Search

Severe acute malnutrition (SAM) remains a major global public health problem. SAM cases are treated using ready‐to‐use therapeutic food (RUTF) at a dosage of ∼200 kcal/kg/day per the standard treatment protocol (STD). Emerging evidence on simplifications to the standard protocol, which among other adaptations, includes reducing the daily RUTF dosage, indicates that it is effective and safe for treating children with SAM. In response to a foreseen stock shortage of RUTF, the government of Afghanistan endorsed the temporary use of a modified treatment protocol in which the daily RUTF dosage was prescribed at 1000 kcal/day (irrespective of body weight) until the child achieved moderate acute malnutrition status (weight‐for‐height z‐score ≥ −3 or mid‐upper arm circumference [MUAC] ≥ 115 mm), at which point 500 kcal/day was prescribed until cured (modified treatment protocol [MTP]). In this paper, we report the results of this nonweight‐based daily RUTF dosage experience. Data of 2042 children with SAM, treated using either the STD protocol (n = 269) or the MTP protocol (n = 1773) from August 2019 to March 2021 in five provinces, were analyzed. The per‐protocol analyses confirmed noninferiority of MTP protocol when compared to STD protocol for recovery rate [93.3% vs. 90.2%; ∆ (95% confidence interval, CI) = 3.1 (−0.9; 7.2) %] and length‐of‐stay [82.6 vs. 75.6 days; ∆ (95% CI) = 6.9 (3.3; 10.5) days], considering the margin of noninferiority of −10% and +14 days, respectively. Weight gain velocity was smaller in the MTP protocol group than in the STD protocol group [3.7 (1.7) vs. 5.2 (2.9) g/kg/day; ∆ (95% CI) = −1.5 (−1.8, −1.2); p < 0.001]. The STD group had a significantly higher mean than the MTP group for absolute MUAC gain [∆ (95% CI) = 1.7 (1.0; 2.3) mm; p < 0.001] and the MUAC velocity [∆ (95% CI) = 0.29 (0.20; 0.37) mm/week; p < 0.001]. Our results confirm the noninferiority of a nonweight‐based daily dosage and support the endorsement of this modification as an alternative to the standard protocol in resource‐constrained contexts. Key messages: More evidence supporting the use of the nonweight‐based daily ready‐to‐use therapeutic food (RUTF) dosage for treating uncomplicated severe acute malnutrition (SAM), in specific contexts, is needed.Our real‐world prospective nonrandomized study showed that the fixed nonweight‐based daily RUTF dosage protocol is as effective as the standard weight‐based protocol for treating uncomplicated SAM in children <5 in the Afghanistan context.Our findings support the reflection of a nonweight‐based daily RUTF dosage in resource‐constrained contexts in national and global policies and guidelines to improve coverage of all children in need of treatment. [ABSTRACT FROM AUTHOR]

In order for teachers to successfully gain new knowledge during professional development (PD), courses must be of high quality and stimulate active involvement from participants. More and more PD courses are taking place online, without clear evidence of whether face‐to‐face and online courses differ in terms of their quality or level of participants' engagement. The present study investigates differences between face‐to‐face and online PD with respect to certain quality characteristics: clarity and structure, cognitive activation, collaboration and practical relevance, as well as participants' behavioural, cognitive and affective engagement. The study is based on 2210 teachers from Germany who participated in 1 of 137 face‐to‐face or 54 online PD courses. Although participants rated face‐to‐face and online courses very positively regarding all quality characteristics and engagement dimensions, they evaluated online courses slightly less favourably compared to face‐to‐face courses. Implications for practice and research are derived to help ensure high‐quality PD offerings in the future. Practitioner notes What is already known about this topic Face‐to‐face and online PD have the potential to be similarly effective. PD quality and participants' engagement can be assumed to be predictors of PD effectiveness. PD quality contains clarity and structure, cognitive activation, collaboration and practical relevance. Engagement is a three‐dimensional construct composed of behavioural, cognitive and affective components. What this paper adds PD quality was rated very positively for online and face‐to‐face courses. Participants rated the quality of online PD lower compared to face‐to‐face PD. Participants rated their engagement in online PD lower compared to face‐to‐face PD. Implications for practice and/or policy PD format should always be chosen with which a higher benefit can be achieved. Quality assurance should take place before PD is conducted. What is already known about this topic Face‐to‐face and online PD have the potential to be similarly effective. PD quality and participants' engagement can be assumed to be predictors of PD effectiveness. PD quality contains clarity and structure, cognitive activation, collaboration and practical relevance. Engagement is a three‐dimensional construct composed of behavioural, cognitive and affective components. What this paper adds PD quality was rated very positively for online and face‐to‐face courses. Participants rated the quality of online PD lower compared to face‐to‐face PD. Participants rated their engagement in online PD lower compared to face‐to‐face PD. Implications for practice and/or policy PD format should always be chosen with which a higher benefit can be achieved. Quality assurance should take place before PD is conducted. [ABSTRACT FROM AUTHOR]

