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Background. Self-awareness is seldom formally assessed by occupational therapists among individuals with traumatic brain injury (TBI). However, impaired self-awareness is prevalent and has a significant impact on rehabilitation outcomes. There is a need to understand clinician perspectives on self-awareness assessments and promote evidence-based practice in clinical settings. Aims. (1) Explore how an education session impacts knowledge and use of self-awareness assessments in occupational therapists working with people with TBI; (2) Understand the barriers that occupational therapists experience when assessing self-awareness in clinical practice. Materials and Methods. A single-group pre-post session design with an integrated knowledge translation approach was used. Occupational therapists working in neurorehabilitation were recruited from two rehabilitation centres through convenience sampling. Participants completed questionnaires before, after, and three months following an education session about the Self-Awareness of Deficits (SADI) assessment. Results. 14 occupational therapists participated in this study. A statistically significant increase in knowledge and confidence in using the SADI was observed both post-session and at 3-month follow-up. Conclusion. Targeted and ongoing education promotes confidence and knowledge retention among occupational therapists. Further research should explore strategies to promote behaviour change. Significance. The barriers identified in this study can provide insights for knowledge translation across clinical contexts.

Background. Physical activity (PA) is essential for maintaining well-being in adults with disabilities. This population experienced reduced PA during the COVID-19 pandemic; yet, the impact on quality of PA participation remains unclear. Purpose. This secondary analysis explored how pandemic restrictions impacted six experiential dimensions of quality of PA participation among adults with disabilities. Methods. An exploratory sequential mixed-methods design, including semi-structured interviews ( n = 10) and self-reported surveys ( n = 61), was conducted in May-2020 and February-2021. Quality of PA participation was measured using the Measure of Experiential Aspects of Participation (MeEAP). Participants included community-dwelling adults over 19 years of age (mean 59.2 ± 14.0 years) living with stroke, spinal cord injury, or other physical disabilities. Findings. Directed content analysis identified three themes related to adjusting PA participation for restrictions, motivation barriers, and valuing social support. These themes highlighted five factors, such as resilience, as potential quantitative predictors of quality of PA participation. While paired correlations with MeEAP scores were observed, these factors were not statistically predictive in multiple regression analysis (adjusted R2 = −0.14, F(10,50) = 0.92, p = .53). Implications. The interplay between Meaning, Autonomy, Engagement, and Belongingness dimensions of quality of PA participation was complex, with an emphasized role for mental health, in adults with disabilities.

Purpose: Peer-support groups for stroke survivors are often organized and facilitated by health authorities and disability related organizations within rehabilitation programs. However, the benefits of peer-led, peer-support groups have not yet been evaluated. The purpose of this study was to explore participants’ experiences in a community-based, peer-led, peer-support group for stroke survivors. Materials and Methods: Semi-structured interviews were conducted and analyzed following constructivist grounded theory with 11 participants who attended a peer-led, peer-support group for people with stroke. The data were also complemented with one quantitative rating question regarding their experience attending the group. Results: Three themes were identified. Meeting unmet needs after stroke captured how the group was created by stroke survivors to address life in the community post-stroke. Buddies helping buddies highlighted that stroke recovery is a shared process at the group, where members help and encourage each other to contribute what they can. Creating authentic friendships revealed how people experienced social connection and developed relationships in the peer-led, peer-support group. Conclusions: Peer-led, peer-support groups may provide opportunities for stroke survivors to connect with like-minded people in their community to have fun while exploring their abilities.

With increased physical restrictions during the coronavirus disease 2019 (COVID-19) pandemic, many individuals, especially older adults and individuals with disabilities, experienced increased feelings of loneliness. This study aimed to identify factors associated with loneliness among older adults and people with disabilities residing in British Columbia (BC), Canada 10 months following COVID-19 physical restrictions. Participants included a total of 70 adults consisting of older adults (>65 years of age) without any self-reported disabilities and adults (aged 19 or above) with disabilities (e.g., stroke, spinal cord injury, etc.). Participants completed standardized self-report measures of their levels of anxiety, depression, social support, mobility, and loneliness. We used hierarchical linear regression to determine the association of age, sex, disability status, anxiety, depression, social support, and mobility with loneliness. Participants reported general low levels of loneliness, anxiety, and depression and an overall high level of perceived social support. Most participants reported living with others. Our analysis showed a positive association between anxiety and loneliness (β = 0.340, p = 0.011) and a negative association between social support and loneliness (β = −0.315, p = 0.006). There was no association between depression and loneliness (β = 0.210, p = 0.116) as well as between mobility and loneliness (β = −0.005, p = 0.968). These findings suggest that anxiety and social support have been significantly associated with loneliness in older adults and people with disabilities during the COVID-19 pandemic. Increased efforts to reduce anxiety and improve social support in clinical and community settings may be helpful in reducing loneliness in older adults and people with disabilities during the COVID-19 pandemic.

The restrictions in 2019 due to Coronavirus impacted Canadians’ daily living, especially those at higher risk of compromised health conditions. This study aimed to describe the physical, psychological, and social well-being of adults with disabilities, and older adults from May to June 2020. Participants from the group of community-dwelling adults (≥19 years of age), who communicated in English, lived in British Columbia, and had Internet access via a computer, tablet, or smartphone with special focus on populations who had stroke, spinal cord injury and other disabilities were included. For measurement outcomes, an online survey was used to administer standardized measures of level of participation, mobility, anxiety and depression, boredom, resilience, technology readiness, social support, and social networks. Seventy-two participants were recruited, with a mean age (SD) of 61.2 (13.8). This study was comprised of two groups: the adult group consisted of individuals with disabilities under the age of 65 (48.6%) and the older adult group consisted of individuals over the age of 65 with and without self-identified disability (51.4%). There was no significant difference in the proportion of participation restriction between adult (83%) and older adult’ (81%) groups (p = 0.69). In the study population, 27.8% and 16.7% of participants exceeded the anxiety and depression cut-off scores, respectively. Boredom was experienced by 76.4% of participants. Participants’ mean (SD) resilience and life space scores were 72.4 (14.0) and 51.9 (24.0), respectively. The older adults (≥65 years) showed significantly lower depression (p = 0.012) and better resilience (p = 0.038), social support (p = 0.043), and social network (p = 0.021) than the younger adults. Issues with anxiety, boredom, participation, and life space activity were identified in both study groups. This information may provide supporting evidence when creating policies to mitigate existent health and social inequities.

This study investigated the experiences of people with disabilities during the first year of the COVID-19 pandemic. Four semi-structured qualitative interviews were conducted individually with 13 participants between May 2020 and February 2021. The data were thematically analyzed. Three themes were identified: (1) “Being an active agent in changing how things are done in the face of COVID restrictions”, revealed changes that participants made to their daily routines resulting from government-imposed and self-imposed restrictions; (2) “Pandemic restrictions wreak havoc”, explained participants challenges with adapting to the restrictions; and (3) “Trying to be resilient in the face of pandemic changes” described participants’ efforts to cope with life during the pandemic. The findings illustrate how life changed for people with disabilities during the pandemic. Participants reported specific types of challenges at each time point. As the vaccine rollout became more imminent, participants expressed more hope for the future and getting back to normal.

