Lower Proportion Research Articles

Effect of traditional therapeutics on prevalence and clinical outcomes of coronavirus disease 2019 in Chinese patients with autoimmune diseases

The impact of the Coronavirus disease 2019 (COVID-19) pandemic on autoimmune diseases (AID) patients has been an important focus. This study was undertaken to characterize the incidence, clinical manifestations and hospitalization among AID affected by COVID-19 and to analyze the association between immunomodulatory medication and these outcomes. Clinical, demographic, maintenance treatment, symptoms and disease course data and outcomes of AID patients with COVID-19 infection were assessed via an online survey tool and printed copy from 1 January till February 28, 2023. A total of 432 patients with AID were enrolled in the study. The results showed the most common conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was hydroxychloroquine (HCQ). The usage of csDMARDs didn't increase the risk of COVID-19 infection. Patients who warranted hospitalization were significantly older. ILD was associated with higher hospitalization rate. No csDMARDs other than calcineurin inhibitor (CNI) was associated with increased risk of hospitalization. HCQ intake was associated with cough. Compared with no glucocorticoids (GCs) group, high doses of GCs were accompanied with higher proportion of gastrointestinal symptoms and tachycardia, lower proportion of sore throat and ageusia. GCs didn't provoke the COVID‐19 infection in patients with AID, but chronic use of oral GCs was significantly more common in those requiring hospitalization, and higher dose of GCs were correlated with higher risk of hospitalization. 97 patients discontinued csDMARDs after infection, which resulted in an elevated risk of hospitalization. Meanwhile, withdrawal of csDMARDs was associated with higher odds of disease flare and lower proportion of remission than maintenance groups. Collectively, our analysis provides the evidence that maintenance treatment of csDMARDs may be more prudent for AID patients during COVID-19 pandemic.

Improved drinking water planning challenges in Urban Households’ in Bamenda city, Cameroon

Access to improved drinking water remains a fundamental need and a basic human right vital for the dignity and health of all people. There is an urgent need to increase access to improved drinking water in urban households in Bamenda city where a low proportion currently appears to be having access. There also exist marked disparity in access amongst the different Sub-divisions which is still to be scientifically investigated. This study sets out to investigate the improved drinking water planning challenges in urban households in Bamenda, Cameroon. The study used systematic field observation, household surveys and administration of 520 copies of questionnaire to urban household heads as primary sources of data collection. The administration of the 520 copies of questionnaire was carried out using purposive and simple random sampling techniques within Bamenda I, II and III Sub-Divisions. Primary data were matched with secondary source information obtained from WHO, UNICEF, UN, CDC, UNDP, PAHO and The University of Bamenda Central Library. Findings revealed that standpipes (41.3%), protected dug well (51.9%), piped water connected to households (54.8%), boreholes (61.9%), rain water collection (63.3%) and spring water harnessed to households (38.6%) constitutes the main urban households improved drinking water sources. Also, natural factors (33.67%) and planning-related challenges (63.33%) work together to limit access to improved drinking water to households. Field observation and measurements revealed that less than 5 urban households share a common water source, while other 42.88% cover <50m to get to the nearest improved drinking water source point. The study highlights that improved drinking water in Bamenda city is currently a limited and non-basic service. The study recommends the expansion of improved drinking water infrastructure by the relevant stakeholders, systematic data collection on factors affecting access to improved drinking water by urban households for better decision making, seek ways to increase accessibility of improved drinking water by the government via MINEE and MINDUH and finally, households should build water towers to store water for continuous use.

Marine Fungal Diversity and Dynamics in the Gulf of Trieste (Northern Adriatic Sea)

Fungi contribute to different important ecological processes, including decomposition of organic matter and nutrient cycling, but in the marine environment the main factors influencing their diversity and dynamics at the spatial and temporal levels are still largely unclear. In this study, we performed DNA metabarcoding on seawater sampled monthly over a year and a half in the Gulf of Trieste (northern Adriatic Sea), targeting the internal transcribed spacer (ITS) and the 18S rRNA gene regions. The fungal communities were diverse, very dynamic, and belonged predominantly to marine taxa. Samples could be clustered in two groups, mainly based on the high (> 30%) or low relative proportion of the ascomycetes Parengyodontium album, which emerged as a key taxon in this area. Dissolved and particulate organic C:N ratio played important roles in shaping the mycoplankton assemblages, suggesting that differently bioavailable organic matter pools may be utilized by different consortia. The proportion of fungal over total reads was 31% for ITS and 0.7% for 18S. ITS had the highest taxonomic resolution but low power to detect early divergent fungal lineages. Our results on composition, distribution, and environmental drivers extended our knowledge of the structure and function of the mycobiome of coastal waters.

