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This article challenges the belief in high-tech solutions to solve socio-environmental crises, proposing a political vision beyond ''green growth'' and ''ecomodernism.''. It advocates for a commons-based technology framework, promoting collective resource management for sustainability. We thus introduce ''cosmolocal'' production, a configuration that strives to connect communities around shared resources and serve their needs while minimizing ecological impact. Despite acknowledged tensions, we contend that the cosmolocal framework could foster institutional and social change, aiming to address environmental degradation and wealth inequality. To support this contention on cosmolocal production's potential, we point to several successful examples from the open-source technology paradigm.

Background: Following discharge, it is crucial for patients to transfer intentions and action plans from inpatient rehabilitation into everyday life. This ensures their reintegration into social and working life and prevents economic costs due to sick leave or reduced earning capacity pension. However, most established aftercare programs do not specifically address occupational problems or challenges during occupational measures such as graded return to work. The aim of this study is to evaluate the efficacy of the low-threshold online self-help intervention marena (Meine Arbeitsbezogene Reha-Nachsorge - My Work-related Rehabilitation Aftercare) to support return to work. Methods: A two-arm randomized-controlled-trial (RCT) will be conducted. A total of N = 400 rehabilitation inpatients across different indication areas (psychosomatic, orthopedic, or cardiologic) aged 18 to 65 years with a planned return to work after medical rehabilitation, have a heightened social-medical risk and private internet access and are insured with the German Pension insurance or statutory health insurance, will be recruited in four medical and psychosomatic clinics in Germany. Participants will be allocated to either the intervention (IG) or the control group (CG). In a stepped-care model, participants of the IG will receive access to the non-guided internet- and mobile-based intervention marena (IG subgroup 1) or marena in combination with GSA-Online plus (IG subgroup 2), a guided psychodynamic internet-based intervention that has proven effective in two trials regarding occupational and health objectives. Based on a priori defined indication criteria, clinic staff will recommend either IG subgroup 1 or IG subgroup 2. The CG will receive optimized treatment as usual with access to a survey feature within marena. The primary outcome will be work status after 6 months (T2) and 12 months (T4). The endpoint at 12 months (T4) after discharge from inpatient rehabilitation will be considered as secondary endpoint. Work status is defined as positive if the participant is working and has ≤ 6 weeks of sick leave at T2 and ≤ 12 weeks of sick leave at T4. Secondary outcomes include successful completion of graded return to work, successful application for benefits for participation in working life, current work ability, social-medical risk, subjective prognosis of future employment, quality of life, somatic symptoms, coping, social support, depression, anxiety, and psychosocial stress. Discussion: This study will contribute to the evidence concerning efficacy of online aftercare interventions. If proven efficacious, marena could provide an individualized and adaptable self-help approach to promote return to work following inpatient rehabilitation.

Background: The present systematic review with meta-analysis is a significant contribution to the understanding of the morphological variability of the facial nerve (FN) extratemporal segment, i.e., the facial trunk (FT) variability, its division, and terminal branching patterns. The study also provides a comprehensive overview of the clinical significance of the FN extracranial division. Methods: Four online databases were utilized to conduct the systematic review according to evidence-based anatomy guidelines. A meta-analysis of the studies included was carried out using R programming software. The combined prevalence of the FN variants was calculated, along with subgroup and cumulative analysis. Results: From the systematic review, 29 studies were retrieved as eligible for our initial purpose. However, 19 studies followed the same classification system and were selected for the meta-analysis, with a total sample of 2453 nerves. The most common pattern of the FN morphology was the FT bifurcation (typical pattern), with a pooled prevalence of 94.1% and a single interconnection (IC) between the temporofacial and cervicofacial branches (23.1% pooled prevalence). Two ICs between these branches were the rarest pattern (8.9% pooled prevalence). Conclusions: Our findings underscore the extensive morphological variability of the FN extratemporal anatomy, which has led to confusion among researchers. While several classification systems have been developed, none accurately represent the typical and variant anatomy. Our meta-analysis provided a small range between 8.9–23.1% for the rarest and most common pattern; thus, diversity is the rule. Therefore, it is not safe to conclude the typical morphology of FN extratemporal anatomy for its whole distribution before the FT’s division (proximally) and its terminal branches (distally). Nevertheless, the bifurcation of the FT can be considered the typical morphology, and it is far more constant than the distal branching pattern. These findings have significant implications for surgical procedures, particularly parotidectomy, where surgeons must exercise utmost caution due to the potential clinical implications of FN injury.

