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Summary Background & aims Donor human milk (DHM) is recommended as the first alternative for preterm infants if their mother's own milk is not available or if the quantity is not sufficient. The most commonly used technique to eliminate microbial contaminants in DHM is holder pasteurization (HoP). However, the heating process during HoP partially destroys milk bioactive factors such as insulin. Therefore, innovative techniques have been developed as alternatives to HoP. The objective of this study was to determine the effect of HoP, high-temperature–short-time (HTST), thermoultrasonication (TUS), ultraviolet-C irradiation (UV-C), and high-pressure processing (HPP) on the insulin concentration in DHM. Methods Milk samples from 28 non-diabetic mothers were collected. The milk samples were aliquoted and either left untreated or treated with HoP (62.5 °C; 30 min), HTST (72 °C; 15 s), TUS (60 W; 6 min), UV-C (4863 J/L), or HPP (500 MPa; 5 min). Results The mean insulin concentration in untreated milk was 79 ± 41 pmol/L. The mean insulin retention rate was 67% for HoP, 78% for HTST, 97% for TUS, 94% for UV-C, and 106% for HPP. The mean insulin concentration in milk treated with HoP was significantly lower compared to untreated milk (p = 0.01). Conclusion TUS, UV-C, and HPP preserve insulin in DHM. The insulin concentration in DHM is affected to a larger extent by HoP than by HTST. These results indicate that TUS, UV-C, and HPP may serve as alternatives to HoP.

BACKGROUND OBJECTIVES: Human milk (HM) is better tolerated than formula in preterm infants. Insulin, which is naturally present in HM but not in formula, has been suggested as a key factor for feeding tolerance, as it appears to stimulate intestinal maturation. Its precise concentrations during the early postnatal period, however, remains unknown. The objective of this study was to assess the natural timecourse of the HM insulin concentration during the first ten days postpartum. The effect of preterm delivery, maternal obesity, and diurnal rhythm were also assessed. METHOD: HM was collected from 31 non-diabetic mothers (21 preterm [gestational age (GA)

BACKGROUND Rheumatology is considered a low-risk specialty, but studies have shown a prevalence of burnout between 42% and 51%. OBJECTIVES The aim was to determine the prevalence of burnout in rheumatologists in Latin America and the factors associated with it. METHODS Cross-sectional study based on a survey completed through Google Forms platform that was sent by the national rheumatology associations of Latin America. Burnout was assessed with the Maslach Burnout Inventory. Data were analyzed using the statistical program SPSS v.22. RESULTS Two hundred ninety-seven rheumatologists from 15 countries were included, mainly Argentina (28.3%), Brazil (26.3%), and Mexico (12.8%). The majority were women 62%, 42.4% worked in public hospitals with an average of 40.1 ± 14.2 hours per week; 31.3% did research, 13.1% clinical trials, 56.6% teaching, and 42.8% administrative work; 36% received an annual income less than $25,000; 56.6% had burnout in at least 1 dimension. Only 20.2% thought they had burnout, 9.1% were currently receiving professional help, and 15.8% had sought help in the past; 72.1% said they were willing to participate in a program to reduce burnout. The rheumatologists with burnout were younger than those without burnout (46.5 vs 49.9 years, p = 0.015). CONCLUSIONS Burnout affects near half of rheumatologists in Latin America and was associated with younger age, long working hours, low satisfaction, less happiness, higher Patient Health Questionnaire-9, suicidal thoughts, anxiety, income, presence of comorbidities, and low self-esteem.

Livestock production by smallholder farmers in southern Africa is often constrained by insufficient fodder during the dry season. The aim of this study was to determine if inclusion of pigeon pea (Cajanus cajan (L.) Millsp.) hedgerows in Megathyrsus maximus ‘Gatton’ pastures could improve fodder production and nutritional yields, and to investigate effects of hedgerow cutting height on fodder production (including both browse and herbage). Treatments included three simulated silvopastoral systems with M. maximus planted between hedgerows, and one treatment that was M. maximus pasture alone. Hedgerows were cut at 60 or 90 cm above ground, or were uncut. Over the first two growing seasons, browse and grass fodder was harvested, dried and weighed four times. A portion of the fodder (comprising browse and herbage) was conserved in the second year and samples analysed for crude protein (CP), neutral detergent fibre (NDF) and acid detergent fibre (ADF) contents (%) and CP, phosphorus (P) and zinc (Zn) yields (kg ha−1). Hedgerows decreased cumulative grass biomass by 18.5%, but increased 1.22-fold the cumulative total fodder biomass when hedgerows were cut to 90 cm, compared to no hedgerows. Hedgerows had no effect on conserved grass herbage biomass (2.7 Mg ha−1 on average), but doubled biomass of conserved total fodder (5.0 Mg ha−1 on average) if hedgerows were cut. Cutting hedgerows increased CP, P and Zn yields, and increased CP and ADF contents, compared to not cutting them or not including them, while NDF was unaffected. Cutting hedgerows to 90 cm increased total browse production, compared to cutting to 60 cm. Pigeon pea seed biomass was unaffected by hedgerow cutting height (870 kg ha−1 on average). In conclusion, pigeon pea hedgerows included into grass pastures increase the quantity and quality of total fodder for livestock feed supplementation during the dry season.

La detección y atención de factores psicosociales que afectan al sector laboral docente, resulta prioritario ya que no es un aspecto que preocupe al nivel directivo de las instituciones de educación superior y aunque las exigencias en seguridad y salud ocupacional obliga a la detección, identificación, prevención y adopción de medidas para garantizar la salud y neutralizar los riesgos ocupacionales, en la práctica no surgen acciones concretas para abordar y tratar los factores de riesgo psicosocial que afectan a los docentes del sistema de educación superior. El objetivo de esta investigacion es identificar los riesgos de la salud ocupacional en el teletrabajo docente, métodos se realizó un estudio de tipo descriptivo de cohorte transversal, el universo se constituyó por docentes de la Facultad de Ciencias de la Salud de la Universidad Técnica de Manabí en un total de 65 docentes. La muestra se conformó por 54 docentes, 33 de la carrera de Psicología y 21 de la carrera de Nutrición. Los resultados de la investigación se obtuvieron mediante la aplicación de encuestas online, mismos que se tabularon en Excel y se presentaron tablas estadísticas con su respectivo análisis, se concluye que se hay factores como carga y fatiga mental en docentes que superan los 39 años de edad por actividades de teletrabajo.

