Background
Laparoscopic incisional and ventral hernia repair (LIVHR) is being used increasingly, with reported outcomes equivalent to those of open hernia repair. Closure of the fascial defect (CFD) ...is a technique that may reduce seroma formation and bulging after LIVHR. Non‐closure of the fascial defect makes the repair of larger defects easier and reduces postoperative pain. The aim of this systematic review was to determine whether CFD affects the rate of adverse outcomes, such as recurrence, pseudo‐recurrence, mesh eventration or bulging, and the rate of seroma formation.
Methods
A systematic search was performed of PubMed, Ovid, the Cochrane Library, Google Scholar and Scopus to identify RCTs that analysed CFD with regard to rates of adverse outcomes. A meta‐analysis was done using fixed‐effect methods. The primary outcome of interest was adverse events. Secondary outcomes were seroma, postoperative pain, mean hospital stay, mean duration of operation and surgical techniques employed.
Results
A total of 16 studies were identified involving 3638 patients, 2963 in the CFD group and 675 in the non‐closure of facial defect group. Significantly fewer adverse events were noted following CFD than non‐closure (4·9 per cent (79 of 1613) versus 22·3 per cent (114 of 511)), with a combined risk ratio (RR) of 0·25 (95 per cent c.i. 0·18 to 0·33; P < 0·001). CFD resulted in a significantly lower rate of seroma (2·5 per cent (39 of 1546) versus 12·2 per cent (47 of 385)), with a combined RR of 0·37 (0·23 to 0·57; P < 0·001), and shorter duration of hospital stay. No significant difference was noted in postoperative pain.
Conclusion
CFD during LIVHR reduces the rate of seroma formation and adverse hernia‐site events.
Defect should be closed
We investigate how inhomogeneous quintessence models may have a specific signature even in the linear regime of large-scale structure formation. The dynamics of the collapse of a dark matter halo is ...governed by the value or the dynamical evolution of the dark energy equation of state, the energy density's initial conditions and its homogeneity nature in the highly non-linear regime. These have a direct impact on the redshift of collapse, altering in consequence the linearly extrapolated density threshold above which structures will end up collapsing. We compute this quantity for minimally coupled and coupled quintessence models, examining two extreme scenarios: first, when the quintessence field does not exhibit fluctuations on cluster scales and below - homogeneous dark energy; and secondly, when the field inside the overdensity collapses along with the dark matter - inhomogeneous dark energy. One shows that inhomogeneous dark energy models present distinct features which may be used to confront them with observational data, for instance, galaxy number counting. Fitting formulae for the linearly extrapolated density threshold above which structures will end up collapsing are provided for models of dark energy with constant equation of state.
Summary
Background
Content‐valid and clinically meaningful instruments are required to evaluate outcomes of therapeutic interventions in alopecia areata (AA).
Objectives
To develop an Investigator's ...Global Assessment (IGA) to interpret treatment response in AA treatment studies.
Methods
Qualitative interviews were conducted in the USA with expert dermatologists and with patients with AA who had experienced ≥ 50% scalp‐hair loss. Thematic data analysis identified critical outcomes and evaluated the content validity of the new IGA.
Results
Expert clinicians (n = 10) judged AA treatment success by the amount of scalp‐hair growth (median 80% scalp hair). Adult (n = 25) and adolescent (n = 5) patients participated. Scalp‐hair loss was the most bothersome AA sign/symptom for most patients. Perceived treatment success – short of 100% scalp hair – was the presence of ~ 70–90% scalp hair (median 80%). Using additional clinician and patient insights, the Alopecia Areata Investigator Global Assessment (AA‐IGA™) was developed. This clinician‐reported outcome assessment is an ordinal, static measure comprising five severity categories of scalp‐hair loss. Nearly all clinicians and patients in this study agreed that, for patients with ≥ 50% scalp‐hair loss, successful treatment would be hair regrowth resulting in ≤ 20% scalp‐hair loss.
Conclusions
We recommend using the Severity of Alopecia Tool to assess the extent (0–100%) of scalp‐hair loss. The AA‐IGA is a robust ordinal measure providing distinct and clinically meaningful gradations of scalp‐hair loss that reflects patients’ and expert clinicians’ perspectives and treatment expectations.
What is already known about this topic?
The Severity of Alopecia Tool is widely used to assess the extent of scalp‐hair loss in patients with alopecia areata.
Guidelines define treatment success as a 50% improvement in scalp hair, and clinical trials have used dynamic thresholds of 50% and 90%.
However, there is no clinical consensus on these endpoints, and patient perspectives on treatment success are unknown.
What does this study add?
