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Aim High level evidence recommends the use of mesh for umbilical hernias with defects >1 cm to reduce recurrence rates without increasing the risk of postoperative complications. For umbilical hernias with defect width ≤1 cm, the literature is sparse. The aim of the study was to assess outcomes after suture and mesh repair of umbilical hernias with defect width Material and Methods By merging data from the Danish Hernia Database and the National Patients Registry from January 2007 until December 2018, patients receiving elective repair of an umbilical hernia with defect width ≤1 cm were identified. Available data included details about comorbidity, surgical technique, 90-days readmission, 90-days reoperation and reoperation for recurrence. Results A total of 7,849 patients were included, of whom 25.7% (2,013/7,849) underwent mesh repair. The cumulative 5-year incidence of reoperation for recurrence was significantly decreased after mesh repair 3.1% (95% C.I. 2.1-4.1) compared with suture repair 6.7% (95% C.I. 6.0-7.4), P Conclusions Even for the smallest umbilical hernias, mesh repair significantly decreased the recurrence rate. Onlay mesh repair was associated with the lowest risk of recurrence without increasing early complications.

Case report - Introduction Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large- and medium-sized arteries. Classic symptoms include headache, scalp tenderness, jaw claudication and visual disturbances. Ophthalmic artery involvement commonly causes anterior ischaemic optic neuropathy. Uncommon ocular features include anterior segment ischaemia, hypotony, tonic pupil or rarely choroidal ischaemia. Heterogenicity of presentation can make diagnosis difficult leading irreversible visual loss. We report a case of bilateral macular choroidal ischaemia with atypical symptoms of GCA. It emphasises the need of complete evaluation in elderly patients with GCA and visual symptoms and the need to start aggressive treatment to prevent visual loss. Case report - Case description 73-year-old caucasian lady presented to the eye emergency department with diplopia. Medical history includes systemic hypertension, hypothyroidism and hyperlipidaemia, no past ocular history. Eye examination was normal except decompensated fourth nerve paresis. Thyroid function was normal. Diplopia resolved spontaneously. Patient re-presented with a floater in the right eye and left-sided atypical headache without jaw claudication. Investigations: normal FBC, CRP 126, ESR 100, PV 1.67. Following rheumatologist review she was commenced on oral prednisolone 60 mg with clinical suspicion of GCA. Temporal artery biopsy confirmed GCA. She had TIA subsequently. MRI revealed small area of acute infarct in left ganglio-capsular region. Clopidogrel was started for secondary prevention. In the ophthalmology clinic she saw a lacy pattern. Her Log MAR VA in right and left eye was 0.64 and 0.76, respectively. Fundoscopy revealed retinal pigment epithelial (RPE) mottling at the maculae, right more than left eye. Optical Coherence Tomography (OCT) macula revealed bilateral RPE elevations and serous pigment epithelial detachment bilaterally, patchy central RPE atrophy with external limiting membrane disruption, more pronounced in the right eye. Fundus fluorescein angiogram and indocyanine green angiography confirmed bilateral choroidal ischaemia (triangular shaped with the base at the equator) at the macula worse in right than left eye. Oral prednisolone was continued with gradual tapering. VA improved to Log MAR 0.5 and Log MAR 0.2 in right and left eye at six weeks. OCT showed signs of RPE re-modelling with resolution of sub retinal fluid (resolution of inflammation). At recent follow up Log MAR VA is 0.26 and 0.06 in right and left eye respectively. She is on oral prednisolone 20 mg once a day tapering 2.5 mg every 2 weeks. OCT shows further re-modelling of the ellipsoid zone in the left eye, but her right eye shows more RPE atrophy and thinning with RPE degeneration. Case report - Discussion We report an unusual case of GCA with atypical symptoms and bilateral choroidal ischaemia. Patients with GCA usually present with systemic symptoms and signs like headache, scalp tenderness, fever, and jaw claudication. Variable presentation can often lead to misdiagnosis and consequent irreversible loss of vision. Visual symptoms as the first and only sign of GCA was first reported in 1952. Posterior ciliary arteries in the eye can be affected leading to optic nerve infarction and subsequent anterior ischaemic optic neuropathy (AION). AION and visual field loss accounts for 80—90% of cases with ocular signs of GCA. Posterior ciliary artery occlusion can rarely cause patches of choroidal infarcts which appear as chorio-retinal degeneration in a couple of weeks. These patches are usually in the mid-peripheral fundus, usually triangular shaped with the base towards equator and apex toward posterior pole. In our case the presentation was very atypical in the sequence of symptoms. Her raised inflammatory markers raised the suspicion of GCA and prompt referral to rheumatology was done. Aggressive treatment with oral steroids was started with stomach and bone protection. Temporal artery biopsy confirmed the diagnosis. The bilateral triangular ischaemic areas found on FFA and ICG confirmed the macular choroidal ischemia. Her OCT also showed bilateral RPE mottling showing degenerative changes due to choroidal infarct from posterior ciliary artery occlusion. We managed to preserve the vision in our case by starting the timely aggressive steroid treatment. In summary, we report an unusual case of GCA with atypical symptoms and bilateral choroidal ischaemia where further visual loss was avoided due to timely intervention. GCA has variety of presentations; a combined team approach of ophthalmologists and rheumatologists can prevent irreversible visual loss in such cases. Case report - Key learning points GCA is a chronic idiopathic inflammation more commonly seen in the large- and medium-sized vessels. Posterior ciliary arteries in the eye can be affected in GCA leading to optic nerve infarction and subsequent anterior ischaemic optic neuropathy (AION). AION and visual field loss accounts for 80—90% of cases with ocular signs of GCA. Posterior ciliary artery occlusion can rarely cause patches of choroidal infarcts which appear as chorio-retinal degeneration in a couple of weeks. These patches are usually in the mid-peripheral fundus, usually triangular shaped with the base towards equator and apex toward posterior pole. Prompt diagnosis and aggressive treatment with corticosteroids can prevent visual loss in one or both eyes. Any patient over 50 years of age presenting with visual symptoms of amaurosis fugax, diplopia, or visual loss with ocular signs of anterior or posterior ischaemic optic neuropathy, central retinal artery occlusion or cilioretinal artery occlusion should create a high suspicion for GCA. This group of patients should have urgent ESR, CRP and PV evaluation. If suspected, high-dose corticosteroids must be started followed by temporal artery biopsy for confirmation. It is imperative to diagnose GCA early and start treatment urgently to prevent visual loss. A multidisciplinary team approach in patients with GCA can prevent sight loss and life too.

