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Diplomová práce se zaměřuje na tvorbu cen námořních a leteckých přeprav z pohledu přepravce. V první části se práce zabývá teoretickým vymezením zkoumané oblasti. V druhé kapitole se práce věnuje analýze vnitřního a vnějšího prostředí ve společnosti Vitesco Technologies Czech Republic s.r.o. v oblasti globálních přeprav. Ve třetí kapitole je uveden návrh změny přístupu k cenotvorbě globálních přeprav. V poslední části práce je proveden výběr poskytovatele služby v rámci navrhované změny a ekonomicky zhodnoceno zavedení služby vybraného poskytovatele., The diploma thesis focuses on the price making of sea freight and air freight from the shipper's point of view. In the first part, the thesis deals with the theoretical base of the researched area. In the second chapter is performed the analysis of the internal and external environment in Vitesco Technologies Czech Republic s.r.o. in the field of global freight. In the third chapter, a proposal for changing the approach to global freight pricing is presented. In the last part of the diploma thesis, is selected the service provider as part of the proposed change and is economically evaluated the implemetation of the selected provider's service in the company., Dopravní fakulta Jana Pernera, Diplomant přednesl ucelenou a logicky uspořádanou obhajobu své diplomové práce. V ní dokázal přesvědčivým způsobem obhájit závěry svých řešení. Na poznámky, resp. připomínky oponenta reagoval správně a v plném rozsahu je zodpověděl. U doplňkových otázek prokázal schopnost logického myšlení, pohotové reakce, jasného a srozumitelného vysvětlení., Dokončená práce s úspěšnou obhajobou

BackgroundGiven the housing instability and frequent residential relocation (both volitional and hegemonic) of people who inject drugs, we sought to determine whether residential relocation (defined as sleeping in a different place in the past 30 days) is associated with health outcomes in a sample of people who inject drugs (PWID).MethodsWe recruited 601 PWID using targeted sampling and interviewed them between 2016 and 2018 in San Francisco and Los Angeles, CA about housing, drug use practices, and service utilization. We then developed multivariable regression models to investigate how residential relocation is associated with violence, health outcomes, and social service access. We analyzed our data between June 2018 and October 2019.ResultsParticipants who relocated in the past 30 days had lower odds of being in substance use treatment (Adjusted Odds Ratio [AOR] = 0.62, 95% Confidence Interval [CI] = 0.42, 0.89) and higher odds of nonfatal overdose (AOR = 2.50, CI = 1.28, 4.90), receptive syringe sharing (AOR = 2.26, CI = 1.18, 4.32), severe food insecurity (AOR = 1.69, CI = 1.14, 2.50), having belongings stolen (AOR = 2.14, CI = 1.42, 3.21), experiencing physical assault (AOR = 1.58, CI = 1.03, 2.43), arrest (AOR = 1.64, CI = 1.02, 2.65), and jail (AOR = 1.90, CI = 1.16, 3.13) in the past 6 months when compared to those who did not relocate.ConclusionsPWID who have relocated in the past 30 days have higher odds of experiencing violence and life- threatening adverse outcomes, and policies that disrupt living circumstances of PWID should be ended in favor of those that support housing stability.

BackgroundGiven the housing instability and frequent residential relocation (both volitional and hegemonic) of people who inject drugs, we sought to determine whether residential relocation (defined as sleeping in a different place in the past 30 days) is associated with health outcomes in a sample of people who inject drugs (PWID).MethodsWe recruited 601 PWID using targeted sampling and interviewed them between 2016 and 2018 in San Francisco and Los Angeles, CA about housing, drug use practices, and service utilization. We then developed multivariable regression models to investigate how residential relocation is associated with violence, health outcomes, and social service access. We analyzed our data between June 2018 and October 2019.ResultsParticipants who relocated in the past 30 days had lower odds of being in substance use treatment (Adjusted Odds Ratio [AOR] = 0.62, 95% Confidence Interval [CI] = 0.42, 0.89) and higher odds of nonfatal overdose (AOR = 2.50, CI = 1.28, 4.90), receptive syringe sharing (AOR = 2.26, CI = 1.18, 4.32), severe food insecurity (AOR = 1.69, CI = 1.14, 2.50), having belongings stolen (AOR = 2.14, CI = 1.42, 3.21), experiencing physical assault (AOR = 1.58, CI = 1.03, 2.43), arrest (AOR = 1.64, CI = 1.02, 2.65), and jail (AOR = 1.90, CI = 1.16, 3.13) in the past 6 months when compared to those who did not relocate.ConclusionsPWID who have relocated in the past 30 days have higher odds of experiencing violence and life- threatening adverse outcomes, and policies that disrupt living circumstances of PWID should be ended in favor of those that support housing stability.

ObjectivesTo examine whether social aspects of the neighborhood environment are associated with early sexual initiation in a California agricultural community of predominantly Latinx adolescents.MethodsIn a prospective cohort study of 599 eighth graders recruited from middle schools in Salinas, California (2015-2019), participants completed five interviews over 2 years. Social environment measures included neighborhood social dynamics (neighborhood disorder, social cohesion, and social network gang exposure); experiences of discrimination; and school connectedness. We estimated associations between baseline social environment and early sexual initiation (<15 years) using Poisson regression with robust standard errors. We compared contraceptive self-efficacy and attitudes by sexual initiation status using ANOVA.ResultsMost youth were Latinx (94%) and age 13 (70%) at enrollment; 53% were female and 49% had a parent employed in agriculture. Additionally, 14% reported first vaginal sex before age 15. Neighborhood disorder (relative risk [RR], 1.13; 95% confidence interval [CI], 1.05-1.21), social network gang exposure (RR, 2.23; 95% CI, 1.49-3.33), and experiences of discrimination (RR, 1.67 [1-2 events versus none], 95% CI, 1.09-2.55; RR, 2.33 [3+ events versus none], 95% CI, 1.07-4.64) were associated with early sexual initiation. School connectedness was protective (RR, 0.44, 95% CI, 0.29-0.69). Youth who initiated sex before age 15 had more negative birth control attitudes and expressed lower motivation to use contraceptives.ConclusionsFindings underscore opportunities to promote early adolescent sexual health through strengthening supportive and safe neighborhood environments with the promise of addressing disparities in unintended pregnancy and sexually transmitted infection rates in later adolescence.

