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The low-frequency sea level variability in the South China Sea (SCS) is examined using high-resolution regional ocean model simulations that span the last six decades. The analysis reveals interdecadal oscillations with a periodicity of 12–13 years as the dominant mode of sea level variability in the SCS. The fluctuations in the Luzon Strait transport (LST) are identified as primary drivers of interannual to interdecadal sea level variability, rather than atmospheric forcing within the SCS. Fourier spectrum analysis is employed to investigate the association between SCS sea level variability and the Interdecadal Pacific Oscillation (IPO), using principal components of SCS sea surface height anomalies, wind stress curl, wind stress components, net short wave flux, as well as the LST and various climate indices. The variations in the SCS sea level are driven by the IPO, which modifies the LST and ocean heat content, impacting the steric sea level.

Abstract This study investigates long‐term sea level changes in the South China Sea (SCS) using a validated high‐resolution regional ocean model simulation for the Maritime Continent. The contributions of ocean mass redistribution and steric sea level are examined to understand the sea level variations. The ocean bottom pressure (OBP) serves as an indicator of sea level variations linked to alterations in ocean mass flux. The OBP accounts for over 80% of the total sea level change over the shelves, while the steric sea level emerges as the dominant factor, contributing over 50% to the sea level change in the deep SCS. Luzon Strait transport shows a weakening trend in the last six decades, resulting in higher heat accumulation and larger steric expansion in the deep SCS. The ocean mass redistribution acts as a mechanism to balance the contrasting steric induced sea level changes over the deep SCS and shallow continental shelves.

Abstract This paper examines whether compliance with COVID-19 mitigation measures is motivated by wanting to save lives or save the economy (or both), and which implications this carries to fight the pandemic. National representative samples were collected from 24 countries (N = 25,435). The main predictors were (1) perceived risk to contract coronavirus, (2) perceived risk to suffer economic losses due to coronavirus, and (3) their interaction effect. Individual and country-level variables were added as covariates in multilevel regression models. We examined compliance with various preventive health behaviors and support for strict containment policies. Results show that perceived economic risk consistently predicted mitigation behavior and policy support—and its effects were positive. Perceived health risk had mixed effects. Only two significant interactions between health and economic risk were identified—both positive.

Anxiety associated with the COVID-19 pandemic and home confinement has been associated with adverse health behaviors, such as unhealthy eating, smoking, and drinking. However, most studies have been limited by regional sampling, which precludes the examination of behavioral consequences associated with the pandemic at a global level. Further, few studies operationalized pandemic-related stressors to enable the investigation of the impact of different types of stressors on health outcomes. This study examined the association between perceived risk of COVID-19 infection and economic burden of COVID-19 with health-promoting and health-damaging behaviors using data from the PsyCorona Study: an international, longitudinal online study of psychological and behavioral correlates of COVID-19. Analyses utilized data from 7,402 participants from 86 countries across three waves of assessment between May 16 and June 13, 2020. Participants completed self-report measures of COVID-19 infection risk, COVID-19-related economic burden, physical exercise, diet quality, cigarette smoking, sleep quality, and binge drinking. Multilevel structural equation modeling analyses showed that across three time points, perceived economic burden was associated with reduced diet quality and sleep quality, as well as increased smoking. Diet quality and sleep quality were lowest among respondents who perceived high COVID-19 infection risk combined with high economic burden. Neither binge drinking nor exercise were associated with perceived COVID-19 infection risk, economic burden, or their interaction. Findings point to the value of developing interventions to address COVID-related stressors, which have an impact on health behaviors that, in turn, may influence vulnerability to COVID-19 and other health outcomes.

It is not clear which are the most effective mechanisms to achieve sustainable lifestyle behaviour. Here the authors study the impact of behavioural interventions excluding economic incentives by performing a large-scale meta-analysis and find that these interventions promote sustainable behaviours to a small degree in the short-term with no evidence of sustained positive effects once the intervention is completed.

