Signs Of Use Research Articles

Motivated signs and multimodal analysis in Gunther Kress’s semiotics

Abstract This article addresses the issue of motivated signs in semiotic theory and practice. It examines two influential versions of the term, Saussure’s and Kress’s, focussing on and triggered by Kress’s influence. It claims Kress’s importance lies not so much in theory as such, as in his analytic practice, multimodal analysis, as underpinned by this theory. Accordingly, it deploys a version of this practice on Kress as he is ‘doing theory’. It uses his late work Multimodality (Kress, Gunther. 2010. Multimodality. London: Bloomsbury) as the main source of examples of theory and objects of analysis, and applies a similar approach to Saussure. The outcome is a theoretically-informed corpus including many examples of motivated signs in use. From this empirical corpus the article makes some indicative generalizations about the role of these signs in semiotic practice. It shows how pervasive these signs are, and how important these are for analysis. It connects them with a crucial but under-researched aspect of all social uses of meaning, the modality meta-function (checking validity/modality of all semiotic acts), in which motivated signs play an essential role. It reveals a more complex Saussure, more complementary to Kress, and enables more powerful multimodal analyses of social meanings and functions of text and talk.

Морфометрические параметры Oxytropis popoviana Peschkova из природных популяций северо-западного побережья озера Байкал (Иркутская область)

Morphometric parameters (plant height, number, length and width of vegetative and generative organs) of living specimens of the rare endemic plant Oxytropis popoviana Peschkova from reference natural populations of the northwestern coast of Lake Baikal were studied for the first time. The variability of various signs has been studied. The obtained morphometric parameters of O. popoviana were compared with those given in the protologue of this species and with the parameters of the closely related species Oxytropis grandiflora (Pall.) DC. The study of the variability of signs for use in diagnostics showed that the most stable parameters of the flower are: the length and width of the flag, the length and width of the boat, the length and width of the cup, the length of the wings. The length and width of the beans also change little. The lengths of the tip of the boat and the bean, as well as the signs of the leaves, are the most variable. A comparison of the morphometric parameters of O. popoviana obtained by us with the values indicated in the O. popoviana protologue, as well as with the data for O. grandiflora, showed the uniqueness of O. popoviana plants in the natural populations of Rytiy and Pokoyniki capes. According to the signs of the vegetative sphere, they approach O. grandiflora, and according to most quantitative and qualitative generative signs they correspond to the parameters of O. popoviana indicated in the protologue, or approach them.

Морфометрические параметры Oxytropis popoviana Peschkova из природных популяций северо-западного побережья озера Байкал (Иркутская область)

Morphometric parameters (plant height, number, length and width of vegetative and generative organs) of living specimens of the rare endemic plant Oxytropis popoviana Peschkova from reference natural populations of the northwestern coast of Lake Baikal were studied for the first time. The variability of various signs has been studied. The obtained morphometric parameters of O. popoviana were compared with those given in the protologue of this species and with the parameters of the closely related species Oxytropis grandiflora (Pall.) DC. The study of the variability of signs for use in diagnostics showed that the most stable parameters of the flower are: the length and width of the flag, the length and width of the boat, the length and width of the cup, the length of the wings. The length and width of the beans also change little. The lengths of the tip of the boat and the bean, as well as the signs of the leaves, are the most variable. A comparison of the morphometric parameters of O. popoviana obtained by us with the values indicated in the O. popoviana protologue, as well as with the data for O. grandiflora, showed the uniqueness of O. popoviana plants in the natural populations of Rytiy and Pokoyniki capes. According to the signs of the vegetative sphere, they approach O. grandiflora, and according to most quantitative and qualitative generative signs they correspond to the parameters of O. popoviana indicated in the protologue, or approach them.

