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Introduction The right subclavian artery normally arises as the first vessel from the brachiocephalic trunk. An aberrant right subclavian artery (ARSA) arises directly from the aortic arch and crosses behind the trachea towards the right arm. This variant occurs in approximately 1–2% of the population; however, the frequency increases in individuals with chromosomal abnormalities such as trisomy 21 and 22q11.2 microdeletion. Prenatal identification of ARSA therefore has a role in screening for such conditions. Methods Databases were searched for studies reporting the prenatal ultrasound evaluation of ARSA and its frequency in normal fetuses and in those with chromosomal abnormalities. Results A total of 23 studies were evaluated. Feasibility for the ultrasound evaluation of ARSA was 85–95%. The sonographic detection of ARSA is best in the three-vessel trachea view; however, sagittal and coronal imaging of the aortic arch may be useful. ARSA in isolation was not found to be associated with chromosomal abnormalities. The prevalence of ARSA in chromosomally abnormal fetuses was up to 24-fold higher than in normal fetuses, but the majority of chromosomally abnormal fetuses with ARSA had additional abnormal ultrasound findings, particularly cardiac abnormalities. Conclusions The prenatal detection of ARSA is a clinically useful prenatal marker for chromosomal abnormalities. In isolation, it is unlikely to be associated with pathogenic genetic variants. The ultrasound diagnosis of ARSA should prompt meticulous assessment of associated abnormalities. Invasive diagnostic testing should be offered to patients with non-isolated ARSA or in the presence of non-reassuring screening results or other risk factors.

Zusammenfassung. Psychotische Erkrankungen im Alter umfassen ein grosses Spektrum an Ursachen und Manifestationen. Häufig treten sie im Rahmen einer Depression, einer demenziellen Entwicklung, eines Substanz- und Medikamentenmissbrauchs oder eines Delirs auf. Während im Alter neue Erkrankungen auftreten können, erreichen zunehmend auch mehr Personen mit langjährig bestehenden, chronisch psychotischen Störungen das höhere Lebensalter. Neben psychotischen Störungen sind im Alter kognitive und somatische Beeinträchtigungen häufig, weshalb eine Fremdanamnese unverzichtbar ist. Die krankheitsbedingt veränderten Lebensumstände, die Komplexität und die jeweils individuelle Situation gilt es bei der Diagnostik und Therapie zu integrieren. Die vorliegenden Empfehlungen sind unter der Federführung der Schweizerischen Gesellschaft für Alterspsychiatrie und -psychotherapie (SGAP) in Zusammenarbeit mit den akademischen Fachgesellschaften für gerontologische und psychiatrische Pflege des Vereins für Pflegewissenschaft und weiteren Fachverbänden entstanden. Ziel ist es, den aktuellen Stand des Wissens über die psychotischen Erkrankungen im Alter sowie über die Möglichkeiten der Diagnostik und Therapie zusammenzufassen und den interprofessionellen, klinischen Teams in der stationären und ambulanten Versorgung zur Verfügung zu stellen.

PURPOSE OF REVIEW Pelvic floor disorders are common among gynecologic cancer survivors. With improvements in survivorship, quality of life conditions in these women need greater attention and care. This review focuses specifically on vulvovaginal symptoms, which are common and have a negative impact on sexual health and quality of life in women affected by gynecologic cancer. RECENT FINDINGS We review publications on treatment-specific sexual health outcomes, screening and treatment of vulvovaginal symptoms and sexual pain, and surgical management options. Recent evidence regarding the safety of concomitant prolapse repair at the time of surgery for gynecologic malignancies and CO2 laser therapy is discussed and areas needing further research and innovation are highlighted. SUMMARY Pelvic floor disorders, including vaginal and sexual health concerns, are common in women affected by gynecologic cancer due to both common risk factors and as a side effects of cancer treatment. Gynecologists play a critical role in screening, treatment, and collaboration with other specialists to provide comprehensive care for these women throughout their lifetime.

Johne’s disease (JD) is a chronic granulomatous enteritis caused by Mycobacterium avium subsp. paratuberculosis (MAP). While it is generally accepted that MAP employs immune subversion mechanisms, aspects of the host-pathogen relationship are not fully understood. We sampled 3 ileal tissue sections from 17 naturally infected cattle ( n = 51 sections) to analyze differences in cell types, apoptosis, and phagocytic cells. Diffuse multibacillary (DM) was the most common lesion type ( n = 17) followed by diffuse intermediate (DI; n = 15). DM lesions had significantly greater proportion of Treg cells (CD3+ FoxP3+) relative to all CD3+ T cells as compared to DI forms ( P < .05). CD68+ individual cell size was significantly smaller in DM than in diffuse lymphocytic (DL) forms ( P < .05). Area of caspase-3 positivity (apoptosis) was greater in DM lesions than DL ( P < .05) and DI ( P < .0001), and was linked to higher numbers of MAP within the macrophage.

