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Objectives The aim of this study was to develop prediction models for the individual-level impacts of cardiovascular events on UK healthcare costs. Methods In the UK Biobank, people 40–70 years old, recruited in 2006–2010, were followed in linked primary (N = 192,983 individuals) and hospital care (N = 501,807 individuals) datasets. Regression models of annual primary and annual hospital care costs (2020 UK£) associated with individual characteristics and experiences of myocardial infarction (MI), stroke, coronary revascularization, incident diabetes mellitus and cancer, and vascular and nonvascular death are reported. Results For both people without and with previous cardiovascular disease (CVD), primary care costs were modelled using one-part generalised linear models (GLMs) with identity link and Poisson distribution, and hospital costs with two-part models (part 1: logistic regression models the probability of incurring costs; part 2: GLM with identity link and Poisson distribution models the costs conditional on incurring any). In people without previous CVD, mean annual primary and hospital care costs were £360 and £514, respectively. The excess primary care costs were £190 and £360 following MI and stroke, respectively, whereas excess hospital costs decreased from £4340 and £5590, respectively, in the year of these events, to £190 and £410 two years later. People with previous CVD had more than twice higher annual costs, and incurred higher excess costs for cardiovascular events. Other characteristics associated with higher costs included older age, female sex, south Asian ethnicity, higher socioeconomic deprivation, smoking, lower level of physical activities, unhealthy body mass index, and comorbidities. Conclusions These individual-level healthcare cost prediction models could inform assessments of the value of health technologies and policies to reduce cardiovascular and other disease risks and healthcare costs. An accompanying Excel calculator is available to facilitate the use of the models.

Over the last several decades, Gallup data shows an increased willingness among members of the public to support presidential candidates from a wide range of religious backgrounds, though a nontrivial proportion of the public is still unwilling to vote for an Atheist, Mormon, or Muslim. What underlies this opposition? We argue that voters evaluate candidates from religious out-groups more negatively on a wide range of dimensions considered desirable for political office, and that this bias should be more pronounced among the highly religious. We show support for these arguments using a survey experiment fielded with YouGov. Atheists and Muslim candidates were perceived more negatively on a large set of traits considered desirable for political office compared to candidates from religious in-groups, and Mormon candidates fall somewhere in between. The Atheist and Muslim candidates were also perceived as less competent on a diverse set of issues.

Flow diverter stents (FDS) are well established in the treatment of intracranial aneurysms which are difficult to treat with conventional endovascular techniques. However, they carry a relatively high risk of specific complications compared to conventional stents. A minor but frequent finding is the occurrence of reversible in-stent-stenosis (ISS) that tend to resolve spontaneously over time. Here, we report the case of a patient in their 30s who was treated with FDS for bilateral paraophthalmic internal carotid artery (ICA) aneurysms. ISS were found at the respective early follow-up examinations on both sides and had resolved at the 1-year follow-up examinations. Surprisingly ISS reoccurred at both sides in later follow-up examinations and again resolved spontaneously. The recurrence of ISS after resolution is a finding that has not been described previously. Its incidence and further development should be investigated systematically. This might contribute to our understanding of the mechanisms underlying the effect of FDS.

Among young people who use drugs in the context of entrenched poverty and homelessness, pregnancy is often viewed as an event that can meaningfully change the trajectory of their lives. However, youth’s desires and decision-making do not always align with the perspectives of various professionals and systems regarding how best to intervene during pregnancies and early parenting. Drawing on longitudinal interviews and fieldwork with young people in Vancouver, Canada, we explore how their romantic relationships powerfully shaped understandings of what was right and wrong and which actions to take during pregnancy and early parenting, and how these moral worlds frequently clashed with the imperatives of healthcare, criminal justice, and child protection systems. We demonstrate how a disjuncture between youth’s desires, decision-making and moralities, and the systems that are intended to help them, can further entrench young people in cycles of loss, defeat, and harm. These cycles are powerfully racialized for young Indigenous people in our context.

