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Arnold, Forgan, and Korpela et al. noted that planet-sized artificial structures could be discovered with Kepler as they transit their host star. We present a general discussion of transiting megastructures, and enumerate 10 potential ways their anomalous silhouettes, orbits, and transmission properties would distinguish them from exoplanets. We also enumerate the natural sources of such signatures. Several anomalous objects, such as KIC 12557548 and CoRoT-29, have variability in depth consistent with Arnold’s prediction and/or an asymmetric shape consistent with Forgan’s model. Since well-motivated physical models have so far provided natural explanations for these signals, the ETI hypothesis is not warranted for these objects, but they still serve as useful examples of how non-standard transit signatures might be identified and interpreted in a SETI context. Boyajian et al. recently announced KIC 8462852, an object with a bizarre light curve consistent with a “swarm” of megastructures. We suggest that this is an outstanding SETI target. We develop the normalized information content statistic M to quantify the information content in a signal embedded in a discrete series of bounded measurements, such as variable transit depths, and show that it can be used to distinguish among constant sources, interstellar beacons, and naturally stochastic or artificial, information-rich signals. We apply this formalism to KIC 12557548 and a specific form of beacon suggested by Arnold to illustrate its utility. [ABSTRACT FROM AUTHOR]

We present the results of our Hubble Space Telescope program and describe how our analysis methods were used to re-evaluate the habitability of some of the most interesting Kepler planet candidates. Our program observed 22 Kepler Object of Interest (KOI) host stars, several of which were found to be multiple star systems unresolved by Kepler. We use our high-resolution imaging to spatially resolve the stellar multiplicity of Kepler-296, KOI-2626, and KOI-3049, and develop a conversion to the Kepler photometry (Kp) from the F555W and F775W filters on WFC3/UVIS. The binary system Kepler-296 (five planets) has a projected separation of (80 AU); KOI-2626 (one planet candidate) is a triple star system with a projected separation of (70 AU) between the primary and secondary components and (55 AU) between the primary and tertiary; and the binary system KOI-3049 (one planet candidate) has a projected separation of (225 AU). We use our measured photometry to fit the separated stellar components to the latest Victoria–Regina Stellar Models with synthetic photometry to conclude that the systems are coeval. The components of the three systems range from mid-K dwarf to mid-M dwarf spectral types.We solved for the planetary properties of each system analytically and via an MCMC algorithm using our independent stellar parameters. The planets range from , mostly Super Earths and mini-Neptunes. As a result of the stellar multiplicity, some planets previously in the Habitable Zone are, in fact, not, and other planets may be habitable depending on their assumed stellar host. [ABSTRACT FROM AUTHOR]

Background: This analysis aimed to evaluate the effectiveness of eliciting sexual partners from HIV-positive clients using the elicitation box model (where an HIV-positive index can report sexual contacts on paper and insert in a box for a health care provider to contact at a later time) compared to the conventional model (in which a health care provider elicits sexual contacts directly from clients) in Akwa Ibom, Southern Nigeria. Methods: Between March 2021 and April 2022, data were collected from index testing registers at 4 health facilities with a high volume of HIV clients currently on treatment in 4 local government areas in Akwa Ibom State. Primary outcome analyzed was the elicitation ratio (number of partners elicited per HIV-index offered index testing services). Secondary outcomes were the index testing acceptance (index HIV-positive clients accepted index testing service), testing coverage (partners tested for HIV from a list of partners elicited from HIV-index accepted index testing services), testing yield (index partners identified HIV positive from index partners HIV-tested), and linkage rate (index partners identified HIV positive and linked to antiretroviral therapy). Results: Of the total 2,705 index clients offered index testing services, 91.9% accepted, with 2,043 and 439 indexes opting for conventional elicitation and elicitation box models, respectively. A total of 3,796 sexual contacts were elicited: 2,546 using the conventional model (elicitation ratio=1:1) and 1,250 using the elicitation box model (elicitation ratio=1:3). Testing coverage was significantly higher in the conventional compared to the elicitation box model ( P <.001). However, there was no significant difference in the testing yield ( P =.81) and linkage rate using the conventional compared to elicitation box models ( P =.13). Conclusion: The implementation of the elicitation box model resulted in an increase in partner elicitation compared to the conventional model. Increasing the testing coverage by implementing the elicitation box model should be considered., (© Dibia et al.)

