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Objective The aims of the study were: (1) to clarify the definitions of “migrant” used in occupational health research; (2) to summarize migrant workers’ industry sectors, occupations and employment conditions; (3) to identify the occupational health and safety services available to migrant workers; (4) to summarize work-related health problems found among migrant workers; (5) to identify the methodological challenges to research into occupational health of migrant workers; and (6) to recommend improvements in migrant occupational health research. Methods This position paper was prepared by researchers from several European countries and Australia, working within the EU COST Action OMEGA-NET. The paper drew on two recent systematic reviews on the occupational health of international migrant workers and other literature, and also identified uncertainties and gaps in the research literature. Migrants may, for example, be temporary or permanent, moving for specific jobs migrants or other reasons. Their ethnicity and language capabilities will affect their work opportunities. Results The occupational health literature seldom adequately identifies the heterogeneity or characteristics of the migrant group being studied. Migrants tend to work in more physically and mentally demanding environments with higher exposures than native workers. Migrants tend to have an increased risk of physical and mental ill health, but less access to health care services. This has been demonstrated recently by high rates of COVID-19 and less access to health care. There have been a number of cross-sectional studies of migrant health but few long-term cohort studies were identified. Other study designs, such as registry-based studies, surveys and qualitative studies may complement cross-sectional studies. Mixed-methodology studies would be valuable in research on migrants’ occupational health. Language and lack of trust are barriers to migrant research participation. Conclusion Targeted research, especially longitudinal, identifying how these economically important but often-vulnerable workers can be best assisted is needed. Researchers should identify the characteristics of the migrant workers that they are studying including visa/migration circumstances (temporary, permanent, undocumented), racial and ethnic characteristics, existing skills and language abilities.

Urinary tract infections (UTIs) make up a significant proportion of the global burden of disease in vulnerable groups and tend to substantially impair the quality of life of those affected, making timely detection of UTIs a priority for public health. However, economic and societal barriers drastically reduce accessibility of traditional lab-based testing methods for critical patient groups in low-resource areas, negatively affecting their overall healthcare outcomes. As a result, cellulose-based materials such as paper and thread have garnered significant interest among researchers as substrates for so-called frugal analytical devices which leverage the material’s portability and adaptability for facile and reproducible diagnoses of UTIs. Although the field may be only in its infancy, strategies aimed at commercial penetration can appreciably increase access to more healthcare options for at-risk people. In this review, we catalogue recent advances in devices that use cellulose-based materials as the primary housing or medium for UTI detection and chart out trends in the field. We also explore different modalities employed for detection, with particular emphasis on their ability to be ported onto discreet casings such as sanitary products. Graphical abstract

Fraudulent papers from paper mills are a serious threat to the entire scientific community. Naunyn-Schmiedeberg’s Archives of Pharmacology has become the target of a massive attack of fraudulent papers originating from paper mills. This editorial highlights 20 important features we observed with paper mills and explains how the journal is responding to this serious threat to restore the integrity of science. Hopefully, this editorial is also helpful for editors of other scientific journals.

The acute and long-lasting side effects of modern multimodal tumour therapy significantly impair quality of life and survival of patients afflicted with malignancies. The key components of this therapy include radiotherapy, conventional chemotherapy, immunotherapy and targeted therapies. In addition to established tumour therapy strategies, up to 30 new therapies are approved each year with only incompletely characterised side effects. This consensus paper discusses the risk factors that contribute to the development of a potentially adverse reaction to tumour therapy and, in addition, defines specific side effect profiles for different treatment groups. The focus is on novel therapeutics and recommendations for the surveillance and treatment of specific patient groups.

To study the relationship between exposure to airborne particles in a pulp and paper mill and markers of inflammation and coagulation in blood. Personal sampling of inhalable dust was performed for 72 subjects working in a Swedish pulp and paper mill. Stationary measurements were used to study concentrations of total dust, respirable dust, PM10 and PM2.5, the particle surface area and the particle number concentrations. Markers of inflammation, interleukins (IL-1b, IL-6, IL-8, and IL-10), C-reactive protein (CRP), serum amyloid A (SAA), and fibrinogen and markers of coagulation factor VIII, von Willebrand, plasminogen activator inhibitor, and D-dimer were measured in plasma or serum. Sampling was performed on the last day of the work free period of 5 days, before and after the shift the first day of work and after the shifts the second and third day. In a mixed model analysis, the relationship between particulate exposures and inflammatory markers was determined. Sex, age, smoking, and BMI were included as covariates. The average 8-h time-weighted average (TWA) air concentration levels of inhalable dust were 0.30 mg/m(3), range 0.005-3.3 mg/m(3). The proxies for average 8-h TWAs of respirable dust were 0.045 mg/m(3). Significant and consistent positive relations were found between several exposure metrics (PM 10, total and inhalable dust) and CRP, SAA and fibrinogen taken post-shift, suggesting a dose-effect relationship. This study supports a relationship between occupational particle exposure and established inflammatory markers, which may indicate an increased risk of cardiovascular disease. Funding Agencies|Swedish Research Council for Health, Working Life and Welfare [2006-0152]

Background The main aim of emergency medical services (EMS) should be to provide universal emergency medical care which is EMS system available to all those who need it. Most of the developed countries have an integrated EMS system that is accessible by a single dial number in the whole country. Nepal does not have a proper EMS system. We conducted a literature review regarding methods of developing an integrated EMS system in Nepal. Result The fragmented system, high demand–low supply, inequity with the service, and inadequately trained responders are major problems associated with EMS in Nepal. Nepal too should develop an integrated single dial number EMS system to meet the current demand of EMS. Having a paramedic in ambulances as the first responders will prevent chaos and save critical time. Funding models have to be considered while developing an EMS considering the capital as well as operational cost. Conclusion Nepal can develop a public private partnership model of EMS where capital cost is provided by the government and operational cost by other methods. Community-based insurance system looks more feasible in a country like Nepal for generating operational cost.

Introduction In adults with a suspicion of peripheral bone infection, evidence-based guidelines in choosing the most accurate diagnostic strategy are lacking. Aim and methods To provide an evidence-based, multidisciplinary consensus document on the diagnostic management of adult patients with PBIs, we performed a systematic review of relevant infectious, microbiological, orthopedic, radiological, and nuclear medicine literature. Delegates from four European societies (European Bone and Joint Infection Society, European Society of Microbiology and Infectious Diseases, European Society or Radiology, and European Association of Nuclear Medicine) defined clinical questions to be addressed, thoroughly reviewed the literature pertinent to each of the questions, and thereby evaluated the diagnostic accuracy of each diagnostic technique. Inclusion of the papers per statement was based on a PICO (Population/problem – Intervention/indicator – Comparator – Outcome) question following the strategy reported by the Oxford Centre for Evidence-based Medicine. For each statement, the level of evidence was graded according to the 2011 review of the Oxford Centre for Evidence-based Medicine. All approved statements were addressed taking into consideration the available diagnostic procedures, patient acceptance, tolerability, complications, and costs in Europe. Finally, a commonly agreed-upon diagnostic flowchart was developed. Electronic supplementary material The online version of this article (10.1007/s00259-019-4262-x) contains supplementary material, which is available to authorized users.

