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Villages are changing as a consequence of global processes of transformation, as well as a summation of small-scale and individual decisions. Village communities are challenged by the way identities change, and search for ways to reflect and exchange ideas on what has disappeared, what aspects of life remain and will be possible. Our aim was to support individual villagers in order to better understand what is changing and to collectively define a future image. The methodology of action research brings in a future-forming orientation: to discuss what might become and to reflect on what is already there. Combined with aspects of participatory design, we set up different actions in Hoepertingen, a village in Haspengouw. Through walking with villagers, generating scenarios, envisioning, enacting, prototyping and more, we assembled and compared different meaning constructs, experimented with possible solutions and developed dialogues about these scenarios. In this paper, we will discuss the ways in which these participatory actions supported us to envision how public places in villages change and generate reflection, and debate about how inhabitants can contribute to this change.

Refereed/Peer-reviewed Relationships and sexual health education is an accepted part of the school curriculum to support adolescent development. In recent years, the nature of this education has expanded to include topics encompassing a social model of health (e.g. with a focus on gender roles). There has, however, been limited exploration of student views about the inclusion of these topics. This paper presents student feedback on South Australia’s Relationships and Sexual Health Programme, a state-wide curriculum produced by the state’s major sexual and reproductive health organisation. The findings are drawn from an annual survey conducted from 2006 to 2017, involving 29,533 secondary school students aged 12–16 years. Regression analyses were used to assess the relationship between the year the survey was conducted and student ratings of the programme (‘good/excellent’ vs ‘poor/satisfactory’) and, separately, the individual topics students’ considered most important. There was a positive association between survey year and rating the programme as ‘good/excellent’ with regard to providing a ‘safe and supportive classroom environment’, and a small negative association between survey year and ‘overall rating’ as ‘good/excellent’. Over time, there was an increase in the number of students selecting the topic ‘consent’ as the most important. These findings demonstrate student support for the inclusion of a range of social health topics in relationships and sexual health education.

Aims To determine the level of glycemic control and cardiovascular (CVD) risk among adults with diabetes in the Eastern Caribbean. Methods Baseline data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were used for the analysis. ECS participants were 40 years of age and older, residing in the US Virgin Islands, Puerto Rico, Trinidad, or Barbados. Participants completed a survey, physical exam, and laboratory studies. CVD risk was calculated using the Atherosclerotic CVD risk equation. Bivariate analysis followed by multinomial logistic regression was used to assess social and biological factors (education, lifestyle, access to care, medical history) associated with level of glycemic control. Results Twenty-three percent of participants with diabetes had an HbA1c ≥ 9% (>75 mmol/mol). Participants with diabetes had poorly controlled CVD risk factors: 70.2% had SBP ≥ 130 mmHg, 52.2% had LDL ≥ 100 mg/dl (2.59 mmol/L), and 73.2% had a 10-year CVD risk of more than 10%. Age and education level were significant, independent predictors of glycemic control. Conclusion There is a high prevalence of uncontrolled diabetes among adults in ECS. The high burden of elevated CVD risk explains the premature mortality we see in the region. Strategies are needed to improve glycemic control and CVD risk factor management among individuals with diabetes in the Caribbean.

Background: In 2017, the European Commission launched 24 European Reference Networks (ERNs). ERN eUROGEN is the network for urorectogenital diseases and complex conditions, and started with 29 full member healthcare providers (HCPs) in 11 countries. It then covered 19 different disease areas distributed over three work -streams (WSs). Objective: To provide an overview and identify challenges in data collection at European level of the ERN eUROGEN patient population treated by HCPs in the network. Design, setting, and participants: A retrospective cohort study was conducted of the 29 HCPs who were full members between 2013 and 2019. Outcome measurements and statistical analysis: Data were extracted from the original HCP applications and the ERN continuous monitoring system. Patient volumes, new patient numbers, and procedures were compared between different WSs, countries, and HCPs. Discrepancies between monitoring and application data were identified. Results and limitations: Between 2013 and 2019, 122 040 patients required long-term care within the 29 HCPs. The volume of patients treated and procedures undertaken per year increased over time. Large discrepancies were found between patient numbers contained in the application forms and those reported in the continuous monitoring system (0-1357% deviation). Conclusions: Patient numbers and procedures increased across ERN eUROGEN HCPs. Reliable data extraction appeared challenging, illustrated by the patient volume dis-crepancies between application forms and the continuous monitoring data. Improved disease definitions, re-evaluation of affiliated HCPs, and valid data extraction are needed for future improvements. Patient summary: We analysed the patient population with rare urorectogenital dis-eases or complex conditions within the ERN eUROGEN network between 2013 and 2019. Clinical activity was found to increase, but differences in patient numbers were evident between healthcare providers. In order to acquire valid patient numbers, both improved definitions of diagnostic codes and greater insight into the data-gathering process are required. (c) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

Audio-visual tracking of an unknown number of concurrent speakers in 3D is a challenging task, especially when sound and video are collected with a compact sensing platform. In this paper, we propose a tracker that builds on generative and discriminative audio-visual likelihood models formulated in a particle filtering framework. We localize multiple concurrent speakers with a de-emphasized acoustic map assisted by the image detection-derived 3D video observations. The 3D multimodal observations are either assigned to existing tracks for discriminative likelihood computation or used to initialize new tracks. The generative likelihoods rely on color distribution of the target and the de-emphasized acoustic map value. Experiments on AV16.3 and CAV3D datasets show that the proposed tracker outperforms the uni-modal trackers and the state-of-the-art approaches both in 3D and on the image plane.

The low rate of technology adoption has long been a key constraint on improving productivity, income and yields in farming, particularly in developing countries where market-based systems of production are not well developed, the subsistence economy remains strong, land is held under communal tenure and family labour is the backbone of production. We examine four case studies of technology adoption to explore key socio-economic factors facilitating or constraining adoption. Our case studies cover an array of adoption situations from different parts of the developing world: 1. The socio-cultural barriers to the adoption of new technologies to control Cocoa Pod Borer in Papua New Guinea; 2. The role of land pressure on differential adoption rates of cocoassie yams amongst ethnic groups in Ivory Coast; 3. Past agricultural practices and their influence on adoption of a new planting pattern and selected oil palm planting material in Cameroon; 4. Taking account of gender relations to facilitate successful adoption of a new oil palm initiative for women smallholders in Papua New Guinea.

We examine the effect of capitalization vs expensing on UK firms’ R&D expenditures. Our investigation is motivated by the UK’s mandatory switch from UK GAAP to IFRS in 2005. Under UK GAAP, firms could elect to expense or capitalize development expenditures, but IFRS mandates capitalization. Thus, “capitalizers” maintained their accounting method, while “switchers” were required to change from expensing to capitalization. Using a difference-in-difference design, we examine the effect of the rule change on the amount and riskiness of the two groups’ R&D expenditures. Consistent with arguments that expensing’s deleterious effect on income causes firms to reduce their R&D outlays, we find that switching firms increased their R&D expenditures more than firms that continued to capitalize. We subject our results to numerous robustness tests, using propensity score matched samples, comparing early vs late switchers, switchers with high vs low R&D expenditure growth, examining R&D behavior in the last year before IFRS adoption, and a placebo test in which we alter the switch date. Across all of these tests, our results support the conclusion that the accounting method affects the amount that firms invest in R&D. Our results attest to the real effects of accounting policy on firms’ R&D investments.

