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Background: Proteins in the urine of women with preeclampsia (PE) bind Congo Red dye (urine congophilia). We sought to determine the diagnostic performance of a paper-based point-of-care test detecting urine congophilia for rapid triage and diagnosis of PE. Methods: Prospective cohort study conducted in 346 consecutive pregnant women evaluated for PE in the Labour and Delivery triage unit at our institution. The Congo Red Dot (CRD) Paper Test (index test) was performed on fresh urine samples. The CRD Paper Test results were compared to an expert adjudicated diagnosis in each case. The accuracy of the CRD Paper Test was also compared to urine and serum analytes (placental growth factor and soluble fms-like tyrosine kinase-1) previously proposed as diagnostic aids for PE. Findings: During the first triage visit, 32% (112/346) of women received a clinical diagnosis of PE. Yet, 63% (217/346) were admitted for in-patient diagnostic work-up or delivery. The CRD Paper Test was positive in 25% (86/346) of the cases. Adjudication confirmed PE in 28% (96/346) of all cases. The CRD Paper Test outperformed measured serum and urine markers (80·2% sensitivity, 89·2% specificity, 92·1% negative predictive value, 86·7% accuracy). The pre-test, positive and negative post-test probabilities were 27·7%, 74·0%, and 8·0%, respectively. Of women who were discharged undelivered, 38% (133/346) had at least one additional triage visit and the interval between the last negative and first positive CRD Paper Test was 12 (interquartile range, [5–34]) days. Interpretation: The CRD Paper Test is a simple, non-invasive, “sample-in/answer-out” point-of-care clinical tool for rapid identification of PE. Funding: Saving Lives at Birth Program and NICHD. Keywords: Preeclampsia, Cohort study, Congophilia, Misfolded proteins, Point-of-care

We consider discrete dynamical systems coming from the models of evolution of populations playing rock - paper - scissors game . Asymptotic behaviour of trajectories of these systems is described, occurrence of the Neimark-Sacker bifurcation and nonexistence of time averages are proved.

In 2018, the American Glaucoma Society (AGS), the world’s largest professional society of glaucoma subspecialists, convened a 12-member task force of experts to craft a position statement about microinvasive glaucoma surgery (MIGS). The main objective of this position statement is to provide a succinct overview of these procedures and to address some misconceptions about MIGS. The members of the task force were selected by the AGS Board of Directors and include AGS members with expertise in developing MIGS, teaching MIGS, performing research on use and outcomes of these procedures, and working with the United States Food and Drug Administration (FDA) and other regulatory agencies about developing criteria to evaluate the efficacy and safety of these devices. Each of the sections of the position statement was prepared by subgroups of the task force, and then the material from the various sections was aggregated, and the leader of the task force (J.D.S.) merged the material into a cohesive draft. This draft was shared with the AGS Executive Committee and other members of the AGS Board of Directors for additional input.

This paper presents an example of how paper folding can be used in a geometry class to support conceptual understanding. Specifically, it explains an activity that constructs a rhombus and explores its attributes by using paper folding. The steps of constructing a rhombus are described and some discussion questions are given to consolidate understanding. © 2017 Informa UK Limited, trading as Taylor & Francis Group.

Publication doctorant; International audience; Our research team is specialized in human-computer systems and their engineering, with focus on interactive software systems for aeronautics (from cockpits to control towers). This context stands out by the need for certification, such as DO-178 or ED-12. Today, formal methods are pushed forward, as one of the best tools to achieve the verification and validation of properties, leading to the certification of these systems. Interactive systems are reactive computer systems that process information from their environment and produce a representation of their internal state. They offer new rich interfaces with sophisticated interactions. Their certification is a challenge, because the validation is often a human based process since traditional formal tools are not always suitable to the verification of graphical properties in particular.In this paper, we explore the scientific work that has been done in formal methods for interactive systems over the last decade, in a systematic study of publications in the International Workshop on Formal Methods for Interactive Systems. We describe an analytical framework that we apply to classify the studied work into classes of properties and used formalisms. We then discuss the emerging findings, mainly the lack of papers addressing the formal specification or validation of perceptibility properties. We conclude with an overview of our future work in this area.

We correct a mistake in a lemma in the paper cited in the title and show that it did not affect any of the other results of the paper. To this end, we prove results on linearly disjoint field extensions that do not seem to be commonly known. We give an example to show that a separability assumption in one of these results cannot be dropped (doing so had led to the mistake). Further, we discuss recent generalizations of the original classification of defect extensions.