The Relevance of Mosque Financial Inclusion and Economic Sustainability

This study aims to answer questions regarding the relevance of mosque financial inclusion and a sustainable economy. This study uses a case study approach and a policy approach with a qualitative paradigm. This study examines the impact of mosque financial inclusion on the economic sustainability of the mosque community using primary data from research objects, namely the Jogokariyan Mosque in Yogyakarta and the Sabilillah Mosque in Malang City. The results of this study indicate that the relevance of mosque financial inclusion to a sustainable economy can be proven in the two mosques that are the object of this research. The Bayt al-Māl, ‘Āmil Zakāh Institution (LAZ), Mosque Cooperatives, and Foundations carry out access indicators without involving the formal financial sector or the government. The inclusion target community can easily access these institutions. It is consumptive-productive based on the signs of use of the Jogokariyan and Sabilillah Malang Mosques. qarḍ ḥasan and grants are the three financial methods for the three mosques. By providing cash lending without interest or collateral, the two mosques have implemented financial inclusion for target communities that do not have bank accounts. It is ideal to be productive and still meet quality metrics for public consumption. Using zakāh, infāq, and ṣadaqah instruments further illustrates the close connection between financial inclusion and a sustainable economy. The community's accessibility to services for basic necessities, education, health, and social mobilization demonstrates its significance.

Intelligent information system for automatic generation of symbols in the APP-6D standard

Military symbols play a key role in the command and control of military forces. By communicating information that meets basic requirements, situational awareness can be quickly achieved; by its graphical nature, it provides a common operating language that greatly facilitates interaction across cultural and linguistic barriers. With the advent of information technology, the need arose for rapidly recognized international standards that could then be taught to computers. The fusion of high standard air, sea and land symbols on APP-6 paper resulted in Mil-Std-2525 and NATO APP-6D. This standard applies to all NATO ground components that are directly or partially involved in C4I operations, system operations, systems development and training in the context of NATO ground component operations. When designing and developing signs, composing their components, factors such as the ability to easily recognize signs, their legibility in different lighting conditions on a diverse cartographic basis, in different sizes and types of electronic screens with different degrees of physical and intellectual fatigue should be taken into account. The conventional signs standard concentrates signs for use in modern multi-chromatic electronic systems. At the same time, all signs can be used in monochrome systems and for freehand decoration. Development of this software will allow creating comfortable conditions for performing such actions as: create and edit tactical graphics of military symbols; ensuring compliance with all standards regarding the conditions of standardization of APP-6D; performing secure transmission of characters between multiple users. The object of the research is an automatic generator of conventional symbols in the tactical military standard APP-6D. The subject of the research is software for automatic generation of tactical symbols in the APP-6D standard. The aim of the work is to develop software that will automatically generate tactical insignia in the APP-6D standard. A comparative analysis of various methods for the development of such systems for generating symbols has been carried out. The project was being developed and it does not have a single equivalent in the Ukrainian language. Also, there are not a single desktop implementation. The project can be part of the software used by the Ukrainian military.

Signs of Use Present a Barrier to Reusable Packaging Systems for Takeaway Food

Single-use packaging is one of the biggest contributors to plastic waste, and reuse has been identified as a key strategy to reduce such waste. However, reusable containers typically become worn, which may influence how consumers think and feel about reuse. The present research explored whether and how evaluations of a takeaway food service changed depending on the appearance of a reusable container. Two studies were conducted (using opportunity sampling) to (i) investigate the effects that signs of use have on people’s perceptions of reusable packaging systems using quantitative methods (Study 1) and (ii) understand the rationale underpinning these evaluations using qualitative methods (Study 2). Study 1 involved an online questionnaire where participants (n = 292) were shown images of reusable bowls for takeaway food with various levels of staining and asked to evaluate the container and the restaurant serving the food using rating scales. Study 2 involved in-person interviews where participants (n = 22) were given the opportunity to inspect either a clean bowl or a stained bowl and then were asked questions about the bowls. Signs of previous use seemed to undermine people’s willingness to reuse containers in the future and were associated with more negative evaluations of the packaging, product, and restaurant serving the food. These findings provide insights into the factors that affect people’s willingness to engage with reusable packaging systems, and we use these findings to suggest behavioural and design interventions that might mitigate negative evaluations and encourage reuse.