Background: Chest-to-arm (CTA) tunneling has been described recently as a technique that allows an optimal exit site at mid-arm even in chronically ill patients with complex clinical issues and challenging problems of vascular access. Method: We adopted CTA tunneling in oncologic and in non-oncologic patients, in totally implanted and in external devices, for both medium and long-term intravenous treatments. We report our experience with 60 cases of CTA tunneling: 19 patients requiring a totally implantable device, who had bilateral contraindication to venous access at the arm and bilateral contraindication to placement of the pocket in the infra-clavicular area; 41 patients requiring an external central venous catheter, who had bilateral contraindication to insertion of peripherally inserted central catheters or femoral catheters, as well as contraindication to an exit site in the infraclavicular area. All venous access devices were inserted with ultrasound guidance and tip location by intracavitary electrocardiography, under local anesthesia. Results: There were no immediate or early complications. Patients with CTA-ports had no late complications. In patients with CTA-tunneled external catheters, there were two dislodgments, four episodes of central line associated blood stream infections, and one local infection. There were no episodes of venous thrombosis or catheter malfunction. Conclusion: Our experience suggests that CTA tunneling is a safe maneuver, with very low risk of complications, and should be considered as an option in patients with complex venous access.

Persistent withdrawal occlusion is a specific catheter malfunction characterized by inability to withdraw blood through the device while infusion is maintained. The main causes are fibroblastic sleeve and tip malposition (associated or not to venous thrombosis around the tip). All current guidelines recommend infusing vesicant/antiblastic drugs through a central venous port only after assessment of blood return. In PWO, blood return is impossible. We have recently started to assess the intravascular position of the tip and the delivery of the infusion in the proximity of the cavo-atrial junction utilizing transthoracic/subxiphoid ultrasound with the ‘bubble test’. We found that this is an easy, real-time, accurate and safe method for verifying the possibility of using a port for chemotherapy even in the absence of blood return, as it occurs with persistent withdrawal occlusion.

Irinotecan (IR) displays significant PK/PD variability. This study evaluated functional hepatic imaging (HNI) and extensive pharmacogenomics (PGs) to explore associations with IR PK and PD (toxicity and response). Eligible patients (pts) suitable for Irinotecan-based therapy. At baseline: (i) PGs: blood analyzed by the Affymetrix-DMET™-Plus-Array (1936 variants: 1931 single nucleotide polymorphisms [SNPs] and 5 copy number variants in 225 genes, including 47 phase I, 80 phase II enzymes, and membrane transporters) and Sanger sequencing (variants in HNF1A, Topo-1, XRCC1, PARP1, TDP, CDC45L, NKFB1, and MTHFR), (ii) HNI: pts given IV 250 MBq-99mTc-IDA, data derived for hepatic extraction/excretion parameters (CLHNI, T1/2-HNI, 1hRET, HEF, Td1/2). In cycle 1, blood was taken for IR analysis and PK parameters were derived by non-compartmental methods. Associations were evaluated between HNI and PGs, with IR PK, toxicity, objective response rate (ORR) and progression-free survival (PFS). N = 31 pts. The two most significant associations between PK and PD with gene variants or HNI parameters (P

Background: In some clinical conditions, central venous access is preferably or necessarily achieved by threading the catheter into the inferior vena cava. This can be obtained not only by puncture of the common femoral vein at the groin, but also—as suggested by few recent studies—by puncture of the superficial femoral vein at mid-thigh. Methods: We have retrospectively reviewed our experience with central catheters inserted by ultrasound-guided puncture and cannulation of the superficial femoral vein, focusing mainly on indications, technique of venipuncture, and incidence of immediate/early complications. Results: From June 2020 to December 2020, we have inserted 98 non-tunneled central venous catheters (tip in inferior vena cava or right atrium) by ultrasound-guided puncture of the superficial femoral vein at mid-thigh or in the lower third of the thigh, all of them secured by subcutaneous anchorage. The success of the maneuver was 100% and immediate/early complications were negligible. Follow-up of hospitalized patients (72.5% of all cases) showed only one episode of catheter dislodgment, no episode of infection and no episode of catheter related thrombosis. Conclusions: The ultrasound approach to the superficial femoral vein is an absolutely safe technique of central venous access. In our experience, it was not associated with any risk of severe insertion-related complications, even in patients with low platelet count or coagulation disorders. Also, the exit site of the catheter at mid-thigh may have advantages if compare to the exit site in the inguinal area.

The American Society for Parenteral and Enteral Nutrition (ASPEN) Position Paper focus is on applying the 4 ethical principles for clinician's decision-making in the use of artificially administered nutrition and hydration (AANH) for adult and pediatric patients. These basic principles are (1) autonomy, respect the patient's healthcare preferences; (2) beneficence, provide healthcare in the best interest of the patient; (3) nonmaleficence, do no harm; and (4) justice, provide all individuals a fair and appropriate distribution of healthcare resources. Preventing and resolving ethical dilemmas is addressed, with an emphasis on a collaborative, interdisciplinary approach. Optimizing early communication and promoting advance care planning, involving completion of an advance directive, including designation of a surrogate decision-maker, are encouraged. Clinicians achieve respect for autonomy when they incorporate the patient, family, community, country, geographical, and presumed cultural values and religious belief considerations into ethical decision-making for adults and children with a shared decision-making process. These discussions should be guided by the 4 ethical principles. Hospital committees and teams, limited-time trials, clinician obligation with conflicts, and forgoing of AANH are addressed. Specific patient conditions are addressed because of the concern for potential ethical issues: coma, decreased consciousness, and dementia; advanced dementia; cancer; eating disorders; and end-stage disease/terminal illness. Incorporated in the Position Paper are ethical decisions during a pandemic and a legal summary involving ethical issues. International authors presented the similarities and differences within their own country or region and compared them with the US perspective.

