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Introduction: Treatment adherence is a critical success factor in the disease-modifying therapy (DMT) of multiple sclerosis (MS). The REBISTART study prospectively evaluated adherence in patients using components of a patient support program (PSP). Methods: The 12-month non-interventional multicenter study examined the real-world adherence to subcutaneously (sc) injected interferon beta-1a (Rebif®). Patient-assessed adherence was measured by a visual analog scale (VAS) and the Morisky Medication Adherence Scale (MMAS). Objective adherence data were obtained by readouts from the RebiSmart® injection device. Results: Of 333 patients, 70.9% used the nursing service as the core component of the PSP. Self-assessed VAS-based adherence was stable over time at 94.0–96.3%. Similarly, MMAS score (maximum 4) was 3.8–3.9 at all visits, also reflecting high self-assessed adherence. In 269 patients using the RebiSmart® injection device, mean readout-based objective adherence was similarly high (93.0–98.4% throughout visits). At last available visit, VAS-based adherence was independent of participation in the PSP nursing service (93.1% with participation versus 91.7% without it). Adherence was also independent of injection method or disease-related measures, including fatigue, depression, cognition, and quality of life. The most frequent reason for the premature discontinuations (38.7% of patients) was "change of treatment" (10.0%). Discussion: We suggest that subgroups that may specifically benefit from PSP include patients who live alone, use multiple comedications, and are affected by cognitive impairment, depression, and/or fatigue. Further studies should investigate the potential usefulness of PSPs in these populations. Conclusions: Very high adherence rates independent of the PSP nursing service over 1 year of treatment indicate that IFN beta-1a sc is an easy-to-use and well-tolerated disease-modifying drug. Trial Registration Number: Vfa.de: No. 892. https://www.vfa.de/de/arzneimittel-forschung/datenbanken-zu-arzneimitteln/nisdb/nis-details/_892. [ABSTRACT FROM AUTHOR]

Background and purpose: Functional neurological disorders (FNDs) have attracted much attention from the neurological medical community over the last decades as new developments in neurosciences have reduced stigma around these by showing brain network dysfunctions. An overlap with other neurological conditions such as multiple sclerosis (MS) is well known by clinicians but there is a lack of clinical and fundamental research in this field to better define diagnosis and therapeutic decisions, as well as a lack of deep understanding of the underlying pathophysiology. Aim: We aimed to provide a critical commentary on the state of knowledge about the borderland between FNDs and MS. Methods: We based our commentary on a joint point of view between an FND specialist and an MS expert. Results: A brief review of the previous literature and relevant new studies covering the overlap between FNDs and MS is presented, along with suggestions for future research directions. Conclusion: There are clear diagnostic criteria for both FNDs and MS and a strict application of these will help better diagnosis and prevent unnecessary treatment escalation in MS or absence of referral to multimodal therapy in FND. Better teaching of younger neurologists is needed as well as prospective research focusing on pathophysiology. [ABSTRACT FROM AUTHOR]

It remains unclear how type of insurance coverage affects long-term, spine-specific patient-reported outcomes (PROs). This study sought to elucidate the impact of insurance on clinical outcomes after lumbar spondylolisthesis surgery. The prospective Quality Outcomes Database registry was queried for patients with grade 1 degenerative lumbar spondylolisthesis who underwent single-segment surgery. Twenty-four-month PROs were compared and included Oswestry Disability Index, Numeric Rating Scale (NRS) back pain, NRS leg pain, EuroQol-5D, and North American Spine Society Satisfaction. A total of 608 patients undergoing surgery for grade 1 degenerative lumbar spondylolisthesis (mean age, 62.5 ± 11.5 years and 59.2% women) were selected. Insurance types included private insurance (n = 319; 52.5%), Medicare (n = 235; 38.7%), Medicaid (n = 36; 5.9%), and Veterans Affairs (VA)/government (n = 17; 2.8%). One patient (0.2%) was uninsured and was removed from the analyses. Regardless of insurance status, compared to baseline, all 4 cohorts improved significantly regarding ODI, NRS-BP, NRS-LP, and EQ-5D scores (P < 0.001). In adjusted multivariable analyses, compared with patients with private insurance, Medicaid was associated with worse 24-month postoperative Oswestry Disability Index (β = 10.2; 95% confidence interval [CI], 3.9–16.5; P = 0.002) and NRS leg pain (β =1.3; 95% CI, 0.3–2.4; P = 0.02). Medicaid was associated with worse EuroQol-5D scores compared with private insurance (β = −0.07; 95% CI −0.01 to −0.14; P = 0.03), but not compared with Medicare and VA/government insurance (P > 0.05). Medicaid was associated with lower odds of reaching ODI minimal clinically important difference (odds ratio, 0.2; 95% CI, 0.03–0.7; P = 0.02) compared with VA/government insurance. NRS back pain and North American Spine Society satisfaction did not differ by insurance coverage (P > 0.05). Despite adjusting for potential confounding variables, Medicaid coverage was independently associated with worse 24-month PROs after lumbar spondylolisthesis surgery compared with other payer types. Although all improved postoperatively, those with Medicaid coverage had relatively inferior improvements. [ABSTRACT FROM AUTHOR]

Inhibition of the lectin pathway of complement ameliorates hypocomplementemia and restores serum bactericidal activity in patients with severe COVID-19 In a separate study of secondary infection in hospitalised COVID-19 patients,10 we demonstrated that serum bactericidal activity (SBA) against I Klebsiella pneumoniae i is compromised in plasma from acute COVID-19 patients. On admission, all 18 COVID-19 patients showed hypocomplementemia, that is low CH SB 50 sb values (Figure 1A), and elevated plasma C5a (Figure 1B), with no significant differences between the treated and untreated groups, despite the untreated patients having less severe disease than those chosen for narsoplimab treatment (Table 1). [Extracted from the article]

• UWB offers superior localization accuracy (∼ 30 cm) but has not been tested in homes. • Gait lab static positioning accuracy was measured as 5.5 ± 9.1 cm and 4.4 ± 6.4 cm (X, Y). • Mock condo static position accuracy was measured as 21.1 ± 9.4 cm and 17.3 ± 8.9 cm (X, Y). • 9 different accuracy factors were tested and only had a 3.5 cm decrease in accuracy. The population of older adults is rapidly growing. In-home monitoring systems have been used to support aging-in-place. Ambient sensors or wearable localizers can be used but may be too low resolution, while camera systems are invasive to privacy. Ultra-wideband (UWB) localization offers precise positioning by placing anchors throughout the house and wearing a tag that is tracked by the anchors. In this study, the accuracy of UWB for indoor tracking was evaluated in a motion capture gait lab and in a mock condo in the Glenrose Rehabilitation Hospital. First, the configuration of UWB was tested, changing factors related to sampling time, anchor placement and line-of-sight. Comparing these factors to the configurations recommended by the manufacturer guidelines, accuracies remained within 14 cm. We then performed static and dynamic accuracy tests, with dynamic testing comprised of rolling and walking motions. In the motion capture lab, we found localization accuracies of 7.0 ± 11.1 cm while in the mock condo, we found accuracies of 27.3 ± 12.9 cm. Dynamic testing with rolling motions had an average of 19.1 ± 1.6 cm while walking was 20.5 ± 4.2 cm. The mean accuracy of UWB is within the 30 cm target for indoor localization. [ABSTRACT FROM AUTHOR]