Drugs and high hospitalization rate: are they related?

IntroductionSubstance use continues to be an important problem among mental health patients either as main diagnosis or as comorbidity. Acute care visits, including emergency department visits and hospitalizations, related to substance use disorders (SUD) are increasing and can be opportunities to engage individuals to get proper treatment (Suen LW et al. J Gen Intern Med 2022; 37(10):2420–2428). Both mental disorders and SUD lead to subsequent chronic physical conditions, premature death, suicide or overdose (Bennett AC. Public Health Rep 2019; 134(1):17-26) that can be accidental or not.24% to 32% of patients with Substance Induced Psychosis develop later a schizophrenia spectrum disorder or bipolar disorder (Starzer MSK et al. Am J Psychiatry 2018;175(4):343–350) leading to a chronic use of medication and, in several instances, to a necessity of psychiatric in-patient treatment with long hospital stays and high readmission rates (Khan S. Health Reports (2017) 28(8)3-8).ObjectivesOur goal was to analyze if substance use is associated with higher psychiatric hospitalization rates.MethodsAn independent-samples t-test was run to determine if there were more hospitalizations among patients with substance use. Afterwards, the Cohen’s D was calculated to measure the effect size and to see the magnitude of the experimental effect.ResultsA sample of 2604 in-patient treatment episodes was used. The sample had 1696 female patients, 908 male patients and 823 patients had substance use. We found that patients with substance use had a statistically significant higher hospitalization rate (6.82±5.27) than the ones without it (5.32±4.84), t(1483)=6.945, p<0.001. Cohen’s effect size value (d=.30) suggested a small practical significance.ConclusionsOur findings go mainly accordingly the literature; we found a significant effect of drugs on readmission rates (Böckmann V et al. Front Psychiatry 2019; 10:828) but we might have thought it would be bigger. That could be explain by undiagnosed substance use (refusal to admit the use, drugs not detected on lab tests, not requesting toxic lab tests) or higher sample percentage of confounding comorbid diagnoses.However, is undoubtable the several risks that drugs bring to our health and so the authors aim to raise awareness among the medical community to the importance being alert for signs of use or psychiatric symptoms to avoid reaching a no turning point. It’s known that doctors frequently fail to diagnose SUD in hospitalized patients and given the linkage between use of certain substances and particular medical reasons for admission, it would be well-advised to search for SUD in certain admission diagnoses (Weintraub E et al. Am J Addict 2001;10(2):167-77). Knowledge of substance use behavior may help reducing relapse rates and to reduce the risk of developing a SUD (Andersson HW et al. Nordic Journal of Psychiatry, 75:3, 160-169).Disclosure of InterestNone Declared

This has already been used! A paradigm to measure the point at which people become unwilling to use reusable containers

Reusing packaging and containers can significantly reduce plastic waste, yet little research has considered whether people are willing to reuse containers, especially as they start to show signs of use. The present research developed a novel method for identifying how worn or dirty a container needs to be before people become unwilling to reuse it and demonstrates how this paradigm can be used to investigate factors that might influence people's willingness to reuse that container. Across four studies, we recruited University staff and students or members of the local and online community and asked them to complete a variation of our paradigm designed to measure their willingness to reuse containers, followed by self-report measures of disgust, concerns about disease, and pro-environmental attitudes and behaviors. The findings demonstrate that: (i) the paradigm can identify the point at which people deem a container unacceptable for reuse, (ii) there is substantial variation in people's thresholds, and (iii) variation can be explained, in part, by individual differences (e.g., feelings of disgust) and contextual factors. This paradigm provides the basis for a scientific study of psychological, physical, and environmental factors that are crucial to the success of reuse models and ultimately, reducing plastic waste.