ImportanceThe US faces a pivotal moment of opportunity and risk regarding issues affecting children (aged 0-17 years). Although the US remains the only United Nations member state to not have ratified the Convention on the Rights of the Child (CRC), a child rights framework is essential for child health professionals seeking to advance many issues affecting children in the US. The Reimagining Children's Rights project (2020-2021) conducted an in-depth environmental scan of relevant literature and policy analysis using the Three Horizons design process to assess strategies that could advance the rights and well-being of children in the US. The project was overseen by a steering committee and informed by an advisory committee composed of youth leaders and experts in children's rights, advocacy, health, law, and a range of child-specific issues (eg, youth justice, early childhood development), who provided expert input on strategic considerations for advancing children's rights.ObservationsSeven findings about advancing children's rights in the US are notable, all reflecting current gaps and opportunities for using a whole-child rights framework in the US, even without formal adoption of the CRC. Actionable strategies, tactics, and tools to leverage sustainable change in the multitude of issue areas can advance the current state of children's rights. High-potential strategies for catalyzing advancement of children's rights include youth activism, innovations in governance and accountability, legislative action, impact litigation, place-based initiatives, education and public awareness, alignment with other children's movements, and research. The child rights framework is unifying and adaptive to future unforeseen challenges.Conclusions and relevanceChildren's rights provide a powerful, synergistic framework for child health professionals-in partnership with youth and other leaders-to increase equity and protect the rights and well-being of all children in the US.

Angeeichte Radarniederschlagsdaten (RADOLAN) liefern wichtige Informationen über die hohe zeitliche und räumliche Variabilität erosiver Regen und deren Erosivität, ihrem Potential Bodenerosion zu verursachen. Notwendige Skalierungsfaktoren wurden ermittelt, welche die Unterschätzung der Erosivität durch die räumliche und zeitliche Auflösung und die Messeigenheiten von RADOLAN kompensieren. Es wurde gezeigt, dass die behördlich etablierte ‚Universal Soil Loss Equation‘ mit skalierten RADOLAN-basierten Erosivitäten zuverlässige Erosionsprognosen liefert., Rain-gauge adjusted radar rain data (RADOLAN) deliver important information about the high spatio-temporal variability of erosive rains and erosivity, rains’ potential to erode soil. Scaling factors were determined which compensate for the underestimation of erosivity by spatial and temporal scale and rain measurement peculiarities of RADOLAN. It was proven that the institutionally established Universal Soil Loss Equation combined with scaled RADOLAN-derived erosivities yields reliable soil loss predictions.

Rising homelessness in the United States has been a considerable source of concern, with policymakers and community members calling for “solutions.” Stigma, as a societal barrier to addressing inequity, is a significant cause of morbidity and mortality for people experiencing homelessness (PEH) and presents a barrier to the proposed solutions. Given that using surveys to study stigma against PEH carries potential social desirability bias, our research team used Twitter, a microblogging platform comprised of 140-character messages (aka, tweets), to get a snapshot of how American Twitter users stigmatize PEH. We conducted a content analysis of 6,400 tweets regarding homelessness collected over 3 months. Our analysis was informed by Erving Goffman’s theoretical framework regarding stigma. Consistent with Goffman’s work, we illustrate the ways that Twitter users rationalized the situation of PEH by creating a “stigma theory,” in which they attribute undesirable characteristics to PEH, highlight the multiple ways in which they “deserve” to be homeless because of their character flaws, and emphasize their devalued “bottom of the heap” status. We describe the ways that this stigma theory of homelessness is expressed in tweets regarding interactions between PEH and housed individuals. Complementing Goffman’s work as applied to PEH, we also describe the ways in which Twitter users impute additional stigmatized identities onto PEH and the role that disgust plays in stigma against PEH. Our findings suggest the need for a multi-level response to stigma, including addressing stigma at the individual and structural levels and providing housing to PEH across communities. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

BACKGROUND: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a complex antibody response that varies by orders of magnitude between individuals and over time. METHODS: We developed a multiplex serological test for measuring antibodies to 5 SARS-CoV-2 antigens and the spike proteins of seasonal coronaviruses. We measured antibody responses in cohorts of hospitalized patients and healthcare workers followed for up to 11 months after symptoms. A mathematical model of antibody kinetics was used to quantify the duration of antibody responses. Antibody response data were used to train algorithms for estimating time since infection. RESULTS: One year after symptoms, we estimate that 36% (95% range, 11%-94%) of anti-Spike immunoglobulin G (IgG) remains, 31% (95% range, 9%-89%) anti-RBD IgG remains, and 7% (1%-31%) of anti-nucleocapsid IgG remains. The multiplex assay classified previous infections into time intervals of 0-3 months, 3-6 months, and 6-12 months. This method was validated using data from a seroprevalence survey in France, demonstrating that historical SARS-CoV-2 transmission can be reconstructed using samples from a single survey. CONCLUSIONS: In addition to diagnosing previous SARS-CoV-2 infection, multiplex serological assays can estimate the time since infection, which can be used to reconstruct past epidemics.

New therapeutic agents for haemophilia with inhibitors that are in development or already licensed are expected to provide transformative treatment options. Many of these new therapies are not based on simply replacing the missing factor; new strategies include bispecific antibody technology that mimics factor VIII coagulation function (emicizumab), and inhibition of anticoagulant proteins such as tissue factor pathway inhibitor (eg PF-06741086) and antithrombin (eg fitusiran). These agents are administered subcutaneously and should significantly reduce treatment burden and increase the ability to deliver prophylaxis for patients. Limited real-world data and validated practical guidance on these recently licensed/upcoming treatments resulted in the authors convening to discuss recommendations on their use. Emicizumab is currently the only licenced nonfactor therapy; thus, our recommendations focus on this product. Target candidates for emicizumab prophylaxis are difficult-to-treat patients with haemophilia A and inhibitors and/or venous access issues, frequent bleeds and target joints. In case of breakthrough bleeding while receiving emicizumab, patients still require treatment with bypassing agents; the adjunct treatment of choice is recombinant activated factor VII. This treatment is also recommended to prevent bleeds in patients with inhibitors undergoing surgery. Our recommendations on suitable laboratory assays and monitoring new products, as well as the benefit of patient-reported outcomes (such as pain and physical activity levels), are included. We also briefly discuss future treatment options for patients with haemophilia B and inhibitors. Although these nonfactor treatments offer great promise, further data and real-world evidence are needed.

