Summary Massive slums have become major features of cities in many low-income and middle-income countries. Here, in the first in a Series of two papers, we discuss why slums are unhealthy places with ...especially high risks of infection and injury. We show that children are especially vulnerable, and that the combination of malnutrition and recurrent diarrhoea leads to stunted growth and longer-term effects on cognitive development. We find that the scientific literature on slum health is underdeveloped in comparison to urban health, and poverty and health. This shortcoming is important because health is affected by factors arising from the shared physical and social environment, which have effects beyond those of poverty alone. In the second paper we will consider what can be done to improve health and make recommendations for the development of slum health as a field of study.
To cite this article: Cernadas JR, Brockow K, Romano A, Aberer W, Torres MJ, Bircher A, Campi P, Sanz ML, Castells M, Demoly P, Pichler WJ, for the European Network of Drug Allergy and the EAACI ...interest group on drug hypersensitivity. General considerations on rapid desensitization for drug hypersensitivity - a consensus statement. Allergy 2010; 65: 1357-1366. Drug hypersensitivity reactions can occur with most drugs, are unpredictable, may affect any organ or system, and range widely in clinical severity from mild pruritus to anaphylaxis. In most cases, the suspected drug is avoided in the future. However, for certain patients, the particular drug may be essential for optimal therapy. Under these circumstances, desensitization may be performed. Drug desensitization is defined as the induction of a temporary state of tolerance of a compound responsible for a hypersensitivity reaction. It is performed by administering increasing doses of the medication concerned over a short period of time (from several hours to a few days) until the total cumulative therapeutic dose is achieved and tolerated. It is a high-risk procedure used only in patients in whom alternatives are less effective or not available after a positive risk/benefit analysis. Desensitization protocols have been developed and are used in patients with allergic reactions to antibiotics (mainly penicillin), insulins, sulfonamides, chemotherapeutic and biologic agents, and many other drugs. Desensitization is mainly performed in IgE-mediated reactions, but also in reactions where drug-specific IgE have not been demonstrated. Desensitization induces a temporary tolerant state, which can only be maintained by continuous administration of the medication. Thus, for treatments like chemotherapy, which have an average interval of 4 weeks between cycles, the procedure must be repeated for every new course. In this paper, some background information on rapid desensitization procedures is provided. We define the drugs and drug reactions indicated for such procedures, describe the possible mechanism of action, and discuss the indications and contraindications. The data should serve as background information for a database (accessible via the EAACI-homepage) with standardized protocols for rapid desensitization for antibiotics, chemotherapeutic agents, monoclonal antibodies/fusion proteins, and other drugs.
•An UAV was used for multi-temporal quantification of vegetation fraction.•Overall classification accuracy up to 92% were achieved with visible vegetation.•The excess green index reported the best ...result for vegetation mapping with UAV imagery.•Flight altitude scarcely affected classification accuracy.•UAV imagery is suitable for analysis of narrow row crops as wheat.
Mapping vegetation in crop fields is an important step in remote sensing applications for precision agriculture. Traditional aerial platforms such as planes and satellites are not suitable for these applications due to their low spatial and temporal resolutions. In this article, a UAV equipped with a commercial camera (visible spectrum) was used for ultra-high resolution image acquisition over a wheat field in the early-season period. From these images, six visible spectral indices (CIVE, ExG, ExGR, Woebbecke Index, NGRDI, VEG) and two combinations of these indices were calculated and evaluated for vegetation fraction mapping, to study the influence of flight altitude (30 and 60m) and days after sowing (DAS) from 35 to 75 DAS on the classification accuracy. The ExG and VEG indices achieved the best accuracy in the vegetation fraction mapping, with values ranging from 87.73% to 91.99% at a 30m flight altitude and from 83.74% to 87.82% at a 60m flight altitude. These indices were also spatially and temporally consistent, allowing accurate vegetation mapping over the entire wheat field at any date. This provides evidence that visible spectral indices derived from images acquired using a low-cost camera onboard a UAV flying at low altitudes are a suitable tool to use to discriminate vegetation in wheat fields in the early season. This opens the doors for the utilisation of this technology in precision agriculture applications such as early site specific weed management in which accurate vegetation fraction mapping is essential for crop-weed classification.