Introduction and Hypothesis: Undesired outcomes after mid-urethral sling (MUS), such as mesh exposure or surgical failure, can necessitate further procedures. The objective of this review is to evaluate the association between surgeon operative volume and the risk of reoperation after MUS., Methods: Eligible studies were selected through an electronic literature search from database and references of the studies included. Databases were searched for original studies reporting on the MUS procedure, reoperation, and operative volume. Random effects models were used to estimate the pooled OR of reoperation according to surgeon volume. Outcomes were divided into two categories: mesh removal and/or revision and subsequent surgery for treatment of SUI., Results: A total of 2,304 abstracts were screened, and 51 studies were assessed through full-text reading. Seven studies were included in the systematic review. High-volume and low-volume surgeons were defined differently in various studies. The odds ratio of the mesh removal/revision procedure was 1.26 (95%CI 1.03-1.53) among those who received their surgery from a low-volume surgeon compared with those who received their surgery from a high-volume surgeon as defined by the studies. The odds ratio of repeated incontinence procedures was 1.18 (95% CI 1.01-1.37)., Conclusions: The odds of a repeat incontinence procedure appear higher if the surgery is performed by a low-volume surgeon, although these results need to be interpreted with caution as the definition of low-volume vs high-volume surgeon varied between studies. As such, operative volume should be included in surgical reporting, and future research should utilize surgical volume as either a continuous exposure or a standardized value of low- vs high-volume MUS surgeons., (© 2022. The International Urogynecological Association.)

The appropriate age at which to perform endometrial biopsy for abnormal uterine bleeding (AUB) is controversial. This study aimed to determine the prevalence of malignant and premalignant pathologies in women aged 41-49 years with AUB and without risk factors for endometrial cancer. Records of women who had undergone a biopsy at the gynaecology clinic of the Centre hospitalier de l'Université de Montréal between 2014 and 2018 were reviewed. Of the 209 women included in the study, 2 had atypical hyperplasia, which resolved without treatment, and 3 had hyperplasia without atypia. The remaining women had benign results, showing that the prevalence of malignant and premalignant endometrial pathologies is low in this subgroup of patients., (Copyright © 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. All rights reserved.)

Enhanced quadrivalent influenza vaccines that include an adjuvant (aQIV) or a high dose of antigen (QIV-HD), which stimulate a stronger immune response in older adults than the standard vaccine (QIVe), are now approved. The objective of this research is to compare available vaccines and determine the cost-effectiveness of immunizing persons aged 65 years and above with aQIV compared to QIVe and QIV-HD in Germany. A compartmental transmission model calibrated to outpatient visits for influenza in Germany was used to predict the number of medically attended infections using the three vaccines. The rates of hospitalizations, deaths, and other economic consequences were estimated with a decision tree using German data where available. Based on meta-analysis, the rVE of -2.5% to 8.9% for aQIV versus QIV-HD, the vaccines are similar clinically, but aQIV is cost saving compared to QIV-HD (unit cost of EUR 40.55). All results were most sensitive to changes in vaccine effectiveness. aQIV may be cost-effective compared to QIVe depending on the willingness to pay for additional benefits in Germany. As aQIV and QIV-HD are similar in terms of effectiveness, aQIV is cost saving compared to QIV-HD at current unit prices.

The purpose of this article is to analyse the results of a survey towards the architects and engineers of construction in order to estimate the perception of the anti-seismic protection amongst these professionals. It focuses more on the architects who design buildings and, in many cases, monitor their implementation. The main result is the observation of inadequacies and gaps in seismic culture amongst the professionals, especially architects. These difficulties require the reinforcement of earthquake-resistant training. This effort to upgrade skills is as important as other aspects of the preventive management of the seismic risk in Algeria., Competing Interests: The authors have declared that no competing interests exist., (© 2020. The Authors.)

