关键词： alternative scoring   bolt-on   Dermatology Life Quality Index   psoriasis   psychometrics   questionnaire modifications   skin disease   systematic review  

摘要： Objectives: Dermatology Life Quality index (DLQI) is the most widely used health-related quality of life questionnaire in dermatology. Little is known about existing questionnaire or scoring modifications of the DLQI. We aimed to systematically review, identify, and categorize all modified questionnaire versions and scoring methods of the DLQI. Methods: We performed a systematic literature search in PubMed, Web of Science, CINAHL, and PsychINFO. Methodologic quality and evidence of psychometric properties were assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) and Terwee checklists. Results: The included 81 articles reported on 77 studies using 59 DLQI modifications. Modifications were used for a combined sample of 25 509 patients with 47 different diagnoses and symptoms from 28 countries. The most frequently studied diseases were psoriasis, hirsutism, acne, alopecia, and bromhidrosis. The modifications were categorized into the following nonmutually exclusive groups: bolt-ons or bolt-offs (48%), disease, symptom, and body part specifications (42%), changes in existing items (34%), scoring modifications (27%), recall period changes (19%), response scale modifications (15%), and illustrations (3%). The evidence concerning the quality of measurement properties was heterogeneous: 4 of 13 studies were rated positive on internal consistency, 1 of 3 on reliability, 3 of 5 on content validity, 9 of 22 on construct validity, 6 of 6 on criterion validity, and 1 of 1 on responsiveness. Conclusion: An exceptionally large number of DLQI modifications have been used that may indicate an unmet need for adequate health-related quality of life instruments in dermatology. The psychometric overview of most questionnaire modifications is currently incomplete, and additional efforts are needed for proper validation.

关键词： Meat sheep   Selection objective   Genetic evaluation   Prolificacy   Weight at 30 days of age   Litter weight  

摘要： Weight of lambs produced per ewe is an important economic-related trait for French meat sheep farmers. Consequently, genetic improvement of their ewes is based on selecting maternal traits using a global index, called MAT, which combines estimated breeding values for litter size at lambing (LS), weight at 30 days of age (W30D) and viability over the same period. The frame of this study is to compare the official approach to genetic evaluation of maternal traits which combine several estimated breeding values with a direct genetic evaluation of a proxy trait of the farmer's objective. The weight of lambs produced per ewe and per lambing was chosen as this proxy of meat production potential of ewes. In a first step, we estimated the genetic parameters of this alternative criterion, the litter weight (LW), which is the sum of the W30Ds of lambs of the same litter. In a second step, we compared these parameters with those of LS, W30D and MAT, which are routinely used. Datasets comprising 2006-2018 records of 190,883 and 271,963 litters of the Ile de France (IF) and Blanche du Massif Central (BMC) breeds respectively, were analysed. The genetic evaluations were performed using Asreml software according to BLUP animal models, which were the closest to the models used in routine evaluation. Two models are presented: a two-trait model LS and W30D and a two-trait model LS and LW. For LS and LW, records are linked to ewes. For W30D, both direct and maternal effects were considered. Direct animal variance (sigma 2a_LW = 28.02 for IF and sigma 2a_LW = 16.55 for BMC) and heritability (h2a_LW = 0.06 for IF and h2a_LW = 0.04 for BMC) of LW suggest it is possible to select based on this trait while simultaneously improving LS (rga_LS/a_LW = 0.78 for IF and rga_LS/a_LW = 0.67 for BMC). Moreover, the genetic progress curves of MAT and LW indicate that the selection based on MAT gave a positive correlated response on LW. Highly correlations between MAT and LW breeding values were esti

关键词： Fusion   DEMO   Superconducting magnets   PF coil   CIC forced flow cable  

摘要： The EUROfusion DEMO machine is at its pre-conceptual stage. The design of the magnet system for this machine is being developed in collaboration with several European research centers. The Poloidal Field (PF) coils proposed by the Swiss Plasma Center (SPC) use a multiple-in-hand Pancake winding technique. A design based on updated plasma scenarios (2018) was recently proposed. The Winding Pack (WP) aspect ratio was kept close to one, similar to the baseline design in the EUROfusion 2018 DEMO baseline document. In this publication, we study the effects of changing WP aspect ratio. A vertically elongated WP cross-section is beneficial in the reduction of the peak magnetic field at WP cross-section, the machine radial extent, and the hydraulic lengths. However, it increases the bending stress on the WP. An updated PF design is presented. The dimensioning and allocation of materials is based on 3-dimensional electromagnetic calculations. Mechanical performance is evaluated against both dynamic fatigue stress and static stresses. The static stresses are evaluated through 3-dimensional finite element simulations to take into account also the ripple effect of TF coils and increase in bending stresses due to the elongation of the WP cross-section. The thermal-hydraulic analysis verifies a temperature margin of 1.5 K and confirms sufficient coolant flow for the prescribed pressure drop. The quench analysis determines the hot-spot temperatures during various quench scenarios.

关键词： Euthanasia   Barbiturates   Potassium chloride   Magnesium Chloride  

摘要： Barbiturate overdose as a method of euthanasia is becoming unacceptable. This has made alternative methods of euthanasia very important. Gunshot or captive bolt euthanasia is among methods that are acceptable, but they may not be esthetically acceptable. This has led to the use of other methods of euthanasia. Inducing anesthesia prior to euthanasia offers an easier method of control. Adjunctive techniques using intravenous potassium or magnesium salts administered intravenously and intracardiac administration of potassium chloride or intrathecal lidocaine offer alternatives that work well and are more environmentally safer than barbiturates. Pithing and exsanguination are also environmentally safer but may not be as esthetically acceptable as the other methods.