Aims Randomized trials support the safety and efficacy of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKA) in patients with nonvalvular atrial fibrillation (AF), leading to increased use of these compounds. Crushed forms of DOACs have shown to be reliable, but evidence supporting percutaneous endoscopic gastrostomy (PEG) delivery is lacking. PEG is a long-term option for enteral food and drug delivery in patients unable to maintain oral intake, bypassing the risks and disadvantages of parenteral nutrition. We investigate the safety and efficacy of Edoxaban administered via PEG in patients with atrial fibrillation and a clinical indication for a long-term anticoagulation. Methods and results In this prospective, single centre observational study, 12 PEG-treated patients with indication to anticoagulation will receive edoxaban via PEG and will be followed-up to 6 months. Plasma anti-Factor Xa activity and edoxaban concentrations will be assessed. Thromboembolic (ischaemic stroke, systemic embolism, venous thromboembolism) and bleeding events (Bleeding Academic Research Consortium and Thrombolysis in Myocardial Infarction) will be recorded at 1 and 6 months. A retrospective analysis of 5 AF cases undergoing PEG-implantation at our Institution, who received edoxaban via PEG, showed plasma anti-FXa levels at steady state of 146 ± 15 ng/ml, without major adverse event at a mean follow-up of 6 months. Conclusion We prospectively investigate PEG-administration of edoxaban in PEG-treated patients requiring long term anticoagulation. Our preliminary retrospective data support this route of DOAC administration.

The purpose of this study was to identify the underlying cognitive attributes used during the design and development of science-based serious educational games. Study methods rely on a modification of cognitive diagnostics, item response theory, and Bayesian estimation with traditional statistical techniques such as factor analysis and model fit analysis to examine the data and model structure. A computational model of the cognitive processing using an artificial neural network (ANN) allowed for examination of underlying mechanisms of cognition from a server-side data set and a 21st century skills assessment. ANN results indicate that the model correctly predicts successful completion of science-based serious educational game (SEG) design tasks related to 21st century skills 86% of the time and correctly predicts failure to complete SEG design tasks related to 21st century skills 78% of the time. The model also reveals the relative importance of each particular cognitive attribute within the 21st century skills framework.

OBJECTIVES Peer counseling may improve upon provider counseling and enhance patient preparedness for midurethral sling (MUS) surgery. We aimed to compare the impact of peer-centered versus standard preoperative video counseling by assessing patient preparedness for MUS surgery. METHODS Women undergoing MUS were randomized to view either a peer-centered (PEER) or standard physician preoperative counseling video (PHYS). The PEER video featured a woman who had undergone MUS surgery and included the standard risks and benefits as well as additional information identified in prior work as important to patients. The PHYS video featured a surgeon discussing risks and benefits. Patients viewed either video at their preoperative visit and completed the Patient Preparedness Questionnaire (PPQ), Surgical Decision Satisfaction, Decisional Regret Scale, and the Urogenital Distress Inventory Short Form. Patients then underwent standard in-person surgeon counseling. Sessions were timed and compared with historical timed sessions. Our primary outcome was between-group differences in 6-week postoperative PPQ scores. RESULTS Patient Preparedness Questionnaire scores did not differ between groups (postoperative PPQ scores: median [interquartile range], 95 [84, 100] vs 92 [80, 100]; P=0.50). The PEER group reported higher decisional regret (15 [0, 28.75] vs 0 [0, 10], P=0.02) and less symptom improvement on Urogenital Distress Inventory Short Form change scores compared with the PHYS group (47.2 [37.2, 62.5] vs 36.1 [16.5, 50], P=0.03); secondary outcomes were not different between groups. In-person counseling times decreased after watching either video compared with the institution's historical standard (8:27 minutes [08:56, 17:14] vs 11:34 minutes [5:22, 13:07]; P < 0.005). CONCLUSION Patient preparedness did not differ between groups. Decision regret did not differ between groups once adjusted for urinary symptoms.

PurposeWhile organizations have learned to understand the importance of developing business process management (BPM) capabilities, digitalization now transforms business processes, and introduces new challenges. Extending prior research examining the value of BPM capabilities in organizations, this study examines the associations of BPM capabilities across direct and indirect digitalization benefits.Design/methodology/approachDrawing from the capabilities perspective of strategic management, the dynamic versus ordinary classification was used to classify eight BPM capabilities. An empirical investigation of associations between the eight BPM capabilities and 20 digitalization benefits is presented based on data collected from 165 BPM professionals across four continents. Factor analyses were performed to verify the framework measures for BPM capabilities and digitalization benefits. The Kendall's tau-b (τb) correlation coefficient was used to measure the strength and direction of associations.FindingsOverall results confirm positive associations between BPM capabilities and digitalization benefits, but the relationship was less dominant for ordinary BPM capabilities and indirect benefits. Furthermore, relationships between individual BPM capabilities and specific digitalization benefits vary both across and within the categories.Practical implicationsThese findings support the moderate capability-based view that puts ordinary and dynamic capabilities on equal footing in dynamic environments, while also providing insight for managers focused on specific outcomes with digitalization efforts.Originality/valueThis study reveals that the strength of associations between BPM capabilities and digitalization benefits varies. This highlights the relevance of ordinary-dynamic and direct-indirect distinctions, and the value of a more fine-grained understanding to better inform practice.

