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Abstract We investigated the incidence and duration of morbidity symptoms among infants aged 6 to 9 months from a low socioeconomic community receiving one egg daily for 6 months. This was a secondary outcome of a randomised controlled trial (RCT) of 500 infants conducted in Jouberton, South Africa. The primary outcome was linear growth. Morbidity data were collected weekly using a symptoms diary and qualitative data with focus group discussions at the endpoint. Ethical approval was obtained from the North-West University Health Research Ethics Committee. The intervention group had a ~ 5% higher incidence of gastrointestinal morbidity (17.0%) compared to the control group (11.9%). Gastrointestinal morbidity without fever tended to be 1.4 times higher in the intervention group (OR: 1.43, 95% CI: 1.03, 1.93; P = 0.058) and tended to be 4 times higher with fever (OR: 4.07, 95% CI: 0.86, 19.23; P = 0.077). The duration of total gastrointestinal and respiratory morbidity was 1.5 days longer in the intervention group (β: 1.491; 95% CI 0.064, 2.918; P = 0.041). Complementary feeding with eggs may have contributed towards an increased risk for gastrointestinal morbidity.

Objective: To investigate the impact of national income level and sex on mortality trends from aortic aneurysm and dissection in addition to all aortic disease as a whole. Methods: Using data from the World Health Organization mortality database, we conducted an analysis of mortality trends from aortic disease between 2000 and 2019, Countries were categorized into middle-income and high-income countries (MICs and HICs) on the basis of income level. Age-standardized and sex-specific age-standardized mortality rates per 100,000 persons, along with male-to-female mortality ratios, were calculated. Trends over the study period were analyzed using joinpoint regression. Results: Our analysis comprised 29 MICs and 46 HICs, with an average population of 595 million and 1042 million during the observation period. During the observation period, age-standardized mortality rates from aortic disease decreased to 2.21 (2.17-2.25) and 2.28 (2.26-2.30) in MICs and HICs, respectively (average annual percentage change of −0.5% in MICs and −1.8% in HICs, P

Objective: to investigate the predictors of vitamin D (vitD) status of undernourished and well-nourished children aged under five years in the North West Province of South Africa.Design: this cross-sectional study assessed sociodemographic data, nutritional supplement intake, vitD-rich food consumption, and sunlight exposure via a structured questionnaire. Venous blood samples were collected to evaluate vitD, iron, and inflammatory markers.Setting: the maternal and child wellness departments of six community clinics in the JB Marks Municipality.Participants: 121 undernourished and 51 well-nourished children, 6–59 months old.Results: The prevalence of serum 25(OH)D

Abstract Background Approximately 30,000 people are affected by severe injuries in Germany each year. Continuous progress in prehospital and hospital care has significantly reduced the mortality of polytrauma patients. With increasing survival rates, the functional outcome, health-related quality (hrQoL) of life and ability to work are now gaining importance. Aim of the study is, the presentation of the response behavior of seriously injured patients on the one hand and the examination of the factors influencing the quality of life and ability to work 12 months after major trauma on the other hand. Building on these initial results, a standard outcome tool shall be integrated in the established TraumaRegister DGU® in the future. Methods In 2018, patients [Injury Severity Score (ISS) ≥ 16; age:18–75 years] underwent multicenter one-year posttraumatic follow-up in six study hospitals. In addition to assessing hrQoL by using the Short-Form Health Survey (SF-12), five additional questions (treatment satisfaction; ability to work; trauma-related medical treatment; relevant physical disability, hrQoL as compared with the prior to injury status) were applied. Results Of the 1,162 patients contacted, 594 responded and were included in the analysis. The post-injury hrQoL does not show statistically significant differences between the sexes. Regarding age, however, the younger the patient at injury, the better the SF-12 physical sum score. Furthermore, the physically perceived quality of life decreases statistically significantly in relation to the severity of the trauma as measured by the ISS, whereas the mentally perceived quality of life shows no differences in terms of injury severity. A large proportion of severely injured patients were very satisfied (42.2%) or satisfied (39.9%) with the treatment outcome. It should be emphasized that patients with a high injury severity (ISS > 50) were on average more often very satisfied with the treatment outcome (46.7%). A total of 429 patients provided information on their ability to work 12 months post-injury. Here, 194 (45.2%) patients had a full employment, and 58 (13.5%) patients were had a restricted employment. Conclusion The present results show the importance of a structured assessment of the postinjury hrQoL and the ability to work after polytrauma. Further studies on the detection of influenceable risk factors on hrQoL and ability to work in the intersectoral course of treatment should follow to enable the best possible outcome of polytrauma survivors.

BackgroundFood plays a dual role in promoting human health and environmental sustainability. Yet, current food systems jeopardize both. Food waste poses a major global challenge due to its significant economic, social, and environmental impacts. Healthcare facilities generate the largest amounts of food waste compared to other forms of catering provision. Food waste correlates with environmental unsustainability and diminished patient satisfaction, compounding the prevalent challenge of hospital malnutrition and contributing to suboptimal patient outcomes.Materials and methodsIn a three-year interventional study (2020-2022) at a psychiatric tertiary care center, we assessed and mitigated food waste using evidence-based measures. We conducted systematic food wastage audits over three years (2020-2022) in May and June, each lasting four weeks. Costs were analyzed comprehensively, covering food, staff, infrastructure, and disposal. Environmental impact was assessed using Umweltbelastungspunkte (UBP) and CO2e/kg emissions, alongside water usage (H2O - l/kg).ResultsEconomic losses due to food wastage were substantial, primarily from untouched plates and partially consumed dinners, prompting meal planning adjustments. Despite a >3% increase in meals served, both food waste mass and costs decreased by nearly 6%. Environmental impact indicators showed a reduction >20%. Vegetables, salad, and fruits constituted a significant portion of waste. Overproduction minimally contributed to waste, validating portion control efficacy.ConclusionOur study highlights significant economic and environmental losses due to hospital food waste, emphasizing the importance of resource efficiency. The strategies outlined offer promising avenues for enhanced efficiency. The decrease in food waste observed over the three-year period underscores the potential for improvement.