Spinal epidural abscesses (SEA) require prompt diagnosis to avoid devastating consequences. Here, we discuss the case of a healthy 20-year-old college student—with a recent diagnosis of strep pharyngitis—who presented with neck pain, fever, and a neurologic deficit—the most common symptoms of SEA. Magnetic resonance imaging revealed a T1-postcontrast, peripherally enhancing epidural collection from C3-T5 with associated cord compression and T3 osteomyelitis. The patient was treated with emergent skip hemilaminectomies for abscess evacuation. Surgical cultures grew Fusobacterium necrophorum, a highly unusual pathogen in SEA. It is an oral anaerobe that translocated through the mucosa in the setting of strep pharyngitis. We treated the patient with ceftriaxone for 6 weeks. The patient had a full neurologic recovery and remains without recurrence of infection 11 months postoperatively. Healthy patients without obvious risk factors may present with SEA, highlighting the need for atypical cases such as these to be brought to clinicians' attention. [ABSTRACT FROM AUTHOR]

Background: Randomized controlled trials (RCTs) are the gold standard for study design and are considered to have the highest level of evidence. The purpose of this study is to evaluate quality of evidence of prospective RCTs that investigated the clinical efficacy of platelet-rich plasma (PRP) treatments for knee osteoarthritis. We hypothesized that a high level of clinical evidence does not correlate with a high-quality scientific study.Material and Methods: A systematic literature search to identified RCTs that evaluated the efficacy of PRP treatments for knee osteoarthritis. Inclusion criteria included studies that contained key terms "Platelet-rich plasma," "PRP", "knee", and "osteoarthritis". Exclusion criteria excluded studies that were not prospective RCTs. Ten RCTs were evaluated by four independent reviewers. The studies were assessed according to the Oxford Levels of Evidence, a modified Coleman Methodology Score, and the revised Consolidated Standards of Reporting Trials (CONSORT) score.Results: Three of the four Observers rated all 10 studies as Level I, while one Observer rated 80% of the studies as Level I. Using the Coleman Methodology Score, the average score for all studies was 58.0 out of 100 points, designating the studies as "fair." Areas of deficiency included clinical effect measurement and intent-to-treat analysis. Using the CONSORT checklist, the average score was 16.9 out of 22 points, designating the studies as "good". Areas of deficiency included inadequate implementation of randomization and interpretation of results.Discussion: Clinicians should critically evaluate research studies regardless of study design. A sophisticated study design and high level of evidence designation does not guarantee quality research. We determined that RCTs for PRP treatment of knee osteoarthritis were not as robust in quality despite their Level I Oxford Level of Evidence rating. [ABSTRACT FROM AUTHOR]

Background: Prior epidemiological and intervention studies have not been able to separate independent effects of dose, timing, and duration of aspirin use in colorectal cancer (CRC) chemoprevention. We examined aspirin-based CRC chemoprevention according to timing in the Nurses' Health Study and Health Professionals Follow-Up Study.Methods: The exposures include cumulative average dose and total duration of aspirin use in more than 10 years before follow-up started (remote period) and in the immediate 10 years before follow-up started (recent period). Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for exposures and CRC risk.Results: Aspirin use of longer than 10 years before follow-up started (HR = 0.88, 95% CI = 0.83 to 0.94) per 5-year increment and the immediate 10 years before follow-up started (HR = 0.90, 95% CI = 0.84 to 0.96) were similarly important in CRC chemoprevention, though a 5-year lag was required for a clear benefit in the recent period. In the remote period, the association was not dose dependent; compared with less than 0.5 standard-dose (325 mg) tablets per week; hazard ratios were 0.78 (95% CI = 0.63 to 0.98), 0.81 (95% CI = 0.72 to 0.91), and 0.74 (95% CI = 0.64 to 0.86) for doses of 0.5 to less than 1.5, 1.5 to less than 5, and 5 and more tablets per week, respectively. However, there was dose dependency in the recent period (with respective HR = 0.91, 95% CI = 0.79 to 1.06; HR = 0.87, 95% CI = 0.77 to 0.98; and HR = 0.76, 95% CI = 0.64 to 0.91).Conclusions: A suggestive benefit necessitates at least 6-10 years and most clearly after approximately 10 years since initiation of aspirin. Remote use and use within the previous 10 years both contribute independently to decrease risk, though a lower dose may be required for a benefit with longer term use. [ABSTRACT FROM AUTHOR]

