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BACKGROUND: Throughout the Syrian conflict, the Syrian government has intentionally attacked health facilities, violating International Humanitarian Law. Previous studies have qualitatively described health system disruptions following attacks on healthcare or established associations between armed conflict and health service utilisation, but there are no quantitative studies exploring the effects of health facility attacks. Our unprecedented study addresses this gap by quantifying the effects of health facility attacks on health service use during the Syrian conflict. METHODS: This retrospective observational study uses 18 537 reports capturing 2 826 627 consultations from 18 health facilities in northwest Syria and 69 attacks on these facilities. The novel study applies case time series design with a generalised non-linear model and stratification by facility type, attack mechanism and corroboration status. RESULTS: The study found significant, negative associations between health facility attacks and outpatient, trauma and facility births. On average, a health facility attack was associated with 51% and 38% reductions in outpatient, RR 0.49 (95% CI 0.43 to 0.57) and trauma consultations, RR 0.62 (95% CI 0.53 to 0.72), the day after an attack, with significant reductions continuing for 37 and 20 days, respectively. Health facility attacks were associated with an average 23% reduction in facility births, the second day after an attack, RR 0.77 (95% CI 0.66 to 0.89), with significant reductions continuing for 42 days. CONCLUSIONS: Attacks on health facilities in northwest Syria are strongly associated with significant reductions in outpatient, trauma and facility births. These attacks exacerbate the adverse effects of armed conflict and impede the fundamental right to health. The findings provide evidence that attacks on health facilities, violations of international humanitarian law by themselves, also negatively affect human rights by limiting access to health services, underscoring the need to strengthen health system resilience in conflict settings, expand systematic reporting of attacks on healthcare and hold perpetrators accountable.

Scientific practices are the skills used to develop scientific knowledge and are essential for careers in science. Despite calls from education and government agencies to cultivate scientific practices, there remains little evidence of how often students are asked to apply them in undergraduate courses. We analyzed exams from biology courses at 100 institutions across the United States and found that only 7% of exam questions addressed a scientific practice and that 32% of biology exams did not test any scientific practices. The low occurrence of scientific practices on exams signals that undergraduate courses may not be integrating foundational scientific skills throughout their curriculum in the manner envisioned by recent national frameworks. Although there were few scientific practices overall, their close association with higher-order cognitive skills suggests that scientific practices represent a primary means to help students develop critical thinking skills and highlights the importance of incorporating a greater degree of scientific practices into undergraduate lecture courses and exams.

Participatory approaches to science and decision making, including stakeholder engagement, are increasingly common for managing complex socio-ecological challenges in working landscapes. However, critical questions about stakeholder engagement in this space remain. These include normative, political, and ethical questions concerning who participates, who benefits and loses, what good can be accomplished, and for what, whom, and by who. First, opportunities for addressing justice, equity, diversity, and inclusion interests through engagement, while implied in key conceptual frameworks, remain underexplored in scholarly work and collaborative practice alike. A second line of inquiry relates to research-practice gaps. While both the practice of doing engagement work and scholarly research on the efficacy of engagement is on the rise, there is little concerted interplay among 'on-the-ground' practitioners and scholarly researchers. This means scientific research often misses or ignores insight grounded in practical and experiential knowledge, while practitioners are disconnected from potentially useful scientific research on stakeholder engagement. A third set of questions concerns gaps in empirical understanding of the efficacy of engagement processes and includes inquiry into how different engagement contexts and process features affect a range of behavioral, cognitive, and decision-making outcomes. Because of these gaps, a cohesive and actionable research agenda for stakeholder engagement research and practice in working landscapes remains elusive. In this review article, we present a co-produced research agenda for stakeholder engagement in working landscapes. The co-production process involved professionally facilitated and iterative dialogue among a diverse and international group of over 160 scholars and practitioners through a yearlong virtual workshop series. The resulting research agenda is organized under six cross-cutting themes: (1) Justice, Equity, Diversity, and Inclusion; (2) Ethics; (3) Research and Practice; (4) Context; (5) Process; and (6) Outcomes and Measurement. This research agenda identifies critical research needs and opportunities relevant for researchers, practitioners, and policymakers alike. We argue that addressing these research opportunities is necessary to advance knowledge and practice of stakeholder engagement and to support more just and effective engagement processes in working landscapes.Supplementary informationThe online version contains supplementary material available at 10.1007/s42532-022-00132-8.