A 10-year-old girl with juvenile idiopathic arthritis in remission presented with a flare of her arthritis. All her joints responded to treatment except the right knee, despite the use of disease-modifying antirheumatic drugs, non-steroidal anti-inflammatory medication and high-dose cortisone. A magnetic resonance imaging scan showed a knee densely packed with rice bodies. After surgical removal of the rice bodies the inflammation settled once again, and the patient remains well on her usual medication.

Splenic diffuse red pulp small B-cell lymphoma (SDRPL) is a rare entity. Diagnosis is typically achieved with splenectomy and most patients remain in remission after this intervention. Hemoglobin value less than 10 g/dL and NOTCH1, TP53, and MAP2K1 gene mutations at diagnosis have been associated with worse outcome. Progression after splenectomy of SDRPL is possible, although transformation to aggressive lymphoma has rarely been reported. We herein report the case of a patient formerly diagnosed with SDRPL with gene mutations involving CREBBP, NOTCH1, ARID2, and TNFRSF14 who transformed to diffuse large B-cell lymphoma six months after splenectomy., Competing Interests: The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript., (© 2023 The Authors. Published by Elsevier Ltd.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: Healthcare workers seem to be more affected by stigma due to the Covid-19 pandemic compared to other occupational groups. However, there is very little research on this topic. The aims of the present study were to investigate pandemic-related stigmatization experiences among nursing and medical staff in Germany and determine the type and effects of stigmatization as well as appropriate prevention and intervention measures., Methods: The interviews were conducted by a semi-structured interview guide and evaluated using qualitative content analysis., Results: Sixteen nurses participated in the interviews. Sources of stigmatization were friends and acquaintances, family members, executives, colleagues, patients and their relatives, strangers and public media. Some of the interviewed persons reported self-stigmatization. A common cause of stigma in the private environment was the fear of infection. In the context of the work, illness-related absence was also named as one of the causes of stigma. The interviewees reported about distancing and avoiding contact, as well as allegations they were faced with. As a result, they suffered from negative feelings and partially from psychosomatic complaints. Some interviewees tried to avoid stigmatization by concealing their own profession or place of work. Help was offered in private and professional context in form of conversations and encouragement., Conclusion: Stigmatization of healthcare professionals during the pandemic has hardly been explored in Germany. There is a particular need for research to quantify the extent, manifestations and effects of work-related stigmatization and to develop suitable preventive measures at workplace and outside of work., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

This contribution is a theoretical reflection based on statistical and empirical data as well as concepts proposed by other authors or institutions. Based on the thesis that the respective social developments equally influence and limit the orientation and design of workplace health promotion, this article deals with the challenges that arise from the contemporary social, political and economic developments for a needs-oriented and effective workplace health promotion. On the basis of a historical review of the lines of development in workplace health promotion, beginning with the Ottawa Charter in 1986, the field of tension in which work-related health promotion approaches generally operate is first outlined. Based on the results of a keyword search in relevant European statistics databases and specialized databases on the topics of demographic change, labor migration and digitalization and flexibilization of work, current development trends in the world of work are traced, priority desiderata for a future design of health promotion are derived from these, and their chances of realization are reflected upon. On the basis of the data collected, it becomes clear that today's world of work is characterized by multidimensional diversification processes, which are accompanied by the risk of worsening social inequalities. The conclusion is that future concepts of workplace health promotion must be more universal than previous approaches, which are often limited to the focus of individual behavioral prevention. The attempt to promote workplace health promotion with economic benefit arguments also runs the risk of reinforcing social inequality. The task of effective workplace health promotion, conversely, must be to initiate critical reflection on current priorities.