As the older adult population rise globally, technologies to monitoring activities of daily living (ADL) may have a role in supporting aging in place for older adults. The objective of this systematic literature review was to study the scope, diversity and readiness of technologies developed to monitor ADL in older adults. We systematically searched two scientific databases (CINAHL and IEEE), following Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA) guidelines. We included studies on technologies used to monitor older adults' ADL in the home but excluded studies focused on communication technologies (phone calls, text messages) or monitoring postures alone. The JBI checklist for case series was used for quality assessment. Extracted details included population characteristics, ADL assessment outcomes, types of monitoring technology, and technology readiness and usability. The search found 147 papers, with 16 papers included in the final analysis. The literature described 48 types of technologies. Of moderate quality studies, five studies used wearables at technology readiness level 4–6 to monitor basic ADL (walking, transfers and walking up stairs) and one used ambient sensors to detect urinary incontinence. Monitoring technologies remain at development stages. More research is needed to strengthen technologies that monitor activities of daily living. Monitoring activities of daily living at home remains focused on using wearables to assess in-home functional mobility to support rehabilitation. Technologies remain a 4–6 readiness level and there is a lack of evidence to recommend in-home monitoring technologies. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective analysis of a prospective registry.Objective: We utilized the Quality Outcomes Database (QOD) registry to investigate the "July Effect" at QOD spondylolisthesis module sites with residency trainees.Summary Of Background Data: There is a paucity of investigation on the long-term outcomes following surgeries involving new trainees utilizing high-quality, prospectively collected data.Methods: This was an analysis of 608 patients who underwent single-segment surgery for grade 1 degenerative lumbar spondylolisthesis at 12 high-enrolling sites. Surgeries were classified as occurring in July or not in July (non-July). Outcomes collected included estimated blood loss, length of stay, operative time, discharge disposition, complications, reoperation and readmission rates, and patient-reported outcomes (Oswestry Disability Index [ODI], Numeric Rating Scale [NRS] Back Pain, NRS Leg Pain, EuroQol-5D [EQ-5D] and the North American Spine Society [NASS] Satisfaction Questionnaire). Propensity score-matched analyses were utilized to compare postoperative outcomes and complication rates between the July and non-July groups.Results: Three hundred seventy-one surgeries occurred at centers with a residency training program with 21 (5.7%) taking place in July. In propensity score-matched analyses, July surgeries were associated with longer operative times ( average treatment effect = 22.4 minutes longer, 95% confidence interval 0.9-449.0, P = 0.041). Otherwise, July surgeries were not associated with significantly different outcomes for the remaining perioperative parameters (estimated blood loss, length of stay, discharge disposition, postoperative complications), overall reoperation rates, 3-month readmission rates, and 24-month ODI, NRS back pain, NRS leg pain, EQ-5D, and NASS satisfaction score (P > 0.05, all comparisons).Conclusion: Although July surgeries were associated with longer operative times, there were no associations with other clinical outcomes compared to non-July surgeries following lumbar spondylolisthesis surgery. These findings may be due to the increased attending supervision and intraoperative education during the beginning of the academic year. There is no evidence that the influx of new trainees in July significantly affects long-term patient-centered outcomes.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: An experimental animal study.Objective: The aim of this study was to investigate the effect of pulsed electromagnetic fields (PEMF) on recovery of sensorimotor function in a rodent model of disc herniation (DH).Summary Of Background Data: Radiculopathy associated with DH is mediated by proinflammatory cytokines. Although we have demonstrated the anti-inflammatory effects of PEMF on various tissues, we have not investigated the potential therapeutic effect of PEMF on radiculopathy resulting from DH.Methods: Nineteen rats were divided into three groups: positive control (PC; left L4 nerve ligation) (n = 6), DH alone (DH; exposure of left L4 dorsal root ganglion [DRG] to harvested nucleus pulposus and DRG displacement) (n = 6), and DH + PEMF (n = 7). Rodents from the DH + PEMF group were exposed to PEMF immediately postoperatively and for 3 hours/day until the end of the study. Sensory function was assessed via paw withdrawal thresholds to non-noxious stimuli preoperatively and 1 and 3 days postoperatively, and every 7 days thereafter until 7 weeks after surgery. Motor function was assessed via DigiGait treadmill analysis preoperatively and weekly starting 7 days following surgery until 7 weeks following surgery.Results: All groups demonstrated marked increases in the left hindlimb response threshold postoperatively. However, 1 week following surgery, there was a significant effect of condition on left hindlimb withdrawal thresholds (one-way analysis of variance: F = 3.82, df = 2, P = 0.044) where a more rapid recovery to baseline threshold was evident for DH + PEMF compared to PC and DH alone. All groups demonstrated gait disturbance postoperatively. However, DH + PEMF rodents were able to regain baseline gait speeds before DH and PC rodents. When comparing gait parameters, DH + PEMF showed consistently less impairment postoperatively suggesting that PEMF treatment was associated with less severe gait disturbance.Conclusion: These data demonstrate that PEMF accelerates sensorimotor recovery in a rodent model of DH, suggesting that PEMF may be reasonable to evaluate for the clinical management of patients with herniation-associated radiculopathy.Level of Evidence: N/A. [ABSTRACT FROM AUTHOR]

High-quality evidence indicates that regular use of aspirin is effective in reducing the risk for precancerous colorectal neoplasia and colorectal cancer (CRC). This has led to US and international guidelines recommending aspirin for the primary prevention of CRC in specific populations. In this review, we summarize key questions that require addressing prior to broader adoption of aspirin-based chemoprevention, review recent evidence related to the benefits and harms of aspirin use among specific populations, and offer a rationale for precision prevention approaches. We specifically consider the mechanistic implications of evidence showing differences in aspirin's effects according to age, the potential role of modifiable mechanistic biomarkers for personalizing prevention, and emerging evidence that the gut microbiota may offer novel aspirin-associated preventive targets to reduce high-risk neoplasia. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis (AIS) is a 3-D spinal deformity that affects 1%–3% of youth. Severe cases require surgical intervention involving the insertion of pedicle screws near the spinal cord, making accurate placement imperative. Currently, surgeons use either CT-navigation methods to guide the placement of screws or free-hand methods. The free-hand method has higher breach rates; however, CT-navigation exposes children to sensitive ionizing radiation. A novel custom 3-D ultrasound (3DUS) system has been developed to provide accuracy benefits similar to traditional CT-navigation systems without exposing patients to ionizing radiation. This study evaluates the accuracy of the custom 3DUS guidance system for localizing 3-D reconstructions of vertebral phantoms and tracking handheld surgical tools in the surgical space. Tool tracking was evaluated with commercial motion tracking cameras using a 3-D-printed pointer device and a high-precision probe device. Experiments were performed on 3-D-printed vertebral phantoms to investigate the positional and orientational accuracy using a high precision reference grid. The 3-D-printed pointer device was shown to be inferior to the high-precision probe, finding positional accuracy of 1.1 ± 1.1 mm versus 0.7 ± 0.4 mm. The rotational accuracy was 0.0° ± 1.7°, which met the surgical objective. The 3DUS localization, which was also evaluated using the vertebral phantoms and reference grid, showed positional accuracy of 0.8 ± 0.6 mm, making it a promising image-guidance tool for scoliosis surgery. [ABSTRACT FROM AUTHOR]