Variations among Electronic Health Record and Physiologic Streaming Vital Signs for Use in Predictive Algorithms in Pediatric Severe Sepsis

AbstractObjective This study sought to describe the similarities and differences among physiologic streaming vital signs (PSVSs) and electronic health record (EHR)-documented vital signs (EVSs) in pediatric sepsis.Methods In this retrospective cohort study, we identified sepsis patients admitted to the pediatric intensive care unit. We compared PSVS and EVS measures of heart rate (HR), respiratory rate, oxyhemoglobin saturation, and blood pressure (BP) across domains of completeness, concordance, plausibility, and currency.Results We report 1,095 epochs comprising vital sign data from 541 unique patients. While counts of PSVS measurements per epoch were substantially higher, increased missingness was observed compared with EVS. Concordance was highest among HR and lowest among BP measurements, with bias present in all measures. Percent of time above or below defined plausibility cutoffs significantly differed by measure. All EVS measures demonstrated a mean delay from time recorded at the patient to EHR entry.Conclusion We measured differences between vital sign sources across all data domains. Bias direction differed by measure, possibly related to bedside monitor measurement artifact. Plausibility differences may reflect the more granular nature of PSVS which can be critical in illness detection. Delays in EVS measure currency may impact real-time decision support systems. Technical limitations increased missingness in PSVS measures and reflect the importance of systems monitoring for data continuity. Both PSVS and EVS have advantages and disadvantages that must be weighed when making use of vital signs in decision support systems or as covariates in retrospective analyses.

Experimental Investigation of Aerostatic Journal Bearings Made of Carbon Fiber-Reinforced Carbon Composites

Abstract This study describes experimental results using carbon fiber-reinforced carbon (C/C) material for porous journal bearings under static conditions. Exerted radial forces of up to 90 N, a supply pressure of up to 6 bar, and a maximum rotational speed of 8000 rpm were tested. The occurrence of pneumatic hammering was not observed under these operating points. Triangulation sensors were mounted vertically and horizontally as well as in front of and behind the tested bearing. These sensors measure the eccentricity and misalignment. The orbit analysis demonstrated an improvement in concentricity with an increment in the supply pressure. The layered structure of the C/C material used for the porous liner is presented. A rotational speed below 8000 rpm negligibly influenced the load-carrying capacity and the flowrate. The vertical misalignment of the shaft was determined in relation to the force-applied test bearing. In addition, two vertically positioned sensors on the support-bearing housing were used to discern the misalignment in the absolute system. On the other hand, reducing the speed to 1000 rpm increased the concentricity error. The shaft showed no significant signs of use after the experiments. The measurements confirm the suitability of the material for porous bearings.

Do consumers mind contamination by previous users? A choice-based conjoint analysis to explore strategies that improve consumers' choice for refurbished products

Refurbishment is an effective strategy to extend product lifetimes in a circular economy. However, consumers believe that refurbished products are contaminated with traces of prior use, which can be indicated by the appearance (e.g., scratches) or functionality (e.g., lower battery capacity) of refurbished products. This research explores strategies to improve consumer adoption of refurbished products by reducing contamination. In a choice-based conjoint analysis, 785 participants were exposed to refurbished headphones varying in features related to contamination, warranty, and price. We tested three contamination-reducing strategies, including (1). Communication about the clean object state, (2). Eliminating signs of use (aesthetic and functional wear-and-tear) and (3). Renewing parts that touch the skin (e.g., ear-cushions). Additionally, we analysed whether different consumer groups are driven by different attributes of refurbished products. Results showed that most consumers value refurbished products that show no signs of wear-and-tear and that have parts touching the skin renewed during the refurbishment process. These attributes are even more important than the reduced price or warranty, even though these are frequently used to market refurbished products. Depending on the consumer group, other contamination-reducing strategies were of great influence. While some consumer groups highly valued that signs of prior use are eliminated through an as-new appearance, others preferred refurbished products without functional wear-and-tear. In conclusion, four design strategies to deal with contamination during multiple life cycles of refurbished products are discussed.