Rising homelessness in the United States has been a considerable source of concern, with policymakers and community members calling for “solutions.” Stigma, as a societal barrier to addressing inequity, is a significant cause of morbidity and mortality for people experiencing homelessness (PEH) and presents a barrier to the proposed solutions. Given that using surveys to study stigma against PEH carries potential social desirability bias, our research team used Twitter, a microblogging platform comprised of 140-character messages (aka, tweets), to get a snapshot of how American Twitter users stigmatize PEH. We conducted a content analysis of 6,400 tweets regarding homelessness collected over 3 months. Our analysis was informed by Erving Goffman’s theoretical framework regarding stigma. Consistent with Goffman’s work, we illustrate the ways that Twitter users rationalized the situation of PEH by creating a “stigma theory,” in which they attribute undesirable characteristics to PEH, highlight the multiple ways in which they “deserve” to be homeless because of their character flaws, and emphasize their devalued “bottom of the heap” status. We describe the ways that this stigma theory of homelessness is expressed in tweets regarding interactions between PEH and housed individuals. Complementing Goffman’s work as applied to PEH, we also describe the ways in which Twitter users impute additional stigmatized identities onto PEH and the role that disgust plays in stigma against PEH. Our findings suggest the need for a multi-level response to stigma, including addressing stigma at the individual and structural levels and providing housing to PEH across communities. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Depression constitutes one of the greatest sources of morbidity and mortality for U.S. adolescents. Latinx are the fastest growing U.S. adolescent population, particularly in rural communities, and suffer from depression at higher rates than other racial/ethnic groups. Informed by community perspectives on adolescent health, we examined factors associated with depression among Latinx early adolescents in an agricultural community. We surveyed 599 predominantly Latinx 8th graders (12 to 15 years old) recruited from middle schools in Salinas, California. Depression was measured cross-sectionally with the Patient Health Questionnaire-8. Exposures included environmental, cultural, and family factors, assessed using validated measures. We used hierarchical logistic regression guided by Garcia Coll's Model for the Study of Developmental Competencies in Minority Children to examine associations between protective factors within each domain and depression. Eighty-six of the 599 youth (14%) scored above the clinical threshold for depression, with higher prevalence among females (19%) than males (10%), p = .001. Environmental (school connectedness and neighborhood social cohesion) and family factors were associated with a lower odds of depression (all p ≤ .01). Social cohesion in neighborhoods and family communication offered similarly strong protective associations with depression. Increased language assimilation was associated with an increased odds of depression (p = .007).

In Kenya, adolescent pregnancy rates are high, contraception utilization is low, and adolescent sexuality is stigmatized. We describe how perceptions of sexuality and pregnancy stigma influence decision-making among adolescents in the informal settlements of Kisumu. We used purposive sampling to recruit 120 adolescent boys and girls aged 15-19 for focus group discussions. A semistructured interview guide was used to elicit social norms and community attitudes about sexual and reproductive health. We analyzed the data using the Framework Approach. The social stigma of adolescent sexuality and the related fear of pregnancy as an unambiguous marker of sexual activity emerged as main themes. This stigma led adolescents to fear social retribution but did not lead to more frequent contraception use due to additional stigma. The intensity of this fear was most acutely expressed by girls, leading some to seek unsafe, sometimes fatal, abortions, and to contemplate suicide. Fear of pregnancy outweighed fear of contracting HIV that was viewed as both treatable and less stigmatized. Our findings illustrate how fear of pregnancy among these adolescents is driven primarily by fears that their community will discover that they are sexually active. Interventions are urgently needed to address adolescent sexual stigma and to prevent negative outcomes.

Even in the best of times, youth experiencing homelessness (YEH) face significant morbidities [[1],[2]]. Youth from marginalized communities, many of which are disproportionately impacted by the COVID-19 pandemic, also disproportionately experience homelessness [[3],[4]]. YEH have been overlooked in COVID-19 response planning. Drawing on our international experiences, we summarize the vulnerability of YEH during the pandemic and describe strategies to mitigate its impact. We focus on unaccompanied minors (aged <18 years) and transition-aged youth (generally aged 18–24 years) who are experiencing homelessness or are unstably housed (Figure 1) [[3]]. Although much of our collective expertise draws on experiences in well-resourced countries, our hope is that this commentary prompts a global dialog about addressing the unique needs and vulnerabilities of YEH in planning, response, and recovery efforts during times of global crises across geographic and sociopolitical contexts.

Bakalářská práce se zabývá přepravou materiálů a zboží ve Společnosti Argo-Hytos s.r.o.,která sídlí ve městě Vrchlabí. V teoretické části je charakterizována přeprava, její postavení v logistickém řetězci a informační systémy usnadňující její plánování. Analytická část práce rozebírá aktuální stav společnosti v oblasti přepravy materiálů a zboží. Návrhová část práce se zabývá návrhy řešení, které povedou ke zlepšení současného stavu v oblasti přepravy materiálů a zboží ve společnosti Argo-Hytos s.r.o. a následně jsou navržená řešení zhodnocena., The bachelor's thesis deals with transportation of materials and goods in Argo-Hytos s.r.o.,a company based in the town of Vrchlabí. Transportation, its standing in the logistics chain and information systems facilitating its planning are characterised in the theoretical part. The analytical part of the thesis analyses the current situation in the company in the field of transportation of materials and goods. The aim of the proposal part of the thesis is to offer proposal of a solution which will lead to improvement of the current situation in the field of transportation of materials and goods in Argo-Hytos s.r.o. and to subsequently evaluate the proposed solution., Dopravní fakulta Jana Pernera, Student přednesl ucelenou a logicky uspořádanou obhajobu své bakalářské práce. V ní dokázal přesvědčivým způsobem obhájit závěry svých řešení. U doplňkových otázek prokázal schopnost logického myšlení, pohotové reakce, jasného a srozumitelného vysvětlení., Dokončená práce s úspěšnou obhajobou

Stable isotopes of dissolved nitrate are widely used in the assessment of denitrification in groundwater but are often difficult to interpret. We, therefore, applied environmental isotopes to determine mean transit times of groundwater and calculate oxygen reduction rates to assess denitrification lag-times. Moreover, Monte Carlo simulations have been carried out to perform δ15N data analyses regarding the effect of mixing and transport of different nitrate sources and denitrification processes on stable isotopes of nitrate., Um die Quellen der Nitratkontamination und Denitrifikationsprozesse im Grundwasser zu bestimmen, werden Nitratisotope zwar weitreichend angewendet, sind aber oft schwierig zu interpretieren. Deshalb haben wir neben den stabilen Isotopen im Nitrat weitere Umweltisotope gemessen, um die mittlere Verweilzeiten des Grundwassers zu bestimmen und daraus Sauerstoffreduktionsraten berechnet. Zudem wurden Monte Carlo Simulationen durchgeführt, um die Einflüsse von Mischung und Transport von verschiedenen Nitratquellen und Denitrifikationsprozessen auf die beobachteten δ15N Werte zu interpretieren.