The goal of the Ending the HIV Epidemic Initiative is to reduce new infections in the United States by 90% by 2030. Success will require fundamentally changing human immunodeficiency virus (HIV) prevention and care delivery to engage more persons with HIV and at risk of HIV in treatment. While the coronavirus disease 2019 (COVID-19) pandemic reduced in-person visits to care facilities and led to concern about interruptions in care, it also accelerated growth of alternative options, bolstered by additional funding support. These included the use of telehealth, medication delivery to the home, and increased flexibility facilitating access to Ryan White HIV/AIDS Program services. While the outcomes of these programs must be studied, many have improved accessibility during the pandemic. As the pandemic wanes, long-term policy changes are needed to preserve these options for those who benefit from them. These new care paradigms may provide a roadmap for progress for those with other chronic health issues as well.

We discuss the recent paper by A. Dar\'os and L.K. Arruda (On the instability of elliptic traveling wave solutions of the modified Camassa-Holm equation, J. Diff. Equat., 266 (2019), 1946-1968). Our intention is to correct some imperfections left by the authors and present the orbital stability of periodic snoidal waves in the energy space., Comment: 10 pages and 2 figures

We study a class of algebras we regard as generalized Rock-Paper-Scissors games. We determine when such algebras can exist, show that these algebras generate the varieties generated by hypertournament algebras, count these algebras, study their automorphisms, and determine their congruence lattices. We produce a family of finite simple algebras., Submitted to the special Topical Collection of Algebra Universalis honoring Ralph Freese, Bill Lampe, and JB Nation

In several recent papers, attempts have been made to apply Wardowski's method of $F$-contractions in order to obtain fixed point results for single and multivalued mappings in $b$-metric spaces. In this article, it is shown that in most cases the conditions imposed on respective mappings are too strong and that the results can be obtained directly, i.e., without using most of the properties of auxiliary function $F$.

We present a tool for the specification and verification of reconfigurable systems. The foundation of the tool is provided by a generic method, called hybridisation of institutions, of extending an arbitrary base institution with features characteristic to hybrid logic, both at the syntactic and the semantic level. Automated proof support for hybridised institutions is obtained via a generic lifting of encodings to first-order logic from the base institution to the hybridised institution. We describe how hybridisation and lifting of encodings to first-order logic are implemented in an extension of the Heterogeneous Tool Set in their full generality. We illustrate the formalism thus obtained with the specification and verification of an autonomous car driving system for highways.

Leonetti proved that whenever $${\mathcal {I}}$$ is an ideal on $${\mathbb {N}}$$ such that there exists an uncountable family of sets that are not in $${\mathcal {I}}$$ with the property that the intersection of any two distinct members of that family is in $${\mathcal {I}}$$ , then the space $$c_{0,{\mathcal {I}}}$$ of sequences in $$\ell _\infty $$ that converge to 0 along $${\mathcal {I}}$$ is not complemented. We provide a shorter proof of a more general fact that the quotient space $$\ell _\infty / c_{0,{\mathcal {I}}}$$ does not even embed into $$\ell _\infty $$ .

Some recent analytical papers have explored limiting behaviors of Landau-deGennes models for liquid crystals in certain extreme ranges of the model parameters: limits of "vanishing elasticity" (in the language of some of these papers) and "low-temperature limits." We use simple scaling analysis to show that these limits are properly interpreted as limits in which geometric length scales (such as the size of the domain containing the liquid crystal material) become large compared to intrinsic length scales (such as correlation lengths or coherence lengths, which determine defect core sizes). This represents the natural passage from a mesoscopic model to a macroscopic model and is analogous to a "London limit" in the Ginzburg-Landau theory of superconductivity or a "large-body limit" in the Landau-Lifshitz theory of ferromagnetism. Known relevant length scales in these parameter regimes (nematic correlation length, biaxial coherence length) can be seen to emerge via balances in equilibrium Euler-Lagrange equations associated with well-scaled Landau-deGennes free-energy functionals., 17 pages; no figures; uses Springer journal LaTeX class file svjour3.cls; uses LaTeX packages mathptmx, amsmath, amssymb, and mathtools. Version 'v2' is an update of the note originally posted Dec 2015. The main change (based upon feedback on the earlier note) is to add consideration of the "low temperature" limit (and to illustrate its relationship to the "large body" limit already discussed)

In this short note, it is shown that there is a gap in the proof of Theorem 11 in the paper of Meyer and Neutsch (J. of Algebra, 1993). We prove, nevertheless, that the statement of the theorem is true and fix the proof by using a certain extremal property of idempotents which has an independent interest., 6 pages, submitted 2017

The aim of this paper is to study a new equivalent form of the weak maximum principle for a large class of differential operators on Riemannian manifolds. This new form has been inspired by the work of Berestycki, Hamel and Rossi for trace operators, and allows us to shed new light on it and to introduce a new sufficient bounded Khas’minskii type condition for its validity. We show its effectiveness by applying it to obtain some uniqueness results in a geometric setting.

This article is intended to indicate and discuss some errors in N. Lavi’s paper “A Ganzstellensatz for semi-algebraic sets and a boundedness criterion for rational functions”.

