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Purpose As more companies choose to disclose corporate social responsibility (CSR) information, it is important to gain an understanding of the quality of disclosures and factors that influence quality. The purpose of this study is to examine the role of culture as a determinant of the quality of voluntary carbon emission disclosures. Design/methodology/approach This study uses regression analysis to test the influence of culture on the quality of carbon disclosures. The sample of this study comes from companies who voluntarily report to the carbon disclosure project. The authors operationalize the quality of disclosure using the Carbon Disclosure Leadership Index. The authors operationalize cultural values using both Hofstede’s metrics (Hofstede, 1980) and Project GLOBE (House et al., 2004). Findings This study predicts and finds a negative relationship between quality of disclosure and high individualism scores. This study also finds that the quality of disclosure is lower for companies located in countries with high power distance scores. The authors find that the quality of disclosure is higher for companies located in countries with gender/assertiveness scores that indicate a higher value on the environment than on the importance of economic growth. While quality is marginally related to uncertainty avoidance using Hofstede's measure, quality is not related to uncertainty avoidance using the Project GLOBE metric. The authors did not find a hypothesized negative significant relationship between quality and long-term orientation. Practical implications Quality is a measure of importance to users and regulators of disclosures. Social implications National culture is an important determinant of CSR disclosure quality. Originality/value This study extends the previous research by using a metric for quality based on an independent evaluation of disclosures and by the role of culture in a multi-country study.

Background The safety and immunogenicity profile of COVID-19 vaccines when administered concomitantly with seasonal influenza vaccines have not yet been reported. We therefore aimed to report the results of a substudy within a phase 3 UK trial, by evaluating the safety, immunogenicity, and efficacy of NVX-CoV2373 when co-administered with licensed seasonal influenza vaccines. Methods We did a planned exploratory substudy as part of the randomised, observer-blinded, placebo-controlled, phase 3 trial of the safety and efficacy of the COVID-19 vaccine (NVX-CoV2373) by co-administrating the influenza vaccine at four study hospitals in the UK. Approximately, the first 400 participants meeting the main study entry criteria—with no contraindications to influenza vaccination—were invited to join the substudy. Participants of the main study were randomly assigned (1:1) to receive two intramuscular injections of either NVX-CoV2373 (5 μg) or placebo (normal saline) 21 days apart; participants enrolled into the substudy were co-vaccinated with a single (0·5 mL) intramuscular, age-appropriate (quadrivalent influenza cell-based vaccine [Flucelvax Quadrivalent; Seqirus UK, Maidenhead] for those aged 18–64 years and adjuvanted trivalent influenza vaccine [Fluad; Seqirus UK, Maidenhead] for those ≥65 years), licensed, influenza vaccine on the opposite deltoid to that of the first study vaccine dose or placebo. The influenza vaccine was administered in an open-label manner and at the same time as the first study injection. Reactogenicity was evaluated via an electronic diary for 7 days after vaccination in addition to monitoring for unsolicited adverse events, medically attended adverse events, and serious adverse events. Immunogenicity was assessed with influenza haemagglutination inhibition and SARS-CoV-2 anti-spike protein IgG assays. Vaccine efficacy against PCR-confirmed, symptomatic COVID-19 was assessed in participants who were seronegative at baseline, received both doses of study vaccine or placebo, had no major protocol deviations affecting the primary endpoint, and had no confirmed cases of symptomatic COVID-19 from the first dose until 6 days after the second dose (per-protocol efficacy population). Immunogenicity was assessed in participants who received scheduled two doses of study vaccine, had a baseline sample and at least one post-vaccination sample, and had no major protocol violations before unmasking (per-protocol immunogenicity population). Reactogenicity was analysed in all participants who received at least one dose of NVX-CoV2373 or placebo and had data collected for reactogenicity events. Safety was analysed in all participants who received at least one dose of NVX-CoV2373 or placebo. Comparisons were made between participants of the substudy and the main study (who were not co-vaccinated for influenza). This study is registered with ClinicalTrials.gov, number NCT04583995. Findings Between Sept 28, 2020, and Nov 28, 2020, a total of 15 187 participants were randomised into the main phase 3 trial, of whom 15 139 received treatment (7569 received dose one of NVX-CoV2373 and 7570 received dose one of placebo). 431 participants were co-vaccinated with a seasonal influenza vaccine in the substudy (217 received NVX-CoV2373 plus the influenza vaccine and 214 received placebo plus the influenza vaccine). In general, the substudy participants were younger, more racially diverse, and had fewer comorbid conditions than those in the main study. Reactogenicity events were more common in the co-administration group than in the NVX-CoV2373 alone group: tenderness (113 [64·9%] of 174 vs 592 [53·3%] of 1111) or pain (69 [39·7%] vs 325 [29·3%]) at injection site, fatigue (48 [27·7%] vs 215 [19·4%]), and muscle pain (49 [28·3%] vs 237 [21·4%]). Incidences of unsolicited adverse events, treatment-related medically attended adverse events, and serious adverse events were low and balanced between the co-administration group and the NVX-CoV2373 alone group. No episodes of anaphylaxis or deaths were reported within the substudy. Co-administration resulted in no change to influenza vaccine immune response although a reduction in antibody responses to the NVX-CoV2373 vaccine was noted. NVX-CoV2373 vaccine efficacy in the substudy (ie, participants aged 18 to