Food Web Structure and Ecosystem Functions of the Water Source in the Middle Route of China’s South-to-North Water Diversion Project

The Danjiangkou Reservoir is the water source of the middle route of China’s South-to-North Water Diversion Project, encompassing the Dan Reservoir and Han Reservoir. However, little is known about the ecological functions of this important ecosystem. Based on a survey conducted in 2023 in the Dan Reservoir, a mass balance model was constructed using Ecopath with Ecosim 6.6 software to characterize its food web structure and ecosystem properties. The model consisted of 18 functional groups, including producers, consumers, and detritus, covering the entire process of energy flow in the ecosystem. The outputs indicated that the fractional trophic level of functional groups in the Dan Reservoir ecosystem ranged from 1.00 to 3.50. The ecotrophic efficiencies of the main economic fish species were all less than 0.9, and the ecotrophic efficiencies of phytoplankton and detritus were less than 0.5. There were two main food chains: the detritus food chain (39%) and the grazing food chain (61%). The total energy transfer efficiency between trophic levels was only 6.02%, and there was a significant phenomenon of energy transfer blockage between trophic levels II and V. Analysis of the overall characteristics of the ecosystem revealed that the total primary production to total biomass (67.96619), connectance index (0.274), and Finn’s cycling index (2.856) of the Dan Reservoir ecosystem all indicate that the ecosystem is immature, with low nutrient recycling efficiency and poor resistance to external disturbances. This may be related to the low proportion of silver carp and bighead carp in the reservoir and the unreasonable structure of the fish community. Our results suggest that it is necessary to scientifically adjust the structure of the fish community, enhance the proportion of filter-feeding and omnivorous fish to improve the energy flow efficiency, and promote the maturity and stability of the Dan Reservoir.

Determinants for Mediterranean diet adherence beyond the boundaries: a cross-sectional study from Sharjah, the United Arab Emirates

BackgroundSubstantial evidence embraced the nutrition competence of the Mediterranean diet (MD) as a healthy model for decreasing the risk of chronic diseases and increasing longevity, with the bonus of ensuring environmental sustainability. Measuring adherence to this diet is marginally investigated in the Arabian Gulf region, an area away from the Mediterranean region. The current study aimed to assess the MD adherence among adults in Sharjah/the United Arab Emirates (UAE), and to identify the most influential predictors for MD adherence among the study participants.MethodsA cross-sectional study design was employed using a self-reported, web-based electronic questionnaire that questioned sociodemographics, lifestyle factors, and familiarity with the MD. The MD adherence was assessed by the Mediterranean Diet Adherence Screener validated questionnaire. The adherence level was classified as low for a total score of [0–5], medium [score 6–7], and high (8–13).ResultsThe study included 1314 participants (age 25–52 years) comprised 822 (62.6%) females and 492 (37.4%) males. There was a moderate adherence score (5.9 ± 1.9) among the study participants. The food constituent expressed the lowest contribution to the MD was fish (9.3%), followed by fruits (12.3%), and legumes (18.3%). The multivariable linear regression analysis showed an overall significant linear trend for the association between the MD adherence score and physical activity, while nutrition information from dietitians and social media were the most two strongly related predictors for the higher adherence (β = 0.747; 95% CI 0.51–0.98, and β 0.60; 95% CI 0.269–0.93; p < 0.001, respectively). On the other side, being a smoker and from a non-Mediterranean country was associated with lower adherence scores (β = 0.538; 95% CI 0.252–0.82, p < 0.001).ConclusionThe findings of the current study showed a moderate adherence, low proportion for high adherence, and a gap in the familiarity with the diet name. Being married, physically active, non-smoker, and getting nutrition information from dietitians and social media were the strongest predictors for higher adherence. It is warranted that public health and nutrition specialists/dietitians to tailor new modern approaches for promoting healthy dietary behaviours consistent with the MD.

