Giant cell arteritis (GCA) is a common large vessel vasculitis in those over age 50 years. This meta-analysis examined the geographical and temporal distribution of the incidence, prevalence, and ...mortality of GCA.
A systematic review was conducted using EMBASE, Scopus, and PubMed from their inceptions until 2019. Studies were included if they reported at least 50 or more GCA patients and defined the location and time frame. Articles on mortality were included and standardized mortality ratio (SMR) was extracted where possible. Mean pooled prevalence, incidence, and SMR were calculated using a random effects model. Linear regression was used to explore correlations between latitude and incidence, prevalence, and mortality.
Of the 3569 citations identified, 107 were included. The pooled incidence of GCA was 10.00 9.22, 10.78 cases per 100,000 people over 50 years old. This incidence was highest in Scandinavia 21.57 18.90, 24.23, followed by North and South America 10.89 8.78, 13.00, Europe 7.26 6.05, 8.47, and Oceania 7.85 - 1.48, 17.19. Pooled prevalence was 51.74 42.04, 61.43 cases per 100,000 people over age 50. Annual mortality was 20.44 17.84, 23.03 deaths/1000. Mortality generally decreased over the years of publication (p = 0.0008). Latitude correlated significantly with incidence (p = 0.0011), but not with prevalence, or mortality.
GCA incidence varies nearly 3-fold between regions and is highest in Scandinavia but not significantly. Mortality may be improving over time.
Existing scholarly discussions of theatrical realism have been predominantly limited to 19th-century European and Russian theater, with little attention paid to wider explorations and alternative ...definitions of the practice. Examining theater forms and artists from China, Japan, and Korea, Realisms in East Asian Performance brings together a group of theater historians to reconsider realism through the performing arts of East Asia. The book’s contributors emphasize trans-regional conversations and activate inter-Asian dialogues on theatrical production. Tracing historical trajectories, starting from premodern periods through today, the book seeks to understand realisms’ multiple origins, forms, and cultural significances, and examines their continuities, disruptions, and divergences. In its diversity of topics, geographic locations, and time periods, Realisms in East Asian Performance aims to globalize and de-center the dominant narratives surrounding realism in theater, and revise assumptions about the spectacular and theatrical forms of Asian performance. Understanding realism as a powerful representational style, chapters collectively reevaluate acts of representation on stage not just for East Asia, but for theater and performance studies more broadly.
The efficacy of ustekinumab, an antagonist of the p40 subunit of interleukin-12 and interleukin-23, as induction and maintenance therapy in patients with ulcerative colitis is unknown.
We evaluated ...ustekinumab as 8-week induction therapy and 44-week maintenance therapy in patients with moderate-to-severe ulcerative colitis. A total of 961 patients were randomly assigned to receive an intravenous induction dose of ustekinumab (either 130 mg 320 patients or a weight-range-based dose that approximated 6 mg per kilogram of body weight 322) or placebo (319). Patients who had a response to induction therapy 8 weeks after administration of intravenous ustekinumab were randomly assigned again to receive subcutaneous maintenance injections of 90 mg of ustekinumab (either every 12 weeks 172 patients or every 8 weeks 176) or placebo (175). The primary end point in the induction trial (week 8) and the maintenance trial (week 44) was clinical remission (defined as a total score of ≤2 on the Mayo scale range, 0 to 12, with higher scores indicating more severe disease and no subscore >1 range, 0 to 3 on any of the four Mayo scale components).
The percentage of patients who had clinical remission at week 8 among patients who received intravenous ustekinumab at a dose of 130 mg (15.6%) or 6 mg per kilogram (15.5%) was significantly higher than that among patients who received placebo (5.3%) (P<0.001 for both comparisons). Among patients who had a response to induction therapy with ustekinumab and underwent a second randomization, the percentage of patients who had clinical remission at week 44 was significantly higher among patients assigned to 90 mg of subcutaneous ustekinumab every 12 weeks (38.4%) or every 8 weeks (43.8%) than among those assigned to placebo (24.0%) (P = 0.002 and P<0.001, respectively). The incidence of serious adverse events with ustekinumab was similar to that with placebo. Through 52 weeks of exposure, there were two deaths (one each from acute respiratory distress syndrome and hemorrhage from esophageal varices) and seven cases of cancer (one each of prostate, colon, renal papillary, and rectal cancer and three nonmelanoma skin cancers) among 825 patients who received ustekinumab and no deaths and one case of cancer (testicular cancer) among 319 patients who received placebo.