In this short note, we show that all results presented in Alderremy et al. (2018) are straightforward and can be obtained immediately as special cases by means of Laplace’s transform. Furthermore, we show that Elzaki’s transform is a special case of Laplace’s transform, and then cannot be a new transform. Also, we mention that the application of the recursion scheme of the new iterative method (NIM) is incorrect. Keywords: Elzaki transform, Laplace transform, Novel Elzaki iterative method

This is a continuation of our first paper in [WY16]. There are two purposes of this paper: One is to give a proof of the main result in [WY16] without going through the argument depending on numerical effectiveness. The other one is to provide a proof of our conjecture, mentioned in [TY], where the assumption of negative holomorphic sectional curvature is dropped to quasi-negative. We should note that a solution to our conjecture is also provided by Diverio-Trapani [DT]. Both proofs depend on our argument in [WY16]. But our argument here makes use of the argument given by the second author and Cheng in [CY75].

In (Barbour, 1990) foundations for diffusion approximation via Stein's method are laid. This paper has been cited more than 130 times and is a cornerstone in the area of Stein's method. A semigroup argument is used therein to solve a Stein equation for Gaussian diffusion approximation. We prove that, contrary to the claim in (Barbour, 1990), the semigroup considered therein is not strongly continuous on the Banach space of continuous, real-valued functions on D[0,1] growing slower than a cubic, equipped with an appropriate norm. We also provide a proof of the exact formulation of the solution to the Stein equation of interest, which does not require the aforementioned strong continuity. This shows that the main results of (Barbour, 1990) hold true., Comment: 8 pages

We correct an error in the Multiple Point Formula (7.3) in the paper mentioned in the title. This correction propagates to formulas (7.5), (7.6), (7.23) and (8.18), and it affects minor results in Section 8, where few statements require an extra assumption, but it does not affect the main results of Section 8.

In T. Kruse and A. Popier, we established existence and uniqueness of solutions of backward stochastic differential equations in under a monotonicity condition on the generator and in a general filtration. There was a mistake in the case . Here we give a corrected proof. Moreover the quasi-left continuity condition on the filtration is removed.

International audience; In a previous paper, we have described the construction of an automaton from a rational expression which has the property that the automaton built from an expression which is itself computed from a co-deterministic automaton by the state elimination method is co-deterministic. It turned out that the definition on which the construction is based was inappropriate, and thus the proof of the property was flawed. We give here the correct definition of the broken derived terms of an expression which allow to define the automaton and the detailed full proof of the property.

Greg Friedman has pointed out that there are sign errors in our paper ‘On the chain-level intersection pairing for PL manifolds’, linked above, and in particular Lemma 10.5(b) (which is a key step in the proof of the main theorem) is not correct as stated. ¶ The purpose of this note is to provide a correction.

The spectral gap conjecture of M. van den Berg [2, formula (65)] asserts that λ2 − λ1 ≥ 3π for all convex euclidean domains of diameter 1, where λ1 and λ2 denote the first two eigenvalues of the Dirichlet Laplacian. Notice that equality holds for the 1-dimensional unit interval, which can be regarded also as a degenerate n-dimensional rectangular box. The gap estimate is conjectured to hold more generally for Schrodinger operators with convex potentials, under Dirichlet boundary conditions; see the work of S.-T. Yau and collaborators [9, 11]. This Schrodinger gap conjecture was proved some time ago in 1 dimension by R. Lavine [8], and more recently in all dimensions by B. Andrews and J. Clutterbuck [1]. The proof in this journal by H. Donnelly [3] of the original gap conjecture in 2 dimensions (for the Dirichlet Laplacian with zero potential) is not correct. The Editors of Mathematische Zeitschrift have asked us to describe the flaws in the proof, in order to clarify the state of the literature. Donnelly’s approach to the problem is a natural one: first perform a shape optimization to rule out a non-degenerate minimizing domain, and then analyze the spectral gap for a sequence of domains degenerating to an interval, with the help of results by D. Jerison [5]. (For some history on this approach, and on the gap conjecture more generally, see the report on the AIM meeting “Low Eigenvalues of Laplace and Schrodinger Operators” [10], especially page 12 of the open problems list.) The error lies in the proof of the shape optimization step, as we now explain. Donnelly wishes to prove that no minimizing domain can exist for

These notes are a companion to the article "Lorentz spacetimes of constant curvature" by Geoffrey Mess, which was first written in 1990 but never published. Mess' paper will appear together with these notes in a forthcoming issue of Geometriae Dedicata., Comment: 26 pages

In this note, we improve some results of Granville and Soundararajan on the distribution of values of the truncated random Euler product L ( 1 , X ; y ) : = ∏ p ⩽ y ( 1 − X ( p ) / p ) −1 , where the X ( p ) are independent random variables, taking the values ±1 with equal probability p / 2 ( p + 1 ) and 0 with probability 1 / ( p + 1 ) .

