A qualitative study of clinicians' experience of a clinical trial for displaced distal radius fractures.

AimsThe aim of this study was to explore clinicians' experience of a paediatric randomized controlled trial (RCT) comparing surgical reduction with non-surgical casting for displaced distal radius fractures.MethodsOverall, 22 staff from 15 hospitals who participated in the RCT took part in an interview. Interviews were informed by phenomenology and analyzed using thematic analysis.ResultsAnalysis of the findings identified the overarching theme of "overcoming obstacles", which described the challenge of alleviating staff concerns about the use of non-surgical casting and recruiting families where there was treatment uncertainty. In order to embed and recruit to the Children's Radius Acute Fracture Fixation Trial (CRAFFT), staff needed to fit the study within clinical practice, work together, negotiate treatment decisions, and support families.ConclusionRecruiting families to this RCT was challenging because staff were uncertain about longer-term patient outcomes, and the difficulties were exacerbated by interdisciplinary tensions. Strong family and clinician beliefs, coupled with the complex nature of emergency departments and patient pathways that differed site-by-site, served as barriers to recruitment. Cementing a strong research culture, and exploring families' treatment preferences, helped to overcome recruitment obstacles

Co-N-C axially coordination regulated H2O2 selectivity via water medicated recombination of solute •OH: A new route

The cobalt, earth abundant transition metal, embedded in nitrogen doped carbon material as single atom site (Co-N-C) has been manifested as promising electrochemical oxygen reduction reaction (ORR) catalyst, however the unsatisfying production selectivity has hampered its widespread applications. Herein, the H2O2 selectivity of Co-N-C catalyst has been tailored with Co axial functional groups. Thermodynamically, the selectivity is regulated due to the fine-tuning of the adsorption of the key reaction intermediates (ΔG*OOH), and five functional groups, including −O, –OH, –CN, −CH3 and −SO3, endow the Co-N-C catalyst with superior H2O2 selectivity. Importantly, we unravel a new water medicated recombination of solute •OH reaction pathway for H2O2 production, which was the result of dissociation of *HOOH in explicit water environment. That is, two •OH species reaction in the liquid environment which originated from the creaking of *OOH intermediates due to the weakened O-O bond by the interaction with surrounding water. This study provides foundational understanding for the ORR catalytic mechanism at the electrochemical interface and opens up new avenues for rational design of targeted high efficiency electrocatalysts

Self-training guided disentangled adaptation for cross-domain remote sensing image semantic segmentation

Remote sensing (RS) image semantic segmentation using deep convolutional neural networks (DCNNs) has shown great success in various applications. However, the high dependence on annotated data makes it challenging for DCNNs to adapt to different RS scenes. To address this challenge, we propose a cross-domain RS image semantic segmentation task that considers ground sampling distance, remote sensing sensor variation, and different geographical landscapes as the main factors causing domain shifts between source and target images. To mitigate the negative impact of domain shift, we propose a self-training guided disentangled adaptation network (ST-DASegNet) that consists of source and target student backbones to extract source-style and target-style features. To align cross-domain single-style features, we adopt feature-level adversarial learning. We also propose a domain disentangled module (DDM) to extract universal and distinct features from single-domain cross-style features. Finally, we fuse these features and generate predictions using source and target student decoders. Moreover, we employ an exponential moving average (EMA) based cross-domain separated self-training mechanism to ease the instability and disadvantageous effect during adversarial optimization. Our experiments on several prominent RS datasets (Potsdam, Vaihingen, and LoveDA) demonstrate that ST-DASegNet outperforms previous methods and achieves new state-of-the-art results. Visualization and analysis also confirm the interpretability of ST-DASegNet. The code is publicly available at https://github.com/cv516Buaa/ST-DASegNet

The optimal antithrombotic strategy for post-stroke patients with atrial fibrillation and extracranial artery stenosis-a nationwide cohort study.

BackgroundIn post-stroke atrial fibrillation (AF) patients who have indications for both oral anticoagulant (OAC) and antiplatelet agent (AP), e.g., those with carotid artery stenosis, there is debate over the best antithrombotic strategy. We aimed to compare the risks of ischemic stroke, composite of ischemic stroke/major bleeding and composite of ischemic stroke/intracranial hemorrhage (ICH) between different antithrombotic strategies.MethodsThis study included post-stroke AF patients with and without extracranial artery stenosis (ECAS) (n = 6390 and 28,093, respectively) identified from the Taiwan National Health Insurance Research Database. Risks of clinical outcomes and net clinical benefit (NCB) with different antithrombotic strategies were compared to AP alone.ResultsThe risk of recurrent ischemic stroke was higher for patients with ECAS than those without (12.72%/yr versus 10.60/yr; adjusted hazard ratio [aHR] 1.104, 95% confidence interval [CI] 1.052-1.158, p ConclusionsFor post-stroke AF patients with ECAS, NOAC monotherapy was associated with lower risks of adverse outcomes and a positive NCB. Combination of AP with NOAC or warfarin did not offer any benefit, but more bleeding especially with AP-warfarin combination therapy

Randomised trial of genetic testing and targeted intervention to prevent the development and progression of Paget's disease of bone.