Abstract In 2013, the World Health Organisation (WHO) updated the recommendations for micronutrient deficiency correction in hospitalised under‐5 children with complicated severe acute malnutrition (SAM). This study aimed to describe the micronutrient deficiency correction practices in relation to WHO 2013 recommendations. Data from medical records of under‐5 children admitted for SAM management at two hospitals in South Africa and three tertiary hospitals in Ghana were extracted. Micronutrient correction practices were compared to the WHO 2013 recommendations by considering the dosage, timing of micronutrient supplementation (vitamin A, iron and folic acid) and therapeutic feeds administered. In total, 723 medical records were included. Nearly half (48.3%) of the children received at least one of the studied micronutrients as a supplement. Vitamin A was supplemented in 27.4% of the children, while iron and folic acid were supplemented in 9.5% and 34.9%, respectively. Among the children who received vitamin A, 60.1% received the first dose on Day 1 of admission. Also, 46.4% of the iron‐supplemented children received iron within the first week of admission. Vitamin A, iron and folic acid were administered within the dose range of 100,000–180,000 IU, 3.1–7.7 mg per kg per day, and 3–5 mg per day, respectively. Additionally, 71.7% of the children reportedly received therapeutic feeds that met WHO recommendations. The micronutrient deficiency correction practices regarding dose and timing differed from the 2013 WHO guidelines. Qualitative studies investigating the reasons for the disparities are recommended.

Objectives This study aimed to develop a patient-centred approach to the burden of acute type A aortic dissection (ATAAD) through modelling. The main objective was to identify potential improvements in managing this life-threatening cardiovascular condition and to provide evidence-based recommendations to optimise outcomes.Design We developed a predictive model along patient pathways to estimate the burden of ATAAD through the years of life lost (YLLs) metric. The model was created based on a systematic review of the literature and was parameterised using demographic data from the German healthcare environment. The model was designed to allow interactive simulation of different scenarios resulting from changes in key impact factors.Setting The study was conducted using data from the German healthcare environment and results from the literature review.Participants The study included a comprehensive modelling of ATAAD cases in Germany but did not directly involve participants.Interventions There were no specific interventions applied in this study based on the modelling design.Primary and secondary outcome measures The single outcome measure was the estimation of YLL due to ATAAD in Germany.Results Our model estimated 102 791 YLL per year for ATAAD in Germany, with 62 432 and 40 359 YLL for men and women, respectively. Modelling an improved care setting yielded 93 191 YLL or 9.3% less YLL compared with the current standard while a worst-case scenario resulted in 113 023 or 10.0% more YLL. The model is accessible at https://acuteaorticdissection.com/ to estimate custom scenarios.Conclusions Our study provides an evidence-based approach to estimating the burden of ATAAD and identifying potential improvements in the management of pathways. This approach can be used by healthcare decision-makers to inform policy changes aimed at optimising patient outcomes. By considering patient-centred approaches in any healthcare environment, the model has the potential to improve efficient care for patients suffering from ATAAD.

Instructors often use humor in teaching their classes. Research suggests that humor can affect how instructors and their teaching are perceived. The current study examined whether the type of humor used by a hypothetical instructor and instructor gender affected the perceived likelihood of engaging with the instructor. College students read a vignette describing the teaching and humor used by a hypothetical instructor. The likelihood that students would engage with the instructor was highest when the instructor's humor style was good-natured and lowest when it was hostile and sarcastic. Instructor gender had no effect on students' likelihood of engaging with the instructor.

Migrant integration trajectories have become more complex, open, uncertain, and continuously changing, over time. For young migrants, their integration endeavour intersects with their process of transition to adulthood, a double transition that poses additional challenges. Recent theoretical perspectives such as “liquid integration” aim at focusing on the dynamic, processual, and temporal nature of migrant integration. The present article focuses on the dynamic interplay of obstacles and enablers that, over time, interact to construct complex, often non-linear, and open-ended integration and coming of age trajectories of young migrants (aged from 18 to 30 years) coming from outside the European Union (EU) to EU countries. Empirical results from the H2020 MIMY (Empowerment through liquid Integration of Migrant Youth in vulnerable conditions) research project in Luxembourg will be presented. In order to address the goal of the research, qualitative data were gathered by means of N = 38 interviews with young migrants with different migratory paths, characteristics and experiences, and specifically included: young migrants from non-EU Portuguese-speaking countries (N = 16), refugees living in reception centres (N = 15), migrants who since arriving in Luxembourg have become publicly visible (N = 7). Content analysis of the interviews allowed a twofold purpose: (1) capturing the unfolding of intersectional integration obstacles that over time play a decisive role in the building of conditions of vulnerability of the double transition under analysis; (2) capturing the multidimensional resources that interactively build up to give rise to resilient and empowering integration and coming of age experiences. The identification of decisive multidimensional obstacles and resources present in the integration endeavour during the process of coming of age allowed us to capture differentiated routes of vulnerability, on the one hand, and resilience/ empowerment on the other. Key ingredients of both vulnerable and more resilient and empowering integration and coming of age trajectories are identified as well as their relational dynamics, enabling to address key challenges for the resilience and empowerment of young migrants in the process of negotiating their transition to adulthood amidst their integration challenges in the Luxembourgish society.

Novel dedicated devices allow transcatheter treatment of pure aortic regurgitation (AR). The JenaValve Trilogy Heart Valve System was introduced as the first dedicated and on-label AR transcatheter aortic valve replacement system, implementing a locator-based and calcium-independent anchoring mechanism. Here, we present the first-in-human transcatheter aortic valve replacement for pure AR via a transcaval access in a patient with prohibitive alternative arterial accesses.