The present work reports a facile strategy to develop L-arginine mediated Zn doped graphitic carbon nitride (g-C
3
N
4
) and its enhanced photocatalytic activity. The physicochemical properties of ...Zn-doped g-C
3
N
4
were studied extensively by XPS, UV–Vis, XRD, SEM and BET analysis. The studied properties of the photocatalyst were then correlated with its photocatalytic hydrogen production rates. Zn doping was evidenced by the presence of Zn-N peak from high-resolution core level XPS spectral analysis. Photocatalytic hydrogen evolution experiments revealed that, upon Zn doping, the hydrogen production rate of g-C
3
N
4
was increased from 34.6 to 78.7 µmol/g.h, i.e. 2.3 times more. The enhancement in the photocatalytic properties after Zn doping was addressed by estimating changes in the positions of conduction band minimum and valence band maximum through XPS valence band spectral analysis.
Median survival of patients with brain metastases from nonsmall cell lung cancer (NSCLC) is poor and more effective treatments are urgently needed. We have evaluated the efficacy of erlotinib in this ...setting and its association with activating mutations in the epidermal growth factor receptor (EGFR) gene. We retrospectively identified patients with NSCLC and brain metastases treated with erlotinib. EGFR mutations in exons 19 and 21 were analysed by direct sequencing. Efficacy and tolerability were compared according to EGFR mutational status. 69 NSCLC patients with brain metastases were identified, 17 of whom harboured EGFR mutations. Objective response rate in patients with EGFR mutations was 82.4%; no responses were observed in unselected patients (p<0.001). Median (95% CI) time to progression within the brain for patients harbouring EGFR mutations was 11.7 (7.9-15.5) months, compared to 5.8 (5.2-6.4) months for control patients whose EGFR mutational status had not been assessed (p<0.05). Overall survival was 12.9 (6.2-19.7) months and 3.1 (2.5-3.9) months (p<0.001), respectively. The toxicity of erlotinib was as expected and no differences between cohorts were observed. Erlotinib is active in brain metastases from NSCLC; this clinical benefit is related to the presence of activating mutations in exons 19 or 21 of the EGFR gene.
Analyze the measurement invariance and the factor structure of the Patient Health Questionnaire-9 (PHQ-9) in the Peruvian population.
Secondary data analysis performed using cross-sectional data from ...the Health Questionnaire of the Demographic and Health Survey in Peru. Variables of interest were the PHQ-9 and demographic characteristics (sex, age group, level of education, socioeconomic status, marital status, and area of residence). Factor structure was evaluated by standard confirmatory factor analysis (CFA), and measurement invariance by multi-group CFA, using standard goodness-of-fit indices criteria for interpreting results from both CFAs. Analysis of the internal consistency (α and ω) was also pursued.
Data from 30,449 study participants were analyzed, 56.7% were women, average age was 40.5 years (standard deviation (SD) = 16.3), 65.9% lived in urban areas, 74.6% were married, and had 9 years of education on average (SD = 4.6). From standard CFA, a one-dimensional model presented the best fit (CFI = 0.936; RMSEA = 0.089; SRMR = 0.039). From multi-group CFA, all progressively restricted models had ΔCFI<0.01 across almost all groups by demographic characteristics. PHQ-9 reliability was optimal (α = ω = 0.87).
The evidence presents support for the one-dimensional model and measurement invariance of the PHQ-9 measure, allowing for reliable comparisons between sex, age groups, education level, socioeconomic status, marital status, and residence area, and recommends its use within the Peruvian population.
Multiloop scattering amplitudes describing the quantum fluctuations at high-energy scattering processes are the main bottleneck in perturbative quantum field theory. The loop-tree duality is a novel ...method aimed at overcoming this bottleneck by opening the loop amplitudes into trees and combining them at integrand level with the real-emission matrix elements. In this Letter, we generalize the loop-tree duality to all orders in the perturbative expansion by using the complex Lorentz-covariant prescription of the original one-loop formulation. We introduce a series of mutiloop topologies with arbitrary internal configurations and derive very compact and factorizable expressions of their open-to-trees representation in the loop-tree duality formalism. Furthermore, these expressions are entirely independent at integrand level of the initial assignments of momentum flows in the Feynman representation and remarkably free of noncausal singularities. These properties, that we conjecture to hold to other topologies at all orders, provide integrand representations of scattering amplitudes that exhibit manifest causal singular structures and better numerical stability than in other representations.
While osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) is the standard treatment in patients with advanced non-small-cell lung cancer (NSCLC) ...with sensitising EGFR and acquired T790M mutations, progression inevitably occurs. The angiogenic pathway is implicated in EGFR TKI resistance.