Introduction The number of patients on intensive care units (ICU) increased manifold during the initial COVID-19 surge and medical staff were relocated to help compensate. The need for central venous catheters (CVCs) increased accordingly and comprised a significant workload under challenging circumstances. Several models were proposed to manage the lines. We assigned a vascular team of vascular surgeons and interventional radiologists for CVCs in ICU. We report on the workload, outcomes and lessons learned. Method 50 consecutive ventilated COVID-19 patients in ICU (median age 63 years, 80% male) who had a CVC inserted by the vascular team from March to May 2020 were assessed. Median follow up was 18 days (range 14– 29 days) after ICU admission. Result 166 CVCs (80 VasCaths) were inserted. Femoral access was preferred. Each patient required a median of 3 lines (IQR 2–4). CVCs were exchanged after median 7 days (IQR 4–9) for thrombosis (35%), infection (24%) or prophylactically (41%). Our learning curve included the establishment of an online referral pathway, CVC teams of two operators, extended disposable CVC kits and ICU based ultrasound scanners. Additional staffing and retraining were avoided. There were no technical complications. Conclusion Ventilated COVID-19 patients require multiple CVCs which is a challenging workload during a pandemic. Vascular surgeons and interventional radiologists with endovascular skills are well positioned to perform central venous cannulation to alleviate the burden on critical care teams. Our lessons learned can help to provide a safe and efficient model amidst the ongoing national outbreaks. Take-home Message With the postponement of many elective vascular procedures during the pandemic crisis, the involvement of vascular surgeons in a dedicated Lines team is an important way that they can contribute given their proficiency with wires and cannulation equipment, as well as familiarity in femoral triangle and jugular anatomy. The retraining of staff and additional on-call rotas can then be avoided.

Background/Aims Younger and older people with rheumatic diseases may experience increased anxiety during the COVID-19 pandemic, due to the uncertainty regarding their likelihood of contracting the virus, its complications alongside their existing condition and whether their immunosuppressive treatments pose additional risks. This study explored trajectories of anxiety in parents of children and young people (CYP) with rheumatic diseases and adults with rheumatic diseases in the six months following March 2020 during the COVID-19 pandemic. Methods CYP and adults recruited to the international COVID-19 European Patient Registry, a parent-led, online, self-referred prospective cohort recruiting participants globally, were selected if enrolled within 20th March to 17th April 2020. Anxiety scores (0-10, 10=Highest anxiety) were collected weekly for up to 28 weeks and denoted parent anxiety in the CYP cohort and self-reported anxiety in the adult cohort. Group-based trajectory models explored anxiety clusters using censored-normal models in the CYP and adult populations, separately. Linear, quadratic and cubic polynomials were tested within 1 to 10 clusters and optimal models selected based on a combination of model fit (BIC), parsimony and clinical plausibility. Demographic (country, age, gender) and clinical (diagnosis, disease control, respiratory comorbidity, immunosuppressive therapy) information and COVID-19 mitigation behaviours (isolation, distancing, none) were collected at initial enrolment and compared between clusters using Chi-squared, Fisher’s exact and Kruskal-Wallis tests. Results Among 498 CYP and 2640 adults, most were female (65%, 89%) and from the UK (50%, 84%), respectively. The most common diagnoses were polyarticular JIA (37%) and oligoarticular JIA (29%) among CYP and RA among the adults (63%). Respiratory comorbidities were uncommon in the CYP (10%) and adult (17%) cohorts, and most were taking any immunosuppressive therapies (85%, 87%), respectively. As of March 2020, 88% and 79% were self-isolating, respectively. In both the parents of CYP and adult cohorts, four trajectory clusters were identified with similar patterns: Persistent extremely high anxiety (32%, 17%), persistent high anxiety (43%, 41%), high anxiety that marginally improved (25%, 32%) and moderate anxiety that improved (11%, 10%). Among CYP, few characteristics distinguished the clusters. However, in the adult cohort, clusters with greater and more persistent anxiety were associated with higher levels of respiratory comorbidities, higher use of immunosuppressive therapies, higher initial levels of self-isolation and slightly older age than those with lower or improving anxiety over time. Conclusion This study reports four trajectories of anxiety during the COVID-19 pandemic that are consistent across parents of CYP with rheumatic diseases and among adults with these conditions. Despite relatively lower risks for CYP, parental anxiety regarding COVID-19 was high and not associated with characteristics of their child or of their child's disease. Among adults with rheumatic diseases, greater anxiety was associated with risk factors potentially associated with COVID-19 morbidity and mortality. Disclosure S.J.W. Shoop-Worrall: None. S.M.M. Verstappen: None. W. Costello: None. S.P. Angevare: None. Y. Uziel: None. C. Wouters: None. N. Wulffraat: Honoraria; Sobi. Grants/research support; Abbvie. R. Beesley: None.