Long-term sequelae in hospitalized Coronavirus Disease 2019 (COVID-19) patients may result in limited quality of life. The current study aimed to determine health-related quality of life (HRQoL) after COVID-19 hospitalization in non-intensive care unit (ICU) and ICU patients. This is a single-center study at the University Hospital of Wuerzburg, Germany. Patients eligible were hospitalized with COVID-19 between March 2020 and December 2020. Patients were interviewed 3 and 12 months after hospital discharge. Questionnaires included the European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L), patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder 7 scale (GAD-7), FACIT fatigue scale, perceived stress scale (PSS-10) and posttraumatic symptom scale 10 (PTSS-10). 85 patients were included in the study. The EQ5D-5L-Index significantly differed between non-ICU (0.78 ± 0.33 and 0.84 ± 0.23) and ICU (0.71 ± 0.27; 0.74 ± 0.2) patients after 3- and 12-months. Of non-ICU 87% and 80% of ICU survivors lived at home without support after 12 months. One-third of ICU and half of the non-ICU patients returned to work. A higher percentage of ICU patients was limited in their activities of daily living compared to non-ICU patients. Depression and fatigue were present in one fifth of the ICU patients. Stress levels remained high with only 24% of non-ICU and 3% of ICU patients (p = 0.0186) having low perceived stress. Posttraumatic symptoms were present in 5% of non-ICU and 10% of ICU patients. HRQoL is limited in COVID-19 ICU patients 3- and 12-months post COVID-19 hospitalization, with significantly less improvement at 12-months compared to non-ICU patients. Mental disorders were common highlighting the complexity of post-COVID-19 symptoms as well as the necessity to educate patients and primary care providers about monitoring mental well-being post COVID-19.

CONTEXT Concussions in youth are highly prevalent. Previously, rest was prescribed to prevent adverse outcomes; however, early return to activity is emerging to improve the recovery trajectory. OBJECTIVES To evaluate the effectiveness of early return to physical and social activity interventions on recovery outcomes in youth with concussion. DATA SOURCES A systematic review was conducted up to October 2022. STUDY SELECTION We included randomized controlled trials (RCTs) and non-RCTs that reported effects of activity-based interventions on symptoms, quality-of-life (QoL), and return to preinjury activity levels in children and youth after a concussion. DATA EXTRACTION Three authors independently extracted data on publication year and country, study setting and design, sample size, participant demographics, intervention, outcome(s), and author conclusion. Meta-analysis was conducted on appropriate RCTs. RESULTS Twenty-four studies were included in the final review, of which 10 were RCTs. There was a significant effect of activity interventions on symptom reporting (standardized mean difference, 0.39 [95% confidence interval, 0.15 to 0.63]; I2, 0%; P = .002). There was not a significant effect of activity-based interventions on QoL (mean difference, −0.91 [95% confidence interval, −7.76 to 5.94]; I2, 0%; P = .79). No meta-analysis was performed on return to preinjury activity levels because of insufficient number of RCTs conducted. LIMITATIONS One outcome was excluded from the meta-analysis. Interventions emphasizing social activity were lacking. CONCLUSIONS Findings indicate that activity-based interventions may significantly improve concussion symptoms. There is insufficient data to understand the effect of activity-based intervention on QoL and return to preinjury activity levels.

Following its withdrawal from the Joint Comprehensive Plan of Action, the USA re-imposed economic and financial sanctions against Iran. Its current unilateral sanctions regime against the country contains extra-territorial sanctions which prohibit non-US nationals and non-US companies from trading with and investing in Iran. Foreign legal and natural persons who do not comply with the US extra-territorial legislation are faced with a variety of limitations, including access restrictions, fines and penalties. Thereby they not only put pressure on operators worldwide but also interfere with the sovereign foreign policy choices of states and international organisations such as the European Union (EU) who support legitimate trade with Iran. Equally problematic are the extra-territorial sanctions contained in the US sanctions regime against Cuba. The article examines the lawfulness of unilateral extra-territorial sanctions as a form of targeted sanction under international law in the relationship between the sanctioning state and other sovereign international actors affected by the extra-territorial legislation in light of the customary law on jurisdiction, the law on sanctions as well as the principle of non-intervention. The relationship between the US and the EU and its Member States will be taken as an example. It will be shown that unilateral extra-territorial sanctions may amount to an abuse of rights in case they are functionally connected to primary sanctions that violate jus cogens norms or that undermine the UN Charter system, irrespective of the strength of the exercised economic pressure.

Psychotherapeutic treatment of adolescents requires age-specific approaches and thus plausibly also involves different change mechanisms than adult psychotherapy. To guide further research and improve therapeutic outcomes for adolescents, we reviewed all RCTs investigating mechanisms of change in the psychological treatment of adolescents to identify the most promising age-, disorder- or treatment-specific mediators. Following the preferred reporting items for systematic reviews (PRISMA), 106 studies were included that reported 252 statistical mediation tests assessed with 181 different measures. Most often studied and significant mediators were cognitive, followed by family-related, and behavioral variables. Several mediators were identified to be promising for future investigations: changes in negative thoughts, dysfunctional beliefs and metacognitive skills; family functioning and parenting skills; as well as successful engagement in therapy activities and increased impulse control. Symptom change during therapy was least often a mediator for other therapeutic changes. Relational and emotional mediators were largely understudied, whereas peer-influence appeared a promising mediator for intervention outcomes. Adolescence-specific mediators were most commonly investigated. Majority of studied mediators were not disorder-specific. There was a tendency to mainly test change mechanisms of specific theoretical models without considering other possible change theories. Further, virtually no studies fulfilled all criteria for rigorously investigating mediation and only nine were classified with an overall good study quality. While bearing in mind the current limitations in study designs, methodological rigor and reporting, there appears to be substantial evidence for transdiagnostic age-specific change models in the psychological treatment of adolescents. For future research, need for consensus on a core set of transdiagnostic and transtheoretical mediators and measures is highlighted. These should address likely core mechanisms of change, as well as take into account age-relevant developmental challenges and biological markers.

The testis produces gametes through spermatogenesis and evolves rapidly at both the morphological and molecular level in mammals1-6, probably owing to the evolutionary pressure on males to be reproductively successful7. However, the molecular evolution of individual spermatogenic cell types across mammals remains largely uncharacterized. Here we report evolutionary analyses of single-nucleus transcriptome data for testes from 11 species that cover the three main mammalian lineages (eutherians, marsupials and monotremes) and birds (the evolutionary outgroup), and include seven primates. We find that the rapid evolution of the testis was driven by accelerated fixation rates of gene expression changes, amino acid substitutions and new genes in late spermatogenic stages, probably facilitated by reduced pleiotropic constraints, haploid selection and transcriptionally permissive chromatin. We identify temporal expression changes of individual genes across species and conserved expression programs controlling ancestral spermatogenic processes. Genes predominantly expressed in spermatogonia (germ cells fuelling spermatogenesis) and Sertoli (somatic support) cells accumulated on X chromosomes during evolution, presumably owing to male-beneficial selective forces. Further work identified transcriptomal differences between X- and Y-bearing spermatids and uncovered that meiotic sex-chromosome inactivation (MSCI) also occurs in monotremes and hence is common to mammalian sex-chromosome systems. Thus, the mechanism of meiotic silencing of unsynapsed chromatin, which underlies MSCI, is an ancestral mammalian feature. Our study illuminates the molecular evolution of spermatogenesis and associated selective forces, and provides a resource for investigating the biology of the testis across mammals. We thank all members of the Kaessmann group, S. Tirier for discussions and N. Trost for the administration of the Kaessmann laboratory server. Computations were performed on the Kaessmann laboratory server and the bwForCluster from the Heidelberg University Computational Center (supported by the state of Baden-Württemberg through bwHPC and the German Research Foundation grant no. INST 35/1134-1 FUGG). This research was supported by grants from the ERC (grant no. 615253, OntoTransEvol) and German Research Council (DFG, grant nos. SFB 873 and KA 1710/4-1) to H.K., by the CellNetworks Postdoc Fellowship and EMBO Long-Term Fellowship to F.M. (grant no. ALTF 591-2017), and by the Australian Research Council (grant no. FT160100267) to F.G. and by the Novo Nordisk Foundation (grant no. NNF21OC0069913) to K.A. and (grant no. NNF18OC0031004) to M.H.S. The use of all other mammalian samples for the type of work described in this study was approved by ERC ethics screening panels (ERC starting grant no. 242597, SexGenTransEvolution and ERC consolidator grant no. 615253, OntoTransEvol).