The aim of the study was to investigate in vitro the antibacterial activity of 8 commercial drinking water additives against major zoonotic poultry pathogens (Campylobacter spp., Escherichia coli, Salmonella Typhimurium, Staphylococcus aureus and Listeria spp.). We tested two essential oil-based phytogenics (Phyto CSC Liquide B, AEN 350 B Liquid), two acid-based eubiotics (Salgard® liquid, Intesti-Flora), and four blends of essential oils and organic acids (ProPhorceTM SA Exclusive, Herbal acid, Rigosol-N and Eubisan 3000). The antibacterial activity was determined by estimating the minimum inhibitory concentration (MIC) using a microdilution method. The MICs of the products against Campylobacter spp. ranged from 0.071% to 0.568% v/v, in which Herbal acid, a blend rich in lactic and phosphoric acids, also containing thyme and oregano oils, exhibited the highest efficacy (MIC: 0.071% v/v) against all the tested strains. The MICs of the tested products against Escherichia coli ranged between 0.071% and 1.894% v/v. Specifically, the MIC of Rigosol-N, a blend of high concentrations of lactic and acetic acid, was 0.142% v/v for both tested strains, whereas the MICs of Intesti-Flora, a mixture rich in lactic and propionic acid, ranged from 0.284% to 0.568% v/v. The MICs of the products against Salmonella Typhimurium were between 0.095% and 1.894% v/v. Specifically, the MIC of Eubisan 3000, a blend rich in oregano oil, was 0.284% v/v. The MICs against Staphylococcus aureus were between 0.142% and 9.090% v/v. The MICs of Phyto CSC Liquide B, which is rich in trans-cinnamaldehyde, were between 3.030% and 9.090% v/v, showing the highest MIC values of all tested products. Finally, the MIC values of the tested commercial products against Listeria spp. were 0.095% to 3.030% v/v. The MICs of ProPhorceTM SA Exclusive, a highly concentrated blend of formic acid and its salts, were 0.095–0.142% v/v against Listeria spp., while the MICs of AEN 350 B Liquid were between 0.284% and 1.894% exhibiting high Listeria spp. strain variability. In conclusion, all the selected commercial products exhibited more or less antibacterial activity against pathogenic bacteria and, thus, can be promising alternatives to antibiotics for the control of zoonotic poultry pathogens and the restriction of antimicrobial-resistant bacteria.

The exploration of novel biomarkers to assess poultry health is of paramount importance, not only to enhance our understanding of the pathogenicity of zoonotic agents but also to evaluate the efficacy of novel treatments as alternatives to antibiotics. The present study aimed to investigate potential gut health biomarkers in broiler chicks challenged by Campylobacter jejuni and subjected to a continuous water disinfection program. A total of 144 one-day-old hatched broiler chicks were randomly allocated to four treatment groups with four replicates each, according to the following experimental design: Group A received untreated drinking water; Group B received drinking water treated with 0.01–0.05% v/v Cid 2000™ (hydrogen peroxide, acetic acid and paracetic acid); Group C was challenged by C. jejuni and received untreated drinking water; and Group D was challenged by C. jejuni and received drinking water treated with 0.01–0.05% v/v Cid 2000™. The use of Cid 2000™ started on day 1 and was applied in intervals until the end of the experiment at 36 days, while the C. jejuni challenge was applied on day 18. Potential biomarkers were investigated in serum, feces, intestinal tissue, intestinal content, and liver samples of broilers. Statistical analysis revealed significant increases (p < 0.001) in serum cortisol levels in C. jejuni-challenged broilers. Serum fluorescein isothiocyanate dextran (FITC-d) increased significantly (p = 0.004) in broilers challenged by C. jejuni and treated with drinking water disinfectant, while fecal ovotransferrin concentration also increased significantly (p < 0.001) in broilers that received the drinking water disinfectant alone. The gene expression levels of occludin (p = 0.003) and mucin-2 (p < 0.001) were significantly upregulated in broilers challenged by C. jejuni, while mucin-2 significantly increased in birds that were challenged and received the drinking water disinfectant (p < 0.001). TLR-4 expression levels were significantly (p = 0.013) decreased in both groups that received the drinking water disinfectant, compared to the negative control group. Finally, the C. jejuni challenge significantly increased (p = 0.032) the crypt depth and decreased (p = 0.021) the villus height-to-crypt-depth ratio in the ileum of birds, while the tested disinfectant product increased (p = 0.033) the villus height in the jejunum of birds. Furthermore, the counts of C. jejuni in the ceca of birds (p = 0.01), as well as its translocation rate to the liver of broilers (p = 0.001), were significantly reduced by the addition of the water disinfectant. This research contributes to novel insights into the intricate interplay of water disinfection and/or C. jejuni challenge with potential intestinal biomarkers. In addition, it emphasizes the need for continued research to unveil the underlying mechanisms, expands our understanding of broiler responses to these challenges and identifies breakpoints for further investigations.

BackgroundParticipant recruitment poses challenges in psycho-oncological intervention research, such as psycho-oncological web-based intervention studies. Strict consecutive recruitment in clinical settings provides important methodological benefits but is often associated with low response rates and reduced practicability and ecological validity. In addition to preexisting recruitment barriers, the protective measures owing to the COVID-19 pandemic restricted recruitment activities in the clinical setting since March 2020. ObjectiveThis study aims to outline the recruitment strategy for a randomized controlled trial evaluating the unguided emotion-based psycho-oncological online self-help (epos), which combined traditional and web-based recruitment. MethodsWe developed a combined recruitment strategy including traditional (eg, recruitment in clinics, medical practices, cancer counseling centers, and newspapers) and web-based recruitment (Instagram, Facebook, and web pages). Recruitment was conducted between May 2020 and September 2021. Eligible participants for this study were adult patients with any type of cancer who were currently receiving treatment or in posttreatment care. They were also required to have a good command of the German language and access to a device suitable for web-based interventions, such as a laptop or computer. ResultsWe analyzed data from 304 participants who were enrolled in a 17-month recruitment period using various recruitment strategies. Web-based and traditional recruitment strategies led to comparable numbers of participants (151/304, 49.7% vs 153/304, 50.3%). However, web-based recruitment required much less effort. Regardless of the recruitment strategy, the total sample did not accurately represent patients with cancer currently undergoing treatment for major types of cancer in terms of various sociodemographic characteristics, including but not limited to sex and age. However, among the web-recruited study participants, the proportion of female participants was even higher (P