Despite data supporting the rapid adoption of telehealth in the delivery of clinical care in North America, the implementation of telehealth visits in clinical research studies has faced critical barriers. These challenges include: (1) variations in state licensure requirements for telehealth; (2) disparities in access to telehealth among disadvantaged populations; (3) lack of consistency among individual Investigational Review Boards (IRBs). Each barrier prevents the systematic conversion of research protocols to include telehealth visits. The Parkinson’s Foundation and members of the Parkinson Study Group submit this Comment to highlight current challenges to implementing telehealth visits for clinical research studies. Our objective is to provide a consensus statement emphasizing the urgent need for regulators to standardize adoption of telehealth practices and to propose recommendations to reduce the burden for implementation in existing research study protocols.

Feeding preterm infants with mother’s own milk is associated with a reduction in postnatal complications and an improved neurocognitive outcome. Therefore, the bioactive factor composition of human milk has been used as a tool for the development of nutritional supplements with a potential prophylactic or therapeutic effect. The aim of this systematic review was to provide an overview on bioactive factors which have been studied as supplement to enteral nutrition in randomized controlled trials, and to provide an overview of ongoing trials. MEDLINE, EMBASE, CENTRAL, and clinical trial registers were searched. Studies on the antimicrobial protein lactoferrin were excluded as these were summarized very recently in three separate systematic reviews. Studies on vitamins D, K and iron were also excluded as they are already incorporated in most international guidelines. We identified 17 different bioactive factors, which were investigated in 26 studies. Despite the encouraging potential effects of several bioactive factors, more high-quality studies with a sufficient number of preterm infants are required before a certain factor may be implemented into clinical practice. Three large trials (n > 500) that investigate the effects of either enteral insulin or vitamin A are currently ongoing and could provide more definite answers on these specific supplements.

Introduction Disability in RA is associated with loss of workdays, greater use of health resources and a higher prevalence of depression. The purpose of this study was to determine the prevalence of functional disability and the factors associated with it. Methods A cross-sectional study was carried out during January-June 2019 at a rheumatology clinic in the city of Guayaquil. Patients with pre-established RA were included. Functional disability was measured using the HAQ-DI. Data were analyzed using the statistical program SPSS v22. We compared characteristics between patients with and without disability using Student's t-test and chi-square. A multiple logistic regression model for functional disability was made. Results We included 395 patients, 87.8% female and 12.2% male with a mean age of 51.4±12 years and mean duration of disease 13.8±7 years. Most patients had extra-articular manifestations (80.8%) and comorbidities (81.3%). The mean HAQ-DI was 0.8±0.9, with a prevalence of disability of 26.6%. We found a statistically significant relationship between disability and female sex (p=0.018), age (p=0.020), presence of extra-articular manifestations (p=0.008), myalgia (p

International audience; Pandemics are difficult times for the mental health of healthcare professionals, who are more likely to present with PTSD-like symptoms. In the context of a highly contagious communicable disease, telemedicine is a useful alternative to usual care, and should be considered as a means to support healthcare professionals’ mental health. This is a multicenter (n = 19), cross-sectional study, based on a 27-item questionnaire, aiming to investigate the acceptability to healthcare workers of a telepsychiatry service as a means of providing mental health support during the COVID-19 pandemic. Between October and December 2020, 321 responses were received, showing that women, caregiving staff, and those directly involved in the care of COVID-19 patients are less favorable to the idea of receiving remote support. In our population, barriers were related to the clinical setting or ethics, and most of the respondents would not accept a drug prescription by telepsychiatry. Although telepsychiatry should be a part of the armamentarium of mental health management, it is not suitable as a stand-alone approach, and should be combined with conventional face-to-face consultations.

El artículo tiene como objetivo analizar la visión prospectiva como plataforma de posicionamiento en la educación superior de las ciencias contables y financieras. Con este propósito la investigación estuvo direccionada por un enfoque postpositivista, cualitativo, de tipo documental y diseño bibliográfico, comprendiendo la revisión literaria, el levantamiento de la información, así como la identificación y categorización de objetivos. Los resultados arrojados evidencian que tanto las ciencias contables como las financieras vienen siendo impartidas bajo premisas tradicionales, innovando muy poco en procesos, procedimientos y metodología. Por lo tanto, se requiere implementar una visión prospectiva en su conceptualización al momento de elaborar el diseño curricular en las respectivas mallas, con el fin de posicionar en el sistema de educación superior. En este sentido, es necesario desarrollar un pensamiento crítico fundamentado en la ética, vislumbrando las implicaciones de la formación del profesional que se aspira egrese de las instituciones universitarias, afianzando valores de responsabilidad, transparencia y honestidad. Concluyendo, que la prospectiva es una herramienta que a través del establecimiento de escenarios, contribuye a la configuración de un posicionamiento efectivo de las ciencias contables y financieras, siendo importante su incorporación en la elaboración de planes y programas educativos.

In the development of cancer therapeutics, no suitable replacements for the use of animals that are capable of modeling such complex disease processes are currently available. In orthotopic models, surgery is often required to access the target organ for tumor cell inoculation. Historically analgesics have been withheld in such models in light of potential effects on tumor development. The current study evaluated the effect of the opioid buprenorphine on tumor growth of a human ovarian cancer cell line (OVCAR5 OT luc2 mCherry). Female CB17 SCID mice (n = 150) underwent surgery for orthotopic inoculation and were assigned to 1 of 3 treatment groups: vehicle control, 1 dose of buprenorphine, or 2 doses of buprenorphine administered perioperatively. Bioluminescence imaging revealed no significant difference on tumor engraftment rate or growth between control and analgesia-treated groups. These data demonstrate that acute, perioperative analgesia with buprenorphine did not alter tumor growth. Although further research is needed to evaluate potential effects of buprenorphine in other cell lines and mouse strains, the justification for withholding analgesia and the potential influence of pain and stress due to insufficient analgesia in these models should be considered thoroughly.