Ustekinumab was more effective than placebo for inducing and maintaining remission in patients with moderate-to-severe ulcerative colitis. (Funded by Janssen Research and Development; UNIFI ClinicalTrials.gov number, NCT02407236.).
HIV testing rates are suboptimal among at-risk men. Crowdsourcing may be a useful tool for designing innovative, community-based HIV testing strategies to increase HIV testing. The purpose of this ...study was to use a stepped wedge cluster randomized controlled trial (RCT) to evaluate the effect of a crowdsourced HIV intervention on HIV testing uptake among men who have sex with men (MSM) in eight Chinese cities.
An HIV testing intervention was developed through a national image contest, a regional strategy designathon, and local message contests. The final intervention included a multimedia HIV testing campaign, an online HIV testing service, and local testing promotion campaigns tailored for MSM. This intervention was evaluated using a closed cohort stepped wedge cluster RCT in eight Chinese cities (Guangzhou, Shenzhen, Zhuhai, and Jiangmen in Guangdong province; Jinan, Qingdao, Yantai, and Jining in Shandong province) from August 2016 to August 2017. MSM were recruited through Blued, a social networking mobile application for MSM, from July 29 to August 21 of 2016. The primary outcome was self-reported HIV testing in the past 3 months. Secondary outcomes included HIV self-testing, facility-based HIV testing, condom use, and syphilis testing. Generalized linear mixed models (GLMMs) were used to analyze primary and secondary outcomes. We enrolled a total of 1,381 MSM. Most were ≤30 years old (82%), unmarried (86%), and had a college degree or higher (65%). The proportion of individuals receiving an HIV test during the intervention periods within a city was 8.9% (95% confidence interval CI 2.2-15.5) greater than during the control periods. In addition, the intention-to-treat analysis showed a higher probability of receiving an HIV test during the intervention periods as compared to the control periods (estimated risk ratio RR = 1.43, 95% CI 1.19-1.73). The intervention also increased HIV self-testing (RR = 1.89, 95% CI 1.50-2.38). There was no effect on facility-based HIV testing (RR = 1.00, 95% CI 0.79-1.26), condom use (RR = 1.00, 95% CI 0.86-1.17), or syphilis testing (RR = 0.92, 95% CI 0.70-1.21). A total of 48.6% (593/1,219) of participants reported that they received HIV self-testing. Among men who received two HIV tests, 32 individuals seroconverted during the 1-year study period. Study limitations include the use of self-reported HIV testing data among a subset of men and non-completion of the final survey by 23% of participants. Our study population was a young online group in urban China and the relevance of our findings to other populations will require further investigation.
In this setting, crowdsourcing was effective for developing and strengthening community-based HIV testing services for MSM. Crowdsourced interventions may be an important tool for the scale-up of HIV testing services among MSM in low- and middle-income countries (LMIC).
ClinicalTrials.gov NCT02796963.
Digital microfluidic biochips (DMFBs) can effectively reduce the cost of biochemical analysis and improve experimental efficiency, as they are easy to carry, use fewer reagent samples and have high ...precision. Paper-based DMFBs (PB-DMFBs) are a branch of microfluidic biochips. This technology prints ink containing carbon nanotubes on special paper to form electrodes and control wire, so the manufacturing cost and time required are far less than the traditional digital microfluidic chip, in which droplets move between two control layers. However, the chip-level synthesis of PB-DMFBs becomes more challenging because all circuits of PB-DMFBs are printed on a single paper layer. Furthermore, current PB-DMFB designs must address various issues, including fabrication cost, reliability, and safety. Therefore, a more flexible method for the chip-level synthesis of PB-DMFBs is needed. In this article, we propose a chip-level synthesis method of PB-DMFBs based on reinforcement learning. Double deep <inline-formula> <tex-math notation="LaTeX">Q </tex-math></inline-formula>-learning networks (Double DQN) are suitable for agents to select actions and estimate actions, and then obtain optimized comprehensive results. Experimental results demonstrate that the proposed method is not only effective and efficient for chip-level synthesis but also scalable to applications with high reliability and safety requirements.
