Identifying adults with acute rhinosinusitis in primary care that benefit most from antibiotics : protocol of an individual patient data meta-analysis using multivariable risk prediction modelling

Introduction Acute rhinosinusitis (ARS) is a prime reason for doctor visits and among the conditions with highest antibiotic overprescribing rates in adults. To reduce inappropriate prescribing, we aim to predict the absolute benefit of antibiotic treatment for individual adult patients with ARS by applying multivariable risk prediction methods to individual patient data (IPD) of multiple randomised placebo-controlled trials. Methods and analysis This is an update and re-analysis of a 2008 IPD meta-analysis on antibiotics for adults with clinically diagnosed ARS. First, the reference list of the 2018 Cochrane review on antibiotics for ARS will be reviewed for relevant studies published since 2008. Next, the systematic searches of CENTRAL, MEDLINE and Embase of the Cochrane review will be updated to 1 September 2020. Methodological quality of eligible studies will be assessed using the Cochrane Risk of Bias 2 tool. The primary outcome is cure at 8-15 days. Regression-based methods will be used to model the risk of being cured based on relevant predictors and treatment, while accounting for clustering. Such model allows for risk predictions as a function of treatment and individual patient characteristics and hence gives insight into individualised absolute benefit. Candidate predictors will be based on literature, clinical reasoning and availability. Calibration and discrimination will be evaluated to assess model performance. Resampling techniques will be used to assess internal validation. In addition, internal-external cross-validation procedures will be used to inform on between-study differences and estimate out-of-sample model performance. Secondarily, we will study possible heterogeneity of treatment effect as a function of outcome risk. Ethics and dissemination In this study, no identifiable patient data will be used. As such, the Medical Research Involving Humans Subject Act (WMO) does not apply and official ethical approval is not required. Results will be submitted for publication in international peer-reviewed journals. PROSPERO registration number CRD42020220108.Peer reviewe

Using mobile virtual reality simulation to prepare for in-person helping babies breathe training: secondary analysis of a randomized controlled trial (the eHBB/mHBS Trial)

Background: Neonatal mortality accounts for approximately 46% of global under-5 child mortality. The widespread access to mobile devices in low- and middle-income countries has enabled innovations, such as mobile virtual reality (VR), to be leveraged in simulation education for health care workers. Objective: This study explores the feasibility and educational efficacy of using mobile VR for the precourse preparation of health care professionals in neonatal resuscitation training. Methods: Health care professionals in obstetrics and newborn care units at 20 secondary and tertiary health care facilities in Lagos, Nigeria, and Busia, Western Kenya, who had not received training in Helping Babies Breathe (HBB) within the past 1 year were randomized to access the electronic HBB VR simulation and digitized HBB Provider’s Guide (VR group) or the digitized HBB Provider’s Guide only (control group). A sample size of 91 participants per group was calculated based on the main study protocol that was previously published. Participants were directed to use the electronic HBB VR simulation and digitized HBB Provider’s Guide or the digitized HBB Provider’s Guide alone for a minimum of 20 minutes. HBB knowledge and skills assessments were then conducted, which were immediately followed by a standard, in-person HBB training course that was led by study staff and used standard HBB evaluation tools and the Neonatalie Live manikin (Laerdal Medical). Results: A total of 179 nur ses and midwives participated (VR group: n=91; control group: n=88). The overall performance scores on the knowledge check (P=.29), bag and mask ventilation skills check (P=.34), and Objective Structured Clinical Examination A checklist (P=.43) were similar between groups, with low overall pass rates (6/178, 3.4% of participants). During the Objective Structured Clinical Examination A test, participants in the VR group performed better on the critical step of positioning the head and clearing the airway (VR group: 77/90, 86%; control group: 57/88, 65%; P=.002). The median percentage of ventilations that were performed via head tilt, as recorded by the Neonatalie Live manikin, was also numerically higher in the VR group (75%, IQR 9%-98%) than in the control group (62%, IQR 13%-97%), though not statistically significantly different (P=.35). Participants in the control group performed better on the identifying a helper and reviewing the emergency plan step (VR group: 7/90, 8%; control group: 16/88, 18%; P=.045) and the washing hands step (VR group: 20/90, 22%; control group: 32/88, 36%; P=.048). Conclusions: The use of digital interventions, such as mobile VR simulations, may be a viable approach to precourse preparation in neonatal resuscitation training for health care professionals in low- and middle-income countries