Study Design: Prospective database analysis.Objective: To assess the effect of age on patient-reported outcomes (PROs) and complication rates after surgical treatment for spondylolisthesis SUMMARY OF BACKGROUND DATA.: Degenerative lumbar spondylolisthesis affects 3% to 20% of the population and up to 30% of the elderly. There is not yet consensus on whether age is a contraindication for surgical treatment of elderly patients.Methods: The Quality Outcomes Database lumbar registry was used to evaluate patients from 12 US academic and private centers who underwent surgical treatment for grade 1 lumbar spondylolisthesis between July 2014 and June 2016.Results: A total of 608 patients who fit the inclusion criteria were categorized by age into the following groups: less than 60 (n = 239), 60 to 70 (n = 209), 71 to 80 (n = 128), and more than 80 (n = 32) years. Older patients showed lower mean body mass index (P < 0.001) and higher rates of diabetes (P = 0.007), coronary artery disease (P = 0.0001), and osteoporosis (P = 0.005). A lower likelihood for home disposition was seen with higher age (89.1% in <60-year-old vs. 75% in >80-year-old patients; P = 0.002). There were no baseline differences in PROs (Oswestry Disability Index, EuroQol health survey [EQ-5D], Numeric Rating Scale for leg pain and back pain) among age categories. A significant improvement for all PROs was seen regardless of age (P < 0.05), and most patients met minimal clinically important differences (MCIDs) for improvement in postoperative PROs. No differences in hospital readmissions or reoperations were seen among age groups (P < 0.05). Multivariate analysis demonstrated that, after controlling other variables, a higher age did not decrease the odds of achieving MCID at 12 months for the PROs.Conclusion: Our results indicate that well-selected elderly patients undergoing surgical treatment of grade 1 spondylolisthesis can achieve meaningful outcomes. This modern, multicenter US study reflects the current use and limitations of spondylolisthesis treatment in the elderly, which may be informative to patients and providers.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

The rapid pace of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) pandemic presents challenges to the real-time collection of population-scale data to inform near-term public health needs as well as future investigations. We established the COronavirus Pandemic Epidemiology (COPE) consortium to address this unprecedented crisis on behalf of the epidemiology research community. As a central component of this initiative, we have developed a COVID Symptom Study (previously known as the COVID Symptom Tracker) mobile application as a common data collection tool for epidemiologic cohort studies with active study participants. This mobile application collects information on risk factors, daily symptoms, and outcomes through a user-friendly interface that minimizes participant burden. Combined with our efforts within the general population, data collected from nearly 3 million participants in the United States and United Kingdom are being used to address critical needs in the emergency response, including identifying potential hot spots of disease and clinically actionable risk factors. The linkage of symptom data collected in the app with information and biospecimens already collected in epidemiology cohorts will position us to address key questions related to diet, lifestyle, environmental, and socioeconomic factors on susceptibility to COVID-19, clinical outcomes related to infection, and long-term physical, mental health, and financial sequalae. We call upon additional epidemiology cohorts to join this collective effort to strengthen our impact on the current health crisis and generate a new model for a collaborative and nimble research infrastructure that will lead to more rapid translation of our work for the betterment of public health. [ABSTRACT FROM AUTHOR]

Our aim is to review the most recent evidence on novel antibody therapies for Alzheimer's disease directed against amyloid‐β. This is a joint statement of the European Association of Neurology and the European Psychiatric Association. After numerous unsuccessful endeavors to create a disease‐modifying therapy for Alzheimer's disease, substantial and consistent evidence supporting the clinical effectiveness of monoclonal antibodies aimed at amyloid‐β is finally emerging. The latest trials not only achieved their primary objective of slowing the progression of the disease over several months but also demonstrated positive secondary clinical outcomes and a decrease in amyloid‐β levels as observed through positron emission tomography scans. Taken as a whole, these findings mark a significant breakthrough by substantiating that reducing amyloid‐β yields tangible clinical benefits, beyond mere changes in biomarkers. Concurrently, the regular utilization of the new generation of drugs will determine whether statistical efficacy translates into clinically meaningful improvements. This may well signify the dawning of a new era in the development of drugs for Alzheimer's disease. [ABSTRACT FROM AUTHOR]

Purpose: Surgical treatment of severe adolescent idiopathic scoliosis (AIS) with posterior spinal instrumentation and fusion with pedicle screws is common, requiring careful screw insertion to prevent pedicle breaches and neurologic complications. Image guidance has been suggested to improve breach rates, though the radiation risk for AIS precludes its common usage. The purpose of this systematic review and meta-analysis was to compare the breach rates and screw-related complications for AIS patients undergoing spine surgery with pedicle screws between freehand screw insertion and image guidance methods.Methods: A comprehensive search of MEDLINE, EMBASE, CINAHL, CENTRAL and Web of Science databases was conducted. Two reviewers independently screened abstracts, full-texts, extracted data and performed risk of bias assessment using the QUIPS quality appraisal tool. Level of evidence summary statements were formulated based on consistency and quality of reporting.Results: Ninety-four studies were found, with 18 studies of moderate risk of bias or better. Moderate evidence from two head-to-head studies shows CT guidance has lower breach rates than freehand methods (OR 0.28 [0.20-0.40, I2 = 1%]), with no complications in either study. From individual studies, moderate evidence showed lower breach rates for image guidance versus freehand methods (13%, I2 = 98% vs. 20%, I2 = 95%). Complication rates were conflicting (0-1.6% for image guidance, 0-1.7% for freehand). Moderate evidence showed increased surgical time for image guidance versus freehand (257.7 min vs. 226.8 min).Conclusions: Meta-analyzed breach rates show moderate evidence of decreased breaches with CT navigation compared with freehand methods. Complication rates remain unknown due to the low complication rates from small sample sizes. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

Purpose: To assess guideline compliance and quality of hepatocellular carcinoma, (HCC) diagnostic imaging within community hospitals (CH) and their Tertiary referral center (TRC) in a moderately high incidence region. Methods: Initial diagnostic workup CT/MRI scans of 251 patients (122 CH, 112 TRC, 17 Non-TRC academic) with HCC over a 15-month period were assessed for Liver reporting and Data System (LI-RADS) guideline compliance. 269 scans (182 CT, 87 MRI) were qualitatively evaluated by 2 independent blinded radiologists for arterial timing, overall image quality, noise and sharpness, with quantification of interobserver variability. The contrast enhancement ratio (CER) for the largest HCC on each scan was calculated using pre- and post-contrast images. Results: 103/104 (99%) of TRC and 44/78 (56%) of CH CTs adhered to LI–RADS imaging guidelines (P < 0.0001). Lack of delayed phase accounted for 32/34 (94%) of noncompliant CH CTs. Regarding MRI, 19/19 (100%) of TRC and 60/68 (88%) of CH scans were adherent (P = 0.12). For both modalities, overall image quality, noise and sharpness were rated significantly higher for TRC than CH. There was moderate interobserver agreement with intraclass correlation coefficient of 0.73, 0.70 and 0.63, respectively. Arterial-phase timing was rated adequate for CT in 75/104 TRC (72%) and 10/68 (14%) CH scans (P < 0.0001) and for MRI in 8/19 (42%) TRC and 23/68 (33%) CH scans (P = 0.17). The CER was significantly higher for TRC versus CH (2.9 vs. 1.9, P < 0.001) and MRI (0.9 vs. 0.7, P = 0.03). Conclusions: Community hospital HCC diagnostic scans significantly lag in critical quality parameters of tumor enhancement, arterial phase timing, perceived image quality, and LI-RADS CT technique compliance compared to a TRC. [ABSTRACT FROM AUTHOR]