Cultural Imprints Elizabeth Oyler, Katherine Saltzman-Li / Elizabeth Oyler, Katherine Saltzman-Li
02/2022
eBook
Cultural Imprints draws on
literary works, artifacts, performing arts, and documents that were
created by or about the samurai to examine individual "imprints,"
traces holding specifically grounded ...historical meanings that
persist through time. The contributors to this
interdisciplinary volume assess those imprints for what they can
suggest about how thinkers, writers, artists, performers, and
samurai themselves viewed warfare and its lingering impact at
various points during the "samurai age," the long period from the
establishment of the first shogunate in the twelfth century through
the fall of the Tokugawa in 1868.
The range of methodologies and materials discussed in
Cultural Imprints challenges a uniform notion of warrior
activity and sensibilities, breaking down an ahistorical,
monolithic image of the samurai that developed late in the samurai
age and that persists today. Highlighting the memory of warfare and
its centrality in the cultural realm, Cultural Imprints
demonstrates the warrior's far-reaching, enduring, and varied
cultural influence across centuries of Japanese history.
Contributors: Monica Bethe, William Fleming, Andrew Goble,
Thomas Hare, Luke Roberts, Marimi Tateno, Alison Tokita, Elizabeth
Oyler, Katherine Saltzman-Li
Genital chlamydia infection in women is often asymptomatic, but may result in adverse outcomes before and during pregnancy. The purpose of this study was to examine the strength of the relationships ...between chlamydia infection and different reproductive health outcomes and to assess the certainty of the evidence.
This review was registered and followed the Cochrane guidelines. We searched three databases to quantitatively examine adverse outcomes associated with chlamydia infection. We included pregnancy and fertility-related outcomes. We performed meta-analyses on different study designs for various adverse outcomes using unadjusted and adjusted analyses.
We identified 4730 unique citations and included 107 studies reporting 12 pregnancy and fertility-related outcomes. Sixty-eight studies were conducted in high-income countries, 37 studies were conducted in low-income or middle-income countries, and 2 studies were conducted in both high-income and low-income countries. Chlamydia infection was positively associated with almost all of the 12 included pregnancy and fertility-related adverse outcomes in unadjusted analyses, including stillbirth (OR=5.05, 95% CI 2.95 to 8.65 for case-control studies and risk ratio=1.28, 95% CI 1.09 to 1.51 for cohort studies) and spontaneous abortion (OR=1.30, 95% CI 1.14 to 1.49 for case-control studies and risk ratio=1.47, 95% CI 1.16 to 1.85 for cohort studies). However, there were biases in the design and conduct of individual studies, affecting the certainty of the overall body of evidence. The risk of adverse outcomes associated with chlamydia is higher in low-income and middle-income countries compared with high-income countries.
Chlamydia is associated with an increased risk of several pregnancy and fertility-related adverse outcomes in unadjusted analyses, especially in low-income and middle-income countries. Further research on how to prevent the sequelae of chlamydia in pregnant women is needed.
CRD42017056818.
Aims
Although diabetes is rapidly increasing in India, there is no national consensus on best practices for screening, diagnosis, and management of gestational diabetes mellitus (GDM). The goal of ...this study was to systematically review the literature for studies reporting the prevalence and screening and diagnostic methods for gestational diabetes in India.
Methods
We searched MEDLINE, Embase, and POPLINE for studies on screening for GDM in India. We included English-language full reports and conference abstracts of cross-sectional studies, prospective, and retrospective cohorts that reported the screening method and prevalence of GDM. We performed descriptive analysis on all studies and meta-analysis, meta-regression, and subgroup meta-analysis on studies with medium or low risk of bias.
Results
We included 64 studies reporting 90 prevalence estimates. Prevalence estimates ranged from 0 to 41.9%. Subset meta-analyses showed that the IADPSG diagnostic criteria found significantly more GDM cases (prevalence = 19.19% 15.5, 23.6,
p
< 0.05) than the WHO 1999 criteria (10.13% 8.17, 12.50) and DIPSI criteria (7.37% 5.2, 10.16). Studies that compared the IADPSG and WHO 1999 criteria showed poor positive agreement (33–79%). Studies specifying time of GDM diagnosis showed that patients (11–60%) develop GDM as early as the first trimester, but many GDM cases (16–40%) are missed if screened only at first visit.