Ureteral stents play a fundamental role in modern time urology. However, following the deployment, stent-related symptoms are frequent and affect patient health and quality of life. Using biodegradable metals as ureteral stent materials have emerged as a promising strategy, mainly due to the improved radial force and slower degradation rate expected. Therefore, this study aimed to characterize different biodegradable metals in urinary tract environment to understand their propensity for future utilization as base materials for ureteral stents. The corrosion of 5 Mg alloys – AZ31, Mg-1Zn, Mg-1Y, pure Mg, and Mg-4Ag – under simulated urinary tract conditions was accessed. The corrosion layer of the different alloys presented common elements, such as Mg(OH)2, MgO, and phosphate-containing products, but slight variations in their chemical compositions were detected. The corrosion rate of the different metals varied, which was expected given the differences in the corrosion layers. On top of this, the findings of this study highlighted the significant differences in the samples' corrosion and corrosion layers when in stagnant and flowing conditions. With the results of this study, we concluded that Mg-1Zn and Mg-4Ag presented a higher propensity for localized corrosion, probably due to a less protective corrosion layer; Mg-4Ag corroded faster than all the other four alloys, and Mg-1Y stood out due to its distinct corrosion pattern, that showed to be more homogeneous than all the other four samples, making this one more attractive for the future studies on biodegradable metals.

This paper investigates the influence of addition of Ca in a Y-Zn-containing magnesium alloy on the dynamic and static recrystallization behaviors and reveals the formation mechanism of the quadrupole texture during thermomechanical processing. Direct extrusion of flat bands has been conducted at various process conditions to study the difference between the two alloys WZ10 and WZX100 in terms of microstructure and texture development. It can be shown that, Ca addition promotes the DRX of WZ10 alloy. During additional heat treatment, the absence of Y segregation at the grain boundaries and the associated lack of solute drag to the boundary mobility leads to a pronounced grain growth during SRX in WZX100 alloy. Furthermore, it is shown that the addition of Ca to Y-Zn is not beneficial in terms of formability. It is demonstrated that alloying elements can have different effects depending on the recrystallization mechanisms. Partially recrystallized microstructure is a prerequisite at the as-extruded status to form the quadrupole texture and during subsequent annealing, which stands for high formability.

Magnesium-based materials show great potential for producing biodegradable stents, but their high corrosion rates are a roadblock.This study investigates whether ultrasound melt treatment can change the corrosion response of an extruded AZ91D-1.0%Ca (wt.%) in Earle's Balanced Salt Solution by tailoring the intermetallics' morphology in the as-extruded state.The results showed that the wires from ultrasound-treated ingots corroded faster than non-treated ones in immersion for up to 6 hours. This trend shifted for longer periods, and ultrasound-treated material showed lower corrosion rates and uniform corrosion, while the non-treated material displayed localized corrosion signs. Tensile testing of the wires demonstrated that immersion in EBSS lowered the tensile strength and elongation at fracture due to material degradation, regardless of the processing route. Nonetheless, this decline was sharper in the non-treated material.These findings suggest that ultrasound melt processing can be a promising method for improving the corrosion resistance of magnesium-based materials, paving the way for their use in manufacturing biodegradable stents.

IntroductionProtocols for noninvasive brain stimulation (NIBS) are generally categorized as “excitatory” or “inhibitory” based on their ability to produce short-term modulation of motor-evoked potentials (MEPs) in peripheral muscles, when applied to motor cortex. Anodal and cathodal stimulation are widely considered excitatory and inhibitory, respectively, on this basis. However, it is poorly understood whether such polarity-dependent changes apply for neural signals generated during task performance, at rest, or in response to sensory stimulation.MethodsTo characterize such changes, we measured spontaneous and movement-related neural activity with magnetoencephalography (MEG) before and after high-definition transcranial direct-current stimulation (HD-TDCS) of the left motor cortex (M1), while participants performed simple finger movements with the left and right hands.ResultsAnodal HD-TDCS (excitatory) decreased the movement-related cortical fields (MRCF) localized to left M1 during contralateral right finger movements while cathodal HD-TDCS (inhibitory), increased them. In contrast, oscillatory signatures of voluntary motor output were not differentially affected by the two stimulation protocols, and tended to decrease in magnitude over the course of the experiment regardless. Spontaneous resting state oscillations were not affected either.DiscussionMRCFs are thought to reflect reafferent proprioceptive input to motor cortex following movements. Thus, these results suggest that processing of incoming sensory information may be affected by TDCS in a polarity-dependent manner that is opposite that seen for MEPs—increases in cortical excitability as defined by MEPs may correspond to reduced responses to afferent input, and vice-versa.

IntroductionPhysical exercise has been shown to have numerous health benefits on co-morbid somatic conditions in psychiatry and can also enhance mental health. Thus, it is not difficult to recommend physical training programs as part of an integrated and holistic treatment approach for mental health disorders. However, getting patients to participate and keeping them engaged is a major challenge. Programs based on martial arts training could be interventions improving physical and mental health with higher attachment rates. The structured discipline, holistic approach integrating physical and mental elements, and empowering activities, may explain higher participant attachment rates.MethodsThus, the main objective of this feasibility study is to describe a newly established group therapy program incorporating interventions from martial arts training with its physical and philosophical parts including mindfulness and breath work.ResultsDuring the 14-month study period from April 2021 to May 2022, a Budo group therapy was used by 215 individual persons with a total of 725 group therapy participations. Retention in the program was good across all settings and very good for persons who participated as outpatients. The mean age of the participants was 33.5 years with a range from 14 to 69 years of age, and about 41% of the participants were female. The therapy program was able to address patients over the whole spectrum of psychiatric diagnoses. Satisfaction and motivation were uniformly self-reported as very good. Patients self-reported improved mental and physical health after participating in a Budo session compared to pre-session.DiscussionBudo group therapy thus can be seen as a feasible, well-accepted and promising new transdiagnostic treatment approach, combining physical activation with resilience enhancement. With minimal contraindications, a broad spectrum of individuals seeking mental health support can engage in this group therapy.