Stigmatization from work-related COVID-19 exposure has not been investigated in detail yet. Therefore, we systematically searched three databases: Medline, Embase, and PsychInfo (until October 2020), and performed a grey literature search (until February 2021). We identified 46 suitable articles from 24 quantitative and 11 qualitative studies, 6 systematic reviews, 3 study protocols and 1 intervention. The assessment of stigmatization varied widely, ranging from a single-item question to a 22-item questionnaire. Studies mostly considered perceived self-stigma (27 of 35 original studies) in healthcare workers (HCWs) or hospital-related jobs (29 of 35). All articles reported on stigmatization as a result of work-related COVID-19 exposure. However, most quantitative studies were characterized by convenience sampling (17 of 24), and all studies-also those with an adequate sampling design-were considered of low methodological quality. Therefore, it is not possible to determine prevalence of stigmatization in defined occupational groups. Nevertheless, the work-related stigmatization of occupational groups with or without suspected contact to COVID-19 is a relevant problem and increases the risk for depression (odds ratio (OR) = 1.74; 95% confidence interval CI 1.29-2.36) and anxiety (OR = 1.75; 95% CI 1.29-2.37). For promoting workers' health, anti-stigma strategies and support should be implemented in the workplace.

Background and Objectives: Diversity is increasing, including among workers. Traditional approaches in occupational safety and health are no longer sufficient to meet the emerging challenges in the workplace. Currently, knowledge about specific needs of workers with a migrant background is insufficient to develop suitable interventions under participatory methods. The aim of this work is to gain knowledge about diversity in the workplace and discuss considerations for suitable prevention and health promotion., Materials and Methods: Research in reports, analyses of the German Socio-Economic Panel, as well as a review of the literature in relevant databases served to collate current findings about health indicators, stress and strain, structural conditions, and occupational prevention and health promotion., Results: Differentiated results about health in the workplace and stress and strain could be identified. In particular, workers with a migrant background are more often exposed to physical stress and harsh environmental conditions. Furthermore, structural conditions are worse for these workers, e.g. due to lower employment rates, as well as enhanced atypical employment among the target group., Conclusion: Plausible explanations for the reported differences are discussed and useful implications are given. However, the overall lack of data and challenges in data collection must be considered.

Juvenile idiopathic arthritis (JIA) is the most prevalent chronic rheumatic disease in children and young people (CYP) and a major cause of pain and disability. The vast majority of the world's children and their families live in less resourced countries (LRCs) and face significant socioeconomic and healthcare challenges. Current recommendations for standards of care and treatment for children with JIA do not consider children living in less resourced countries. In order to develop appropriate recommendations for the care of CYP with JIA in less resourced countries a meeting of experienced pediatric rheumatologists from less resourced countries was convened with additional input from a steering group of international pediatric rheumatologists with experience in developing recommendations and standards of care for JIA. Following a needs assessment survey of healthcare workers caring for CYP with JIA in LRC, a literature review was carried out and management recommendations formulated using Delphi technique and a final consensus conference. Responses from the needs assessment were received from 121/483 (25%) practitioners from 25/49 (51%) less resourced countries. From these responses, the initial 84 recommendations were refined and expanded through a series of 3 online Delphi rounds. A final list of 90 recommendations was proposed for evaluation. Evidence for each statement was reviewed, graded, and presented to the consensus group. The degree of consensus, level of agreement, and level of evidence for these recommendations are reported. Recommendations arrived at by consensus for CYP with JIA in less resourced countries cover 5 themes: (1) diagnosis, (2) referral and monitoring, (3) education and training, (4) advocacy and networks, and (5) research. Thirty-five statements were drafted. All but one statement achieved 100% consensus. The body of published evidence was small and the quality of evidence available for critical appraisal was low. Our recommendations offer novel insights and present consensus-based strategies for the management of JIA in less resourced countries. The emphasis on communicable and endemic diseases influencing the diagnosis and treatment of JIA serves as a valuable addition to existing JIA guidelines. With increasing globalization, these recommendations as a whole provide educational and clinical utility for clinicians worldwide. The low evidence base for our recommendations reflects a shortage of research specific to less resourced countries and serves as an impetus for further inquiry towards optimizing care for children with JIA around the world.