Summary Background Few large projects have evaluated the factors that influence the HIV RNA concentrations (viral load) in cerebrospinal fluid (CSF) during antiretroviral therapy (ART) over time. We aimed to determine the correlates of HIV RNA in CSF in a large cohort. Methods We analysed longitudinal data from adults living with HIV in the US CHARTER cohort. Participants in the CHARTER study were recruited from six US academic medical centres—in Baltimore (MD), Galveston (TX), New York (NY), St Louis (MO), San Diego (C92A), and Seattle (WA). Participants in this study had been assessed at least three times between Sept 4, 2003, and Sept 14, 2010, and were taking ART and underwent venous and lumbar puncture with measurement of HIV RNA concentration at all assessments. The lower limit of quantification of the HIV RNA assays was 50 copies per mL. Data were analysed with longitudinal mixed effects logistic regression to identify correlates of HIV RNA concentration (as a binary [detectable or not] and as a continuous variable) in CSF over time. We tested demographic characteristics, plasma HIV RNA, nadir and current CD4 cell count in blood, current CD8 cell count in blood, estimated duration of HIV infection, AIDS diagnosis, duration of ART, adherence to ART, ART characteristics, and CSF characteristics as potential correlates. Findings At the time of analysis, 2207 assessments from 401 participants met the criteria for inclusion in this study. Mean duration of observation was 33·7 months (range 12–84). HIV RNA concentrations in 710 (32·2%) plasma specimens and in 255 (11·6%) CSF specimens were greater than the lower limit of quantification. The best multivariate model of HIV RNA concentration in CSF greater than the lower limit of quantification over time included increased plasma HIV RNA concentration (odds ratio 18·0 per 1 log10 copy per mL, 95% CI 11·3 to 28·8; p Interpretation The identified correlates of HIV RNA concentration in CSF during ART could strengthen clinical prediction of risk for failure to achieve or maintain HIV RNA suppression in CSF. Because most participants in this analysis were ART-experienced and were taking a three-drug regimen that did not include an integrase inhibitor, future research should focus on participants who are taking their first ART regimens or regimens that include integrase inhibitors or two drugs. Funding The work was supported by the National Institute of Mental Health and the National Institute of Neurological Disorders and Stroke.

Background: Pollen is a major trigger for allergic symptoms in sensitized individuals. Airborne pollen is usually monitored by Hirst type pollen samplers located at rooftop level, providing a general overview of the pollen distribution in the larger surroundings. In this feasibility study, grass pollen-sensitized subjects monitored the pollen in their direct environment using a portable pollen sampler (Pollensniffer) and scored their symptoms, to study the relation between symptom severity and personal grass pollen exposure. For comparison the symptoms were also correlated with pollen collected by the rooftop sampler.Methods: After recruitment 18 participants were screened for grass pollen specific (GP-sIgE) of which 12 were eligible. Nine participants completed the study (May, 2018). They were asked to monitor personal pollen exposure using a Pollensniffer on their way to school, work or other destination, and to score their symptoms via a mobile app on a scale from 0 to 10. Daily pollen concentrations were collected by a Hirst type sampler at rooftop level. Pollen grains were analyzed using a microscope.Results: Three of the four participants with high GP-sIgE (≥9.6 kU/l) reported high symptom scores (>4) and an analysis showed a significant correlation (CC) between eye, nose, and lung symptoms and the grass pollen counts collected by the Pollensniffer, as well as the daily grass pollen concentrations monitored by the rooftop sampler (CC≥0.54). In contrast, the participants with low GP-sIgE levels (Conclusion: The results of this feasibility study suggest that correlations between the severity of clinical symptoms of grass pollen allergic patients, and grass pollen counts as determined by the Pollensniffer or a rooftop sampler, is restricted to patients with high GP-sIgE levels, high symptom scores, and no relevant other sensitizations. Based on the low numbers of subjects with severe symptoms included in this feasibility study, no conclusions can be drawn on the performance of the Pollensniffer in relating symptoms and pollen exposure in comparison with the rooftop sampler.Trial Registration: The study was approved by the Committee Medical Ethics of the LUMC (approval numbers: NL63953.058.17/ P17.304).

Objectives Drugs with anticholinergic properties are associated with an increased prevalence of delirium, especially in older persons. The aim of this study was to evaluate the association between the use of this class of drugs in nursing home (NH) patients and prevalence of delirium, particularly in people with dementia. Design Cross-sectional multicenter study. Setting and participants 3924 nursing home patients of 57 nursing homes in 7 European countries participating in the Services and Health for Elderly in Long TERmcare (SHELTER) project. Methods Descriptive statistics, calculation of percentage, and multivariable logistic analysis were applied to describe the relationship between anticholinergic drug use and prevalence of delirium in NH patients. The Anticholinergic Risk Scale (ARS) and the Anticholinergic Burden Scale (ACB) were used to calculate the anticholinergic load. Results 54% of patients with dementia and 60% without dementia received at least 1 anticholinergic drug according to the ACB. The prevalence of delirium was higher in the dementia group (21%) compared with the nondementia group (11%). Overall, anticholinergic burden according to the ACB and ARS was associated with delirium both in patients with and without dementia, with odds ratios ranging from 1.07 [95% confidence interval (CI) 0.94-1.21] to 1.26 (95% CI 1.11-1.44). These associations reached statistical significance only in the group of patients with dementia. Among patients with dementia, delirium prevalence increased only modestly with increasing anticholinergic burden according to the ACB, from 20% (with none or minimal anticholinergic burden) to 25% (with moderate burden) and 27% delirium (with strong burden scores). Conclusions and Implications The ACB scale is relatively capable to detect anticholinergic side effects, which are positively associated with prevalence of delirium in NH patients. Given the modest nature of this association, strong recommendations are currently not warranted, and more longitudinal studies are needed.

It is my great pleasure to introduce this comic. Our project originated from an honest conversation with my friend and colleague Prof Chris Murray: how to communicate complex issues surrounding the issue of organ donation? Over the last seven years I have had the honour of being an ambassador for the Organ Donation campaign by telling my son, Andrew’s, story. Through my role as an Organ Donation ambassador I meet courageous and selfless people. Some are in desperate need of hope, some are in the position to provide hope, and those who, through their professionalism and dedication, transform lives. Our sincere thanks for the support of the following organisations: University of Dundee; the NHS Blood and Transplant Specialist Nurses in Organ Donation; Dundee Comics Creative Space; Good Life, Good Death, Good Grief, and the Organ Donation Comics team. it is only through their support that this project came to fruition. In the following pages we share heartfelt stories and life experiences related to organ donation. By doing so we hope to bring awareness to a wider audience and prompt honest conversations about organ donation. Finally, I would like thank my sons Andrew and Stuart for warming my heart. Through tears and laughter we present to you… The Gift.452

Delirium is a common serious complication in dementia that is associated with poor prognosis and a high burden on caregivers and healthcare professionals. Appropriate care is therefore important at an early stage for patients with delirium superimposed on dementia To gain insight into the care of six patients with delirium superimposed on dementia, 19 semi-structured interviews were conducted focused on the experiences of caregivers and professionals. The interviews revealed four themes that appeared to play a role: 1. experiences with and views on behavioral problems of these patients, 2. recognition and diagnosis of delirium in dementia, 3. views on good care and 4. organizational aspects. Knowledge gaps about delirium in dementia, as well as ethical considerations, play an important role in organizing timely and adequate care for patients with delirium superimposed on dementia.