Abstract Background The One Health (OH) approach integrates multiple competencies in the prevention and control of disease outbreaks. Through a range of OH competence-based activities, the Africa One Health University Network (AFROHUN) built the capacity of selected students at Makerere University and Mbarara University of Science and Technology. This study applied the Systems Theoretical Framework (STF) of career development to establish the employment status of AFROHUN-Uganda alumni, and the facilitators and barriers to application of the OH approach in their organisations. Methods We conducted an embedded mixed-methods study among a random sample of 182 AFROHUN-Uganda alumni of the 2013–2018 cohorts. For quantitative data, descriptive statistics were computed using Stata 14.0 statistical software. A total of 12 in-depth interviews were conducted, and NVivo 12 Pro was used to organise data during thematic analysis. Results While the majority, 87.4% were or got employed after participating in the AFROHUN Uganda capacity building programme, 68.1% were employed at the time of the survey, 57.7% had worked with their current employer for at least a year, and 39% held managerial positions. The facilitators of applying the OH approach into employing organisations included being knowledgeable about OH, the presence of a multidisciplinary workforce, the nature of activities implemented, and existing partnerships and collaborations between organisations. The barriers to the application of the OH approach included limited funding, a negative attitude towards working with people from other disciplines, and limited knowledge of the One Health approach. Conclusion Notably, more than two-thirds of the OH alumni were employed, and more than a third held managerial position. While these findings portray a fairly good absorption rate of the OH alumni into the workforce, they also highlight the facilitators of application of the OH approach that need to be promoted as well as the barriers that need to be addressed if the application of the OH approach is to be improved within the workforce.

Maintaining respiratory tract health is crucial for layers, impacting gut health, laying performance, and egg quality. Viral diseases and standard vaccinations can compromise tracheal epithelium function, leading to oxidative stress. This study assessed the impact of a blend of feed additives, predominantly lysozyme (L), essential oils (EO), and vitamins (VIT) (referred to as L + EO + VIT), on young layers during an oral vaccination schedule. The supplementation significantly enhanced antibody titers for Newcastle Disease Virus (NDV) and Infectious Bronchitis Virus (IBV) after vaccination, trachea functionality and intestinal health in the jejunum, increased egg production, and exhibited a trend toward higher egg weight. Although feed intake showed no significant difference, egg quality remained consistent across experimental groups. Moreover, L + EO + VIT supplementation elevated total phenolic content in eggs, improving oxidative stability in both fresh and stored eggs, particularly under iron-induced oxidation. Notably, it substantially reduced yolk lipid peroxidation and albumen protein carbonyls. In conclusion, water supplementation with L + EO + VIT may enhance humoral immune response to IBV and NDV, positively impacting hen productivity. These findings indicate improved tracheal function and enhanced oxidative stability, emphasizing the potential of this blend in promoting overall health and performance in layers.

BackgroundStudents were at an increased risk for elevated mental symptoms during the first year of the COVID-19 pandemic compared to pre-pandemic levels. As universities remained closed much longer than anticipated, the mental burden was expected to persist through the second year of the pandemic. The current study aimed to investigate the prevalence of mental distress from 2019 through 2021 and identify risk factors for elevated mental burden, focusing on gender.MethodsWe analyzed three cross-sectional online surveys among students at the University of Mainz, conducted in 2019 (n = 4,351), 2020 (n = 3,066), and 2021 (n = 1,438). Changes in the prevalence of depressive symptoms, anxiety, suicidal ideation, and loneliness were calculated using Pearson's chi-square tests and analyses of variance. Multiple linear regressions yielded associated risk factors.ResultsThe proportion of students with clinically relevant depressive symptoms was significantly higher during the pandemic (38.9% in 2020, and 40.7% in 2021), compared to pre-pandemic (29.0% in 2019). Similarly, more students reported suicidal ideation and generalized anxiety during the pandemic with a peak in the second pandemic year (2021). The level of loneliness was significantly higher in 2020, compared to 2019, and remained at a high level in 2021 (p < 0.001, ηp2 = 0.142). Female and diverse/open gender, being single, living alone, and being a first-year student were identified as risk factors associated with mental burden during the pandemic.DiscussionMental burdens remained elevated among students through the second year of the pandemic and were associated with socio-demographic risk factors and pandemic-related concerns. Future research should monitor recovery and evaluate the need for psychosocial support.