Conclusions
In India, prevalence estimates of GDM vary substantially by diagnostic criteria. When evaluating screening and diagnostic criteria for GDM, providers should consider their patients’ needs and correlate screening criteria with pregnancy outcomes.
Background
Since 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has diversified extensively, producing five highly virulent lineages designated as variants of concern (VOCs). The ...Delta VOC emerged in India with increased transmission, immune evasion, and mortality, causing a massive global case surge in 2021. This study aims to understand how the Delta VOC evolved by characterizing mutation patterns in the viral population before and after its emergence. Furthermore, we aim to identify the influence of positive and negative selection on VOC evolution and understand the prevalence of different mutation types in the viral genome.
Methods
Three groups of whole viral genomes were retrieved from GISAID, sourced from India, with collection periods as follows: Group A—during the initial appearance of SARS-CoV-2; Group B—just before the emergence of the Delta variant; Group C—after the establishment of the Delta variant in India. Mutations in >1% of each group were identified with BioEdit to reveal differences in mutation quantity and type. Sites under positive or negative selection were identified with FUBAR. The results were compared to determine how mutations correspond with selective pressures and how viral mutation profiles changed to reflect genetic diversity before and after VOC emergence.
Results
The number of mutations increased progressively in Groups A–C, with Group C reporting a 2.2- and 1.9-fold increase from Groups A and B, respectively. Among all the observed mutations, Group C had the highest percentage of deletions (22.7%; vs. 4.2% and 2.6% in Groups A and B, respectively), and most mutations altered the final amino acid code, such as non-synonymous substitutions and deletions. Conversely, Group B had the most synonymous substitutions that are effectively silent. The number of sites experiencing positive selection increased in Groups A–C, but Group B had 2.4- and 2.6 times more sites under negative selection compared to Groups A and C, respectively.
Conclusion
Our findings demonstrated that viral genetic diversity continuously increased during and after the emergence of the Delta VOC. Despite this, Group B reports heightened negative selection, which potentially preserves important gene regions during evolution. Group C contains an unprecedented quantity of mutations and positively selected sites, providing strong evidence of active viral adaptation in the population.
Pregnant women in sub-Saharan Africa have high rates of maternal morbidity. There is interest in the impact of the vaginal microbiome on maternal health, including HIV and sexually transmitted ...infection (STI) acquisition. We characterized the vaginal microbiota of South African women ≥ 18 years with and without HIV in a longitudinal cohort over two visits during pregnancy and one visit postpartum. At each visit, we obtained HIV testing and self-collected vaginal swabs for point-of-care testing for STIs and microbiota sequencing. We categorized microbial communities and evaluated changes over pregnancy and associations with HIV status and STI diagnosis. Across 242 women (mean age 29, 44% living with HIV, 33% diagnosed with STIs), we identified four main community state types (CSTs): two lactobacillus-dominant CSTs (dominated by
Lactobacillus crispatus
and
Lactobacillus iners
respectively) and two diverse, non-lactobacillus-dominant CSTs (one dominated by
Gardnerella vaginalis
and one by diverse facultative anaerobes). From the first antenatal visit to the third trimester (24–36 weeks gestation), 60% of women in the
Gardnerella
-dominant CST shifted to lactobacillus-dominant CSTs. From the third trimester to postpartum (mean 17 days post-delivery), 80% of women in lactobacillus-dominant CSTs shifted to non-lactobacillus-dominant CSTs with a large proportion in the facultative anaerobe-dominant CST. Microbial composition differed by STI diagnosis (PERMANOVA
R
2
= 0.002,
p
= 0.004), and women diagnosed with an STI were more likely to be categorized as
L. iners
-dominant or
Gardnerella
-dominant CSTs. Overall, we found a shift toward lactobacillus dominance during pregnancy and the emergence of a distinct, highly diverse anaerobe-dominant microbiota profile in the postpartum period.
PDF