Objective: This retrospective cohort study seeks to identify risk factors associated with complications following posterior cervical laminectomy and fusion (PCLF) surgery. Methods: Adults undergoing PCLF from 2012 through 2018 at a single center were identified. Demographic and radiographic data, surgical characteristics, and complication rates were compared. Multivariate logistic regression models identified independent predictors of complications following surgery. Results: A total of 196 patients met the inclusion criteria and were included in the study. The medical, surgical, and overall complication rates were 10.2%, 23.0%, and 29.1% respectively. Risk factors associated with medical complications in multivariate analysis included impaired ambulation status (odds ratio [OR], 2.27; p = 0.02) and estimated blood loss over 500 mL (OR, 3.67; p = 0.02). Multivariate analysis revealed preoperative narcotic use (OR, 2.43; p = 0.02) and operative time (OR, 1.005; p = 0.03) as risk factors for surgical complication, whereas antidepressant use was a protective factor (OR, 0.21; p = 0.01). Overall complication was associated with preoperative narcotic use (OR, 1.97; p = 0.04) and higher intraoperative blood loss (OR, 1.0007; p = 0.03). Conclusion: Preoperative narcotic use and estimated blood loss predicted the incidence of complications following PCLF for CSM. Ambulation status was a significant predictor of the development of a medical complication specifically. These results may help surgeons in counseling patients who may be at increased risk of complication following surgery. [ABSTRACT FROM AUTHOR]

Even in families with a high prevalence of multiple sclerosis (MS), we are as yet unable to predict the development of MS with adequate accuracy at the individual level. To predict or not to predict: Multiple sclerosis and B-cell subset-specific genetic risk scores Although this work does show that the genetic susceptibility factors of MS correlate with the composition of the B-cell compartment early in life even of healthy children, it also highlights some current limitations and unmet needs in improving MS prediction. [Extracted from the article]

Let K be a field with a valuation and let S be the polynomial ring S := K[x1, . . . , xn]. We discuss the extension of Gröbner theory to ideals in S, taking the valuations of coefficients into account, and describe the Buchberger algorithm in this context. In addition we discuss some implementation and complexity issues. The main motivation comes from tropical geometry, as tropical varieties can be defined using these Grobner bases, but we also give examples showing that the resulting Grobner bases can be substantially smaller than traditional Gröbner bases. In the case K = Q with the p-adic valuation the algorithms have been implemented in a Macaulay 2 package. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Ni/P25 TiO 2 and Au/P25 TiO 2 afford similar H 2 production rates in alcohol-water mixtures. • Ni/P25 TiO 2 outperforms Au/P25 TiO 2 in methanol-water mixtures under UV excitation. • H 2 production rates depend on the alcohol hole scavenger and alcohol concentration. • At 10 vol%, rates follow the order glycerol > ethylene glycol > methanol > ethanol. • At 40 vol%, rates follow the order methanol > ethylene glycol > glycerol > ethanol. Abstract This study systematically compares the performance of 0.5 wt% Ni/P25 TiO 2 and 2 wt% Au/P25 TiO 2 photocatalysts for H 2 production in alcohol-water mixtures under UV excitation. HRTEM, XANES and EXAFS confirmed the presence of 5–8 nm Ni0 and Au0 nanoparticles on the surface of the photocatalysts. H 2 production tests were conducted in various alcohol-water systems (0–100 vol%), using methanol, ethanol, ethylene glycol and glycerol. The Ni/P25 TiO 2 and Au/P25 TiO 2 photocatalysts demonstrated remarkably similar performance for hydrogen production in all the alcohol-water systems tested. At low alcohol concentrations (15 vol% or less), H 2 production rates followed the order glycerol > ethylene glycol > methanol > ethanol, whilst at higher alcohol concentrations methanol (optimum 40 vol%) and ethanol (optimum 80–90 vol%) afforded the highest rates. Rates depended on the polarity and oxidation potential of the alcohol. Further, anatase-rutile heterojunctions in P25 TiO 2 were found to greatly enhance H 2 production. [ABSTRACT FROM AUTHOR]

As surgical techniques for deformity correction evolve towards minimizing tissue trauma, further clarity is warranted to define differences in complication profiles between cMIS and open surgeries. To compare cMIS and open surgery reoperation rates and identify contributing etiologies to reoperation in each cohort. Prospective multicenter observational series. Database enrollment required age =18 years, adult spinal deformity and circumferential minimally invasive spine surgery. Reoperation rate, patient reported outcomes (PROMS), spinopelvic parameters, mechanical failures (defined as rod breakage/dislocation, screw breakage/loosening, set screw loosening, proximal/distal junctional kyphosis, pseudoarthrosis) and other factors contributing to re-operation such as wound infection, medial breach, nerve impingement by screw, vertebral body fracture, sagittal/coronal imbalance, and wound infection. A total of 85 patients (pts) with cMIS for ASD with 2-year follow-up (2YFU) were identified and propensity matched to 85 patients in open cohort. Propensity matching was performed based on pre-operative PT, PI-LL, BMI, and SVA. Patient demographic variables, reoperation rate, and complications contributing to reoperation were compared with uni- and multi-variate analysis at any time in each cohort (33 open, 17 cMIS). PROMS at 2YFU were compared in the reoperated cohorts. Total of 33 reoperation in the open cohort vs 17 in cMIS were identified. The reoperation rate was significantly higher in the open cohort at 39% (33/85) compared to 20% (17/85) in the cMIS cohort (P= 0.012). The reoperation rate in open cohort related to mechanical failure was 52% (17/33) compared to 35% (6/17) in cMIS cohort (P= 0.43). No significant difference was found in rates of specific etiologies contributing to complications in the cMIS vs open reoperation cohorts under uni- and multivariate analysis. The change in spinopelvic parameters among the two reoperation cohorts at 2YFU were statistically not significant (δCVA, δSVA, δPI-LL, δPT, δLL CA, δTL CA). Under univariate analysis, the following PROMS were similar: ODI, NRS Leg and Back Pain, EQ5D, EQ5D-VAS, SF-36 PCS,SF-36 MCS. However, SRS-22 in open cohort was significantly higher at 2YFU (3.55 ± 0.73 open vs. 3,10 ± 0.56 MIS, p = 0.029). Findings in our ongoing study show that cMIS procedures were associated with a significantly lower reoperation rate compared to open surgical approaches. PROMS and the change in spinopelvic parameters were similar at 2YFU in both reoperated cohorts (except for SRS-22 favored open cohort). This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Purpose This paper aims to investigate the responses of laminated glass under soft body impact, including elastic impact and fracture/fragmentation consideration.Design/methodology/approach The simulation uses the combined finite-discrete element method (FDEM) which combines finite element mesh into discrete elements, enabling the accurate prediction of contact force and deformation. Material rupture is modelled with a cohesive fracture criterion, evaluating the process from continua to discontinua.Findings Responses of laminated glass under soft impact (both elastic and fracture) agree well with known data. Crack initiation time in laminated glass increases with the increase of the outside glass thickness. With the increase of Eprojectile, failure mode is changing from flexural to shear, and damage tends to propagate longitudinally when the contact surface increases. Results show that the FDEM is capable of modelling soft impact behaviour of laminated glass successfully.Research limitations/implications The work is done in 2D, and it will not represent fully the 3D mechanisms.Originality/value Elastic and fracture behaviour of laminated glass under soft impact is simulated using the 2D FDEM. Limited work has been done on soft impact of laminated glass with FDEM, and special research endeavours are warranted. Benchmark examples and discussions are provided for future research. [ABSTRACT FROM AUTHOR]