IntroductionCyclic adenosine monophosphate (cAMP) levels in the lymphoblasts and leukocytes of patients with major depressive disorder (MDD) have been reported to be downregulated compared to in controls. cAMP is a derivative of adenosine triphosphate (ATP), and low ATP turnover has been reported in the state of hypometabolism associated with human MDD and with mammalian hibernation due to suppression of mitochondrial metabolism. Similarities have been noted between many state-dependent neurobiological changes associated with MDD in humans and with mammalian hibernation.MethodsTo compare cAMP levels between human MDD and mammalian hibernation and to investigate whether cAMP downregulation is another state-dependent neurobiological finding, we measured cAMP concentrations in lysed leukocytes, plasma, and serum in serial blood specimens from nine female captive black bears (Ursus americanus; CBBs), and cortisol levels in serum from 10 CBBs.ResultsCortisol levels were significantly higher during hibernation in CBBs, confirming previous findings in hibernating black bears and similar to findings in humans with MDD. cAMP levels were significantly lower during hibernation versus active states (pre-hibernation and exit from hibernation) and were similar to the cAMP downregulation reported in MDD patients versus euthymic patients or controls. cAMP level changes during the different states (hibernation, pre-hibernation, active) confirm their state-dependent status.DiscussionThese findings are similar to the neurobiological findings associated with the hypometabolism (metabolic depression) observed during mammalian hibernation and reported during MDD. A sudden increase in cAMP levels was observed before entrance into pre-hibernation and during exit from hibernation. Further investigation is suggested into the possible role of elevated cAMP levels in initiation of the chain reaction of changes in gene expression, proteins, and enzymes leading to the suppression of mitochondrial metabolism and to low ATP turnover. This process leads to hypometabolism, the old adaptive mechanism that is used by organisms for energy preservation and is associated with both mammalian hibernation and human MDD.

Abstract Background The Africa One Health University Network (AFROHUN) with support from the United States Agency for International Development (USAID), has since 2012 conducted pre and in-service One health (OH) trainings with the objective of improving global health security. These trainings aim to build competencies that, enhance a multidisciplinary approach to solving global health challenges. Despite the investment in OH trainings, there is limited documentation of the extent of acquisition and application of the OH competencies at workplaces. This tracer study explored the extent of acquisition and application of the OH competencies by the AFROHUN-Uganda alumni. Methods A cross-sectional study was conducted among a random sample of 182 AFROHUN-Uganda alumni of 2013–2018 cohorts. A blended approach of interviewer-administered and self-administered questionnaires was used. Virtual platforms such as Zoom, Microsoft teams, and Skype, and phone interviews were used to collect data when face-to-face interactions with alumni were not possible. Data were collected electronically, either through a link or with the aid of the KoboCollect mobile application, pre-installed on android enabled devices, and analysed using STATA14.0. Results The majority of respondents, 78.6% (143/182) had jobs that required application of OH knowledge and skills, 95.6% (174/182) had learned employable skills from OH activities and 89.6% (163/182) had applied such skills when searching for employment. About 21.7% (34/180) to a very high extent required OH field-specific theoretical knowledge at their workplaces, 27.4% (43/80) to a very high extent required OH field-specific practical knowledge/skills, 42.7% (67/180) to a high extent required a change in attitude and perceptions towards working with people from different disciplines, 49.0% (77/180) required collaboration and networking skills, and more than half, 51.0% (80/180) required team building skills. Conclusions The majority of OH alumni to a very high extent acquired and applied OH competences such as teamwork, effective communication, community entry and engagement, report writing and problem-solving skills. This study revealed the significant contribution of the AFROHUN Uganda OH activities towards supportive work environments, and highlights areas of improvement such as supporting the trainees to acquire people-management skills, innovation, and an entrepreneurial mind set.

Abstract Background The global spread of the SARS-CoV-2 virus highlights both the importance of frontline healthcare workers (HCW) in pandemic response and their heightened vulnerability during infectious disease outbreaks. Adequate preparation, including the development of human resources for health (HRH) is essential to an effective response. ICAP at Columbia University (ICAP) partnered with Resolve to Save Lives and MOHs to design an emergency training initiative for frontline HCW in 11 African countries, using a competency-based backward-design approach and tailoring training delivery and health facility selection based on country context, location and known COVID-19 community transmission. Methods Pre- and post-test assessments were conducted on participants completing the COVID-19 training. Parametric and non-parametric methods were used to examine average individual-level changes from pre- to post-test, and compare performance between countries, cadres, sex and facility types. A post-evaluation online training survey using Qualtrics was distributed to assess participants’ satisfaction and explore training relevance and impact on their ability to address COVID-19 in their facilities and communities. Results A total of 8797 HCW at 945 health facilities were trained between June 2020 and October 2020. Training duration ranged from 1 to 8 days (median: 3 days) and consisted of in person, virtual or self guided training. Of the 8105 (92%) HCW working at health facilities, the majority (62%) worked at secondary level facilities as these were the HF targeted for COVID-19 patients. Paired pre- and post-test results were available for 2370 (25%) trainees, and 1768 (18%) participants completed the post-evaluation training survey. On average, participants increased their pre- to post-test scores by 15 percentage points (95% CI 0.14, 0.15). While confidence in their ability to manage COVID-19 was high following the training, respondents reported that lack of access to testing kits (55%) and PPE (50%), limited space in the facility to isolate patients (45%), and understaffing (39%) were major barriers. Conclusion Ongoing investment in health systems and focused attention to health workforce capacity building is critical to outbreak response. Successful implementation of an emergency response training such as this short-term IPC training initiative in response to the COVID-19 pandemic, requires speed, rigor and flexibility of its design and delivery while building on pre-existing systems, resources, and partnerships.