Single-domain stripe order in a high-temperature superconductor

The coupling of spin, charge and lattice degrees of freedom results in the emergence of novel states of matter across many classes of strongly correlated electron materials. A model example is unconventional superconductivity, which is widely believed to arise from the coupling of electrons via spin excitations. In cuprate high-temperature superconductors, the interplay of charge and spin degrees of freedom is also reflected in a zoo of charge and spin-density wave orders that are intertwined with superconductivity. A key question is whether the different types of density waves merely coexist or are indeed directly coupled. Here we profit from a neutron scattering technique with superior beam-focusing that allows us to probe the subtle spin-density wave order in the prototypical high-temperature superconductor La$${}_{1.88}$$Sr$${}_{0.12}$$CuO$${}_{4}$$ under applied uniaxial pressure to demonstrate that the two density waves respond to the external tuning parameter in the same manner. Our result shows that suitable models for high-temperature superconductivity must equally account for charge and spin degrees of freedom via uniaxial charge-spin stripe fluctuations

Ultrafast x-ray-induced nuclear dynamics in diatomic molecules using femtosecond x-ray-pump-x-ray-probe spectroscopy

Citation: Lehmann, C. S., Picon, A., Bostedt, C., Rudenko, A., Marinelli, A., Moonshiram, D., . . . Southworth, S. H. (2016). Ultrafast x-ray-induced nuclear dynamics in diatomic molecules using femtosecond x-ray-pump-x-ray-probe spectroscopy. Physical Review A, 94(1), 7. doi:10.1103/PhysRevA.94.013426The capability of generating two intense, femtosecond x-ray pulses with a controlled time delay opens the possibility of performing time-resolved experiments for x-ray-induced phenomena. We have applied this capability to study the photoinduced dynamics in diatomic molecules. In molecules composed of low-Z elements, K-shell ionization creates a core-hole state in which the main decay mode is an Auger process involving two electrons in the valence shell. After Auger decay, the nuclear wave packets of the transient two-valence-hole states continue evolving on the femtosecond time scale, leading either to separated atomic ions or long-lived quasibound states. By using an x-ray pump and an x-ray probe pulse tuned above the K-shell ionization threshold of the nitrogen molecule, we are able to observe ion dissociation in progress by measuring the time-dependent kinetic energy releases of different breakup channels. We simulated the measurements on N-2 with a molecular dynamics model that accounts for K-shell ionization, Auger decay, and the time evolution of the nuclear wave packets. In addition to explaining the time-dependent feature in the measured kinetic energy release distributions from the dissociative states, the simulation also reveals the contributions of quasibound states

Hetero-site-specific X-ray pump-probe spectroscopy for femtosecond intramolecular dynamics

Citation: Picon, A., Lehmann, C. S., Bostedt, C., Rudenko, A., Marinelli, A., Osipov, T., . . . Southworth, S. H. (2016). Hetero-site-specific X-ray pump-probe spectroscopy for femtosecond intramolecular dynamics. Nature Communications, 7, 6. doi:10.1038/ncomms11652New capabilities at X-ray free-electron laser facilities allow the generation of two-colour femtosecond X-ray pulses, opening the possibility of performing ultrafast studies of X-ray-induced phenomena. Particularly, the experimental realization of hetero-site-specific X-ray-pump/X-ray-probe spectroscopy is of special interest, in which an X-ray pump pulse is absorbed at one site within a molecule and an X-ray probe pulse follows the X-ray-induced dynamics at another site within the same molecule. Here we show experimental evidence of a hetero-site pump-probe signal. By using two-colour 10-fs X-ray pulses, we are able to observe the femtosecond time dependence for the formation of F ions during the fragmentation of XeF2 molecules following X-ray absorption at the Xe site

Self-consumption of electricity produced with photovoltaic systems in apartment buildings - Update of the situation in various IEA PVPS countries

Over the last two decades, grid-connected solar photovoltaic systems have increased from a niche market to one of the leading power generation capacity additions annually. In 2019 the total worldwide installed photovoltaic electricity generation capacity exceeded 630 GW. It is forecasted that 1 TW will be reached by 2022. This further development is coupled with the question at what prices solar photovoltaic electricity can be provided and delivered to the customers. The installation of PV systems for self-consumption is already now an interesting option for many people but in general limited to those who have access to a rooftop they own or can use. Enabling residents of multi apartment buildings to commonly use electricity generated by a PV system (collective self-consumption) is a relatively new development and is still facing a lot of administrative and regulatory challenges. This paper provides an overview of existing regulatory schemes in IEA PVPS countries and presents and analysis of two self-consumption case studies.</p

