era pathogen genomes, which likely contributed to the lobar pneumonia cause of death (CoD): Klebsiella pneumoniae (13.8X); Acinetobacter nosocomialis (28.4X); and Acinetobacter junii (30.1X). Ante- and perimortem evidence of St.LI’s lived experiences chronicle the poverty, systemic racism, and race-based structural violence experienced by marginalized communities in St. Louis, which contributed to St.LI’s poor health, CoD, anatomization, and inclusion in the Robert J. Terry Anatomical Collection. These same embodied inequalities continue to manifest as health disparities affecting many contemporary communities in the United States.

Migraine and pregnancy

Background. Migraine is a frequent neurological disorder affecting mostly women in the childbearing age. It is influenced by fluctuation of female hormones, especially estrogen levels. Objectives. This review aims to describe the expression of migraine during the reproductive ages summarizing the diagnosis and effective, available treatment options. Materials and Methods. We performed a literature review searching relevant information on the subject in PubMed and Medscape databases. Outcomes. It reveals that during the first trimester due to symptoms of hyperemesis gravidarum, migraine attacks can exacerbate, while, through second and third trimester when estrogen levels rise, women report relief of symptoms. Therapy includes firstly behavioural approach and secondly pharmacological drugs along with non-invasive procedures, some still under investigation for pregnant state. For mild cases the first line is acetaminophen alone or together with antiemetics and in more severe cases or in women with past history of migraine triptans can used as the mainstay therapy. Conclusions. Despite recent discoveries on therapy and drugs, our understanding of the way medications may affect the fetus or new-born is incomplete and further evidence is needed, bringing potential for improved management of migraine during pregnancy.