Characterization of Mixtures of Rugulopteryx okamurae Compost and Plant Residues to Determine the Most Effective Composition as a Substrate and Source of Nutrients

The increasing invasion of Rugulopteryx okamurae algae along the coast of southeastern Spain has prompted efforts to explore its potential as a resource. Consequently, composting this alga is considered a viable solution for agricultural applications. This study investigates the composting process of mixtures of R. okamurae seaweed with plant residues and characterizes the final compost for its use as a substrate and/or source of nutrients to determine the most effective composition of the mixture. The composting process was conducted using varying proportions of seaweed (100%, 30–35%, and 15%) combined with plant residues (from vegetable plants, fruits, and gardens) and included both washed and unwashed seaweed. The first trials revealed challenges associated with Rugulopteryx okamurae, such as a low C/N ratio and algae washing. Consequently, a second trial was conducted to optimize the mixtures, aiming for a C/N ratio close to 30. Additionally, it was decided not to wash the algae to reduce the electrical conductivity (EC) in the mixtures. The findings indicate that the composting process remains unaffected by high electrical conductivity when algae are unwashed. However, washing the algae before composting did affect the compost quality, as the composts with washed algae with garden waste (SwP 34.0 dS m−1) had a lower electrical conductivity (EC) than did the unwashed composts with garden waste (SP 51.6 dS m−1 and SFP 64.9 dS m−1). On the other hand, the compost-only horticultural and garden waste (FHP 43.7 dS m−1) had a high EC; therefore, the EC was not increased with low proportions of unwashed algae, as was seen with the compost with 15% unwashed algae (SFHP 47.6 dS m−1). The other quality parameters were not affected by the absence of algae washing at the beginning of the composting process.

Dental service utilization in the general adult population in Bangladesh.

With the help of a national community-based survey, the analysis aimed to estimate the number of adults in Bangladesh who used dental services (DSU). The 8185 participants (18-69 years old) in the Bangladesh cross-sectional STEPS survey in 2018 provided national data for analysis. Predisposing, enabling, and need factors for DSU were included in the interview data, physical examinations, and biochemical analyses. To estimate the DSU (last 12 months) predictors, Poisson regression was employed. Seven out of 10 participants (71.0%) had never DSU, 13.2% within the past 12 months, and 15.9% more than 12 months ago. In terms of predisposing factors, the final model showed a negative relationship between past 12-month DSU and living in the northern region (adjusted prevalence ratio-APR: 0.75, 95% CI: 0.59, 0.96). The enabling factors of living in an urban area (APR: 1.19, 95% CI: 1.01, 1.41) and seeing a doctor or other healthcare provider within the previous year (APR: 1.37, 95% CI: 1.08, 1.74) were positively correlated with DSU. In terms of need factors, dental pain (APR: 15.37, 95% CI: 9.68, 24.40), multimorbidity (APR: 1.26, 95% CI: 1.02, 1.55), oral health impact (OHI) speech problem (APR: 1.35, 95% CI: 1.13, 1.63), and OHI felt tense (APR: 1.34, 95% CI: 1.10, 1.64) were positively associated with DSU. A low proportion of participants had DSU in the past 12 months and several associated factors were identified.

Clinical management of iron deficiency anemia in Japan: iron prescription patterns, treatment effectiveness, and assessments.

Iron deficiency anemia is one of the most common types of anemia, but real-world clinical management practices in Japan are unclear. This study retrospectively explored iron prescription patterns, treatment effectiveness, and assessments. Patients with at least one treatment period between September 2020 and September 2022 were included and classified into three groups (ferric carboxymaltose [FCM]: 7437 patients, saccharated ferric oxide [SFO]: 98,648 patients, and oral iron: 359,547 patients). Iron-related laboratory values over time and testing proportions were evaluated. Median baseline hemoglobin levels were lowest with FCM (FCM: 8.10g/dL, SFO: 8.70g/dL, oral iron: 9.70g/dL), but changes in hemoglobin levels by 12weeks were greatest with FCM (FCM: 3.20g/dL, SFO: 2.60g/dL, oral iron: 1.70g/dL). The median serum ferritin level at 8weeks after FCM treatment was 43.70ng/mL for ≤500mg, versus 123.30ng/mL for >500 to ≤1500mg. All groups had a low proportion of serum ferritin and transferrin saturation (TSAT) testing at diagnosis (<38%), which decreased further for post-treatment assessment (<24%). This study suggests the importance of prescribing an appropriate total iron cumulative dose per the package insert, along with diagnosis and assessments based on serum ferritin/TSAT.