Too often youth from vulnerable communities see themselves talked about in academic research, but are rarely involved as co-researchers or co-authors of research. The purpose of this article is to share our reflections on engaging youth, their experiences and their perspectives on the multi-levels of impact of participatory action research methodologies, such as community-based action research or youth participatory action research. This article discusses more broadly how our participatory methodologies have impacted our co-researchers and ourselves. In it, we provide additional details about our past research projects, as well as theorizing those details in terms of how critical theory serves as a tool within participatory methodologies. We reflect on the experiences engaging participatory methodologies in two different contexts and examine the collective impacts, comparing and contrasting the findings. We draw on our field research: one researcher worked with co-researchers from Kakuma Refugee Camp, Kenya, and the other worked alongside youth co-researchers from an alternative secondary school in the USA. Two of our co-authors are also co-researchers, and they offer a deeper insight into how these methodologies impacted their lives.

Atrophy of neurons in the prefrontal cortex (PFC) plays a key role in the pathophysiology of depression and related disorders. The ability to promote both structural and functional plasticity in the PFC has been hypothesized to underlie the fast-acting antidepressant properties of the dissociative anesthetic ketamine. Here, we report that, like ketamine, serotonergic psychedelics are capable of robustly increasing neuritogenesis and/or spinogenesis both in vitro and in vivo. These changes in neuronal structure are accompanied by increased synapse number and function, as measured by fluorescence microscopy and electrophysiology. The structural changes induced by psychedelics appear to result from stimulation of the TrkB, mTOR, and 5-HT2A signaling pathways and could possibly explain the clinical effectiveness of these compounds. Our results underscore the therapeutic potential of psychedelics and, importantly, identify several lead scaffolds for medicinal chemistry efforts focused on developing plasticity-promoting compounds as safe, effective, and fast-acting treatments for depression and related disorders.

A unique challenge for organizations is in leading diverse, dispersed teams whose members are motivated to work independently, but are willing to collaborate. The purpose of this study was to gain an understanding of how nuanced variations in motivational patterns influences the relationship between work satisfaction and virtual team effectiveness. A sequential, mixed methods design was used to analyze and explain the moderating effects of motivational orientation on this relationship. In the first, quantitative phase, participating virtual team members completed an online survey with items comprising the five motivation source scales from the Motivation Sources Inventory, work satisfaction, and eleven variables measuring utilization of virtual team effectiveness attributes from the Virtual Teams Survey. Seven hypotheses were tested, with support found for three of the hypotheses. Work satisfaction and utilization of the virtual team effectiveness attributes were found to be positively correlated. Support was also found for hypotheses that the relationship between work satisfaction and utilization of the virtual team effectiveness attributes will be stronger for virtual team members (VTMs) with low self-concept external and / or moderate or high goal internalization patterns. In the second, qualitative phase, follow-up interviews were conducted to support and provide rationale for the quantitative results. Qualitative analysis of interviews revealed three major themes focused on concerns regarding team leadership, organizational support, and technology. Viewed in context with the quantitative results, the themes suggest that work satisfaction may be improved for most VTMs, regardless of motivation pattern, by strengthening leadership, aligning rewards with goals, and enhancing the technology used for team communication.

This study examined the effect of agriculture faculty training in and practice of methodologies to explicitly teach critical thinking skills related to course content and subsequent change in student critical thinking disposition. Twelve instructors in 14 agriculture courses underwent a year-long program of instruction in effective critical thinking development. Students completed the University of Florida-Engagement, Maturity, and Innovativeness assessment (UF-EMI) at the beginning and the end of the semester. Pair-wise comparisons showed significant increases in all three critical thinking dispositions (i.e., engagement, cognitive maturity, and innovativeness). In addition, a step-wise regression on the data gathered at the end of the semester showed that grade point average was positively related to all three critical thinking dispositions and being in one's first year of college was negatively related to each dimension. The 300 course level was negatively related to innovativeness and engagement. Being in the second and third year of college were also negatively related to engagement. This study supports the notion that instructors can influence students' critical thinking disposition within the limited time of a college semester. (Contains 5 tables.)