ObjectiveTo assess work-related participation impairments and support needs of adult patients in inpatient and day-care treatment at a Swiss psychiatric university hospital.MethodologyCross-sectional survey on a department-dependent cut-off date in May and June 2022 using a standardized structured interview.ResultsData were available for 93 patients (response rate 59%), of which 51% (n = 47) stated that they had a job or training place. Patients in first hospitalization and with a job or training place were approached significantly more often. Regardless of age and first hospitalization, 76% of the patients expressed a need for support, of which 92% expressed interest in job coaching. A total of 54% of the patients stated that they had received support from the treatment team.ConclusionFrom the patients’ point of view, work and education were not addressed by the treatment team across the board and independently of patient characteristics. The need for support was insufficiently met. There is a considerable interest for support programs through job coaching, and this offers opportunities to promote the inclusion of patients in the regular labor market.

Background: Vitamin D (vitD) plays a role in iron metabolism by the suppression of hepcidin, while iron deficiency also impairs vitD metabolism. In undernourished children, iron and vitamin D deficiency are common. There is little knowledge of the inter-relationship between these two nutrients in undernourished and non-undernourished children. Aim: To assess the association between 25-hydroxyvitamin D (25(OH)D) and iron status, and the effect of 3 doses of 50,000 IU of vitD on iron status in undernourished and non-undernourished children. Methods: We measured serum 25(OH)D, haemoglobin (Hb), ferritin and soluble transferrin receptor in 121 undernourished and 51 non-undernourished children in clinics in the North-West Province of South Africa. Three doses of 50,000 IU/week of vitD was supplemented to children with suboptimal vitD levels. Results: The overall prevalence of suboptimal vitD concentration (25(OH)D

This article provides ethical guidance on using race in health research as a variable or in defining the study population. To this end, a plain, non-exhaustive checklist is provided for researchers and research ethics committees, preceded by a brief introduction on the need for justification when using race as a variable or in defining a study population, the problem of exoticism, that distinctions pertain between race, ethnicity and ancestry, the problematic naming of races, and that race does not serve well as a presumed biological construct in genetic research.

Abstract This special issue of Comparative Migration Studies on the occasion of the IMISCOE 2021 Conference with the theme “Crossing borders, connecting cultures” features five invited contributions by several conference speakers as well as an article by the host university.

Background/aimSchool-aged children in low- and middle-income countries carry the highest burden of intestinal helminth infections, such as soil-transmitted helminths (STH). STH infections have been associated with negative consequences for child physical and cognitive development and wellbeing. With the epidemiological transition and rise in cardiovascular disease (CVD), studies have shown that helminth infections may influence glucose metabolism by preventing obesity. Thus, the aim of this study was to determine the association of STH infections in schoolchildren from Gqeberha, focusing on physical activity, physical fitness, and clustered CVD risk score.MethodsThis cross-sectional study involved 680 schoolchildren (356 girls and 324 boys; mean age 8.19 years, SD±1.4) from disadvantaged communities in Gqeberha (formerly, Port Elizabeth), South Africa. Stool samples were collected and examined for STH infections using the Kato-Katz method. Physical activity (accelerometer) and physical fitness (grip strength, 20 m shuttle run) were measured using standard procedures. Furthermore, anthropometry, blood pressure, as well as glycated haemoglobin and lipid profile from capillary blood samples were assessed. We employed one-way ANOVAs to identify the associations of STH infections in terms of species and infection intensity with physical activity, physical fitness, and clustered CVD risk score.ResultsWe found a low STH infection prevalence (7.2%) in our study, with participants infected with at least one intestinal helminth species. In comparison to their non-infected peers, children infected with STH had lower mean grip strength scores, but higher mean VO2max estimation and higher levels of MVPA (p < .001). When considering type and intensity of infection, a positive association of A. lumbricoides infection and MVPA was found. In contrast, light T. trichiura-infected children had significantly lower grip strength scores compared to non and heavily-infected children. VO2max and MVPA were positively associated with light T. trichiura infection. No significant association between the clustered CVD risk score and infection with any STH species was evident.ConclusionsSTH-infected children had lower grip strength scores than their non-infected peers, yet, achieved higher VO2max and MVPA scores. Our study highlights that the type and intensity of STH infection is relevant in understanding the disease burden of STH infections on children's health. The findings of our study must be interpreted cautiously due to the low infection rate, and more research is needed in samples with higher prevalence rates or case-control designs.

The burden of non-communicable diseases is increasing, with risk factors emerging early in life. Physical activity reduces cardiovascular risk, but limited evidence exists for children from lower-income countries and mostly relies on self-reported methods that might be inaccurate and biased. We aimed to compare self-reported and accelerometer-measured physical activity in relation to cardiovascular risk markers in children from underserved communities in South Africa. We analysed cross-sectional data from 594 children aged 8 to 13. Physical activity was measured via accelerometry and the Physical Activity Questionnaire for Older Children (PAQ-C). Correlation analyses and linear regression models examined the relationship between accelerometer-measured and self-reported physical activity and their association with cardiovascular risk markers (body mass index, blood pressure, blood lipid profile and glycated haemoglobin). Results show a positive but weak correlation between PAQ-C scores and accelerometer-measured moderate-to-vigorous physical activity (MVPA). MVPA was inversely associated with body mass index, whilst sedentary behaviour correlated positively with lipid levels. PAQ-C scores were inversely associated with systolic blood pressure. The comparison of self-reported and accelerometer-measured physical activity in children from Gqeberha, South Africa, revealed inconsistencies in their correlation and association with cardiovascular risk markers. Accelerometry provided a more accurate cardiovascular risk estimation than PAQ-C, although associations were weak. Further, longitudinal studies should investigate the predictive power of both methodologies. These findings inform researchers and public health practitioners in the choice of method for physical activity appraisal beyond practical considerations, especially when combined with cardiovascular risk and in lower-income settings. Significance: We explore two widely used methods to assess physical activity levels in children. By comparing both methods, we expose inconsistencies in their correlation and association with cardiovascular risk markers. These data can guide researchers and public health practitioners in the use of one method beyond practical considerations. Whilst this work focuses on children from marginalised areas of South Africa, the issues explored are of relevance to other lower-income settings. Open data set: https://doi.org/10.5281/zenodo.7217145