Let H(Dn) be the space of holomorphic functions on the unit polydisk Dn, and let , where p, q> 0, α = (α1,…,αn) with αj > -1, j =1,..., n, be the class of all measurable functions f defined on Dn such thatwhere Mp(f,r) denote the p-integral means of the function f. Denote the weighted Bergman space on . We provide a characterization for a function f being in . Using the characterization we prove the following result: Let p> 1, then the Cesàro operator is bounded on the space .

International audience

We show that a A-linear map of Hilbert A-modules is induced by a unitary Hilbert module operator if and only if it extends to an ordinary unitary on appropriately defined enveloping Hilbert spaces. Applications to the theory of multiplicative unitaries let us to compute the equivalence classes of Hilbert modules over a class of C*-algebraic quantum groups. We, thus, develop a theory that, for example, could be used to show non-existence of certain co-actions. In particular, we show that the Cuntz semigroup functor takes a co-action to a multiplicative action.

The present study, which is a continuation of the previous paper, augments a recent work on the use of phylogenetic networks. We develop techniques to characterize the topology of various X-trees and binary trees of biological and phylogenetic interests. We have obtained the results for various k-level X-trees and phylogenetic networks with variants of Zagreb, Szeged, Padmakar-Ivan, Schultz and Atom Bond Connectivity topological indices.

The study of the dynamics of the size of a population via mathematical modelling is a problem of interest and widely studied. Traditionally, continuous deterministic methods based on differential equations have been used to deal with this problem. However discrete versions of some models are also available and sometimes more adequate. In this paper, we randomize the Pielou logistic equation in order to include the inherent uncertainty in modelling. Taking advantage of the method of transformation of random variables, we provide a full probabilistic description to the randomized Pielou logistic model via the computation of the probability density functions of the solution stochastic process, the steady state and the time until a certain level of population is reached. The theoretical results are illustrated by means of two examples, the first one consists of a numerical experiment and the second one shows an application to study the diffusion of a technology using real data.

In the preceding article “The closure of a class of colimits” by M.H. Albert and G.M. Kelly, the authors were unable, except in one special case, to answer the following question. Let an indexing type ψ for colimits be such that every category admitting all ∅-indexed colimits for ∅ in some class Φ also admits ψ-indexed colimits; need a functor which preserves all Φ-indexed colimits also preserve ψ-indexed ones? Without settling the question, the present authors give two more positive results in this direction, including an affirmative answer when Φ-indexed colimits are conical.

Background: The emerging novel coronavirus disease 2019 (COVID-19) has become one of the leading cause of deaths worldwide in 2020. The present systematic review and meta-analysis estimated the magnitude of sleep problems during the COVID-19 pandemic and its relationship with psychological distress. Methods: Five academic databases (Scopus, PubMed Central, Pro Quest, ISI Web of Knowledge, and Embase) were searched. Observational studies including case-control studies and cross-sectional studies were included if relevant data relationships were reported (i.e., sleep assessed utilizing the Pittsburgh Sleep Quality Index or Insomnia Severity Index). All the studies were English, peer-reviewed papers published between December 2019 and February 2021. PROSPERO registration number: CRD42020181644. Findings: 168 cross-sectional, four case-control, and five longitudinal design papers comprising 345270 participants from 39 countries were identified. The corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among the general population, and 57% among COVID-19 patients (all p-values < 0.05). Sleep problems were associated with depression among healthcare professionals, the general population, and COVID-19 patients, with Fishers Z scores of -0.28, -0.30, and -0.36, respectively. Sleep problems were positively (and moderately) associated with anxiety among healthcare professionals, the general population, and COVID-19 patients, with Fishers z scores of 0.55, 0.48, and 0.49, respectively. Interpretation: Sleep problems appear to have been common during the ongoing COVID-19 pandemic. Moreover, sleep problems were found to be associated with higher levels of psychological distress. With the use of effective programs treating sleep problems, psychological distress may be reduced. Vice versa, the use of effective programs treating psychological distress, sleep problems may be reduced. (C) 2021 The Author(s). Published by Elsevier Ltd. Funding Agencies|Ministry of Science and Technology, TaiwanMinistry of Science and Technology, Taiwan [MOST109-2327-B006-005]

In this short paper I report on a paper published in Nonlinear Analysis: Real World Applications in 2004. There is a major mistake early in that paper which makes most of its claims false. The class of reaction–diffusion systems considered in the paper has been the object of a renewed investigation in the past few years, by myself and others, and recent discoveries provide explicit counter-examples.