Oxidative stress is a cause for numerous diseases and aging processes. Thus, one is keen to tune the level of intracellular stress and to learn from that. An unusual approach is presented here. The methodology involves multifunctional surfactants. Although their molecular design is non-biological, a fullerenol head group attached covalently to pi-conjugated dyes, the surfactants possess superior biocompatibility. Using an intrinsic fluorescence signal as a probe we show that the amphiphiles becomes incorporated into the Caco-2 cells. There, they are able to exhibit additional functions. The compound reduces cellular stress in dark reaction pathways. The antagonistic property is activated under irradiation, the photocatalytic production of ROS, resulting in cell damage. The feature is activated even by NIR-light via a two-photon process. The properties as molecular semiconductors leads to a trojan horse situation and allows programming the spatial distribution of cytotoxicity. This article is protected by copyright. All rights reserved.

BACKGROUND Seventy-five percent of people with mental health disorders have an onset of illness between ages 12-24 years. Many in this age group report substantial obstacles to receiving quality youth-centered mental health care services. With the rapid development of technology, and the recent COVID-19 pandemic, mobile health (mHealth) has presented new opportunities for youth mental health research, practice, and policy. OBJECTIVE The research objectives were to: 1) synthesize the current evidence supporting mHealth interventions for youth who experience mental health challenges; and 2) identify current gaps in the mHealth field related to youth mental health service access and health outcomes. METHODS Guided by the methods of Arksey and O’Malley, we conducted a scoping review of peer-reviewed studies that used mHealth tools to improve youth mental health (Jan 2016-Feb 2022). Using MEDLINE, PubMed, PsycINFO, and Embase databases, we searched using the following key terms: 1) mHealth; 2) youth and young adults; 3) mental health. The current gaps were analyzed using content analysis. RESULTS The search produced 4270 records, of which 151 met inclusion criteria. Included articles highlight the comprehensive aspects of youth mHealth intervention resource allocation for targeted conditions, mHealth delivery methods, measurement tools, evaluation of mHealth intervention, and youth engagement. The median age for participants in all studies is 17 years old (Q1:14; Q3:21). Only three studies (2%) involved participants who reported their sex or gender outside of the binary option. Many studies (n = 68, 45%) were published after the COVID-19 outbreak. Study types and designs varied, with 60 (40%) identified as randomized controlled trials (RCTs). Notably, 143 out of 151 studies (95%) came from developed countries, suggesting an evidence shortfall on the feasibility of implementing mHealth services in lower-resourced settings. Additionally, the results highlighted concerns related to weak study design, expert engagement and the types of outcome measures selected to capture impact or changes over time. There is also a lack of standardized regulations and guidelines for researching mHealth technologies for youth and the use of non-youth-centered approaches to implementing results. CONCLUSIONS This study may be used to inform future work, as well as the development of youth-centered mHealth tools that can be implemented and sustained over time for diverse types of youth. Implementation science research that prioritizes youth engagement is needed to advance current understanding of mHealth implementation. As well, core outcome sets may support a youth-centered measurement strategy to capture outcomes in a systematic way that prioritizes equity, diversity, inclusion, and robust measurement science. Finally, this study suggests that future practice and policy research is needed to ensure the risk of mHealth is minimized and this innovative healthcare service is meeting the emerging needs of youth over time. CLINICALTRIAL

Individuals with disabilities underwent substantial changes in life due to the COVID-19 pandemic. However, little is known about the experiences of this population during the first year of the pandemic. Hence, drawing on data from a longitudinal mixed-methods study, this study aimed to identify different COVID-19 life profiles among people with disabilities. Sixty-one participants were interviewed at four timepoints, which paralleled restriction changes in British Columbia, Canada. These data were analyzed to identify different life profiles over the course of the first year of the pandemic. The analysis identified three interlinked profiles: (1) ‘being in a straitjacket’ examines the increasing restriction-related frustrations experienced by participants; (2) ‘seizing the reins’ explores the positive routines that participants established by filling the gaps with meaningful activities; and (3) ‘staying content during COVID’ describes a ‘keep calm, carry on’ attitude, where minimal impact of the pandemic was observed by participants. The three COVID-19 life profiles provide insight to the challenges encountered, resources used, and the varying experiences of individuals with disabilities as they adjusted to a different way of living. These findings can facilitate future research that could develop interventions and services for individuals with disabilities in subsequent pandemics or disasters.

Background Numerous predictive clinical scores with varying discriminatory performance have been developed in the context of the current coronavirus disease 2019 (COVID-19) pandemic. To support clinical application, we test the transferability of the frequently applied 4C mortality score (4C score) to the German prospective Cross-Sectoral Platform (SUEP) of the National Pandemic Cohort Network (NAPKON) compared to the non COVID-19 specific quick sequential organ failure assessment score (qSOFA). Our project aims to externally validate these two scores, stratified for the most prevalent variants of concerns (VOCs) of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in Germany. Methods A total of 685 adults with polymerase chain reaction (PCR)-detected SARS-CoV-2 infection were included from NAPKON-SUEP. Patients were recruited from 11/2020 to 03/2022 at 34 university and non-university hospitals across Germany. Missing values were complemented using multiple imputation. Predictive performance for in-hospital mortality at day of baseline visit was determined by area under the curve (AUC) with 95%-confidence interval (CI) stratified by VOCs of SARS-CoV-2 (alpha, delta, omicron) (Figure 1). Figure 1:Study flow chart with inclusion criteria and methodological workflow. Results Preliminary results suggest a high predictive performance of the 4C score for in-hospital mortality (Table 1). This applies for the overall cohort (AUC 0.813 (95%CI 0.738-0.888)) as well as the VOC-strata (alpha: AUC 0.859 (95%CI 0.748-0.970); delta: AUC 0.769 (95%CI 0.657-0.882); omicron: AUC 0.866 (95%CI 0.724-1.000)). The overall mortality rates across the defined 4C score risk groups are 0.3% (low), 3.2% (intermediate), 11.6% (high), and 49.5% (very high). The 4C score performs significantly better than the qSOFA (Chi2-test: p=0.001) and the qSOFA does not seem to be a suitable tool in this context. Table 1:Discriminatory performance of the 4C Mortality Score and the qSOFA score within the validation cohort NAPKON-SUEP stratified by the Variant of Concerns of SARS-CoV-2. Conclusion Despite its development in the early phase of the pandemic and improved treatment, external validation of the 4C score in NAPKON-SUEP indicates a high predictive performance for in-hospital mortality across all VOCs. However, since the qSOFA was not specifically designed for this predictive issue, it shows low discriminatory performance, as in other validation studies. Any interpretations regarding the omicron stratum are limited due to the sample size. Disclosures Daniel Pape, Dr., Advanz Pharma Germany: Support for attending meetings and/or travel for ECCMID 2021 Martin Hower, n/a, MSD: Advisor/Consultant|Trogarzo: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant Björn-Erik O. Jensen, Dr. med., GILEAD: Advisor/Consultant|GILEAD: Lectures, Travel|GSK: Lectures, Travel Jörg J. Vehreschild, Univ.-Prof. Dr. med., Ärztekammer Nordrhein: Honoraria|Academy for Infectious Medicine, University Manchester: Honoraria|Astellas Pharma: Grant/Research Support|Astellas Pharma: Honoraria|Back Bay Strategies: Honoraria|Basilea: Grant/Research Support|Basilea: Honoraria|Deutsches Zetrum für Luft- und Raumfahrt (DLR): Grant/Research Support|German Centre for Infection Research (DZIF): Grant/Research Support|German Centre for Infection Research (DZIF): Honoraria|German Federal Ministry of Education and Research (BMBF): Grant/Research Support|German Society for Infectious Diseases (DGI): Honoraria|German Society for Internal Medicine (DGIM): Honoraria|GILEAD: Advisor/Consultant|GILEAD: Grant/Research Support|GILEAD: Honoraria|Janssen: Honoraria|Merck / MSD: Grant/Research Support|Merck / MSD: Honoraria|Molecular Health: Honoraria|Netzwerk Universitätsmedizin: Honoraria|NordForsk: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Rigshospitalet Copenhagen: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria|University Hospital Aachen: Honoraria|University Hospital Freiburg/ Congress and Communication: Honoraria|University of Bristol: Grant/Research Support.