Background Global nurse shortages present a threat to the sustainability of remote and rural healthcare. Interventions have been developed to support recruitment and retention of nurses that focus on providing pre-nursing experience for school pupils who intend to pursue nursing careers. However, there is a lack of evidence around how pre-nursing experience supports transition into nurse education. Aims This study aims to explore the impact of a pre-nursing scholarship for school pupils in remote and rural areas of Scotland on experiences of transition into nurse education. Methods This was a qualitative study involving semi-structured telephone and face-to-face interviews with pre-nursing scholarship participants. Results An authentic pre-nursing experience supported school pupils’ transition to nurse education. First, it increased students’ self-efficacy, both in their decision to choose nursing as a career and their ability to nurse. Second, it helped students to realise that the opportunity to study closer to home was available to them. Third, it supported students’ educational and social integration, helping them feel prepared for university teaching and learning approaches and the social experience of being a student. Conclusions Pre-nursing experience can support transition into nurse education and contribute to career pathways that support recruitment and retention of nurses in remote and rural areas.

Babesiosis is attracting increasing attention as a worldwide emerging zoonosis. The first case of human babesiosis in Europe was described in the late 1950s and since then more than 60 cases have been reported in Europe. While the disease is relatively rare in Europe, it is significant because the majority of cases present as life-threatening fulminant infections, mainly in immunocompromised patients. Although appearing clinically similar to human babesiosis elsewhere, particularly in the USA, most European forms of the disease are distinct entities, especially concerning epidemiology, human susceptibility to infection and clinical management. This paper describes the history of the disease and reviews all published cases that have occurred in Europe with regard to the identity and genetic characteristics of the etiological agents, pathogenesis, aspects of epidemiology including the eco-epidemiology of the vectors, the clinical courses of infection, diagnostic tools and clinical management and treatment. Funding has been provided by a grant from the Society for Promoting Quality Assurance in Medical Laboratories (INSTAND, e.V. Düsseldorf) and a grant from the Health Institute Carlos III (PI20CIII/00037 to EM and LGM), Spain. Sí

The adoption of healthcare technology is central to improving productivity in this sector. To provide new evidence on how technology affects healthcare markets, we focus on one area where adoption has been particularly rapid: surgery for prostate cancer. Over just six years, robotic surgery grew to become the dominant intensive prostate cancer treatment method. Using a difference-in-differences design, we show that adopting a robot drives prostate cancer patients to the hospital. To test whether this result reflects market expansion or business stealing, we also consider market-level effects of adoption and find they are significant but smaller, suggesting that adoption expands the market while also reallocating some patients across hospitals. Marginal patients are relatively young and healthy, inconsistent with the concern that adoption broadens the criteria for intervention to patients who would gain little from it. We conclude by discussing implications for the social value of technology diffusion in healthcare markets.

Often considered a condition of aging women, pelvic floor disorders may initially present in pregnancy and postpartum, having a negative impact on quality of life during this important time in a woman's life. This review outlines the clinical approach to implementing pelvic health into obstetric care through education and promotion of pelvic health in pregnancy, screening for pelvic floor disorders routinely, and providing support through resources, treatment, and referrals if pelvic floor disorders develop during pregnancy and postpartum.

Physical exercise is often encouraged in cancer patients, mainly for the purpose of rehabilitation and for its psychological benefit. Some authors also suggest that exercise—specially in patient with peripherally inserted central venous access devices—may contribute to reduce the risk of catheter-related thrombosis. Still, the impact of physical exercise on the risk of device-related complications is not yet defined. We report a case of secondary migration of the tip of an arm port, caused by high-intensity exercise in a woman undergoing chemotherapy because of ovarian cancer. Tip migration was suspected because of malfunction (persistent withdrawal occlusion) and diagnosis established after ultrasound examination and chest x-ray. Even if exercise may yield benefit in the cancer patient on chemotherapy, the risk of mechanical complication of the venous access device—such as tip migration—should be considered in the case of high-intensity exercise.

Purpose of review Transvaginal mesh kits were widely used to treat pelvic organ prolapse for over a 10-year period in the early 2000s. Due to safety concerns and FDA regulations, these mesh kits are no longer available for use. Thus, current Obstetricians and Gynecologists are likely to encounter these meshes, but may have no previous experience or exposure to the devices making it difficult to adequately monitor, counsel, and care for patients that underwent these types of procedures. This review highlights the most commonly used transvaginal mesh kit types, provides insight into signs and symptoms related to transvaginal mesh complications, and provides guidance for management of mesh complications. Recent findings Not all transvaginal mesh will give rise to a complication. If complications do occur, treatment options range from conservative observation to total mesh excision. Management must be customized to an individual patient's needs and goals. Summary Transvaginal mesh kits promised increased durability of surgical repair for pelvic organ prolapse. Safety concerns over time caused these kits to no longer be available for use. Practicing Obstetricians and Gynecologists should be aware of the history of transvaginal mesh and the signs and symptoms of mesh complications.