The human dopamine transporter gene SLC6A3 has been consistently implicated in several neuropsychiatric diseases but the disease mechanism remains elusive. In this risk synthesis, we have concluded that SLC6A3 represents an increasingly recognized risk with a growing number of familial mutants associated with neuropsychiatric and neurological disorders. At least five loci were related to common and severe diseases including alcohol use disorder (high activity variant), attention-deficit/hyperactivity disorder (low activity variant), autism (familial proteins with mutated networking) and movement disorders (both regulatory variants and familial mutations). Association signals depended on genetic markers used as well as ethnicity examined. Strong haplotype selection and gene-wide epistases support multimarker assessment of functional variations and phenotype associations. Inclusion of its promoter region’s functional markers such as DNPi (rs67175440) and 5’VNTR (rs70957367) may help delineate condensate-based risk action, testing a locus-pathway-phenotype hypothesis for one gene-multidisease etiology.

Background Good interpersonal communication is the cornerstone of social work practice, enhancing the outcomes of people in receipt of its services. Social workers’ communication skills are often identified as an area of concern. Communication skills can be developed and refined through training or education. The teaching and learning of communication skills is firmly embedded in many social work qualifying courses; however, considerable heterogeneity exists regarding such complex interventions and the theoretical underpinnings of which have not been made explicit. Realist synthesis can help explain how, why, for whom and in what circumstances an intervention might work, which is an important first step for helping educators to tailor courses to meet the needs of different learner groups and, where applicable, the employing agencies and government departments who fund them. Methods Realist synthesis is an interpretive, theory-driven and explanatory approach that aims to explain the interplay between the context, mechanisms and outcomes of interventions. This realist synthesis seeks to understand and explain to what extent, how, why, for whom and in what circumstances complex educational interventions aimed at teaching communication skills to social work students produces its effects. A five-step process will be followed iteratively. In step 1, the initial programme theory will be developed. Step 2 will involve searching for evidence. In step 3, selection and appraisal will take place. Step 4 requires data to be extracted and organised, and in step 5, data will be analysed and synthesised. Discussion The teaching and learning of communication skills in social work education is under theorised. The findings from this realist synthesis aim to help policymakers and educators make informed decisions about the design and delivery of complex educational interventions aimed at improving the communication skills of social work students. The realist synthesis will be conducted and reported in accordance with the RAMESES guidelines and standards. Systematic review registration The review is registered with the Open Science Framework. https://doi.org/10.17605/OSF.IO/BYHC7

Die COVID-19-Infektion kann sich uber das pulmonale Erscheinungsbild hinaus mit einer Vielzahl an sowohl akuten als auch chronischen neurologischen und neuropsychiatrischen (Begleit‑)Symptomen und Erkrankungen manifestieren. Unspezifische Symptome wie Kopfschmerzen, Mudigkeit, Geruchs- und Geschmacksstorung wurden haufiger, schwere Erkrankungen wie Enzephalopathie, Enzephalitis und zerebrovaskulare Ereignisse verhaltnismasig selten berichtet. Die Heterogenitat der neurologischen und neuropsychiatrischen Erscheinungsbilder ist gros, wie auch die Bandbreite der aufgezeichneten Pravalenzen in den einzelnen Studien. Hoheres Patientenalter, vorbestehende neurologische und nichtneurologische Komorbiditaten sowie eine schwere COVID-19-Erkrankung waren assoziiert mit einem erhohten Risiko fur schwere neurologische Komplikationen und eine hohere Krankenhausmortalitat. Wahrscheinliche neurotrope Pathomechanismen des SARS-CoV‑2 wurden diskutiert, eine daruber hinausgehende multifaktorielle Genese der neurologisch/neuropsychiatrischen Symptome und Erkrankungen ist jedoch wahrscheinlich.

