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This work demonstrates the employment of tungsten trioxide/polydimethylsiloxane nanocomposite saturable absorber (WO3/PDMS-SA) in realizing mode-locked conventional soliton (CS) and noise-like pulse (NLP) laser generation in net anomalous dispersion. The switching formation from CS regime of 970.0 fs pulse duration to NLP regime of 182.0 fs coherent spike with 65.3 ps pedestal was achieved by varying its pump power. The pulse laser exhibited good stability of 50.76 and 49.82 dB signal-to-noise ratio at 9.09 MHz fundamental repetition rate and trivial variation during stability test for CS and NLP regime, respectively. This work expresses the feasibility of WO3/PDMS-SA in attaining various types of mode-locked pulse phenomena using a fixed cavity configuration conceivably beneficial for compact dual-purpose laser systems.

Introduction: Data concerning the global burden of hidradenitis suppurativa (HS) are limited. Reported prevalence estimates vary between 0.0003% and 4.1%, and data from various geographical regions are still to be collected. Previously reported prevalences have been limited by the methodological approach and source of data. This has resulted in great heterogeneity as prevalence data from physician-diagnosed cases poorly match those of self-reported apparent HS disease. Methods: The Global Hidradenitis Suppurativa Atlas (GHiSA) introduces an innovative approach to determine the global prevalence of HS. This approach involves using a previously validated questionnaire to screen apparently healthy adults accompanying a patient to a non-dermatological outpatient clinic visit in a hospital or a private/family medicine clinic. The screening questionnaire (i.e., the index test) is combined with a subsequent physician-based in-person validation (i.e., the reference standard) of the participants who screen positive. Approximately ten percent of the screen-negative participants are also clinically assessed to verify the diagnostic precision of the test. The local prevalence (pi) will be estimated from each country that submits the number of patients who are HS positive according to the index test and clinical examination (n), and the corresponding total number of observations (N). Conclusion: The GHiSA Global Prevalence studies are currently running simultaneously in 58 countries across six continents (Africa, Europe, Australia, North America, South America, and Asia). The goal of the combined global proportion is the generation of a single summary (i.e., proportional meta-analysis), which will be done after a logit transformation and synthesized using a random-effects model. The novel standardization of the Global Prevalence Studies conducted through GHiSA enables direct international comparisons, which were previously not possible due to substantial heterogeneity in past HS prevalence studies. [ABSTRACT FROM AUTHOR]

Background Several registries for hidradenitis suppurativa (HS) already exist in Europe and the USA. There is currently no global consensus on a core dataset (CDS) for these registries. Creating a global HS registry is challenging, owing to logistical and regulatory constraints, which could limit opportunities for global collaboration as a result of differences in the dataset collected. The solution is to encourage all HS registries to collect the same CDS of information, allowing registries to collaborate. Objectives To establish a core set of items to be collected by all HS registries globally. The core set will cover demographic details, comorbidities, clinical examination findings, patient-reported outcome measures and treatments. Methods Beginning in September 2022, 20 participants – including both clinicians with expertise in HS and patient advocates – from eight countries across three continents participated in a Delphi process consisting of four rounds of voting, with all participants completing each round. A list of potential items for inclusion in the core set was generated from the relevant published literature, including systematic reviews of comorbidities in HS, clinical and examination findings, and epidemiology. For disease severity and progression items, the Hidradenitis SuppuraTiva Core outcome set International Collaboration (HiSTORIC) core set and other relevant instruments were considered for inclusion. This resulted in 47 initial items. Participants were invited to suggest additional items to include during the first round. Anonymous feedback was provided to inform each subsequent round of voting to encourage consensus. Results The eDelphi process established a CDS of 48 items recommended for inclusion in all HS registries globally. Conclusions The routine adoption of this CDS in current and future HS registries should allow registries in different parts of the world to collaborate, enabling research requiring large numbers of participants. [ABSTRACT FROM AUTHOR]

This paper focused on the novel design of receiver side of wavelength division multiplexing passive optical network (WDM-PON). It serves the need for a dramatic change in demand for high data rate beyond 10 gigabits per second (Gbps) at the last mile for a larger coverage area or distance. This increase in demand for higher bandwidth is due to the emerging future technologies like Internet of things (IoT), silicon on chip (SoC), cloud computing, machine learning (ML), and artificial intelligence (AI). Simulation results demonstrated for the different coverage areas which compare the bit error rate (BER), quality (Q)-Factor, and eye height as per the guidelines of ITU-T. It has been predicted that the proposed WDM-PON design supports up to a distance of 60 km. Results have been verified for 40 km, 50 km, 60 km, and 70 km, respectively, at 100 GHz frequency spacing with acceptable BER and better quality (Q)-factor as defined by ITU. [ABSTRACT FROM AUTHOR]