The expansion in the repertoire of genes linked to thoracic aortic aneurysms (TAA) has revolutionised our understanding of the disease process. The clinical benefits of such progress are numerous, particularly helping our understanding of non-syndromic hereditary causes of TAA (HTAAD) and further refinement in the subclassification of disease. Furthermore, the understanding of aortic biomechanics and mechanical homeostasis has been significantly informed by the discovery of deleterious mutations and their effect on aortic phenotype. The drawbacks in genetic testing in TAA lie with the inability to translate genotype to accurate prognostication in the risk of thoracic aortic dissection (TAD), which is a life-threatening condition. Under current guidelines, there are no metrics by which those at risk for dissection with normal aortic diameters may undergo preventive surgery. Future research lies with more advanced genetic diagnosis of HTAAD and investigation of the diverse pathways involved in its pathophysiology, which will i) serve to improve our understanding of the underlying mechanisms, ii) improve guidelines for treatment and iii) prevent complications for HTAAD and sporadic aortopathies.

Although in recent years plenty of work was published on LEGO® Serious Play®, there are only a manageable number of publications about its applicability in a research context. Undoubtedly, LEGO® Serious Play® can be a methodological enrichment particularly for participatory research with people in vulnerable conditions. However, its utilization in research should always be well reflected and adapted to the specific research context. Based on experiences gained in the H2020 project “MIMY – EMpowerment through liquid integration of Migrant Youth in vulnerable conditions”, the following article depicts the potentials and limitations of LEGO® Serious Play® and critically assesses its value for research purposes.

Magnesium alloys play an essential role in metallic lightweight construction for modern mobility applications due to their low density, excellent specific strength, and very good castability. For some years now, degradable implants have also been made from magnesium alloys, which, thanks to this special functionality, save patients a second surgery for explantation. New additive manufacturing processes, which are divided into powder-based and wire-based processes depending on the feedstock used, can be utilized for these applications. Therefore, magnesium alloys should also be used here, but this is hardly ever implemented, and few literature reports exist on this subject. This is attributable to the high affinity of magnesium to oxygen, which makes the use of powders difficult. Therefore, magnesium wires are likely to be used. In this paper, a magnesium-based nanocomposite wire is made from an AM60 (Mg-6Al-0.4Mn) (reinforced with 1 wt% AlN nanoparticles and containing calcium to reduce flammability), using a high-shear process and then extruded into wires. These wires are then used as feedstock to build up samples by wire-arc directed energy deposition, and their mechanical properties and microstructure are examined. Our results show that although the ductility is reduced by adding calcium and nanoparticles, the yield strength in the welding direction and perpendicular to it is increased to 131 MPa.

Mobile phone technology has been a catalyst that has added an innovative dimension in health care and created new opportunities for digital health services. These digital devices can be viewed as an extension of the person using them due to the deluge of personal information that can be collected and stored on them. Data collected on mobile phones are used extensively in health services and research. Personal, mobility and location data are constantly collected. The unique mobile phone architecture provides for an easy flow of data between various role players such as application developers and phone manufacturers. The collection, storage and sharing of personal information on mobile phones elicit various legal questions relating to the protection of privacy, consent, liability and the accountability of stakeholders such as health insurance providers, hospital groups and national departments of health. Significance: We analyse the major legal concerns of mobility and location data collection and processing through mobile phones in the context of health care and provide recommendations to develop data protection guidelines that are built on the principles of lawfulness, fairness and transparency. The issues explored are of relevance in an African context and to a broader international audience.

IntroductionRisk factors for noncommunicable diseases such as insufficient physical activity (PA), overweight or hypertension are becoming increasingly predominant among children globally. While school-based interventions are promising preventive strategies, evidence of their long-term effectiveness, especially among vulnerable populations, is scarce. We aim to assess the short-term effects of the physical and health KaziKidz intervention on cardiometabolic risk factors and the long-term, pre-and post-COVID-19 pandemic changes thereof in high-risk children from marginalized communities.MethodsThe intervention was tested in a cluster-randomized controlled trial between January and October 2019 in eight primary schools near Gqeberha, South Africa. Children with overweight, elevated blood pressure, pre-diabetes, and/or borderline dyslipidemia were identified and re-assessed 2 years post-intervention. Study outcomes included accelerometry-measured PA (MVPA), body mass index (BMI), mean arterial pressure (MAP), glucose (HbA1c), and lipid levels (TC to HDL ratio). We conducted mixed regression analyses to assess intervention effects by cardiometabolic risk profile, and Wilcoxon signed-rank tests to evaluate longitudinal changes in the high-risk subpopulation.ResultsWe found a significant intervention effect on MVPA during school hours for physically inactive children, and among active as well as inactive girls. In contrast, the intervention lowered HbA1c and TC to HDL ratio only in children with glucose or lipid values within the norm, respectively. At follow-up, the intervention effects were not maintained in at-risk children, who showed a decline in MVPA, and an increase in BMI-for-age, MAP, HbA1c and TC to HDL ratio.ConclusionWe conclude that schools are key settings in which to promote PA and improve health; however, structural changes are necessary to ensure that effective interventions reach marginalized school populations and achieve sustainable impact.