The Protecting Access to Medicare Act (PAMA) mandates clinical decision support mechanism (CDSM) consultation for all advanced imaging. There are a growing number of studies examining the association of CDSM use with imaging appropriateness, but a paucity of multicenter data. This observational study evaluates the association between changes in advanced imaging appropriateness scores with increasing provider exposure to CDSM. Each provider’s first 200 consecutive anonymized requisitions for advanced imaging (CT, MRI, ultrasound, nuclear medicine) using a single CDSM (CareSelect, Change Healthcare) between January 1, 2017 and December 31, 2019 were collected from 288 US institutions. Changes in imaging requisition proportions among four appropriateness categories (“usually appropriate” [green], “may be appropriate” [yellow], “usually not appropriate” [red], and unmapped [gray]) were evaluated in relation to the chronological order of the requisition for each provider and total provider exposure to CDSM using logistic regression fits and Wald tests. The number of providers and requisitions included was 244,158 and 7,345,437, respectively. For 10,123 providers with ≥ 200 requisitions (2,024,600 total requisitions), the fraction of green, yellow, and red requisitions among the last 10 requisitions changed by +3.0% (95% confidence interval +2.6% to +3.4%), −0.8% (95% CI −0.5% to −1.1%), and −3.0% (95% CI 3.3% to −2.7%) in comparison with the first 10, respectively. Providers with > 190 requisitions had 8.5% (95% CI 6.3% to 10.7%) more green requisitions, 2.3% (0.7% to 3.9%) fewer yellow requisitions, and 0.5% (95% CI −1.0% to 2.0%) fewer red (not statistically significant) requisitions relative to providers with ≤ 10 requisitions. Increasing provider exposure to CDSM is associated with improved appropriateness scores for advanced imaging requisitions.

In the paper, by virtue of the binomial inversion formula, a general formula of higher order derivatives for a ratio of two differentiable function, and other techniques, the authors compute several sums in terms of the beta function and its partial derivatives, polygamma functions, the Gauss hypergeometric function, and a determinant. These results generalize known ones in combinatorics. This preprint has been formally published as "Feng Qi and Chuan-Jun Huang, Computing sums in terms of beta, polygamma, and Gauss hypergeometric functions, Revista de la Real Academia de Ciencias Exactas, Fisicas y Naturales Serie A Matematicas, Vol. 114, Paper No. 191, 9 pages (2020); available online at https://doi.org/10.1007/s13398-020-00927-y."

COVID-19 pandemic has affected all aspects of people's lives and disrupted the economy. Forecasting the number of cases infected with this virus can help authorities make accurate decisions on the interventions that must be implemented to control the pandemic. Investigation of the studies on COVID-19 forecasting indicates that various techniques such as statistical, mathematical, and machine and deep learning have been utilized. Although deep learning models have shown promising results in this context, their performance can be improved using auxiliary features. Therefore, in this study, we propose two hybrid deep learning methods that utilize the statistical features as auxiliary inputs and associate them with their main input. Specifically, we design a hybrid method of the multihead attention mechanism and the statistical features (ATT_FE) and a combined method of convolutional neural network and the statistical features (CNN_FE) and apply them to COVID-19 data of 10 countries with the highest number of confirmed cases. The results of experiments indicate that the hybrid models outperform their conventional counterparts in terms of performance measures. The experiments also demonstrate the superiority of the hybrid ATT_FE method over the long short-term memory model.

Background: Pertussis is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis (B. pertussis). The infection is difficult to diagnose especially in underserved or resource-limited areas. We developed a low-cost and instrument-free diagnostic method for rapid and accurate detection of B. pertussis on a point-of-care (POC) testing device. Methods: We developed a paper/polymer hybrid microfluidic biochip integrated with loop-mediated isothermal amplification (LAMP) method for the rapid and accurate detection of B. pertussis. This microfluidic approach was validated by testing 100 de-identified remnant clinical nasopharyngeal swabs and aspirates, which were confirmed to be either positive or negative for B. pertussis by a validated real-time PCR assay at the Children's Hospital Los Angeles. Findings: The instrument-free detection results could be successfully read by the naked eye within 45 min with a limit of detection (LOD) of 5 DNA copies per well. Our optimized bacterial lysis protocol allowed the direct testing of clinical samples without any complicated sample processing/preparation (i.e. DNA extraction) or the use of any equipment (e.g. centrifuges). The validation of the microfluidic approach was accomplished by testing 100 clinical samples. High sensitivity (100%) and specificity (96%) with respect to real-time PCR were achieved. Interpretation: This microfluidic biochip shows great potential for point-of-care disease diagnosis in various venues including schools and physician's offices, especially in low-resource settings in developing nations. Funding: NIH/NIAID under award number R21AI107415, NIH RCMI Pilot Grant, the Philadelphia Foundation, the Medical Center of the Americas Foundation. Keywords: Pertussis diagnosis, Point-of-care detection, Microfluidic biochip, Whooping cough, Loop-mediated isothermal amplification (LAMP)

The equivalence between pure discrete spectrum and regular model sets in d-dimensional unimodular substitution tilings is discussed., Primitive substitution tilings on whose expansion maps are unimodular are considered. It is assumed that all the eigenvalues of the expansion maps are algebraic conjugates with the same multiplicity. In this case, a cut-and-project scheme can be constructed with a Euclidean internal space. Under some additional condition, it is shown that if the substitution tiling has pure discrete spectrum, then the corresponding representative point sets are regular model sets in that cut-and-project scheme.