Learning Through Practice: On How Kemyt Contributed to Crafting and Transmitting Scribal Knowledge

Summary This paper is conceived as a first step towards the Kemyt (re)contextualization. By exploring the specific layout and paratext of Kemyt, it intends to shed light on the scribes who wrote the many partial copies of this letter-like composition and in which circumstances. I first address the layout, the ink choices, and the writing orientation. I then turn my attention to the text structure: dividers, ending marks, as well as colophons, dedications, and underwriting. The dated ostraca and their frequent identification as school exercises are discussed before moving on to the textual revision practices and looking for an explanation to the low proportion of corrected texts despite faulty content. All this enabled me to highlight a set of scribal practices, in which scribes draw, some being proper to the Kemyt, some being common to the rest of the text production. These practices revealed a complex network, from beginning students to senior scribes, through assistant scribes and early career scribes, which contributed to the crafting and the transmission of scribal knowledge during the New Kingdom.

#1244 Rates of eGFR and UACR testing in patients with chronic kidney disease in England: Clinical Practice Research Datalink 2010-2019

Abstract Background and Aims The NICE chronic kidney disease (CKD) treatment guidelines recommend regular laboratory measurements of both kidney function (eGFR) and damage (proteinuria) to appropriately inform efforts to prevent and treat progression of CKD. Recommendations also indicate frequency of such testing should increase with CKD progression. There are few data on rates of testing in patients with confirmed CKD with particularly paucity in patients with various stages of CKD. Method This non-interventional, observational study utilised data from primary care electronic health records from Clinical Practice Research Datalink (CPRD) AURUM. Patients aged ≥18 years with CKD registered in CPRD with at least one year of follow-up (FU) between January 1, 2010 and December 31, 2019 were identified. CKD was defined by an eGFR &amp;lt;60 ml/min/1.73 m2 and/or presence of a uACR measurement ≥3 mg/mmol, both confirmed by a second measurement 90-365 days later (index). Patients with eGFR &amp;lt;9 ml/min/1.73 m2 at index were excluded. Frequency of renal testing (eGFR and UACR) for each complete year of FU was quantified starting the day after index and patients were censored the last day of the final complete calendar year of FU after index. Frequency of renal testing per FU year was calculated overall and by CKD stage and level of albuminuria at index. Results In the 650 565 patients with CKD identified, mean age (SD) was 76.1 (11.3) years, 55.4% were female, and 88.5% White. Most (62.0%) patients had stage 3a CKD (eGFR 45-&amp;lt;59 ml/min/1.73 m2) at index. Among patients with UACR measurements within 1 year prior to index (54.1%), 49.3% were A1 (&amp;lt;3 mg/mmol), 43.4% A2 (3-30 mg/mmol) and 7.3% A3 (&amp;gt;30 mg/mmol) at index. During the first year of FU, 81.45% of patients had 1+ eGFR test whereas 39.2% had 1+ UACR test. Patients more frequently received 1+ eGFR per year over subsequent years of FU but the low proportion with 1+ UACR test per year remained stable for UACR. The mean (SD) number of eGFR and UACR tests performed per patient in the first year of FU was 2.09 (2.39) and 0.49 (0.70), respectively. More frequent eGFR testing was observed with lower eGFR at index and across subsequent years of FU. Frequency of UACR testing was lower at more advanced stages of CKD at index in all FU years, however, no trends in UACR testing frequency were observed by level of albuminuria at index. Conclusion This evidence from a population-based sample of patients with confirmed CKD in England, indicates that eGFR is being monitored in the majority of patients, yet UACR testing is suboptimal according to NICE guidelines regardless of level of kidney function or level of albuminuria. Although eGFR testing is more frequent at more advanced stages of CKD, UACR testing seems to become less frequent with more advanced stages of CKD. With emergence of new therapies to prevent progression of CKD, efforts to increase frequency of UACR testing are needed (particularly in earlier CKD stages) to ensure that patients who are at risk of worsening CKD and albuminuria receive appropriate management.