A number of text compression algorithms have been proposed in the past decades, which have been very effective and usually operate on conventional character/word-based approaches. A novel data compression perspective of data mining is explored in this research and the paper focuses on novel frequent sequence/pattern mining approach to text compression. This work attempts to make use of longer-range correlations between words in languages for achieving better text compression. We propose a novel and efficient method by making the compression of any word-level text in a universal manner for corpora across domains referred as Universal Huffman Tree-based encoding. The major contribution of this work is in terms of avoidance of code table communication to the decoder. Simulation results over benchmark datasets indicate that Universal Huffman encoding employing frequent sequence mining (achieves [20%, 89%] improvement in compression in reduced time. The paper also contributes a usable interface for Data compression that employs the proposed frequent sequent mining-based data compression algorithm. The interface supports features such as feedback, consistency, usability, navigation, visual appeal, performance and accessibility on par with existing compression softwares. The work results in an intelligent data compression software employing knowledge engineering perspective.

Kandamaran Krishnamurthy,1 Natasha Sobers,2 Alok Kumar,1 Nkemcho Ojeh,1 Andrea Scott,3 Clyde Cave,3 Subir Gupta,1 Joanne Bradford-King,3 Bidyadhar Sa,4 Oswald Peter Adams,1 Michael H Campbell,1 Md Anwarul Azim Majumder1 1Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados; 2Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados; 3The Queen Elizabeth Hospital, Bridgetown, Barbados; 4Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and TobagoCorrespondence: Md Anwarul Azim MajumderFaculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, BarbadosEmail azim.majumder@cavehill.uwi.eduIntroduction: Due to increased exposure risk and the potential impact of COVID-19 infection, health care professionals (HCP) are a target group for COVID-19 vaccination. This study aimed to examine the acceptability of COVID-19 vaccines among HCP at the Queen Elizabeth Hospital, Barbados.Design and Methods: A cross-sectional survey of HCP was conducted between February 14 and 27, 2021 using an online questionnaire. The questionnaire included demographic information, knowledge of novel coronavirus, intention to accept the COVID-19 vaccination, vaccine literacy (VL), and perceptions and attitudes regarding COVID-19 vaccines. Mean VL scores were calculated. The relationship between socio-demographic variables and vaccine intent was assessed using a multivariable logistic regression model.Results: Of 343 HCPs, 55.1% indicated they would accept the COVID-19 vaccine if it were available; 44.9% expressed hesitancy towards the COVID-19 vaccine. We assessed the impact of socio-demographic factors and previous vaccine behavior on vaccine intent; after adjustment of the multivariable logistic regression model, non-Barbadian nationality and previous flu vaccine uptake were statistically significant predictors of reported intent to take the COVID-19 vaccine. Persons who indicated that they would take the vaccine had a higher mean vaccine literacy score [3.46 95% CI (3.40, 3.52)] than those who were not ready to take the vaccine immediately [3.23 95% CI (3.15, 3.30)]. VL scores were higher among the 29.5% of HCPs who believed vaccines should be mandatory.Conclusion: This study highlighted vaccine hesitancy among HCPs in the sole public tertiary hospital of Barbados. As HCP perceptions may help or hinder the campaign to promote vaccine uptake in Barbados, vaccine promotion programs targeting HCPs are needed to ensure the success of the country’s COVID-19 vaccination drive.Keywords: vaccine intake, vaccine hesitancy, vaccine literacy, healthcare professionals, COVID-19, Barbados

Lay abstract Acute low back pain is one of the most common reasons patients present to the emergency department (ED), and it is often difficult to treat. The erector spinae plane block (ESPB) is a nerve block used to treat thoracic, rib, spine and abdominal wall pain. There is currently limited evidence to support its use in treating low back pain in the ED. This case series looks at outcomes of six patients who presented to the ED with low back pain who were treated with an ESPB that targets the low back muscles. Visual Analog Scale pain score reduction after the procedure ranged between 71 and 100%, with an average of 81.8%. The average length of stay (LOS) prior to the nerve block was 225 min, with a range of 107–480 min. Average LOS after the block was 73.5 min, with a range of 26–180 min. Five of six patients did not have any return ED visits for back pain. All six patients required no opiates after the procedure in the ED or after discharge. These cases show the ESPB is a promising technique that gives emergency physicians a rapid, safe and opiate-sparing option for the treatment of low back pain. ESPBs can result in decreased pain, decreased LOS, decreased opiate requirements and decreased admission for refractory pain.

Background The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. Methods Mixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. Results The dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n=55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR=3.0; 95% confidence interval [CI], 1.3–7.0); nursing management support of the trial (OR=2.6; 95% CI, 1.1–6.5); performance of a dummy run (OR=2.6; 95% CI, 1.1–6.1); nursing colleagues seeing the value of the intervention(s) (OR=2.1; 95% CI, 0.9–5.7); and site investigators' belief in the effectiveness of the intervention (OR=3.2; 95% CI, 1.2–9.4). Conclusions ASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork. Clinical trial registration ClinicalTrials gov NCT03853824.

BACKGROUND: Left ventricular assist device (LVAD) has been increasingly used in patients with advanced heart failure. This study aimed to assess the impact of implementation of LVAD therapy on heart transplantation (HTx) service in Hong Kong (HK). METHODS: LVAD program was started in 2010 in HK and patients who had been put on HTx waiting list since the start of HTx program in HK from 1992 to 2020 were included for analysis. Survival on HTx waiting list between pre-LVAD era 1992–2009 and post-LVAD era 2010–2020 were analyzed by Kaplan-Meier method and compared by log-rank test. Multivariate analysis by time-dependent Cox-proportional hazard model was used to identify independent predictors of HTx waiting list mortality. RESULTS: A total of 478 heart transplant listing episodes involving 457 patients were included for analysis. There were 232 heart transplantations (HTxs), including one re-transplantation, during the study period. There were 110 patients who received LVAD as bridge to transplantation (BTT) and 30 of them had undergone subsequent HTx. The 1-, 2- and 3-year survival on waiting list were 82.3%, 61.7% and 43.0% respectively in the pre-LVAD era (n=178), while the 1-, 2- and 3-year survival were significantly improved at 85.7%, 81.8% and 78% respectively in the post-LVAD era (n=300), (P=0.003). Time-dependent multivariate analysis revealed that LVAD support was independently associated with significant reduction of waiting list mortality [odds ratio (OR): 0.21; 95% confidence interval (CI): 0.10–0.44, P

Building Information Modelling (BIM) has been touted as a new outstanding technology and governments who have noticed this is getting involved. This study investigated the current level of the Kenyan Government’s involvement and how this has influenced adoption amongst building contractors. This study also compares global trends in the context to Kenya. This study identified roles like initiation and regulation that governments could undertake to encourage adoption. A random sampling of registered contractors with active construction sites within Nairobi County was used to identify respondents. Using a one-sample t-test with a universal mean of 2 representing weak government involvement, with t (61) = 2.39, α > 0.05, M = 2.05 and S = 1.53, the Kenyan government’s involvement in BIM and its performance on the roles was weak. There was no relationship between the government roles and BIM except for BIM Initiation which had a weak positive relationship. This study makes recommendations like the creation of a legal BIM mandate and the establishment of a BIM implementation body This is the first in-depth study in Kenya that critically looks at the government’s role on issues relating to BIM amongst Building contractors and gives precedence for subsequent comparative studies locally or regionally.