Zusammenfassung Ziel der Studie In der vorliegenden Studie werden Knappheitsentscheidungen von medizinischen Laien bei der Behandlung von COVID-19(„Coronavirus Disease 2019“)-Patienten untersucht. Methodik In den multivariaten clusterkorrigierten Regressionen werden die Antworten auf 1802 Fallsituationen einer Vignettenstudie ausgewertet, die von 181 medizinischen Laien eingeschätzt wurden. Ergebnisse Jüngere Patienten, Männer, Erkrankte mit hohen Genesungschancen, eigenen Kindern und einem Beruf in einem Krankenhaus werden von den medizinischen Laien bevorzugt eingestuft. Schlussfolgerung Medizinische Laien wenden bewusst oder unbewusst soziale Kriterien der Entscheidungsfindung bei Knappheit der medizinischen Ressourcen an, die aus professioneller medizinischer und ethischer Sicht unzulässig sind. Zur Einschätzung der Akzeptanz in der allgemeinen Bevölkerung sollte dieser Umstand berücksichtigt werden.

Individuals with a moderate to severe traumatic brain injury (TBI) experience substantial changes in their life. This constructivist grounded theory study aimed to develop an explanatory model that explores the impact of changes in social participation and self-identity after sustaining a TBI. Sixteen participants with moderate to severe TBI (mean age = 49.8, 69% male) were recruited, and were on average 16.4 years post-injury (SD = 10.4). Data from semi-structured interviews were analysed thematically. An overarching theme of "living in a reshaped reality" was identified, which depicted how changes in social participation and self-identity influenced ongoing experiences with TBI. Three main themes were generated: (1) "there's nothing that's the same" highlighted the daily challenges individuals faced post-injury, (2) "rebuilding and restarting" described how individuals with TBI navigated through their unfamiliar reality, and (3) "embrace it and run with it" explored participants' reactions towards life with a TBI. An explanatory model was developed, consisting of the overarching theme ("living in a reshaped reality") with the three integrated themes. Future research and clinical practices can build on this understanding to develop programmes to help individuals address their needs in post-injury life.

STAG2 is a component of the large, evolutionarily highly conserved cohesin complex, which has been linked to various cellular processes like genome organization, DNA replication, gene expression, heterochromatin formation, sister chromatid cohesion, and DNA repair. A wide spectrum of germline variants in genes encoding subunits or regulators of the cohesin complex have previously been identified to cause distinct but phenotypically overlapping multisystem developmental disorders belonging to the group of cohesinopathies. Pathogenic variants in

Oxidative stress is a cause for numerous diseases and aging processes. Thus, one is keen to tune the level of intracellular stress and to learn from that, and an unusual approach is presented here. The methodology involves multifunctional surfactants. Although their molecular design is non-biological, a fullerenol head group attached covalently to -conjugated dyes, the surfactants possess superior biocompatibility. Using the intrinsic fluorescence signal as a probe it is proven, the amphiphiles become incorporated into the membranes of Caco-2 cells. There, they are able to exhibit additional functions. The compound reduces cellular stress in dark reaction pathways. The antagonistic property is activated under irradiation, the photocatalytic production of ROS, resulting in cell damage and finally to apoptosis. The feature is activated even by NIR-light via a two-photon process. The properties as molecular semiconductors leads to a trojan horse situation and allows programming the spatial distribution of cytotoxicity.

Die Pferdegestutzte Biografiearbeit ist ein praventives Konzept, welches sich aus Elementen der Pferdegestutzten Interventionen und der Biografiearbeit zusammensetzt. Durch den strukturierten Ruckblick auf die eigene Lebensgeschichte konnen individuelle Ressourcen wahrgenommen und fur die weitere Zukunftsgestaltung genutzt werden. Die Entwicklungsphasen der einzelnen Lebensabschnitte werden dabei mit spezifischen Aufgaben unter Einbezug des Pferdes herausgearbeitet. Zur Belegung der Wirksamkeit wurden wissenschaftlich fundierte Studien initiiert. Durch den Nachweis des positiven Nutzens der Pferdegestutzten Biografiearbeit kann perspektivisch das Angebotsspektrum fur die reittherapeutische Praxis erweitert werden.

Background COVID-19 public health restrictions (i.e. physical distancing) compromise individuals’ ability to self-manage their health behaviours and may increase the risks of adverse health events. Objectives To evaluate the student-delivered Community Outreach teleheAlth program for Covid education and Health promotion (COACH) on health-directed behaviour (self-management) among older adults (≥65 years of age, n = 75). Secondary objectives estimated the influence of COACH on perceived depression, anxiety, and stress; social support; health-related quality of life; health promotion self-efficacy; and other self-management domains. Methods COACH was developed to provide chronic disease management and prevention support among older adults via telephone or videoconferencing platforms (i.e. Zoom). In this single-group, pre-post study, our primary outcome was measured using the health-directed behaviour subscale of the Health Education Impact Questionnaire. Secondary measures included the Depression, Anxiety and Stress Scale, Medical Outcomes Study: Social Support Survey, MOS Short Form-36, and Self-Rated Abilities for Health Practices Scale. Paired sample t-tests were used to analyse outcome changes. Results Mean age of participants was 72.4 years (58.7% female; 80% ≥2 chronic conditions). Health-directed behaviour significantly improved after COACH (P < 0.001, d = 0.45). Improved health promotion self-efficacy (P < 0.001, d = 0.44) and decreased mental health were also observed (P < 0.001, d = −1.69). Discussion COACH likely contributed to improved health-directed behaviour and health promotion self-efficacy despite the diminished mental health-related quality of life during COVID-19. Our findings also highlight the benefits of using health professional students for the delivery of virtual health promotion programs. Clinical Trial Information ClinicalTrials.gov ID: NCT04492527