Ein Schadel-Hirn-Trauma (SHT) durch Gewalteinwirkung kann zu einer Funktionsstorung und Verletzung des Gehirns fuhren. Akzidentelle und nichtakzidentelle Traumata sind nach wie vor weltweit die haufigste Todesursache im Kindesalter. Es wird davon ausgegangen, dass ca. 20 % der SHT bei Kindern unter 2 Jahren nichtakzidentell verursacht sind. Dem nichtakzidentellen SHT ist in allen Fallen die gewaltsame Einwirkung auf das Gehirn und Ruckenmark gemeinsam, hervorgerufen durch das massive Hin- und Herschutteln des an den Oberarmen bzw. Korper festgehaltenen Kindes. Dies kann zu einem Abriss von Blutgefasen insbesondere von Bruckenvenen fuhren sowie zu axonalen Scherverletzungen der Nervenverbindungen und Hirnschwellung. Durch die Mitbeteiligung des Hirnstamms kann es zu einem initialen kurzfristigen Atemstillstand kommen. Daraus resultierende klinische Symptome umfassen u. a. Trinkschwache, Schlafrigkeit, Apathie, zerebrale Krampfanfalle, Atemstorungen, Temperaturstorungen und Erbrechen infolge eines erhohten Hirndrucks. Langzeitstorungen konnen neben neurologischen und neuropsychologischen Storungen, Horstorungen, Sehstorungen bis zur Blindheit, Schulleistungsschwache sein. Zusatzlich finden sich auch metaphysare Frakturen und Rippenfrakturen unterschiedlichster Auspragung. Da das Schutteltrauma eine schlechte Prognose hat, sind praventive Masnahmen sinnvoll: Aufklarung!

Cervical disc arthroplasty is an established procedure, but studies with data on long-term clinical outcome, reoperation for symptomatic adjacent segment degeneration (sASD), and degenerative changes based on MRI findings are rare. Thus, a file review was performed and patients with complete documentation of neurological status at preoperative, postoperative, 12 month, 3–4 years follow-up including surgical reports for reoperation with a minimum follow-up of 9 years were included. Final follow-up assessment included a physical examination, assessment of pain levels, Odoms criteria, Neck disability index. The degeneration of each cervical segment at preoperative and at final follow-up was assessed using an MRI. Forty-six out of 68 included patients participated, the mean follow-up was 11 (range 9–15) years, at which 71.7% of patients were free of arm pain, 52.2% of patients were free of neck pain, 63% of patients had no sensory dysfunction, and full motor strength was noted in 95.6% of patients. The clinical success rate was 76.1%, the mean NDI was 12%. Overall repeated procedure rate was 17%, the reoperation rate for sASD was 9%, and removal of CDA was performed in 4%. MRI showed progressive degeneration but no significant changes of SDI from preoperative to final follow-up.

Spinal vascular malformations include various entities, including spinal dural arteriovenous (AV) fistulas, acquired malformations and cavernous hemangiomas, and spinal arteriovenous malformations. AV fistula refers to a spinal cord vascular malformation in which there is a short-circuit connection between a dural artery and a perimedullary vein superficial to the myelon. The condition is relatively rare, initial clinical symptoms are often misinterpreted, and a definitive diagnosis is often delayed by 12 months or more. However, early diagnosis is important to prevent progression of clinical symptoms, which may include paraplegia. Early magnetic resonance imaging (MRI) is helpful, showing intramedullary edema in the T2-weighted sequences and superficial, markedly dilated veins. Treatment consists of ligation of the AV fistula, either surgically or by embolization. Cavernous hemangiomas, consisting of a large number of closely located immature blood vessels, are also relatively rare and have a low risk of bleeding (approximately 0.2-0.5%). Venous hemorrhage may also occur, resulting in clinical symptoms (including paraplegia).

The morphology and elemental composition of alluvial gold grains from the Betare Oya gold district were investigated as part of a district exploration strategy. The morphology and general chemistry of the grains, determined using scanning electron microscopy (SEM)—energy dispersive spectroscopy and electron probe microanalyzer (EMPA), respectively, revealed three categories of grains: (1) gold grains with irregular to regular, bent-up and folded outlines with irregular and pitted surfaces and a flatness index ranging from 2.1 to 4.6; (2) gold grains with regular and polished outlines, smooth surfaces with few or no cavities and a characteristic flatness index range between 3.0 and 8.6; (3) and elongate grains. Rounding of the grains, physical abrasion and bent/folded features suggest that the alluvial gold grains have been transported in a high-energy environment, but not necessarily over long distances from their source rock(s). The gold grains are alloyed with Ag and Cu with concentrations of Ag ranging from 0 to 14.19 wt% whereas Cu concentrations are between 0.03 and 0.15 wt%. SEM images of sites where active weathering of gold is indicated by the presence of colloidal gold, i.e., crevices possessing sedimentary materials on the surface of the grains, revealed the presence of bacteria. All of the gold grains analyzed possess high purity (~ 100% Au) at the water–sediment–gold interface demonstrating that Ag and Cu are highly dispersed in placer systems relative to gold, and that gold can be dissolved and subsequently re-precipitated possibly with the aid of bacteria in alluvial systems.