Background: The present systematic review with meta-analysis is a significant contribution to the understanding of the morphological variability of the facial nerve (FN) extratemporal segment, i.e., the facial trunk (FT) variability, its division, and terminal branching patterns. The study also provides a comprehensive overview of the clinical significance of the FN extracranial division. Methods: Four online databases were utilized to conduct the systematic review according to evidence-based anatomy guidelines. A meta-analysis of the studies included was carried out using R programming software. The combined prevalence of the FN variants was calculated, along with subgroup and cumulative analysis. Results: From the systematic review, 29 studies were retrieved as eligible for our initial purpose. However, 19 studies followed the same classification system and were selected for the meta-analysis, with a total sample of 2453 nerves. The most common pattern of the FN morphology was the FT bifurcation (typical pattern), with a pooled prevalence of 94.1% and a single interconnection (IC) between the temporofacial and cervicofacial branches (23.1% pooled prevalence). Two ICs between these branches were the rarest pattern (8.9% pooled prevalence). Conclusions: Our findings underscore the extensive morphological variability of the FN extratemporal anatomy, which has led to confusion among researchers. While several classification systems have been developed, none accurately represent the typical and variant anatomy. Our meta-analysis provided a small range between 8.9–23.1% for the rarest and most common pattern; thus, diversity is the rule. Therefore, it is not safe to conclude the typical morphology of FN extratemporal anatomy for its whole distribution before the FT's division (proximally) and its terminal branches (distally). Nevertheless, the bifurcation of the FT can be considered the typical morphology, and it is far more constant than the distal branching pattern. These findings have significant implications for surgical procedures, particularly parotidectomy, where surgeons must exercise utmost caution due to the potential clinical implications of FN injury. [ABSTRACT FROM AUTHOR]

Aggressive behaviors in those with intellectual disability (ID) and autism (ASD) have been linked to a variety of factors including ID level, age, sex, psychiatric disorders, and medical conditions but these factors have not been studied, in large samples, in terms of how they affect the stimuli that trigger aggression. In this survey of 2243 adults, four triggers of aggression associated with frustration, discomfort, change in the physical/social environment, and defensive reactions were analyzed for their relation to ID level, ASD, age, sex, number of psychiatric diagnoses, sleeping problems, seizures, visual impairment, ear infections and gastrointestinal problems. All four triggers were associated with increasing number of psychiatric disorders, with frustration, discomfort, and change intolerance commonly linked to sleeping problems and ASD. Implications for assessment and intervention are discussed.

BackgroundRepeat HIV testing during pregnancy and breastfeeding identifies women with incident infections, those living with HIV who have been lost to care, and infants at risk for HIV infection. We report data from repeat testing for women in maternal and child health (MCH) services at 10 health facilities in Mozambique.MethodsRoutinely collected data from health facility registers are reported from April-November 2019. From antenatal care (ANC), we report numbers and proportions of women eligible for retesting; returned for care when retesting eligible; retested; and HIV-positive (HIV+) at retesting. From child welfare clinics (CWC), we report mothers retested; tested HIV-positive; HIV+ mothers linked to ART services; HIV-exposed infants (HEI) tested for HIV with polymerase chain reaction (PCR) tests; HEI testing PCR positive; PCR-positive infants linked to care.ResultsIn ANC, 28,233 pregnant women tested HIV-negative at first ANC visit, 40.7% had a follow-up visit when retesting eligible, among whom 84.8% were retested and 0.3%(N = 26) tested HIV+. In CWC, 26,503 women were tested; 0.8%(N = 212) tested HIV+ and 74.1%(N = 157) of HIV+ women were linked to care. Among 157 HEI identified in CWC, 68.4%(N = 145) received PCR testing and 19.3%(N = 28) tested positive.ConclusionIn ANC, less than half of pregnant women eligible for retesting returned for follow-up visits, and test positivity was low among women retested in ANC and CWC. In CWC, linkage to infant testing was poor and almost 20% of HEI were PCR-positive. Implementing retesting for pregnant and breastfeeding women is challenging due to high numbers of women and low testing yield.