Introduction Fine Needle Aspiration Cytology (FNAC) is the best diagnostic tool for evaluating thyroid nodules pre-operatively. The Bethesda System for Reporting Thyroid Cyto-pathology (TBSRTC) in America and THY classification in Europe are standardized reporting systems for thyroid FNAC specimens using six categories. As compared to the first edition in 2009, a second edition of TBSRTC published in 2017 has revised risk of malignancy (ROM) for these categories, with focus on atypia of unknown significance (Thy3A) upgraded to 10-30% from previously 5-15%, and suspicion for follicular neoplasm (Thy3F) 25-40% from previous 15-30%. Method A three-year audit of thyroid surgeries performed in two high volume thyroid institutions from January 2016 to September 2019, was performed retrospectively. The FNAs were performed by thyroid specialist radiologists with a cytopathology technician in attendance for rapid on-site evaluation and reported as per TBSRTC and Thy classification, by a Consultant Cyto-pathologist from a single institution. Result A total of 702 patients were examined. There were 552 patients who had corresponding FNAC prior to surgery (mean age 53.6 years, females 79%). The rates of malignancy were, Thy1: 9.3%, Thy2: 4.6%, Thy3A: 10.8%, Thy3F: 28.7%, Thy4: 82.3% and Thy5: 100%. The main types of thyroid malignancy were Papillary (73.6%), Follicular (14.1%), Medullary (4%), Anaplastic (4.7%) and others (3.6%). Conclusion Pre-operative diagnosis of thyroid nodules using TBSRTC was comparable and the criteria helped avoid misinterpretation of results. Our results were comparable with the risk of malignancy in 2009 edition of TBSRTC, as compared to the 2017 revision. Take-home message Pre-operative diagnosis of thyroid nodules using The Bethesda System for Reporting Thyroid Cyto-pathology (TBSRTC) was comparable and the criteria helped avoid misinterpretation of results. Our results were comparable with the risk of malignancy in 2009 edition of TBSRTC, as compared to the 2017 revision.

Background There is limited evidence about fathers’ preferences related to using mHealth tools to receive nutrition and obesity prevention information for their preschool aged children. Objective The purpose of this qualitative study was to determine fathers’ preferred mHealth nutrition-related topics, features, and delivery methods. Study Design, Setting, Participants Low-income fathers (n = 29) of preschool aged children from 2 US states were individually interviewed by a trained research assistant using a semi-structured interview script. Measurable Outcome/Analysis Interview questions were based on the Theory of Planned Behavior to determine fathers’ subjective norms, preferences, and attitudes towards mHealth tools, content and video preferences, and behavioral intentions related to using mHealth tools. The classic analysis approach was used to determine major themes from transcribed interviews. Descriptive statistics of participants were derived from a demographics questionnaire. Results Fathers were, on average, 36 years old, and the majority were non-White (69%) and non-Hispanic (79%), with almost half having a high school education or less (48%). Overall themes indicated that fathers preferred mHealth tools such as an app, social media, videos, text messages, and email. There were mixed opinions on the use of memes and GIFs. Requested topics included healthy eating, child feeding, meal preparation, food safety, physical activity, and mental health related information. Features should include practical tips, meal plans, recipes, a calendar with healthy lifestyle reminders, options to connect with other fathers, and personalization for their child. Content should be short, funny, appealing, engaging, informational, beneficial, and include visuals, yet be credible, relatable, and straightforward. Frequency of information should be posted or shared every day or at least once or twice a week. Conclusion The use of an app or social media to communicate healthy eating and child feeding information to low-income fathers of preschool age children may be a viable nutrition education strategy. Funding NIFA.

Background A third of Sjögren’s syndrome (SS) patients develop ectopic lymphoid structures (ELS) in their salivary glands (SG). ELS play an active role in autoimmunity and contribute to the development of MALT lymphoma. Interleukin 27 (IL-27) exerts key immunomodulatory actions on numerous immune cells but its role in the formation and regulation of ELS in the SG of SS is unknown. Here we used a murine model of SG ELS to elucidate the role of IL-27 and its interaction with IL-17 in the development, regulation and function of ELS. We extended our observations on a cohort of SS patients to identify IL-27 cellular source, target cells and functional properties in modulating CD4 T cells function. Methods A single dose of reporter-encoding adenovirus was delivered directly to the SG of wild-type (WT) and IL-27RA-deficient (KO) mice to trigger ELS formation. For IL-17 blockade, anti-mouse IL-17A antibody was used. ELS development and peripheral immune responses were tracked by immuno-histopathology, FACS, and qPCR. Minor SG biopsies were collected from SS and non-specific sialadenitis (sicca) patients. Peripheral blood mononuclear cells (PBMC) isolated from SS and rheumatoid arthritis (RA) patients and age/sex-matched healthy donors (HD). For in vitro experiments PBMCs were incubated with IL-27 and analysed by FACS and cytokines levels were measured in culture supernatants. Tissue IL-27 was assessed by multicolour immunofluorescence. Results In WT mice, SG ELS formation was preceded by upregulation of IL-27p28 and infiltration of IL-27 producing cells. KO mice displayed larger, more abundant ELS in the SG. Higher expression levels of ELS-related genes (Cxcl13, Ccl19, Ltb, Aid) compared to WT mice were measured. KO mice showed an uncontrolled SG Th17 response and systemic IL-17A blockade caused a reduction in ELS size and in the expression of ELS-related genes. In SS patients SG and serum, we observed higher expression levels of IL-27 transcripts and protein, compared to sicca. SG IL-27 was selectively increased in ELS+ patients. IL-27 staining was detected in the T cell-rich areas of SG ELS often co-localizing with DC-LAMP+ dendritic cells. While IL-27 was able to significantly downregulate IL-17 production in HD and RA, CD4 T cells from patients with SS failed to downregulate IL-17 but showed an aberrant IFNγ release upon IL-27 incubation. Conclusion The IL-27-mediated restriction of Th17 expansion plays a critical role in the regulation of germinal centre response. Both in murine inducible ELS and in patients with SS, dendritic cells appear as the main cellular source of IL-27. IL-27 consistently failed to downregulate IL-17 release in CD4 T cells from SS patients, albeit its expression was increased in the ELS+ subset of SS, suggesting that a profound dysregulation of the IL-27/IL-17 axis play an important role in ELS formation in this condition. Disclosures D. Lucchesi None. R. Coleby None. E. Pontarini None. E. Prediletto None. F. Rivellese None. D. Hill None. A. Derrac Soria None. S. Jones None. I. Humphreys None. N. Sutcliffe None. A. Tappuni None. C. Pitzalis None. G. Jones None. M. Bombardieri None.