IntroductionThoracic endovascular aortic repair (TEVAR) of the arch is challenging given its complex geometry and the involvement of supra-aortic arteries. Different branched endografts have been designed for use in this region, but their haemodynamic performance and the risk for post-intervention complications are not yet clear. This study aims to examine aortic haemodynamics and biomechanical conditions following TVAR treatment of an aortic arch aneurysm with a two-component single-branched endograft.MethodsComputational fluid dynamics and finite element analysis were applied to a patient-specific case at different stages: pre-intervention, post-intervention and follow-up. Physiologically accurate boundary conditions were used based on available clinical information.ResultsComputational results obtained from the post-intervention model confirmed technical success of the procedure in restoring normal flow to the arch. Simulations of the follow-up model, where boundary conditions were modified to reflect change in supra-aortic vessel perfusion observed on the follow-up scan, predicted normal flow patterns but high levels of wall stress (up to 1.3M MPa) and increased displacement forces in regions at risk of compromising device stability. This might have contributed to the suspected endoleaks or device migration identified at the final follow up.DiscussionOur study demonstrated that detailed haemodynamic and biomechanical analysis can help identify possible causes for post-TEVAR complications in a patient-specific setting. Further refinement and validation of the computational workflow will allow personalised assessment to aid in surgical planning and clinical decision making.

Summary: Background: High-sensitivity Troponin T (hsTnT), a biomarker of cardiomyocyte overload and injury, relates to aortic valve replacement (AVR) and mortality in severe aortic stenosis (AS). However, its prognostic value remains unknown in asymptomatic patients with AS. We aimed to investigate if an hsTnT level >14 pg/mL (above upper limit of normal 99th percentile) is associated with echocardiographic AS-severity, subsequent AVR, ischaemic coronary events (ICE), and mortality in asymptomatic patients with non-severe AS. Methods: In this post-hoc sub-analysis of the multicentre, randomised, double-blind, placebo-controlled SEAS trial (ClinicalTrials.gov, NCT00092677), we included asymptomatic patients with mild to moderate-severe AS. We ascertained baseline and 1-year hsTnT concentrations and examined the association between baseline levels and the risk of the primary composite endpoint, defined as the first event of all-cause mortality, isolated AVR (without coronary artery bypass grafting (CABG)), or ICE. Multivariable regressions and competing risk analyses examined associations of hsTnT level >14 pg/mL with clinical correlates and 5-year risk of the primary endpoint. Findings: Between January 6, 2003, and March 4, 2004, a total of 1873 patients were enrolled in the SEAS trial, and 1739 patients were included in this post-hoc sub-analysis. Patients had a mean (SD) age of 67.5 (9.7) years, 61.0% (1061) were men, 17.4% (302) had moderate-severe AS, and 26.0% (453) had hsTnT level >14 pg/mL. The median hsTnT difference from baseline to 1-year was 0.8 pg/mL (IQR, −0.4 to 2.3). In adjusted linear regression, log(hsTnT) did not correlate with echocardiographic AS severity (p = 0.36). In multivariable Cox regression, a hsTnT level >14 pg/mL vs. hsTnT ≤14 pg/mL was associated with an increased risk of the primary composite endpoint (HR, 1.41; 95% CI, 1.18–1.70; p = 0.0002). In a competing risk model of first of the individual components of the primary endpoint, a hsTnT level >14 pg/mL was associated with ICE risk (HR 1.71; 95% CI, 1.23–2.38; p = 0.0013), but not with isolated AVR (p = 0.064) or all-cause mortality (p = 0.49) as the first event. Interpretation: hsTnT level is within the reference range (≤14 pg/mL) in 3 out of 4 non-ischaemic patients with asymptomatic mild-to-moderate AS and remains stable during a 1-year follow-up regardless of AS-severity. An hsTnT level >14 pg/mL was mainly associated with subsequent ICE, which suggest that hsTnT concentration is primarily a risk marker of subclinical coronary atherosclerotic disease. Funding: Merck & Co., Inc., the Schering-Plough Corporation, the Interreg IVA program, Roche Diagnostics Ltd., and Gangstedfonden. Open access publication fee funding provided by prof. Olav W. Nielsen and Department of Cardiology, Bispebjerg University Hospital, Denmark.

BACKGROUND: Over the past 25 years, diagnosis and therapy for acute aortic dissection (AAD) have evolved. We aimed to study the effects of these iterative changes in care. METHODS: Patients with nontraumatic AAD enrolled in the International Registry of Acute Aortic Dissection (61 centers; 15 countries) were divided into time-based tertiles (groups) from 1996 to 2022. The impact of changes in diagnostics, therapeutic care, and in-hospital and 3-year mortality was assessed. Cochran-Armitage trend and Jonckheere-Terpstra tests were conducted to test for any temporal trend. RESULTS: Each group consisted of 3785 patients (mean age, ≈62 years old; ≈65.5% males); nearly two-thirds had type A AAD. Over time, the rates of hypertension increased from 77.8% to 80.4% (P=0.002), while smoking (34.1% to 30.6%, P=0.033) and atherosclerosis decreased (25.6%-16.6%; P<0.001). Across groups, the percentage of surgical repair of type A AAD increased from 89.1% to 92.5% (P<0.001) and was associated with decreased hospital mortality (from 24.1% in group 1 to 16.7% in group 3; P<0.001). There was no difference in 3-year survival (P=0.296). For type B AAD, stent graft therapy (thoracic endovascular aortic repair) was used more frequently (22.3%-35.9%; P<0.001), with a corresponding decrease in open surgery. Endovascular in-hospital mortality decreased from 9.9% to 6.2% (P=0.003). As seen with the type A AAD cohort, overall 3-year mortality for patients with type B AAD was consistent over time (P=0.084). CONCLUSIONS: Over 25 years, substantial improvements in-hospital survival were associated with a more aggressive surgical approach for patients with type A AAD. Open surgery has been partially supplanted by thoracic endovascular aortic repair for complicated type B AAD, and in-hospital mortality has decreased over the time period studied. Postdischarge survival for up to 3 years was similar over time. [ABSTRACT FROM AUTHOR]

The idea for this Special Issue emerged from the Editors’ collaboration on the framework of the European project MIMY: EMpowerment through liquid Integration of Migrant Youth in vulnerable conditions [...]