Background Trials of immune checkpoint inhibitors (ICIs) have published patient-reported quality of life (QOL), but the size and heterogeneity of this literature can make patient education difficult. This meta-analysis aimed to describe change in QOL and symptomatology in patients receiving ICIs for cancer. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases were searched through November 2019 for articles or abstracts of prospective, original studies reporting longitudinal QOL in adult cancer patients treated with ICIs. The prespecified primary outcomes were change in global QOL among patients treated with ICIs and difference in change since baseline in global QOL between patients treated with ICI vs non-ICI active treatment. Secondary outcomes included physical functioning and symptomatology. All statistical tests were 2-sided. Results Of 20 323 publications, 26 met inclusion criteria. Global QOL did not change over time in patients treated with ICIs (k = 26, n = 6974; P = .19). Larger improvements in global QOL was observed in patients receiving ICI vs non-ICI regimens (k = 16, ICI: n = 3588; non-ICI: n = 2948; P Conclusions This study is among the first to quantitatively summarize QOL in patients treated with ICIs. Findings suggest ICI recipients report no change in global QOL and higher QOL than patients treated with non-ICI regimens.

Summary: Background: Treatment and control of malaria depends on artemisinin-based combination therapies (ACTs) and is challenged by drug resistance, but thus far resistance to artemisinins and partner drugs has primarily occurred in southeast Asia. The aim of this study was to characterise antimalarial drug susceptibility of Plasmodium falciparum isolates from Tororo and Busia districts in Uganda. Methods: In this prospective longitudinal study, P falciparum isolates were collected from patients aged 6 months or older presenting at the Tororo District Hospital (Tororo district, a site with relatively low malaria incidence) or Masafu General Hospital (Busia district, a high-incidence site) in eastern Uganda with clinical symptoms of malaria, a positive Giemsa-stained blood film for P falciparum, and no signs of severe disease. Ex-vivo susceptibilities to ten antimalarial drugs were measured using a 72-h microplate growth inhibition assay with SYBR Green detection. Relevant P falciparum genetic polymorphisms were characterised by molecular methods. We compared results with those from earlier studies in this region and searched for associations between drug susceptibility and parasite genotypes. Findings: From June 10, 2016, to July 29, 2019, 361 P falciparum isolates were collected in the Busia district and 79 in the Tororo district from 440 participants. Of 440 total isolates, 392 (89%) successfully grew in culture and showed excellent drug susceptibility for chloroquine (median half-maximal inhibitory concentration [IC50] 20·0 nM [IQR 12·0–26·0]), monodesethylamodiaquine (7·1 nM [4·3–8·9]), pyronaridine (1·1 nM [0·7–2·3]), piperaquine (5·6 nM [3·3–8·6]), ferroquine (1·8 nM [1·5–3·3]), AQ-13 (24·0 nM [17·0–32·0]), lumefantrine (5·1 nM [3·2–7·7]), mefloquine (9·5 nM [6·6–13·0]), dihydroartemisinin (1·5 nM [1·0–2·0]), and atovaquone (0·3 nM [0·2–0·4]). Compared with results from our study in 2010–13, significant improvements in susceptibility were seen for chloroquine (median IC50 288·0 nM [IQR 122·0–607·0]; p100 nM) was more common in isolates from the Tororo district (11 [15%] of 71), compared with those from the Busia district (12 [4%] of 320; p=0·0017). We showed significant increases between 2010–12 and 2016–19 in the prevalences of wild-type P falciparum multidrug resistance protein 1 (PfMDR1) Asn86Tyr from 60% (391 of 653) to 99% (418 of 422; p

Chun-Sheng Hsu,1– 4 Shin-Tsu Chang,1,5,6 Oswald Ndi Nfor,2 Kuan-Jung Lee,2 Chien-Chang Ho,7,8 Chuan-Ching Liu,1 Shiuan-Shinn Lee,2 Yung-Po Liaw2,9 1Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung City, 40201, Taiwan; 2Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, 40201, Taiwan; 3School of Medicine, National Defense Medical Center, Taipei City, 11490, Taiwan; 4College of Medicine, National Chung Hsing University, Taichung City, 402, Taiwan; 5Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centre, Taipei City, 11490, Taiwan; 6Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung City, 813414, Taiwan; 7Department of Physical Education, Fu Jen Catholic University, New Taipei, 24205, Taiwan; 8Research and Development Center for Physical Education, Health, and Information Technology, Fu Jen Catholic University, New Taipei, 24205, Taiwan; 9Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, TaiwanCorrespondence: Yung-Po Liaw; Shiuan-Shinn LeeDepartment of Public Health and Institute of Public Health, Chung Shan Medical University, No. 110 Sec. 1 Jianguo N. Road, Taichung City, 40201, TaiwanTel +886 424730022 ext. 11838; +886 424730022 ext.12185Fax +886 423248179Email Liawyp@csmu.edu.tw; shinn@csmu.edu.twPurpose: The Lipoprotein lipase (LPL) gene is a significant contributor to dyslipidemia. It has shown associations with several conditions including atherosclerosis, obesity, and metabolic syndrome (MetS). We assessed the interactive association between MetS and rs3779788 of the LPL gene based on aerobic exercise.Materials and Methods: Data were available for 7532 Taiwan Biobank (TWB) participants recruited between 2008 and 2016. We used multiple logistic regression to determine the odds ratios (OR) for MetS and their 95% confident intervals (C.I.). Potential variables included LPL rs3779788, aerobic exercise, sex, age, education, marital status, body mass index (BMI), smoking, alcohol consumption, midnight snacking, vegetarian diet, coffee, dietary fat, and tea drinking.Results: Aerobic exercise was protective against MetS (OR, 0.858; 95% C.I., 0.743– 0.991). Compared to CC/CT genotype, the OR for developing MetS was 0.875, (95% C.I., 0.571– 1.341) in TT individuals. The test for interaction was significant for the rs3779788 variant and aerobic exercise (p = 0.0484). In our group analyses, the OR for MetS was 0.841 (95% C.I., 0.727– 0.974) in CC/CT and 4.076 (95% C.I., 1.158– 14.346) in TT individuals who did aerobic exercise compared to those who did not.Conclusion: Our study indicated that aerobic exercise improved metabolic syndrome in Taiwanese adults with rs3779788 CC/CT genotype relative to those with TT genotype.Keywords: polymorphisms, variant, physical activity, metabolic disorders