Fracture and fragmentation responses of laminated glass under hard body impact are modelled with the combined finite-discrete element method (FEM-DEM). The method is essentially a discrete element method with finite element mesh be embedded in, yielding more accurate contact forces as well as mass and energy conservation. Failure models of glass, interlayer and glass-interlayer interface are discussed respectively and proven to be reliable in simulating the rupture of laminated glass. Numerical examples are presented and validated with results from different sources, and the advantage of the FEM-DEM modelling on the impact failure of laminated glass over its parent FEM and DEM is demonstrated. The influences of Young's modulus of interlayer are further discussed, showing that a stiff resin can effectively improve the deformation performance at little expense of energy absorption. In general, modelling the impact failure of laminated glass using the combined finite-discrete element method is successful. [ABSTRACT FROM AUTHOR]

Background Context: Severe adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity requiring surgery to stop curve progression. Posterior spinal instrumentation and fusion with pedicle screws is the standard surgery for AIS curve correction. Vascular and neurologic complications related to screw malpositioning are concerns in surgeries for AIS. Breach rates are reported at 15.7%, implant-related complications at 1.1%, and neurologic deficit at 0.8%. Free-hand screw insertion remains the prevailing method of screw placement, whereas image guidance has been suggested to improve placement accuracy.Purpose: This study aimed to systematically review the screw-related complication and breach rates from posterior spinal instrumentation and fusion with pedicle screws for patients with AIS when using free-hand methods for screw insertion compared with image guidance methods.Study Design: This is a systematic review of prognosis, comparing image guidance with no image guidance in surgery.Patient Sample: One randomized controlled trial and multiple prospective cohort studies that reported complication or breach rates in posterior spinal instrumentation and fusion with pedicle screws for AIS.Outcome Measures: Number of complications and breaches reported in databases or recorded from postoperative imaging.Methods: Databases searched included MEDLINE, Embase, CINAHL, CENTRAL, and Web of Science. Studies of Level 3 evidence or greater as defined by the Centre for Evidence-Based Medicine were included. Articles were screened to focus on patients with AIS undergoing posterior fusion with pedicle screws or hybrid systems. Two independent reviewers screened abstracts, full texts, and extracted data. The Quality in Prognostic Studies (QUIPS) appraisal tool was used to determine studyrisk of bias (ROB). Level of evidence summary statements were formulated based on consistency and quality of reporting.Results: Seventy-nine cohort studies were identified, including four comparing computed tomography (CT) guidance with free-hand methods head-to-head, eight on image guidance, and 671. on free-hand methods alone. Moderate evidence from individual head-to-head studies show CT guidance has lower breach rates than free-hand methods. No complications were found in these studies. From individual cohort studies, moderate evidence shows CT guidance has lower point estimates of breach rates than free-hand methods at 7.9% compared with 9.7%-17.1%. Screw-related complication rates are conflicting at 0% in CT navigation compared with 0%-1.7% in 13 low- and moderate-quality studies.Conclusions: Although point estimates on breach rates are decreased with CT navigation compared with free-hand methods, complication rates remain conflicting between the two methods. Current evidence is limited by small sample sizes, lack of comparison groups, and poorly predefined complications. Randomized controlled trials with larger samples with standardized definitions and recording of predefined breach and complication occurrences are recommended. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis (AIS) is a 3-dimensional spinal deformity involving lateral curvature and axial rotation. Surgical intervention involves insertion of pedicle screws into the spine, requiring accuracies of 1 mm and 5° in translation and rotation to prevent neural and vascular complications. While commercial CT-navigation is available, the significant cost, bulk and radiation dose hinders their use in AIS surgery. The objective of this study was to evaluate a commercial-grade Optitrack Prime 13W motion capture cameras to determine if they can achieve adequate accuracy for screw insertion guidance in AIS. Static precision, camera and tracked rigid body configurations, translational and rotational accuracy were investigated. A 1-h camera warm-up time was required to achieve precisions of 0.13 mm and 0.10°. A three-camera system configuration with cameras at equal height but staggered depth achieved the best accuracy. A triangular rigid body with 7.9 mm markers had superior accuracy. The translational accuracy for motions up to 150 mm was 0.25 mm while rotational accuracy was 4.9° for rotations in two directions from 0° to 70°. Required translational and rotational accuracies were achieved using this motion capture system as well as being comparable to surgical-grade navigators. [ABSTRACT FROM AUTHOR]

In this work, we report an innovative mechanism, the Kirkendall effect, in creating three-dimensional (3D) microporous catalysts with tunable pore sizes for the growth of hierarchic ultrathin graphite foams (HP-UGFs) with unique properties. Employing the Kirkendall effect is one of the first demonstrated for fabricating 3D porous catalysts, where tunable pores of 1.9–8.3 μm are created on 3D interconnected struts (∼100 μm). With the catalysts, we readily synthesized freestanding HP-UGFs that offer higher crystallinity and electric conductivity, larger surface area, as well as enhanced electric invariance to strains compared to those of conventional ultrathin graphite foams. A gauge factor as low as ∼10 at a strain as high as 80% is achieved owing to the unique porous corrugations created on the microstruts of the HP-UGFs. This work may inspire a new paradigm in designing and synthesizing a new type of 3D porous architecture made of 2D materials with controlled local corrugations, which could greatly benefit flexible electronics. [ABSTRACT FROM AUTHOR]