IntroductionPaget's disease of bone (PDB) frequently presents at an advanced stage with irreversible skeletal damage. Clinical outcomes might be improved by earlier diagnosis and prophylactic treatment.MethodsWe randomised 222 individuals at increased risk of PDB because of pathogenic SQSTM1 variants to receive 5 mg zoledronic acid (ZA) or placebo. The primary outcome was new bone lesions assessed by radionuclide bone scan. Secondary outcomes included change in existing lesions, biochemical markers of bone turnover and skeletal events related to PDB.ResultsThe median duration of follow-up was 84 months (range 0-127) and 180 participants (81%) completed the study. At baseline, 9 (8.1%) of the ZA group had PDB lesions vs 12 (10.8%) of the placebo group. Two of the placebo group developed new lesions versus none in the ZA group (OR 0.41, 95% CI 0.00 to 3.43, p=0.25). Eight of the placebo group had a poor outcome (lesions which were new, unchanged or progressing) compared with none of the ZA group (OR 0.08, 95% CI 0.00 to 0.42, p=0.003). At the study end, 1 participant in the ZA group had lesions compared with 11 in the placebo group. Biochemical markers of bone turnover were significantly reduced in the ZA group. One participant allocated to placebo required rescue therapy with ZA because of symptomatic disease. The number and severity of adverse events did not differ between groups.ConclusionsGenetic testing for pathogenic SQSTM1 variants coupled with intervention with ZA is well tolerated and has favourable effects on the progression of early PDB.Trial registration numberISRCTN11616770

Microbiome and mitogenomics of the chigger mite Pentidionis agamae: potential role as an Orientia vector and associations with divergent clades of Wolbachia and Borrelia

Abstract Background Trombiculid mites are globally distributed, highly diverse arachnids that largely lack molecular resources such as whole mitogenomes for the elucidation of taxonomic relationships. Trombiculid larvae (chiggers) parasitise vertebrates and can transmit bacteria (Orientia spp.) responsible for scrub typhus, a zoonotic febrile illness. Orientia tsutsugamushi causes most cases of scrub typhus and is endemic to the Asia-Pacific Region, where it is transmitted by Leptotrombidium spp. chiggers. However, in Dubai, Candidatus Orientia chuto was isolated from a case of scrub typhus and is also known to circulate among rodents in Saudi Arabia and Kenya, although its vectors remain poorly defined. In addition to Orientia, chiggers are often infected with other potential pathogens or arthropod-specific endosymbionts, but their significance for trombiculid biology and public health is unclear. Results Ten chigger species were collected from rodents in southwestern Saudi Arabia. Chiggers were pooled according to species and screened for Orientia DNA by PCR. Two species (Microtrombicula muhaylensis and Pentidionis agamae) produced positive results for the htrA gene, although Ca. Orientia chuto DNA was confirmed by Sanger sequencing only in P. agamae. Metagenomic sequencing of three pools of P. agamae provided evidence for two other bacterial associates: a spirochaete and a Wolbachia symbiont. Phylogenetic analysis of 16S rRNA and multi-locus sequence typing genes placed the spirochaete in a clade of micromammal-associated Borrelia spp. that are widely-distributed globally with no known vector. For the Wolbachia symbiont, a genome assembly was obtained that allowed phylogenetic localisation in a novel, divergent clade. Cytochrome c oxidase I (COI) barcodes for Saudi Arabian chiggers enabled comparisons with global chigger diversity, revealing several cases of discordance with classical taxonomy. Complete mitogenome assemblies were obtained for the three P. agamae pools and almost 50 SNPs were identified, despite a common geographic origin. Conclusions P. agamae was identified as a potential vector of Ca. Orientia chuto on the Arabian Peninsula. The detection of an unusual Borrelia sp. and a divergent Wolbachia symbiont in P. agamae indicated links with chigger microbiomes in other parts of the world, while COI barcoding and mitogenomic analyses greatly extended our understanding of inter- and intraspecific relationships in trombiculid mites. </jats:sec

Bioinspired multiscale adaptive suction on complex dry surfaces enhanced by regulated water secretion.

Suction is a highly evolved biological adhesion strategy for soft-body organisms to achieve strong grasping on various objects. Biological suckers can adaptively attach to dry complex surfaces such as rocks and shells, which are extremely challenging for current artificial suction cups. Although the adaptive suction of biological suckers is believed to be the result of their soft body's mechanical deformation, some studies imply that in-sucker mucus secretion may be another critical factor in helping attach to complex surfaces, thanks to its high viscosity. Inspired by the combined action of biological suckers' soft bodies and mucus secretion, we propose a multiscale suction mechanism which successfully achieves strong adaptive suction on dry complex surfaces which are both highly curved and rough, such as a stone. The proposed multiscale suction mechanism is an organic combination of mechanical conformation and regulated water seal. Multilayer soft materials first generate a rough mechanical conformation to the substrate, reducing leaking apertures to micrometres (~10 µm). The remaining micron-sized apertures are then sealed by regulated water secretion from an artificial fluidic system based on the physical model, thereby the suction cup achieves long suction longevity on complex surfaces but minimal overflow. We discuss its physical principles and demonstrate its practical application as a robotic gripper on a wide range of complex dry surfaces. We believe the presented multiscale adaptive suction mechanism is a powerful unique adaptive suction strategy which may be instrumental in the development of versatile soft adhesion