Migraine is a leading cause of morbidity and disability worldwide. Triptans were the first migraine-specific drug class developed and have proven efficacy in treatment of this neurological disease. They are however contraindicated in patients with cardiovascular disease and possibly others, owning to their vasoconstrictive properties. This review will focus on lasmiditan, which has been called the first ‘ditan’ and ‘neurally acting anti-migraine agent’, designed to selectively agonize the serotonin 5-HT1F receptor subtype, providing anti-migraine effects without concomitant vasoconstriction. To date, lasmiditan has proven safe and effective for the acute treatment of migraine in two Phase II and four Phase III trials. Post hoc analysis revealed that the majority of treatment-emergent adverse events were CNS-related, mild-to-moderate in severity and self-limiting. The US FDA label recommends that patients not drive or operate machinery until at least 8 h after taking each dose of lasmiditan.

The National Academies Board on Human Systems Integration (BOHSI) has organized this session exploring the changing nature of an essential human activity—work. Policing, the military, healthcare, and numerous other fields are being shaped by powerful forces. The Panel brings together prominent researchers to reflect on the organizational and societal changes as well as the impact of emerging technologies that are likely to shape the nature of work in the future.

Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.

Background and Aims: A retrospective study was to analyze the association of plasma renin activity (PRA) with overall survival and liver disease-related events in decompensated liver cirrhosis with ascites treated by tolvaptan. Methods: We included 196 patients with decompensated cirrhosis treated with tolvaptan and for whom hepatic ascites had remained uncontrolled by conventional diuretics. Factors associated with prognosis and appearance of liver disease-related events were investigated, including vasopressin, sympathetic nervous system hormones (adrenaline, noradrenaline, and dopamine), and the renin-angiotensin system (PRA and aldosterone) at the beginning of tolvaptan treatment. Results: Age, history of hepatocellular carcinoma (HCC), and PRA were identified as independent factors for prognosis after tolvaptan treatment. The median survival time in patients with PRA ≥9.5 ng/mL/h at the beginning of tolvaptan treatment was significantly shorter than in patients with PRA p < 0.001). PRA and a history of HCC were independent factors for the occurrence of liver disease-related events. The median event-free period in patients with PRA ≥3.2 ng/mL/h was significantly shorter than that of patients with PRA p < 0.001). Conclusions: PRA is an independent predictor of prognosis and appearance of liver disease-related events in patients with decompensated cirrhosis who have started tolvaptan treatment.

Academic engagement with small business and entrepreneurship was facilitated by the availability of European Union (EU) funding, which also stimulated the emergence of a small business and entrepreneurship (SBE) ‘community of practice’. Gradually, the SBE community developed into a ‘landscape of practice’ as small business research moved towards maturity. Furthermore, the SBE landscape of practice has coalesced around three core concepts: entrepreneurial learning, social networks and social capital. EU funding was the catalyst for many SBE academics in the UK to engage with practitioners involved with starting and managing their own businesses. The UK’s exit from the EU will inevitably mean that universities will no longer have access to EU Structural Funds. This has major implications for the UK SBE community’s engagement with practice as well as for entrepreneurs and business owners who have benefitted from a range of programmes designed to improve the performance of smaller firms.

Neuropsychological evaluation has become a standard component of long-term follow-up care for survivors of pediatric cancer. The purpose of the present study was to examine access to, and benefits of, neuropsychological evaluation for survivors. A retrospective chart review was conducted on cancer survivors who were referred for neuropsychological evaluation from a multidisciplinary long-term follow-up (LTFU) clinic approximately 5 years following treatment cessation. Descriptive statistics were calculated, and t-tests and chi-square analyses were utilized to examine variables that may impact survivors’ access to neuropsychological services. One hundred seven survivors between 6 and 26 years old were referred for a neuropsychological evaluation. Referred male patients were less likely than female patients to schedule an evaluation. Consultation with a neuropsychologist in the LTFU clinic was related to more referrals but did not improve attrition rates (55%). Twenty-four percent of evaluated patients displayed severe cognitive impairment and 75% were diagnosed with a psychological disorder. Utilization of educational and behavioral health services did not significantly change following evaluation. Survivors’ utilization of neuropsychological services is lower for males than females. The presence of a neuropsychologist in a multidisciplinary team clinic can improve identification of survivors that may benefit from neuropsychological evaluation. Many survivors did not receive recommended services, suggesting patients and families may need additional supports following evaluation. Future research should focus on improving survivors’ access to neuropsychological services and identifying barriers to receiving recommended services.

Mei-Hsuen Huang,1 Yu-Fan Liu,2,3 Oswald Ndi Nfor,4 Shu-Yi Hsu,4 Wei-Yong Lin,5– 7 Yuan-Shiun Chang,1 Yung-Po Liaw4,8 1Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan; 2Department of Biomedical Sciences, Chung Shan Medical University, Taichung, Taiwan; 3Division of Allergy, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan; 4Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 40201, Taiwan; 5Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan; 6Department of Medical Research, China Medical University Hospital, Taichung, 40447, Taiwan; 7Brain Diseases Research Center, China Medical University, Taichung, 40402, Taiwan; 8Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, 40201, TaiwanCorrespondence: Yung-Po LiawDepartment of Public Health and Institute of Public Health, Chung Shan Medical University, No. 110, Sec. 1 Jianguo N. Road, Taichung City, 40201, TaiwanTel +886-4-24730022 ext.11838Fax +886-4-23248179Email Liawyp@csmu.edu.twYuan-Shiun ChangDepartment of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, College of Chinese Medicine, China Medical University, Taichung, 40402, TaiwanTel +886-4-22053366 ext. 5502Fax +886-4-22083362Email yschang@mail.cmu.edu.twPurpose: We investigated the interactive effect of rs10506151 polymorphism of the Leucine-rich repeat kinase 2 (LRRK2) gene and type 2 diabetes (T2D) on neurodegenerative disease (ND) risk.Materials and Methods: Data of 17, 927 participants in the Taiwan Biobank (TWB) assessed between 2008 and 2015 were linked to healthcare records in the National Health Insurance Research Database (NHIRD). The odd ratios (ORs) and 95% confidence intervals (CIs) for NDs were determined using logistic regression analysis.Results: There were 145 cases with NDs, and 28.28% (n = 41) of these individuals had T2D. Associations of neurodegenerative disorders with LRRK2 rs10506151 variant and T2D were not significant. The corresponding ORs (95% CI) for NDs were 1.06 (0.75– 1.49) in CA/AA compared to CC individuals and 0.93 (0.63– 1.39) in those with T2D compared to non-diabetic participants. However, we found evidence of a significant interaction between rs10506151 and T2D (p = 0.0073). After stratification by genotypes of rs10506151, the OR for NDs was 0.37 (CI, 0.17– 0.82) in CA/AA individuals with T2D and 1.41 (0.88– 2.27) in their CC counterparts. When CA/AA individuals with T2D represented the reference group, the OR (95% CI) was 1.74 (0.81– 3.73) in CC individuals with no T2D, 2.47 (CI, 1.14– 5.38) in CA/AA individuals with no T2D, and 2.34 (CI, 1.07– 5.11) in CC individuals with T2D.Conclusion: Our data indicated that the risk of NDs was significantly lower among diabetic individuals with combined CA/AA of the LRRK2 rs10506151 variant in Taiwan.Keywords: polymorphism, neurodegenerative disorders, diabetes, variation

