Management of asthma in childhood: study protocol of a systematic evidence update by the Paediatric Asthma in Real Life (PeARL) Think Tank

IntroductionClinical recommendations for childhood asthma are often based on data extrapolated from studies conducted in adults, despite significant differences in mechanisms and response to treatments. The Paediatric Asthma in Real Life (PeARL) Think Tank aspires to develop recommendations based on the best available evidence from studies in children. An overview of systematic reviews (SRs) on paediatric asthma maintenance management and an SR of treatments for acute asthma attacks in children, requiring an emergency presentation with/without hospital admission will be conducted.Methods and analysisStandard methodology recommended by Cochrane will be followed. Maintenance pharmacotherapy of childhood asthma will be evaluated in an overview of SRs published after 2005 and including clinical trials or real-life studies. For evaluating pharmacotherapy of acute asthma attacks leading to an emergency presentation with/without hospital admission, we opted to conduct de novo synthesis in the absence of adequate up-to-date published SRs. For the SR of acute asthma pharmacotherapy, we will consider eligible SRs, clinical trials or real-life studies without time restrictions. Our evidence updates will be based on broad searches of Pubmed/Medline and the Cochrane Library. We will use A MeaSurement Tool to Assess systematic Reviews, V.2, Cochrane risk of bias 2 and REal Life EVidence AssessmeNt Tool to evaluate the methodological quality of SRs, controlled clinical trials and real-life studies, respectively. Next, we will further assess interventions for acute severe asthma attacks with positive clinical results in meta-analyses. We will include both controlled clinical trials and observational studies and will assess their quality using the previously mentioned tools. We will employ random effect models for conducting meta-analyses, and Grading of Recommendations Assessment, Development and Evaluation methodology to assess certainty in the body of evidence.Ethics and disseminationEthics approval is not required for SRs. Our findings will be published in peer reviewed journals and will inform clinical recommendations being developed by the PeARL Think Tank.PROSPERO registration numbers CRD42020132990, CRD42020171624.</p

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Obstructive sleep apnea and hypertension: A Bidirectional causal relation

Respiratory Assembly, Hellenic Society for the Advancement o f Biomedical Research, Athens, Greece Athens Breath Centre, Athens, Greece Chest Centre, Aintree University Hospital, Liverpool, UK Respiratory Department, State University o f Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova Respiratory Department, General Hospital of Nikaia St. Panteleimon, Piraeus, Greec

Obstructive sleep apnea and hypertension:A bidirectional causal relation

Respiratory Assembly, Hellenic Society for the Advancement o f Biomedical Research, Athens, Greece Athens Breath Centre, Athens, Greece Chest Centre, Aintree University Hospital, Liverpool, UK Respiratory Department, State University o f Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova Respiratory Department, General Hospital of Nikaia St. Panteleimon, Piraeus, Greec

Optical and Elastic Properties of Diamond-like Carbon with Metallic Inclusions: a Theoretical Study

A tough material commonly used in coatings is diamond-like carbon (DLC), that is, amorphous carbon with content in four-fold coordinated C higher than ∼70, and its composites with metal inclusions. This study aims to offer useful guidelines for the design and development of metal-containing DLC coatings for solar collectors, where the efficiency of the collector depends critically on the performance of the absorber coating. We use first-principles calculations based on density functional theory to study the structural, electronic, optical, and elastic properties of DLC and its composites with Ag and Cu inclusions at 1.5 and 3.0 atomic concentration, to evaluate their suitability for solar thermal energy harvesting. We find that with increasing metal concentration optical absorption is significantly enhanced while at the same time, the composite retains good mechanical strength: DLC with 70-80 content in four-fold coordinated C and small metal concentrations (3 at. ) will show high absorption in the visible (absorption coefficients higher than 10 5 cm-1) and good mechanical strength (bulk and Youngs modulus higher than 300 and 500 GPa, respectively)

Comparative Assessment of the Dyeing Process for Pristine and Modified Cotton Fabrics towards the Reduction of the Environmental Fingerprint

Though an important and chronic source of dyes released to the environment, the determination of the release of dyes that occurs during household or industrial washing is usually disregarded. The main scope of this study is to reveal the extent of dye release through washing, and to understand if the modification of cotton fabrics with cationic polymers could reduce it. Modified cotton fabrics, dyed with Acid Blue 281 (AB) or by a mixture of the reactive dyes Novacron Yellow S-3R (NY), Novacron Ruby S-3B (NR) and Novacron Dark Blue S-GL (NDB), underwent a certified washing process. The dyed fabrics were analyzed colorimetrically, while the washing waters were analyzed spectroscopically, via UV/Vis absorption and surface enhanced Raman scattering (SERS). In the modified fabrics dyed with the acid dye, an increased dye uptake was noticed that exhibited a color intensity of K/S~16, compared to K/S~0.45 of the unmodified fabrics. The corresponding normalized dye release (dye concentration/color intensity factor) in the wash water was ~1.6 for the modified fabrics, compared to ~6.5 in the case of the unmodified fabrics, indicating the significance of cotton modification on both the dye uptake and dye release during washing. In the fabrics dyed with a mixture of selected reactive dyes, the color uptake of modified (K/S~10) was also increased compared with unmodified fabrics (K/S~4.5). An important observation, is that in the case of the dyeing of the reactive dyes mixture, a selectivity on the part of the dye uptake was noticed, since the contribution of NY (yellow) is higher compared to that of the blue (positive value of color indicator coordinate (b)); however, this also resulted in an increased NY dye release during washing. The findings of this study could contribute to the dye release problem control due to fabric washing, and to the understanding of any potential selectivity on the part of dye&ndash;cotton interactions