BackgroundInternet-based mental health interventions are considered effective in providing low-threshold support for people with mental health disorders. However, there is a lack of research investigating the transferability of such online programs into routine care settings. Low treatment adherence and problems with technical implementation often limit a successful transfer into clinical routines. This naturalistic study aims to identify influencing factors on program adherence in patients who participated in an online intervention during inpatient or day-clinic psychotherapeutic treatment.Methods and findingsIn a naturalistic study, we investigated the transferability of the transdiagnostic psychodynamic online self-help program KEN-Online, which includes eight consecutive units. Between May 2017 and October 2018, patients who received inpatient or day-clinic psychotherapeutic treatment at the Department of Psychosomatic Medicine and Psychotherapy in the University Medical Center Mainz have been offered to use KEN-Online. Of the n = 749 patients who were admitted to the clinic, n = 239 patients (32%) registered for participation in KEN-Online. While 46.9% of the participants did not complete any unit (inactive participants), 53.1% completed at least the first unit (active participants). Age, number of diagnoses, and symptom severity were associated with (in)active participation. Adherence decreased over time resulting in only 17 participants (7.6%) who completed all units. None of the sociodemographic and medical characteristics proved to be significant predictors of adherence. Analyses of effectiveness showed a significant reduction of anxiety and depression in active participants in the course of participation, with higher improvements in participants that completed more than half of the units.ConclusionAdherence to the online self-help program KEN-Online was lower in the naturalistic setting than in a previous clinical trial, but was still associated with greater program effectiveness. Adherence-promoting measures are crucial to increase the effectiveness of such interventions in clinical settings.

Background: Uncertainty continues to surround mild traumatic brain injury (mTBI) diagnosis, symptoms, prognosis, and outcome due in part to a lack of objective biomarkers of injury and recovery. As mTBI gains recognition as a serious public health epidemic, there is need to identify risk factors, diagnostic tools, and imaging biomarkers to help guide diagnosis and management. Methods: One hundred and eleven patients (15-50 years old) were enrolled acutely after mTBI and followed with up to four standardized serial assessments over 3 months. Each encounter included a clinical exam, neuropsychological assessment, and magnetic resonance imaging (MRI). Chi-square and linear mixed models were used to assess changes over time and determine potential biomarkers of mTBI severity and outcome. Results: The symptoms most frequently endorsed after mTBI were headache (91%), not feeling right (89%), fatigue (86%), and feeling slowed down (84%). Of the 104 mTBI patients with a processed MRI scan, 28 (27%) subjects had white matter changes which were deemed unrelated to age, and 26 of these findings were deemed unrelated to acute trauma. Of the neuropsychological assessments tested, 5- and 6-Digit Backward Recall, the modified Balance Error Scoring System (BESS), and Immediate 5-Word Recall significantly improved longitudinally in mTBI subjects and differentiated between mTBI subjects and controls. Female sex was found to increase symptom severity scores (SSS) at every time point. Age ≥ 25 years was correlated with increased SSS. Subjects aged ≥ 25 also did not improve longitudinally on 5-Digit Backward Recall, Immediate 5-Word Recall, or Single-Leg Stance of the BESS, whereas subjects < 25 years improved significantly. Patients who reported personal history of depression, anxiety, or other psychiatric disorder had higher SSS at each time point. Conclusions: The results of this study show that 5- and 6-Digit Backward Recall, the modified BESS, and Immediate 5-Word Recall should be considered useful in demonstrating cognitive and vestibular improvement during the mTBI recovery process. Clinicians should take female sex, older age, and history of psychiatric disorder into account when managing mTBI patients. Further study is necessary to determine the true prevalence of white matter changes in people with mTBI.

This study investigated the effect of three commercial water acidifiers on the performance, gut health, and C. jejuni colonization in experimentally challenged broiler chicks. A total of 192 one-day-old broiler chicks (Ross 308®) were randomly allocated into 6 treatment groups with 4 replicates according to the following experimental design: group A, birds were not challenged and received tap water; group B, birds were challenged and received tap water; groups C, D, E, and F, birds were challenged and received tap water treated with 0.1% v/v SPECTRON®, with 0.1–0.2% v/v ProPhorce™ SA Exclusive, with 0.1–0.2% v/v Premium acid, and with 0.1–0.2% v/v Salgard® Liquid, respectively. The continuous water acidification evoked undesirable effects on broilers’ performance and to an increased number of birds with ulcers and erosions in the oral cavity and the upper esophageal area. ProPhorce™ SA Exclusive and Premium acid significantly reduced the C. jejuni counts in the crop, whereas Salgard® Liquid significantly reduced the C. jejuni counts in the ceca of birds. At slaughter age, only Premium acid significantly reduced C. jejuni counts in the ceca of birds. All the tested products ameliorated the changes induced by C. jejuni infection in the pH in the ceca of birds. It can be concluded that besides the effectiveness of the tested products in controlling C. jejuni in broilers, their continuous application evoked undesirable effects on broilers’ performance, leading to the need to modify the dosage scheme in future investigations.