Background In patients with cardiac resynchronization therapy defibrillators (CRT-Ds), intracardiac impedance measured by dedicated CRT-D software may be used to monitor hemodynamic changes. We investigated the relationship of hemodynamic parameters assessed by intracardiac impedance and by echocardiography in a controlled clinical setting. Methods The study enrolled 68 patients (mean age, 66 ± 9 years; 74% males) at 12 investigational sites. The patients had an indication for CRT-D implantation, New York Heart Association class II/III symptoms, left ventricular ejection fraction 15%–35%, and a QRS duration ≥150 ms. Two months after a CRT-D implantation, hemodynamic changes were provoked by overdrive pacing. Intracardiac impedance was recorded at rest and at four pacing rates ranging from 10 to 40 beats/min above the resting rate. In parallel, echocardiography measurements were performed. We hypothesized that a mean intra-individual correlation coefficient (rmean) between stroke impedance (difference between end-systolic and end-diastolic intracardiac impedance) measured by CRT-D and the aortic velocity time integral (i.e., stroke volume) determined by echocardiography would be significantly larger than 0.65. Results The hypothesis was evaluated in 40 patients with complete data sets. The rmean was 0.797, with a lower confidence interval bound of 0.709. The study hypothesis was met (p = 0.007). A stepwise reduction of stroke impedance and stroke volume was observed with increasing heart rate. Conclusions Intracardiac impedance measured by implanted CRT-Ds correlated well with the aortic velocity time integral (stroke volume) determined by echocardiography. The impedance measurements bear potential and are readily available technically, not requiring implantation of additional material beyond standard CRT-D system., Highlights • Intracardiac impedance measurement feature (ICI-MF) is integrated in some CRT-Ds. • We studied relationship between echo hemodynamic parameters and ICI-MF of CRT-Ds. • Stroke volume by echo correlated well with stroke impedance by ICI-MF of CRT-Ds. • Stepwise reduction in stroke impedance and stroke volume with increasing heart rate. • The ICI-MF bears potential and requires only a ‘standard’ CRT-D system implantation.

Background Cyclin‐dependent kinase 4 and 6 (CDK4/6) inhibitor targeted therapies dramatically improve survival outcomes for metastatic breast cancer (MBC), but they are associated with significant symptom burden that can impact patients’ health‐related quality of life (HRQOL) and treatment outcomes. This study is the first to describe CDK4/6 inhibitor symptoms from the lived perspectives of MBC patients taking CDK4/6 inhibitors and healthcare providers involved in MBC care. This study also explored patients’ symptom management and HRQOL concerns, and gathered feedback about developing supportive interventions for MBC. Methods MBC patients taking CDK4/6 inhibitors (N = 20) and MBC healthcare providers (N = 12) participated in semi‐structured interviews that were analyzed for qualitative themes. MBC patients completed surveys about HRQOL, symptoms, and unmet needs. Results Patient and provider perceptions of CDK4/6 inhibitor symptoms did not align with patients perceiving symptoms as more burdensome. Patients reported that supportive resources (e.g., support groups, blogs) that are not specific to MBC do not adequately meet their needs. Patients and providers were enthusiastic about developing supportive interventions specifically for MBC and offered considerations for designing such interventions. Conclusions Findings highlight differences in perceptions of CDK4/6 inhibitor symptom burden between MBC patients and providers. Results will inform the development of supportive interventions to assist MBC patients in managing CDK4/6 inhibitor symptom burden and maintaining HRQOL. Such interventions could also improve treatment outcomes., Metastatic breast cancer (MBC) patient and provider perceptions of symptoms associated with CDK4/6 inhibitor did not align, with patients perceiving symptoms as more burdensome. Patients reported that supportive resources (e.g., support groups, blogs) that are not specific to MBC do not adequately meet their needs, however patients and providers were enthusiastic about developing supportive interventions specifically for MBC and offered considerations for designing such interventions. Results will inform the development of supportive interventions to assist MBC patients in managing CDK4/6 inhibitor symptom burden and maintaining health‐related quality of life.

Background The COVID-19 pandemic results in disproportional consequences for psychiatric patients. Due to restraints in physical contacts, providers switched from face-to-face contacts to teletherapy, but prior experiences were mostly limited. The study aimed at assessing symptom dynamics, potentially increased adversities and factors influencing a successful transition into teletherapy in adolescent psychiatric outpatients during the COVID-19 pandemic. Method Thirty adolescent psychiatric outpatients participated in an interview-based study. The differential impact of the COVID-19 pandemic was measured by integrating patients' and psychiatrists' judgements. Results Patients who reported deteriorated symptoms and patients who showed (partial) improvement of symptomatology could be separated by feelings of isolation (specific to deterioration) and perceived reduction in school-associated stress (unique to improvement). Patients with worsening symptomatology showed a significantly higher degree of psychosocial disability before lockdown and at the first interview. Patients who deteriorated in their level of psychosocial functioning also reported negatively on teletherapy. These patients were verbally less differentiated concerning emotions and affect, reported introspection and rumination, and stated distinctly lower levels of perceived social support. Concerning adversities, no clear trend could be identified, but some patients reported increased domestic violence and neglect. Conclusions Patients with a higher degree of psychosocial disability suffer disproportionally from the crisis, so that an assessment of functioning should serve as a triage tool. Also, a screening of the perceived level of social support should be established before offering teletherapy. Additionally, the provision of strategies to enhance verbalisation and differentiation of emotions and affect might be beneficial.