EIGER is a single-photon-counting hybrid pixel detector developed at the Paul Scherrer Institut, Switzerland. It is designed for applications at synchrotron light sources with photon energies above 5 keV. Features of EIGER include a small pixel size (75 µm × 75 µm), a high frame rate (up to 23 kHz), a small dead-time between frames (down to 3 µs) and a dynamic range up to 32-bit. In this article, the use of EIGER as a detector for electrons in low-energy electron microscopy (LEEM) and photoemission electron microscopy (PEEM) is reported. It is demonstrated that, with only a minimal modification to the sensitive part of the detector, EIGER is able to detect electrons emitted or reflected by the sample and accelerated to 8-20 keV. The imaging capabilities are shown to be superior to the standard microchannel plate detector for these types of applications. This is due to the much higher signal-to-noise ratio, better homogeneity and improved dynamic range. In addition, the operation of the EIGER detector is not affected by radiation damage from electrons in the present energy range and guarantees more stable performance over time. To benchmark the detector capabilities, LEEM experiments are performed on selected surfaces and the magnetic and electronic properties of individual iron nanoparticles with sizes ranging from 8 to 22 nm are detected using the PEEM endstation at the Surface/Interface Microscopy (SIM) beamline of the Swiss Light Source.

Purpose: The goal of this study was to assess and compare the potential clinical and economic value of emerging bone-forming agents using the only currently available agent, teriparatide, as a reference case in patients at high, near-term (imminent, 1- to 2-year) risk of osteoporotic fractures, extending to a lifetime horizon with sequenced antiresorptive agents for maintenance treatment., Methods: Analyses were performed by using a Markov cohort model accounting for time-specific fracture protection effects of bone-forming agents followed by antiresorptive treatment with denosumab. The alternative bone-forming agent profiles were defined by using assumptions regarding the onset and total magnitude of protection against fractures with teriparatide. The model cohort comprised 70-year-old female patients with T scores below -2.5 and a previous vertebral fracture. Outcomes included clinical fractures, direct costs, and quality-adjusted life years. The simulated treatment strategies were compared by calculating their incremental "value" (net monetary benefit)., Findings: Improvements in the onset and magnitude of fracture protection (vs the teriparatide reference case) produced a net monetary benefit of $17,000,000 per 10,000 treated patients during the (1.5-year) bone-forming agent treatment period and $80,000,000 over a lifetime horizon that included 3.5 years of maintenance treatment with denosumab., Implications: Incorporating time-specific fracture effects in the Markov cohort model allowed for estimation of a range of cost savings, quality-adjusted life years gained, and clinical fractures avoided at different levels of fracture protection onset and magnitude. Results provide a first estimate of the potential "value" new bone-forming agents (romosozumab and abaloparatide) may confer relative to teriparatide., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

Background and Objective: High-fidelity medical simulation is a source of stress for participants. The aim of this study was to assess if repeated simulated courses decrease perceived stress and/or physiological stress level and increase performance in anaesthesiology registrars., Method: Fourteen anaesthesiology specialty registrars participated individually in three successive sessions of crisis simulation in the operating room. Participants' perceived stress levels were measured by self-assessment (simple numerical scale from 0 to 10 [0=no stress, 10=maximum stress]) and physiological stress was estimated via the maximal heart rate measured by a Holter system). Technical and non-technical performances were also assessed. Data are expressed as medians with interquartile ranges and extremes (median (IQR [Min-Max]))., Results: Between the first and third session, simulation repetition was associated with a decrease in perceived stress (9 (8-10 [5-10]) versus 7 (5-8 [2-9]) from session 1 to session 3 respectively, P=0.02), whereas physiological stress assessed by the maximum heart rate remained unchanged (130 beats per minute (116-141 [85-170]) and 123 beats per minute (115-136 [88-166]) between sessions 1 and 3 respectively). There was also a significant inverse correlation between perceived stress levels experienced by registrars during the session and non-technical performance (P=0.008)., Conclusion: We observed a reduction in perceived stress levels experienced by registrars while physiological stress was unchanged with repeating simulation sessions combining simulated practice and debriefing. Learning through simulation could improve perceived stress management in critical situations., (Copyright © 2016 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)

MÖNCH is a 25 µm-pitch charge-integrating detector aimed at exploring the limits of current hybrid silicon detector technology. The small pixel size makes it ideal for high-resolution imaging. With an electronic noise of about 110 eV r.m.s., it opens new perspectives for many synchrotron applications where currently the detector is the limiting factor, e.g. inelastic X-ray scattering, Laue diffraction and soft X-ray or high-resolution color imaging. Due to the small pixel pitch, the charge cloud generated by absorbed X-rays is shared between neighboring pixels for most of the photons. Therefore, at low photon fluxes, interpolation algorithms can be applied to determine the absorption position of each photon with a resolution of the order of 1 µm. In this work, the characterization results of one of the MÖNCH prototypes are presented under low-flux conditions. A custom interpolation algorithm is described and applied to the data to obtain high-resolution images. Images obtained in grating interferometry experiments without the use of the absorption grating G 2 are shown and discussed. Perspectives for the future developments of the MÖNCH detector are also presented.