Abstract Skin prick testing is an essential test procedure to confirm sensitization in IgE-mediated allergic disease in subjects with rhinoconjunctivitis, asthma, urticaria, anapylaxis, atopic eczema and food and drug allergy. This manuscript reviews the available evidence including Medline and Embase searches, abstracts of international allergy meetings and position papers from the world allergy literature. The recommended method of prick testing includes the appropriate use of specific allergen extracts, positive and negative controls, interpretation of the tests after 15 – 20 minutes of application, with a positive result defined as a wheal ≥3 mm diameter. A standard prick test panel for Europe for inhalants is proposed and includes hazel (Corylus avellana), alder (Alnus incana), birch (Betula alba), plane (Platanus vulgaris), cypress (Cupressus sempervirens), grass mix (Poa pratensis, Dactilis glomerata, Lolium perenne, Phleum pratense, Festuca pratensis, Helictotrichon pretense), Olive (Olea europaea), mugwort (Artemisia vulgaris), ragweed (Ambrosia artemisiifolia), Alternaria alternata (tenuis), Cladosporium herbarum, Aspergillus fumigatus, Parietaria, cat, dog, Dermatophagoides pteronyssinus, Dermatophagoides farinae, and cockroach (Blatella germanica). Standardization of the skin test procedures and standard panels for different geographic locations are encouraged worldwide to permit better comparisons for diagnostic, clinical and research purposes.

The recent identification of copy-number variation in the human genome has opened up new avenues for the discovery of positional candidate genes underlying complex genetic disorders, especially in the field of psychiatric disease. One major challenge that remains is pinpointing the susceptibility genes in the multitude of disease-associated loci. This challenge may be tackled by reconstruction of functional gene-networks from the genes residing in these loci. We applied this approach to autism spectrum disorder (ASD), and identified the copy-number changes in the DNA of 105 ASD patients and 267 healthy individuals with Illumina Humanhap300 Beadchips. Subsequently, we used a human reconstructed gene-network, Prioritizer, to rank candidate genes in the segmental gains and losses in our autism cohort. This analysis highlighted several candidate genes already known to be mutated in cognitive and neuropsychiatric disorders, including RAI1, BRD1, and LARGE. In addition, the LARGE gene was part of a sub-network of seven genes functioning in glycobiology, present in seven copy-number changes specifically identified in autism patients with limited co-morbidity. Three of these seven copy-number changes were de novo in the patients. In autism patients with a complex phenotype and healthy controls no such sub-network was identified. An independent systematic analysis of 13 published autism susceptibility loci supports the involvement of genes related to glycobiology as we also identified the same or similar genes from those loci. Our findings suggest that the occurrence of genomic gains and losses of genes associated with glycobiology are important contributors to the development of ASD.

Water resource professionals and others involved in managing water resources face increasingly complex challenges. Effective leadership development programs are needed to produce water leaders who can address these challenges. Leadership programs must be designed not simply to increase participants' environmental and leadership knowledge but to develop in participants the requisite abilities and skills. This exploratory study determines the extent to which water-related leadership programs go beyond knowledge only, event-type workshops to determine what proportion are grounded in leadership theory, and employ developmental experiences with assessment, challenge, and support components. Results indicate that most water professionals and others seeking to develop 21st century leadership abilities and skills to manage water resources are not getting the developmental experiences they need. Water-related leadership development programs must be grounded in evidence-based theory; provide assessment, challenge, and support; and offer a variety of developmental experiences and the opportunity to learn from experience. There is an urgent need for new or revised leadership development programs for those interested in water resource management.

Anecdotal reports suggest school nurses and staff treat increasing numbers of public school students with chronic diseases. However, professionals know little about actual disease burden in schools. This study measured prevalence of chronic disease medication administration rates in a large, urban midwestern school district. Data from daily medication logs were recorded by school nurses during a single week. Medications and administrations were sorted by disease type. Prevalence rates were calculated for six chronic diseases: asthma, diabetes, seizures, attention deficit/hyperactivity disorder, other mental/behavioral disorders, and other diseases/conditions. Separate rates stratified by school grade, poverty level and type of school were calculated. Overall 3.12% of students received medication for chronic diseases, including 2.13% for psychiatric/mental disorders and 1.91% for attention deficit/hyperactivity disorder alone. These rates were lower than estimates from other states. Factors that contributed to this finding are reviewed.