Vaccines are proving to be highly effective in controlling hospitalisation and deaths associated with SARS-CoV-2 infection but the emergence of viral variants with novel antigenic profiles threatens to diminish their efficacy. Assessment of the ability of sera from vaccine recipients to neutralise SARS-CoV-2 variants will inform the success of strategies for minimising COVID19 cases and the design of effective antigenic formulations. Here, we examine the sensitivity of variants of concern (VOCs) representative of the B.1.617.1 and B.1.617.2 (first associated with infections in India) and B.1.351 (first associated with infection in South Africa) lineages of SARS-CoV-2 to neutralisation by sera from individuals vaccinated with the BNT162b2 (Pfizer/BioNTech) and ChAdOx1 (Oxford/AstraZeneca) vaccines. Across all vaccinated individuals, the spike glycoproteins from B.1.617.1 and B.1.617.2 conferred reductions in neutralisation of 4.31 and 5.11-fold respectively. The reduction seen with the B.1.617.2 lineage approached that conferred by the glycoprotein from B.1.351 (South African) variant (6.29-fold reduction) that is known to be associated with reduced vaccine efficacy. Neutralising antibody titres elicited by vaccination with two doses of BNT162b2 were significantly higher than those elicited by vaccination with two doses of ChAdOx1. Fold decreases in the magnitude of neutralisation titre following two doses of BNT162b2, conferred reductions in titre of 7.77, 11.30 and 9.56-fold respectively to B.1.617.1, B.1.617.2 and B.1.351 pseudoviruses, the reduction in neutralisation of the delta variant B.1.617.2 surpassing that of B.1.351. Fold changes in those vaccinated with two doses of ChAdOx1 were 0.69, 4.01 and 1.48 respectively. The accumulation of mutations in these VOCs, and others, demonstrate the quantifiable risk of antigenic drift and subsequent reduction in vaccine efficacy. Accordingly, booster vaccines based on updated variants are likely to be required over time to prevent productive infection. This study also suggests that two dose regimes of vaccine are required for maximal BNT162b2 and ChAdOx1-induced immunity.

Background Embolic stroke of undetermined source (ESUS) accounts for up to 25% of strokes. Understanding risk factors associated with ESUS is important in reducing stroke burden worldwide. However, ESUS patients are younger and present with fewer traditional risk factors. Significant global variation in ESUS populations also exists making the clinical picture of this type of stroke unclear. Methods and results ESUS patients were pair matched for age, sex, and ethnicity with a group of all other strokes (both n = 331). Exploratory factor analysis was applied in both groups to 14 risk and clinical factors to identify latent factors. In ESUS patients, two latent factors emerged consisting primarily of heart-related variables such as left ventricular wall motion abnormalities, reduced ejection fraction, and increased left atrial volume index, as well as aortic arch atherosclerosis. This is in comparison to the all other strokes group, which was dominated by traditional stroke risk factors. Conclusions Our findings support the existence of a unique pattern of risk factors specific to ESUS. We show that LVWMA and corresponding changes in left heart function are a potential source of emboli in these patients. In addition, the clustering of aortic arch atherosclerosis with left heart factors suggests a causal link. Through the application of exploratory factor analysis, this work contributes to a further understanding of stroke mechanisms in ESUS.