Beside the Ocean: Coastal Landscapes at the Bay of Skaill, Marwick, and Birsay Bay, Orkney. Archaeological Research 2003–2018. By DavidGriffiths, JaneHarrison and MichaelAthanson. Oxford and Philadelphia: Oxbow Books. 2019. xxviii + 346 pp. £45. ISBN 978 1 78925 096 1 (hardback); ISBN 978 1 78925 097 8 (epub).

Beside the Ocean: Coastal Landscapes at the Bay of Skaill, Marwick, and Birsay Bay, Orkney. Archaeological Research 2003–2018. By DavidGriffiths, JaneHarrison and MichaelAthanson. Oxford and Philadelphia: Oxbow Books. 2019. xxviii + 346 pp. £45. ISBN 978 1 78925 096 1 (hardback); ISBN 978 1 78925 097 8 (epub).

Diversity and abundance of large tree holes used by Tawny Owls Strix aluco in lowland temperate forests

ABSTRACT Capsule Tawny Owls Strix aluco used a wide variety of tree holes for roosting, but only a minority were used for nesting, which comprised those holes at greater heights in larger trees and with a flat base. Aims We aimed to determine the type and dimensions of tree holes used by Tawny Owls for roosting and nesting, including which tree species were the most important hole providers, and the density of tree holes available for Tawny Owls in forests of different age classes. Methods We conducted visual searches for all large tree holes within study plots, recorded their measurements and signs of use, comparing the features of used and unused holes. Data were collected in medium-aged and old-growth forests (Ukraine, Homilsha Forest, 750 ha, 10 seasons) and in primeval forest (Poland, Białowieża Forest, 150 ha, 2 seasons). Results Roosting holes came in a wide variety of shapes and sizes, frequently being very deep and with an uneven base. Hole entrances needed to be over 10 cm wide and the hollows more than 20 cm deep, presumably to enable owls to enter and evade predators. All nesting holes had a flat base and were located in larger trees, at greater heights than roosting holes. Old trees of low commercial timber value (European Hornbeam Carpinus betulus, Small-leaved Lime Tilia cordata, European Pear Pyrus communis) were the most important hole providers. Suitable holes were found in trees of at least 80 years old, and their abundance increased with tree age, exceeding 50 holes/km2 in the primeval forest. Conclusion Despite the abundance of suitable roosting holes, nesting holes remained a rare resource associated with larger, older trees. As tree species of low economic value were the main hole providers, these should be retained in forestry operations.

Itching as the onset of pain (part 3)

Itchy skin is an extremely unpleasant symptom that can provoke insomnia, depression, irritability, loss of appetite. There are several theories of itching. According to one of them, itching is a modified pain caused by a slight irritation of the nerve endings in the skin. According to the second, itching is an independent symptom, in the formation of which nervous, humoral and vascular mechanisms are involved. Other theories consider itching as a reaction of the autonomic nervous system or a hereditary pathological condition. According to recent studies, itchy skin is characterized by the absence of a universal peripheral mediator of itching. The trigger for itching is the action of pruritogen – a mechanical, chemical, thermal or electrical stimulant directly or indirectly through mediators. Free ends of type A delta fibers and type C fibers play a crucial role in itching and pain. If this was previously confirmed only by clinical observations, now there are neurophysiological studies that support the theory that itching and pain fibers are one with different activity thresholds. Today, it is unacceptable that there are separate specific receptors for different sensations. It is now assumed that there are mixed receptors for heat, cold, pain, itching and touch [95]. Systematic use of substances included in the list of drugs and manifested by mental and physical dependence on them – drug addiction, one of the diseases of society. But drug addiction is sometimes forced, according to medical indications, in cases of palliative conditions. Depending on the stage of the person after taking the drug or in the interval between drug use, one of the signs of use may be severe itching of the skin. And after excluding both the main diseases that cause itching and other secondary causes of itching, it can be assumed that a person has idiopathic generalized pruritus (itching) of unknown origin (GPOU). The itching of the elderly, which is quite common in the elderly, as a manifestation of concomitant, often combined, somatic pathology, but may also be due to physiological changes, both on the skin and on the physiological aging of nerve endings.

