Absorbable versus silk sutures for surgical treatment of trachomatous trichiasis in Ethiopia: a randomised controlled trial.

BACKGROUND: Trachoma causes blindness through an anatomical abnormality called trichiasis (lashes touching the eye). Trichiasis can recur after corrective surgery. We tested the hypothesis that using absorbable sutures instead of silk sutures might reduce the risk of recurrent disease among patients with major trichiasis in a randomised trial. METHODS AND FINDINGS: 1,300 individuals with major trichiasis from rural villages in the Amhara Region of Ethiopia were recruited and assigned (1:1) by computer-generated randomisation sequence to receive trichiasis surgery using either an absorbable suture (polyglactin-910) or silk sutures (removed at 7-10 days) in an otherwise identical surgical technique. Participants were examined every 6 months for 2 years by clinicians masked to allocation. The primary outcome measure was recurrent trichiasis (≥one lash touching the eye) at 1 year. There was no difference in prevalence of recurrent trichiasis at 1 year (114 [18.2%] in the absorbable suture group versus 120 [19.7%] in the silk suture group; odds ratio = 0.90, 95% CI 0.68-1.20). The two groups also did not differ in terms of corneal opacification, visual acuity, conjunctival inflammation, and surgical complications. CONCLUSIONS: There was no evidence that use of absorbable polyglactin-910 sutures was associated with a lower prevalence of trichiasis recurrence at 1 year postsurgery than silk sutures. However, from a programmatic perspective, polyglactin-910 offers the major advantage that patients do not have to be seen soon after surgery for suture removal. The postoperative review after surgery using absorbable polyglactin-910 sutures can be delayed for 3-6 months, which might allow us to better determine whether a patient needs additional surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT00522860

Direct imaging of shock wave splitting in diamond at Mbar pressure

Understanding the behavior of matter at extreme pressures of the order of a megabar (Mbar) is essential to gain insight into various physical phenomena at macroscales—the formation of planets, young stars, and the cores of super-Earths, and at microscales—damage to ceramic materials and high-pressure plastic transformation and phase transitions in solids. Under dynamic compression of solids up to Mbar pressures, even a solid with high strength exhibits plastic properties, causing the induced shock wave to split in two: an elastic precursor and a plastic shock wave. This phenomenon is described by theoretical models based on indirect measurements of material response. The advent of x-ray free-electron lasers (XFELs) has made it possible to use their ultrashort pulses for direct observations of the propagation of shock waves in solid materials by the method of phase-contrast radiography. However, there is still a lack of comprehensive data for verification of theoretical models of different solids. Here, we present the results of an experiment in which the evolution of the coupled elastic–plastic wave structure in diamond was directly observed and studied with submicrometer spatial resolution, using the unique capabilities of the x-ray free-electron laser (XFEL). The direct measurements allowed, for the first time, the fitting and validation of the 2D failure model for diamond in the range of several Mbar. Our experimental approach opens new possibilities for the direct verification and construction of equations of state of matter in the ultra-high-stress range, which are relevant to solving a variety of problems in high-energy-density physics

Optical characterization of lithium fluoride thin-film imaging detectors for monochromatic hard X-rays

Lithium fluoride (LiF) crystals and thin films have been successfully investigated as X-ray imaging detectors based on optical reading of visible photoluminescence emitted by stable radiation-induced F2 and F+3 colour centres. In this work, the visible photoluminescence response of optically-transparent LiF film detectors of three different thicknesses, grown by thermal evaporation on Si(100) substrates and irradiated with monochromatic 7 keV X-rays at several doses in the range between 13 and 4.5 × 103 Gy, was carefully investigated by fluorescence optical microscopy. For all the film thicknesses, the photoluminescence response linearly depends on the irradiation dose in the investigated dose range. The lowest detected dose, delivered to the thinnest LiF film, only 0.5 μm thick, is estimated 13 Gy. Edge-enhancement imaging experiments, conducted by irradiating LiF film detectors at the same energy placing an Au mesh in front of them at a distance of 15 mm, allowed estimating a spatial resolution of (0.38 ± 0.05) μm, which is comparable to the microscope one. This very high spatial resolution in LiF film radiation detectors based on colour centres photoluminescence is combined with the availability of a wide field of view on large areas

Integrated care as a means to improve primary care delivery for adults and adolescents in the developing world: a critical analysis of Integrated Management of Adolescent and Adult Illness (IMAI)