BackgroundLittle data is available on the long-term psychosocial effects of disclosure of HIV status that may occur in late adolescence, even when disclosure is timely. Moreover, few studies have described the post-disclosure psychosocial needs of older adolescents who experience delayed disclosure. This study sought to address existing knowledge gaps in the post-disclosure experiences and psychosocial needs of older adolescents living with HIV (ALWHIV).MethodsWe conducted focus group discussions (FGDs) and in-depth interviews (IDIs) among older perinatally infected adolescents aged 16-19 years We collected socio-demographic data and baseline viral load (copies/ml) results for the preceding six months using interviewer-administered questionnaires and clinical notes abstraction. We analysed data inductively and deductively to identify themes related to the experiences and expectations of adolescents with the disclosure and post-disclosure period.ResultsAdolescents who reported having received timely disclosure expressed that as they grew older, they began to comprehend the lifelong repercussions of an HIV diagnosis and experienced a re-emergence of the negative feelings similar to those experienced during the post-disclosure period. Those who received the knowledge of their HIV status during late adolescence experienced prolonged periods of negative self-perception and anger at not receiving their HIV status earlier. They also expressed a need for more information during the disclosure process on the prevention of onward transmission of the virus, safe conception practices resulting in HIV negative children, and information on how to disclose their HIV status to sexual partners or peers. Anticipated stigma was experienced universally by these older adolescents and was a major barrier towards adherence and coping with an HIV status. Caregivers or siblings with a similar HIV status were a source of social support. Adolescents felt that the support of peers (ALWHIV) hel

Japanese encephalitis virus (JEV) is the main cause of human viral encephalitis in Asia, with a mortality rate reaching 30%, mostly affecting children. The traditionally described cycle involving wild birds as reservoirs, pigs as amplifying hosts and Culex mosquitoes as vectors is questioned, with increasing evidence of a more complex multi-host system involved in areas where densities of pigs are low, such as in Cambodia. In 2018, we examined pigs, chickens, ducks and dogs from Kandal province, Cambodia, for antibody response against JEV by hemagglutination inhibition and virus neutralization assays. Forces of infection (FOI) for flaviviruses and JEV were estimated per species and per unit of body surface area (BSA). JEV seroprevalence reached 31% (95% CI: 23–41%) in pigs, 1% (95% CI: 0.1–3%) in chickens, 12% (95% CI: 7–19%) in ducks and 35% (95% CI: 28–42%) in dogs. Pigs were most likely to be infected (FOI: 0.09 per month), but the FOI was higher in ducks than in pigs for a given BSA (ratio of 0.13). Dogs had a lower FOI than ducks but a higher FOI than chickens (0.01 per month). For a given BSA, dogs were less likely to be infected than pigs (ratio of 1.9). In Cambodia, the virus may be circulating between multiple hosts. Dogs live in close contact with humans, and estimating their exposure to JEV infection could be a relevant indicator of the risk for humans to get infected, which is poorly known due to underdiagnosis. Understanding the JEV cycle and developing tools to quantify the exposure of humans is essential to adapt and support control measures for this vaccine-preventable disease.

Mosquito-borne flaviviruses with an enzootic transmission cycle like Japanese encephalitis virus (JEV) and West Nile virus (WNV) are a major public health concern. The circulation of JEV in Southeast Asia is well-documented, and the important role of pigs as amplification hosts for the virus is long known. The influence of other domestic animals especially poultry that lives in high abundance and close proximity to humans is not intensively analyzed. Another understudied field in Asia is the presence of the closely related WNV. Such analyses are difficult to perform due to the intense antigenic cross-reactivity between these viruses and the lack of suitable standardized serological assays. The main objective of this study was to assess the prevalence of JEV and WNV flaviviruses in domestic birds, detailed in chickens and ducks, in three different Cambodian provinces. We determined the flavivirus seroprevalence using an hemagglutination inhibition assay (HIA). Additionally, we investigated in positive samples the presence of JEV and WNV neutralizing antibodies (nAb) using foci reduction neutralization test (FRNT). We found 29% (180/620) of the investigated birds positive for flavivirus antibodies with an age-depended increase of the seroprevalence (OR = 1.04) and a higher prevalence in ducks compared to chicken (OR = 3.01). Within the flavivirus-positive birds, we found 43% (28/65) with nAb against JEV. We also observed the expected cross-reactivity between JEV and WNV, by identifying 18.5% double-positive birds that had higher titers of nAb than single-positive birds. Additionally, seven domestic birds (10.7%) showed only nAb against WNV and no nAb against JEV. Our study provides evidence for an intense JEV circulation in domestic birds in Cambodia, and the first serological evidence for WNV presence in Southeast Asia since decades. These findings mark the need for a re-definition of areas at risk for JEV and WNV transmission, and the need for further and intensifie