Beyond proximity: Extending the “greening hypothesis” in the context of vacant lot stewardship

Research increasingly shows that greening activity can spur contagious or imitative behavior among nearby neighbors within residential landscapes. Krusky et al. (2015) examined this phenomenon in the context of vacant lots and found support for a “greening hypothesis” that residential yards near vacant lots that were converted to community gardens exhibited higher levels of care than yards near untended vacant lots. Although such activity implies a temporal, causal relationship, research to date has only tested the spatial dimension of greening through correlational measures of proximity assessed at one point in time. We extend this work by analyzing vacant lot greening as a function of time, space, scale of analysis, and other factors. We studied residential property owners (N = 321) who purchased nearby city-owned vacant lots through the Chicago Large Lot Program. Improvements made in the condition and care of large lots in the year after purchase were positively related to the proximity, condition and care of the individual’s previously owned property, and signs of use and care of the lot before purchase (blotting). We also examined whether block-level indicators of care and disorder were associated with improvements made to lots purchased on the block. We found few associations but discovered these same block-level indicators of care and disorder more strongly predicted the percent of large lots sold on that block, suggesting that greening activity may be bidirectional. These findings expand understanding of the dynamics of vacant lot stewardship and have implications for building more robust theories of urban greening.

Монгольское сочинение о гадании по приметам из собрания Рукописного фонда Института восточных рукописей РАН

Introduction. Investigations of source issues dealing with history of everyday life have been intensively developed in Oriental studies — including Mongol studies — since the mid-to-late 20th century, and still remain a vital task. Meanwhile, this area of social history can help take a fresh look at many processes that have taken place in Mongolia. It covers all cycles of everyday life of the Mongols ‒ economy, life and seasonal rituals, daily religious practices, magical rituals associated with sacrifices, treatment of cattle, divinations, etc. The goal of the current article is to introduce into scientific discourse one rare source, a written artifact, characterizing divination practices used by Mongols in everyday life. The source base of history of everyday life, as a rule, is incomplete as materials to make a picture of everyday life of people are always insufficient. Moreover, these lacunae are obvious in the field of written sources. It is clear that the detection of texts that would reflect all aspects of life of Mongolia’s population in full is impossible. Various aspects have not been captured in writing, many have been lost. However, there are still a number of texts. The main material for research was the text under code Q 695 from the Manuscript Fund of the Institute of Oriental Manuscripts of the RAS (St. Petersburg). The latter deals with omens and divination by omens. The text has no title page, so the title is totally unknown. The results of the research demonstrate that inherent qualities of the text itself and its contents that might indicate its origin are not evident. The significant attention paid to the cattle breeding theme might attest to the Mongolian character of the monument. However, there are also stories that are not typical for nomadic life. There are signs of use of Tibetan and Chinese materials. Thus, one can say that this work has a heterogeneous character and is a compilation from different sources. As for the concepts of omens themselves, those obviously have a wider area of distribution than certain national borders and reflect practices of protecting life in a wide area of Central Asia, Northern India, and China. The manuscript consists of 8 sheets, pages 3 and 9 are absent. The manuscript is not old, the text is written on Russian paper in black ink, pen. The handwriting is not professional, the text is full of spelling and grammatical mistakes. The work can be divided into several parts, e.g., omens regarding behavior of animals: horses, cows, sheep; birds flying into in homes; barking and howling of dogs; buzz of pots; deformity of animals; behavior of dogs, appearance of a tornado, on the gnashing of teeth. Obviously, the work is a collection of narratives from various sources.

Obredi za bolne in umirajoče v virih iz Klosterneuburga

This article investigates extant documents from the Augustinian canonry of Klosterneuburg (Codices Claustroneoburgenses 628, 629, 1022A, and 1022B) to gain insight into the community’s rites for the sick and dying. The sources largely agree in the material prescribed for the rites. Scribal annotations and signs of use within the manuscripts indicate that the same rites were used for both the men and women of the double house; the manuscripts’ rubrics also leave open the possibility that men and women participated in the rites together.