Natural products harbor unique and complex structures that provide valuable antibiotic scaffolds. With an increase in antibiotic resistance, natural products once again hold promise for new antimicrobial therapies, especially those with unique scaffolds that have been overlooked due to a lack of understanding of how they function. Dithiolopyrrolones (DTPs) are an underexplored class of disulfide-containing natural products, which exhibit potent antimicrobial activities against multidrug-resistant pathogens. DTPs were thought to target RNA polymerase, but conflicting observations leave the mechanisms elusive. Using a chemical genomics screen in Escherichia coli, we uncover a mode of action for DTPs-- the disruption of metal homeostasis. We show that holomycin, a prototypical DTP, is reductively activated, and reduced holomycin chelates zinc with high affinity. Examination of reduced holomycin against zinc-dependent metalloenzymes revealed that it inhibits E. coli class II fructose bisphosphate aldolase, but not RNA polymerase. Reduced holomycin also strongly inhibits metallo-β-lactamases in vitro, major contributors to clinical carbapenem resistance, by removing active site zinc. These results indicate that holomycin is an intracellular metal-chelating antibiotic that inhibits a subset of metalloenzymes and that RNA polymerase is unlikely to be the primary target. Our work establishes a link between the chemical structures of DTPs and their antimicrobial action; the ene-dithiol group of DTPs enables high-affinity metal binding as a central mechanism to inhibit metabolic processes. Our study also validates the use of chemical genomics in characterizing modes of actions of antibiotics and emphasizes the potential of metal-chelating natural products in antimicrobial therapy. [ABSTRACT FROM AUTHOR]

Objective: Delayed-release dimethyl fumarate (DMF; also known as gastro-resistant DMF) and fingolimod are approved oral disease-modifying treatments for relapsing-remitting multiple sclerosis. In phase 3 trials, DMF (DEFINE/CONFIRM) and fingolimod (FREEDOMS/FREEDOMS II) resulted in significant reductions in clinical and magnetic resonance imaging activity, with acceptable safety profiles. Direct comparisons of these treatments are not possible due to a lack of head-to-head trials. We compared 2 year efficacy of DMF versus fingolimod at the approved dosage using a matching-adjusted indirect approach.Research Design and Methods: Individual patient data from DEFINE and CONFIRM, and aggregate data from FREEDOMS and FREEDOMS II, were pooled and compared using the matching-adjusted in-direct method. To account for cross-trial differences, data from trials with available individual patient data were adjusted to match aggregate data (i.e. average patient characteristics) from trials without patient-level data. Data from DMF-treated patients were weighted such that average baseline characteristics matched those of fingolimod-treated patients. After matching, weighted treatment outcomes for DMF-treated patients (240 mg twice daily) were compared with summary outcomes for fingolimod-treated patients (0.5 mg once daily). All comparison results of DMF versus fingolimod used fingolimod as the reference.Results: After matching, baseline characteristics were balanced between DMF and fingolimod. At year 2, the efficacy of DMF was similar to that of fingolimod for annualized relapse rate (rate ratio [95% confidence interval (CI)]: 1.11 [0.88, 1.40]), 12 week confirmed disability progression (hazard ratio [95% CI]: 0.90 [0.63, 1.29]), and Multiple Sclerosis Functional Composite (mean difference [95% CI]: 0.04 [-0.05, 0.13]). For patient-reported outcomes (EuroQoL 5-Dimensions questionnaire), the mean differences (95% CI) were 0.05 (0.01, 0.08) for utility score and 3.22 (0.58, 5.86) for visual analog scale score, significantly favoring DMF. There was no significant difference in the percentage of patients with no evidence of disease activity (NEDA) for DMF versus fingolimod among matching-adjusted patients with complete NEDA data: rate ratio (95% CI): 0.92 (0.51, 1.64).Conclusions: Using the matching-adjusted indirect comparison approach, the efficacy of DMF and fingolimod were similar on all clinical outcomes, while patient-reported outcomes showed greater benefit with DMF. Study limitations include possible confounding from unobserved/unknown differences between trials, and trial length may have been insufficient to detect significant differences on disability progression.Clinical Trial Registration: NCT00420212 (DEFINE); NCT00451451 (CONFIRM); NCT00289978 (FREEDOMS); NCT00355134 (FREEDOMS II). [ABSTRACT FROM AUTHOR]

The fracture behaviour of glass under hard body impact is simulated using the combined finite-discrete element method with a finite element incorporated into the discrete elements. A Mode I fracture model is employed and proven to be successful in modelling the crack initiation and tracking the crack propagation in glass. Cone, flexural and punching damages are obtained thus qualitatively verified the glass fracture model. A parametric study on tensile strength, fracture energy and impact velocity further examines the breakage behaviour of glass, demonstrating the applicability of this computational technique for the analysis of glass impact mechanism. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is significant cause of morbidity and mortality worldwide. There is mounting evidence suggesting that COPD patients are at increased risk of severe COVID-19 outcomes; however, it remains unclear whether they are more susceptible to acquiring SARS-CoV-2 infection. In this comprehensive review, we aim to provide an up-to-date perspective of the intricate relationship between COPD and COVID-19. We conducted a thorough review of the literature to examine the evidence regarding the susceptibility of COPD patients to COVID-19 infection and the severity of their disease outcomes. While most studies have found that pre-existing COPD is associated with worse COVID-19 outcomes, some have yielded conflicting results. We also discuss confounding factors such as cigarette smoking, inhaled corticosteroids, and socioeconomic and genetic factors that may influence this association. Furthermore, we review acute COVID-19 management, treatment, rehabilitation, and recovery in COPD patients and how public health measures impact their care. In conclusion, while the association between COPD and COVID-19 is complex and requires further investigation, this review highlights the need for careful management of COPD patients during the pandemic to minimize the risk of severe COVID-19 outcomes. [ABSTRACT FROM AUTHOR]

Teriflunomide is a once-daily oral agent that has been licensed in the EU since August 2013 for the treatment of adult patients with relapsing-remitting multiple sclerosis (RRMS). More recently (September 2014), the EU summary of product characteristics (SmPC) was updated to include data from patients with a first clinical demyelinating event. This review examines the EU SmPC for teriflunomide, with reference to key clinical and safety outcomes and practical considerations for prescribing physicians. In two phase III trials (TEMSO and TOWER) in patients with relapsing forms of MS, teriflunomide 14 mg significantly reduced the annualized relapse rate and the risk of confirmed disability progression sustained for at least 12 weeks. Magnetic resonance imaging (MRI) total lesion volume, gadolinium-enhancing lesions, and unique active lesions were reduced with teriflunomide treatment in TEMSO. In the TOPIC study, in patients with a first clinical demyelinating event, teriflunomide treatment significantly reduced the time to a second clinical episode (relapse). Across the clinical studies, teriflunomide was generally well tolerated; adverse events reported in ≥ 10% of teriflunomide-treated patients were diarrhea, nausea, increased alanine aminotransferase, and alopecia. Data from the clinical development program support the use of teriflunomide in a broad spectrum of patients with RRMS. [ABSTRACT FROM AUTHOR]