Although mental health difficulties are common in people with epilepsy, their assessment and treatment are rarely incorporated into routine medical care, with detrimental effects on quality of life. Several barriers to access traditional face to face interventions have been identified, including travel restriction and shortage of appropriately trained mental health clinicians. Digital mental health interventions offer the potential to improve access to mental health treatment. The main aim of the present study is to systematically review the empirical literature to identify what digital mental health interventions for adults, children and young people with epilepsy are currently available, as well as exploring if these interventions are effective in improving mental health and wellbeing. Searches were conducted using the MEDLINE, PsycINFO, Web of Science and Embase. The reference lists of papers collected were examined in order to identify any further relevant articles cited in peer-reviewed journals. A total of 1490 papers were identified; of these 11 were included in this review. The protocol was registered in the PROSPERO database (CRD42022318658) and the PRISMA 2020 statement was followed. Seven digital interventions were identified. All interventions were based predominantly on CBT and mindfulness techniques and showed promising results in reducing symptoms of depression, with some studies also reporting encouraging results in reducing anxiety and improving satisfaction with life and the quality of life of adults and children and young people with epilepsy. In summary, digital mental health interventions for people with epilepsy seem to be effective and have the potential to improve access to psychological interventions and reach underserved clinical populations. However, further well-powered and methodological rigorous studies are needed to confirm the effect of such interventions for people with epilepsy. • Assessment and treatment of mental health difficulties in people with epilepsy are rarely incorporated into routine medical care. • Digital mental health interventions have the potential to improve access to psychological interventions. • We identified five digital mental health interventions for adults and two for children and young people with epilepsy. • All interventions are primarily based on CBT and mindfulness and showed encouraging results in improving depression, anxiety and quality of life of people with epilepsy. • Further well powered clinical trials are necessary to confirm the effectiveness of such interventions. [ABSTRACT FROM AUTHOR]

Explores the social ecology of classroom aggression, demystifying four common "response dispositions" (exquisite sensitivity, group offense patrol, slight trigger disease, and heavy into violence) that provide fertile ground for uncivil behavior. To create a climate of classroom civility, teachers should engage in self-analysis, imagine a civil climate, build a repertoire of initiatives and responses, and make a long-term commitment to civility. (28 references) (MLH)

Modeling infectious diseases has been shown to be of great importance and utility during the ongoing COVID-19 pandemic. From today’s globalized information landscape, however, a plethora of new factors arise that have not been covered in previous models. In this paper, we present an agent-based model that reflects the complex interplay between the spread of a pathogen and individual protective behaviors under the influence of media messaging. We use the Rescorla-Wagner model of associative learning for the growth and extinction of fear, a factor that has been proposed as a major contributor in the determination of protective behavior. The model space, as well as heterogeneous social structures among the agents, are created from empirical data. We incorporate factors like age, gender, wealth, and attitudes towards public health institutions. The model is able to reproduce the empirical trends of fear and protective behavior in Germany but struggles to simulate the accurate scale of disease spread. The decline of fear seems to promote a second wave of disease and the model suggests that individual protective behavior has a significant impact on the outcome of the epidemic. The influence of media in the form of messages promoting protective behavior is negligible in the model. Further research regarding factors influencing long-term protective behavior is recommended to improve communication and mitigation strategies. [ABSTRACT FROM AUTHOR]

As a part of a research project at the University of the German Armed Forces we investigate steel fiber concrete for use in protective structures. At the chair for concrete construction of the University of German Armed Forces a literature study on protective concrete components under gunfire and contact detonation was conducted. In a first short experimental study tests were performed in order to obtain data for numerical modeling and for supplementary test setups. In the main research project different mixtures of steel fiber concrete were produced and investigated under gunfire and contact detonation. For the concrete local raw material from the area of mission was used as aggregates and cement. Plates for the contact detonation with different thicknesses, varying fiber geometries and reinforcement systems were produced. The plates for contact detonation were loaded with 850 g PETN explosive at the test facility of the German Armed Forces Technical Center for Protective and Special Technologies. During the contact detonation a pressure wave runs through the plate and is reflected as a tensile wave at the free surface, opposite to the loaded surface. This tensile wave generates a damage crater on the rear side of the plate. The volume as well as the surface of the crater is determined by Impact-Echo tests, by 3D-scans and by measurements of the crater geometry. One target of this project is to work out a semi empirical formula for the determination of the crater volume and its surface in dependence on the main input parameters in order to provide a mobile application for the soldiers in charge of the infrastructure during a mission. The input parameters for this formula include amongst others the compressive strength f ck , the bending tensile strength f ct , the fiber geometry and the fiber content. This publication focuses on the conduction of the contact detonation tests. Furthermore, a mathematical approach for numerical analysis is presented. [ABSTRACT FROM AUTHOR]