BackgroundLittle data is available on the long-term psychosocial effects of disclosure of HIV status that may occur in late adolescence, even when disclosure is timely. Moreover, few studies have described the post-disclosure psychosocial needs of older adolescents who experience delayed disclosure. This study sought to address existing knowledge gaps in the post-disclosure experiences and psychosocial needs of older adolescents living with HIV (ALWHIV).MethodsWe conducted focus group discussions (FGDs) and in-depth interviews (IDIs) among older perinatally infected adolescents aged 16-19 years We collected socio-demographic data and baseline viral load (copies/ml) results for the preceding six months using interviewer-administered questionnaires and clinical notes abstraction. We analysed data inductively and deductively to identify themes related to the experiences and expectations of adolescents with the disclosure and post-disclosure period.ResultsAdolescents who reported having received timely disclosure expressed that as they grew older, they began to comprehend the lifelong repercussions of an HIV diagnosis and experienced a re-emergence of the negative feelings similar to those experienced during the post-disclosure period. Those who received the knowledge of their HIV status during late adolescence experienced prolonged periods of negative self-perception and anger at not receiving their HIV status earlier. They also expressed a need for more information during the disclosure process on the prevention of onward transmission of the virus, safe conception practices resulting in HIV negative children, and information on how to disclose their HIV status to sexual partners or peers. Anticipated stigma was experienced universally by these older adolescents and was a major barrier towards adherence and coping with an HIV status. Caregivers or siblings with a similar HIV status were a source of social support. Adolescents felt that the support of peers (ALWHIV) hel

Introduction: Due to the circumstances of the Covid-19 pandemic, the teaching during the block internship at the Department for Otorhinolaryngology was switched to digital learning. Various online courses were created and the utilisation by the students was analyzed. Material & methods: Examination videos, surgical images and videos were created and live lectures were held. In addition, patient cases of common otorhinolaryngological diseases were reconstructed on an interactive platform. A total of 16 cases were offered in weekly rotation. These cases are provided with gap texts, open and selection questions, links and videos and thematically appropriate digression offers. The time-consuming creation was carried out as a HTML 5 learning package with the authoring program Exelearning 2.5. Each case was to be evaluated separately after being worked on by the students. Results: The direct feedback and the evaluation results of the students on the internship and case presentations were consistently positive. However, on average only 50.72% of the registered students took part in the weekly video meetings. In the course of the semester, the willingness to participate decreased. In addition, the willingness to evaluate the patient cases was low.Discussion: With the case presentation tool, concrete patient examples can be well presented, especially when patient contact is not possible (especially in an ENT clinic due to violation of distance and hygienic rules). Even though the evaluations were positive in terms of content, the frequency of utilisation and also the motivation for feedback seems disappointing. This seems to be associated above all with an increasing return to everyday life after the end of the lockdown., Einleitung: Aufgrund der Umstände der Covid-19-Pandemie wurde der Unterricht während des Blockpraktikums der Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde auf digitales Lernen umgestellt. Diverse Online-Lehrangebote wurden erstellt und die Nutzung der Studierenden analysiert. Material & Methoden: Es wurden Untersuchungsvideos, Operationsbilder und -videos erstellt sowie Live-Vorlesungen abgehalten. Darüber hinaus wurden Patientenfälle von häufigen HNO-Erkrankungen rekonstruiert auf einer interaktiven Plattform angeboten. Insgesamt wurden 16 Fälle im wöchentlichen Wechsel angeboten, diese sind mit Lückentexten, offenen und Auswahl-Fragen, weiterführenden Links und Videos und thematisch passenden Exkurs-Angeboten versehen. Die zeitaufwendige Erstellung erfolgte als HTML 5 Lernpaket mit dem Autorenprogramm Exelearning 2.5. Jeder Fall sollte nach Bearbeitung durch die Studierenden separat evaluiert werden. Ergebnisse: Die direkten Rückmeldungen und die Evaluationsergebnisse der Studierenden zum Praktikum und zu den Fallbearbeitungen waren durchweg positiv. An den wöchentlichen Videomeetings haben jedoch zum Beispiel im Schnitt nur 50,72% der angemeldeten Studierenden teilgenommen. Im Laufe des Semesters nahm die Teilnahmebereitschaft ab. Zudem war die Bereitschaft die Patientenfälle zu evaluieren gering.Diskussion: Mit dem Tool der Fallvorstellung können konkrete Patientenbeispiele, insbesondere bei nicht möglichem Patientenkontakt (vor allem in der HNO wegen Verletzung der Abstandsregeln), gut dargestellt werden. Auch wenn die Evaluationen inhaltlich positiv waren, erscheint uns die Nutzungshäufigkeit und auch Motivation zum Feedback enttäuschend. Dies scheint vor allem mit zunehmender Rückkehr zum Alltagsgeschehen nach dem Ende des Lockdowns assoziiert zu sein.

Toshko Lissitchkov,1 Anna Klukowska,2 Evgeny Buevich,3 Irina Maltceva,3 Guenter Auerswald,4 Oleksandra Stasyshyn,5 Wilfried Seifert,6 Tobias Rogosch6 1Specialized Hospital for Active Treatment (SHAT), Sofia, Bulgaria; 2Department of Paediatrics, Haematology and Oncology of Warsaw Medical University, Warsaw, Poland; 3GOUVPO Altaysky State Medical University of Roszdrav, Bernaul, Russian Federation; 4Prof. Hess Kinderklinik, Klinikum Bremen-Mitte, Bremen, Germany; 5Institute of Pathology and Transfusion Medicine AMN, Lviv, Ukraine; 6Clinical Development, CSL Behring, Marburg, GermanyCorrespondence: Toshko LissitchkovSpecialized Hospital for Active Treatment (SHAT) “JOAN PAVEL”, 67A Stoletov Blvd, Sofia 1233, BulgariaTel +35 989 436 9096Email t_lissitchkov@yahoo.comObjective: Plasma-derived von Willebrand factor/factor VIII (pdVWF/FVIII; VONCENTO®, CSL Behring) is a high-concentration, low-volume, high-purity concentrate, which contains a high level of high-molecular-weight multimers and a VWF/FVIII ratio of ∼ 2.4:1. The SWIFT (“Studies with von Willebrand factor/Factor VIII”) program is evaluating pdVWF/FVIII in patients with von Willebrand disease (VWD). The long-term efficacy and safety profile of pdVWF/FVIII was investigated in this multicenter, open-label, extension study.Methods: Pediatric, adolescent, and adult patients with VWD who required treatment of non-surgical bleeds (NSBs), treatment during surgical events or who were receiving prophylaxis and who had completed one of two previous clinical trials of pdVWF/FVIII were included. Efficacy and safety analyses were performed for on-demand (n=10), prophylaxis (n=8), or on-demand and prophylaxis (n=2) treatment in patients pre-treated with pdVWF/FVIII for ≥ 12 months.Results: Seven patients experienced a total of 402 NSBs in the on-demand arm, of which 77 required treatment and nine NSB events in three patients were considered major. Nine patients re