BackgroundBalance rehabilitation programs represent the most common treatments for balance disorders. Nonetheless, lack of resources and lack of highly expert physiotherapists are barriers for patients to undergo individualized rehabilitation sessions. Therefore, balance rehabilitation programs are often transferred to the home environment, with a considerable risk of the patient misperforming the exercises or failing to follow the program at all. Holobalance is a persuasive coaching system with the capacity to offer full-scale rehabilitation services at home. Holobalance involves several modules, from rehabilitation program management to augmented reality coach presentation. ObjectiveThe aim of this study was to design, implement, test, and evaluate a scoring model for the accurate assessment of balance rehabilitation exercises, based on data-driven techniques. MethodsThe data-driven scoring module is based on an extensive data set (approximately 1300 rehabilitation exercise sessions) collected during the Holobalance pilot study. It can be used as a training and testing data set for training machine learning (ML) models, which can infer the scoring components of all physical rehabilitation exercises. In that direction, for creating the data set, 2 independent experts monitored (in the clinic) 19 patients performing 1313 balance rehabilitation exercises and scored their performance based on a predefined scoring rubric. On the collected data, preprocessing, data cleansing, and normalization techniques were applied before deploying feature selection techniques. Finally, a wide set of ML algorithms, like random forests and neural networks, were used to identify the most suitable model for each scoring component. ResultsThe results of the trained model improved the performance of the scoring module in terms of more accurate assessment of a performed exercise, when compared with a rule-based scoring model deployed at an early phase of the system (k-statistic value of 15.9% for sitting exercises, 20.8% for standing exercises, and 26.8% for walking exercises). Finally, the resulting performance of the model resembled the threshold of the interobserver variability, enabling trustworthy usage of the scoring module in the closed-loop chain of the Holobalance coaching system. ConclusionsThe proposed set of ML models can effectively score the balance rehabilitation exercises of the Holobalance system. The models had similar accuracy in terms of Cohen kappa analysis, with interobserver variability, enabling the scoring module to infer the score of an exercise based on the collected signals from sensing devices. More specifically, for sitting exercises, the scoring model had high classification accuracy, ranging from 0.86 to 0.90. Similarly, for standing exercises, the classification accuracy ranged from 0.85 to 0.92, while for walking exercises, it ranged from 0.81 to 0.90. Trial RegistrationClinicalTrials.gov NCT04053829; https://clinicaltrials.gov/ct2/show/NCT04053829

Chronic exposure to high ambient temperatures is detrimental to laying hen performance and egg quality. Plant secondary metabolites may alleviate effects, partly due to their antioxidant activities. Herein, we investigated the effects of dietary supplementation with a phytonutrient solution (PHYTO) consisting of a plant extract combination of Scutellaria baicalensis and Curcuma longa on young layers (25–32 wk of age) raised under naturally elevated temperature conditions. Four hundred, 24-wk-old Lohmann hens were allocated in 50 cages and, after a week of adaptation, were offered a diet either containing 2 g/kg of PHYTO or not, for 8 wk. Hen BW was measured at the beginning and end of the trial, and egg production and feed intake were recorded weekly. At week 32, four eggs per cage were collected to determine egg quality characteristics as well as the rate of lipid and albumen oxidation in fresh eggs. At the end of the trial, two hens per cage were blood sampled for assessment of biochemical markers, one of which was euthanized for histopathological evaluation of the liver and intestine and assessment of intestinal histomorphometry. The herbal mixture supplementation significantly increased egg production rate at weeks 28 and 29 and for the overall production period, and feed efficiency at weeks 26–29. In addition, the degree of liver necrosis and microvascular thrombosis was lower (P < 0.05) whereas intestinal villosity was greater in duodenal and jejunal segments (P < 0.05) in the PHYTO compared to the control group. Supplementation also reduced (P < 0.05) blood concentrations of corticosterone, alanine aminotransferase activity, and TBARS, and a reduction in catalase activity was observed. Egg quality characteristics were not affected, except for eggshell thickness, egg diameter, and eggshell breaking strength that were superior in the PHYTO group (P < 0.05). PHYTO supplementation significantly improved egg lipid oxidation status of fresh eggs. In conclusion, supplementation with PHYTO improved laying hen productivity and egg quality, which was associated with an improvement in laying hen thermotolerance.

Improving the use of viral load (VL) testing for adolescents and young people living with HIV (AYPLWH) is a priority for Kenya’s Ministry of Health (MOH). Despite expansion of VL testing coverage and rollout of national policies, guidelines and training, VL result utilisation for AYPLWH remains suboptimal, with inadequate adherence to national guidelines recommending everyone on antiretroviral therapy (ART) with unsuppressed viral load (UVL) (≥401 copies/mL) receive three enhanced adherence counselling (EAC) sessions and a repeat VL test within 3 months. In March 2019, ICAP at Columbia University partnered with the MOH to launch a Quality Improvement Collaborative (QIC) at 22 health facilities in the Eastern Province to optimise management of AYPLWH on ART with UVL. Over 17 months, facility QI teams tested interventions targeting client education, workflow modifications, commodity management, community engagement and improved documentation. The QIC led to marked improvement in the proportion of clients completing three EAC sessions and repeat VL testing. Median completion rate was 16% (n=479) at baseline (from March 2018 to February 2019) and rose to 73% (n=755) during the implementation period (from March 2019 to July 2020). In the final month (July 2020), rates rose to 90% (n=31). Another success was the increase in the proportion of clients whose VL was resuppressed on repeat testing, which improved from 34% (n=273) at baseline to 62% (n=710) during the implementation period and 77% (n=44) in the final month. The QIC also led to improvement in the proportion of AYPLWH on first-line ART whose regimens were switched within 2 months of recorded UVL results, which rose from 58% (n=48) at baseline to 94% (n=128) during the implementation period. In summary, the QIC helped facility teams to identify and prioritise local, contextually appropriate innovations which led to swift improvement in three critical indicators of VL utilisation.