Purpose Studies show that conflict can negatively affect psychological health. The Syrian crisis is 8 years old and yet little is known about the impact of the conflict on the well-being of Syrians who remain. This gap was addressed by conducting an empirical study on the mental health burden of Syrian children in two areas of the country. Methods 492 children between 8 and 15 years were randomly selected from schools in Damascus and Latakia. The incidence of psychological disorder symptoms was measured using self-report screening instruments, the Children’s Revised Impact of Event Scale (CRIES-8) and the Revised Children’s Anxiety and Depression Scale (RCADS-25). Simultaneously, sociodemographic and traumatic event information was collected. Binary logistic regression was used to identify factors that influence the development of post-traumatic stress disorder (PTSD) symptoms. Results In our sample, 50.2% of students were internally displaced and 32.1% reported a negative experience. 60.5% of those tested had at least one probable psychological disorder with PTSD the most common (35.1%), followed by depression (32.0%), and anxiety (29.5%). Binary logistic regression indicated that PTSD symptoms were predicted by: living in Damascus [odds ratio (OR) 2.36, 95% confidence interval (CI) 1.51–3.69], being female (1.54, 1.02–2.34), having depression and anxiety (2.55, 1.48–4.40), and the negative experiences; displacement and daily warzone exposure (1.84, 1.02–3.30 and 2.67, 1.08–6.60). Conclusions Syrian children are experiencing traumatic events and war-associated daily stresses that are hugely impacting psychological well-being. Our data offer guidance for mental health providers regarding risk factors and highlights the use of the school system to reach suffering children.

Background and Purpose: Embolic stroke of undetermined source (ESUS) is an important contributor to stroke worldwide. Little is known about ESUS in developing parts of the world such as South Asia, West Asia and North Africa despite the high stroke burden in these areas. The purpose of the study was to characterize the prevalence, demographic, risk factor and clinical aspects of ESUS in patients from South Asia, West Asia and North Africa residing in Qatar. Methods: Data were retrospectively collected on 3103 stoke patients. Risk factors and clinical features of the ESUS group were compared to all other strokes using Chi–square or student's t–tests. Logistic regression was used to identify factors associated with ESUS. ESUS patients were compared based on ethnicity using Chi-square or one-way ANOVA. Results: 634 patients (30·9%, 95% CI (28·9%-32·9%) met the ESUS criteria. Mean age was 56·3 years ± 13·7 and South Asian ESUS patients were younger than West Asians or North Africans (67·1 ± 13·5 versus 52·1 ± 10·8 versus 53·5 ± 14·2, P = .001). Smoking, diastolic function, prior antiplatelets and wall motion abnormalities were more common in ESUS. Logistic regression showed that South Asian ethnicity (OR 1·50, CI 1·14-1·97, P = ·003), diastolic dysfunction (OR 1·47, CI 1·23-1·75, P = ·005), global (OR 1·79, CI 1·41-2·26, P = ·001) and focal (OR 5·48, CI 3·79-7·92, P = ·001) wall motion abnormalities, predicted ESUS. Conclusions: ESUS is a major cause of stroke in patients from West Asia, South Asia and North Africa residing in Qatar. The clinical profile and risk factors for ESUS vary based on ethnicity. In South Asians, ESUS occurs at a younger age and is most likely cardiogenic in origin.

A theory of action control (General Tau Theory) is applied to analyzing normal and abnormal movements in PD; and to designing and testing the efficacy of a sonic aid for PD. A central aspect of the theory, which is supported by experimental evidence across a variety of actions and species, is that the trajectories of competent skilled actions follow a particular temporal pattern, which is described by the mathematical function, tauG. Since tauG-control of actions can be largely deficient in PD, we designed a device that generates whoop-like sounds, where the fundamental frequency of the sound follows the tauG pattern. Our hypothesis was that by listening to these sounds the nervous system of someone with PD might be helped subsequently to self-generate tauG patterns in their nervous system, which might facilitate movement control in different situations. Five adults with PD, and five age-matched controls, took part in the study. They each listened to the sounds under two conditions: (a) experimental - turning a handle for 5 minutes while the sounds were played (b) control - turning the handle without the sounds. Before and after each condition, the tauG-control of lateral body sway while standing was measured (without the sounds playing), using force-plates, on two tasks: (i) keeping the feet down, (ii) lifting the trailing foot. The number of participants out of five, who showed greater ratio improvement following practice with whoop sounds compared to without sounds, was, on each task, high for the PDs compared with the age-matched controls (4 vs 2 or 3). Thus, for the PDs, listening to the tauG whoop-like sounds while performing one action (handle turning) improved subsequent tauG-control on a different task (body-swaying).