Lysosomal storage disorders (LSDs) are a very heterogeneous group of hereditary disorders. The diagnostic process usually involves complex sampling, processing, testing, and validation procedures, performed by specialized laboratories only, which causes great limitations in reaching a diagnosis for patients affected by these diseases.There are few studies about LSDs in Colombia. The diagnostic limitations often make medical practitioners disregard the possibility of these disorders while diagnosing their patients. The current study documents the results of a 7-year screening in high-risk patients, aimed to detect LSDs using dried blood spots (DBS) collected on filter paper, with a micromethodology that facilitates diagnosis even with a large number of samples.The activities of α-galactosidase A, α glucosidase, α-L-iduronidase, arylsulfatase B, β-galactosidase, β-glucosidase, total hexosaminidase, iduronate sulfatase, and chitotriosidase were analyzed in high-risk patients for lysosomal disease. The catalytic activity was evaluated with fluorometric micromethods using artificial substrates marked with 4-methylumbelliferone.The reference values for a control population were established for the enzymes listed above, and 242 patients were found to have an enzyme deficiency, guiding to the following diagnoses: Fabry disease (n = 31), Pompe disease (n = 16), Hurler Syndrome (n = 15), Maroteaux-Lamy Syndrome (n = 34), GM1 Gangliosidosis (n = 10), Morquio B (n = 1), Gaucher disease (n = 101), Sandhoff disease (n = 1), Mucolipidosis (n = 2), and Hunter Syndrome (n = 31). In conclusion, this protocol provides a comprehensive diagnostic approach which could be carried out in Colombia and made it available to medical services spread around the country, enabling the identification of a large number of patients affected by LSDs, which could potentially benefit from the therapeutic tools already available for many of these diseases.

How did Britons view China in 2020, at the height of the Covid-19 pandemic? This paper presents new, detailed evidence of the negative and worsening perceptions of China in the UK across three domains: public opinion (based on survey data collected in autumn 2020), political elites in parliament, and the media. The worsening of perceptions of China emerged in the context of a changing and more contested China policy from the UK government and a greater level of public debate about China, partly a consequence of the onset of the Covid-19 pandemic. The paper places analysis of these perceptions in the context of the development of relations between the UK and China. Together with deteriorating Chinese views of the UK's China policy and controversy over a number of developments in China, widespread negative views about China among the British public and in political circles will constrain UK-China relations from developing in a more positive direction.

Purpose The development of assistive technologies that support people in social interactions has attracted increased attention in HCI. This paper presents a systematic review of studies of Socially Assistive Systems targeted at older adults and people with disabilities. The purpose is threefold: (1) Characterizing related assistive systems with a special focus on the system design, primarily including HCI technologies used and user-involvement approach taken; (2) Examining their ways of system evaluation; (3) Reflecting on insights for future design research. Methods A systematic literature search was conducted using the keywords “social interactions” and “assistive technologies” within the following databases: Scopus, Web of Science, ACM, Science Direct, PubMed, and IEEE Xplore. Results Sixty-five papers met the inclusion criteria and were further analyzed. Our results showed that there were 11 types of HCI technologies that supported social interactions for target users. The most common was cognitive and meaning understanding technologies, often applied with wearable devices for compensating users’ sensory loss; 33.85% of studies involved end-users and stakeholders in the design phase; Four types of evaluation methods were identified. The majority of studies adopted laboratory experiments to measure user-system interaction and system validation. Proxy users were used in system evaluation, especially in initial experiments; 42.46% of evaluations were conducted in field settings, primarily including the participants’ own homes and institutions. Conclusion We contribute an overview of Socially Assistive Systems that support social interactions for older adults and people with disabilities, as well as illustrate emerging technologies and research opportunities for future work.

This paper discusses the scope for international macroprudential policy coordination in a financially integrated world economy. It begins with a review of the transmission channels associated with, and the empirical evidence on, financial spillovers and spillbacks. Limitations of the existing literature are also identified. The potential gains associated with cross-border macroprudential coordination, dwelling on both recent analytical contributions and quantitative studies based on multi-country models with financial frictions, are then evaluated. The issue of whether coordination of macroprudential policies simultaneously requires some degree of monetary policy coordination is also discussed. The analysis focuses on the potential for policy coordination between major advanced economies and a group identified as systemically-important middle-income countries (SMICs). Next, practical ways to promote international macroprudential policy coordination are considered. Following a discussion of Basel III’s Principle of reciprocity and ways to improve it, the paper advocates a further strengthening of the current statistical, empirical and analytical work conducted by international financial institutions to evaluate, and raise awareness of, the gains from international coordination of macroprudential policies.

In recent years, there has been a growing interest in the use of reference conceptual models to capture information about complex and sensitive business domains (e.g., finance, healthcare, space). These models play a fundamental role in different types of critical semantic interoperability tasks. Therefore, domain experts must be able to understand and reason with their content. In other words, these models need to be cognitively tractable. This paper contributes to this goal by proposing a model clustering technique that leverages on the rich semantics of ontology-driven conceptual models (ODCM). In particular, we propose a formal notion of Relational Context to guide the automated clusterization (or modular breakdown) of conceptual models. Such Relational Contexts capture all the information needed for understanding entities "qua players of roles" in the scope of an objectified (reified) relationship (relator). The paper also presents computational support for automating the identification of Relational Contexts and this modular breakdown procedure. Finally, we report the results of an empirical study assessing the cognitive effectiveness of this approach.

Coronavirus disease 2019 (COVID-19) pandemic is currently a serious global health threat. While conventional laboratory tests such as quantitative real-time polymerase chain reaction (qPCR), serology tests, and chest computerized tomography (CT) scan allow diagnosis of COVID-19, these tests are time-consuming and laborious, and are limited in resource-limited settings or developing countries. Point-of-care (POC) biosensors such as chip-based and paper-based biosensors are typically rapid, portable, cost-effective, and user-friendly, which can be used for COVID-19 in remote settings. The escalating demand for rapid diagnosis of COVID-19 presents a strong need for a timely and comprehensive review on the POC biosensors for COVID-19 that meet ASSURED criteria: Affordable, Sensitive, Specific, User-friendly, Rapid and Robust, Equipment-free, and Deliverable to end users. In the present review, we discuss the importance of rapid and early diagnosis of COVID-19 and pathogenesis of COVID-19 along with the key diagnostic biomarkers. We critically review the most recent advances in POC biosensors which show great promise for the detection of COVID-19 based on three main categories: chip-based biosensors, paper-based biosensors, and other biosensors. We subsequently discuss the key benefits of these biosensors and their use for the detection of antigen, antibody, and viral nucleic acids. The commercial POC biosensors for COVID-19 are critically compared. Finally, we discuss the key challenges and future perspectives of developing emerging POC biosensors for COVID-19. This review would be very useful for guiding strategies for developing and commercializing rapid POC tests to manage the spread of infections.Graphical abstract.

Online learning has become one of the most important learning styles, yet with the need of supervisors to consistently keep the learners motivated and on-task. Some learners could be supervised by outer factors, and distance learners have to be motivated by themselves. However, online learning engagement is hardly to be assessed by supervisors in real time. With the rapid development of information technology, it is able to remedy the above problem by using intelligent video surveillance techniques. In this paper, we propose a novel framework of learning engagement assessment which introduces facial expression recognition to timely acquire the emotional changes of the learners. Moreover, a new facial expression recognition method is proposed based on domain adaptation, which is suitable for the MOOC scenario. The experiments show the effectiveness of our proposed framework on assessing learners’ learning engagement. The comparisons with the state-of-the-art methods also demonstrate the superiority of our proposed facial emotion recognition method.