Monitoring of airborne pollen concentrations provides an important source of information for the globally increasing number of hay fever patients. Airborne pollen are traditionally counted under the microscope, but with the latest developments in image recognition methods, automating this process has become feasible. A challenge that persists, however, is that many pollen grains cannot be distinguished beyond the genus or family level using a microscope. Here, we assess the use of a Convolutional Neural Network (CNN) to increase taxonomic accuracy for airborne pollen. As a case study we use the nettle family (Urticaceae), which contains two main genera (Urtica and Parietaria) common in European landscapes which pollen cannot be separated by trained specialists. While pollen from Urtica species have very low allergenic relevance, those from several species of Parietaria are severely allergenic. We collect pollen from both fresh as well as from herbarium specimens and use these to train the CNN model VGG16. The model shows that Urticaceae pollen can be distinguished with 98.3% accuracy. We then apply our model on Urticaceae pollen collected from aerobiological samples and show that the genera can be confidently distinguished, despite the more challenging input images that are often overlain by debris. Our method can also be applied to other pollen families in the future and will thus help to make allergenic pollen monitoring more specific.

Summary Background & aims Experimental (nutritional) interventions in preterm infants frequently focus on intestinal maturation, as improving tolerance to enteral nutrition is a major goal. Intestinal permeability and lactase activity serve as markers for intestinal maturation. We aimed to develop a protocol for the simultaneous assessment of both markers in human-milk-fed preterm infants by a sugar absorption test. In addition, we developed a new gas chromatography-mass spectrometry (GC–MS) method for the analysis of lactulose, lactose, and mannitol in urine and milk collected during the sugar absorption test. Methods The sugar absorption test was performed on days 4, 7, and 14 postpartum in 12 preterm infants (gestational age of 26–32 weeks). Human milk was collected, pooled, and divided into equal portions to provide a stable lactose intake for 24 h. Urine was collected in the last 6 h of this 24 h period, after administration of a bolus test sugar solution. Samples were analyzed by GC–MS after derivatization by oxime formation combined with acetylation. Results The GC–MS method was validated and used for the accurate measurement of lactulose, lactose, and mannitol concentrations. The urinary lactulose/mannitol ratio declined with time, suggesting a decreased intestinal permeability. The urine-to-milk-lactulose/lactose ratio increased as a result of increased lactase activity with time. Conclusions The developed protocol for simultaneous assessment of intestinal permeability and lactase activity can be used to monitor the effect of experimental (nutritional) interventions in human-milk-fed preterm infants. Urine and milk samples obtained during the sugar absorption test can be accurately analyzed by GC–MS.

Objectives To determine whether ultrasound (US) imaging of obese pregnant women in early gestation improves fetal cardiac visualization. Methods We report a prospective longitudinal trial comparing late first- and early second-trimester US to traditional second-trimester US for fetal cardiac screening in maternal obesity. All study participants received US for fetal cardiac screening at a gestational age of 13 weeks to 15 weeks 6 days using a transvaginal or transabdominal approach (UST1). All patients also underwent a traditional transabdominal examination at 20 to 22 weeks (UST2). If UST2 failed to complete the cardiac visualization, a follow up examination (second UST2) was performed 2 to 4 weeks later. Imaging was considered complete if the visceral situs, 4 chambers, outflow tracts, and 3 vessels were visualized. The completion rates between UST1 and UST2 were the primary outcomes. A power analysis (85%) and sample size calculation (n = 145) were performed. Results A total of 152 pregnancies met study criteria. Completion rates of cardiac screening were 77% for UST1 and 70% for UST2 (P = .143). This comparison reached statistical significance in patients with a body mass index of greater than 40 kg/m2 (UST1 [69%] versus UST2 [38%]; P = .001). Sixty-two percent of patients with a body mass index of greater than 40 kg/m2 required second UST2. The highest fetal cardiac screening completion rate was achieved when UST1 was combined with UST2 (96.1%). In 1 fetus, congenital heart disease was detected at UST1 and later confirmed. Conclusions This study represents the largest prospective trial assessing early-gestation US for fetal cardiac screening in the setting of maternal obesity. In obese pregnancies, the addition of early-gestation US to the 20- to 22-week US substantially improves the visualization of fetal cardiac anatomy.

Non-pharmacological therapies are now used in many nursing homes often with residents presenting a risk of behavioural disorders. They include music therapy, animal-assisted therapy, physical activity as well as other approaches such as light therapy or aromatherapy. It requires rigorous assessment, the permanent involvement and engagement of residents as well as the staff as part of a compassionate and participative approach.

Faced with the ageing of the French population, it is essential to envisage new technologies to improve the living conditions of elderly people and enable them to communicate more effectively. A study sought to understand the views of senior citizens and the caregivers who look after them regarding these new tools, their appropriation, the support required and their uses. This analysis highlights areas to reflect upon and improve in terms of the services which need to be provided to overcome the reticence of certain users.

Background: Chagas disease is a major neglected vector-borne disease. In this study, we investigated the safety and efficacy of three oral E1224 (a water-soluble ravuconazole prodrug) regimens and benznidazole versus placebo in adult chronic indeterminate Chagas disease. Method: In this proof-of-concept, double-blind, randomised phase 2 clinical trial, we recruited adults (18–50 years) with confirmed diagnosis of Trypanosoma cruzi infection from two outpatient units in Bolivia. Patients were randomised with a computer-generated randomisation list, which was stratified by centre and used a block size of ten. Patients were randomly assigned (1:1:1:1:1) to five oral treatment groups: high-dose E1224 (duration 8 weeks, total dose 4000 mg), low-dose E1224 (8 weeks, 2000 mg), short-dose E1224 (4 weeks + 4 weeks placebo, 2400 mg), benznidazole (60 days, 5 mg/kg per day), or placebo (8 weeks, E1224-matched tablets). Double-blinding was limited to the E1224 and placebo arms, and assessors were masked to all treatment allocations. The primary efficacy endpoint was parasitological response to E1224 at the end of treatment, assessed by PCR. The secondary efficacy endpoints were parasitological response to benznidazole at end of treatment, assessed by PCR; sustainability of parasitological response until 12 months; parasite clearance and changes in parasite load; incidence of conversion to negative response in conventional and non-conventional (antigen trypomastigote chemiluminescent ELISA [AT CL-ELISA]) serological response; changes in levels of biomarkers; and complete response. The primary analysis population consisted of all randomised patients by their assigned treatment arms. This trial is registered with ClinicalTrials.gov, number NCT01489228. Findings: Between July 19, 2011, and July 26, 2012, we screened 560 participants with confirmed Chagas disease, of whom 231 were enrolled and assigned to high-dose E1224 (n=45), low-dose E1224 (n=48), short-dose E1224 (n=46), benznidazole (n=45), or placebo (n=47). Parasite clearance was observed with E1224 during the treatment phase, but no sustained response was seen with low-dose and short-dose regimens, whereas 13 patients (29%, 95% CI 16·4–44·3) had sustained response with the high-dose regimen compared with four (9%, 2·4–20·4) in the placebo group (p