Objective Risk factors for chronic diseases such as insufficient physical activity (PA), overweight or hypertension are getting more predominant among children. While school-based interventions are promising preventive strategies, evidence of their long-term effectiveness, especially among vulnerable populations is scarce. KaziKidz is a physical education intervention that promotes healthy and active lifestyles among children from low-income communities. We aim at assessing the short- and long-term effects of KaziKidz on cardiovascular risk factors in high-risk children from disadvantaged communities. Methods The intervention was tested in a cluster-randomized controlled trial between January and October 2019 in eight primary schools in South Africa. Children with adverse cardiovascular profiles were defined as presenting at least one risk factor for (1) overweight, (2) elevated blood pressure, (3) glycaemia, and/or (4) cholesterolemia. After their identification, high-risk children were re-assessed 2-years post-intervention. Study outcomes include accelerometry-measured PA (MVPA), body-mass-index (BMI), mean arterial pressure (MAP), glucose (HbA1c), and lipid levels (TC/HDL). We conducted mixed regression analyses to assess intervention effects by cardiovascular risk profile, and Wilcoxon signed-rank tests to evaluate longitudinal changes in the high-risk subpopulation. Results A significant intervention effect on MVPA during school hours was found for physically inactive children (B: 1.71, 95% CI: 0.14 – 3.35, p-value: 0.008), and among active (B: 1.80, 95% CI: -0.22 – 3.82, p-value: 0.035) and inactive (B: 2.03, 95% CI: 0.58 – 3.42, p-value: < 0.001) girls. In contrast, the intervention lowered HbA1c (B: -0.26, 95% CI: -0.52 – -0.01, p-value: 0.037) and TC/HDL (B: -0.11, 95% CI: 0.18 – -0.05, p-value: 0.002) only in children with normal glucose or lipid values, respectively. The intervention effects were not maintained in at-risk children at follow-up. A decline was observed in MVPA from 53.29 to 41.90 min/day (z = -1.95, p = 0.05, r = 0.26), and an increase in BMI-for-age (z = -0.34, p = 0.737, r = 0.03), MAP (z = -5.18, p < 0.001, r = 0.42), HbA1c (z = -1.63, p = 0.104, r = 0.25) and TC/HDL (z = -1.61, p = 0.11, r = 0.21). Conclusion We conclude that schools are key settings to promote PA and improve health; however, because the intervention effects were not maintained in children at risk of NCDs, structural changes that ensure effective interventions reach disadvantaged populations are necessary to achieve sustainable impact.

ObjectivePt-Mal-LHRH is a newly synthesized chemotherapeutic agent that was designed to selectively target the luteinizing hormone-releasing hormone (LHRH) receptor expressed by triple negative breast cancer (TNBC). The aim of this study was to evaluate the therapeutic dosing, tumor reduction efficacy, and selective distribution of Pt-Mal-LHRH in-vivo.Methods and resultsLHRH tissue expression levels in-vivo were investigated using western blotting and LHRH was found to be increased in reproductive tissues (mammary, ovary, uterus). Further, Pt-Mal-LHRH was found to have increased TNBC tumor tissue platinum accumulation compared to carboplatin by inductively coupled plasma mass spectrometry analysis. The platinum family, compound carboplatin, was selected for comparison due to its similar chemical structure and molar equivalent doses were evaluated. Moreover, in-vivo distribution data indicated selective targeting of Pt-Mal-LHRH by enhanced reproductive tissue accumulation compared to carboplatin. Further, TNBC tumor growth was found to be significantly attenuated by Pt-Mal-LHRH compared to carboplatin in both the 4T1 and MDA-MB-231 tumor models. There was a significant reduction in tumor volume in the 4T1 tumor across Pt-Mal-LHRH doses (2.5-20 mg/kg/wk) and in the MDA-MB-231 tumor at the dose of 10 mg/kg/wk in models conducted by an independent contract testing laboratory.ConclusionOur data indicates Pt-Mal-LHRH is a targeting chemotherapeutic agent towards the LHRH receptor and reduces TNBC tumor growth in-vivo. This study supports drug conjugation design models using the LHRH hormone for chemotherapeutic delivery as Pt-Mal-LHRH was found to be a more selective and efficacious than carboplatin. Further examination of Pt-Mal-LHRH is warranted for its clinical use in TNBCs, along with, other reproductive cancers overexpressing the LHRH receptor.

Recovery orientation (RO) is directed at living a worthwhile life despite being impaired by the constraints of mental illness. Although being quite common in general psychiatry in Switzerland, the dual mission of forensic psychiatry—safeguarding and therapy—challenges the idea of establishing RO as a work philosophy in this context. This explorative study qualitatively investigates baseline expectations and professional perspectives of forensic staff members concerning the idea of establishing RO in Swiss forensic psychiatric wards. Thereby, three central themes were worked out, namely “challenges associated with recovery,” “expected barriers,” and “possible recovery-oriented interventions.” From a general point of view, the staff members were uncertain whether RO interventions could be introduced at all, and if so, to what extent. This, on the one hand, had to do with structural obstacles such as security requirements; however, personal obstacles in the form of different, sometimes contradictory attitudesand ideals and fearful anticipations—such as the loss of authority and power—also played a central role. As forensic psychiatric wards are non-existent in Latin-speaking Switzerland, the study does only refer to the German-speaking language region.