Within the elderly population, psychogeriatric patients may be particularly susceptible to negative mental health effects of the coronavirus crisis. Detailed information about the psychosocial well-being of psychogeriatric patients during the pandemic is still sparse. Here we examined which aspects of subjective experience of the COVID-19 pandemic especially affect levels of depression, anxiety and quality of life in psychogeriatric patients with and without cognitive impairment. A cross-sectional paper survey was conducted during the first German lockdown among patients with a diagnosed psychiatric disorder (≥ 60 years) or a diagnosed neurodegenerative disease (regardless of their age) from the department for neurodegenerative diseases and geriatric psychiatry at the University of Bonn. The WHO-5-, GAD-7- and WHOQOL-old score were used to determine levels of depression, anxiety and quality of life. The second part obtained information about the subjective experience of the COVID-19 pandemic. Statistical analysis included among others principal component analysis and multiple linear regression analysis. COVID-19-related, immediate distress was a strong predictor of elevated symptoms of depression, anxiety and a reduced quality of life. COVID-19-related concerns regarding health and financial security, however, were not significantly associated with negative mental health outcomes. The overall prevalence of symptoms of depression (50.8% [95% CI 43.8–57.6%]) and anxiety (32.7% [95% CI 26.4–39.2%]) among psychogeriatric patients was high. Our findings indicate that psychogeriatric patients are not significantly affected by COVID-19-related concerns but are primarily suffering from emotional consequences resulting from changed living conditions due to the pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s00406-021-01340-1.

Emerging intelligent environments are considered to offer significant opportunities to positively impact human life, both at an individual and at a societal level, and in particular to provide useful means to support people in their daily life activities and thus improve well-being for everybody, especially for older people and for people with limitations of activities. In this context, accessibility and usability, although necessary, are not sufficient to ensure that applications and services are appropriately designed to satisfy human needs and overcome potential functional limitations in the execution of everyday activities fundamental for well-being. This position paper puts forward the claim that, in order to achieve the above objective, it is necessary that: (i) the design of Assistive Intelligent Environments is centered around the well-being of people, roughly intended as the possibility of executing the (everyday) human activities necessary for living (independently), thus emphasizing usefulness in addition to usability; (ii) the technological environment is orchestrated around such activities and contains knowledge about how they are performed and how people need to be supported to perform them; (iii) the environment makes use of monitoring and reasoning capabilities in order to adapt, fine-tune and evolve over time the type and level of support provided, and this process takes place considering ethical values; (iv) the applications must also support the possibility of contact with other people, who in many cases may be the only effective help. Moving forward from the Design for All paradigm, this paper discusses how the latter can be revisited under the perspective of technology’s usefulness and contribution to human well-being. Subsequently, it introduces a practical notion of well-being based on the ICF classification of human functions and activities and discusses how such notion can constitute the starting point and the focus of design approaches targeted to assist people in their everyday life mainly (but not exclusively) in the home environment. As a subsequent step, the need for integrating Artificial Intelligence capabilities in assistive intelligent environments is discussed, based on the complexity of the human problems to be addressed and the diversity of the types of support needed. The proposed approach is exemplified and illustrated through the experience acquired in the development of four applications, addressing vital aspects of human life, namely nutrition, stress management, sleep management and counteracting loneliness. Finally, based on the acquired experience, the need to take into account ethical values in the development of assistive intelligent environments is discussed.

Background Accelerated by the coronavirus disease 2019 (Covid-19) pandemic, major and lasting changes are occuring in healthcare structures, impacting people's experiences and value creation in all aspects of their lives. Information systems (IS) research can support analysing and anticipating resulting effects. Aim The purpose of this study is to examine in what areas health information systems (HIS) researchers can assess changes in healthcare structures and, thus, be prepared to shape future developments. Method A hermeneutic framework is applied to conduct a literature review and to identify the contributions that IS research makes in analysing and advancing the healthcare industry. Results We draw an complexity theory by borrowing the concept of 'zooming-in and out', which provides us with a overview of the current, broad body of research in the HIS field. As a result of analysing almost 500 papers, we discovered various shortcomings of current HIS research. Contribution We derive future pathways and develop a research agenda that realigns IS research with the transformation of the healthcare industry already under way.

This paper aims to explore various possibilities in the evolving global gas market by constructing game-theoretical models involving the major players: Russia and Qatar exporting gas to the Asia-Pacific and Europe, respectively. We explore a series of hypothetical scenarios based on competitive and collusive settings for the Asia-Pacific LNG market and based on Qatar's export route to the European gas market. The scenarios that are examined are (1) Russia as the follower and Qatar as the leader in a Stackelberg game; (2) Russia and Qatar as Cournot competitors; (3) collaboration between Russia and Qatar as bilateral monopolies; (4) Qatar exporting gas to European borders; (5) Qatar exporting gas to the last transit country; and (6) Qatar transporting gas to the Turkish border under a multi-pricing scheme. Demand is estimated under each scenario to simulate the respective export volumes, prices and quantities, and profit in each scenario. By exploring these market interactions, we find that it is essential for Russia to strike a deal with Qatar in the Asian market and accelerate their gas production in order to compete as an LNG market leader. Russia is likely to benefit more if it can link with Qatar to act as a monopoly on their segmental demand curve. On the other hand, Qatar's profit is expected to be higher under the scenario when Qatar sells all the gas to the last transit country as the sole demand point instead of passing through transit countries.

In the era of autonomous robots, multi-targets search methods inspired researchers to develop adapted algorithms to robot constraints, and with the rising of Swarm Intelligence (SI) approaches, Swarm Robotics (SRs) became a very popular topic. In this paper, the problem of searching for an exponentially increasing number of targets in a complex and unknown environment is addressed. Our main objective is to propose a Robotic target search strategy based on the EHO (Elephants Herding Optimization) algorithm, namely Robotic-EHO (REHO). The main additions were the collision-free path planning strategy, the velocity limitation, and the extension to the multi-target version in discrete environments. The proposed method has been the subject of many experiments, emulating the search of infected individuals by COVID-19 in a context of containment within complex and unknown random environments, as well as in the real case study of USA. The particularity of these environments is their increasing targets' number and the dynamic Containment Rate (CR) that we propose. The experimental results show that REHO reacts much better in high Containment Rate, early start search mission, and where the robots' speed is higher than the virus spread speed.

COVID-19 is an acronym for coronavirus disease 2019. Initially, it was called 2019-nCoV, and later International Committee on Taxonomy of Viruses (ICTV) termed it SARS-CoV-2. On 30th January 2020, the World Health Organization (WHO) declared it a pandemic. With an increasing number of COVID-19 cases, the available medical infrastructure is essential to detect the suspected cases. Medical imaging techniques such as Computed Tomography (CT), chest radiography can play an important role in the early screening and detection of COVID-19 cases. It is important to identify and separate the cases to stop the further spread of the virus. Artificial Intelligence can play an important role in COVID-19 detection and decreases the workload on collapsing medical infrastructure. In this paper, a deep convolutional neural network-based architecture is proposed for the COVID-19 detection using chest radiographs. The dataset used to train and test the model is available on different public repositories. Despite having the high accuracy of the model, the decision on COVID-19 should be made in consultation with the trained medical clinician.