Examining facilitative services for entry into substance use disorder treatment: A cluster analysis of treatment facilities.

We examined services to facilitate access to entering substance use disorder (SUD) treatment among a national sample of SUD treatment facilities. We analyzed data from the National Survey of Substance Abuse Treatment Services (N-SSATS) 2020. Facilities were included in the sample based on criteria such as SUD treatment provision and being in the U.S. Cluster analysis was conducted using variables including ownership, levels of care, and whether facilities provide services or accept payment options aimed at reducing treatment barriers. National and state-level data on the percentage of facilities in each cluster were presented. Among N = 15,788 SUD treatment facilities four distinct clusters were identified: Cluster 1 consisted of for-profit and government outpatient facilities with high proportions of services to reduce barriers (22.2%). Cluster 2, comprised of non-profit outpatient facilities, offered the most comprehensive array of services to minimize barriers to treatment among all four clusters (25.2%). Cluster 3 included facilities with diverse ownership and care levels and provided a moderate to high degree of services aimed at reducing entry barriers to treatment (26.0%). Cluster 4 was primarily for-profit outpatient facilities with a low proportion of these services (26.6%). This study revealed facility-level groupings with different services to reduce barriers to SUD treatment across various clusters of SUD treatment facilities. While some facilities offered extensive services, others provided fewer. Differences in cluster distributions point to possible facilitators to treatment access for some persons seeking admission to specific treatment facilities. Efforts should be made to ensure that individuals seeking SUD treatment can access these services, and facilities should be adequately equipped to meet their diverse needs.

Measuring multi-year changes in the Symbiodiniaceae algae in Caribbean corals on coral-depleted reefs

Monitoring coral cover can describe the ecology of reef degradation, but rarely can it reveal the proximal mechanisms of change, or achieve its full potential in informing conservation actions. Describing temporal variation in Symbiodiniaceae within corals can help address these limitations, but this is rarely a research priority. Here, we augmented an ecological time series of the coral reefs of St. John, US Virgin Islands, by describing the genetic complement of symbiotic algae in common corals. Seventy-five corals from nine species were marked and sampled in 2017. Of these colonies, 41% were sampled in 2018, and 72% in 2019; 28% could not be found and were assumed to have died. Symbiodiniaceae ITS2 sequencing identified 525 distinct sequences (comprising 42 ITS2 type profiles), and symbiont diversity differed among host species and individuals, but was in most cases preserved within hosts over 3 yrs that were marked by physical disturbances from major hurricanes (2017) and the regional onset of stony coral tissue loss disease (2019). While changes in symbiont communities were slight and stochastic over time within colonies, variation in the dominant symbionts among colonies was observed for all host species. Together, these results indicate that declining host abundances could lead to the loss of rare algal lineages that are found in a low proportion of few coral colonies left on many reefs, especially if coral declines are symbiont-specific. These findings highlight the importance of identifying Symbiodiniaceae as part of a time series of coral communities to support holistic conservation planning. Repeated sampling of tagged corals is unlikely to be viable for this purpose, because many Caribbean corals are dying before they can be sampled multiple times. Instead, random sampling of large numbers of corals may be more effective in capturing the diversity and temporal dynamics of Symbiodiniaceae metacommunities in reef corals.

Corporate Social Responsibility and Stock Price Reactions

This research aims to investigate the impact of CSR disclosure on share prices, mediated by profitability. This research uses a quantitative method and gathering secondary data from OSIRIS and Company Sustainability Reports on the Indonesia Stock Exchange (BEI) website, as well as relevant company websites. This study's sample consists of 99 mining companies from 2018 to 2022. To determine the indirect effect of the mediating variable, this study used multiple regression analysis using the IBM SPSS and the Sobel test. The findings show that CSR Disclosure has no significant effect on share prices due to the low proportion of CSR disclosures in the company's sustainability report. Meanwhile, CSR Disclosure has a significant negative effect on profitability, and profitability has a significant positive effect on share prices. Profitability can mediate the relationship between CSR Disclosure and share prices.