Triple elimination is an initiative supporting the elimination of mother-to-child transmission of three diseases--human immunodeficiency virus (HIV) infection, syphilis and hepatitis B. Significant progress towards triple elimination has been made in some regions, but progress has been slow in sub-Saharan Africa, the region with the highest burden of these diseases. The shared features of the three diseases, including their epidemiology, disease interactions and core interventions for tackling them, enable an integrated healthsystems approach for elimination of mother-to-child transmission. Current barriers to triple elimination in sub-Saharan Africa include a lack of policies, strategies and resources to support the uptake of well established preventive and treatment interventions. While much can be achieved with existing tools, the development of new products and models of care, as well as a prioritized research agenda, are needed to accelerate progress on triple elimination in sub-Saharan Africa. In this paper we aim to show that health systems working together with communities in sub-Saharan Africa could deliver rapid and sustainable results towards the elimination of mother-to-child transmission of all three diseases. However, stronger political support, expansion of evidence-based interventions and better use of funding streams are needed to improve efficiency and build on the successes in prevention of mother-to-child transmission of HIV. Triple elimination is a strategic opportunity to reduce the morbidity and mortality from HIV infection, syphilis and hepatitis B for mothers and their infants within the context of universal health coverage. La triple elimination est une initiative visant a soutenir l'eradication de la transmission mere-enfant de trois maladies - l'infection au virus de l'immunodeficience humaine (VIH), la syphilis et l'hepatite B. Bien que des avancees considerables aient ete observees en ce sens dans certaines regions, les progres demeurent lents en Afrique subsaharienne, pourtant durement touchee par ces maladies. Les caracteristiques communes aux trois affections, notamment leur epidemiologie, les interactions entre elles et les principales interventions necessaires a leur prise en charge permettent aux systemes de sante d'adopter une approche integree pour eviter la transmission mere-enfant. Plusieurs obstacles entravent actuellement la triple elimination en Afrique subsaharienne, parmi lesquels l'absence de politiques, de strategies et de ressources pour garantir la disponibilite de traitements preventifs et curatifs bien etablis. Les outils existants offrent deja de nombreuses solutions; mais pour accelerer la progression de cette triple elimination en Afrique subsaharienne, il est indispensable de developper de nouveaux produits et modeles de soins, ainsi qu'un programme de recherche prioritaire. Dans le present document, nous voulons montrer que si les systemes de sante collaborent avec les communautes en Afrique subsaharienne, ils pourront obtenir des resultats rapides et durables en vue d'eradiquer la transmission mere-enfant des trois maladies susmentionnees. Neanmoins, une telle demarche implique un soutien politique massif, l'expansion des interventions fondees sur des donnees scientifiques, et une meilleure utilisation des sources de financement afin d'ameliorer l'efficacite et de s'appuyer sur les reussites en matiere de prevention de la transmission du VIH de la mere a l'enfant. La triple elimination represente une occasion strategique de reduire la morbidite et la mortalite liees a l'infection au VIH, a la syphilis et a l'hepatite B, tant chez les meres que chez les nourrissons, dans un contexte de couverture maladie universelle. La triple eliminacion es una iniciativa que apoya la eliminacion de la transmision maternoinfantil de tres enfermedades: la infeccion por el virus de la inmunodeficiencia humana (VIH), la sifilis y la hepatitis B. En algunas regiones se han logrado avances significativos hacia la triple eliminacion, pero los progresos se han desarrollado con mayor lentitud en el Africa subsahariana, la region con la mayor carga de estas enfermedades. Las caracteristicas comunes de las tres enfermedades, como su epidemiologia, las interacciones entre ellas y las intervenciones basicas para combatirlas, permiten un enfoque integrado de los sistemas de salud para la eliminacion de la transmision maternoinfantil. Los obstaculos actuales para la triple eliminacion en el Africa subsahariana incluyen la falta de politicas, estrategias y recursos para apoyar la adopcion de intervenciones preventivas y de tratamiento bien establecidas. Aunque se puede lograr mucho con las herramientas existentes, se necesita el desarrollo de nuevos productos y modelos de atencion, asi como una agenda de investigacion prioritaria, para acelerar el progreso de la triple eliminacion en el Africa subsahariana. En este documento pretendemos demostrar que los sistemas de salud que trabajan conjuntamente con las comunidades del Africa subsahariana podrian obtener resultados rapidos y sostenibles hacia la eliminacion de la transmision maternoinfantil de las tres enfermedades. Sin embargo, se necesita un mayor apoyo politico, la ampliacion de las intervenciones basadas en la evidencia y un mejor uso de los flujos de financiacion para mejorar la eficiencia y aprovechar los exitos en la prevencion de la transmision maternoinfantil del VIH. La triple eliminacion es una oportunidad estrategica para reducir la morbilidad y la mortalidad de la infeccion por el VIH, la sifilis y la hepatitis B para las madres y sus hijos en el contexto de la cobertura sanitaria universal., Triple elimination Triple elimination is the elimination of mother-to-child transmission of three infections prevalent in low- and middle-income countries--human immunodeficiency virus (HIV), syphilis and hepatitis B virus. The African Region [...]