BackgroundIn recent years, digital tools have become a viable means for patients to address their health and information needs. Governments and health care organizations are offering digital tools such as self-assessment tools, symptom tracking tools, or chatbots. Other sources of digital tools, such as those offered through patient platforms, are available on the internet free of charge. We define patient platforms as health-specific websites that offer tools to anyone with internet access to engage them in their health care process with peer networks to support their learning. Although numerous social media platforms engage users without up-front charges, patient platforms are specific to health. As little is known about their business model, there is a need to understand what else these platforms are trying to achieve beyond supporting patients so that patients can make informed decisions about the benefits and risks of using the digital tools they offer.ObjectiveThe aim of this study is to explore what patient platforms are trying to achieve beyond supporting patients and how their digital tools can be used to generate income.MethodsTextual and visual data collected from a purposeful selection of 11 patient platforms from September 2013 to August 2014 were analyzed using framework analysis. Data were systematically and rigorously coded and categorized according to key issues and themes by following 5 steps: familiarizing, identifying a thematic framework, indexing, charting, and mapping and interpretation. We used open coding to identify additional concepts not captured in the initial thematic framework. This paper reports on emergent findings on the business models of the platforms and their income-generating processes.ResultsOur analysis revealed that in addition to patients, the platforms support other parties with interests in health and information exchanges. Patient platforms did not charge up-front fees but generated income from other sources, such as advertising, sponsorship, marketing (eg, sending information to users on behalf of sponsors or providing means for sponsors to reach patients directly), supporting other portals, and providing research services.ConclusionsThis study reports on the mechanisms by which some patient platforms generate income to support their operations, gain profit, or both. Although income-generating processes exist elsewhere on social media platforms in general, they pose unique challenges in the health context because digital tools engage patients in health and information exchanges. This study highlights the need to minimize the potential for unintended consequences that can pose health risks to patients or can lead to increased health expenses. By understanding other interests that patient platforms support, our findings point to important policy implications, such as whether (and how) authorities might protect users from processes that may not always be in their best interests and can potentially incur costs to the health system.

Background During the 2020s, there has been extensive debate about the possibility of using contact tracing (CT) to contain the SARS-CoV-2 pandemic, and concerns have been raised about data security and privacy. Little has been said about the effectiveness of CT. In this paper, we present a real data analysis of a CT experiment that was conducted in Italy for 8 months and involved more than 100,000 CT app users. Objective We aimed to discuss the technical and health aspects of using a centralized approach. We also aimed to show the correlation between the acquired contact data and the number of SARS-CoV-2–positive cases. Finally, we aimed to analyze CT data to define population behaviors and show the potential applications of real CT data. Methods We collected, analyzed, and evaluated CT data on the duration, persistence, and frequency of contacts over several months of observation. A statistical test was conducted to determine whether there was a correlation between indices of behavior that were calculated from the data and the number of new SARS-CoV-2 infections in the population (new SARS-CoV-2–positive cases). Results We found evidence of a correlation between a weighted measure of contacts and the number of new SARS-CoV-2–positive cases (Pearson coefficient=0.86), thereby paving the road to better and more accurate data analyses and spread predictions. Conclusions Our data have been used to determine the most relevant epidemiological parameters and can be used to develop an agent-based system for simulating the effects of restrictions and vaccinations. Further, we demonstrated our system's ability to identify the physical locations where the probability of infection is the highest. All the data we collected are available to the scientific community for further analysis.

Climate modelling plays a crucial role for understanding and addressing the climate challenge, in terms of both mitigation and adaptation. It is therefore of central importance to understand to what extent climate models are adequate for relevant purposes, such as providing certain kinds of climate change projections in view of decision-making. In this perspective, the issue of the stability of climate models under small relevant perturbations in their structure (or small relevant ‘structural model errors’ with respect to the target system) seems particularly important. Within this framework, a debate has emerged in the philosophy of science literature about the relevance for climate modelling of the mathematical notion of structural stability. This paper adresses several important foundational and epistemological questions that arise in this context, in particular about the the role of abstract mathematical considerations of a qualitative nature (in some precise, topological sense) for concrete modelling projects with mainly quantitative purposes.