Background Clinical heterogeneity, a hallmark of systemic autoimmune diseases (SADs) impedes early diagnosis and effective treatment, issues that may be addressed if patients could be grouped into a molecular defined stratification. Methods With the aim of reclassifying SADs independently of the clinical diagnoses, unsupervised clustering of integrated whole blood transcriptome and methylome cross-sectional data of 918 patients with 7 SADs and 263 healthy controls was undertaken. An inception cohort prospectively followed for 6 and 14 months was studied to validate the results in early cases and analyze if cluster assignment was modified with time. Results Four clusters were identified Three aberrant clusters were ‘acute phase inflammatory’, ‘T cell immunity’, and ‘interferon’, each including all diagnoses, were defined by genetic, clinical, serological and cellular features. A fourth cluster showed no specific molecular pattern, to which 74% of healthy controls clustered with patients. The inception cohort showed that most patients were either assigned always to the same cluster or moved from the healthy-like cluster to a single aberrant cluster resembling the relapsing-remitting dynamic of these diseases, showing that single aberrant molecular signatures characterize each individual patient. Conclusions Patients with SADs share molecular signatures and can be therefore stratified into three disease clusters differentiating each patient into a specific molecular disease pathway. Such assignment is stable with time. These results have important implications for understanding disease progression and therapy design marking a paradigm shift in our view of SADs. Acknowledgment This work has been supported through a grant from the Innovative Medicines Initiative Joint Undertaking No. 115565 and in-kind and in-cash contributions from the EFPIA partners. G.B. is supported by the Instituto de Salud Carlos III (ISCIII, Spanish Health Ministry), through the Sara Borrell subprogram (CD18/00153). The authors would like to particularly express their gratitude to the patients, nurses and many others who helped directly or indirectly in the consecution of this study.

Content In Argentina the attention of some childhood diseases, such as cancer, is centralized in Buenos Aires. About half of the children who fall ill with cancer must migrate to another city in search of diagnosis or medical treatment for this disease. This gives rise to different forms of territorial mobility for access to health services, a topic that has not received much attention in medical anthropology. The aim of this presentation is to share the results of a doctoral research work about the therapeutic itineraries and care practices carried out by parents of children affected by cancer. The ethnographic fieldwork was carried out during May 2013 to December 2015 at a public Hospital located in Buenos Aires, as well as a non-governmental organization created to support low-income families who are suffering from this disease and, finally, a hotel where some families stay when they arrive to Buenos Aires during the period of the medical treatment and controls. The methodology consisted on observations and semi-structured interviews to child’s parents and primary carers. I will try to bring to discussion some theoretical and methodological implications about the notion of therapeutic itinerary, a category that has gained strength due to its enormous explanatory and analytical potential. Based on analyzing the reality of our health services, the work aims to expose the potential of ‘peripheral perspectives’1 to cope with a highly changing and uneven world. Reference Oliveira LRCd. O oficio do antropologo, ou como desvendar evidencias simbolicas.Anuario Antropologico Brasilia: Departamento de Antropologia, UnB, 2008 2007.

Objective To evaluate Rev It Up!, a pilot nutrition education curriculum for teens, when it is taught by either paraprofessional or professional educators. Use of Theory or Research Research shows teens consume low levels of fruits, vegetables, and whole grain foods; and excessive levels of sugar-sweetened beverages and fast foods. Further, they do not meet physical activity (PA) recommendations. Rev It Up!, which was informed by the Theory of Planned Behavior, addresses these issues with teens, an audience at the inception of controlling their own food choices. Target Audience Urban teens (N=118) in high school health classes participating in the NJ Expanded Food and Nutrition Education Program (EFNEP). Eighty-five were taught by professional staff (2018-2019 school year); the other 33 were taught by paraprofessionals (2019-2020 school year). Program Description Rev It Up! is a 10-lesson curriculum that employs gamification to provide nutrition and PA education. Evaluation Methods The curriculum was assessed using the EFNEP 9-12th Grade Nutrition Education Survey, pre- and post-education. Results Wilcoxon Signed Rank tests revealed that, pre- to post-intervention, students taught by professionals reported improvements in fruit consumption (P Conclusion Rev It Up! shows promise in being a curriculum that paraprofessionals can utilize to improve teen's nutrition behaviors. One limitation is that class periods were often too short to teach PA, which may account for the lack of reported improvements in PA behaviors. Future curriculum revisions should ensure that both nutrition and PA activities can be adequately addressed during allotted class periods. Funding Expanded Food and Nutrition Education Program.

BackgroundAnti-epileptic drug therapy is a great challenge for the practitioners during pregnancy and lactation. Levetiracetam (LEV) is commonly prescribed to pregnant women, however, there are only few publications on its use during lactation with small number of participants.ObjectiveTo monitor LEV levels in breast-milk of epileptic mothers treated with LEV.MethodsBreastfeeding women treated with LEV during pregnancy and after delivery were recruited. Milk sample was collected before administration of the drug and other samples were collected at time points of 1,3,6,9, and 12 hours after drug administration. Breastmilk and blood LEV levels were measured using HPLC.ResultsFourteen breastfeeding women participated in the study: 9 infants were fully breastfed whereas 5 were partially breastfed. Maternal average daily dose of LEV was 2517 mg. Average infant´s age was 8 weeks (3–22w). Average infant´s weight 4368 gr (3300–7000 gr). Milk/Plasma LEV concentration ratio was 0.88 (0.23–1.1). Relative Infant Dose (RID) was 40% in partial breast feeding, and 61% in full breastfeeding. Estimated average daily dose that all infants received through milk was 158 mg/d (83–250 mg). The normalized dose for the average infant weight per day was 36 mg, which is 15% less than the maximal daily dose of LEV in infants (max. daily dose in infants 1–6 months in 42 mg/d). No adverse reactions were observed in the breastfeed infants.ConclusionsAlthough the RID of LEV were found to be high, no adverse reactions were observed in the infants; Nevertheless, further studies are needed to elucidate the high variability of LEV excretion into breastmilk.Disclosure(s)Nothing to disclose