JUNGFRAU (adJUstiNg Gain detector FoR the Aramis User station) is a two-dimensional hybrid pixel detector for photon science applications at free-electron lasers and synchrotron light sources. The JUNGFRAU 0.4 prototype presented here is specifically geared towards low-noise performance and hence soft X-ray detection. The design, geometry and readout architecture of JUNGFRAU 0.4 correspond to those of other JUNGFRAU pixel detectors, which are charge-integrating detectors with 75 µm × 75 µm pixels. Main characteristics of JUNGFRAU 0.4 are its fixed gain and r.m.s. noise of as low as 27 e(-) electronic noise charge (<100 eV) with no active cooling. The 48 × 48 pixels JUNGFRAU 0.4 prototype can be combined with a charge-sharing suppression mask directly placed on the sensor, which keeps photons from hitting the charge-sharing regions of the pixels. The mask consists of a 150 µm tungsten sheet, in which 28 µm-diameter holes are laser-drilled. The mask is aligned with the pixels. The noise and gain characterization, and single-photon detection as low as 1.2 keV are shown. The performance of JUNGFRAU 0.4 without the mask and also in the charge-sharing suppression configuration (with the mask, with a `software mask' or a `cluster finding' algorithm) is tested, compared and evaluated, in particular with respect to the removal of the charge-sharing contribution in the spectra, the detection efficiency and the photon rate capability. Energy-dispersive and imaging experiments with fluorescence X-ray irradiation from an X-ray tube and a synchrotron light source are successfully demonstrated with an r.m.s. energy resolution of 20% (no mask) and 14% (with the mask) at 1.2 keV and of 5% at 13.3 keV. The performance evaluation of the JUNGFRAU 0.4 prototype suggests that this detection system could be the starting point for a future detector development effort for either applications in the soft X-ray energy regime or for an energy-dispersive detection system.

JUNGFRAU (adJUstiNg Gain detector FoR the Aramis User station) is a two-dimensional hybrid pixel detector for photon science applications in free electron lasers, particularly SwissFEL, and synchrotron light sources. JUNGFRAU is an automatic gain switching, charge-integrating detector which covers a dynamic range of more than 10(4) photons of an energy of 12 keV with a good linearity, uniformity of response, and spatial resolving power. The JUNGFRAU 1.0 application-specific integrated circuit (ASIC) features a 256 × 256 pixel matrix of 75 × 75 μm(2) pixels and is bump-bonded to a 320 μm thick Si sensor. Modules of 2 × 4 chips cover an area of about 4 × 8 cm(2). Readout rates in excess of 2 kHz enable linear count rate capabilities of 20 MHz (at 12 keV) and 50 MHz (at 5 keV). The tolerance of JUNGFRAU to radiation is a key issue to guarantee several years of operation at free electron lasers and synchrotrons. The radiation hardness of JUNGFRAU 1.0 is tested with synchrotron radiation up to 10 MGy of delivered dose. The effect of radiation-induced changes on the noise, baseline, gain, and gain switching is evaluated post-irradiation for both the ASIC and the hybridized assembly. The bare JUNGFRAU 1.0 chip can withstand doses as high as 10 MGy with minor changes to its noise and a reduction in the preamplifier gain. The hybridized assembly, in particular the sensor, is affected by the photon irradiation which mainly shows as an increase in the leakage current. Self-healing of the system is investigated during a period of 11 weeks after the delivery of the radiation dose. Annealing radiation-induced changes by bake-out at 100 °C is investigated. It is concluded that the JUNGFRAU 1.0 pixel is sufficiently radiation-hard for its envisioned applications at SwissFEL and synchrotron beam lines.