Through qualitative interviews with 10 expert dermatologists and 30 patients with alopecia areata who had experienced ≥ 50% scalp‐hair loss, we developed the Alopecia Areata Investigator Global Assessment (AA‐IGA™) to measure five clinically meaningful gradations of alopecia areata scalp‐hair loss that reflects patients’ and clinicians’ perspectives and expectations of treatment success in alopecia areata treatment studies.
What are the clinical implications of this work?
The AA‐IGA is a robust ordinal measure that can inform clinical evaluation of alopecia areata treatment outcomes.
The AA‐IGA can be used to determine clinically meaningful treatment success for alopecia areata, with success defined by patients and clinicians as reaching ≤ 20% scalp‐hair loss.
Linked Comment: Blome. Br J Dermatol 2020; 183:609.
Linked Comment: Blome. Br J Dermatol 2020; 183:609.
Plain language summary available online
Context.
Proxima Centauri is the closest star to the Sun. This small, low-mass, mid M dwarf is known to host an Earth-mass exoplanet with an orbital period of 11.2 days within the habitable zone, as ...well as a long-period planet candidate with an orbital period of close to 5 yr.
Aims.
We report on the analysis of a large set of observations taken with the ESPRESSO spectrograph at the VLT aimed at a thorough evaluation of the presence of a third low-mass planetary companion, which started emerging during a previous campaign.
Methods.
Radial velocities (RVs) were calculated using both a cross-correlation function (CCF) and a template matching approach. The RV analysis includes a component to model Proxima’s activity using a Gaussian process (GP). We use the CCF’s full width at half maximum to help constrain the GP, and we study other simultaneous observables as activity indicators in order to assess the nature of any potential RV signals.
Results.
We detect a signal at 5.12 ± 0.04 days with a semi-amplitude of 39 ± 7 cm s
−1
. The analysis of subsets of the ESPRESSO data, the activity indicators, and chromatic RVs suggest that this signal is not caused by stellar variability but instead by a planetary companion with a minimum mass of 0.26 ± 0.05
M
⊕
(about twice the mass of Mars) orbiting at 0.029 au from the star. The orbital eccentricity is well constrained and compatible with a circular orbit.
Context.
Ultra-hot Jupiters are excellent laboratories for the study of exoplanetary atmospheres. WASP-121b is one of the most studied; many recent analyses of its atmosphere report interesting ...features at different wavelength ranges.
Aims.
In this paper we analyze one transit of WASP-121b acquired with the high-resolution spectrograph ESPRESSO at VLT in one-telescope mode, and one partial transit taken during the commissioning of the instrument in four-telescope mode.
Methods.
We take advantage of the very high S/N data and of the extreme stability of the spectrograph to investigate the anomalous in-transit radial velocity curve and study the transmission spectrum of the planet. We pay particular attention to the removal of instrumental effects, and stellar and telluric contamination. The transmission spectrum is investigated through single-line absorption and cross-correlation with theoretical model templates.
Results.
By analyzing the in-transit radial velocities we were able to infer the presence of the atmospheric Rossiter–McLaughlin effect. We measured the height of the planetary atmospheric layer that correlates with the stellar mask (mainly Fe) to be 1.052 ± 0.015
R
p
and we also confirmed the blueshift of the planetary atmosphere. By examining the planetary absorption signal on the stellar cross-correlation functions we confirmed the presence of a temporal variation of its blueshift during transit, which could be investigated spectrum-by-spectrum thanks to the quality of our ESPRESSO data. We detected significant absorption in the transmission spectrum for Na, H, K, Li, Ca
II
, and Mg, and we certified their planetary nature by using the 2D tomographic technique. Particularly remarkable is the detection of Li, with a line contrast of ~0.2% detected at the 6
σ
level. With the cross-correlation technique we confirmed the presence of Fe
I
, Fe
II
, Cr
I
, and V
I
. H
α
and Ca
II
are present up to very high altitudes in the atmosphere (~1.44
R
p
and ~2
R
p
, respectively), and also extend beyond the transit-equivalent Roche lobe radius of the planet. These layers of the atmosphere have a large line broadening that is not compatible with being caused by the tidally locked rotation of the planet alone, and could arise from vertical winds or high-altitude jets in the evaporating atmosphere.
Context.
Despite swift progress in the characterisation of exoplanet atmospheres in composition and structure, the study of atmospheric dynamics has not progressed at the same speed. While ...theoretical models have been developed to describe the lower layers of the atmosphere, and independently, the exosphere, little is known about the intermediate layers up to the thermosphere.
Aims.
We aim to provide a clearer picture of atmospheric dynamics for the class of ultra-hot Jupiters, which are highly irradiated gas giants, based on the example of WASP-76 b.
Methods.