This research used the second data within banking syariah, where the data banking is a banking syariah listed in the Indonesian Banking during period 6 years ago. The type of datain this study is the method of data analysis used is Multiple Regression. The test results showed the influence negative hypothesis between the Credit Risk toward banking performance syariah listed on the Indonesian Banking. The influence negative hypothesis between the Liquidity Risk toward banking performance syariah listed on the Indonesian Banking. The influence negative hypothesis between the Capital Risk toward banking performance syariah listed on the Indonesian Banking. The influence negative hypothesis between the Operational Risk toward banking performance syariah listed on the Indonesian Banking. The implication of this study is to Islamic banking management uses this information as a benchmark study to enhance the performance of banks and customers for consideration whether to save and depositing the funds in the bank.

Oxygen-related Thermal Donors in n-type Czochralski silicon (Cz-Si) wafers have been investigated using hyperspectral photoluminescence imaging and OxyMap. Thermal Donors give rise to two photoluminescence emissions, one narrow peak at 0.767 eV, and one broad band with centre peak at 0.72 eV that is also measurable at room temperature. The spectral imaging was first carried out on the sample cooled to 90 K, then repeated at room temperature (300 K). The possibility to delimitate at room temperature defects-rich zones with hyperspectral photoluminescence imaging is evidenced.

We report on a degradation of the electronic properties of uncompensated seed-end n-type (phosphorus-doped) Czochralski silicon wafers under light soaking. We unambiguously demonstrate that this degradation is related to the formation and/or activation of a bulk defect under illumination. We bring general information about its activation/formation (illumination intensities, spatial distribution) as well as deactivation features. We show that this defect can be permanently suppressed in a few seconds at high temperatures (850 °C). Conversely annealing at low temperature (200 °C) was found to lead only to a temporary deactivation, the defect being reactivated/reformed after subsequent illumination. As a consequence, this defect could be harmful to solar cell technologies processed at low temperature, such as amorphous/crystalline silicon heterojunction (SHJ). The impact of the defect on SHJ cells performances is experimentally assessed at device level. Eventually the possible nature of the defect is discussed in the light of all collected data.

Objectives The 2012 Eunice Kennedy Shriver National Institute of Child Health fetal imaging consensus suggested that fetal anatomy ultrasound in obese pregnancies be performed at 20 to 22 weeks, with follow-up in 2 to 4 weeks if anatomy is incomplete. It was postulated that imaging in early gestation may improve visualization, although no prospective trials had been done to date. Methods We performed a prospective longitudinal blinded trial comparing an early gestation ultrasound (13 + 0 to 15 + 6 weeks) with the traditional second-trimester ultrasound for completion of the fetal anatomy survey in obese patients. Inclusion criteria included singleton gestation, body mass index (BMI) more than 30, less than 16 + 0 weeks' gestation, and no karyotype abnormality; exclusion criteria included age younger than 18 years, more than 16 weeks' gestation at time of consent, and BMI less than 30. Participants received a transvaginal and/or transabdominal sonogram for fetal anatomic survey at 13 + 0 to 15 + 6 weeks' gestation (US1). Images from US1 were blinded to physicians and sonographers performing subsequent examinations. All participants underwent the traditional transabdominal sonogram at 18 to 24 weeks (US2). If US2 failed to complete the anatomic survey, a repeat transabdominal sonogram (2-US2) was performed 2 to 4 weeks later. Results A total of 152 pregnancies met the criteria. Anatomy completion rate was 57.2% for US1 and 62.5% for US2, which was not statistically significant, even when stratified by BMI. Excluding the philtrum, the US1 performed better than US2 for class III obesity (65.5% versus 45.5% [P = .035]). Combination of US1 + US2 yielded a higher completion rate than US2 + 2-US2 (94.1% versus 83.6% [P = .0023]). Conclusions In the setting of maternal obesity, the addition of an ultrasound in early gestation may be of highest benefit for patients with class III obesity (BMI > 40 kg/m2).

In this work, Cu(In,Ga)Se2 (CIGS) absorbers with thicknesses ranging from 2 µm to 370 nm were prepared by a two-step process using electrodeposition of Cu-In-Ga followed by annealing under a pure Se atmosphere. Based on compositional characterizations, it is shown that in order to decrease the thickness of the precursors, it is not enough to reduce only the deposition time of Cu-In-Ga layers without working on the composition and deposition parameters of the thin films. After the optimization of annealing conditions, the properties of the absorbers and solar cells with three different thicknesses (2 µm, 0.7 µm and 0.37 µm) were compared. It is shown that, in spite of the decreasing thickness, hence a decrease in JSC, the VOC of ultrathin CIGS electrodeposited solar cells can be improved due to an increase in the Ga content of the electrodeposited absorbers. Without deliberate light trapping and anti-reflecting coating from the very thin absorber layer of 0.37 µm, an efficiency of 8.7% with VOC of 685 mV, JSC of 19 mA/cm2 and FF of 67%, was achieved.