BOOSTER is an open-label randomised phase II trial investigating the efficacy and safety of combined osimertinib 80 mg daily and bevacizumab 15 mg/kg every 3 weeks, versus osimertinib alone, in patients with EGFR-mutant advanced NSCLC and acquired T790M mutations after failure on previous EGFR TKI therapy. Primary endpoint was investigator-assessed progression-free survival (PFS). Secondary endpoints were overall survival (OS), objective response rate (ORR) and adverse events (AEs).
Between May 2017 and February 2019, 155 patients were randomised (combination: 78; osimertinib: 77). At data cut-off of 22 February 2021, median follow-up was 33.8 months interquartile range (IQR): 26.5-37.6 months and 129 (83.2%) PFS events were reported in the intention-to-treat population. There was no difference in median PFS between the combination 15.4 months; 95% confidence interval (CI) 9.2-18.0 months and osimertinib arm (12.3 months; 95% CI 6.2-17.2 months; stratified log-rank P = 0.83), hazard ratio (HR) = 0.96; 95% CI 0.68-1.37. Median OS was 24.0 months (95% CI 17.8-32.1 months) in the combination arm and 24.3 months (95% CI 16.9-37.0 months) in the osimertinib arm (stratified log-rank P = 0.91), (HR = 1.03; 95% CI 0.67-1.56). Exploratory analysis revealed a significant interaction of smoking history with treatment for PFS (adjusted P = 0.0052) with a HR of 0.52 (95% CI 0.30-0.90) for smokers, and 1.47 (95% CI 0.92-2.33) for never smokers. ORR was 55% in both arms and the median time to treatment failure was significantly shorter in the combination than in the osimertinib arm, 8.2 months versus 10.8 months, respectively (P = 0.0074). Safety of osimertinib and bevacizumab was consistent with previous reports with grade ≥3 treatment-related AEs (TRAEs) reported in 47% and 18% of patients on combination and osimertinib alone, respectively.
No difference in PFS was observed between osimertinib plus bevacizumab and osimertinib alone. Grade ≥3 TRAEs were more common in patients on combination.
•A randomised trial comparing bevacizumab plus osimertinib versus osimertinib alone in EGFR-mutant NSCLC with T790M mutations.•The primary endpoint was investigator-assessed PFS.•No difference in PFS was observed between osimertinib plus bevacizumab and osimertinib alone.•TRAEs of grade ≥3 were more common in patients on combination than osimertinib alone.
Tree pruning is a costly practice with important implications for crop harvest and nutrition, pest and disease control, soil protection and irrigation strategies. Investigations on tree pruning ...usually involve tedious on-ground measurements of the primary tree crown dimensions, which also might generate inconsistent results due to the irregular geometry of the trees. As an alternative to intensive field-work, this study shows a innovative procedure based on combining unmanned aerial vehicle (UAV) technology and advanced object-based image analysis (OBIA) methodology for multi-temporal three-dimensional (3D) monitoring of hundreds of olive trees that were pruned with three different strategies (traditional, adapted and mechanical pruning). The UAV images were collected before pruning, after pruning and a year after pruning, and the impacts of each pruning treatment on the projected canopy area, tree height and crown volume of every tree were quantified and analyzed over time.
The full procedure described here automatically identified every olive tree on the orchard and computed their primary 3D dimensions on the three study dates with high accuracy in the most cases. Adapted pruning was generally the most aggressive treatment in terms of the area and volume (the trees decreased by 38.95 and 42.05% on average, respectively), followed by trees under traditional pruning (33.02 and 35.72% on average, respectively). Regarding the tree heights, mechanical pruning produced a greater decrease (12.15%), and these values were minimal for the other two treatments. The tree growth over one year was affected by the pruning severity and by the type of pruning treatment, i.e., the adapted-pruning trees experienced higher growth than the trees from the other two treatments when pruning intensity was low (<10%), similar to the traditionally pruned trees at moderate intensity (10-30%), and lower than the other trees when the pruning intensity was higher than 30% of the crown volume.
Combining UAV-based images and an OBIA procedure allowed measuring tree dimensions and quantifying the impacts of three different pruning treatments on hundreds of trees with minimal field work. Tree foliage losses and annual canopy growth showed different trends as affected by the type and severity of the pruning treatments. Additionally, this technology offers valuable geo-spatial information for designing site-specific crop management strategies in the context of precision agriculture, with the consequent economic and environmental benefits.
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