Guenter Auerswald,1 Claudia Djambas Khayat,2 Oleksandra Stasyshyn,3 Genadi Iosava,4 Irina Romashevskaya,5 Marta Julia López,6 Wilfried Seifert,7 Tobias Rogosch7 1Hess Kinderklinik, Klinikum Bremen-Mitte, Bremen, Germany; 2Hotel Dieu de France Hospital, St Joseph University, Beirut, Lebanon; 3Institute of Blood Pathology and Transfusion Medicine, Academy of Medical Sciences of Ukraine, Lviv, Ukraine; 4Institute for Hematology and Transfusiology, Tbilisi, Georgia; 5Republican Research Centre for Radiation Medicine and Human Ecology, Gomel, Belarus; 6Hematology, Hospital Roosevelt, Guatemala, Guatemala; 7Clinical Development, CSL Behring, Marburg, GermanyCorrespondence: Guenter AuerswaldHess Kinderklinik, Klinikum Bremen-Mitte, Bremen, GermanyTel +49 176-10113362Email guenterauerswald@aol.comPurpose: Formulation V (VONCENTO®) is a plasma-derived high-concentration/low-volume, high-purity von Willebrand factor (VWF)/factor VIII (FVIII) concentrate, originally indicated for von Willebrand disease (VWD) in adults and adolescents. This multicenter, open-label study (SWIFTLY-VWD) evaluated the pharmacokinetics (PK), as well as hemostatic efficacy and safety, of Formulation V in pediatric patients (< 12 years) with severe VWD requiring treatment or prophylaxis of bleedings.Methods: PK investigations were performed following one dose of Formulation V at Day 1 and 180. Nonsurgical bleeds were analyzed, while hemostatic efficacy was graded as excellent/good/moderate/none. Safety assessments included adverse events, and presence of VWF and/or FVIII inhibitors.Results: Formulation V was administered as on-demand (N=13) or prophylaxis therapy (N=4) for 12 months (< 6 years, N=9; 6 to < 12 years, N=8). PK parameters for VWF markers were generally comparable to adults but showed lower VWF:ristocetin cofactor (RCo) exposure. Incidence of major bleeds was lower for prophylaxis (3.3%) than on-demand therapy (27.1%); joint bleeds were also lower (

Japanese encephalitis virus (JEV) is the main cause of human viral encephalitis in Asia, with a mortality rate reaching 30%, mostly affecting children. The traditionally described cycle involving wild birds as reservoirs, pigs as amplifying hosts and Culex mosquitoes as vectors is questioned, with increasing evidence of a more complex multi-host system involved in areas where densities of pigs are low, such as in Cambodia. In 2018, we examined pigs, chickens, ducks and dogs from Kandal province, Cambodia, for antibody response against JEV by hemagglutination inhibition and virus neutralization assays. Forces of infection (FOI) for flaviviruses and JEV were estimated per species and per unit of body surface area (BSA). JEV seroprevalence reached 31% (95% CI: 23–41%) in pigs, 1% (95% CI: 0.1–3%) in chickens, 12% (95% CI: 7–19%) in ducks and 35% (95% CI: 28–42%) in dogs. Pigs were most likely to be infected (FOI: 0.09 per month), but the FOI was higher in ducks than in pigs for a given BSA (ratio of 0.13). Dogs had a lower FOI than ducks but a higher FOI than chickens (0.01 per month). For a given BSA, dogs were less likely to be infected than pigs (ratio of 1.9). In Cambodia, the virus may be circulating between multiple hosts. Dogs live in close contact with humans, and estimating their exposure to JEV infection could be a relevant indicator of the risk for humans to get infected, which is poorly known due to underdiagnosis. Understanding the JEV cycle and developing tools to quantify the exposure of humans is essential to adapt and support control measures for this vaccine-preventable disease.

Mosquito-borne flaviviruses with an enzootic transmission cycle like Japanese encephalitis virus (JEV) and West Nile virus (WNV) are a major public health concern. The circulation of JEV in Southeast Asia is well-documented, and the important role of pigs as amplification hosts for the virus is long known. The influence of other domestic animals especially poultry that lives in high abundance and close proximity to humans is not intensively analyzed. Another understudied field in Asia is the presence of the closely related WNV. Such analyses are difficult to perform due to the intense antigenic cross-reactivity between these viruses and the lack of suitable standardized serological assays. The main objective of this study was to assess the prevalence of JEV and WNV flaviviruses in domestic birds, detailed in chickens and ducks, in three different Cambodian provinces. We determined the flavivirus seroprevalence using an hemagglutination inhibition assay (HIA). Additionally, we investigated in positive samples the presence of JEV and WNV neutralizing antibodies (nAb) using foci reduction neutralization test (FRNT). We found 29% (180/620) of the investigated birds positive for flavivirus antibodies with an age-depended increase of the seroprevalence (OR = 1.04) and a higher prevalence in ducks compared to chicken (OR = 3.01). Within the flavivirus-positive birds, we found 43% (28/65) with nAb against JEV. We also observed the expected cross-reactivity between JEV and WNV, by identifying 18.5% double-positive birds that had higher titers of nAb than single-positive birds. Additionally, seven domestic birds (10.7%) showed only nAb against WNV and no nAb against JEV. Our study provides evidence for an intense JEV circulation in domestic birds in Cambodia, and the first serological evidence for WNV presence in Southeast Asia since decades. These findings mark the need for a re-definition of areas at risk for JEV and WNV transmission, and the need for further and intensifie

Study Design: Biomechanical. Objective: This study evaluates the biomechanical properties of lag-screws used in vertebral pincer fractures at the thoracolumbar junction. Methods: Pincer fractures were created in 18 bisegmental human specimens. The specimens were assigned to three groups depending on their treatment perspective, either bolted, with the thread positioned in the cortical or cancellous bone, or control. The specimens were mounted in a servo-hydraulic testing machine and loaded with a 500 N follower load. They were consecutively tested in 3 different conditions: intact, fractured, and bolted/control. For each condition 10 cycles in extension/flexion, torsion, and lateral bending were applied. After each tested condition, a computed tomography (CT) scan was performed. Finally, an extension/flexion fatigue loading was applied to all specimens. Results: Biomechanical results revealed a nonsignificant increase in stiffness in extension/flexion of the fractured specimens compared with the intact ones. For lateral bending and torsion, the stiffness was significantly lower. Compared with the fractured specimens, no changes in stiffness due to bolting were discovered. CT scans showed an increasing fracture gap during axial loading both in extension/flexion, torsion, and lateral bending in the control specimens. In bolted specimens, the anterior fragment was approximated, and the fracture gap nullified. This refers to both the cortical and the cancellous thread positions. Conclusion: The results of this study concerning the effect of lag-screws on pincer fractures appear promising. Though there was little effect on stiffness, CT scans reveal a bony contact in the bolted specimens, which is a requirement for bony healing.