In this paper, linear regression (LR), multi-linear regression (MLR) and polynomial regression (PR) techniques are applied to propose a model Li-MuLi-Poly. The model predicts COVID-19 deaths happening in the United States of America. The experiment was carried out on machine learning model, minimum mean square error model, and maximum likelihood ratio model. The best-fitting model was selected according to the measures of mean square error, adjusted mean square error, mean square error, root mean square error (RMSE) and maximum likelihood ratio, and the statistical t-test was used to verify the results. Data sets are analyzed, cleaned up and debated before being applied to the proposed regression model. The correlation of the selected independent parameters was determined by the heat map and the Carl Pearson correlation matrix. It was found that the accuracy of the LR model best-fits the dataset when all the independent parameters are used in modeling, however, RMSE and mean absolute error (MAE) are high as compared to PR models. The PR models of a high degree are required to best-fit the dataset when not much independent parameter is considered in modeling. However, the PR models of low degree best-fits the dataset when independent parameters from all dimensions are considered in modeling.

Engaging deep neural networks for textual sentiment analysis is an extensively practiced domain of research. Textual sentiment classification harnesses the full computational potential of deep learning models. Typically, these research works are carried either with a popular open-source data corpus, or self-extracted short phrase texts from Twitter, Reddit, or web-scrapped text data from other resources. Rarely do we see a large amount of data on a current ongoing event is being collected and cultured further. Also, an even more complex task would be to model the data from a currently ongoing event, not only for scaling the sentiment accuracy but also for making a predictive analysis for the same. In this paper, we propose a novel approach for achieving sentiment evaluation accuracy by using a deep neural network on live-streamed tweets on Coronavirus and future case growth prediction. We develop a large tweet corpus exclusively based on the Coronavirus tweets. We split the data into train and test sets, alongside we perform polarity classification and trend analysis. The refined outcome from the trend analysis helps to train the data to provide an incremental learning curvature for our neural network, and we obtain an accuracy of 90.67%. Finally, we provide a statistical-based future prediction for Coronavirus cases growth. Not only our model outperforms several previous state-of-art experiments in overall sentiment accuracy comparison for similar tasks, but it also maintains a throughout performance stability among all the test cases when tested with several popular open-source text corpora.

There is currently little systematic knowledge about the contribution of different factors to the increase in health care spending in high-income countries such as Switzerland. The aim of this paper is to decompose inpatient care costs in the Swiss canton of Zurich by 100 diseases and 42 age/sex groups and to assess the contribution of six factors to the change in aggregate costs between 2013 and 2017. These six factors are population size, age and sex structure, inpatient treated prevalence, utilization in terms of stays per patient, length of stay per case, and costs per treatment day. Using detailed inpatient cost data at the case level, we find that the most important contributor to the change in disease-specific costs was a rise in costs per treatment day. For most conditions, this effect was partly offset by a reduction in the average length of stay. Changes in population size accounted for one third of the total increase, but population structure had only a small positive association with costs. The most expensive cases accounted for the largest part of the increase in costs, but the magnitude of this effect differed across diseases. A better understanding of the factors related to cost changes at the disease level over time is essential for the design of targeted health policies aiming at an affordable health care system.

Graphical Abstract Eco-innovations are innovations capable of helping to reduce the environmental impacts of production processes. In this sense, the adoption of models that assess comprehensively, in an integrated manner and in different perspectives, the general performance of these innovations allows managers to guide their decisions. The object of this research is the use of an eco-innovation in the production processes of cassava, where the waste generated is treated by biodigesters. These cassava processing industries are located in southern Brazil, Paraná State, comprising a multiple case study. A literature review was also carried out to propose a set of indicators capable of assessing the overall impact of this eco-innovation in eight lines of action: (1) environmental, (2) social, (3) economic, (4) human resource training, (5) institutional development, (6) introduction of innovation, (7) unwanted occurrences, and (8) characteristics of environmental management. To compile and process the data, the computerized model INOVA-tec System was used. The objective was to employ the INOVA-tec System model as an instrument for evaluating eco-innovative processes in leading companies in its segment, looking for evidence to expand its usability to other realities in the agro-industry. The results show that the technology scenario is favorable to its dissemination; however, the low performance of the indicators together makes it underutilized.

Telehealth drastically reduces the time burden of appointments and increases access to care for homebound patients. During the COVID-19 pandemic, many outpatient practices closed, requiring an expansion of telemedicine capabilities. However, a significant number of patients remain unconnected to telehealth-capable patient portals. Currently, no literature exists on the success of and barriers to remote enrollment in telehealth patient portals. From March 26 to May 8, 2020, a total of 324 patients were discharged from Mount Sinai Beth Israel (MSBI), a teaching hospital in New York City. Study volunteers attempted to contact and enroll patients in the MyChart patient portal to allow the completion of a post-discharge video visit. If patients were unable to enroll, barriers were documented and coded for themes. Of the 324 patients discharged from MSBI during the study period, 277 (85%) were not yet enrolled in MyChart. Volunteers successfully contacted 136 patients (49% of those eligible), and 39 (14%) were successfully enrolled. Inability to contact patients was the most significant barrier. For those successfully contacted but not enrolled, the most frequent barrier was becoming lost to follow-up (29% of those contacted), followed by lack of interest in remote appointments (21%) and patient technological limitations (9%). Male patients, and those aged 40–59, were significantly less likely to successfully enroll compared to other patients. Telehealth is critical for healthcare delivery. Remote enrollment in a telemedicine-capable patient portal is feasible, yet underperforms compared to reported in-person enrollment rates. Health systems can improve telehealth infrastructure by incorporating patient portal enrollment into in-person workflows, educating on the importance of telehealth, and devising workarounds for technological barriers.

Regulation has not been a primary focus of research within the information systems discipline or the research domain of electronic markets. A framework is presented to support understanding of the field. A review of published works has established that many research opportunities exist. The usefulness of the framework is validated by means of an examination of the platform-based business sector, with particular reference to Uber.

Purpose We aimed to estimate the structure of internalizing and externalizing symptoms and potential time dynamics in their association. This is understudied among adolescents, despite increasing internalizing and decreasing externalizing symptoms in recent years. Methods We analyzed data from US Monitoring the Future cross-sectional surveys (1991–2018) representative of school-attending adolescents (N = 304,542). Exploratory factor analysis using maximum likelihood estimation method and promax rotation resulted in a two-factor solution (factor correlation r = 0.24) that differentiated eight internalizing and seven conduct-related externalizing symptoms. Time-varying effect modification linear regression models estimated the association between standardized internalizing and externalizing symptoms factor scores over time overall and by gender. Results In 2012, trends in average factor scores diverged for internalizing and externalizing factors. The average standardized internalizing factor score increased from − 0.03 in 2012 to 0.06 in 2013 and the average externalizing factor score decreased from − 0.06 in 2011 to − 0.13 in 2012. We found that for every one-unit increase in standardized internalizing factor score, standardized externalizing factor score increased by 0.224 units in 2010 (95% CI: 0.215, 0.233); the magnitude of this increase was 22.3% lower in 2018 (i.e., 0.174 units; 95% CI: 0.160, 0.188). Decoupling of internalizing and externalizing symptoms began earlier among boys (~ 1995) than among girls (~ 2010). Conclusion The decoupling of internalizing and externalizing symptoms among adolescents suggests that changes in the prevalence of shared risk factors for adolescent psychiatric symptoms affect these dimensions in opposing directions, raising the importance of considering symptoms and their risk factors together in prevention and intervention efforts. Supplementary Information The online version contains supplementary material available at 10.1007/s00127-021-02189-4.