Latin America has scarce information related to rheumatologist's education, working conditions, productivity, and job satisfaction. The purpose of this survey was to describe the training and clinical practice characteristics of the rheumatology community in Latin America.This is a cross-sectional study. A digital survey was created, approved, and endorsed by the scientific committee of the Pan-American League of Associations for Rheumatology (PANLAR) and later sent to the rheumatology associations of the region. The data was analyzed in the statistical program SPSS v.22.We included 600 surveys of rheumatologists from 19 Latin American countries. The majority were females (53%) and mestizos (58%). The mean age was 46.8 ± 11.7 years. The most frequent workplace was public/government hospitals 33.5% followed by private practice 28.8%, private hospital 20.8%, and university hospital 15.5%. The average number of weekly working hours was 37.8 ± 17.7. 87.5% worked in adult rheumatology, 12.7% pediatric rheumatology, and 23.5% internal medicine. Average satisfaction with practice as a rheumatologist was 5.3/7, career options 4.3/7, location 4.7/7, income 3.5/7, job security 3.7/7, and colleagues and co-workers 4.5/7. Finally, 69.7% had an annual compensation of 50,000 US dollars.The majority of the rheumatologists in the region who responded were women, worked in public hospitals, and were satisfied with their clinical practice. There was a low level of income for the region. Key Points • This is the first study that showed the demographic and clinical practice characteristics of rheumatologists in Latin America. • The challenges faced by Latin rheumatologists are like those faced by the region: ethnic diversity, gender differences, migration, difficult access to education, limited research, and low income. • Due to the high prevalence of rheumatic diseases and the shortage of professionals in this area, it is essential to analyze the current workforce and the projections of supply and demand in rheumatology that are expected in the future.

Aggression in male mice often leads to injury and death, making social housing difficult. We tested whether (1) small group size, (2) early age of allocation to a group decreases aggression and 3) manipulation increases aggression in male mice. A 14wk study was performed to assess the following conditions in male CD-1/ICR mice: group size (1, 2, or 3), age at grouping (5 or 7wks), and manipulation (daily scruffing or minimal weekly handling). Wounds, body weights, food consumption, nest scores, sucrose consumption, fecal corticosterone and blood for hematology were collected. At the end of the study, mice were euthanized and pelted to assess wounding with the pelt aggression lesion scale (PALS). No signs of acute or chronic stress were observed in any of the groups. Trio housed mice showed less bite wounds than pair housed mice. In general, mice in larger groups ate less but weighed more. Individually housed mice, however, had high nest scores, low body weights, and increased sucrose and food consumption. These results suggest that even when nesting material is provided, individual mice may be experiencing thermal stress. Based on this data, CD-1 mice can successfully be housed for up to 14wks and groups of 3 may be the best for reducing even minor levels of aggression (i.e. wounding).

Consumption forecast models with their proper billing allow establishing strategies to avoid overloads in systems and penalties for high consumption. This paper presents a comparison of multivariate data prediction models that allow detecting the final monthly cost of electricity consumption in relation to the different billing parameters. As relevant results, it was obtained that the models based on decision support machines have a better sensitivity when compared with different metrics that evaluate the prediction error with training set improved by backward elimination criteria.

Background Premenstrual dysphoric disorder (PMDD) is an understudied, debilitating disorder of women. Given evidence for prefrontal cortical and limbic dysfunction in PMDD, we compared intrinsic connectivity of the executive control network (ECN), default mode network (DMN), and amygdala in women with PMDD vs. controls. Methods Thirty-six women (18 PMDD, 18 control) participated in fMRI during the follicular and luteal phases of the menstrual cycle. At each time, resting-state functional connectivity was evaluated both before and after participants performed an emotion regulation task. The ECN was identified using independent components analysis, and connectivity of left and right amygdala seeds was also evaluated. Results Nonparametric permutation testing identified a cluster in the left middle temporal gyrus (MTG) with significantly stronger connectivity to the left ECN in women with PMDD vs. controls in all four fMRI sessions. Women with PMDD exhibited no difference in functional connectivity between menstrual cycle phases. Amygdala connectivity did not differ between the groups but differed significantly with menstrual phase, with left amygdala connectivity to cingulate cortex being significantly stronger during the follicular vs. luteal phase. Right amygdala connectivity to the middle frontal gyrus was also stronger during the follicular vs. luteal phase, with no group differences. These findings suggest that women with PMDD have different intrinsic network dynamics in the left executive control network compared to healthy controls.

Objective This study aims to compare completion rates and reproducibility of myocardial performance index (MPI) using conventional spectral Doppler versus tissue Doppler in an unselected high-risk third trimester population.Study Design This was a prospective cross-sectional study of high-risk pregnancies at ≥28 + 0 weeks’ gestation. Conventional spectral and tissue Doppler MPI of the left ventricle (LV) and right ventricle (RV) was attempted on all patients.Results Seventy-nine pregnancies were evaluated. LV tissue Doppler MPI was completed more frequently than LV conventional spectral Doppler MPI (63/79, 79.7% vs. 45/79, 55.7%), p-value Conclusion Tissue Doppler had statistically higher completion rates than conventional spectral Doppler, including the obese subgroup, with evidence of strong reproducibility in the third trimester.

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Background The aim of this retrospective study was to examine the longitudinal association between disease activity and radiographic damage in a cohort of patients with early RA (symptom onset Methods Baseline to 3-year follow-up data were used from patients included in the DREAM remission induction cohort. Patients received protocolized T2T treatment, aimed at 28-joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR) remission. Disease activity (DAS28-ESR and C-reactive protein, CRP) were assessed at least every 3 months; X-rays of the hand and feet at inclusion, 6 months, and 1, 2, and 3 years were scored using modified Sharp/van der Heijde scoring (SHS). Between and within-person associations between time-integrated disease activity and radiographic progression over time were examined. Results A subset of 229 out of 534 included patients were available for analysis. At the between-patient level, time-integrated DAS28-ESR scores were not significantly correlated with progression at the 6 month and 2-year follow-up and only weakly at the 1-year (Pearson’s correlation coefficient r = 0.17, P r = 0.21, P r between 0.39 and 0.59; P values Conclusions In early RA patients treated according to T2T, radiographic progression appears to be an individually determined disease process, driven by factors other than consistent high disease activity. For individual patients, the intra-patient relation between disease activity and cumulative radiographic damage during the first 6 months is a good indicator for this relation in later years. Trial registration Netherlands Trial Register NTR578, 12 January 2006.