Background: The 2022/23 influenza season in the United Kingdom saw the return of influenza to prepandemic levels following two seasons with low influenza activity. The early season was dominated by A(H3N2), with cocirculation of A(H1N1), reaching a peak late December 2022, while influenza B circulated at low levels during the latter part of the season. From September to March 2022/23, influenza vaccines were offered, free of charge, to all aged 2–13 (and 14–15 in Scotland and Wales), adults up to 49 years of age with clinical risk conditions and adults aged 50 and above across the mainland United Kingdom. Methods: End‐of‐season adjusted vaccine effectiveness (VE) estimates against sentinel primary‐care attendance for influenza‐like illness, where influenza infection was laboratory confirmed, were calculated using the test negative design, adjusting for potential confounders. Methods: Results In the mainland United Kingdom, end‐of‐season VE against all laboratory‐confirmed influenza for all those > 65 years of age, most of whom received adjuvanted quadrivalent vaccines, was 30% (95% CI: −6% to 54%). VE for those aged 18–64, who largely received cell‐based vaccines, was 47% (95% CI: 37%–56%). Overall VE for 2–17 year olds, predominantly receiving live attenuated vaccines, was 66% (95% CI: 53%–76%). Conclusion: The paper provides evidence of moderate influenza VE in 2022/23. [ABSTRACT FROM AUTHOR]

This paper introduces a generalization of the Hasse derivative in the sense of the complex conformable derivative. The definition coincides with the classical version of the Hasse derivative of order i$$ i $$. Accordingly, a new base, named complex conformable Hasse derivative bases (CCHDBs), is defined. We investigate the existence of expansions of analytic functions in a series of CCHDBs in Fréchet space on closed and open disks, open regions surrounding closed disks, for all entire functions and at the origin. Moreover, an upper bound for the order and type of the CCHDBs is obtained and proved to be attainable. The 핋ρ‐property of CCHDBs is also discussed. Our results improve and extend the analog results in the complex analysis related to the classical complex derivative of a base of polynomials (BPs). The obtained results clarify several implications for the CCHDBs of special functions such as Euler, Bernoulli, Chebyshev, Bessel, and Gontcharaff polynomials. [ABSTRACT FROM AUTHOR]

This paper estimates the impact of reforming competition authorities on perceived antitrust effectiveness using methods of causal inference. We study how 20 countries reformed their competition authorities in depth between 1995 and 2020, and what has been the outcome of such reforms in the perceived competition policy effectiveness by the business community compared with 18 control countries in a balanced panel. As the political economy literature warned, we find that reforms paradoxically have not always improved antitrust effectiveness. Some of the reforms approved stalled or backlashed as politicians opted for a Machiavelli option: undertaking "counter‐reforms" even in the name of an apparent but deceptive progressiveness and pro‐competition drive. [ABSTRACT FROM AUTHOR]

Recent studies have demonstrated that finely tuned deep neural networks (DNNs) are susceptible to adversarial attacks. Conventional physical attacks employ stickers as perturbations, achieving robust adversarial effects but compromising stealthiness. Recent innovations utilise light beams, such as lasers and projectors, for perturbation generation, allowing for stealthy physical attacks at the expense of robustness. In pursuit of implementing both stealthy and robust physical attacks, the authors present an adversarial catoptric light (AdvCL). This method leverages the natural phenomenon of catoptric light to generate perturbations that are both natural and stealthy. AdvCL first formalises the physical parameters of catoptric light and then optimises these parameters using a genetic algorithm to derive the most adversarial perturbation. Finally, the perturbations are deployed in the physical scene to execute stealthy and robust attacks. The proposed method is evaluated across three dimensions: effectiveness, stealthiness, and robustness. Quantitative results obtained in simulated environments demonstrate the efficacy of the proposed method, achieving an attack success rate of 83.5%, surpassing the baseline. The authors utilise common catoptric light as a perturbation to enhance the method's stealthiness, rendering physical samples more natural in appearance. Robustness is affirmed by successfully attacking advanced DNNs with a success rate exceeding 80% in all cases. Additionally, the authors discuss defence strategies against AdvCL and introduce some light‐based physical attacks. [ABSTRACT FROM AUTHOR]