We jointly analysed two datasets that were obtained with the HARPS and ESPRESSO spectrographs to interpret the resolved planetary sodium doublet. We then applied the MERC code, which retrieves wind patterns, speeds, and temperature profiles on the line shape of the sodium doublet. An updated version of MERC, with added planetary rotation, also provides the possibility of modelling the latitude dependence of the wind patterns.
Results.
We retrieve the highest Bayesian evidence for an isothermal atmosphere, interpreted as a mean temperature of 3389 ± 227 K, a uniform day- to nightside wind of 5.5
−2.0
+1.4
km s
−1
in the lower atmosphere with a vertical wind in the upper atmosphere of 22.7
−4.1
+4.9
km s
−1
, switching atmospheric wind patterns at 10
−3
bar above the reference surface pressure (10 bar).
Conclusions.
Our results for WASP-76 b are compatible with previous studies of the lower atmospheric dynamics of WASP-76 b and other ultra-hot Jupiters. They highlight the need for vertical winds in the intermediate atmosphere above the layers probed by global circulation model studies to explain the line broadening of the sodium doublet in this planet. This work demonstrates the capability of exploiting the resolved spectral line shapes to observationally constrain possible wind patterns in exoplanet atmospheres. This is an invaluable input to more sophisticated 3D atmospheric models in the future.
In recent years, the advent of a new generation of radial velocity instruments has allowed us to detect planets with increasingly lower mass and to break the one Earth-mass barrier. Here we report a ...new milestone in this context by announcing the detection of the lowest-mass planet measured so far using radial velocities: L 98-59 b, a rocky planet with half the mass of Venus. It is part of a system composed of three known transiting terrestrial planets (planets b–d). We announce the discovery of a fourth nontransiting planet with a minimum mass of 3.06
−0.37
+0.33
M
⊕
and an orbital period of 12.796
−0.019
+0.020
days and report indications for the presence of a fifth nontransiting terrestrial planet. With a minimum mass of 2.46
−0.82
+0.66
M
⊕
and an orbital period 23.15
−0.17
+0.60
days, this planet, if confirmed, would sit in the middle of the habitable zone of the L 98-59 system. L 98-59 is a bright M dwarf located 10.6ṗc away. Positioned at the border of the continuous viewing zone of the
James Webb
Space Telescope, this system is destined to become a corner stone for comparative exoplanetology of terrestrial planets. The three transiting planets have transmission spectrum metrics ranging from 49 to 255, which undoubtedly makes them prime targets for an atmospheric characterization with the
James Webb
Space Telescope, the
Hubble
Space Telescope, Ariel, or ground-based facilities such as NIRPS or ESPRESSO. With an equilibrium temperature ranging from 416 to 627 K, they offer a unique opportunity to study the diversity of warm terrestrial planets without the unknowns associated with different host stars. L 98-59 b and c have densities of 3.6
−1.5
+1.4
and 4.57
−0.85
+0.77
g cm
−3
, respectively, and have very similar bulk compositions with a small iron core that represents only 12 to 14% of the total mass, and a small amount of water. However, with a density of 2.95
−0.51
+0.79
g cm
−3
and despite a similar core mass fraction, up to 30% of the mass of L 98-59 d might be water.
•Collaborative swarm intelligence is proposed to estimate PV parameters.•The proposed methodology mitigates premature convergence and population stagnation.•Benchmark functions and experimental data ...are used to test the new methodology.•The new methodology determines reliable solutions quickly and accurately.•Several comparisons and metrics support the obtained results.
To properly evaluate, control and optimize photovoltaic (PV) systems, it is crucial to accurately estimate the equivalent electric circuit parameters from the respective mathematical models that characterize the PV cells or modules behavior. This is currently a hot research topic that has attracted the attention of numerous researchers. In this paper, we propose a new hybrid methodology that combines diversification and intensification mechanisms from different metaheuristics (MHs) to estimate PV parameters precisely. The proposed methodology has the capacity to adapt to the specific optimization problem and maintain diversity when building solutions, thus mitigating premature convergence and population stagnation. This methodology can incorporate several MHs (two or more swarms) with different potentialities, enabling a good balance between diversification and intensification mechanisms. Furthermore, it is able to explore a multidimensional search space in different regions simultaneously. To validate its performance, the proposed methodology was compared with other well-established MHs in several benchmark functions, and used to estimate PV parameters in single and double-diode models in two case studies, the first using standard literature data, and the second using measured data from a real application with and without the occurrence of partial shading. The proposed methodology was able to find highly accurate solutions with reduced computational cost and high reliability. Comparisons with the other MHs demonstrate that the proposed methodology presents a very competitive performance when solving the PV parameter estimation problem.
Summary
Background
Valid patient‐reported outcome (PRO) measures are required to evaluate alopecia areata (AA) treatments.