Uniaxial pressure induced stripe order rotation in La1.88Sr0.12CuO4

Static stripe order is detrimental to superconductivity. Yet, it has been proposed that transverse stripe fluctuations may enhance the inter-stripe Josephson coupling and thus promote superconductivity. Direct experimental studies of stripe dynamics, however, remain difficult. From a strong-coupling perspective, transverse stripe fluctuations are realized in the form of dynamic “kinks”—sideways shifting stripe sections. Here, we show how modest uniaxial pressure tuning reorganizes directional kink alignment. Our starting point is La1.88Sr0.12CuO4 where transverse kink ordering results in a rotation of stripe order away from the crystal axis. Application of mild uniaxial pressure changes the ordering pattern and pins the stripe order to the crystal axis. This reordering occurs at a much weaker pressure than that to detwin the stripe domains and suggests a rather weak transverse stripe stiffness. Weak spatial stiffness and transverse quantum fluctuations are likely key prerequisites for stripes to coexist with superconductivity

Evolution of a Non-Abelian Cosmic String Network

We describe a numerical simulation of the evolution of an $S_3$ cosmic string network which takes fully into account the non-commutative nature of the cosmic string fluxes and the topological obstructions which hinder strings from moving past each other or intercommuting. The influence of initial conditions, string tensions, and other parameters on the network's evolution is explored. Contrary to some previous suggestions, we find no strong evidence of the ``freezing'' required for a string-dominated cosmological scenario. Instead, the results in a broad range of regimes are consistent with the familiar scaling law; i.e., a constant number of strings per horizon volume. The size of this number, however, can vary quite a bit, as can other overall features. There is a surprisingly strong dependence on the statistical properties of the initial conditions. We also observe a rich variety of interesting new structures, such as light string webs stretched between heavier strings, which are not seen in Abelian networks.Comment: 89 pages, Tex, figures included, phyzzx macros included. Revised version: minor changes in wording and layout; some errors corrected in Table 2; references added. Animations now available at http://physics.unc.edu/~mcgraw/stringmovies.htm

Using Mobile Virtual Reality Simulation to Prepare for In-Person Helping Babies Breathe Training: Secondary Analysis of a Randomized Controlled Trial (the eHBB/mHBS Trial)

Background: Neonatal mortality accounts for approximately 46% of global under-5 child mortality. The widespread access to mobile devices in low- and middle-income countries has enabled innovations, such as mobile virtual reality (VR), to be leveraged in simulation education for health care workers. Objective: This study explores the feasibility and educational efficacy of using mobile VR for the precourse preparation of health care professionals in neonatal resuscitation training. Methods: Health care professionals in obstetrics and newborn care units at 20 secondary and tertiary health care facilities in Lagos, Nigeria, and Busia, Western Kenya, who had not received training in Helping Babies Breathe (HBB) within the past 1 year were randomized to access the electronic HBB VR simulation and digitized HBB Provider’s Guide (VR group) or the digitized HBB Provider’s Guide only (control group). A sample size of 91 participants per group was calculated based on the main study protocol that was previously published. Participants were directed to use the electronic HBB VR simulation and digitized HBB Provider’s Guide or the digitized HBB Provider’s Guide alone for a minimum of 20 minutes. HBB knowledge and skills assessments were then conducted, which were immediately followed by a standard, in-person HBB training course that was led by study staff and used standard HBB evaluation tools and the Neonatalie Live manikin (Laerdal Medical). Results: A total of 179 nurses and midwives participated (VR group: n=91; control group: n=88). The overall performance scores on the knowledge check (P=.29), bag and mask ventilation skills check (P=.34), and Objective Structured Clinical Examination A checklist (P=.43) were similar between groups, with low overall pass rates (6/178, 3.4% of participants). During the Objective Structured Clinical Examination A test, participants in the VR group performed better on the critical step of positioning the head and clearing the airway (VR group: 77/90, 86%; control group: 57/88, 65%; P=.002). The median percentage of ventilations that were performed via head tilt, as recorded by the Neonatalie Live manikin, was also numerically higher in the VR group (75%, IQR 9%-98%) than in the control group (62%, IQR 13%-97%), though not statistically significantly different (P=.35). Participants in the control group performed better on the identifying a helper and reviewing the emergency plan step (VR group: 7/90, 8%; control group: 16/88, 18%; P=.045) and the washing hands step (VR group: 20/90, 22%; control group: 32/88, 36%; P=.048). Conclusions: The use of digital interventions, such as mobile VR simulations, may be a viable approach to precourse preparation in neonatal resuscitation training for health care professionals in low- and middle-income countries