OBJECTIVES Peripherally inserted central catheters are increasingly used in ICU as an alternative to centrally inserted central catheters for IV infusion. However, their reliability for hemodynamic measurements with transpulmonary thermodilution is currently unknown. We investigated the agreement between transpulmonary thermodilution measurements obtained with bolus injection through peripherally inserted central catheter and centrally inserted central catheter (reference standard) using a transpulmonary thermodilution-calibrated Pulse Contour hemodynamic monitoring system (VolumeView/EV1000). DESIGN Prospective method-comparison study. SETTING Twenty-bed medical-surgical ICU of a teaching hospital. PATIENTS Twenty adult ICU patients who required hemodynamic monitoring because of hemodynamic instability and had both peripherally inserted central catheter and centrally inserted central catheter in place. INTERVENTION The hemodynamic measurements obtained by transpulmonary thermodilution after injection of a cold saline bolus via both centrally inserted central catheter and either a single-lumen 4F or a double-lumen 5F peripherally inserted central catheter using were compared. In order to rule out bias related to manual injection, measurements were repeated using an automated rapid injection system. MEASUREMENTS AND MAIN RESULTS A total of 320 measurements were made. Cardiac index was significantly higher when measured with double-lumen 5F peripherally inserted central catheter than with centrally inserted central catheter (mean, 4.5 vs 3.3 L/min/m; p < 0.0001; bias, 1.24 L/min/m [0.27, 2.22 L/min/m]; bias percentage, 31%). Global end-diastolic index, extravascular lung water index, and stroke volume index were also overestimated (853 ± 240 vs 688 ± 175 mL/m, 12.2 ± 4.2 vs 9.4 ± 2.9 mL/kg, and 49.6 ± 14.9 vs 39.5 ± 9.6 mL/m, respectively; p < 0.0001). Lower, albeit significant differences were found using single-lumen 4F peripherally inserted central catheter (mean cardiac index, 4.2 vs 3.7 L/min/m; p = 0.043; bias, 0.51 L/min/m [-0.53, 1.55 L/min/m]; bias percentage, 12.7%). All differences were confirmed, even after standardization of bolus speed with automated injection. CONCLUSIONS Bolus injection through peripherally inserted central catheter for transpulmonary thermodilution using EV1000 led to a significant overestimation of cardiac index, global end-diastolic index, extravascular lung water index, and stroke volume index, especially when double-lumen 5F peripherally inserted central catheter was used (ClinicalTrial.gov NCT03834675).

Objective To know whether motor deficits after tumor surgery are transient is reassuring for the patient and crucial for planning rehabilitation and adjuvant treatment. We analyze the value of postoperative MRI navigated transcranial magnetic stimulation (nTMS) compared to intraoperative MEP monitoring in predicting recovery of motor function. Methods Retrospective series of nTMS mappings within 14 days after surgery for supratentorial tumors (09/2014–05/2018). All patients with motor deficits of Medical-Research-Council-Grade (MRCS) 0–4- were included. Results We performed nTMS mapping on average 3.8 days after surgery and recorded nTMS MEP in 11 of 13 patients. Motor strength recovered to at least MRCS 4 within one month if postoperative nTMS elicited MEPs (positive predictive value 90.9%). If nTMS did not elicit MEPs, the patient did not recover (negative predictive value 100%). Intraoperative MEP and postoperative nTMS were equally predictive for long-term motor recovery. In cases of intraoperative MEP alteration/signal loss, but a positive postoperative nTMS mapping, 2/3 patients demonstrated a good motor recovery. Conclusion nTMS may predict long-term motor recovery of patients suffering from severe motor deficits directly after resection of tumors located in motor eloquent areas. Significance In cases of intraoperative MEP alterations, postoperative nTMS may clarify the potential for motor recovery.

Background Pediculosis in cattle causes significant itching, irritation and stress to the animal, often resulting in skin damage and poor coat condition. The control of bovine pediculosis in Ireland is based predominantly on commercial insecticides belonging to one of two chemical classes, the synthetic pyrethroids and the macrocyclic lactones. In recent years, pyrethroid tolerance has been reported in a number of species of livestock lice in the United Kingdom and Australia. Results In this pilot survey, lice were detected in 16 (94%) out of 17 herds visited. Two species of lice, Bovicola bovis and Linognathus vituli were identified. In vitro contact bioassays showed evidence of deltamethrin tolerance in Bovicola bovis collected from 4 farms. This was confirmed by repeatedly assessing louse infestations on treated animals on one farm. Conclusions To our knowledge this is the first record of insecticide tolerant populations of lice in Irish cattle. The results also provide new data on the species of lice infesting beef cattle in Ireland and the prevalence and control of louse infestations in Irish beef cattle herds.

The coronavirus pandemic has laid bare societal discourses regarding age differences and stereotypes. Using sociological approaches to risk and drawing on some examples from the Australian online news media, we illustrate how risk management approaches and risk uncertainties in response to the coronavirus, have homogenised younger and older peoples, and widely positioned them in a binary generational conflict of ‘risky’ and ‘at risk’. Younger people are frequently framed as healthy, active agents: they are engaging in risky behaviours that endanger their health and that of others. In contrast, older people have been typically cast as passive and at risk: ‘the elderly’ and ‘the vulnerable elderly’. In extreme cases, older people have also been framed as burdensome and worthless. In this chapter, we examine how age was framed or ‘staged’ during COVID-19 to illustrate how ageist language and dichotomous pandemic framings – grounded on blame and shame – add to social divisions and ‘othering’, shape risk management strategies, and cloud public health messaging on risk, viral spread, and physical distancing measures.