Racial and Ethnic Concordance Between the Patient and Anesthesia Team and Patients' Satisfaction With Pain Management During Cesarean Delivery.

Racial and ethnic concordance between patients and health care providers increases patient satisfaction but has not been examined in obstetric anesthesia care. This study evaluated the association between racial and ethnic concordance and satisfaction with management of pain during cesarean delivery (PDCD). This was a secondary analysis on a cohort of patients undergoing cesarean deliveries under neuraxial anesthesia that examined PDCD. The outcome was satisfaction, recorded within 48 hours after delivery using the survey question, "Overall, how satisfied are you with the anesthesia care during the C-section as it relates to pain management?" Using a 5-point Likert scale, satisfaction was defined with the answer "very satisfied." Participants were also asked, "If you have another C-section, would you want the same anesthesia team?" The exposure was racial and ethnic concordance between the patient and anesthesia team members (attending with a resident, nurse anesthetist, or fellow) categorized into full concordance, partial concordance, discordance, and missing. Risk factors for satisfaction were identified using a multivariable analysis. Among 403 participants, 305 (78.2%; 95% confidence interval [CI], 73.8-82.1) were "very satisfied," and 358 of 399 (89.7%; 95% CI, 86.3-92.5) "would want the same anesthesia team." Full concordance occurred in 18 (4.5%) cases, partial concordance in 117 (29.0%), discordance in 175 (43.4%), and missing in 93 (23.1%). Satisfaction rate was 88.9% for full concordance, 71.8% for partial concordance, 81.1% for discordance, and 78.5% for missing (P value = .202). In the multivariable analysis, there was insufficient evidence for an association of concordance with satisfaction. Compared to full concordance, partial concordance was associated with a nonsignificant 57% (95% CI, -113 to 91) decrease in the odds of being satisfied, discordance with a 29% (95% CI, -251 to 85) decrease, and missing with a 39% (95% CI, -210 to 88) decrease. Risk factors for not being "very satisfied" were PDCD, anxiety disorders, pregnancy resulting from in vitro fertilization, intravenous medication administration, intrapartum cesarean with extension of labor epidural, having 3 anesthesia team members (instead of 2), and a higher intraoperative blood loss. Our inability to identify an association between concordance and satisfaction is likely due to the high satisfaction rate in our cohort (78.2%), combined with low proportion of full concordance (4.5%). Addressing elements such as PDCD, anxiety, intravenous medication administration, and use of epidural anesthesia for cesarean delivery, and a better understanding of the interplay between concordance and satisfaction are warranted.

Profiling of Early Immune Responses to Vaccination Using THP-1-Derived Dendritic Cells.

The COVID-19 pandemic has made assessing vaccine efficacy more challenging. Besides neutralizing antibody assays, systems vaccinology studies use omics technology to reveal immune response mechanisms and identify gene signatures in human peripheral blood mononuclear cells (PBMCs). However, due to their low proportion in PBMCs, profiling the immune response signatures of dendritic cells (DCs) is difficult. Here, we develop a predictive model for evaluating early immune responses in dendritic cells. We establish a THP-1-derived dendritic cell (TDDC) model and stimulate their maturation in vitro with an optimal dose of attenuated yellow fever 17D (YF-17D). Transcriptomic analysis reveals that type I interferon (IFN-I)-induced immunity plays a key role in dendritic cells. IFN-I regulatory biomarkers (IRF7, SIGLEC1) and IFN-I-inducible biomarkers (IFI27, IFI44, IFIT1, IFIT3, ISG15, MX1, OAS2, OAS3) are identified and validated in vitro and in vivo. Furthermore, we apply this TDDC approach to various types of vaccines, providing novel insights into their early immune response signatures and their heterogeneity in vaccine recipients. Our findings suggest that a standardizable TDDC model is a promising predictive approach to assessing early immunity in DCs. Further research into vaccine efficacy assessment approaches on various types of immune cells could lead to a systemic regimen for vaccine development in the future.