Importance: Concussions are common among children and youth. To date, the pediatric concussion literature has focused on quantitative reports of the effects of concussion and return-to-activity guidelines. However, the subjective experiences of children and youth returning to occupations postconcussion have largely been ignored. An understanding of these experiences is critical to inform effective concussion management. Objective: To investigate the experiences of children and youth returning to occupations after sustaining a concussion and the impacts on their future engagement in occupation. Design: Qualitative interpretive description was used for data analysis and interpretation. Setting: Community. Participants: Children and youth ages 11 to 18 yr from a cohort study were recruited to be interviewed about their experiences of engaging in occupations postconcussion. Outcomes and Measures: Interviews were conducted 3 to 24 mo postconcussion, transcribed verbatim, and analyzed using interpretive description to identify themes. Results: Eight children and youth (5 male, 3 female) were included. Analyses revealed three themes of the experiences of children and youth returning to occupations after concussion: diverse experiences of concussion, knowledge is key to concussion management, and concussions affect occupational engagement. Conclusions and Relevance: This study highlights the importance of considering a person’s needs to enable effective concussion treatment plans. The results suggest the need for an occupation-based framework to guide interventions in pediatric concussion management. What This Article Adds: Our findings indicate that children and youth report variable recovery patterns, a lack of knowledge about concussion recovery, and a negative effect of concussion on occupational engagement.

Proteus syndrome is a very rare disorder with progressive, asymmetrical, and disproportionate overgrowth of body parts with a highly variable phenotype. It is associated with mosaicism for the recurrent heterozygous somatic gain-of-function variant c.49GA (p.Glu17Lys) in the protein kinase AKT1. We report on a girl with a progressive intraosseous lipoma of the frontal bone and additional, nonspecific features including mild developmental delay, strabism, and a limbal dermoid of the left eye. She did not fulfill the criteria for a clinical diagnosis of Proteus syndrome. However, mutation analysis of AKT1 in a lipoma biopsy revealed this specific activating variant. Several cases of progressive intraosseous lipoma of the frontal bone have been reported in the literature. Only in two of these observations, a tentative diagnosis of Proteus syndrome was made, based on additional clinical features, although without molecular-genetic verification. We conclude that oligosymptomatic Proteus syndrome should be considered in progressive intraosseous lipoma, as recognition of this diagnosis has relevant implications for genetic counseling and opens novel treatment options with AKT1 inhibitors rather than surgical procedures.

Stroke survivors report limited social participation, despite it being an important rehabilitation outcome. Interdisciplinary interventions for increasing social participation amongst stroke survivors lack theoretical guidance and evidence-based approaches. The Behavior Change Wheel (BCW) theorizes that capability, opportunity, and motivation contribute to behavior change.This study applied the BCW to understand the relationship between social participation and stroke survivors' capability, opportunity, and motivation.In this cross-sectional study, we recruited 30 community-dwelling adult stroke survivors. Assessments explored the frequency and satisfaction of social participation; physical and psychological capability; environmental accessibility and social opportunity; and motivation. A linear regression analysis was done.Motivation (RMotivation and environmental accessibility are statistically significant independent predictors of frequency of social participation after stroke. Motivation is the strongest predictor of satisfaction with social participation. Clinicians may support stroke survivors to promote social participation using approaches that increase motivation and environmental accessibility. Development of such theoretically sound interventions may be guided by the BCW.

Coronavirus disease 2019 restrictions impacted Canadians' daily living, especially those at higher risk of compromised health conditions. This study aimed to describe the physical, psychological, and social well-being of adults with disabilities, and older adults from May to June 2020. An online survey was used to administer standardized measures of mobility, anxiety and depression, boredom, resilience, technology readiness, social support, social networks, and participation. Seventy-two participants were recruited, with a mean age (SD) of 61.2 (13.8). 69.4% of participants had a disability, and 51.4% were older adults. 27.8% and 16.7% of participants exceeded the anxiety and depression cut-off scores, respectively. Boredom and restriction in participation were experienced by 76.4% and 80.1% of participants, respectively. Participants' mean (SD) resilience and life space scores were 72.4 (14.0) and 51.9 (24.0), respectively. Individuals with disabilities have comparatively higher mean anxiety (5.5 to 3.3), depression (4.8 to 2.9), and boredom (92.2 to 72.3) scores than those without. Individuals with a disability had lower resilience (69.9 to 78.0) and felt more life space restrictions (45.4 to 67.6). Our findings revealed issues with anxiety, boredom, participation, and life space activity. This information may provide supporting evidence when creating policies to mitigate existent health and social inequities.

We examine the role of preshearing on the flow properties of polymer solutions containing essentially an acrylamide-based copolymer obtained from an emulsified polymer emulsion inverted by a surfactant. The polymer solutions were presheared using three methods: (1) a Buddeberg disperser, (2) an Ultra-Turrax disperser, and (3) pressure-driven flow through a capillary. Shearing the polymer solution was done under fast flow to induce high stretching of the polymer chains and thus promote the break-up of the longest ones (i.e., decrease in relaxation time and shear-thinning level). The unsheared and presheared polymer solutions were forced through sand packs to compare their corresponding flow resistances. We observed that the reduction in the viscosity and screen factor of the presheared polymer solutions is path independent regardless of the shearing device. We found a critical Weissenberg number (Wic ∼ 13) above which the viscosity of the polymer solutions started to decrease. The resistance factor for the polymer solutions presheared with the Ultra-Turrax disperser at an energy input of 31.3 and 290.7 MJ/m3 was nearly 3 and 7 times, respectively, lower than for the unsheared polymer solution, while the viscosity decreased only by 27 and 48%, respectively. The sand-pack experiments were successfully interpreted using a numerical model taking into account time-dependent retention. The model showed that the flow of the presheared polymer solutions through the sand packs was enhanced mainly due to the breaking of the longest polymer chains, which results in smaller mechanical entrapment. This preshearing of the water-soluble polymers can be used in multiple industrial applications, including chemical enhanced oil recovery and optimization of polymer processing.