Cancer patient survival has steadily increased following treatment over the last 50 years. However, treatments like radiation or chemotherapy are damaging to human health and result in a wide range of negative side effects. Cranial radiation for example, causes an array of cognitive deficits such as verbal intelligence decline or slower processing speed.1 These types of problems can manifest for years post treatment and cause a range of social, physical and emotional difficulties. Traditional medical survival endpoints ignore these factors. Given this reality, and the increasing number of survivors, it is unsurprising that best practice in oncology has moved towards including the Quality of Life (QoL) monitoring of patients during and post treatment.2 The Qatar Government recognises this and in their Qatar National Cancer Strategy3 advise that ‘the goal of specialised care is achievement of the best quality of life for patients and their families with good symptom management during treatment and at end of life’.Quality of life is defined as an “individuals’ perceptions of their position in life, in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns”.4The impact of a cancer diagnosis extends to all those in a patients extended social network. This is especially true for children where cancer procedures produce a great deal of anxiety and distress, as well as pain and physical discomfort. One-third of children who undergo treatment will suffer from moderate or severe side effects.6 and several studies report that the QoL for children under treatment is poor.7,8 Normal psychological functioning can be disrupted and day-to-day living and development perturbed. Reduced motor functioning and autonomy, impaired emotional processing (anxiety, depression) and cognitive problems are common weeks or years after diagnosis. The developmental stages that young people go through make the effects of treatment especially problematic. For example, adolescence is a difficult time and results in a range of psychosocial issues even during normal development (e.g. high suicide rates). Adding a potentially life threating disease to this already complicated developmental stage is potentially of significance. Careful monitoring of the QoL of children, teenagers and young adults (CTYA) therefore, is essential. In doing so it is possible to understand the unique problems young people face with a view to intervention and improved survival.Sixty CTYA constituting 25% of all CTYA oncology patients in Qatar, were given the PedsQL questionnaire (Varni 1998). PedsQL is given to patients and their parents and uses a 5-point Likert scale to ask about physical, emotional, social and school/work functioning. Means and SDs were calculated for each domain as well as psychosocial, physical and overall QoL. In some domains we found one third of patients had poor QoL or were at risk (e.g. 36% were suffering physically). Parents also underestimated their children's emotional well-being. We show how these findings informed the development of a number of interventions and in forming the QoL Clinic at Hamad, the first such dedicated clinic in the Gulf region.

This study aims to investigate the perception of bullying amongst Qataris and Arabic speakers in Qatar by covering several areas (1) to what extent is the term "tanamour" used amongst Arabic speakers to refer to bullying and how far is it promoted; (2) attempts to identify which other words might be used to explain bullying in the country; (3) To what extent are people aware of distinguishing bullying from incidents according to the criteria of imbalance of power, intention, and repetition. Three scenarios were presented orally which contained incidents of bullying or aggression. The first scenario described intentional and repeated direct bullying (a boy continuously having his chocolate stolen at school). The second related a case of intentional and repeated cyberbullying (two boys continuously spread rumours about their classmate). The final scenario was not a case of bullying but rather, a one-off incident where a boy hits their classmate. Participants were asked to describe how they saw these incidents so that the terms used could be recorded (part A). This phase allowed people to describe events in their own words freely without prompting. In the second phase, participants were asked to select from a previously determined list, the most appropriate word they felt described the three scenarios already given and were presented via a laptop. The list contained commonly used terms for bullying behaviours in Arabic. However, if participants felt none of the words adequately described the behaviours, they were encouraged to use their own. Participants were not informed directly that the meetings would be about bullying but rather 'behaviours they may encounter in daily life'. They were also told that there were no 'correct answers' and to just state their opinion as they wished (including saying nothing or ending participation if they wanted). Two researchers were present at every meeting except one where it was appropriate for a female only. All sessions were recorded except one where participants found it inappropriate. Focus groups included 36 participants and took place either in participant's homes or places of work, and took 20-60 minutes long depending on group number and length of discussion. The study took place amongst families, friends and social workers in Qatar where 36% of the sample were Qataris and the rest were from other different Arabic speaking countries such as Egypt, Syria, Yemen, Palestine, Bahrain, Jordan, Somalia and Iraq. Even though this is a preliminary study, the findings indicate that there is some diversity due to the differences in cultures as there is considerable confusion with regards to the terminology used to describe bullying in Arabic. With respect to the aims of the study it has been unequivocally demonstrated that 'tanamor' is not widely used in Qatar and that when it is, it is often misused. There isn't a clear word emerged that has any equivalence to bullying in English. It is clear that there is a tremendous amount of work to be done to qualify both a term and concept behind this damaging behaviour in the Middle-East. Acknowledgements: The authors would like to thank Qatar National Research Fund (QNRF) a member of Qatar Foundation Doha, Qatar, National Priority Research Programs grant (NPRP 5- 1134-3-240) funded to Dr. Muthanna Samara. We also would like to thank the teachers and head teachers in Qatar who were kind enough to provide us with information and advice.