The lipopolysaccharides (LPS) of Proteus penneri 28 and Proteus vulgaris O31 (PrK 55/57) were degraded with dilute acetic acid and structurally identical high-molecular-mass O-polysaccharides were isolated by gel-permeation chromatography. Sugar analysis and nuclear magnetic resonance (NMR) spectroscopic studies showed that both polysaccharides contain D -GlcNAc, 2-acetamido-2,6-dideoxy- L -glucose ( L -2-acetamido-2,6-dideoxyglucose (N-acetylquinovosamine)) and 2-acetamido-3-O-[(S)-1-carboxyethyl]-2-deoxy- D -glucose (N-acetylisomuramic acid) and have the following structure: Download : Download full-size image where (S)-1-carboxyethyl [a residue of (S)-lactic acid] (S-Lac) is an ether-linked residue of (S)-lactic acid. The O-polysaccharide studied is structurally similar to that of P. penneri 26, which differs only in the absence of S-Lac from the GlcNAc residue. Based on the O-polysaccharide structures and serological data of the LPS, it was suggested classifying these strains in one Proteus serogroup, O31, as two subgroups: O(31a), 31b for P. penneri 28 and P. vulgaris PrK 55/57 and O31a for P. penneri 26. A serological relatedness of the LPS of Proteus O(31a), 31b and P. penneri 62 was revealed and substantiated by sharing epitope O31b, which is associated with N-acetylisomuramic acid. It was suggested that a cross-reactivity of P. penneri 28 O-antiserum with the LPS of several other P. penneri strains is due to a common epitope(s) on the LPS core.

Both NRT36S and A5 are NAG-ST-producing, serogroup O31 Vibrio cholerae. NRT36S is encapsulated and causes diarrhea when administered to volunteers; A5 is unencapsulated and does not colonize or cause illness in humans. The capsule/LPS (CPS/LPS) biogenesis regions in these two isolates were similar except that a 6.5-kb fragment in A5 has replaced a 10-kb fragment in NRT36S in the middle of the CPS/LPS gene cluster. Although the genes of the replaced region were homologous to genes from other CPS/LPS, they had little similarity to NRT36S and were not homologous to genes from other Vibrios. Data of this study highlight the apparent mobility within the CPS/LPS region that would provide a basis for the large number of observed V. cholerae serogroups and the emergence of novel epidemic strains.

Background/introduction Varied advice is given to women about testing for chlamydia (CT) and gonorrhoea (NG) whilst menstruating. Some are advised it makes no difference, others are advised not to test or are offered urine sampling instead of a vulvovaginal swab. There is no published evidence to inform such advice. Aim(s)/objectives To determine if menses affects the performance of CT/NG NAATs. Methods Using data collected in a large CT/NG NAATs diagnostic study we compared the prevalence of infections in menstruating women versus those not menstruating. Results Of the 3973 study participants 162 (4%) were menstruating and 3811 were not. 30 (18.5%) menstruating women had CT and 10 (6.2%) had NG; 380 (10%) non-menstruating women had CT and 90 (2.4%) had NG. Menstruating women were more likely to be diagnosed with CT (OR 2.05; p = 0.0008) and NG (OR 2.72; p = 0.0055); less likely to have had a previous STI (OR 0.66) and to have cervicitis (OR 0.21) but more likely to be a STI contact (OR 2.13) and have bacterial STI symptoms (OR 1.36). After adjusting for these confounding variables menstruating women remained more likely to be diagnosed with CT (Adjusted OR 1.98; 95% CI 1.27–3.09; p = 0.003). Discussion/conclusion Menses does not have a negative effect of the performance of CT/NG NAATs; in fact the prevalence of infections was higher in menstruating women. Only 4% of women were menstruating suggesting that women avoid attending for STI testing during their period unless really necessary. Hence testing should be performed during menstruation using vulvovaginal or endocervical swabs.

Methods: Out patients with RA fulfilling ACR 1987 criteria and healthy individuals (controls) not having renal failure or metabolic bone disease were included. Age, sex, overall pain and fatigue (Likert scale of 1–10), disease duration, current treatment, disease activity (DAS28–3) and functional status (mHAQ) were noted. Quality of life was assessed using WHOQol Bref, depression using BPHQ (brief patient health questionnaire) and HADS (hospital anxiety and depression scale). All have Hindi and English versions. Tender point examination was done and fibromyalgia was defined using ACR 1990 criteria. Statistical analysis was done using the t test and chi square test for univariate and linear regression for multivariate analysis.

The production and use of carbon nanotubes (CNTs) have become extremely wide within the last decade. Hence, the high interest in producing non-expensive and quality CNTs has motivated many research projects. This research considers the design and development of new technology for producing MWCNTs by electrolysis in molten salts using non-stationary and stationary current regimes. The electrolysis is simple, ecological, economical, and flexible, and it offers possibilities for accurate control of various parameters, such as applied voltage, current density, or temperature. We infer the underlying relationship between the parameters and the quality of the experimentally produced MWCNTs by using explainable tree-based Machine Learning (ML) models. We train several models in a supervised manner, whereas in model covariates, we use the parameters of the MCWNTs, and as a target variable, the quality of the produced MWCNT. Domain experts label all the experimental examples in our data set. Controlling these parameters enables high-yield production and, particularly important, obtaining MWCNTs, which are up to ten times cheaper than other existing technologies.

Mosquitoes are a great threat to human health to date and are a subject of interdisciplinary research involving scientists from many areas. Recently much attention has been put to novel approaches to mosquito repellent products that involve the use of novel materials, such as carbon nanomaterials, where it is essential to determine their properties. This research discusses the full molecular characterization of carbon nanotubes (CNTs) produced by electrolysis in molten salts. Each CNT has its mathematical representation due to its hexagonal lattice structure. Multi-wall carbon nanotubes (MWCNTs) are considered. The focus is on determining their structural parameters: innermost and outermost diameters, chiral indices m and n, number of walls, and unit cell parameters. Corresponding frequency parts of Raman spectra of four experimentally produced CNTs are elaborated, and Python programming and Mathematica are employed for the most accurate (m,n) assignment. Determining the chirality of these samples enables the calculation of other structural properties, which are performed now, including their graph representation. The latter enables the evaluation of different distance-based topological indices (Wiener, Balaban, Sum-Balaban, Harary index, etc.) to predict some index-related properties of the molecules.