Background: Objectives: To know the availability of treatment for rheumatologic and autoimmune conditions in Latin America, according to rheumatologists in the region. Methods: A digital survey was created using Google Forms, it was approved and endorsed by the scientific committee of PANLAR, and later sent to the different Rheumatology associations of the region. The data was analyzed in the statistical program SPSS v.23. Results: 456 surveys were filled by rheumatologists from 23 countries. The majority were females (54%). The mean age was 47.18 ± 11.79 [25-78] years. 91% reported access to DMARDs, methotrexate 95%, azathioprine 94%, cyclophosphamide 92%, hydroxychloroquine 92%, leflunomide 90%, mycophenolate mofetil 90%, sulfazalasin 88%, cyclosporine 80%, tacrolimus 64%, chloroquine 60%. 85% have access to biological therapy: adalimumab (78%), etarnercept (83%), rituximab (81%), infliximab (74%), tocilizumab (73%), abatacept (67%), golimumab (63%), certolizumab (59%), secukinumab (55%), ustekinumab (44%), certolizumab (59%), belimumab (47%), canakinumab (22%), sarilumab (15%), ixekizumab (12%), anakinra (10%) and rilonacept (3%). 58% have access to biosimilar drugs: rituximab (27%), infliximab (24%), etanercept (18%) and adalimumab (4%). 61% have access to small molecules such as: tofacitinib 62%, baricitinib 18% and ruxolutinib 1%. Regarding the survey by each country 95% reported access to DMARDs: between 80-100% (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Dominican Republic). 70% of the countries reported access to biological therapy between 80-100% (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Panama, Paraguay, Puerto Rico, Uruguay.) 15% did not have access to biosimilar therapy (Cuba, Honduras and Uruguay). 30% have access to therapy with small molecules between 80 -100% (Argentina, Guatemala, Honduras, Panama, Paraguay and Dominican Republic), 25% did not have access to small molecules (Cuba, Uruguay and Venezuela). Conclusion: It is evident that most Latin American countries have access to drugs focused on rheumatic diseases, however, there are substantial differences in countries that do not have access to all therapies. In addition, newer treatment as small molecules are less accessible to the region. Disclosure of Interests: None declared

Background: Currently, Latin America does not have detailed information of rheumatologists in the region based on: education, working conditions, productivity, distribution of time between work activities and job satisfaction. Objectives: The purpose of this survey was to provide more information on the rheumatology community in Latin America Methods: A digital survey was created using the Google Forms platform, it was approved and endorsed by the scientific committee of PANLAR and later sent to the different rheumatology associations of the region. The data was analyzed in the statistical programSPSS v.23: Results: 456 surveys of rheumatologists from 23 countries were received. The majority were females (54%). The mean age was 47.18 ± 11.79 [25-78] years, with a majority of mixed race 58%. 63% are married, 23% are single, 8% are divorced, 5% in free union and 2% are widowed. The mean number of children was 2 [0-7]. Birthplaces included Argentina (27%), Brazil (18%). The setting of the professional practice after obtaining the title of specialists was: public hospital (35%), private (25%), private/teaching in a university hospital (12%), public/teaching in a university hospital (14%), and industry (1%). The main place of work was in public/government hospitals by 30% followed by private practice 31%, private hospital 23%, university hospital 15% and nonprofit organizations 1%. The average of weekly working hours was 39.12 ± 27.53. 89% of the sample practices adult rheumatology, 17% pediatric rheumatology, 2% immunology and 3% another specialty. 30% had an early arthritis care center at their workplace, 71% had an infusion unit, 17% had ultrasound, 23% had a densitometer, 17% had a resonator and 9% had X-rays, however, most work in collaboration. 30% have training in ultrasound and 9% are in training period, 75% have training in reading densitometry and 2% in training period, 54% have training in resonance reading and 11% in training period. The average satisfaction with practice as a rheumatologist was 5/7, career options/professional growth 4/7, geographic location 5/7, income 4/7, job security 4/7, colleagues and co-workers 5/7. 33% had an annual compensation of Conclusion: The majority of rheumatologists in the region who responded were female and feel satisfied with their clinical practice. This survey shows a low level of income for the region, however, more data should be obtained. This is the first study of its kind in Latin America, being an initiative for similar projects. Disclosure of Interests: None declared

Background:Rheumatology is considered a low-risk specialty, but studies have shown a prevalence of burnout between 42% to 51%1,2. Factors associated with it include the use of electronic medical records, administrative tasks and prolonged working hours. This has several repercussions such as higher prevalence of depression/anxiety and less productivity.Objectives:To determine the prevalence of burnout in rheumatologists in Latin America and the factors associated with it.Methods:Cross-sectional study based on a survey completed through Google Forms platform that was sent by the national rheumatology associations of Latin America. Burnout was assessed with the Maslach Burnout Inventory (MBI) with cut off values of ≥27 for emotional exhaustion (EE), ≥10 for depersonalization (DP), and ≤33 for personal accomplishment (PA). Other variables were studied such as demographics, working conditions, satisfaction, comorbidities, depression using PHQ-9 and happiness using the Subjective Happiness Scale. Data was analyzed using the statistical program SPSS v.22.Results:297 rheumatologists from 15 countries were included, mainly Argentina (28.3%), Brazil (26.3%) and Mexico (12.8%). The majority were women 62%, 42.4% worked in public hospitals with an average of 40.1 ± 14.2 hours per week. 31.3% did research, 13.1% clinical trials, 56.6% teaching, and 42.8% administrative work. 36% received an annual income less than 25K.56.6% had burnout in at least 1 dimension. According to the dimensions, 35.7% had burnout in EE, 25.6% in PA and 26.6% in DP. 32.3% had burnout in only 1 dimension, 17.2% in two and 7.1% in all three dimensions. Only 20.2% thought they had burnout, 9.1% were currently with professional help and 15.8% had sought help in the past. 72.1% said they were willing to participate in a program to reduce burnout.The rheumatologists with burnout were younger than those without burnout (46.5 vs 49.9 years, p = 0.015), mentioned more frequently that they would like to decrease the number of working hours (56.5% vs 36.4%, p = 0.002) and had lower practice satisfaction (5.2 vs 6.2, p Conclusion:Burnout affects near half of rheumatologists in Latin America and was associated to younger age, long working hours, low satisfaction, less happiness, higher PHQ-9, suicidal thoughts, anxiety, income, presence of comorbidities and low self-esteem. Most of the rheumatologists were willing to participate in programs to reduce burnout which represents an opportunity for interventions to reduce this syndrome.References:[1]Martin K. Medscape Rheumatologist Lifestyle, Happiness & Burnout Report 2020. 2020; Available at: https://www.medscape.com/slideshow/2020-lifestyle-rheumatologist-6012480#4. Accessed July 10, 2020.[2]Tiwari V, Kavanaugh A, Martin G, Bergman M. High impact of burnout on rheumatology practitioners. Journal of rheumatology 2020:jrheum.191110.Disclosure of Interests:None declared

A significant fraction of Czochralski (Cz) Silicon (Si) wafers suffer from oxygen-related bulk quality issues. The detection of such wafers in the as-cut state during incoming inspection has become a topic of attention as higher efficiency solar cell structures are developing. However such detection - for instance using photoluminescence images – has not yet proven successful due to a high risk of detection errors Shih et al. (2015) [1] . In this work, we tentatively introduce a material quality indicator referred to as “Thermal History Index” (THI) and investigate its ability, in conjunction with the interstitial oxygen concentration ([Oi]), to allow a better identification of low bulk quality wafers.