Alpha synuclein has a key role in the pathogenesis of Parkinson’s disease (PD), Dementia with Lewy Bodies (LBD) and Multiple System Atrophy (MSA). Immunotherapies aiming at neutralising toxic αSyn species are being investigated in the clinic as potential disease modifying therapies for PD and other synucleinopathies. In this study, the effects of active immunisation against αSyn with the UB-312 vaccine were investigated in the Thy1SNCA/15 mouse model of PD. Young transgenic and wild-type mice received an immunisation regimen over a period of 6 weeks, then observed for an additional 9 weeks. Behavioural assessment was conducted before immunisation and at 15 weeks after the first dose. UB-312 immunisation prevented the development of motor impairment in the wire test and challenging beam test, which was associated with reduced levels of αSyn oligomers in the cerebral cortex, hippocampus and striatum of Thy1SNCA/15 mice. UB-312 immunotherapy resulted in a significant reduction of theαSyn load in the colon, accompanied by a reduction in enteric glial cell reactivity in the colonic ganglia. Our results demonstrate that immunisation with UB-312 prevents functional deficits and both central and peripheral pathology in Thy1SNCA/15 mice. Supplementary Information The online version contains supplementary material available at 10.1007/s00401-021-02381-5.

Little is known about the relationship of COVID-19 outcomes with onychomycosis. We investigated the relationship of onychomycosis with COVID-19 outcomes. A retrospective cohort study was performed on SARS-CoV-2 positive adult outpatients or inpatients who had onychomycosis and other skin diseases. Overall, 430 adults were identified with SARS-CoV-2 and a skin disease, including 98 with diagnosed onychomycosis. In bivariable logistic regression models, onychomycosis was associated with increased hospitalization {odds ratio(OR) [95% confidence interval (CI)]: 3.56 [2.18-5.80]}, initial inpatient vs. outpatient visits (OR [95% CI]: 2.24 [1.35-3.74]), use of oxygen therapy (OR [95% CI]: 2.77 [1.60-4.79]), severe-critical vs. asymptomatic-mild severity (OR [95% CI]: 2.28 [1.32-3.94]), and death (OR [95% CI]: 7.48 [1.83-30.47]) from COVID-19, but not prolonged hospitalization (OR [95% CI]: 1.03 [0.47-2.25]). In multivariable models adjusting for socio-demographics, comorbidities, and immunosuppressant medication use, the associations with onychomycosis remained significant for hospitalization, inpatient visits, oxygen therapy, severe-critical COVID-19. Onychomycosis was a significant independent risk factor for COVID-19 severity, hospitalization, and receiving supplemental oxygen therapy.

Deep reinforcement learning has the advantage of being able to encode fairly complex behaviors by collecting and learning empirical information. In the current study, we have proposed a framework for reinforcement learning in decentralized collision avoidance where each agent independently makes its decision without communication with others. In an environment exposed to various kinds of dynamic obstacles with irregular movements, mobile robot agents could learn how to avoid obstacles and reach a target point efficiently. Moreover, a path planner was integrated with the reinforcement learning-based obstacle avoidance to solve the problem of not finding a path in a specific situation, thereby imposing path efficiency. The robots were trained about the policy of obstacle avoidance in environments where dynamic characteristics were considered with soft actor critic algorithm. The trained policy was implemented in the robot operating system (ROS), tested in virtual and real environments for the differential drive wheel robot to prove the effectiveness of the proposed method. Videos are available at https://youtu.be/xxzoh1XbAl0 .

Purpose Multiple names within the literature refer to a clinical picture affecting infants and consisting of a large or fast growing head circumference with enlarged cortical subarachnoid spaces (CSAS) while cranial sutures are open. This myriad of terms demonstrates the confusion about the entity, that may even group together different etiological processes. In this review, we aim to shed light on this matter in an effort to restate the defining features of the clinical picture and sum the evidence and current understanding of its pathophysiology and related imaging findings. Methods Extensive and updated review of the literature with special focus on defining features, clinical history with long term evaluation and pathophysiological process. Results Functional and molecular CSF studies as well as clinical evidence challenges the common pathophysiological theory based on non-functional arachnoid villi. Conversely, there is increasing evidence supporting cerebro-venous system abnormalities as the main pathophysiological factor. Additionally, long term cohorts studies show that it may have subtle but irreversible neurodevelopmental consequences. Conclusion Subarachnomegaly is an age-related condition of the infancy with radiological enlargement of CSAS and often self limiting course. However, considering the evidence on pathophysiology as outlined herein and long term outcome reports, further research effort is needed to assess the consequences of venous outflow impairment and enlarged CSAS and how this relates to imaging findings and neurodevelopment test results later in life

Temperature has been studied in relation to many health outcomes. However, few studies have explored its effect on the risk of hospital admission for rheumatoid arthritis (RA). A distributed lag non-linear model (DLNM) was used to analyze associations between mean temperature, diurnal temperature range (DTR), temperature change between neighboring days (TCN), and daily admissions for RA from 2015 to 2019 in Anqing, China. Subgroup analyses based on age, gender, rheumatoid factors, and admission route were performed. In total, 1456 patients with RA were hospitalized. Regarding the cumulative-lag effects of extreme cold temperature (5th percentile = 3℃), the risks of admissions for RA were increased and highest at lag 0–11 (RR = 2.68, 95% CI: 1.23–5.86). Exposing to low (5th percentile = 1.9℃) and high (95th percentile = 14.2℃) DTRs both had increased risks of RA admission, with highest RRs of 1.40 (95% CI: 1.03–1.91) and 1.24 (95% CI: 1.0–1.53) at lag 0 day, respectively. As for TCN, the marginal risk of admission in RA patients was found when exposed to high TCN (95th percentile = 2.9℃) with the largest single-day effect at lag 10 (RR = 1.11, 95% CI: 1.01–1.23). In subgroup analyses, females were more susceptible to extreme cold temperature, low and high DTRs, and high TCN. In regard to extreme cold temperature, significant risk of hospital admission in females only appeared at lag 2 (RR = 1.48, 95% CI: 1.02–2.15) and lag 0–2 (RR = 2.35, 95% CI: 1.11–4.95). It is clear that RA patients exposed to changing temperature may increase risks of admission. Supplementary Information The online version contains supplementary material available at 10.1007/s00484-021-02207-9.

From the classical Chinese literary masterpiece Investiture of the Gods to contemporary film animation, Nezha’s image is profound. Examining the portrayals of Nezha, namely in those most celebrated animated films, we argue that his role as the epitome of a ‘god like figure’ is in constant displacement and return. Using the framework of archetype and displacement as advanced by Northrop Frye, with a more pluralistic myth analysis extension found in the myth critique of Gilbert Durand, this article examines the multi-layered mythical mini structures within Nezha’s displacement and return in Chinese animation, to explore the themes, images, and archetype represented by the character from the perspective of Chinese history and culture. We argue that Nezha’s displacement and return in Chinese animation expresses the need and call for a traditional heroic image in a particular era. As such, Nezha’s intertextuality exposes the profound inner patterns that form and refashion the Chinese collective unconscious, performing as a recurring mirror that symbolically inform and transform human experiences in China.