This paper discusses the role of visual inspections in the UK highways bridge inspection regime, and how current practice results in inspection data that are less reliable than they could, and should, be. Evidence that visual inspections in general are not totally reliable is discussed. Similar problems have been overcome in other areas, such as pavement inspection, by using technological aids during the data collection and inspection process. It is hoped that better bridge condition data could be obtained by making use of technology to assist the visual inspection process on bridges. Some of the ways in which images could be recorded to make the inspection process more reliable and reproducible are discussed, and a prototype system that has been developed with the aim of providing a full, high-resolution image record of the visual condition of a bridge, which is suitable for use, is presented. [ABSTRACT FROM AUTHOR]

The ability to categorize stimuli - predator or prey, friend or foe - is an essential feature of the decision-making process. Underlying that ability is the development of an internally generated category boundary to generate decision outcomes. While classic temporal difference reinforcement models assume midbrain dopaminergic neurons underlie the prediction error required to learn boundary location, these neurons also demonstrate a robust response to nonreward incentive stimuli. More recent models suggest that this may reflect a motivational aspect to performing a task which should be accounted for when modeling dopaminergic neuronal behavior. To clarify the role of substantia nigra dopamine neurons in uncertain perceptual decision making, we investigated their behavior using single neuron extracellular recordings in patients with Parkinson's disease undergoing deep brain stimulation. Subjects underwent a simple auditory categorical decision-making task in which they had to classify a tone as either low- or high-pitched relative to an explicit threshold tone and received feedback but no reward. We demonstrate that the activity of human SN dopaminergic neurons is predictive of perceptual categorical decision outcome and is modulated by uncertainty. Neuronal activity was highest during difficult (uncertain) decisions that resulted in correct responses and lowest during easy decisions that resulted in incorrect responses. This pattern of results is more consistent with a 'motivational' role with regards to perceptual categorization and suggests that dopamine neurons are most active when critical information - as represented by uncertainty - is available for learning decision boundaries. [ABSTRACT FROM AUTHOR]

This study compares the performance of 5 different Au/TiO 2 photocatalysts for H 2 production in alcohol–water mixtures under UV excitation, placing particular emphasis on the role of the TiO 2 support and alcohol sacrificial reagent. 1.5 wt.% Au/TiO 2 photocatalysts were prepared by the deposition–precipitation with urea method, using P25 TiO 2 (85% anatase and 15% rutile, 49 m 2 g −1 ), sol–gel anatase (39 m 2 g −1 ), hydrothermally synthesised anatase (115 m 2 g −1 ), commercial brookite (33 m 2 g −1 ) and hydrothermally synthesised rutile (29 m 2 g −1 ) as supports. UV–Vis, TEM, XRD, XPS and Au L 3 -edge EXAFS characterisation studies confirmed the presence of gold nanoparticles of mean size 5–10 nm on all the Au/TiO 2 photocatalysts, which generated intense localised surface plasmon resonances (LSPRs) centred between 560 and 590 nm. Gold nanoparticle deposition suppressed electron–hole pair recombination in each TiO 2 support following UV excitation, and created cathodic sites on TiO 2 for H 2 evolution. Photocatalytic H 2 production tests were conducted in water, methanol–water, ethanol–water, ethylene glycol–water and glycerol–water mixtures (alcohol concentration 10 vol.%) at a UV flux of 6.5 mW cm −2 . H 2 production rates decreased in the order Au/P25 > Au/anatase SG ≈ Au/brookite > Au/anatase HT ≫ Au/rutile HT when the rates were normalised against photocatalyst surface area. For each Au/TiO 2 photocatalyst, the rates decreased in the order glycerol > ethylene glycol > methanol > ethanol. Good correlations were established between H 2 production rates and the number of hydroxyl groups, polarity and relative hole scavenging ability of the alcohols. Results improve knowledge about the role of sacrificial reagents in photocatalytic hydrogen production. [ABSTRACT FROM AUTHOR]

Severe prolonged lymphopenia as rare side-effect of dimethyl fumarate is mostly reversible. Caldito et al. report a case of persistent severe lymphopenia over 5 years after discontinuation of dimethyl fumarate. We discuss several clinical implications. Safe withdrawal of disease modifying therapies in terms of reoccurrence of disease activity and drug related adverse events need further attention as our treatment armamentarium continues to grow. [ABSTRACT FROM AUTHOR]

This clinical commentary discusses the occurrence of drug-induced aseptic meningitis in patients undergoing natalizumab treatment and other immunotherapies. [ABSTRACT FROM AUTHOR]

Low-cost semiconductor photocatalysts that can efficiently harvest solar energy and generate H 2 from water or biofuels will be critical to future hydrogen economies. Here, we evaluate the performance of low-cost Ni/TiO 2 photocatalysts (Ni loadings 0–4 wt.%) for H 2 production from ethanol–water mixtures (0–100 vol.% EtOH) under UV excitation. Ni(II) was deposited on P25 TiO 2 by the complex precipitation method, followed by H 2 reduction at 500 °C for 2 h to obtain Ni/TiO 2 photocatalysts. TGA, TEM, XRD, Ni 2p XPS, Ni L-edge NEXAFS, Ni K-edge EXAFS, UV–Vis and photoluminescence measurements confirmed that Ni 0 was the dominant nickel species on the surface of the Ni/TiO 2 photocatalysts, with the Ni particle size ∼1–2 nm. The photocatalytic activity of Ni/TiO 2 photocatalysts was highly dependent on the Ni loading, with the optimal Ni loading being 0.5 wt.%, which afforded a H 2 production rate of 11.6 mmol g −1 h −1 (or 0.258 mmol m −2 h −1 ) at an EtOH:H 2 O volume ratio of 10:90 and a UV flux comparable to that in sunlight. High H 2 production rates were achieved over a wide range of EtOH:H 2 O concentrations, with a 95:5 volume ratio affording the highest rate (24.3 mmol g −1 h −1 ). The 0.5 wt.% Ni/TiO 2 photocatalyst displayed superior photocatalytic activity to a 2 wt.% Au/TiO 2 reference photocatalyst at low ethanol concentrations (1–15 vol.%), which is attributed to the high co-catalyst dispersion achieved in the Ni/TiO 2 system. Results suggest that Ni/TiO 2 photocatalysts are promising alternatives to M/TiO 2 (M = Pd, Pt or Au) photocatalysts for solar H 2 production from biofuels. [ABSTRACT FROM AUTHOR]