Background: The management of patients with disorders of consciousness (DOC) presents substantial challenges in clinical practice. Deep brain stimulation (DBS) has emerged as a potential therapeutic approach, but the lack of standardized regulatory parameters for DBS in DOC hinders definitive conclusions. Objective: This comprehensive review aims to provide a detailed summary of the current issues concerning patient selection, target setting, and modulation parameters in clinical studies investigating the application of DBS for DOC patients. Methods: A meticulous systematic analysis of the literatures was conducted, encompassing articles published from 1968 to April 2023, retrieved from reputable databases (PubMed, Embase, Medline, and Web of Science). Results: The systematic analysis of 21 eligible articles, involving 146 patients with DOC resulting from acquired brain injury or other disorders, revealed significant insights. The most frequently targeted regions were the Centromedian‐parafascicular complex (CM‐pf) nuclei and central thalamus (CT), both recognized for their role in regulating consciousness. However, other targets have also been explored in different studies. The stimulation frequency was predominantly set at 25 or 100 Hz, with pulse width of 120 μs, and voltages ranged from 0 to 4 V. These parameters were customized based on individual patient responses and evaluations. The overall clinical efficacy rate in all included studies was 39.7%, indicating a positive effect of DBS in a subset of DOC patients. Nonetheless, the assessment methods, follow‐up durations, and outcome measures varied across studies, potentially contributing to the variability in reported efficacy rates. Conclusion: Despite the challenges arising from the lack of standardized parameters, DBS shows promising potential as a therapeutic option for patients with DOC. However, there still remains the need for standardized protocols and assessment methods, which are crucial to deepen the understanding and optimizing the therapeutic potential of DBS in this specific patient population. [ABSTRACT FROM AUTHOR]

To assess the clinical data on the effectiveness of stem cell therapy for diabetic foot (DF) based on recent systematic reviews and meta‐analyses (SRs/MAs). SRs/MAs that evaluate the clinical evidence on the efficacy of stem cell therapy for DF were identified through a systematic search in public databases. The methodological quality and evidence quality of the included SRs/MAs were assessed separately by two researchers. Eight SRs/MAs were included in this analysis. Since there were no registered protocol or exclusion criteria for the included SRs/MAs, the methodological quality was rated as critically low. There was no high‐quality evidence available for the outcomes, and the evidence quality ranged from critically low to moderate. Evidence degradation was most commonly caused by the risk of bias, followed by imprecision, publication bias and inconsistency. In conclusion, stem cell therapy may be effective for DF. However, this conclusion should be approached with caution, considering the quality of the supporting SRs/MAs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness and safety of perampanel (PER) monotherapy (MT) or add‐on therapy (AT) in Chinese children with epilepsy, as well as to evaluate the data from routine therapeutic drug monitoring (TDM) of PER for these pediatric patients. Methods: This retrospective and observational study was carried out on children with epilepsy (n = 340) from 2020 to 2022 at the Children's Hospital of Nanjing Medical University. Outcome measures were the responder rate (50% or greater seizure reduction), long‐term efficacy, and tolerability (number and types of adverse events) in MT and AT groups. Concentrations of plasma PER obtained from these patients, if available, were analyzed too. Results: A total of 279 patients achieved at least 3 months of therapy, and 58.1% responded to PER therapy. 53 of the responders were seizure‐free (32.7%). The retention rate dropped from 88.0% at 3 months to 40.6% at 12 months after treatment. Patients with MT achieved better seizure control than those with AT (P < 0.001). Intriguingly, PER exerted a very weak effect on patients who took more than 2 ASMs or were diagnosed with drug‐resistant epilepsy. There were no significant differences in tolerability between the two groups. In addition, 179 patients were routinely monitored for PER, and the trough concentrations (C0) for these patients ranged from 30.0 to 992.0 ng/mL. However, no significant difference in C0 was observed between responders and nonresponders (333 ng/mL vs 325.5 ng/mL, P = 0.264). Significance: This study provides effectiveness and safety data on Chinese children with epilepsy treated with PER either as MT or as AT. The efficacy of patients receiving MT was much better than cases administered with more than 2 ASMs or diagnosed with drug‐resistant epilepsy. In addition, no association was found between the plasma PER concentration and efficacy or safety. Plain Language Summary: The study reports the effects of perampanel on seizures and adverse effects in Chinese patients with epilepsy younger than 18 years. Seizures decreased in 58.1% of patients (responders); in a third of these responders, seizures stopped. After treatment was started, 88% of patients were still on perampanel at 3 months and 40.6% at 12 months. People who were treated with perampanel only were more likely to respond than those who received perampanel and other antiseizure treatments, although perampanel was tolerated equally well in these groups. Plasma perampanel concentration did not predict seizure response or adverse effects. [ABSTRACT FROM AUTHOR]