This paper deals with the impact of the wire manufacturing process on the mechanical property development of two magnesium alloys, AZ31 and ZX10. For this study, wires were produced with different diameters of up to 0.2 mm via direct one-step extrusion as a hot forming route and were directly compared to conventional cold drawing manufacturing routes with diameters up to 0.3 mm and associated heat-treatment. The alloy dependent microstructure development is resolved with respect to the underlying recrystallization mechanisms, which determines the texture development and concurrently the strength and ductility properties of the wires. The experimental results clearly show that the manufacturing process, the degree of deformation (wire diameter) as well as the alloy itself have a major impact on the texture development and mechanical properties of the wires. While AZ31, does not enable a strong impact on the microstructure development, ductility in ZX10 is enhanced with a concurrent weak texture development due to adjusted dynamic recrystallization during hot forming. In contrast, such microstructures cannot be adjusted in the cold forming routes due to static recrystallization. However, it is possible to improve of the properties significantly by drawing, which is limited by the first two drawing passes.

While the COVID-19 pandemic has captured the attention of the global community since the end of 2019, deadly health pandemics are not new to Africa. Tuberculosis (TB), malaria and human immunodeficiency virus (HIV) count amongst other serious diseases that have had a catastrophic impact on the African continent. Effective responses to such pandemics require high-quality, comprehensive data sets that can inform policymaking and enhance healthcare decision-making. While data is driving the information economy in the 21st century, the scarcity in Africa of carefully curated, large epidemiologic data sources and analytical capacity to rapidly identify and understand emerging infectious diseases poses a major challenge to mounting a time-sensitive response to unfolding pandemics. Data access, sharing and transfer between countries are crucial to effectively managing current and future health pandemics. Data access and sharing, however, raises questions about personal privacy, the adequacy of governance mechanisms to regulate cross-border data flows, and ethical issues relating to the collection and use of personal data in the interests of public health. Sub-Saharan Africa’s most research-intensive countries are characterised by diverse data management and privacy governance frameworks. Such regional variance can impede time-sensitive data sharing and highlights the need for urgent governance reforms to facilitate effective decision-making in response to rapidly evolving public health threats. Significance: We explore governance considerations that ought to apply to the collection, transfer, and use of data in public health emergencies. Specifically, we provide an overview of the prevailing data sharing governance landscape in selected African countries. In doing so, we identify limitations and gaps that impede effective data collation, sharing and analysis. This work could find utility amongst a range of stakeholders, including bioinformaticians, epidemiologists, artificial intelligence coders, and government decision-makers. While this work focuses primarily on an African context, the issues explored are of universal concern and therefore of relevance to a broader international audience.

An inverted bottle empties in a time Te,0 through a process called “glugging”, whereby gas and liquid compete at the neck (of diameter DN). In contrast, an open-top container empties in a much shorter time Te through “jetting” due to the lack of gas–liquid competition. Experiments and theory demonstrate that, by introducing a perforation (diameter dp), a bottle empties through glugging, jetting, or a combination of the two. For a certain range of dp/DN, the perforation increases the emptying time, and a particular value of dp/DN is associated with a maximum emptying time Te,max. We show that the transition from jetting to glugging is initiated by the jet velocity reaching a low threshold, thereby allowing a slug of air entry into the neck that stops jetting and starts the glugging. Once initiated, the glugging proceeds as though there is no perforation. Experimental results covered a range of Eötvös numbers from Eo∼ 20–200 (equivalent to a range of DN/Lc∼ 4–15, where Lc is the capillary length). The phenomenon of bottle emptying with a perforation adds to the body of bottle literature, which has already considered the influence of shape, inclination, liquid properties, etc.

The processability during massive deformation of magnesium-wrought products is hampered by the low formability of magnesium alloys. The research results of recent years demonstrate that rare earth elements as alloying elements improve the properties of magnesium sheets, such as formability, strength and corrosion resistance. The substitution of rare earth elements by Ca in Mg-Zn-based alloys results in a similar texture evolution and mechanical behaviour as RE-containing alloys. This work is an approach to understanding the influence of Mn as an alloying element to increase the strength of a Mg-Zn-Ca alloy. For this aim, a Mg-Zn-Mn-Ca alloy is used to investigate how Mn affects the process parameters during rolling and the subsequent heat treatment. The microstructure, texture and mechanical properties of rolled sheets and heat treatment at different temperatures are compared. The outcome of casting and the thermo-mechanical treatment are used to discuss how to adapt the mechanical properties of magnesium alloy ZMX210. The alloy ZMX210 behaves very similarly to the ternary Mg-Zn-Ca alloys. The influence of the process parameter rolling temperature on the properties of the ZMX210 sheets was investigated. The rolling experiments show that the ZMX210 alloy has a relatively narrow process window.

The role of 25-hydroxyvitamin D [25(OH)D] in reducing the risk of cardiovascular disease (CVD) has been recognized, but the mechanisms involved are unclear. Researchers have discovered a link between vitamin D and fibrinogen. Until now, data on the relationship between vitamin D and the γ' splice variant of fibrinogen and fibrin clot characteristics remain unexplored. In this study, 25(OH)D, total and γ' fibrinogen, as well as turbidimetrically determined plasma clot properties, were quantified, and fibrinogen and FXIII SNPs were genotyped in 660 Black, apparently healthy South African women. Alarmingly, 16 and 45% of the women presented with deficient and insufficient 25(OH)D, respectively. Total fibrinogen and maximum absorbance (as a measure of clot density) correlated inversely, whereas γ' fibrinogen correlated positively with 25(OH)D. γ' fibrinogen increased whereas maximum absorbance decreased over the deficient, insufficient, and sufficient 25(OH)D categories before and after adjustment for confounders. 25(OH)D modulated the association of the SNPs regarding fibrinogen concentration and clot structure/properties, but did not stand after correction for false discovery rate. Because only weak relationships were detected, the clinical significance of the findings are questionable and remain to be determined. However, we recommend vitamin D fortification and supplementation to reduce the high prevalence of this micronutrient deficiency and possibly to improve fibrinogen and plasma clot structure if the relationships are indeed clinically significant. There is a need for large cohort studies to demonstrate the relationship between vitamin D and cardiovascular and inflammatory risk factors as well as to uncover the molecular mechanisms responsible.