BackgroundAcute kidney injury is a risk factor for death in cardiac surgical patients. Plasma cystatin C and creatinine have different temporal profiles in the postoperative setting, but the associations of simultaneous changes in both filtration markers compared with change in only one marker with prognosis after hospital discharge are not well described.MethodsThis is a longitudinal study of 1,199 high-risk adult cardiac surgical patients in the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury) Consortium who survived hospitalization. We examined in-hospital peak changes of cystatin C and creatinine in the 3 days after cardiac operations. We evaluated associations of these filtration markers with death, adjusting for demographics, operative characteristics, medical comorbidities, preoperative estimated glomerular filtration rate, preoperative urinary albumin-to-creatinine ratio, and site.ResultsDuring the first 3 days of hospitalization, nearly twice as many patients had a 25% or higher rise in creatinine (30%) compared with a 25% or higher peak rise in cystatin C (15%). The risk of death was higher in those with elevations in cystatin C (adjusted hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.4 to 2.37) or creatinine (adjusted HR, 1.90; 95% CI, 1.32 to 2.72) compared with patients who experienced a postoperative decrease in either filtration marker. Patients who had simultaneous elevations of 25% or higher in cystatin C and creatinine were at similar adjusted risk for 3-year mortality (HR, 1.79; 95% CI, 1.03 to 3.1) as those with a 25% or higher increase in cystatin C alone (HR, 2.2; 95% CI, 1.09 to 4.47).ConclusionsElevations in creatinine postoperatively are more common than elevations in cystatin C. However, elevations in cystatin C appeared to be associated with a higher risk of death after hospital discharge.

ImportanceIdentifying patients at risk of chronic kidney disease (CKD) progression may facilitate more optimal nephrology care. Kidney failure risk equations, including such factors as age, sex, estimated glomerular filtration rate, and calcium and phosphate concentrations, were previously developed and validated in 2 Canadian cohorts. Validation in other regions and in CKD populations not under the care of a nephrologist is needed.ObjectiveTo evaluate the accuracy of the risk equations across different geographic regions and patient populations through individual participant data meta-analysis.Data sourcesThirty-one cohorts, including 721,357 participants with CKD stages 3 to 5 in more than 30 countries spanning 4 continents, were studied. These cohorts collected data from 1982 through 2014.Study selectionCohorts participating in the CKD Prognosis Consortium with data on end-stage renal disease.Data extraction and synthesisData were obtained and statistical analyses were performed between July 2012 and June 2015. Using the risk factors from the original risk equations, cohort-specific hazard ratios were estimated and combined using random-effects meta-analysis to form new pooled kidney failure risk equations. Original and pooled kidney failure risk equation performance was compared, and the need for regional calibration factors was assessed.Main outcomes and measuresKidney failure (treatment by dialysis or kidney transplant).ResultsDuring a median follow-up of 4 years of 721,357 participants with CKD, 23,829 cases kidney failure were observed. The original risk equations achieved excellent discrimination (ability to differentiate those who developed kidney failure from those who did not) across all cohorts (overall C statistic, 0.90; 95% CI, 0.89-0.92 at 2 years; C statistic at 5 years, 0.88; 95% CI, 0.86-0.90); discrimination in subgroups by age, race, and diabetes status was similar. There was no improvement with the pooled equations. Calibration (the difference between observed and predicted risk) was adequate in North American cohorts, but the original risk equations overestimated risk in some non-North American cohorts. Addition of a calibration factor that lowered the baseline risk by 32.9% at 2 years and 16.5% at 5 years improved the calibration in 12 of 15 and 10 of 13 non-North American cohorts at 2 and 5 years, respectively (P = .04 and P = .02).Conclusions and relevanceKidney failure risk equations developed in a Canadian population showed high discrimination and adequate calibration when validated in 31 multinational cohorts. However, in some regions the addition of a calibration factor may be necessary.

AbstractBackgroundThe mortality rate for melanoma continues to rise and the greatest improvement in melanoma survival is attributable to early detection with skin cancer screening exams. However, physicians feel that limited training in the examination of skin and limited clinical time both serve as barriers to adequately assess high-risk lesions.ObjectiveTo test the use of The Integrated Skin Exam film as an instructional tool to teach the examination of skin in a live classroom setting, outside of the purview of the original formal study.MethodsIdentical cross-sectional surveys were administered pre- and post-film to a class of first-year medical students at the time of viewing The Integrated Skin Exam film. Results were compared to the initial assessment of this film as a teaching tool in a research setting.ResultsOf the maximum 182 possible surveys administered, we collected 148 pre-surveys and 142 post-surveys (81.3% and 78.0% 33 response rates, respectively). After viewing the film, students showed improvement in identification of high-risk demographic 34 groups (79.3% vs 58.9%, p