The oxygen isotope relation between precipitation and animal is used for tracing the origin of animal tissues or products; however, this relation may be altered during the following steps: (1) from precipitation to feed water; (2) from diet (including feed and drinking water) to body water; (3) from body water to hair O. These alterations should be deliberately considered in order to obtain reliable original information through the isotope analysis of animal tissues and products., Das Sauerstoffisotopenverhältnis von Niederschlag und Tieren kann zur Herkunftsermittlung tierischer Produkte verwendet werden, wobei das Verhältnis durch folgende Übertragungsschritte beeinflusst wird: (1) vom Niederschlag ins Trink-/ Futtermittelwasser; (2) vom Trink-/ Futtermittelwasser in Körperflüssigkeiten; (3) von Körperflüssigkeiten in Proteine. Die Berücksichtigung der dabei auftretenden Effekte ist für eine zuverlässige Herkunftsanalyse tierischer Produkte notwendig.

The standard therapy for patients with haemophilia is prophylactic treatment with replacement factor VIII (FVIII) or factor IX (FIX). Patients who develop inhibitors against FVIII/FIX face an increased risk of bleeding, and the likelihood of early development of progressive arthropathy, alongside higher treatment-related costs. Bypassing agents can be used to prevent and control bleeding, as well as the recently-licensed prophylaxis, emicizumab, but their efficacy is less predictable than that of factor replacement therapy. Antibody eradication, by way of immune tolerance induction (ITI), is still the preferred management strategy for treating patients with inhibitors. This approach is successful in most patients, but some are difficult to tolerize and/or are unresponsive to ITI, and they represent the most complicated patients to treat. However, there are limited clinical data and guidelines available to help guide physicians in formulating the next treatment steps in these patients. This review summarizes currently available treatment options for patients with inhibitors, focussing on ITI regimens and those ITI strategies that may be used in difficult-to-treat patients. Some alternative, non-ITI approaches for inhibitor management are also proposed. This article is protected by copyright. All rights reserved.

Understanding the trends of hydro-climatic variables and hydrological processes is crucial for effective management of the scarce water resources of the Upper Blue Nile River basin. As the result of the combined effect of land use/land cover and climate changes, annual streamflow increased by 16.9% from 1971 to 2010. In the future, Tana sub-basin is more prone to water scarcity because of the large size future planned water resource development. Prior to its implementation, more caution is needed to minimize negative impacts on the environment., Das Verständnis über Trends hydroklimatischer Variablen und hydrologischer Prozesse ist entscheidend für ein effektives Wassermanagement des Einzugsgebiets des Oberen Blauen Nils. Infolge der kombinierten Auswirkungen von Landnutzung/Landbedeckung und Klimawandel stieg der jährliche Abfluss von 1971 bis 2010 um 16,9%. In Zukunft wird das Tana-Einzugsgebiet aufgrund der großen, zukünftig geplanten Bewässerungsprojekte anfälliger für Wasserknappheit. Daher ist vor deren Implementierung große Sorgfalt geboten, um negative Umweltauswirkungen zu minimieren.

Angeeichte Radarniederschlagsdaten (RADOLAN) liefern wichtige Informationen über die hohe zeitliche und räumliche Variabilität erosiver Regen und deren Erosivität, ihrem Potential Bodenerosion zu verursachen. Notwendige Skalierungsfaktoren wurden ermittelt, welche die Unterschätzung der Erosivität durch die räumliche und zeitliche Auflösung und die Messeigenheiten von RADOLAN kompensieren. Es wurde gezeigt, dass die behördlich etablierte ‚Universal Soil Loss Equation‘ mit skalierten RADOLAN-basierten Erosivitäten zuverlässige Erosionsprognosen liefert., Rain-gauge adjusted radar rain data (RADOLAN) deliver important information about the high spatio-temporal variability of erosive rains and erosivity, rains’ potential to erode soil. Scaling factors were determined which compensate for the underestimation of erosivity by spatial and temporal scale and rain measurement peculiarities of RADOLAN. It was proven that the institutionally established Universal Soil Loss Equation combined with scaled RADOLAN-derived erosivities yields reliable soil loss predictions.

PurposeLittle is known about fatherhood in middle adolescence. To better understand their sexual health needs, we describe relationship characteristics, perception of masculinity, and associated sexually transmitted infection (STI) risk behaviors in a community-based sample of urban middle adolescent boys who have fathered a child or been involved with a pregnancy.MethodsWe used venue-based sampling to recruit 339 boys (aged 14-17 years) in neighborhoods with high STI prevalence. We administered a brief survey on sexual relationship and pregnancy history, STI risk, juvenile justice involvement, and masculinity.ResultsFifteen percent had either fathered a child or been involved with a pregnancy. In multivariate analysis, controlling for age and ethnicity, adolescent fathers were more likely to be involved with juvenile justice and engage in STI risk behaviors. These included condom nonuse and partner checking a cell phone. Although of borderline significance, older partners, past STI testing, and drug or alcohol use at last sex improved model fit.ConclusionAdolescent fathers have distinct relational and sexual health needs. Their specific needs should be targeted by prevention programs.