BACKGROUND The aim of this study is to determine relationships between lung aeration assessed by lung ultrasound (LUS) with non-invasive ventilation (NIMV) outcome, intensive care unit (ICU) admission and mechanical ventilation (MV) needs in COVID-19 respiratory failure. METHODS A cohort of adult patients with COVID-19 respiratory failure underwent LUS during initial assessment. A simplified LUS protocol consisting in scanning six areas, three for each side, was adopted. A score from 0 to 3 was assigned to each area. Comprehensive LUS score (LUSsc) was calculated as the sum of the score in all areas. LUSsc, the amount of involved sonographic lung areas (LUSq), the number of lung quadrants radiographically infiltrated and the degree of oxygenation impairment at admission (SpO 2 /FiO2 ratio) were compared to NIMV Outcome, MV needs and ICU admission. RESULTS Among 85 patients prospectively included in the analysis, 49 of 61 needed MV. LUSsc and LUSq were higher in patients who required MV (median 12 [IQR 8-14] and median 6 [IQR 4-6], respectively) than in those who did not (6 [IQR 2-9] and 3 [IQR 1-5], respectively), both P

Background A correlation between unsuccessful noninvasive ventilation (NIV) and poor outcome has been suggested in de-novo Acute Respiratory Failure (ARF) patients. Consequently, it is of paramount importance to identify accurate predictors of NIV outcome. The aim of our preliminary study is to evaluate the Diaphragmatic Thickening Fraction (DTF) and the respiratory rate/DTF ratio as predictors of NIV outcome in de-novo ARF patients. Methods Over 36 months, we studied patients admitted to the emergency department with a diagnosis of de-novo ARF and requiring NIV treatment. DTF and respiratory rate/DTF ratio were measured by 2 trained operators at baseline, at 1, 4, 12, 24, 48, 72 and 96 h of NIV treatment and/or until NIV discontinuation or intubation. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of DTF and respiratory rate/DTF ratio to distinguish between patients who were successfully weaned and those who failed. Results Eighteen patients were included. We found overall good repeatability of DTF assessment, with Intra-class Correlation Coefficient (ICC) of 0.82 (95% confidence interval 0.72–0.88). The cut-off values of DTF for prediction of NIV failure were p 0.6 for both operators (p Conclusion DTF and respiratory rate/DTF ratio may both represent valid, feasible and noninvasive tools to predict NIV outcome in patients with de-novo ARF. Trial registration ClinicalTrials.gov Identifier: NCT02976233, registered 26 November 2016.

BackgroundPolicy-makers are increasingly seeking rigorous evidence on the impact of programs that go beyond typical health care settings to improve outcomes for low-income families during the critical period around the transition to parenthood and through early childhood.MethodsThis study is a randomized controlled trial evaluating the impact of the Nurse-Family Partnership’s expansion in South Carolina. The scientific trial was made possible by a “Pay for Success” program embedded within a 1915(b) Waiver from Medicaid secured by the South Carolina Department of Health and Human Services. This protocol describes study procedures and defines primary and secondary health-related outcomes that can be observed during the intervention period (including pregnancy through the child’s first 2 years of life). Primary study outcomes include (1) a composite indicator for adverse birth outcomes including being born small for gestational age, low birth weight (less than 2500 g), preterm birth (less than 37 weeks’ gestation), or perinatal mortality (fetal death at or after 20 weeks of gestation or mortality in the first 7 days of life), (2) a composite outcome indicating health care utilization or mortality associated with major injury or concern for abuse or neglect occurring during the child’s first 24 months of life, and (3) an indicator for an inter-birth interval of DiscussionEvidence from this trial on the impact of home visiting services delivered at scale as part of a Medicaid benefit can provide policy-makers and stakeholders with crucial information about the effectiveness of home visiting programs in improving health and well-being for low-income mothers and children and about novel financing mechanisms for cross-silo interventions.Trial registrationThe trial was registered prospectively on the American Economic Association Trial Registry (the primary registry for academic economists doing policy trials) on 16 February 2016 (AEARCTR-0001039). ClinicalTrials.govNCT03360539. Registered on 28 November 2017.

Background Single-lumen 4Fr or double-lumen 5Fr power injectable peripherally inserted central catheters (PICCs) are not accurate for trans-pulmonary thermodilution (TPTD), since they overestimate cardiac index and other TPTD-derived parameters when compared with centrally inserted central catheters (CICCs) because of the smaller size of their lumen. We hypothesize that PICCs with larger lumen size may be reliable for the cardiac index assessment using the TPTD. Methods This is a single-centre, prospective method–comparison study that included adult patients admitted in ICU who required a calibrated Pulse Contour hemodynamic monitoring system (VolumeView/EV1000™) for circulatory shock and had both PICC and CICC in place. We compared TPTD measurements via single-lumen 5Fr or triple-lumen 6Fr polyurethane power injectable PICCs with triple-lumen 7Fr CICC (reference standard). To rule out biases related to manual injection, measurements were repeated using an automated rapid injection system. We performed Bland–Altman analysis accounting for multiple observations per patient. Results A total of 320 measurements were performed in 15 patients. During the manual phase, the cardiac index measured with either single-lumen 5Fr or triple-lumen 6Fr PICCs were comparable with cardiac index measured with triple-lumen 7Fr CICC (3.2 ± 1.04 vs. 3.2 ± 1.06 L/min/m2, bias 2.2% and 3.3 ± 0.8 vs. 3.0 ± 0.7 L/min/m2, bias 8.5%, respectively). During the automated phase, triple-lumen 6Fr PICC slightly overestimated the cardiac index when compared to triple-lumen 7Fr CICC (CI 3.4 ± 0.7 vs. 3.0 ± 0.7 L/min/m2, bias 12.5%; p = 0.012). For both single-lumen 5Fr and triple-lumen 6Fr PICCs, percentage error vs. triple-lumen 7Fr CICC was below 20% (14.7% and 19% during the manual phase and 14.4% and 13.8% during the automated phase, respectively). Similar results were observed for TPTD-derived parameters. Conclusions During hemodynamic monitoring with TPTD, both single-lumen 5Fr PICCs and triple-lumen 6Fr PICCs can be used for cold fluid bolus injection as an alternative to CICC (ClinicalTrials.gov NCT04241926).