The effects of platinum (Pt) and gold (Au) and on the soil bacterial community was evaluated in four different Australian soil types (acidic Burn Grounds (BGR), organic matter–rich Fox Lane, high silt/metal Pinpinio (PPN), and alkali Minnipa (MNP) spiked with either Pt or Au at 1, 25, and 100 mg kg−1 using a next-generation sequencing approach (amplicon-based, MiSeq). Soil type and metal concentrations were observed to be key drivers of Pt and Au effects on soil microbial community structure. Different trends were therefore observed in the response of the bacterial community to Pt and Au amendments; however in each soil type, Pt and Au amendment caused a detectable shift in community structure that in most samples was positively correlated with increasing metal concentrations. New dominant groups were only observed in BGR and PPN soils at 100 mg kg−1 (Kazan-3B-28 and Verrucomicrobia groups (BGR, Pt) and Firmicutes and Caldithrix groups (PPN, Pt) and WS2 (BGR, Au). The effects of Pt on soil microbial diversity were largely adverse at 100 mg kg−1 and were pronounced in acidic, basic, and metal/silt-rich soils. However, this effect was concentration-related; Au appeared to be more toxic to soil bacterial communities than Pt at 25 mg kg−1 but Pt was more toxic at 100 mg kg−1. More bacterial groups such as those belonging to Burkholderiales/Burkholderiaceae, Alicyclobacillaceae, Rubrobacteraceae, Cytophagaceae, Oxalobacteraceae were selectively enriched by Pt compared to Au (Sphingomonadaceae and Rhodospirillaceae) amendments irrespective of soil type. The research outcomes have important implications in the management (remediation) of Pt- and Au-contaminated environments.

Zusammenfassung Hintergrund Die Therapiestrategie von Patienten mit akutem Schlaganfall der Arteria cerebri media (ACM) wird durch die Lokalisation der Okklusion beeinflusst. Diese Studie zielte darauf ab, die klinischen Ergebnisse bei Patienten mit akutem ischämischem ACM-Verschluss, die mit endovaskulärer mechanischer Thrombektomie (EVT) behandelt wurden, entsprechend dem Okklusionsort zu analysieren. Methoden Es wurden 54 Patienten (Alter: 73 ± 15 Jahre; 59 % weiblich), die aufgrund eines akuten ACM-Verschlusses mittels EVT behandelt wurden, eingeschlossen. In koronar reformatierten MIP-Bildern (Maximumintensitätsprojektion) der CT-Angiographie wurde die Distanz zum Thrombus (DT), also dem Abstand vom Karotis‑T zum Beginn des Thrombus, gemessen. Die Korrelation zwischen DT, klinischer Symptomatik und klinischem Outcome der Patienten mit EVT-Therapie wurde analysiert. Ergebnisse Die DT korrelierte mit der klinischen Symptomatik, gemessen an der National Institutes of Health Stroke Scale (NIHSS; p = 0,017; R = −0,324), bei Aufnahme. Sie korrelierte auch mit der modifizierten Rankin-Skala nach 90 Tagen (90-Tage-mRS; p = 0,014; R = −0,333). Die DT ist ein Prädiktor für ein gutes klinisches Outcome (mRS nach 90 Tagen) nach EVT; Odds-Ratio: 1,113 (p = 0,02; 95 % Konfidenzintervall [KI] 1,017–1,219). Eine DT >10 mm korrelierte signifikant (p = 0,036) mit einem guten klinischen Outcome (90-Tage-mRS ≤2). Schlussfolgerung Die DT korreliert mit der klinischen Symptomatik von Patienten mit akutem ACM-Verschluss. Darüber hinaus sie ein unabhängiger Prädiktor für das klinische Outcome von Patienten, die an einem akuten Schlaganfall durch ACM-Okklusion leiden.