The intersection of technological changes and societal evolution has transformed every aspect of human life. Technological advancements are transforming how healthcare knowledge is expanding and accelerating the outreach of critical medical services delivery (Jamal et al. in Health Information Management Journal 38(3):26–37, 2009). While this transformation facilitates new opportunities simultaneously it also introduces challenges (Jacobzone and Oxley, 2001). Appropriate Health Technology (HT) is vital to new and existing global health care programs. Therefore, qualified professionals who can safely guide the development, evaluation, installation, integration, performance assurance, and risk mitigation of HT must be in position to lead. Trained Clinical Engineers (CE) and Biomedical Engineers (BE) have been recognized by the World Health Organization (WHO) as the essential practitioners to providing this critically needed guidance. Over the past four years, a senior professional group participated in an international project that seeks evidence for the hypothesis - that the engagement of CE and BE in guiding HT - impacts positively on patient outcomes, while the alternative is that there is no difference. The group collected published data that was subjected to peer review screening; additional data qualification conditions are described in this paper. The project was initiated at the Global CE Summit during the first International Clinical Engineering and Health Technology Management Congress (ICEHTMC) in Hangzhou, China in October 2015 (Global Clinical Engineering Summit at the First International Clinical Engineering and Health Technology Management Congress, 2015). Following the adoption of a resolution to investigate CE contributions to the improvement of world health status, an international survey and literature survey were initiated. During the first two years of this project 150 case studies from 90 countries were identified covering the previous ten years. The results of this survey were presented to health leaders at the World Health Organization (WHO) World Health Assembly in 2016. Last year, 250 case studies were added including 35 more countries covering the 2016–2017 period. The combined project contains 400 qualified submissions from 125 countries. The conclusion was that engagement of CE and BME is critical for successful investment in HT and for achieving intended patient outcomes. This paper describes the project’s plan, the results of the literature review performed, and the evidence identified during the process.

Unlearning has evinced immense traction and opportunity in debates pertaining to organizational learning, innovation, management of change, knowledge management, and new product development, to name but a few. Provided the diversity and expansiveness of the phenomenon, past studies have undertaken both narrative and systematic reviews to synthesize the field of organizational unlearning (OU). Although highly commendable and enlightening, these scholarly efforts would be augmented by contemplating the share of leading management journals towards furthering the research on unlearning. Moreover, a systematic comprehension of the research themes of OU can be instrumental in representing the intellectual structure of the field. For this purpose, we undertake a combination of bibliometric and thematic analysis to identify critical trends that have helped shape unlearning research. The results discern the main scientific actors (articles, authors, journals, universities), research design, and dimensions of OU. In addition, eight clusters of unlearning along with underlying theoretical perspectives are analyzed, which may help scholars integrate the development of one domain to another, formulate pertinent research questions related to OU, and encourage interdisciplinary research.

Global annual deaths from Trauma are greater than any other single cause in the global working population, and, more than all contagious diseases added together including COVID-19. The number of people injured, either temporarily or permanently, is greater than any other medical condition. This problem affects Low and Middle Income Countries (LMICs) disproportionately. The numbers are so great as to cause “zone out” and present a human rights issue. This is a particular issue as Trauma presently receives less than 1% of global healthcare funding. This article will highlight and discuss many of the issues and raise some uncomfortable arguments showing that improvement is needed, necessary and achievable.

Purpose To review the use of different valve types in infants with hydrocephalus, in doing so, determining whether an optimal valve choice exists for this patient cohort. Methods We conducted (1) a literature review for all studies describing valve types used (programmable vs. non-programmable, valve size, pressure) in infants (≤ 2 years) with hydrocephalus, (2) a review of data from the pivotal BASICS trial for infant patients and (3) a separate, institutional cohort study from Alder Hey Children’s Hospital NHS Foundation Trust. The primary outcome was any revision not due to infection. Results The search identified 19 studies that were included in the review. Most did not identify a superior valve choice between programmable and non-programmable, small compared to ultra-small, and differential pressure compared to flow-regulating valves. Five studies investigated a single-valve type without a comparator group. The BASICS data identified 391 infants, with no statistically significant difference between gravitational and programmable subgroups. The institutional data from our tertiary referral centre did not reveal any significant difference in failure rate between valve subtypes. Conclusion Our review highlights the challenges of valve selection in infant hydrocephalus, reiterating that the concept of an optimal valve choice in this group remains a controversial one. While the infant-hydrocephalic population is at high risk of valve failure, heterogeneity and a lack of direct comparison between valves in the literature limit our ability to draw meaningful conclusions. Data that does exist suggests at present that there is no difference in non-infective failure rate are increasing in number, with the British valve subtypes in infant hydrocephalus, supported by both the randomised trial and institutional data in this study.

Assessing the current Artificial intelligence (AI) situation is a crucial step towards its implementation into radiology practice. The study aimed to assess radiographer willingness to accept AI in radiology work practice and the impact of AI in work performance. An exploratory cross-sectional online survey conducted for radiographers working within the Middle East and India was conducted from May–August 2020. A previously validated survey used to obtain radiographer's demographics, knowledge, perceptions, organization readiness, and challenges of integrating AI into radiology. The survey was accessible for radiographers and distributed through the societies page. The survey was completed by 549 radiographers distributed as (77.6%, n = 426) from the Middle East while (22.4%, n = 123) from India. A majority (86%, n = 773) agreed that AI currently plays an important role in radiology and (88.0%, n = 483) expected that AI would play a role in radiology practice and image production. The challenges for AI implementation in practice were developing AI skills (42.8%, n = 235) and AI knowledge development (37.0%, n = 203). Participants showed high interest to integrate AI in under and postgraduate curriculum. There is excitement about what AI could offer, but education input is a requirement. Fears are expressed about job security and how radiology may work across all ages and educational backgrounds. Radiographers become aware of AI role and challenges, which can be improved by education and training.

Purpose Rapid antigen-detecting tests (Ag-RDTs) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can transform pandemic control. Thus far, sensitivity (≤ 85%) of lateral-flow assays has limited scale-up. Conceivably, microfluidic immunofluorescence Ag-RDTs could increase sensitivity for SARS-CoV-2 detection. Methods This multi-centre diagnostic accuracy study investigated performance of the microfluidic immunofluorescence LumiraDx™ assay, enrolling symptomatic and asymptomatic participants with suspected SARS-CoV-2 infection. Participants collected a supervised nasal mid-turbinate (NMT) self-swab for Ag-RDT testing, in addition to a professionally collected nasopharyngeal (NP) swab for routine testing with reverse transcriptase polymerase chain reaction (RT-PCR). Results were compared to calculate sensitivity and specificity. Sub-analyses investigated the results by viral load, symptom presence and duration. An analytical study assessed exclusivity and limit-of-detection (LOD). In addition, we evaluated ease-of-use. Results The study was conducted between November 2nd 2020 and 4th of December 2020. 761 participants were enrolled, with 486 participants reporting symptoms on testing day. 120 out of 146 RT-PCR positive cases were detected positive by LumiraDx™, resulting in a sensitivity of 82.2% (95% CI 75.2–87.5%). Specificity was 99.3% (CI 98.3–99.7%). Sensitivity was increased in individuals with viral load ≥ 7 log10 SARS-CoV2 RNA copies/ml (93.8%; CI 86.2–97.3%). Testing against common respiratory commensals and pathogens showed no cross-reactivity and LOD was estimated to be 2–56 PFU/mL. The ease-of-use-assessment was favourable for lower throughput settings. Conclusion The LumiraDx™ assay showed excellent analytical sensitivity, exclusivity and clinical specificity with good clinical sensitivity using supervised NMT self-sampling. Trial registration number and registration date DRKS00021220 and 01.04.2020