Purpose: We aimed to identify the underlying genetic cause for a novel form of distal arthrogryposis. Methods: Rare variant family-based genomics, exome sequencing, and disease-specific panel sequencing were used to detect ADAMTS15 variants in affected individuals. Adamts15 expression was analyzed at the single-cell level during murine embryogenesis. Expression patterns were characterized using in situ hybridization and RNAscope. Results: We identified homozygous rare variant alleles of ADAMTS15 in 5 affected individuals from 4 unrelated consanguineous families presenting with congenital flexion contractures of the interphalangeal joints and hypoplastic or absent palmar creases. Radiographic investigations showed physiological interphalangeal joint morphology. Additional features included knee, Achilles tendon, and toe contractures, spinal stiffness, scoliosis, and orthodontic abnormalities. Analysis of mouse whole-embryo single-cell sequencing data revealed a tightly regulated Adamts15 expression in the limb mesenchyme between embryonic stages E11.5 and E15.0. A perimuscular and peritendinous expression was evident in in situ hybridization in the developing mouse limb. In accordance, RNAscope analysis detected a significant coexpression with Osr1, but not with markers for skeletal muscle or joint formation. Conclusion: In aggregate, our findings provide evidence that rare biallelic recessive trait variants in ADAMTS15 cause a novel autosomal recessive connective tissue disorder, resulting in a distal arthrogryposis syndrome. (C) 2022 The Authors. Published by Elsevier Inc. on behalf of American College of Medical Genetics and Genomics., US National Institute of Neurological Disorders and Stroke [R35 NS 105078]; US National Human Genome Research Institute (NHGRI); National Heart, Lung, and Blood Institute [UM1 HG006542, R01 GM106373, U01 HG011758, 512848]; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health [P50HD103555]; International Rett Syndrome Foundation (IRSF) [3701-1]; NHGRI [K08 HG008986]; German Research Council (DFG) [KO 2891/9-1]; BIH Center for Regenerative Therapies (BCRT), We are grateful to the families for their participation in this study. We thank Aris. N. Economides and Manuel Holtgrewe for their valuable suggestions and support. J.R.L. laboratory is supported by the US National Institute of Neurological Disorders and Stroke (R35 NS 105078) and in part by the US National Human Genome Research Institute (NHGRI) and National Heart, Lung, and Blood Institute to the Baylor-Hopkins Center for Mendelian Genomics (BHCMG; UM1 HG006542), the National Institute of General Medical Sciences (NIGMS; R01 GM106373), the NHGRI Baylor College of Medicine Genomics Research Elucidates Genetics of Rare Diseases (BCM-GREGoR; U01 HG011758), the Muscular Dystrophy Association (512848), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health under award number P50HD103555 for use of the Clinical Translation Core facilities. D.P. is supported by International Rett Syndrome Foundation (IRSF; grant #3701-1). J.E.P. was supported by NHGRI K08 HG008986. U.K. obtained funding from the German Research Council (DFG)(KO 2891/9-1) and the BIH Center for Regenerative Therapies (BCRT)(cross-field project GenoPro).

Single cell multi-omics analysis has the potential to yield a comprehensive understanding of the cellular events that underlie the basis of human diseases. The cardinal feature to access this information is the technology used for single-cell isolation, barcoding, and sequencing. Most currently used single-cell RNA-sequencing platforms have limitations in several areas including cell selection, documentation and library chemistry. In this study, we describe a novel high-throughput, full-length, single-cell RNA-sequencing approach that combines the CellenONE isolation and sorting system with the ICELL8 processing instrument. This method offers substantial improvements in single cell selection, documentation and capturing rate. Moreover, it allows the use of flexible chemistry for library preparations and the analysis of living or fixed cells, whole cells independent of sizing and morphology, as well as of nuclei. We applied this method to dermal fibroblasts derived from six patients with different segmental progeria syndromes and defined phenotype associated pathway signatures with variant associated expression modifiers. These results validate the applicability of our method to highlight genotype-expression relationships for molecular phenotyping of individual cells derived from human patients.

The vertebrate brain emerged more than ∼500 million years ago in common evolutionary ancestors. To systematically trace its cellular and molecular origins, we established a spatially resolved cell type atlas of the entire brain of the sea lamprey – a jawless species whose phylogenetic position affords the reconstruction of ancestral vertebrate traits – based on extensive single-cell RNA-seq and in situ sequencing data. Comparisons of this atlas to neural data from the mouse and other jawed vertebrates unveiled various shared features that enabled the reconstruction of the core cell type composition, tissue structures, and gene expression programs of the ancestral brain. However, our analyses also revealed key tissues and cell types that arose later in evolution. For example, the ancestral vertebrate brain was likely devoid of cerebellar cell types and oligodendrocytes (myelinating cells); our data suggest that the latter emerged from astrocyte-like evolutionary precursors on the jawed vertebrate lineage. Our work illuminates the cellular and molecular architecture of the ancestral vertebrate brain and provides a foundation for exploring its diversification during evolution.

Background: Chronic diseases are prevalent in Canada’s aging population (≥65 years). Positive health behaviours (e.g., physical activity, healthy diet) are critical for the management of chronic diseases (e.g., stroke, heart disease). However, novel coronavirus (COVID-19) prevention strategies of quarantining, social isolation, and physical distancing may compromise one's ability to manage health and engage in daily activities, possibly increasing risk of adverse health events. The Community Outreach teleheAlth program for Covid education and Health promotion (COACH) program has demonstrated an increase in health promoting behaviours, but little is known about participants’ experiences in participating in the program. The program entailed six telehealth sessions over two months that focused on health coaching, behaviour change, and COVID education. The objectives of this study were to describe: (1) chronic disease prevention and management strategies of older adults (≥65 years of age) during COVID-19; and (2) participants’ experience in COACH sessions delivered by medical students at the University of British Columbia. Methods: Twenty-four COACH participants participated in semi-structured interviews that were conducted through Zoom videoconferencing. Interview questions focused on how participants managed their own health before and during COVID-19. Qualitative description was the guiding methodological framework. Interviews were transcribed verbatim and analyzed thematically. Findings: Participants’ mean age was 73.4 years (58% female) with 75% reporting two or more chronic conditions (e.g., stroke, heart disease, coronary artery disease, diabetes, heart attack). Three themes described participants’ prevention and management strategies, including: i) having a purpose for optimizing health; ii) using internal self-control strategies; and iii) leveraging external support strategies. COACH further supported participants during COVID-19, as represented through coach interactions as well as knowledge and skill development. Conclusion: Findings suggest that older adults engage in internal self-control strategies and external support means to manage current chronic conditions and promote health and well-being. Health professional program students have a potential role in health promotion and in assuming the role of coach in telehealth promotion programs for older adults.

Background: Cardiac surgery often represents the only treatment option in patients with infective endocarditis (IE). However, IE surgery may lead to a sudden release of inflammatory mediators, which is associated with postoperative organ dysfunction. We investigated the effect of hemoadsorption during IE surgery on postoperative organ dysfunction. Methods: This multicenter, randomized, nonblinded, controlled trial assigned patients undergoing cardiac surgery for IE to hemoadsorption (integration of CytoSorb to cardiopulmonary bypass) or control. The primary outcome (change in sequential organ failure assessment score [ΔSOFA]) was defined as the difference between the mean total postoperative SOFA score, calculated maximally to the 9th postoperative day, and the basal SOFA score. The analysis was by modified intention to treat. A predefined intergroup comparison was performed using a linear mixed model for ΔSOFA including surgeon and baseline SOFA score as fixed effect covariates and with the surgical center as random effect. The SOFA score assesses dysfunction in 6 organ systems, each scored from 0 to 4. Higher scores indicate worsening dysfunction. Secondary outcomes were 30-day mortality, duration of mechanical ventilation, and vasopressor and renal replacement therapy. Cytokines were measured in the first 50 patients. Results: Between January 17, 2018, and January 31, 2020, a total of 288 patients were randomly assigned to hemoadsorption (n=142) or control (n=146). Four patients in the hemoadsorption and 2 in the control group were excluded because they did not undergo surgery. The primary outcome, ΔSOFA, did not differ between the hemoadsorption and the control group (1.79±3.75 and 1.93±3.53, respectively; 95% CI, –1.30 to 0.83; P =0.6766). Mortality at 30 days (21% hemoadsorption versus 22% control; P =0.782), duration of mechanical ventilation, and vasopressor and renal replacement therapy did not differ between groups. Levels of interleukin-1β and interleukin-18 at the end of integration of hemoadsorption to cardiopulmonary bypass were significantly lower in the hemoadsorption than in the control group. Conclusions: This randomized trial failed to demonstrate a reduction in postoperative organ dysfunction through intraoperative hemoadsorption in patients undergoing cardiac surgery for IE. Although hemoadsorption reduced plasma cytokines at the end of cardiopulmonary bypass, there was no difference in any of the clinically relevant outcome measures. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03266302.