The e-commerce market is considered one of the potential but fully competitive markets. However, it is also clear that gap-filling or market-dominating is a never-ending process in the e-commerce market. For this reason, this is one of the amazing playgrounds attracting many participants. The question is How and by which latecomer firms can enter and succeed in the existing e-commerce market. Therefore, this paper analyses the chances for latecomer enterprises to enter the competitive e-commerce market. To pursue this goal, the paper will analyze the role of the disruptive innovation theory and its e-commerce applications. The results reveal that applying disruptive business-model innovation is a better way for fledgling e-commerce brands to enter the existing market and succeed in competing with incumbents. Furthermore, the case of THE YES – a women’s fashion e-commerce platform, and Pinduoduo – a Chinese largest agriculture-focused technology platform, are also analyzed as practical cases to join the research’s results.

Die im Koalitionsvertrag skizzierte Innovationspolitik stellt einen Übergang zwischen traditioneller und transformativer Politik dar. Die aktuelle deutsche Innovationspolitik zeichnet sich, neben unternehmenszentrierten Maßnahmen, vor allem durch die Ausrichtung auf gesamtgesellschaftliche Ziele aus. Dies bedeutet eine graduelle Weiterentwicklung im Vergleich zur Vorgängerregierung. Im Zentrum steht die Reorganisation von Wissenstransfer für gesellschaftliche Transformationen. Auswirkungen der Innovationspolitik der Ampelkoalition ergeben sich in den Bereichen der Technologieoffenheit, der Legitimation der Politikmaßnahmen und der Partizipation bei Änderung der Zielsetzungen. The innovation policy of the new German government is at the threshold between the traditional and the transformative. In addition to company-oriented measures, current innovation policy in Germany is characterised above all by its orientation toward benefits for society as a whole. This represents an incremental development compared to the previous government. The focus is on reorienting knowledge transfer for societal transitions. Against this background, the innovation policy outlined in the coalition agreement contains traditional and transformative elements. Effects of the innovation policy arise in the areas of openness to technology, legitimacy of policy measures and participation.

The ever-increasing worldwide demand for automation has augmented the adoption of technologies such as artificial intelligence and machine learning for industrial developments. Among the recent technological advancements, intelligent robots are increasingly becoming an integral part of several firms. The study focuses on the impact of intelligent robots on productivity, competitiveness and how firms are leveraging automation. This study uses centering resonance analysis (CRA) to develop an empirically grounded understanding of the rationale for robotization, through secondary archived data. Through the content analysis of over 261 online published articles, we decipher the derived themes through the following theoretical frameworks: behavioral, economic, and operations management perspectives. The findings suggest that firms are leveraging the concept of robotization to increase performance, efficiency, and profit. The deployment of robots in various firm domains focuses on public welfare, consumer orientation, and a sustainable environment and agriculture. JEL classification: M15, O31, Q55, Códigos JEL: M15, O31, Q55, Keywords: Automation, Robotization, Text-mining, Centering resonance analysis, Empirical study

In his groundbreaking work Sources of Innovation, Eric von Hippel discussed from where in (and out of) the value-chain innovations came in different industries: the customer, the manufacturer, the supplier, or third-party innovator (universities, research laboratories, etc.).The world has changed, and new phenomena have become apparent. This article is a conceptual paper that discusses these new phenomena and presents a tentative updated pheno-typology of the sources of innovation, adding six to von Hippel's original four. To build these phenotypes it draws heavily on Kaulio (1998), Borrus and Zysman (1997) and Hart & Kim (2002).As principal take-away, the consequences for knowledge production and transfer are discussed for each of the 10 phenotypes, in comparison to the in-house, non-open innovation, default phenotype. JEL classification: O31, 032, Códigos JEL: O31, 032, Keywords: Innovation, Tacit knowing, Differentiation, Monopoly rent, Sources of innovation

We investigate how a firm's export activity and country idiosyncrasies determine the firm's adoption of environmental innovation (EI) as well as the firm's decision to extend its number of EI typologies. To this end, we append two waves of the Community Innovation Survey, differentiate our sample of 14 European countries into advanced and less-advanced countries, merge the resulting data with export statistics from theWorld Input-Output Tables and apply a hurdle negative binomial model. In a finding new to the literature, we reveal heterogeneous effects in how the firm's export activity determines its EI adoption decision, depending on the country the firm is based and which foreign market the firm serves. We do not find any export destination independent environmental premium to export activity for firms based in an advanced country, which replicates prior studies mainly focusing on single countries. Conversely, for firms based in less-advanced countries, we observe that increased export activity boosts EI adoption and the number of EI typologies adopted. Moreover, our empirical analysis reveals for firms based in both country groups that exports towards environmentally demanding countries boost EI, while there is no environmental premium of exports towards emerging countries. The importance of the direction of trade provides a novel perspective on regulation-push and demand-pull mechanisms as determinants of EI adoption, normally investigated for domestic markets, and in our paper extended to foreign markets with a different set of stakeholders preferences...