Background: Context-specific evidence of the spectrum of type 2 diabetes (T2D) burden is essential for setting priorities and designing interventions to reduce associated morbidity and mortality. However, there are currently limited data on the burden of T2D complications and comorbidity in sub-Saharan Africa (SSA). Here, we aimed to estimate the burden and risk factors for T2D complications and comorbidity in a large sample of sub-Saharan Africans. Methods: Using a standardized protocol, we documented and estimated the burden of T2D complications and comorbidities in 2,784 diabetes participants enrolled from tertiary health centers from Nigeria, Ghana and Kenya. T2D complications and comorbidities evaluated by study physicians and clinic staffs included cardiometabolic, ocular, neurological and renal characteristics. Using the same protocol, we contextualized the burden of these complications and comorbidities by evaluating them in a sample of 3,209 individuals without diabetes enrolled from the catchment communities where the cases originated. Logistic regression models were used to identify risk factors and to adjust estimates of risk. Results: The mean age of T2D participants was 56 (SD 11) years with a median duration of diabetes of 5 (interquartile range 2-10) years. The notable complications/comorbidities observed in this sample of T2D participants included hypertension (71%; 95% CI 69-73), obesity 27% (25-29) and hyperlipidemia 34% (32-36). Diabetic retinopathy was found in 15% (13-17) and cataracts in 32% (30-35). About 13% (12-15) had impaired renal function as assessed by eGFR, representing 1 in 8 participants. Erectile dysfunction was a complication in 35% (32-38) of men. Age, duration of T2D and body mass index were significant risk factors for most complications/comorbidities. Population-attributable fraction ranged between 6 and 64 percent for most comorbidities. Conclusion: We observed a substantial burden of diabetes complications and comorbidity in this sample of T2D participants from SSA. Given the reported association of these complications with increased burden of T2D morbidity and mortality we call for public health strategies that prioritise early detection, the maintenance of healthy blood pressure, weight and lipid levels, as well as strengthen health care system capacities to provide treatment and care for neurological and ophthalmological complications of diabetes. Funding Statement: The study was supported in part by the Intramural Research Program of the National Institutes of Health in the Center for Research on Genomics and Global Health (CRGGH). The CRGGH is supported by the National Human Genome Research Institute (NHGRI), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the Center for Information Technology, and the Office of the Director at the National Institutes of Health (1ZIAHG200362). Support for participant recruitment and initial genetic studies of the AADM study was provided by NIH grant No. 3T37TW00041-03S2 from the Office of Research on Minority Health. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study received ethical approval from the Institutional Review Board at each study site, Howard University and the United States National Institutes of Health.

Background: Total knee arthroplasty (TKA) is one the most common elective procedures in the world. Post-operative infection is one of its most devastating complications, often necessitating multiple additional surgeries. We aimed to describe the relationship between surgical duration and risk of deep infection following primary elective TKA. Methods: In this cohort study we analyses primary TKAs done between 2009 and 2016 in Ontario, Canada. We utilized restricted cubic splines to identify a threshold of surgical duration that was associated with an increased risk for infection requiring surgery. Patients with a ‘short’ duration of surgery were matched to those with a ‘long’ duration on patient age (±3 years), patient sex, severe obesity (BMI > 40), the primary surgeon, the hospital and the type of anesthetic. Findings: In 92,343 primary TKAs, the median surgical duration was 106 min. We identified a cut-point of 100 min that was associated with an increased risk for infection. Subsequently, 17,815 TKA recipients with a ‘long’ procedure length were matched to those with a ‘short’ procedure length. ‘Long’ procedures had a higher rate of deep infection (1.1% versus 0.6%, p

Background: Paclitaxel-coated balloons (DCB) are suitable to reduce the risk of restenosis after angioplasty of atherosclerotic femoropopliteal lesions. However, numerous types of DCBs are distinguished by drug density and coating. Conflicting evidence exists about the risk of all-cause death. Methods: Randomised trials published between Jan 1, 2005 and Feb 3, 2019 were identified by searching MEDLINE, CENTRAL, and Clinical.trials.gov. Studies on DCB versus plain old balloon angioplasty (POBA) for the treatment of femoropopliteal artery disease were included, and those focused on in-stent restenosis or critical limb ischemia were excluded. Random-effects meta-analysis was conducted to assess the main outcomes of freedom from target lesion revascularisation (FfTLR) and all-cause mortality. Findings: Of 552 identified records, 14 studies including 2504 patients were eligible. DCB significantly increased the probability of FfTLR with substantial heterogeneity (12-month: risk ratio [RR] 1·24 [95% CI 1·14- 2·27], I2 = 66%; 24-month RR 1·39 [95% CI 1·39-1·52], I2 = 21%). The risk of all-cause mortality was similar between groups at 12 months (RR 0·87 [95% CI 0·48-1·59]), and non-significantly increased after DCB angioplasty at 24 months (RR 1·53 [95% CI 0·94-2·50]). Interpretation: Efficacy of DCB for femoropopliteal angioplasty differs substantial across studies. Effect size depends on the type of DCB, treatment strategy, and lesion complexity. The risk of all-cause death at two years tended to be increased after DCB without evidence of causation. Trial Registration Number: This study is registered with ClinicalTrials.gov (NCT02927574). Funding Statement: The authors stated: "There was no funding source for this study." Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: This systematic review and meta-analysis was conducted according to the Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