Energy, nutrients and organisms move over landscapes, connecting ecosystems across space and time. Meta-ecosystem theory investigates the emerging properties of local ecosystems coupled spatially by these movements of organisms and matter, by explicitly tracking exchanges of multiple substances across ecosystem borders. To date, meta-ecosystem research has focused mostly on abiotic flows-neglecting biotic nutrient flows. However, recent work has indicated animals act as spatial nutrient vectors when they transport nutrients across landscapes in the form of excreta, egesta and their own bodies. Partly due to its high level of abstraction, there are few empirical tests of meta-ecosystem theory. Furthermore, while animals may be viewed as important mediators of ecosystem functions, better integration of tools is needed to develop predictive insights of their relative roles and impacts on diverse ecosystems. We present a methodological roadmap that explains how to do such integration by discussing how to combine insights from movement, foraging and ecosystem ecology to develop a coherent understanding of animal-vectored nutrient transport on meta-ecosystems processes. We discuss how the slate of newly developed technologies and methods-tracking devices, mechanistic movement models, diet reconstruction techniques and remote sensing-that when integrated have the potential to advance the quantification of animal-vectored nutrient flows and increase the predictive power of meta-ecosystem theory. We demonstrate that by integrating novel and established tools of animal ecology, ecosystem ecology and remote sensing, we can begin to identify and quantify animal-mediated nutrient translocation by large animals. We also provide conceptual examples that show how our proposed integration of methodologies can help investigate ecosystem impacts of large animal movement. We conclude by describing practical advancements to understanding cross-ecosystem contributions of animals on the move. Understanding the mechanisms by which animals shape ecosystem dynamics is important for ongoing conservation, rewilding and restoration initiatives around the world, and for developing more accurate models of ecosystem nutrient budgets. Our roadmap will enable ecologists to better qualify and quantify animal-mediated nutrient translocation for animals on the move.

Higher education institutions around the globe are focussedon creating inclusive environments for all students. Initiatives are being crafted to assist marginalised students to obtain better outcomes in key metrics such as enrolment rates, retention rates, graduation rates, and resultant employability statistics. This article presents findings from a quantitative study conducted at a large research university in the United Kingdom that examined factors that impacted the persistence and engagement levels ofBlack and Minority Ethnic students. The study examined such factors as resilience, challenges, persistence, decision-making, student support, communications and feelings of belonging.Significant differences were found among Black, Asian, White and Other minority groups on multiple factors contributing to persistence and engagement. Recommendations for practice change in university operations, specifically Student Affairs and Academic Affairs, are offered.

Trade facilitation is any process involved in the reduction in trading costs associated with enforcement, regulation, and administration of trade policies. This process intended to lower the related transaction costs for firms in global commerce thereby enabling continued growth in cross border trade in goods and service. Trade facilitation is a diverse and challenging subject with potential benefits for both private business people and governments at national, regional and international levels. Governments initiated a trade facilitation reform programme following complaints about widespread corruption and poor administrative practices. The reform programme included the implementation of single-point clearance and mechanism, the introduction of risk assessment procedures and the publication of customs nights and responsibilities in export clearance. The empirical literature indicates that, none of the study has been conducted in Rwanda to assess how the EAC custom union procedures improved the trade facilitation in Rwanda. To conduct this kind of study is very important because it helped to describe the extent at which cargo clearance procedures, tariff charges and other institution factors influence the trade facilitation in Rwanda. Rwanda is a land-locked country, facing tremendous difficulties in accessing major markets in the regional as well as in the rest of the world. These difficulties emanated from high transport costs owing to the fact that she has no direct access to the sea. Rwanda has been continually showing deficit in export and imports compared to other neighbouring partner states in EAC. Since there is no data about the procedures and systems applied by the individual partner around the boarders/Customs in Rwanda, the study therefore intended to analyze the influence of customs union on trade facilitation for Rwanda resulted from regional integration signed by the East Africa community. The results from the survey show that 0.83% strongly disagreed, 2.51% disagreed, 0.83% was not sure, and 42.3% agreed that they appreciate the cargo clearance procedures at the customs and 53.53% strongly agreed. The results from the survey revealed that majority of the respondents appreciate the cargo clearance procedures. The results further revealed that, the few cases where there is delay in the clearance originates mainly on the description on the rules of the origin. This is because to some products it becomes hard to determine the proportion of imported material in the mixture of the manufactured products. The results from the survey revealed that before EAC, each country used different clearance documents with different way of clearing the goods and description of the goods, but ever since the establishment of the EAC, all countries use the documents and same description of the goods. This helps in simplifying the clearance procedures of the goods since every trader knows what is required. The Partner States agree to simplify their trade documentation and procedures in order to facilitate trade in goods within the Community. The results from the survey revealed that the level of bureaucracy in the clearance of goods is low as evidenced by the majority of the respondents. This helps in reducing the time traders spends at customs during clearing and hence enhancing trade within the member state.

The medicolegal landscape of cannabis continues to change, and with ever increasing access there has been a concurrent proliferation of research seeking to understand the utility of cannabinoids in treating innumerable conditions with pain at the forefront. This article seeks to summarize clinically relevant findings in cannabinoid research to better prepare clinicians in the utility of cannabis in the treatment of pain.

Introduction: We undertook this study to know the sensitivity, specificity and post-test probabilities of hip aspiration when diagnosing periprosthetic hip infections. We also examined “dry tap” (injection with saline and aspiration) results and aspiration volumes. Methods: This is a retrospective cohort study of patients aspirated for suspected periprosthetic joint infection between July 2012 and October 2016. All aspirations were carried out by one trained surgical care practitioner (SCP). All aspirations followed an aseptic technique and fluoroscopic guidance. Aspiration was compared to tissue biopsy taken at revision. Aspiration volumes were analysed for comparison. Results: Between January 2012 and September 2016, 461 hip aspirations were performed by our SCP. Of these 125 progressed to revision. We calculated sensitivity 59 % (confidence interval (CI) 35 %–82 %) and specificity 94 % (CI 89 %–98 %). Pre-test probability for our cohort was 0.14. Positive post-test probability was 0.59 and negative post-test probability 0.06. Aspiration volume for infected (n=17) and non-infected (n=108) joints was compared and showed no significant difference. Dry taps were experienced five times; in each instance the dry tap agreed with the biopsy result. Conclusions: Our data show that hip aspiration culture is a highly specific investigation for diagnosing infection but that it is not sensitive. Aspiration volume showed no significant difference between infected and non-infected groups. Each time a joint was infiltrated with saline to achieve a result, the result matched tissue sampling.

Background Alcohol consumption is one of the modifiable risk factors for intracerebral hemorrhage, which accounts for approximately 10–20% of all strokes worldwide. We evaluated the association of stroke with genetic polymorphisms in the alcohol metabolizing genes, alcohol dehydrogenase 1B (ADH1B, rs1229984) and aldehyde dehydrogenase 2 (ALDH2, rs671) genes based on alcohol consumption. Methods Data were available for 19,500 Taiwan Biobank (TWB) participants. We used logistic regression models to test for associations between genetic variants and stroke. Overall, there were 890 individuals with ischemic stroke, 70 with hemorrhagic stroke, and 16,837 control individuals. Participants with ischemic but not hemorrhagic stroke were older than their control individuals (mean ± SE, 58.47 ± 8.17 vs. 48.33 ± 10.90 years, p Conclusions Our study suggests that the ADH1B rs1229984 TC + CC genotype and alcohol exposure of at least 150 ml/week may increase the risk of developing hemorrhagic stroke among Taiwanese adults.