Gastrointestinal nematodes (GIN) are a cause of significant losses in animal production worldwide. In recent years, there have been important advances in the biological control of GIN of ruminants and horses. While these measures are still relatively under-utilised in practice, interest will undoubtedly grow due to the emergence of drug resistant parasite populations, the rise in demand for organically farmed products (which does not allow prophylactic use of drugs, including anthelmintics) and legislation, which regulates and restricts the use of anthelmintics. This review provides an overview of the most promising biocontrol agents of GIN of grazing animals including nematophagous fungi, dung beetles, earthworms, predacious nematodes and nematophagous mites. Recent advancements in these fields are evaluated, and the potential reasons for the delayed development and slow uptake of biocontrol agents are discussed. It is now widely believed that no method of GIN control is sustainable alone, and a combination of strategies (i.e. integrated pest management) is required for long term, effective parasite control. This review shows that, although their efficacies are lower than those of conventional anthelmintics, biological control agents are an important adjunct to traditional GIN control.

The increase of online commerce in Indonesia has made consumers' shopping behavior change dramatically, faced with many choices of e-commerce platforms, making consumers easily switch from one platform into another. Fierce price competition continues to be played on this competition, making companies continue to “burn money” or spending more on the promotion budget to be able to compete on the industry. The purpose of this study is to make shopper in this segmentation to understand the market better and seeking the effect of popularity claims on online hasty buying decisions on each segment produced, especially in collectivist culture consumers. Data is distributed to 300 respondents, processed using cluster analysis and simple regression. The results showed four segmentations (Smart shopper, Impulsive shopper, Aesthetic shopper, and Comfortable shopper). Another result shown that one out of four segments had a positive and significant influence that was popularity claim towards online impulsive buying decisions.

COVID-19 has not only an impact on health aspects but also other issues, including the economy. At times of crisis that is full of challenges, individuals who prefer to compelled to do what needs to protected from the negativity caused by the disaster. One who managed to save himself in times of crisis caused a panic of buying that happens a lot in retail stores. Companies must study the efforts made by buyers related to panic buying that is happening around them. Companies can explore these insights through sentiments formed from social media user posts on social media platforms. This research explores consumer sentiment related to panic purchases using qualitative analysis with NVivo software. The results of a study of 647 posts on Twitter microblogging revealed that panic buying contained negative attitude. Based on the results of this analysis, there are tactical steps that can be taken by companies in supporting individual efforts to protect themselves from losses caused by the COVID-19 outbreak.

There is widespread interest in programs aiming to reduce spending and improve health care quality among "superutilizers," patients with very high use of health care services. The "hotspotting" program created by the Camden Coalition of Healthcare Providers (hereafter, the Coalition) has received national attention as a promising superutilizer intervention and has been expanded to cities around the country. In the months after hospital discharge, a team of nurses, social workers, and community health workers visits enrolled patients to coordinate outpatient care and link them with social services.We randomly assigned 800 hospitalized patients with medically and socially complex conditions, all with at least one additional hospitalization in the preceding 6 months, to the Coalition's care-transition program or to usual care. The primary outcome was hospital readmission within 180 days after discharge.The 180-day readmission rate was 62.3% in the intervention group and 61.7% in the control group. The adjusted between-group difference was not significant (0.82 percentage points; 95% confidence interval, -5.97 to 7.61). In contrast, a comparison of the intervention-group admissions during the 6 months before and after enrollment misleadingly suggested a 38-percentage-point decline in admissions related to the intervention because the comparison did not account for the similar decline in the control group.In this randomized, controlled trial involving patients with very high use of health care services, readmission rates were not lower among patients randomly assigned to the Coalition's program than among those who received usual care. (Funded by the National Institute on Aging and others; ClinicalTrials.gov number, NCT02090426; American Economic Association registry number, AEARCTR-0000329.).

Babesiosis, caused by piroplasmid protozoans in the genus Babesia, is arguably the most important vector-borne disease of livestock and companion animals and is growing in importance as a zoonosis. Ixodid ticks were identified as vectors more than a hundred years ago, but the particular tick species transmitting some significant pathogens are still unknown. Moreover, it is only recently that the complexity of the pathogen–tick relationship has been revealed as a result of studies enabled by gene expression and RNA interference methodology. In this article, we provide details of demonstrated and incriminated vectors, maps of the current knowledge of vector distribution, a summary of established features of the pathogen life cycle in the vector, and an outline of molecular research on pathogen–tick relationships. The article concludes with a discussion of vector ecology and disease epidemiology in a global-change context and with suggestions for future research.