Background: Hypoxaemia is a common complication of pneumonia and a major risk factor for death, but less is known about hypoxaemia in other common conditions. We evaluated the epidemiology of hypoxaemia and oxygen use in hospitalised neonates and children in Nigeria. Methods: We conducted a prospective cohort study among neonates and children (

Background: Robotic-assisted percutaneous coronary intervention (R-PCI) has been successfully employed in the United States since 2011. Performing R-PCI from a remote location has never been reported but if feasible would extend availability of treatment to many patients with coronary artery disease (CAD) who would otherwise go without. Objective: To assess the feasibility of remote tele-R-PCI with the operator 20 miles away from the patients. Methods: Five patients with single, type A coronary artery lesions treatable by PCI consented to participate. The primary endpoint was procedural success with no major adverse cardiac events (MACE) before discharge. Procedural success was defined as achieving

Background: This study examines associations between sex composition of older siblings and infant mortality by sex, to guide efforts to address excess female infant mortality in India. Methods: We conducted a retrospective cross-sectional study of infant mortality in India using four waves of data from the nationally-representative National Family Health Survey, collected between 1992 and 2016 (unweighted N = 338,504 for children aged 1–5). We used sex-stratified multivariable logistic regression models to assess the associations between sex composition of older siblings and risk of infant mortality. Findings: Male infants with two living older sisters and no living older brothers had lower odds of infant mortality relative to those with one living older brother (e.g., 2015–16 AOR 0.62, 95% CI 0.50–0.76); this effect was significant for boys across all waves of data but was not seen for girls in any wave. Exploratory models focused on third order births found that boys were less likely than girls to die in infancy if born subsequent to two older sisters (2015–16 AOR 0.48, 95% CI 0.31–0.74); analysis of crude prevalence data indicated that this converts into a 64% greater risk for infant mortality for girls relative to boys in this third-order group. Interpretation: Higher birth order males with older sisters have greater protection against infant mortality, a finding that has persisted for over 25 years. To address ongoing gender inequities in infant survival in India, greater focus is needed to support higher birth order girls and social norm movements against son preference. Keywords: Infant mortality, India, Gender analysis, Sex-disaggregated analyses, Sibling composition

Background: Pressure ulcers (PUs) are complications of serious acute/chronic illness. Specialist mattresses used for prevention lack high quality effectiveness evidence. We aimed to compare clinical and cost effectiveness of 2 mattress types. Methods: Multicentre, Phase III, open, prospective, parallel group, randomised controlled trial in 42 UK secondary/community in-patient facilities.2029 high risk (acutely ill, bedfast/chairfast and/or Category 1 PU/pain at PU site) adult in-patients were randomised (1:1, allocation concealment, minimisation with random element) factors including: centre, PU status, facility and consent type. Interventions were alternating pressure mattresses (APMs) or high specification foam (HSF) for maximum treatment phase 60 days. Primary outcome was time to development of new PU Category ≥2 from randomisation to 30 day post-treatment follow-up in intention-to treat population. Trial registration: ISRCTN 01151335. Findings: Between August 2013 and November 2016, we randomised 2029 patients (1016 APMs: 1013 HSF) who developed 160(7.9%) PUs. There was insufficient evidence of a difference between groups for time to new PU Category ≥2 Fine and Gray Model Hazard Ratio HR = 0.76, 95%CI0.56–1.04); exact P = 0.0890; absolute difference 2%). There was a statistically significant difference in the treatment phase time to event sensitivity analysis, Fine and Gray model HR = 0.66, 95%CI, 0.46–0.93; exact P = 0.0176); 2.6% absolute difference). Economic analyses indicate that APM are cost-effective.There were no safety concerns. Interpretation: In high risk (acutely ill, bedfast/chairfast/Category 1 PU/ pain on a PU site) in-patients, we found insufficient evidence of a difference in time to PU development at 30-day final follow-up, which may be related to a low event rate affecting trial power. APMs conferred a small treatment phase benefit. Patient preference, low PU incidence and small group differences suggests the need for improved targeting of APMs with decision making informed by patient preference/comfort/rehabilitation needs and the presence of potentially modifiable risk factors such as being completely immobile, nutritional deficits, lacking capacity and/or altered skin/Category1 PU. Keywords: Pressure ulcer, Randomised controlled trial, Medical device, Prevention