Hypertension often occurs in concurrence with obesity and diabetes mellitus, commonly referred to as metabolic syndrome. Renal denervation (RDNx) lowers arterial pressure (AP) and improves glucose metabolism in drug-resistant hypertensive patients with high body mass index. In addition, RDNx has been shown to reduce renal inflammation in the mouse model of angiotensin II hypertension. The present study tested the hypothesis that RDNx reduces AP and renal inflammation and improves glucose metabolism in obesity-induced hypertension. Eight-week-old C57BL/6J mice were fed either a low-fat diet (10 kcal%) or a high-fat diet (45 kcal%) for 10 weeks. Body weight, food intake, fasting blood glucose, and glucose metabolism (glucose tolerance test) were measured. In a parallel study, radiotelemeters were implanted in mice for AP measurement. High fat-fed C57BL/6J mice exhibited an inflammatory and metabolic syndrome phenotype, including increased fat mass, increased AP, and hyperglycemia compared with low-fat diet mice. RDNx, but not Sham surgery, normalized AP in high-fat diet mice (115.8±1.5 mm Hg in sham versus 96.6±6.7 mm Hg in RDNx). RDNx had no significant effect on AP in low-fat diet mice. Also, RDNx had no significant effect on glucose metabolism or renal inflammation as measured by the number of CD8, CD4, and T helper cells or levels of inflammatory cytokines in the kidneys. These results indicate that although renal nerves play a role in obesity-induced hypertension, they do not contribute to impaired glucose metabolism or renal inflammation in this model. [ABSTRACT FROM AUTHOR]

The inflammatory response regulates congestive heart failure (CHF) development. T cell activation plays an important role in tissue inflammation. We postulate that CD28 or B7 deficiency inhibits T cell activation and attenuates CHF development by reducing systemic, cardiac, and pulmonary inflammation. We demonstrated that chronic pressure overload-induced end-stage CHF in mice is characterized by profound accumulation of activated effector T cells (CD3(+)CD44(high) cells) in the lungs and a mild but significant increase of these cells in the heart. In knockout mice lacking either CD28 or B7, there was a dramatic reduction in the accumulation of activated effector T cells in both hearts and lungs of mice under control conditions and after transverse aortic constriction. CD28 or B7 knockout significantly attenuated transverse aortic constriction-induced CHF development, as indicated by less increase of heart and lung weight and less reduction of left ventricle contractility. CD28 or B7 knockout also significantly reduced transverse aortic constriction-induced CD45(+) leukocyte, T cell, and macrophage infiltration in hearts and lungs, lowered proinflammatory cytokine expression (such as tumor necrosis factor-α and interleukin-1β) in lungs. Furthermore, CD28/B7 blockade by CTLA4-Ig treatment (250 μg/mouse every 3 days) attenuated transverse aortic constriction-induced T cell activation, left ventricle hypertrophy, and left ventricle dysfunction. Our data indicate that CD28/B7 deficiency inhibits activated effector T cell accumulation, reduces myocardial and pulmonary inflammation, and attenuates the development of CHF. Our findings suggest that strategies targeting T cell activation may be useful in treating CHF. [ABSTRACT FROM AUTHOR]

Introduction: Perineal wound complications are a main problem after abdominoperineal resection (APR). There is little evidence concerning perineal wound management. This study describes and evaluates the role of vacuum-assisted closure (VAC) therapy in wound management strategies of perineal wound infections after APR.Methods: Patients undergoing APR for malignant disease between January 2007 and January 2013 were identified retrospectively. Data regarding occurrence and management of perineal wound complications were collected. Perineal wound infections were classified into minor or major complications and time to wound healing was measured. Time to wound healing was compared between patients receiving routine care or with additional VAC therapy.Results: Of 171 included patients, 76 (44.4%) had minor and 36 (21.1%) major perineal wound infections. Management of major infected perineal wounds consisted of drainage (n = 16), debridement (n = 4), drainage combined with debridement (n = 4), VAC therapy alone (n = 5), or VAC therapy combined with other treatments (n = 7). Median duration of perineal wound healing in major infected wounds was 141 days (range 17-739). Median time to wound healing was not different in patients treated with (172 days, range 23-368) or without VAC therapy (131 days, range 17-739).Discussion and Conclusion: In this study, VAC therapy did not shorten time to wound healing. However, prospective studies are required to investigate the role of VAC therapy in management of infected perineal wounds after APR. Up to then, wound management will remain to be based on clinical perception and 'gut-feeling'. [ABSTRACT FROM AUTHOR]