Variants in transcription factor p63 have been linked to several autosomal dominantly inherited malformation syndromes. These disorders show overlapping phenotypic characteristics with various combinations of the following features: ectodermal dysplasia, split-hand/foot malformation/syndactyly, lacrimal duct obstruction, hypoplastic breasts and/or nipples, ankyloblepharon filiforme adnatum, hypospadias and cleft lip/palate. We describe a family with six individuals presenting with a striking novel phenotype characterized by a furrowed or cleft tongue, a narrow face, reddish hair, freckles and various foot deformities. Whole-exome sequencing (WES) identified a novel heterozygous variant, c.3G>T, in TP63 affecting the translation initiation codon (p.1Met?). Sanger sequencing confirmed dominant inheritance of this unique variant in all six affected family members. In summary, our findings indicate that heterozygous variants in TP63 affecting the first translation initiation codon result in a novel phenotype dominated by a cleft tongue, expanding the complex genotypic and phenotypic spectrum of TP63-associated disorders.

Background Equine-assisted therapy is more often practiced with children and adolescents than with the elderly, although individuals in the second half of life could also profit from it. This group, from the age of 50, is characterised by increasing emotional, social, health-related and cognitive changes; a critical life event, such as a neurological illness or loss of a family member, can increase the likelihood of subclinical depression. Individuals who exhibit depressive symptoms not necessarily diagnosed with a major depression may suffer from relevant losses of quality of life (e.g. sleep disorders, memory disorders, feelings of guilt, hopelessness). Despite the fact that the various healthcare systems are in general more frequently used, such individuals often do not receive adequate therapy. The processing of one’s biography (reminiscence) is an elementary component of most psychotherapy approaches and has been demonstrated to treat and prevent the development of major depression. In this study, equine-assisted biographical work (EABW), a combination of equine-assisted therapy and biographical work, will be applied with individuals with subclinical depression in the second half of their life. Methods This is a multicentre, prospective, randomised, controlled and open phase III study in enrolling participants with subclinical depression. The aim of the study is to evaluate whether a preventive, equine-assisted, age-specific treatment combining elements of equine-assisted intervention with those of biographical work offers better treatment potentials in comparison to a control group with no intervention. Study participants in the intervention group will receive weekly equine-assisted biographical work over a period of 8 weeks. The primary endpoint is the change in Beck Depression Inventory-II (BDI-II) in a pre-post comparison. Secondary endpoints include other health-related questionnaires including quality of life, reminiscence functions and anxiety. Discussion The present study is the first randomised study examining the efficacy of biographical work with a horse and has the potential to establish an empirically based treatment for individuals in the second half of life and improving the symptoms of subclinical depression. Trial registration German Clinical Trials Register DRKS00017010 . Registered on 01 April 2019

The 3.25 Å resolution crystallographic structure of the substrate-binding domain of the erythrocyte-exported Hsp70 chaperone from the malaria parasite Plasmodium falciparum was determined. The parasite domain is shown to be highly similar to the equivalent domain of a human Hsp70 chaperone in structure and mode of substrate engagement., The malaria parasite Plasmodium falciparum extensively modifies erythrocytes that it invades by exporting a large complement of proteins to the host cell. Among these exported components is a single heat-shock 70 kDa class protein, PfHsp70-x, that supports the virulence and growth rate of the parasite during febrile episodes. The ATP-binding domain of PfHsp70-x has previously been resolved and showed the presence of potentially druggable epitopes that differ from those on human Hsp70 chaperones. Here, the crystallographic structure of the substrate-binding domain (SBD) of PfHsp70-x is presented in complex with a hydrophobic peptide. The PfHsp70-x SBD is shown to be highly similar to the counterpart from a human erythrocytic Hsp70 chaperone. The binding of substrate at the interface between β-sandwich and α-helical subdomains of this chaperone segment is also conserved between the malaria parasite and humans. It is hypothesized that the parasite may partly exploit human chaperones for intra-erythrocytic trafficking and maintenance of its exported proteome.

Lone Tree pit lake became acidic during groundwater recovery at a gold mine in Nevada. Alkalinity was added periodically to shift the lake to a neutral pH. Improved knowledge of the pit lake’s sources of acidity was essential for water quality prediction. The primary source of acidity and metals at Lone Tree appears to be dissolution of chemical loads by groundwater flowing through sulfide-enriched rocks exposed in the highwall. About 60% of the highwall consisted of potentially acid-generating rock based on analysis of sulfur and carbon in blast-hole samples collected during mining. Analysis of acid ingress over time indicated that complete oxidation of about 2.3 m of highwall would account for the sulfate and acidity mass balance in the pit lake. In addition, the analysis showed that chemical loading stored in the submerged highwall was likely released over many years by influent groundwater. A synthetic rinsing curve was calibrated against measured water quality to simulate chemical releases from the weathered rock.

Zusammenfassung. Resilienz, psychische Gesundheit und Wohlbefinden sind als Begriffe aktuell in der Positiven Psychologie und Psychiatrie allgegenwärtig. Dennoch sind immer noch viele Fragen zu ihrer Definition, Erfassung und Förderung ungeklärt. In dieser Übersichtsarbeit werden daher Studienergebnisse zur Beantwortung dieser Fragen zusammengetragen. Diese Ergebnisse legen nahe, dass es sich bei der Resilienz um einen dynamischen Anpassungsprozess an chronische Stressoren oder potenziell traumatische Erlebnisse handelt, dessen Ausgang von den Schutz- und Risikofaktoren einer Person abhängig ist. Dabei ist Resilienz als mehrdimensionales Konstrukt zu verstehen, das über das Leben hinweg und je nach Lebensbereich und Stressor unterschiedliche Ausprägungen annehmen kann. Erste Interventionen zur Förderung der Resilienz bei Kindern und Jugendlichen zielen auf eine Verbesserung ausgewählter persönlicher (Assets) und umweltbezogener Schutzfaktoren (Ressourcen) ab und erbrachten unmittelbar nach der Intervention positive Effekte auf die psychische Symptomatik. Das Konzept des Wohlbefindens wird wegen der deutlichen Überlappung beider Konstrukte häufig als Indikator oder Teil der Resilienz angesehen, wobei eine allgemeingültige Definition auch hierfür fehlt. Künftige Quer- und Längsschnittstudien sollten sich daher der Frage widmen, was die Kernkomponenten und die zugrundeliegenden Mechanismen beider Konstrukte sind und worin sie sich unterscheiden. Zudem sollten Studien vermehrt auf mögliche Alterseffekte und kulturelle Besonderheiten bezüglich der Dimensionen von Resilienz und Wohlbefinden fokussieren, um die gegenwärtige Konzeptualisierungen besser auszudifferenzieren.