BackgroundGiven the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical.MethodsWe conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12–19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7.ResultsOverall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = −0.44; 95% CI −0.81 to −0.07) and suicidal ideation (g = −0.31, 95% CI −0.52 to −0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = −0.98, 95% CI −1.15 to −0.81; suicidal ideation: g = −1.16, 95% CI −1.51 to −0.80; BPD symptoms: g = −0.97, 95% CI −1.31 to −0.63).ConclusionsDBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

Penelitian ini bertujuan untuk mengetahui pengaruh e-service quality dan perceived value terhadap customer satisfaction. Penelitian ini merupakan penelitian dengan pendekatan kuantitatif dengan jumlah sampel sebanyak 100 responden yang merupakan pengguna Bukalapak yang sudah pernah melakukan pembelian melalui aplikasi mobile Bukalapak minimal sebanyak 2 kali, sampel ditentukan menggunakan teknik nonprobability purposive sampling. Pengukuran yang digunakan adalah kuesioner yang disebarkan melalui Google Form kepada responden. Data dianalisis dengan SPSS 25. Hasil penelitian ini menunjukkan bahwa e-service quality berpengaruh signifikan terhadap customer satisfaction dengan nilai t hitung 6,112 > t tabel 1,98, perceived value berpengaruh signifikan terhadap customer satisfaction dengan nilai t hitung 5,310 > t tabel 1,98, e-service quality dan perceived value berpengaruh signifikan terhadap customer satisfaction secara simultan dengan nilai f hitung 86,815 > f tabel 3,09.

The authors are extremely grateful to the Office of Naval Research (ONR) for their support of Sound as Indicators of Health and Welfare of the Navy’s Dolphin; ONR Grant# N00014-18-1-2643. Animal sounds are commonly used by humans to infer information about their motivations and their health, yet, acoustic data is an underutilized welfare biomarker especially for aquatic animals. Here, we describe an acoustic monitoring system that is being implemented at the U.S. Navy Marine Mammal Program where dolphins live in groups in ocean enclosures in San Diego Bay. A four-element bottom mounted hydrophone array is used to continuously record, detect and localize acoustic detections from this focal group. Software provides users an automated comparison of the current acoustic behavior to group historical data which can be used to identify periods of normal, healthy thriving dolphins, and allows rare instances of deviations from typical behavior to stand out. Variations in a group or individual’s call rates can be correlated with independent veterinary examinations and behavioral observations in order to better assess dolphin health and welfare. Additionally, the monitoring system identifies time periods in which a sound source from San Diego Bay is of high-enough amplitude that the received level at our array is considered a potential concern for the focal animals. These time stamps can be used to identify and potentially mitigate exposures to acoustic sources that may otherwise not be obvious to human listeners. We hope this application inspires zoos and aquaria to innovate and create ways to incorporate acoustic information into their own animal welfare management programs. Publisher PDF

More than 3400 residential apartment buildings around Australia have flammable cladding. The costs to rectify this defect fall onto homeowners. However, there is limited information about what the ...

Background: Palbociclib, with endocrine therapy, has demonstrated clinical benefit in patients with ER+ve HER2-ve metastatic breast cancer in randomised controlled clinical trials. Further observational data is beneficial to illustrate how these results translate into benefit in routine practice. Furthermore, detecting predictors of response aids clinical decision-making. Our primary aim was to report the survival data and adverse event (AE) rates in a real-life population treated with palbociclib. Secondarily, we aimed to identify predictors of response. Method: We retrospectively analysed 150 patients with metastatic breast cancer treated with palbociclib and endocrine therapy in routine clinical practice, over 3 years in three sites across South East Scotland. Baseline demographics (including disease site, prior treatment, bloods), progression data, AE rates, delays/dose reduction (DR) were recorded. For statistical analysis, we calculated actuarial rates of progression and breast cancer specific survival (BCSS) for the whole cohort. Survival analysis was performed using Kaplan-Meier and cox regression statistics. Statistical associations between variables were analysed by generalised linear models with chi-square statistics. Results: The average patient age was 61.4 years and most were post-menopausal (86.7%). Around two thirds (63.3%) were previously treated adjuvantly and most were performance status 0 (51.3%) or 1 (44.0%). Commonest disease sites were bone (76.0%), liver (46.0%), lung (42.7%) or nodes (36.7%). Patients were prescribed palbociclib with either; aromatase inhibitor (AI) (74.0%) as 1st line or fulvestrant (26.0%) as 2nd line. Standard starting dose was 125mg (87.3%). Rationale for a lower starting dose was mainly due to patient age (78.9%), by physician’s choice.For the whole cohort, the actuarial progression rate at 24 months was 0.45 (95%CI±0.12) and BCSS rate was 0.69 at 24 months (95%CI±0.16). In the AI sub-group (n=111), at 12 months, the actuarial progression rate was 0.26 (95%CI±0.10) and BCSS rate was 0.86 at 12 months (95%CI±0.08). In the fulvestrant sub-group (n=39), the actuarial progression rate was 0.56 (95%CI±0.25) and BCSS was 0.82 (95%CI±0.14) at 12 months. Most common sites of progression were; visceral (84.1%), bone (40.1%), nodal (18.2%) or chest wall (6.8%). less had progressive disease (11.7% vs. 42.8%), compared to the fulvestrant group (n=28). The commonest AE was fatigue. During treatment, 67.1% had grade 3/4 neutropenia. Neutropenic sepsis rates were low (1.3%). Around half (47.9%) required DR, mainly for neutropenia (81.4%). A lower baseline ANC was associated with a lower ANC during cycle 1 (p Citation Format: Ailsa J Oswald, Peter Hall, Arran Turnbull, Olga Oikonomidou. Palbociclib real-world data in metastatic breast cancer: A multi-site report of survival and adverse events in routine clinical practice in Scotland [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS10-55.

To develop an automated segmentation approach for cochlear microstructures [scala tympani (ST), scala vestibuli (SV), modiolus (Mod), mid-modiolus (Mid-Mod), and round window membrane (RW)] in clinical cone beam computed tomography (CBCT) images of the temporal bone for use in surgical simulation software and for preoperative surgical evaluation. This approach was developed using the publicly available OpenEar (OE) Library that includes temporal bone specimens with spatially registered CBCT and 3D micro-slicing images. Five of these datasets were spatially aligned to our internal OSU atlas. An atlas of cochlear microstructures was created from one of the OE datasets. An affine registration of this atlas to the remaining OE CBCT images was used for automatically segmenting the cochlear microstructures. Quantitative metrics and visual review were used for validating the automatic segmentations. The average DICE metrics were 0.77 and 0.74 for the ST and SV, respectively. The average Hausdorff distance (AVG HD) was 0.11 mm and 0.12 mm for both scalae. The mean distance between the centroids for the round window was 0.32 mm, and the mean AVG HD was 0.09 mm. The mean distance and angular rotation between the mid-modiolar axes were 0.11 mm and 9.8 degrees, respectively. Visually, the segmented structures were accurate and similar to that manually traced by an expert observer. An atlas-based approach using 3D micro-slicing data and affine spatial registration in the cochlear region was successful in segmenting cochlear microstructures of temporal bone anatomy for use in simulation software and potentially for pre-surgical planning and rehearsal.