Understanding the trends of hydro-climatic variables and hydrological processes is crucial for effective management of the scarce water resources of the Upper Blue Nile River basin. As the result of the combined effect of land use/land cover and climate changes, annual streamflow increased by 16.9% from 1971 to 2010. In the future, Tana sub-basin is more prone to water scarcity because of the large size future planned water resource development. Prior to its implementation, more caution is needed to minimize negative impacts on the environment., Das Verständnis über Trends hydroklimatischer Variablen und hydrologischer Prozesse ist entscheidend für ein effektives Wassermanagement des Einzugsgebiets des Oberen Blauen Nils. Infolge der kombinierten Auswirkungen von Landnutzung/Landbedeckung und Klimawandel stieg der jährliche Abfluss von 1971 bis 2010 um 16,9%. In Zukunft wird das Tana-Einzugsgebiet aufgrund der großen, zukünftig geplanten Bewässerungsprojekte anfälliger für Wasserknappheit. Daher ist vor deren Implementierung große Sorgfalt geboten, um negative Umweltauswirkungen zu minimieren.

Objectives. The mortality rate of a street-recruited homeless youth cohort in the United States has not yet been reported. We examined the six-year mortality rate for a cohort of street youth recruited from San Francisco street venues in 2004. Methods. Using data collected from a longitudinal, venue-based sample of street youth 15-24 years of age, we calculated age, race, and gender-adjusted mortality rates. Results. Of a sample of 218 participants, 11 died from enrollment in 2004 to December 31, 2010. The majority of deaths were due to suicide and/or substance abuse. The death rate was 9.6 deaths per hundred thousand person-years. The age, race and gender-adjusted standardized mortality ratio was 10.6 (95% CI [5.3-18.9]). Gender specific SMRs were 16.1 (95% CI [3.3-47.1]) for females and 9.4 (95% CI [4.0-18.4]) for males. Conclusions. Street-recruited homeless youth in San Francisco experience a mortality rate in excess of ten times that of the states general youth population. Services and programs, particularly housing, mental health and substance abuse interventions, are urgently needed to prevent premature mortality in this vulnerable population.

Objectives. The mortality rate of a street-recruited homeless youth cohort in the United States has not yet been reported. We examined the six-year mortality rate for a cohort of street youth recruited from San Francisco street venues in 2004. Methods. Using data collected from a longitudinal, venue-based sample of street youth 15-24 years of age, we calculated age, race, and gender-adjusted mortality rates. Results. Of a sample of 218 participants, 11 died from enrollment in 2004 to December 31, 2010. The majority of deaths were due to suicide and/or substance abuse. The death rate was 9.6 deaths per hundred thousand person-years. The age, race and gender-adjusted standardized mortality ratio was 10.6 (95% CI [5.3-18.9]). Gender specific SMRs were 16.1 (95% CI [3.3-47.1]) for females and 9.4 (95% CI [4.0-18.4]) for males. Conclusions. Street-recruited homeless youth in San Francisco experience a mortality rate in excess of ten times that of the state's general youth population. Services and programs, particularly housing, mental health and substance abuse interventions, are urgently needed to prevent premature mortality in this vulnerable population.

The health of adolescents, perhaps more than in any other period of their life, is shaped by the social determinants of health (SDH). The constellation of SDH that disadvantages a specific group's health may also make members of that population unable or unwilling to engage in health research. To build a comprehensive body of knowledge about how SDH operate within a specific social context, researchers must design studies that take into account how various vulnerabilities and oppressions may affect people's experiences of being recruited, interviewed and retained in a study. In 2014, we initiated a prospective cohort study with Latino youth living in the agricultural area of Salinas, California. We began this study with the understanding that it was imperative to develop methodological strategies that actively addressed potential challenges in ways that were culturally responsive, community engaged and inclusive. In this article, we describe our approach to developing best practices in four key areas: 1) building community partnerships and engagement; 2) consideration of staffing and staff support; 3) engaging youth's perspectives; and 4) developing culturally appropriate research protocols. In our sample of 599 participants, nearly all youth identify as Latinx (94 per cent), half (49 per cent) have at least one parent employed as a farmworker, 60 per cent reside in crowded housing conditions, and 42 per cent have mothers who did not complete high school. Given these multiple vulnerabilities, we view a robust number of youth expressing interest in study participation, the willingness of their parents to permit their children to be enrolled, and the achievement of an ambitious sample target as evidence that our efforts to undertake best practices in community-engaged and inclusive research were well received.

ContextThe homeless population is aging. Older homeless adults experience premature development of age-related conditions and an elevated symptom burden. Little is known about symptom experience among older homeless adults.ObjectivesTo characterize the experience, understanding, and management of physical, psychological, social (e.g., loneliness), and existential (e.g., regret, loss of dignity) symptoms among older homeless adults.MethodsWe conducted semistructured interviews from June 2016 to March 2017 with a purposive sample of participants from the Health Outcomes of People Experiencing Homelessness in Older Middle Age cohort, a longitudinal study of homeless adults aged 50 and older. We analyzed data between June 2016 and December 2017 using thematic analysis.ResultsWe found four main themes: 1) nonphysical symptoms are interwoven with, and as distressing as, physical symptoms; 2) individuals attribute symptoms to childhood abuse, manual labor, the conditions of homelessness, and aging; 3) symptoms interfere with daily functioning, causing negative changes in personality, energy, and motivation; and 4) individuals cope with symptoms through religion, social support, and substance use.ConclusionHomelessness causes and exacerbates physical and psychological distress. Interventions should address multiple interconnected dimensions of suffering. Health systems that care for homeless patients should adapt palliative care practices using a stepwise approach. Homeless shelters should adopt policies and modifications that increase privacy and autonomy while promoting community building. Housing interventions should promote community building. All who work with people experiencing homelessness should avoid stigmatizing language and recognize homeless individuals' sources of strength and coping.

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Mild haemophilia is defined by factor levels between 0.05 and 0.40 IU/mL and is characterised by traumatic bleeds. Major issues associated with mild haemophilia are that it may not present for many years after birth, and that awareness, even within families, may be low. Methodological problems exist in diagnosis, such as inconsistencies in results obtained from different assays used to measure factor levels in mild haemophilia. Advances in genetic testing provide insight into diagnosis as well as the likelihood of inhibitor development, which is not uncommon in patients with mild or moderate haemophilia and can increase morbidity. The management of patients with mild haemophilia is a challenge. This review includes suggestions around formulating treatment plans for these patients, encompassing the full spectrum from clinical care of the newly diagnosed neonate to that of the ageing patient with multiple comorbidities. Management strategies consider not only the vast differences in these patients' needs, but also risks of inhibitor development and approaches to optimally engage patients.