Objectives
To develop a content‐valid and clinically meaningful PRO measure ...to assess AA scalp hair loss with scores comparable with the five‐response‐level Alopecia Areata Investigator Global Assessment (AA‐IGA™).
Methods
A draft PRO measure was developed based on input from 10 clinical experts in AA. The PRO measure was cognitively debriefed, modified and finalized through two rounds of qualitative semistructured interviews with patients with AA who had experienced ≥ 50% scalp hair loss. Data were thematically analysed.
Results
Adults (round 1: n = 25; round 2: n = 15) and adolescents aged 15–17 years (round 1: n = 5) in North America participated. All patients named scalp hair loss as a key AA sign or symptom. Patients demonstrated the ability to self‐report their current amount of scalp hair using percentages. In round 1 not all patients interpreted the measurement concept consistently; therefore, the PRO was modified to clarify the measurement concept to improve usability. Following modifications, patients in round 2 responded without difficulty to the PRO measure. Patients confirmed that they could use the five‐level response scale to rate their scalp hair loss: no missing hair, 0%; limited, 1–20%; moderate, 21–49%; large, 50–94%; nearly all or all, 95–100%. Almost all patients deemed hair regrowth resulting in ≤ 20% scalp hair loss a treatment success.
Conclusions
The Scalp Hair Assessment PRO™ is a content‐valid, clinically meaningful assessment of distinct gradations of scalp hair loss for evaluating AA treatment for patients with ≥ 50% hair loss at baseline.
What is already known about this topic?
Assessing patient‐reported outcomes is critical in patient‐focused drug development.
The patient perspective on their own signs, symptoms and unmet needs provides a key clinical trial data source for evaluating treatment outcomes.
Clinically meaningful and content‐valid patient‐reported outcome (PRO) measures are required to collect these data in alopecia areata (AA) clinical trials.
What does this study add?
This study developed a content‐valid PRO measure for patients with AA to self‐report the status of their scalp hair loss.
This novel PRO measure allows scalp hair loss to be characterized into clinically meaningful gradations across the range of 0–100% missing scalp hair.
What are the clinical implications of this work?
The Scalp Hair Assessment PRO™ provides a new clinical outcome assessment of AA scalp hair loss for use in both clinical trials to evaluate the efficacy of novel treatments and in clinical practice to obtain a patient‐centred perspective on the key sign and symptom of AA.
With corresponding response options to the newly developed Alopecia Areata Investigator Global Assessment (AA‐IGA™), clinician and patient assessments are comparable to elucidate any perceived differences between respondents.
Linked Comment: Rencz. Br J Dermatol 2020; 183:986–987.
Context.
The study of exoplanet atmospheres is essential for understanding the formation, evolution, and composition of exoplanets. The transmission spectroscopy technique is playing a significant ...role in this domain. In particular, the combination of state-of-the-art spectrographs at low- and high-spectral resolution is key to our understanding of atmospheric structure and composition.
Aims.
We observed two transits of the close-in sub-Saturn-mass planet, WASP-127b, with ESPRESSO in the frame of the Guaranteed Time Observations Consortium. We aim to use these transit observations to study the system architecture and the exoplanet atmosphere simultaneously.
Methods.
We used the Reloaded Rossiter-McLaughlin technique to measure the projected obliquity
λ
and the projected rotational velocity
v
eq
⋅sin(
i
*
). We extracted the high-resolution transmission spectrum of the planet to study atomic lines. We also proposed a new cross-correlation framework to search for molecular species and we applied it to water vapor.
Results.
The planet is orbiting its slowly rotating host star (
v
eq
⋅sin(
i
*
) = 0.53
−0.05
+0.07
km s
−1
) on a retrograde misaligned orbit (
λ
= −128.41
−5.46
+5.60
°). We detected the sodium line core at the 9-
σ
confidence level with an excess absorption of 0.34 ± 0.04%, a blueshift of 2.74 ± 0.79 km s
−1
, and a full width at half maximum of 15.18 ± 1.75 km s
−1
. However, we did not detect the presence of other atomic species but set upper limits of only a few scale heights. Finally, we put a 3-
σ
upper limit on the average depth of the 1600 strongest water lines at equilibrium temperature in the visible band of 38 ppm. This constrains the cloud-deck pressure between 0.3 and 0.5 mbar by combining our data with low-resolution data in the near-infrared and models computed for this planet.
Conclusions.
WASP-127b, with an age of about 10 Gyr, is an unexpected exoplanet by its orbital architecture but also by the small extension of its sodium atmosphere (~7 scale heights). ESPRESSO allows us to take a step forward in the detection of weak signals, thus bringing strong constraints on the presence of clouds in exoplanet atmospheres. The framework proposed in this work can be applied to search for molecular species and study cloud-decks in other exoplanets.
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