Background: More than three decades after the 1978 Declaration of Alma-Ata enshrined the goal of ‘health for all’, high-quality primary care services remain undelivered to the great majority of the world’s poor. This failure to effectively reach the most vulnerable populations has been, in part, a failure to develop and implement appropriate and effective primary care delivery models. This paper examines a root cause of these failures, namely that the inability to achieve clear and practical consensus around the scope and aims of primary care may be contributing to ongoing operational inertia. The present work also examines integrated models of care as a strategy to move beyond conceptual dissonance in primary care and toward implementation. Finally, this paper examines the strengths and weaknesses of a particular model, the World Health Organization’s Integrated Management of Adolescent and Adult Illness (IMAI), and its potential as a guidepost toward improving the quality of primary care delivery in poor settings. Discussion Integration and integrated care may be an important approach in establishing a new paradigm of primary care delivery, though overall, current evidence is mixed. However, a number of successful specific examples illustrate the potential for clinical and service integration to positively impact patient care in primary care settings. One example deserving of further examination is the IMAI, developed by the World Health Organization as an operational model that integrates discrete vertical interventions into a comprehensive delivery system encompassing triage and screening, basic acute and chronic disease care, basic prevention and treatment services, and follow-up and referral guidelines. IMAI is an integrated model delivered at a single point-of-care using a standard approach to each patient based on the universal patient history and physical examination. The evidence base on IMAI is currently weak, but whether or not IMAI itself ultimately proves useful in advancing primary care delivery, it is these principles that should serve as the basis for developing a standard of integrated primary care delivery for adults and adolescents that can serve as the foundation for ongoing quality improvement. Summary As integrated primary care is the standard of care in the developed world, so too must we move toward implementing integrated models of primary care delivery in poorer settings. Models such as IMAI are an important first step in this evolution. A robust and sustained commitment to innovation, research and quality improvement will be required if integrated primary care delivery is to become a reality in developing world

Future space experiment platforms for astrobiology and astrochemistry research

Space experiments are a technically challenging but a scientifically important part of astrobiology and astrochemistry research. The International Space Station (ISS) is an excellent example of a highly successful and long-lasting research platform for experiments in space, that has provided a wealth of scientific data over the last two decades. However, future space platforms present new opportunities to conduct experiments with the potential to address key topics in astrobiology and astrochemistry. In this perspective, the European Space Agency (ESA) Topical Team Astrobiology and Astrochemistry (with feedback from the wider scientific community) identifies a number of key topics and summarizes the 2021 “ESA SciSpacE Science Community White Paper” for astrobiology and astrochemistry. We highlight recommendations for the development and implementation of future experiments, discuss types of in situ measurements, experimental parameters, exposure scenarios and orbits, and identify knowledge gaps and how to advance scientific utilization of future space-exposure platforms that are either currently under development or in an advanced planning stage. In addition to the ISS, these platforms include CubeSats and SmallSats, as well as larger platforms such as the Lunar Orbital Gateway. We also provide an outlook for in situ experiments on the Moon and Mars, and welcome new possibilities to support the search for exoplanets and potential biosignatures within and beyond our solar system

Measuring the principal Hugoniot of inertial-confinement-fusion-relevant TMPTA plastic foams

Wetted-foam layers are of significant interest for inertial-confinement-fusion capsules, due to the control they provide over the convergence ratio of the implosion and the opportunity this affords to minimize hydrodynamic instability growth. However, the equation of state for fusion-relevant foams are not well characterized, and many simulations rely on modeling such foams as a homogeneous medium with the foam average density. To address this issue, an experiment was performed using the VULCAN Nd:glass laser at the Central Laser Facility. The aim was to measure the principal Hugoniot of TMPTA plastic foams at 260mg/cm3, corresponding to the density of liquid DT-wetted-foam layers, and their “hydrodynamic equivalent” capsules. A VISAR was used to obtain the shock velocity of both the foam and an α-quartz reference layer, while streaked optical pyrometry provided the temperature of the shocked material. The measurements confirm that, for the 20–120 GPa pressure range accessed, this material can indeed be well described using the equation of state of the homogeneous medium at the foam density

Aspergillus Genomes and the Aspergillus Cloud

Aspergillus Genomes is a public resource for viewing annotated genes predicted by various Aspergillus sequencing projects. It has arisen from the union of two significant resources: the Aspergillus/Aspergillosis website and the Central Aspergillus Data REpository (CADRE). The former has primarily served the medical community, providing information about Aspergillus and associated diseases to medics, patients and scientists; the latter has focused on the fungal genomic community, providing a central repository for sequences and annotation extracted from Aspergillus Genomes. By merging these databases, genomes benefit from extensive cross-linking with medical information to create a unique resource, spanning genomics and clinical aspects of the genus. Aspergillus Genomes is accessible from http://www.aspergillus-genomes.org.uk