Effects of harvest date and additives on maize silage quality under boreal conditions

There is increasing interest in Finland to cultivate maize for silage, although the climatic conditions are in the borderline for maize due to the short and cool growing season. This may result in an immature crop that differs from typical maize for ensiling by having low dry matter (DM) and starch concentrations. We evaluated the preservation characteristics of forage maize during 2019 and 2020 harvested in Helsinki, Finland, at two stages of maturity. The DM concentration of the crops ranged from 230 to 360 g kg-1, and starch concentration from 179 to 283 g kg-1 DM. The crops were ensiled in laboratory scale using four different chemical organic acid based additives or a heterofermentative lactic acid bacteria inoculant. A control silage without additive treatment was also included. All silages were well fermented with low pH (average 3.75) and proportion of ammonia N in total N (average 47 g kg-1). Formic acid based additives restricted silage fermentation and most chemical additives improved the aerobic stability of maize silages compared to the control and inoculant treated silages that, under the conditions of the current study, did not differ from each other.

European Stroke Organisation (ESO) and European Society for Minimally Invasive Neurological Therapy (ESMINT) Guideline on Acute Management of Basilar Artery Occlusion.

The aim of the present European Stroke Organisation (ESO) guideline is to provide evidence-based recommendations on the acute management of patients with basilar artery occlusion (BAO). These guidelines were prepared following the Standard Operational Procedure of the ESO and according to the GRADE methodology.Although BAO accounts for only 1-2% of all strokes, it has very poor natural outcome. We identified 10 relevant clinical situations and formulated the corresponding Population Intervention Comparator Outcomes (PICO) questions, based on which a systematic literature search and review was performed. The working group consisted of 10 voting members (five representing ESO and five ESMINT) and three non-voting junior members. The certainty of evidence was generally very low. In many PICOs, available data were scarce or lacking, hence, we provided expert consensus statements.First, we compared intravenous thrombolysis (IVT) to no IVT, but specific BAO-related data do not exist. Yet, historically, IVT was standard of care for BAO patients who were also included (albeit in small numbers) in IVT trials. Non-randomised studies of IVT-only cohorts showed high proportion of favourable outcomes. Expert Consensus suggests using IVT up to 24 hours unless otherwise contraindicated. We further suggest IVT plus endovascular treatment (EVT) over direct EVT. EVT on top of best medical treatment (BMT) was compared to BMT alone within 6 and 6-24 hours from last seen well. In both time windows, we observed a different effect of treatment depending on a) the region where the patients were treated (Europe vs. Asia), b) on the proportion of IVT in the BMT arm, and c) on the initial stroke severity. In case of high proportion of IVT in the BMT group and in patients with NIHSS below 10, EVT plus BMT was not found better than BMT alone. Based on very low certainty of evidence, we suggest EVT+BMT over BMT alone (this is based on results of patients with at least 10 NIHSS points and a low proportion of IVT in BMT). For patients with an NIHSS below 10, we found no evidence to recommend EVT over BMT. In fact, BMT was non-significantly better and safer than EVT. Furthermore, we found a stronger treatment effect of EVT+BMT over BMT alone in proximal and middle locations of BAO compared to distal location. While recommendations for patients without extensive early ischaemic changes in the posterior fossa can, in general, follow those of other PICOs, we formulated an Expert Consensus Statement suggesting against reperfusion therapy in those with extensive bilateral and/or brainstem ischaemic changes. Another Expert Consensus suggests reperfusion therapy regardless of collateral scores. Based on limited evidence, we suggest direct aspiration over stent retriever as the first-line strategy of mechanical thrombectomy. As an Expert Consensus, we suggest rescue percutaneous transluminal angioplasty and/or stenting after a failed EVT procedure. Finally, based on very low certainty of evidence, we suggest add-on antithrombotic treatment during EVT or within 24 hours after EVT in patients with no concomitant IVT and in whom EVT was complicated (defined as failed or imminent re-occlusion, or need for additional stenting or angioplasty).

Signal enhancement ratio of multi-phase contrast-enhanced MRI: an imaging biomarker for survival in pancreatic adenocarcinoma.