A computer-based simulation, Hazelton High at REST (HHR), with embedded performance-based assessments and Likert-type survey questions was created to assess preservice teacher recognition of racial and gender intolerant behaviors. The simulation was modeled after the Racial Ethical Sensitivity Test (REST), a reliable video-based assessment, measuring professionals’ ethical sensitivity for cultural competence and recognition of intolerant behaviors in school settings. Ethical sensitivity skills, based on education professional ethics, are used to determine knowledge of ethical responsibility and professional attitudes and behaviors. A mixed-methods comparison study was conducted between HHR and the REST-video with 31 preservice science education students to investigate the effect of each on their ethical sensitivity. A post-simulation assessment was also conducted to determine and the usability and perception of HHR. It was hypothesized; HHR, an immersive simulation, would affect perspective taking of preservice science teachers and indirectly influence their ethical sensitivity. Data analysis determined ethical sensitivity score (EES) for HHR and REST-video using a survey and performance-based assessments. Post-simulation interview helped inform how a participant perceived the HHR. Results indicate the REST-video group had a significantly higher EES than the HHR group. Performance-based assessments within HHR showed a more comprehensive and complex picture of participant EES. The implication of this work for science education programs to use professional codes as a guide for evaluation and development of candidate disposition concerning cultural competency and the use of Serious Educational Games (SEGs) as ethical sensitivity assessments.

Background:\ud \ud The aim of this study was to investigate the association between self-rated eyesight and handgrip strength in a large, representative population of older adults.\ud \ud Methods:\ud \ud Data were from 7433 older adults (≥52 years) participating in the English Longitudinal Study of Ageing. Linear regression was used to analyze the association between self-rated eyesight and handgrip strength cross-sectionally in 2004/2005, and longitudinally over 4‑year follow-up, adjusting for a range of sociodemographic and health-related variables.\ud \ud Results:\ud \ud In cross-sectional and prospective models, poor eyesight was strongly associated with lower handgrip strength after adjustment for age, sex, ethnicity, socioeconomic status and body mass index (BMI, cross-sectional B = −1.39 kg, 95% confidence interval, CI −1.84 to −0.94, p

The quality of Mount Puntang Coffee is very famous amongst foreign countries, even it has been recognized world widely as one of the best coffee in the world. However, it does not necessarily make Mount Puntang’s coffee easy to market and sell. One of the parties that feels the is impacted by it is Haben Nagen, a brand and coffee shop owner who is also a farmer and become a part of the Mount Puntang coffee lovers community. From a short interview conducted to the people live in Bandung and Jakarta, on the average they answered that they did not know Gunung Puntang coffee, they also did not know if Mount Puntang coffee was one of the best coffees in the world. If Indonesian people, especially the people around West Java, don't know the quality of coffee from Mount Puntang, how are they interested in buying it?. For this reason, the solution offered to the owners of the Haben Nagen coffee brand is to create an artificial offline crowd in the form of a human crowd on 2 (two) locations which are their sales channels, namely: 1). Haben Nagen coffee shop, and 2). The exhibition booth where Haben Nagen participated in it. Human crowd is an artificial crowd which is formed from a certain number of people, which is used as a special treatment that aims to attract the attention of people outside the crowd to join in the human crowd and do the same thing done by people in the crowd. In a shorter discussion, the human crowd serves as the attention of the public, so that the surrounding people become more aware of a brand / product where human crowd is implemented, and then make an impulsive purchase.

OBJECTIVE To compare outcomes of efficiency, safety, patient, and surgeon satisfaction between absorbable subcuticular staples and subcuticular suture for caesarean section skin closure. DESIGN A prospective, randomised, non-blinded, parallel-group trial. SETTING Mayo Clinic Family Birth Center in Rochester, MN, USA. POPULATION At least 18 years old and 24 weeks' gestation, undergoing caesarean section. Exclusion criteria were body mass index >50, chorioamnionitis, intrauterine fetal death, and multifetal gestation. METHODS Patients were stratified by prior caesarean section, body mass index, and surgeon level and randomised to absorbable subcuticular staples or subcuticular suture. Electronic medical records and surveys were used. MAIN OUTCOME MEASURES Primary outcomes were total operating time, from incision start to close. Secondary outcomes included subcuticular skin closure time, patient and surgeon satisfaction, percutaneous injuries, pain (analgesic use), cosmesis, and wound complications. RESULTS Of 220 randomised patients, 206 were included in the final analysis (103 per group). Baseline characteristics were similar. The primary outcome of total operative time was not significantly different between groups [54.0 (44.9-63.6) versus 58.0 (50.4-68.2) minutes, P = 0.053]. The subcuticular staple group had shorter subcuticular skin closure time [median 2.6 (1.8-4.0) versus 8.5 (6.2-10.5) minutes, P < 0.001]. There were no differences in analgesic use, wound complications, cosmesis or patient satisfaction. One needlestick injury occurred with suture. Surgeons were more likely to recommend (97% versus 85%, P = 0.004) and use (98% versus 82%, P < 0.001) absorbable subcuticular staples. CONCLUSION For caesarean section skin closure, absorbable subcuticular staples did not result in significantly different total operative times compared with sutures. Analgesic use, wound complications, and cosmesis were comparable. Patient and surgeon satisfaction were high with both methods. TWEETABLE ABSTRACT Absorbable subcuticular staples associated with a similar total operative time compared with suture.