The paper aims to assess how public support for innovation activities influences the economic performance of Czech companies. In the framework of the research, attention was paid to more than 600 Czech companies that received support to start their innovation activities. The analysis was performed on the case of the Innovation Program, which was co-financed by the European Regional Development Fund. The Innovation Program is the largest Czech program for innovation support and mainly supports the launching of technological innovations in practice. The detailed analysis included 214 defined enterprises, for which all necessary information was available. The research analyzed the turnover of companies before obtaining support and after the implementation of the project. The research results show how the grant affects different size categories of enterprises and how the effect of the aid varies across sectors of the national economy. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

The paper intends to scrutinize the effects of augmented (AR) reality and virtual reality (VR) technology implementation in cultural tourism. Therefore, the paper explored and presented the following: (i) AR, and VR (AR/VR) based technology concept in general, (ii) AR/VR technologies application in cultural tourism with an emphasis on their potential to protect cultural heritage; (iii) the overview of AR/VR presence in cultural tourism in the 27 European Union countries (EU-27). In the discussion part, besides empirical results based on the EU-27 desk research, AR/VR technologies in cultural tourism are additionally reconsidered from the aspect of climate change. In conclusion, what is encouraged is the application of AR/VR in cultural tourism due to the benefits AR and VR bring in terms of (i) delivering quite substantial content to their visitors any time from any place, (ii) reducing the negative impact of tourism on cultural heritage and (iii) developing related strategies based on more sustainable principles and concepts. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

With the advertising industry and practice changing significantly in the last decade, it is likely that the existing management practices in advertising agencies also need some transformation. Through exploring management innovation principles and practices, novel practices might be applied by advertising agencies to exploit changes in their environment and enhance organizational performance. This paper explores the application and framework for novel management practices in an advertising agency. A proposed model is based on the principles of management innovation and the activities needed to drive management innovation. The topic is relevant for advertising agencies to understand better management innovation possibilities and enhancement it could create for them to compete in new markets and stay ahead of new competition. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Based on Schumpeterian theoretical considerations, this paper investigates the innovation behavior of firms during the severe economic crisis of the year 2008/2009. It focuses on transition countries of Central and Eastern Europe and Central Asia, which have completely restructured their innovation systems through the course of transition from planned to market economies a relatively short time ago. As a result of the crisis, we observe a strong decline of innovation activity in all transition economies. In line with the literature, there is, however, empirical evidence for both creative destruction as well as creative accumulation. This underlines two key findings: firstly, the universality and durability of Schumpeterian assumptions, and secondly, a call for anti-cyclical innovation policy.

The FinTech innovation of e-money products in the financial sector has not gained sufficient recognition in Nigeria’s developing country. Despite the numerous economic benefits associated with this innovation, physical cash for financial transactions is still prevalent. Banks are still experiencing some level of cash withdrawals and deposits by individuals who refuse to embrace modern technology. This study stresses the economic benefits of e-payment channels available today and statistically supports evidence to substantiate their usefulness. In this study, we use banks’ e-money products as the independent variables, while GDP is employed as a proxy for the economy. The data are collected from 2006-2019 and are analyzed with multiple regression techniques using E-views version 9 software. The result shows that all banks’ e-money products have a significant favorable influence on the economy except the POS that is yet to gain momentum. The study suggests the full implementation of the cashless policy, proper education of the populace and guidelines to check electronic fraud.

Mit Patentdaten der weltweit forschungsstärksten Unternehmen lassen sich Informationen über die regionale und technologische Verteilung ihrer Forschungsaktivitäten generieren. Daraus ergeben sich Anhaltspunkte zu den Motiven der Internationalisierung. Unternehmen betreiben Forschung und Entwicklung im Ausland überwiegend in technologischen Feldern, wo sie bereits stark sind und der ausländische Standort über Vorteile verfügt. Die wichtigsten Heimatländer forschender Unternehmen sind auch die wichtigsten Zielländer der Auslandsforschung. Somit dürften nicht nur die Unternehmen, sondern auch diese Forschungsstandorte von der Internationalisierung der Forschung und Entwicklung profitieren. Patent data from the world's top corporate R&D investors can be used to generate information on the regional and technological distribution of their research activities. This provides clues about the motives for internationalisation. Companies conduct R&D abroad predominantly in technological fields where they have a domestic advantage and the foreign location has advantages. The most important home countries of research-based companies are also the most important target countries for research abroad. Thus, both the companies and the research locations are likely to benefit from the internationalisation of R&D.

This paper analyses correlations between several organizational characteristics and product/process innovations in enterprises in Serbia. We used the World Bank Enterprise Survey data on 339 small, medium, and large companies from various industries. Many of the factors analysed in this study are consistent with theoretical conclusions in the literature on this topic and relate to organizational maturity. Also, factors such as the size of the company and the industry to which it belongs were analysed. For correlations testing, the Chi-square correlation coefficient and the Cramer’s V test were used. The analysis revealed correlations between innovativeness and many organizational characteristics. However, in some cases, contrary to theoretical claims, correlations were not confirmed. We found that the introduction of new products and/or processes in the company is influenced by business strategy, production targets, number of performance indicators monitored, establishment of quality management system, formal training programs for company’s full-time employees, ease of achieving the company’s production targets, level of awareness of management and employees about the company’s production targets, spending on research and development activities within the company, and acquisition of external knowledge, way of promoting non-managers in a company, time frame of the company’s production targets, company’s size and main market.

The Great Financial Crisis of 2008 exposed certain weaknesses in the field of investment banking and the necessity to adapt certain innovative solutions to the newly created economic and financial environment. The process of securitization is a financial innovation, which some financial analysts consider one of the causes of the Great Financial Crisis. Although it is often linked to the emergence of the Great Financial Crisis, the advantages of the securitization model, together with a level of adaptability and enhanced process control throughout all procedural levels, significantly outweigh its perceived shortcomings. The financial system of the Republic of Srpska continues to be characterized by the growth of nonperforming loans in bank assets, mainly caused by increased systemic risk due to the current COVID-19 pandemic and declining economic activity in the country, but also by a well-developed financial system infrastructure, which is necessary in order to allow the application of the securitization model to significantly contribute to increasing financial stability in the conditions of volatile financial structure. The model of securitization of nonperforming loans and its application in the process of bank restructuring can be the mainstay of the stabilization of the financial system. The aim of the research is to demonstrate that the application of the adapted securitization model of nonperforming assets of banks and its application in the process of bank restructuring in the conditions of unstable financial structure may contribute to financial stability and control of increase of a systemic risk. Securitization increases the supply of quality financial instruments, the number of participants in the process of transformation of financial assets and develops a more resilient financial market. The results include emergence of additional funding sources for financial institutions, generation of nonperforming assets’ problems, with additional liquidity and diversification for many of their clients.