Introduction Impaired self-awareness negatively impacts on how well persons with traumatic brain injury (TBI) learn and use strategies needed in daily life. Verbal feedback is a component of metacognitive strategy training recommended for addressing impaired self-awareness in TBI rehabilitation. Yet, it remains unknown how effectively verbal feedback on occupational performance improves self-awareness for the specific occupation involved. This study investigated the effect of verbal feedback on task-specific self-awareness for individuals with TBI. Methods A secondary analysis was conducted on selected data extracted from a randomised, assessor-blinded controlled trial in which 36 participants with impaired self-awareness post-TBI were allocated into two feedback intervention groups, verbal feedback and a control condition of experiential feedback only. All participants engaged in four sessions of meal preparation with an occupational therapist using a metacognitive strategy training approach. Participants in the verbal feedback group received feedback on their performance in a discussion with the occupational therapist following each session. Task-specific self-awareness was measured using discrepancy scores (therapist ratings minus self-ratings) on a Meal Independence Rating Scale (MIRS). Data were analysed using a mixed 2 × 2 analysis of variance. Results Positive MIRS discrepancy scores at pre-intervention reflected the propensity of participants to over-estimate their abilities There was a significant main effect of time, indicating overall gains in task-specific self-awareness at post-intervention (p = .01), but no significant group-by-time interaction. Changes in participants' self-ratings post-intervention were minimal. Instead, reduced MIRS discrepancy scores resulted largely from changes in therapists' ratings, indicating improvement in occupational performance. Conclusion Participants in both groups demonstrated improvements in occupational performance, but this did not correspond with changes in task-specific self-awareness. In this small sample, there was no statistically significant improvement in self-awareness associated with the provision of verbal feedback after occupational performance over and above the benefits of experiential feedback.

Zusammenfassung. Vernachlässigung, körperliche, psychische oder sexuelle Misshandlung erhöhen das Risiko für Entwicklungsstörungen wie auch das Risiko gesundheitlicher Langzeitfolgen im Erwachsenenalter. Die Prävention von Misshandlungen ist deshalb wichtig. In der Schweiz zeigt sich ein mehrschichtiges Präventionsmodell, dessen Hauptfokus auf der Stützung der Familie liegt. Ein verbessertes gesellschaftliches Bewusstsein hinsichtlich der wichtigen Bedeutung einer adäquaten kindlichen Betreuung steht sowohl im Interesse jedes Einzelnen wie auch im Interesse des Gesundheitssystems und der Gesellschaft als Ganzes.

Zusammenfassung. Für Jugendliche sind soziale Medien allgegenwärtig und sie verwenden sie, um ihren Gedanken, Gefühlen und Verhaltensweisen Ausdruck zu verleihen. Entsprechend bietet sich mit neuen interdisziplinären Methoden die Möglichkeit, die in sozialen Netzwerken vorhandenen Massendaten (Big Data) automatisch und maschinell zu analysieren, um darin Indikatoren für psychische Auffälligkeiten und Störungen im Sinne von Abweichungen von den üblichen Aktivitäts- und Kommunikationsmustern zu identifizieren. Diese Übersichtsarbeit gibt zunächst eine Einführung in das Konzept und mögliche Anwendungsbereiche von Big Data in sozialen Medien. Darauf aufbauend werden die ersten Studien diskutiert, die mittels dieser Analysen psychische Auffälligkeiten im Jugendalter entdecken konnten, da sich Unterschiede in der Struktur der sozialen Netzwerke, in der Verwendung von Wörtern und in der Kommunikation von Meinungen und Gefühlen fanden. Der Einbezug einer Vielzahl von Messzeitpunkten für die Modellierung intraindividueller Veränderungen könnte künftig in Kombination mit Mediatoranalysen helfen, besser zu verstehen, wann und durch welche Mechanismen sich der Konsum sozialer Medien auf die psychische Gesundheit auswirkt. Künftige Studien sollten zudem durch die Berücksichtigung weiterer Störungsbilder und Informationsquellen, verschiedener Altersgruppen und zusätzlicher sozialer Netzwerke zur Entwicklung von genaueren Prädiktionsmodellen zur Früherkennung psychischer Störungen in dieser Altersgruppe beitragen und darauf abgestimmte personalisierte Interventionen zur Förderung der psychischen Gesundheit und Resilienz anbieten.

The German government initiated the Network University Medicine (NUM) in early 2020 to improve national research activities on the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic. To this end, 36 German Academic Medical Centers started to collaborate on 13 projects, with the largest being the National Pandemic Cohort Network (NAPKON). The NAPKON’s goal is creating the most comprehensive Coronavirus Disease 2019 (COVID-19) cohort in Germany. Within NAPKON, adult and pediatric patients are observed in three complementary cohort platforms (Cross-Sectoral, High-Resolution and Population-Based) from the initial infection until up to three years of follow-up. Study procedures comprise comprehensive clinical and imaging diagnostics, quality-of-life assessment, patient-reported outcomes and biosampling. The three cohort platforms build on four infrastructure core units (Interaction, Biosampling, Epidemiology, and Integration) and collaborations with NUM projects. Key components of the data capture, regulatory, and data privacy are based on the German Centre for Cardiovascular Research. By December 01, 2021, 34 university and 34 non-university hospitals have enrolled 4,241 patients with local data quality reviews performed on 2,812 (66%). 47% were female, the median age was 53 (IQR: 38-63)) and 3 pediatric cases were included. 30% of patients were hospitalized, 11% admitted to an intensive care unit, and 4% of patients deceased while enrolled. 7,143 visits with biosampling in 3,595 patients were conducted by November 29, 2021. In this overview article, we summarize NAPKON’s design, relevant milestones including first study population characteristics, and outline the potential of NAPKON for German and international research activities.Trial registration:· https://clinicaltrials.gov/ct2/show/NCT04768998· https://clinicaltrials.gov/ct2/show/NCT04747366· https://clinicaltrials.gov/ct2/show/NCT04679584

The German government initiated the Network University Medicine (NUM) in early 2020 to improve national research activities on the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic. To this end, 36 German Academic Medical Centers started to collaborate on 13 projects, with the largest being the National Pandemic Cohort Network (NAPKON). The NAPKON’s goal is creating the most comprehensive Coronavirus Disease 2019 (COVID-19) cohort in Germany. Within NAPKON, adult and pediatric patients are observed in three complementary cohort platforms (Cross-Sectoral, High-Resolution and Population-Based) from the initial infection until up to three years of follow-up. Study procedures comprise comprehensive clinical and imaging diagnostics, quality-of-life assessment, patient-reported outcomes and biosampling. The three cohort platforms build on four infrastructure core units (Interaction, Biosampling, Epidemiology, and Integration) and collaborations with NUM projects. Key components of the data capture, regulatory, and data privacy are based on the German Centre for Cardiovascular Research. By April 01, 2022, 34 university and 40 non-university hospitals have enrolled 5298 patients with local data quality reviews performed on 4727 (89%). 47% were female, the median age was 52 (IQR 36–62-) and 50 pediatric cases were included. 44% of patients were hospitalized, 15% admitted to an intensive care unit, and 12% of patients deceased while enrolled. 8845 visits with biosampling in 4349 patients were conducted by April 03, 2022. In this overview article, we summarize NAPKON’s design, relevant milestones including first study population characteristics, and outline the potential of NAPKON for German and international research activities.Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04768998.https://clinicaltrials.gov/ct2/show/NCT04747366.https://clinicaltrials.gov/ct2/show/NCT04679584