关键词： Phase II study   Breast cancer   Preventive medicine   Exemestane   Drug schedule and alternative dose  

摘要： Introduction: Aromatase inhibitors are effective in lowering breast cancer incidence among postmenopausal women, but adverse events represent a barrier to their acceptability and adherence as a preventive treatment. This study aims to assess whether lowering exemestane schedule may retain biological activity while improving tolerability in breast cancer patients. Methods/design: We are conducting a, pre-surgical, non-inferiority phase IIb study in postmenopausal women with newly diagnosed estrogen receptor-positive breast cancer. Participants are randomized to receive either exemestane 25 mg/day or 25 mg/three times-week or once a week for 4 to 6 weeks prior to surgery. The primary endpoint is the percentage change of serum estradiol concentration between baseline and surgery comparing the three arms. Sample size of 180 women was calculated assuming a 6% non-inferiority of the percent change of estradiol in the lower dose arms compared with the 80% decrease predicted in the full dose arm, with 80% power and using a one-sided 5% significance level and a two-sample t-test. Main secondary outcomes are: safety;change in Ki-67 in cancer and adjacent pre-cancer tissue, circulating sex hormones, adipokines, lipid profile, insulin and glucose changes, in correlation with drug and metabolites concentrations. Results and discussion: The present paper is focused on methodology and operational aspects of the study. A total of 180 participants have ben enrolled. The trial is still blinded, and the analyses are ongoing. Despite the short term duration, results may have relevant implications for clinical management of women at increased risk of developing a ER positive breast cancer.

关键词： Coronary artery   COVID-19   IVIG   Kawasaki disease  

摘要： Objective To study the clinical profile and outcome of children with MIS-C treated with methylprednisolone pulse therapy and/or intravenous immunoglobulin (IVIG). Method This prospective observational study included children satisfying CDC MIS-C criteria admitted from September to November, 2020. Primary outcome was persistence of fever beyond 36 hours after start of immunomodulation therapy. Secondary outcomes included duration of ICU stay, mortality, need for repeat immunomodulation, time to normalization of CRP and persistence of coronary abnormalities at 2 weeks. Results Study population included 32 patients with MIS-C with median (IQR) age of 7.5 (5-9.5) years. The proportion of children with gastrointestinal symptoms was 27 (84%), cardiac was 29 (91%) and coronary artery dilatation was 11 (34%). Pulse methylprednisolone and intravenous immunoglobulin were used as first line therapy in 26 (81%), and 6 (19%) patients, respec-tively. Treatment failure was observed in 2/26 patients in methylprednisolone group and 2/6 patients in IVIG group. C-reactive protein levels less than 60mg/L by day 3 was seen in 17(74%) in methylprednisolone group and 2 (25%) in IVIG group (P=0.014). There was no mortality. At 2 weeks follow-up coronary artery dilatation persisted in 4 in methylprednisolone group and 1 in IVIG group. Conclusion In patients with SARS-CoV-2 related MIS-C, methylprednisolone pulse therapy was associated with favorable short-term outcomes.

摘要： Among the top 5 leading causes of cancer deaths in the United States, PC is the only malignancy for which screening is not recommended (2). Because of the overall low incidence of PC (1,2), even a fairly specific test with high positive predictive value would yield an unacceptable large burden of false-positives. See PDF] With the recent recommendation that all individuals with newly diagnosed PC undergo germline genetic testing to potentially guide treatment options, germline mutation carriers will be more readily identified and their family members would benefit from testing for the familial gene (14). Cascade testing, or testing of at-risk family members of patients with PC found to have a germline mutation at initial diagnosis, will potentially identify an increasing number of individuals who could benefit from PC screening. [...]PC screening is currently reserved for HRI who have an inherited predisposition and high lifetime risk of PC development and not recommended in the general population (4,7,8).

关键词： lone‐   pair ns   (2) electronic configurations   material design   optoelectronic applications   performance enhancement   structural dimensionality  

摘要： Lead halide perovskites have emerged in the last decade as advantageous high-performance optoelectronic semiconductors, and have undergone rapid development for diverse applications such as solar cells, light-emitting diodes , and photodetectors. While material instability and lead toxicity are still major concerns hindering their commercialization, they offer promising prospects and design principles for developing promising optoelectronic materials. The distinguished optoelectronic properties of lead halide perovskites stem from the Pb2+ cation with a lone-pair 6s(2) electronic configuration embedded in a mixed covalent-ionic bonding lattice. Herein, we summarize alternative Pb-free semiconductors containing lone-pair ns(2) cations, intending to offer insights for developing potential optoelectronic materials other than lead halide perovskites. We start with the physical underpinning of how the ns(2) cations within the material lattice allow for superior optoelectronic properties. We then review the emerging Pb-free semiconductors containing ns(2) cations in terms of structural dimensionality, which is crucial for optoelectronic performance. For each category of materials, the research progresses on crystal structures, electronic/optical properties, device applications, and recent efforts for performance enhancements are overviewed. Finally, the issues hindering the further developments of studied materials are surveyed along with possible strategies to overcome them, which also provides an outlook on the future research in this field.

摘要： A growing movement to integrate the arts and humanities into health professions education is afoot. While educators may easily conceive how arts-based teaching can improve clinically relevant skills such as observation and critical thinking, they may not realize it also has the potential to transform learners in myriad ways beyond sharpening these fundamental skills. In this article, the authors review how visual arts-based education can promote clinical excellence by enhancing communication and interpersonal skills, professionalism and humanism, diagnostic acumen and clinical reasoning, and passion for clinical medicine. They describe the most widely studied visual arts-based education method, Visual Thinking Strategies, in detail as an exemplar of how arts-based pedagogy can help health care professionals strive for and ultimately achieve clinical excellence.