Objectives: This study ascertained the regulation of the stem cell marker CD133 and its potential applicability for prognostication of gastrointestinal stromal tumors (GISTs)., Methods: A total of 95 resected GISTs were included in the study. CD133 protein expression was assessed immunohistochemically on tissue microarrays. Methylation percentage was quantified by pyrosequencing. Gene expression in cell lines GIST48b and GIST882 upon treatment with DNA demethylation agent 5-aza-2'-deoxycytidine was analyzed by quantitative polymerase chain reaction., Results: The expression of hypermethylated CD133 could be reactivated in the GIST cell line upon hypomethylation with the drug. Similarly, in patient material, CD133 methylation percentage correlated inversely with the protein expression and reflected tumor size with hypermethylation in small (<2 cm) tumors and virtually no methylation in large (>10 cm) GISTs. The gene's methylation percentage and expression level were clearly specific to anatomic sites and distinct driver mutations. KIT -mutant gastric GISTs exhibited significantly lower methylation degrees and concomitant high CD133 protein abundance compared with KIT -mutant GISTs from the small intestine. CD133 hypermethylation was documented in PDGFRA -mutant gastric GISTs along with low CD133 expression compared with KIT -mutant gastric GISTs. High CD133 expression was a prognosticator of shorter disease-free survival in all patients. In a subgroup of KIT -mutant gastric GISTs, low CD133 methylation degree was correlated with a shorter disease-free survival., Conclusions: Our results strongly suggest epigenetic regulation of CD133 expression by promoter methylation in GISTs. Pending further validation studies, high abundance of the protein can serve as a marker for malignant GISTs., (© American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Pulmonary Langerhans cell histiocytosis (PLCH) is a rare, smoking-related histiocytic disorder with variable clinical symptoms. Like in other non-pulmonary Langerhans cell proliferations, PLCH has recently been shown to harbour BRAF V600E mutations in a significant subset of cases, thus challenging the concept of PLCH being a reactive disorder. Here, we analysed 38 formalin-fixed and paraffin-embedded PLCH nodules of nine patients for BRAF mutation using two different molecular methods. Using pyrosequencing and allele-specific quantitative PCR (AS-PCR), BRAF V600E mutations were found in 16/38 (42%) and 31/37 (84%) nodules, respectively. Analysing different nodules of the same patients with pyrosequencing 3/6 patients showed a concordant BRAF mutation status. When allele-specific quantitative PCR was used, condordant results were found in 5/6 patients. Our findings clearly indicate that (a) the sensitivity of the method used is crucial in analysing BRAF mutation status, (b) AS-PCR is more sensitive in detecting BRAF V600E mutations than pyrosequencing,, ((c) BRAF mutation is frequent and might play a key role in the pathogenesis of PLCH and (d) PLCH is a true neoplastic disease.)

Background Systemic lupus erythematosus (SLE) is a life-threatening multisystem autoimmune disease that is more severe in patients of African ancestry and children, yet pediatric SLE on the African continent has been understudied. This study describes a cohort of pediatric SLE (PULSE) patients in South Africa. Methods Patients with a diagnosis of SLE (1997 American College of Rheumatology criteria) diagnosed prior to age 19 years in Cape Town, South Africa, were enrolled in this cross-sectional study from September 2013 to December 2014. Information on clinical and serological characteristics was extracted from medical records. Results were compared to a well-described North American pediatric SLE cohort. Results Seventy-two South African patients were enrolled in the study; mean age 11.5 years; 82% were girls. The racial distribution was 68% Coloured, 24% Black, 5% White and 3% Asian/Indian. Most patients presented with severe lupus nephritis documented by renal biopsy (61%). Of patients with lupus nephritis, 63% presented with International Society of Nephrology/Renal Pathology Society class III or IV. Patients in the PULSE cohort were more likely to be treated with cyclophosphamide, methotrexate and azathioprine. The PULSE cohort had high disease activity at diagnosis (mean Systemic Lupus Erythematosus Disease Activity Index-2K (SLEDAI-2K) 20.6). The SLEDAI-2K at enrolment in the PULSE cohort (5.0) did not differ from the North American pediatric SLE cohort (4.8). Sixty-three per cent of the PULSE cohort had end organ damage with Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI) score >0 (mean SLICC-DI 1.9), compared to 23% in a previously reported US cohort. Within the PULSE cohort, nine (13%) developed end-stage renal disease with six (8%) requiring transplant, strikingly higher than North American peers (transplant rate <1%). Conclusions The PULSE cohort had highly active multiorgan disease at diagnosis and significant disease damage at enrolment in the South African registry. South African patients have severe lupus nephritis and poor renal outcomes compared to North American peers. Our study revealed a severe disease phenotype in the PULSE cohort resulting in poor outcomes in this high-risk population.