To evaluate signal enhancement ratio (SER) for tissue characterization and prognosis stratification in pancreatic adenocarcinoma (PDAC), with quantitative histopathological analysis (QHA) as the reference standard. This retrospective study included 277 PDAC patients who underwent multi-phase contrast-enhanced (CE) MRI and whole-slide imaging (WSI) from three centers (2015-2021). SER is defined as (SIlt - SIpre)/(SIea - SIpre), where SIpre, SIea, and SIlt represent the signal intensity of the tumor in pre-contrast, early-, and late post-contrast images, respectively. Deep-learning algorithms were implemented to quantify the stroma, epithelium, and lumen of PDAC on WSIs. Correlation, regression, and Bland-Altman analyses were utilized to investigate the associations between SER and QHA. The prognostic significance of SER on overall survival (OS) was evaluated using Cox regression analysis and Kaplan-Meier curves. The internal dataset comprised 159 patients, which was further divided into training, validation, and internal test datasets (n = 60, 41, and 58, respectively). Sixty-five and 53 patients were included in two external test datasets. Excluding lumen, SER demonstrated significant correlations with stroma (r = 0.29-0.74, all p < 0.001) and epithelium (r = -0.23 to -0.71, all p < 0.001) across a wide post-injection time window (range, 25-300 s). Bland-Altman analysis revealed a small bias between SER and QHA for quantifying stroma/epithelium in individual training, validation (all within ± 2%), and three test datasets (all within ± 4%). Moreover, SER-predicted low stromal proportion was independently associated with worse OS (HR = 1.84 (1.17-2.91), p = 0.009) in training and validation datasets, which remained significant across three combined test datasets (HR = 1.73 (1.25-2.41), p = 0.001). SER of multi-phase CE-MRI allows for tissue characterization and prognosis stratification in PDAC. The signal enhancement ratio of multi-phase CE-MRI can serve as a novel imaging biomarker for characterizing tissue composition and holds the potential for improving patient stratification and therapy in PDAC. Imaging biomarkers are needed to better characterize tumor tissue in pancreatic adenocarcinoma. Signal enhancement ratio (SER)-predicted stromal/epithelial proportion showed good agreement with histopathology measurements across three distinct centers. Signal enhancement ratio (SER)-predicted stromal proportion was demonstrated to be an independent prognostic factor for OS in PDAC.

Enhancing selective production of atomic oxygen through nanosecond pulse-burst driven mode in a He/O2 dielectric barrier discharge

In this study, the temporal evolution of O atoms in a nanosecond burst-pulsed dielectric barrier discharge (DBD) is measured by two-photon absorption laser-induced fluorescence spectroscopy. The experiment is conducted at burst conditions of 50, 100, and 200 kHz pulse frequency, 10 Hz burst frequency, and 20–400 pulses in 0.1%–2% O2 + He mixtures. The accumulation effect of O atoms in the burst mode is observed and the density gradually saturates at around 100 pulses. Increasing the pulse frequency effectively enhances the O saturation density. The 0-dimensional kinetic model reveals that the saturation effect is primarily balanced by the formation and loss characteristics of O atoms. Similar saturation effect is also observed in the typical continuous periodic pulse mode (one pulse each cycle), but with a saturation density about one order of magnitude lower than that in the burst case, highlighting the burst excitation mode as an effective method for enhancing the instantaneous peak production of O atoms. Further investigations into the influence of O2 proportion on the selective production of O atoms are also performed. The results suggest that a low O2 proportion (<2%) and pulse-burst driven mode for the He/O2 DBD facilitates the selective production of O atoms while competing with O3 formation.

Change in Marriage Behaviour in North-Central Namibia 1925–2009

Namibia is the only country in Africa for which historical data is available to describe the change in marriage behavior since the 1920s. The aim of this article is to describe and to understand how the age at first marriage changed and how it was related to cohabitation since the 1920s in Namibia. The description of changes is based on parish register material and the family reconstitution method. The mean age at first marriage was over 20 for both sexes as early as the 1920s. In 1945–49, the mean age at first marriage started to increase, reaching about 29 for men and 24 for women at the end of the 1950s. The explanation for the increase was labor migration. The new cohabitation model was introduced from the end of the 1970s to the 1980s. Features of this model were cohabitation before marriage, late marriage age, a low married proportion of the population and high proportion of premarital births.