Background The novel coronavirus pandemic (COVID-19) has catalyzed the development of online educational resources. Webinars provide opportunities for convenient distance-learning and provision of expert lectures, while reducing the financial and practical costs of attending conferences. This cross-sectional survey aims to collect subjective opinion on the usefulness of webinars as an educational platform compared to face-to-face interactions, and whether surgeons and surgeons-in-training want webinars to remain a permanent platform for training and development in the future. Methods A free-to-attend online series of international expert lectures on a range of plastic surgery topics was delivered. Attendees were invited to anonymously complete a survey on attitudes towards webinars as an educational platform over a 2-week period. Results A total of 883 complete responses were collected. Overall webinar attendance increased following the pandemic, with 97.4% of respondents reporting they view webinars for at least 1 h per week following implementation of COVID-19 restrictions. 90.4% respondents indicated that they intend to continue utilizing webinars even once COVID-19 restrictions are eased, and 77.8% stated they learn as much from online webinars as in-person lectures. However, irrespective of training grade, a significant proportion of respondents believe webinars should not replace face-to-face meetings. Conclusions This study provides evidence that, while face-to-face meetings remain a valued component of education in Plastic Surgery, webinars are a useful adjunct to conventional methods, and may feature more prominently in the educational landscape of the future. Level of evidence: Not gradable.

Purpose The risk psychological distress (PD) confers on mortality due to specific chronic diseases compared to suicide is unclear. Using the National Health Interview Survey (NHIS), we investigated the association between PD levels and risk of all-cause and chronic disease-specific mortality and compared the contribution of chronic disease-related mortality to that of suicide. Methods Data from 195, 531 adults, who participated in the NHIS between 1997 and 2004, were linked to the National Death Index records through to 2006. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) across four levels of PD, measured using the Kessler-6 scale. Outcomes included all-cause mortality, and mortality due to all CVDs and subtypes, all cancers and subtypes, diabetes mellitus, alcoholic liver disease and suicide. Results During a mean follow-up time of 5.9 years, 7665 deaths occurred. We found a dose–response association between levels of PD and all-cause mortality, with the adjusted HRs (95% CI) elevated for all levels of PD, when compared to asymptomatic levels: subclinical 1.10 (1.03–1.16), symptomatic 1.36 (1.26–1.46) and highly symptomatic 1.57 (1.37–1.81). A similar association was found for all CVDs and certain CVD subtypes, but not for cancers, cerebrovascular diseases diabetes mellitus. Excess mortality attributable to suicide and alcoholic liver disease was evident among those with levels of PD only. Conclusion PD symptoms, of all levels, were associated with an increased risk of all-cause and CVD-specific mortality while higher PD only was associated with suicide. These findings emphasise the need for lifestyle interventions targeted towards improving physical health disparities among those with PD. Supplementary Information The online version contains supplementary material available at 10.1007/s00127-021-02116-7.

Purpose The adverse impact of hearing loss (HL) extends beyond auditory impairment and may affect the individuals' psychosocial wellbeing. We aimed to examine whether there exists a causal psychosocial pathway between HL and depression in later life, via socioeconomic factors and quality of life, and whether hearing aids usage alleviates depressive symptoms over time. Methods We examined the longitudinal relationship between HL and depressive symptoms (CES-D) applying dynamic cross-lagged mediation path models. We used the full dataset of participants aged 50–89 years (74,908 person-years), from all eight Waves of the English Longitudinal Study of Ageing (ELSA). Their quality of life (CASP-19) and their wealth were examined as the mediator and moderator of this relationship, respectively. Subgroup analyses investigated differences among those with hearing aids within different models of subjectively and objectively identified HL. All models were adjusted for age, sex, retirement status and social engagement. Results Socioeconomic position (SEP) influenced the strength of the relationship between HL and depression, which was stronger in the lowest versus the highest wealth quintiles. The use of hearing aids was beneficial for alleviating depressive symptoms. Those in the lowest wealth quintiles experienced a lower risk for depression after the use of hearing aids compared to those in the highest wealth quintiles. Conclusion HL poses a substantial risk for depressive symptoms in older adults, especially those who experience socioeconomic inequalities. The early detection of HL and provision of hearing aids may not only promote better-hearing health but could also enhance the psychosocial wellbeing of older adults, particularly those in a lower SEP.

A prominent characteristic of the COVID-19 pandemic is the marked geographic variation in COVID-19 prevalence. The objective of the current study is to assess the influence of population density and socio-economic measures (socio-economic ranking and the Gini Index) across cities on coronavirus infection rates. Israel provides an interesting case study based on the highly non-uniform distribution of urban populations, the existence of one of the most densely populated cities in the world and diversified populations. Moreover, COVID19 challenges the consensus regarding compact planning design. Consequently, it is important to analyze the relationship between COVID19 spread and population density. The outcomes of our study show that ceteris paribus projected probabilities to be infected from coronavirus rise with population density from 1.6 to 2.72% up to a maximum of 5.17-5.238% for a population density of 20,282-20,542 persons per square kilometer (sq. km.). Above this benchmark, the anticipated infection rate drops up to 4.06-4.50%. Projected infection rates of 4.06-4.50% are equal in cities, towns and regional councils (Local Authorities) with the maximal population density of 26,510 and 11,979-13,343 persons per sq. km. A possible interpretation is that while denser cities facilitate human interactions, they also enable and promote improved health infrastructure. This, in turn, contributes to medical literacy, namely, elevated awareness to the benefits associated with compliance with hygienic practices (washing hands), social distancing rules and wearing masks. Findings may support compact planning design principles, namely, development of dense, mixed use, walkable and transit accessible community design in compact and polycentric regions. Indeed, city planners should weigh the costs and benefits of many risk factors, including the COVID19 pandemic.

Background A small aortic annulus is associated with increased risk of prosthesis–patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI). Whether specific transcatheter heart valve (THV) designs yield superior hemodynamic performance in these small anatomies remains unclear. Methods Data from 8411 consecutive patients treated with TAVI from May 2012 to April 2019 at four German centers were retrospectively evaluated. A small aortic annulus was defined as multidetector computed tomography-derived annulus area 2. TAVI was performed with a balloon-expanding intra-annular (Sapien-3, n = 288), self-expanding intra-annular (Portico, n = 110), self-expanding supra-annular (Evolut, n = 179 and Acurate-Neo, n = 428) and mechanically expanding infra-annular (Lotus, n = 64) THV according to local practice. PPM was defined as indexed effective orifice area ≤ 0.85cm2/m2. Results A small annulus was found in 1069 (12.7%) patients. PPM was detected in 38.3% overall with a higher prevalence after implantation of a balloon-expanding intra-annular or mechanically expanding infra-annular THV compared to self-expanding intra- and supra-annular THV. Multivariable analysis linked self-expanding THV (Evolut: Odds ratio [OR] 0.341, Acurate-Neo: OR 0.436, Portico: OR 0.291), postdilatation (OR 0.648) and age (OR 0.968) to lower rates of PPM, while aortic valve calcification was associated with an increased risk (OR 1.001). Paravalvular regurgitation > mild was more frequent after TAVI with self-expanding THV (p = 0.04). Conclusion In this large contemporary multicenter patient population, a substantial number of patients with a small aortic anatomy were left with PPM after TAVI. Self-expanding supra- and intra-annular THV demonstrated superior hemodynamics in these patients at risk, however at the cost of higher rates of residual paravalvular regurgitation. Graphic abstract