Objective: Use of metal springs for treatment of craniosynostosis is gaining ground in the surgical armamentarium, as these springs simplify operative technique, help to avoid extended approaches, and thus minimize morbidity. Nevertheless, these devices have to be removed eventually. The purpose of this study was to perform cranial expansion with a fully integrated, biodegradable polymer spring in an animal model and to assess the efficacy of and histological reaction to this device., Material and Methods: This was an experimental, unblinded, prospective study. Twelve female New Zealand rabbits (Oryctolagus cuniculus) aged 6 weeks were randomly allocated to two groups. Control animals underwent linear craniectomy alone. Intervention animals underwent craniectomy with placement of a poly(lactic-co-glycolic acid)/polyisoprene (PLGA/PI) copolymer blend spring for cranial expansion transverse to the ostectomy. Expansion was measured radiographically over 12 weeks with amalgam markers. At the end of the experiment period, histological analysis was performed to quantify inflammatory reaction., Results: The copolymer blend springs had a mean strength of 4.2N. In the intervention group, cranial expansion at the frontal markers was 9.6-11.67 mm (significantly greater than in controls). Histological analysis showed minor inflammatory reactions., Conclusion: In this animal model, cranial expansion by linear craniectomy followed by bioabsorbable spring placement was feasible and well tolerated by adjacent tissues., (Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: To report the prevalence, clinical differences and complications of right-sided diverticulosis (RD) and to investigate the potential disparities from left-sided diverticulosis (LD) in the Vietnamese population., Subjects and Methods: A retrospective cohort study was conducted using medical records of Vietnamese-born patients from 2000 to 2013 in a community teaching hospital in Boston, Mass., USA. By simple randomization, a randomized control group of 299 Caucasian patients was also selected from the same time frame [167 males (M) and 132 females (F)]. Colonoscopy reports were reviewed for demographics (age and gender), indication and anatomical location of the colonic diverticulosis (CD), concomitant colonic findings, symptoms, and endoscopic complications., Results: A total of 207 patients were included in the Vietnamese cohort (mean age 61.6 ± 8.9 years). The mean age at first screening colonoscopy was 58.2 ± 7.2 years (114 F/92 M, 55.7/44.4%). Our study identified 104 (50.5%) patients with LD (57 M/47 F), 65 (31.1%) with RD (35 M/30 F) and 38 (18.4%) with both LD and RD (23 M/15 F); 133 (64%) were asymptomatic. A total of 21 (33%) patients with RD were symptomatic. The mean age of the control group was 61.6 ± 8.1 years. The average age at first screening colonoscopy was 52.8 ± 6.4 years. Of the 299 in the Caucasian group, 254 (84.9%) had LD (114 M/140 F), 9 (3.0%) had RD (2 M/7 F) and 36 (12%) had both LD and RD (16 M/20 F); 225 (75%) were asymptomatic and came in for screening colonoscopies. A total of 2 patients (22%) with RD were symptomatic., Conclusion: RD was common in this Vietnamese population, and the prevalence was higher than in the Caucasian control group., (© 2015 S. Karger AG, Basel.)