Item banking and computer-adaptive testing in clinical trials: Standing in sight of the PROMISed land.

The use of patient-reported outcome instruments (PRO) in clinical trials in order to capture the impacts of treatment on patients is widespread. However, regulatory agencies have over the past decade highlighted the need for PROs that are fit for purpose and target relevant aspects of the patient's condition. Many legacy PROs were developed with little patient input, are lengthy, and may lack relevance having not been modified or adapted as medical treatments have advanced. Computer-adaptive test (CAT) systems provide the possibility of targeted approaches to capturing patient-centric data, while minimising patient burden. Coupled with greater patient input in the development of PROs, CAT offers the opportunity of overcoming the shortcomings of the previous generation of PROs. This paper describes the some of the issues facing legacy PROs, current regulatory guidance, and initiatives, such as the Patient-Reported Outcome Measurement Information System (PROMIS), as well as the early signs of use of CAT to capture PRO data in clinical trials.

ACCURACY OF THE LEVER SIGN TO DIAGNOSE ANTERIOR CRUCIATE LIGAMENT TEAR: A SYSTEMATIC REVIEW WITH META-ANALYSIS

The Lever sign has gained recent notoriety for its purported anterior cruciate ligament (ACL) diagnostics and simplicity of performance. The purpose of this systematic review with meta-analysis is to summarize the diagnostic accuracy of the Lever sign for use during assessment of the knee for an ACL tear in subjects with suspected acute and chronic knee injury. Systematic review with meta-analysis. A computer-assisted literature search of MEDLINE, CINAHL, and EMBASE databases using keywords related to diagnostic accuracy of the knee joint. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the search and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies (QUADAS). Mixed effects models were used to summarize accuracy. Eight articles, with only two demonstrating high quality, were included. Six of the articles were included in a meta-analysis. Diagnostic values, utilizing arthroscopy as a gold standard, were: pooled SN 0.55 (95% CI 0.22 to 0.84), pooled SP 0.89 (95% CI 0.44 to 0.99), positive likelihood ratio (+LR) 9.2 (95% CI 0.70 to 46.1), negative likelihood ratio (-LR) 0.58 (95% CI 0.18 to 1.28). Post-test probability with a positive finding (57% sampling prevalence) reached 92% (95% CI 83 to 97%). Post-test probability with a negative finding (57% sampling prevalence) reached 43% (95% CI 39 to 47%). Based on limited evidence of heterogeneous methodological quality, the Lever sign can moderately change post-test probability to rule in an ACL tear. These results should be interpreted cautiously due to a limited number of studies, with small sample sizes and study quality affecting test accuracy. Future investigation should be expanded to include additional high-quality studies examining diverse clinical contexts, as they become available, to enable a more comprehensive clinical examination of this test. 3aPROSPERO Registration # CRD42018084954.

Assessing the severity of atopic dermatitis in clinical trials and practice

There is a tremendous need for accurate and reproducible scoring systems for the grading of skin disease to further the development of research and standards of care. There are presently greater than 60 measures that have been used to assess the severity of atopic dermatitis. These assessments vary considerably with respect to content, scale, instructions, validity, and concordance. This contribution reviews the available scoring systems of atopic dermatitis signs based on their design and merit in specific settings. These scores assess lesional intensity and/or extent, symptoms, disease course, and epidermal function. Scoring atopic dermatitis, Investigator Global Assessment, and Eczema Area and Severity Index are the most commonly used assessments of atopic dermatitis signs. Eczema Area and Severity Index has emerged as the preferred outcome measure of atopic dermatitis signs for use in clinical trials. Unfortunately, Eczema Area and Severity Index can be cumbersome in clinical practice. Itch intensity (visual analog or numeric rating scales) and Patient-Oriented Eczema Measure have emerged as the preferred patient-reported outcome in clinical trials. Clinicians’ gestalt global assessment of severity, Patient-Oriented Eczema Measure, and intensity of itch may be feasible for clinical practice.