Purpose The incidence of bone and joint infections is increasing while their treatment remains a challenge. Although guidelines and recommendations exist, evidence is often lacking and treatment complicated by complex clinical presentations and therapeutic options. Interdisciplinary boards shown to improve management of other diseases, seem potentially helpful. We describe the establishment of an osteomyelitis board to show the existing demand for such a platform. Methods All patients discussed in the board for bone and joint infections between October 2014 and September 2020 were included in this retrospective study. Data were extracted from patient records and analyzed descriptively. Results A total of 851 requests related to 563 patients were discussed in the board during the study period. After a run-in period of 3 years, a stable number of cases (> 170/year) were discussed, submitted by nearly all hospital departments (22 of 25). Recommendations were mainly related to antibiotic treatment (43%) and to diagnostics (24%). Periprosthetic joint infections were the most frequent entity (33%), followed by native vertebral osteomyelitis and other osteomyelitis. In 3% of requests, suspected infection could be excluded, in 7% further diagnostics were recommended to confirm or rule out infection. Conclusions A multidisciplinary board for bone and joint infections was successfully established, potentially serving as a template for further boards. Recommendations were mainly related to antibiotic treatment and further diagnostics, highlighting the need for interdisciplinary discussion to individualize and optimize treatment plans based on guidelines. Further research in needed to evaluate impact on morbidity, mortality and costs.

Purpose Migrant children underutilize mental health services (MHS), but differences according to age, reason for migration, type of problem, and time have not been thoroughly analyzed. We aimed to explore utilization of MHS among migrant children and youth and to study if the hypothesized lower utilization could be explained by fewer neurodevelopmental assessments. Methods A cohort of the population aged 0–24 years in Stockholm, comprising 472,129 individuals were followed for maximum 10 years, between January 1, 2006 and December 31, 2015. We categorized individuals as accompanied refugee migrants, unaccompanied refugee migrants and non-refugee migrants, or Swedish-born. We used survival and logistic analyses to estimate rates of utilization of MHS. Results Migrant children and youth utilized less MHS than the majority population, with hazard ratios ranging from 0.62 (95% CI: 0.57; 0.67) to 0.72 (95% CI: 0.69; 0.76). Refugee and non-refugee children utilized less mental health care than their Swedish peers, apart from the youngest refugees (0–10 years) who had similar utilization as Swedish-born. The lower rates were partly explained by all migrant youths’ lower risk of being diagnosed with a neurodevelopmental condition. Time in Sweden had a major impact, such that unaccompanied refugee minors had a higher utilization in their first 2 years in Sweden (OR: 3.39, 95% CI: 2.96; 3.85). Conclusion Migrant youth use less MHS compared with native-born peers, and this is partly explained by fewer neurodevelopmental diagnoses. Strengthening the awareness about unmet needs, and the referring capacity by professionals in contact with migrant children could help reduce barriers to care.

Purpose Recently discovered molecular classifications for urothelial bladder cancer appeared to be promising prognostic and predictive biomarkers. The present study was conducted to evaluate the prognostic impact of molecular subtypes assessed by two different methodologies (gene and protein expression), to compare these two approaches and to correlate molecular with histological subtypes in a consecutively collected, mono-institutional muscle-invasive bladder cancer (MIBC) cohort. Methods 193 MIBC were pathologically re-evaluated and molecular subtypes were assessed on mRNA (NanoString technology, modified 21-gene-containing MDACC approach) and protein levels (immuno-histochemical [IHC] analysis of CK5, CK14, CD44, CK20, GATA3 and FOXA1). Descriptive statistical methods and uni-/multi-variable survival models were employed to analyze derived data. Results Neither gene expression nor protein-based subtyping showed significant associations with disease-specific (DSS) or recurrence-free survival (RFS). Agreement between mRNA (reference) and protein-based subtyping amounted 68.6% for basal, 76.1% for luminal and 50.0% for double-negative tumors. Histological subtypes associated with RFS in uni-variable (P = 0.03), but not in multivariable survival analyses. Tumors with variant histology predominantly showed luminal subtypes (gene expression subtyping: 36/55 cases, 65.5%; protein subtyping: 44/55 cases, 80.0%). Squamous differentiation significantly associated with basal subtypes (gene expression subtyping: 44/45 squamous cases, 97.8%; protein subtyping: 36/45 cases, 80.0%). Conclusion In our consecutive cystectomy cohort, neither gene, protein expression-based subtyping, nor histological subtypes associated with DSS or RFS in multi-variably adjusted survival analyses. Application of a limited IHC subtyping marker panel showed high concordance of 83.9% with gene expression-based subtyping, thus underlining the utility for subtyping in pathological routine diagnostics. In addition, histological MIBC subtypes are strong indicators for intrinsic subtypes.

Background Heyde syndrome (HS) is known as the association of severe aortic stenosis (AS) and recurrent gastrointestinal bleeding (GIB) from angiodysplasia. Data on the prevalence of HS and results after TAVI remain scarce. Methods 2548 consecutive patients who underwent TAVI for the treatment of AS from 2008 to 2017 were evaluated for a history of GIB and the presence of HS. The diagnosis of HS was defined as a clinical triad of severe AS, a history of recurrent GIB, and an endoscopic diagnosis of angiodysplasia. These patients (Heyde) were followed to investigate clinical outcomes, bleeding complications and the recurrence of GIB and were compared to patients with GIB unrelated to HS (Non-Heyde). Results A history of GIB prior to TAVI was detected in 190 patients (7.5%). Among them, 47 patients were diagnosed with HS (1.8%). Heyde patients required blood transfusions more frequently compared to Non-Heyde patients during index hospitalization (50.0% vs. 31.9%, p = 0.03). Recurrent GIB was detected in 39.8% of Heyde compared to 21.2% of Non-Heyde patients one year after TAVI (p = 0.03). In patients diagnosed with HS and recurrent GIB after TAVI, the rate of residual ≥ mild paravalvular leakage (PVL) was higher compared to those without recurrent bleeding (73.3% vs. 38.1%, p = 0.05). Conclusion A relevant number of patients undergoing TAVI were diagnosed with HS. Recurrent GIB was detected in a significant number of Heyde patients during follow-up. A possible association with residual PVL requires further investigation to improve treatment options and outcomes in patients with HS. Graphic abstract

This article synthesises and highlights outcomes from a governance and risk forum that identified emerging risks for businesses and organisations. A governance framework is first presented followed by a discussion of recent developments in relation to elements of the framework as part of a mini-review of the literature. Emerging risks and opportunities around the changing nature of work, corporate culture, blockchain and cyber security were highlighted, with a particular emphasis on climate-related risks. Key questions to ask as a non-executive director or governance and risk committee members regarding these risks include could our sector or organisation be impacted by these emerging risks and opportunities? What could be the implications if these risks were to materialise and to what extent will our current business and operating model be impacted? How could our organisation be seizing the opportunity created by the pending changes in these areas? The findings and implications of the governance and risk issues are highlighted for the extractives sector and are especially important as the extractive sector faces challenges in its transformation. The study is novel as it highlights insights from the practitioner perspective of governance which is not captured in the literature. Recommended remedies for each risk are provided, and businesses are advised to undertake a focused review of non-financial risks, including corporate or organisational culture.