We report on a patient with refractory Myasthenia gravis with acetylcholine receptor antibodies with two prior myasthenic crises suffering from COVID-19 with rapid evolving weakness and respiratory failure. Respiratory failure developed and prolonged mechanical ventilation was necessary. After plasmapheresis, residual, severe generalized and bulbar weakness persisted. Complement inhibition with eculizumab was, therefore, introduced and lead to rapid recovery. In refractory myasthenic crisis individualised therapies could be successful.

Purpose: The aims of this study were to investigate the clinical feasibility and to report our preliminary treatment outcomes of combined intracavitary/interstitial brachytherapy (IC/IS BT), using a hybrid applicator and magnetic resonance imaging (MRI)based treatment planning in patients with locally advanced cervical cancer. Materials and Methods: Between January 2017 and December 2018, eight patients with locally advanced uterine cervical cancer were treated with primary radiation therapy including hybrid BT. Patients with distant metastasis other than para-aortic lymph node spread were excluded from this study. A hybrid applicator for guidance of parametrial needles was used to perform highdoseratebrachytherapy (HDR BT) with MRIbased treatment pre-planning. Parametrial extent of the disease or large residual disease in these patients was judged to exceed the coverage limit of intracavitary brachytherapy alone. The number of needles, chosen guiding holes through the ovoids, and insertion depths were based on the extent of residual disease. We investigated the dosimetric gain by comparing the clinical IC/IS optimized plan (IC/IS clinical) with an additionally generated optimized plan without needle use (ICstudy). Results: The clinical use of the hybrid applicator system proved to be feasible in all 32 treatment fractions. The applicator Fletcher interstitial 6mm or Utrecht interstitial consists of the IC tandem and two ovoids thatserves as a template for needle insertion. MRI preplanning was performed the week before the implant in 5 cases and the day ofapplication with applicator in place in 3 cases. Four to eight needles were placed per fraction, and overall a total of 152 needles were used. Significant differences in (IC/IS) plan and (IC study) plan were derived for dose application to the target volume D90 high-riskclinical target volume (D90 CTV HR) was 90.1Gy in (IC/ISclinical) plan vs 85.36 Gy in (IC study) plan with an average gain of 4.74 Gy. Likewise, sparing of organs at risk (OAR) differed significantly for bladder D2cc:82,5 Gy(IC/ISclinical) vs95.7 Gy (IC study) and rectum D2cc: 65,5 Gy (IC/ISclinical) vs 67.8 Gy (IC study).With an average follow-up of 27,25 months (range 18–34 months): no patient experienced local relapse, three patients experienced distantmetastasis two of them died, no acute complications such as bleeding or organ penetration occurred due to needle placement, one patient developed recto-vaginal fistula. Conclusions: Our preliminary clinical experience indicates that combined intracavitary and interstitial MRI based brachytherapy in patients with significant residual disease extending up to the distal third of parametriaafter externalbeam therapy is feasible and allows excellent local control and a low rate of morbidity.

Background The partograph is a graphic record of labour progress, and maternal and fetal condition, which was introduced to detect preventable maternal complications during parturition. It is plotted against time for intrapartum monitoring. There is a difference in how widely the modified partograph is used to monitor labour among health workers in primary healthcare across different countries, according to the World Health Organization. This study assessed primary healthcare workers' knowledge of how to use the partograph for labour monitoring in Ibadan, Nigeria. Methods The study used a cross-sectional descriptive survey to recruit 136 purposively selected respondents. A semi-structured questionnaire was administered for data collection. Data were analysed using the Statistical Package for Social Sciences version 23. Hypotheses were tested using the Chi-square test and logistic regression at PResults The majority of respondents reportedly had good knowledge of how to use the partograph (72%) but did not use it when monitoring labour (82.4%). The odds of using a partograph was four times more likely in participants with good knowledge (odds ratio=3.61, PConclusions There is a need for collaboration across all tiers of government with the National Primary Health Development Agency to develop and implement health policies that will encourage the utilisation of a partograph for monitoring labour.

Background and Purpose: Paragangliomas are rare tumors of the head and neck. Their management remains problematic and varies considerably depending on the center. This study reported 14 years of experience in the management of head and neck paraganglioma (HNPGls). We aimed to assess the therapeutic results of these tumors in terms of local control and overall survival. Materials and Methods: We included 16 patients followed for HNPGls and treated by radiotherapy from January 2006 to June 2018 in the National Institute of Oncology in Rabat. Results: The median age was 44.5 years (15 - 67). 13 patients were female and three male with a sex ratio of 4.3. Cervical mass was the common sign (56.3%). All patients received radiation therapy. This radiation was exclusive in 43.7% of cases or adjuvant to partial surgical resection in 56.3%. The median dose of radiotherapy was 54 Gy (46 - 60) and it was delivered by a three-dimensional conformal radiotherapy technique in 15 patients and volumetric modulated arc therapy in one. There were few acute complications such as grade I and II mucositis and dermatitis. After a median follow-up of 5.6 years (2 - 13.4), local control, defined by radiological stability or regression, was obtained in 14 patients, two patients progressed and one died. Progression-free survival rates at 5 and 7 years were 93.8% and 78.1% respectively, and overall survival at 5 and 7 years was 92.3%. Conclusions: Surgery is the first-line treatment for HNPGls. When surgery is not possible or incomplete, radiotherapy has its place in the therapeutic strategy of this rare disease for long-term local control.

The layered silicates Egyptian Blue (CaCuSi4O10, EB), Han Blue (BaCuSi4O10, HB) and Han Purple (BaCuSi2O6, HP) emit as bulk materials bright and stable fluorescence in the near-infrared (NIR), which is of high interest for (bio)photonics due to minimal scattering, absorption and phototoxicity in this spectral range. So far the optical properties of nanosheets (NS) of these silicates are poorly understood. Here, we exfoliate them into monodisperse nanosheets, report their physicochemical properties and use them for (bio)photonics. The approach uses ball milling followed by tip sonication and centrifugation steps to exfoliate the silicates into NS with lateral size and thickness down to ≈ 16–27 nm and 1–4 nm, respectively. They emit at ≈ 927 nm (EB-NS), 953 nm (HB-NS) and 924 nm (HP-NS), and single NS can be imaged in the NIR. The fluorescence lifetimes decrease from ≈ 30–100 μs (bulk) to 17 μs (EB-NS), 8 μs (HB-NS) and 7 μs (HP-NS), thus enabling lifetime-encoded multicolor imaging both on the microscopic and the macroscopic scale. Finally, remote imaging through tissue phantoms reveals the potential for bioimaging. In summary, we report a procedure to gain monodisperse NIR fluorescent silicate nanosheets, determine their size-dependent photophysical properties and showcase the potential for NIR photonics.