Background: Firms increasingly depend on external actors for the process of generating innovation. Interaction with these actors might occur through an official collaboration agreement or via external actors as the source of information. Objectives: Although open innovation has received more attention, still less is known about its effect on organizational innovation. To fill this gap, this study investigates the impact of various external knowledge sources on the willingness of small and mediumsized enterprises to introduce organizational innovation. Methods/Approach: To achieve the proposed objective, the German Community Innovation Survey conducted in 2017 is used for the econometric analysis. Results: Different external sources of knowledge are relevant for the introduction of organizational innovation in small firms (customers in the private sector, competitors, conferences, and crowdsourcing) compared to medium-sized firms (customers in the private sector and industry associations). Conclusions: External knowledge sources are more important for small firms compared to medium firms, and those small firms are more likely to use various sets of external knowledge.

The use of financial technologies (FinTech) by financial market participants fostered a discussion among public authorities on the use technologies for regulatory (RegTech) and supervisory (SupTech) purposes. This paper discusses the application of innovative technologies to crisis resolution (ResTech) and sets out its potential scope of application. ResTech is the application of technologies: i) to support the work of resolution authorities in developing resolution plans and in resolving financial firms; and ii) to allow financial firms to achieve regulatory compliance and better risk management in a more effective and automated manner. This paper also argues that the features and market dynamics of resolution differ from those of RegTech and SupTech: there is little market incentive for the private sector to foster innovation in the area of crisis resolution. The lack of private sector incentives to invest in R&D on how to resolve a firm’s crisis leaves the task to resolution authorities. In addition, resolution-technologies may support the identification of optimal liquidation strategy for small and medium-sized financial firms, by ensuring the maximisation of creditors’ proceeds out of the insolvency estate.

This paper introduces a new measure of patent value - Maintenance Renewal Score (MRSc) - reflecting assignee valuing the patent by paying successive renewal fees. We generate MRSc's for nanotechnology patents issued by the US Patent Office from 1999 through 2009, with US assignees and US inventors. Patenting increases over this period, coincident with increased US funding of nanotechnology R&D. We compare maintenance rates over the period, and against a comparison set of all 1999 USPTO grants to US inventors/assignees. We find differences in propensity to maintain the nanopatents by institution type, technological sector, and patent complexity.

The authors of this article established the goal to investigate parameters related to the staff motivation for engineering change in the industrial company as case study and to predict the ways of improving the performance of the company. Employees of the company can be more motivated to generate innovative ideas and to implement them. That can be related to the better engineering change situation. For this reason, in this work, we have explored the environment and opportunities to improve the engineering performance of the company in the context of engineering change. The authors of the paper have conducted several studies, collected and analysed important information. Methods used – review of scientific literature and other sources of information, case study, structural systematic analysis, and sociological survey of industrial company personnel based on hypothesis. The object of the research was motives for engineering change in the industrial company. Motivated organizational behaviour actions, that focus on creation and realization of innovative ideas for engineering change, can be based on creation of an innovation-friendly environment. As our research has shown, it is important to consider parameters related to the staff motivation, such as, satisfaction with the company’s declared policy, satisfaction with the management’s behaviour in encouraging employees, freedom of employees to communicate and take creative initiative.

This research covered the palliative material distribution project in Lagos State, Nigeria, during the lockdown and restriction on movement because of COVID-19 pandemic. The study engaged reports from extant literature and tertiary data sources such as the newspapers, the Internet, and website source. Relevant data gathered from these sources were conceptually analysed and discussed along with extant literature. The research also adopted the use of rich pictures for further presentation of the research. A key finding from the research is the need to redesign the distribution process and consider proper structuring of the project. And further engagement with the affected stakeholders to address crucial issues such as marginalisation that can defeat the purpose, which is to emancipate the affected indigents of the State from the harrowing effects of COVID-19 lockdown and other emergencies-related critical incidences such as starvation and criminalities. The study proposed a model for a resilience approach to effectively address the current palliative distribution process challenges in Lagos State, the epicentre of COVID-19 in Nigeria.

International audience; Peer networks can positively affect individual careers and the scientific enterprise as a whole. People's willingness to contribute to such networks is poorly understood. In an email experiment, we investigated how framing the future research environment affects people's willingness to contribute to an emerging academic network. In spite of relatively large treatment effects, we do not find statistically significant effects of pessimistic or optimistic messaging on the willingness to contribute. We discuss limitations of the small sample size and the future research potential of network nudges.

This paper finds that the shift from buying music as a physical product towards subscribing to music services implies a decrease of 85 percent in the price paid per song. We estimate that in 2019 the global quality adjusted value from streamed music was $76 billion compared to current revenues of $11.4 billion. Thus, the shift from consuming music in physical form towards subscribing to music services creates an enormous consumer surplus that is not recorded in GDP.

The “shutdown” economy of April 2020 is compared to a normally functioning economy both in terms of market and nonmarket activities. Three novel methods and data indicate that a full shutdown of “nonessential” activities puts market production about 25 % below normal in the short run. At an annual rate, a full shutdown costs $9 trillion, or about $18,000 per household per quarter. Employment already fell 24 million by early April 2020. These costs indicate, among other things, the value of innovation in both health and general business sectors that can accelerate the time when, and the degree to which, normal activity resumes.

This paper empirically investigates whether cryptocurrencies might have a useful role in financial modelling and risk management in the energy markets. To do so, the causal relationship between movements on the energy markets (specifically the price of crude oil) and the value of cryptocurrencies is analysed by drawing on daily data from April 2013 to April 2019. We find that shocks to the US and European crude oil indices are strongly connected to the movements of most cryptocurrencies. Applying a non-parametric statistic, Transferring Entropy (an econophysics technique measuring information flow), we find that some cryptocurrencies (XEM, DOGE, VTC, XLM, USDT, XRP) can be used for hedging and portfolio diversification. Furthermore, the results reveal that the European crude oil index is a source of shocks on the cryptocurrency market while the US oil index appears to be a receiver of shocks.