The authors report a very rare case of gestational gigantomastia and the pregnancy could be carried out in term. The patient has been operated of bilateral mastectomy with immediate reconstruction. Surgery is the only radical treatment. Mastectomy with secondary reconstruction is reserved to cases where the intervention must be fast. Mastectomy with immediate reconstruction is the advised intervention if there is a later desire of pregnancy. Mammary reduction is more aesthetic, and allows only one intervention, but exposes to an important risk of recurrence and is not recommended if there is a later desire of pregnancy., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) have been shown to effectively treat grass pollen allergies, although direct comparisons are sparse., Objective: To estimate the relative efficacy of SLIT tablets compared with SCIT and SLIT drops in commercially available products though network meta-analysis., Methods: A literature search of MEDLINE, Embase, and Cochrane Library publications. Randomized, double-blind clinical trials of SCIT, SLIT drops, and SLIT tablets for grass pollen were included. Bayesian network meta-analyses estimated the standardized mean difference (SMD) across 3 immunotherapy modalities on allergic rhinoconjunctivitis symptom and medication score data from publications or received from authors. Both fixed and random effects models were investigated., Results: Thirty-seven studies were included in meta-analyses for symptom scores and 31 studies for medication scores. In the random effects model, SCIT and SLIT tablets were significantly different from placebo for symptom scores: SMDs (95% CI) of -0.32 (-0.45 to -0.18) and -0.32 (-0.41 to -0.23), respectively. No significant difference was identified for SLIT drops compared with placebo (SMD, -0.17; -0.37 to 0.04). For medication scores, significant differences compared with placebo were observed for SCIT (SMD, -0.33; 95% CI, -0.52 to -0.13), SLIT tablets (SMD, -0.23; 95% CI, -0.29 to -0.17), and SLIT drops (SMD, -0.44; 95% CI, -0.83 to -0.06). Network meta-analysis revealed no significant differences in SMDs (95% credible interval) for symptom scores (0.0145 [-0.19 to 0.23]) or medication scores (0.133 [-0.31 to 0.57]) between SLIT tablets and SCIT, or for symptom scores (-0.175 [-0.37 to 0.02]) and medication scores (0.188 [-0.18 to 0.56]) between SLIT tablets and SLIT drops., Conclusions: The comparisons for grass pollen immunotherapy products commercialized in at least 1 country indicate comparable reductions in allergic rhinoconjunctivitis symptoms and supplemental medication use for SLIT tablets and SCIT in the first pollen season., (Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

The occurrence of lactation is a rare complication of breast plastic surgery. During the course of his practice, the plastic surgeon will probably encounter this complication. The goal of this article is to carry out a literature review of all published galactorrhea and/or galactocele cases following a breast-reduction or a breast-augmentation, representing a total of 34 cases reported in 21 articles. The physiopathology of this complication is linked to an inappropriate secretion of prolactin in a surgical context. The factors favoring this complication would be the number of pregnancies, a history of recent and extensive nursing, and the intake of certain medicines such as an oestro-progestative pill. The main symptom of this complication is the occurrence of a uni- or bilateral galactorrhea, on average 12.6 days after the surgery. The main differential diagnosis is a postoperative infection. The explorations presented a hyperprolactinemia in 69% of cases. No biological inflammatory syndrome was reported. A fluid collection evoking a galactocele was visible on the ultrasound in 65% of cases. One case of prolactin-secreting pituitary adenoma was reported. Depending on the case, the treatment varied from a simple surveillance to the association of a dopamine agonist, an antibiotic therapy, and a surgical revision. A diagnostic and therapeutic management strategy is proposed., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: Demonstrating improved overall survival (OS) with new multiple myeloma (MM) treatments is becoming difficult because of extended survival, so progression-free survival (PFS) is commonly used as a surrogate endpoint for OS. We evaluated PFS as a potential surrogate for OS by examining whether observed treatment effects on PFS are positively associated with treatment effects on OS in MM., Methods: A systematic literature review identified 21 randomized control trials reporting hazard ratios (HRs) for treatment effects on PFS and OS. Pearson's r estimated the relationship between HRs (HRPFS and HROS), and between log-transformed HRs (log(HRPFS) and log(HROS)). R(2) values were estimated from linear regression models of the HR and the log(HR) relationships. Sensitivity and subgroup analyses examined the robustness of the HR findings., Results: Positive correlations were found between HRPFS and HROS (r = 0.82; p < 0.0001) and between log(HRPFS) and log(HROS) (r = 0.80; p < 0.0001). Linear regression models produced R(2) values of 0.67 and 0.63 when regressing HROS on HRPFS, and log(HROS) on log(HRPFS), respectively. Sensitivity analyses supported the HR findings., Conclusion: This analysis provides evidence for a positive association between treatment effects on PFS and OS. Studies involving patient level data are necessary to confirm whether PFS is a valid surrogate for OS in MM., (© 2015 S. Karger GmbH, Freiburg.)