This article uses the customer portfolio management (CPM) approach to examine how a company can define the value of customers and segment these customers into portfolios. By segmenting customers into portfolios, an organization can better understand the relative importance of each customer to the company's total profit. Such an understanding will help companies retain valuable customers create additional value with these customers through relationship development. The purpose of this article is to contribute to the body of customer relationship management (CRM) literature by introducing a conceptual framework of the customer portfolio management (CPM) matrix, which focuses on two issues: (1) cost to serve and (2) value of the customer to the company. From this framework, a firm can segment its customer base into four portfolios, platinum, gold, silver, and bronze, and deliver services accordingly.

The purpose of South Africa's White Paper on Science and Technology was to set South Africa on a path away from its historically exclusive and relatively dysfunctional National System of Innovation to one more inclusive in its representation and dealings with civil society, the private sector and the marginalised - particularly the poor. Despite the links of subsequent science, technology and innovation policies and strategies to development outcomes, the focus on the poor was notably overlooked. In the decade since the White Paper was released, the gradual and minimal 'trickle-down benefits' of innovation failed to address increasing inequality, unemployment and subsequent poverty across South Africa. Evidence from our study of four rural district municipalities, using a purposively designed snowball sampling approach, indicates that current innovation activities in these areas appear prominent in the service or tertiary economic sector. This evidence reinforces prevailing ideas that the service sector is an important area for innovation and development, while the primary sector, including agricultural activities, remains important but perhaps less than previously emphasised. The high number of public, private and non-profit enterprises innovating in the service sector delineates this sector as a crucial entry point for innovation linked development. However, several prevailing trends with regard to innovation networks and the diffusion of innovations exist as challenges across all three sectors. These obstacles need to be overcome if the innovation and development nexus is to be strengthened and lead to broader local socioeconomic development and economic growth.

In the drylands of Ethiopia, several road water harvesting practices (RWHP) have been used to supplement rain-fed agriculture. However, factors affecting adoption of RWHP and their impacts were not studied systematically. Understanding the factors influencing the adoption of RWHP for sustainable agricultural intensification and climate resilience is critical to promoting such technologies. This paper investigates the impacts of using rural roads to harvest rainwater runoff and the factors causing farmers to adopt the practice. Road water harvesting is considered a possible mechanism for transformative climate change adaptation. By systematically capturing rainfall with rural road infrastructure, rain-related road damage is reduced, erosion and landscape degradation due to road development is lessened, and farm incomes increase due to the beneficial use of harvested water, resulting in an increased climate change resilience. This paper uses a binary probit model and propensity score matching methods based on a household survey of 159 households and 603 plots. The results of the probit model show that the education level of the household, family labor, access to markets, and distance of the farming plot from the farmer&rsquo, s dwelling are statistically significant in explaining farmers&rsquo, adoption of RWHP in the study area. The casual impact estimation from the propensity score matching suggests that RWHP has positive and significant impacts on input uses (farmyard manure and fertilizer), crop yield, and farm income among the sample households.

With aging of HIV populations, there is concern that Alzheimer’s disease (AD) may become prevalent and difficult to distinguish from HIV-associated neurocognitive disorders. To date, there are no reports documenting histologically verified Alzheimer’s neuropathology in individuals with HIV and dementia. Herein, we report two antiretroviral-treated, virally suppressed, HIV-infected individuals autopsied by the Manhattan HIV Brain Bank. Subject A presented to study at 52 years, already dependent in instrumental activities of daily living (ADLs), with severe cognitive impairment inclusive of learning and memory dysfunction. Her history was significant for educational disability and head trauma. She had rapid cognitive decline and, by death at age 59 years, was bed-bound, incontinent, and non-communicative. At autopsy, she exhibited severe AD neuropathologic change (NIA-AA score A3B3C3) and age-related tau astrogliopathy (ARTAG). She was homozygous for APOE e3/e3. No HIV DNA was detected in frontal lobe by nested polymerase chain reaction. Subject B was a community dwelling 81-year-old woman who experienced sudden death by pulmonary embolus. Prior to death, she was fully functional, living independently, and managing all ADLs. At autopsy, she displayed moderate amyloid and severe tau AD neuropathologic changes (A2B3C2), ARTAG, and cerebral congophilic angiopathy. She was an APOE e3/e4 heterozygote, and HIV DNA, but not RNA, was detected in frontal lobe, despite 20 years of therapy-induced viral suppression. We conclude that in the setting of HIV, AD neuropathology may occur with or without symptomatic cognitive dysfunction; as with seronegative individuals, there are likely to be complex factors in the generation of clinically relevant impairments.

Item does not contain fulltext IMPORTANCE: Infections and necrotizing enterocolitis, major causes of mortality and morbidity in preterm infants, are reduced in infants fed their own mother's milk when compared with formula. When own mother's milk is not available, human donor milk is considered a good alternative, albeit an expensive one. However, most infants at modern neonatal intensive care units are predominantly fed with own mother's milk. The benefits of add-on donor milk over formula are not clear. OBJECTIVE: To determine whether providing donor milk instead of formula as supplemental feeding whenever own mother's milk is insufficiently available during the first 10 days of life reduces the incidence of serious infection, necrotizing enterocolitis, and mortality. DESIGN, SETTINGS, AND PARTICIPANTS: The Early Nutrition Study was a multicenter, double-blind randomized clinical trial in very low-birth-weight infants (birth weight

Objectives To investigate changes in the cardiac axis (CAx) within the cardiac cycle of normal fetuses and fetuses with congenital heart defects (CHD). Methods This was a retrospective case–control study in which stored videoclips of four-chamber views from 527 prenatal ultrasound examinations performed at 18 + 0 to 36 + 6 weeks of gestation were reviewed. Among the ultrasound scans included, 287 were of normal fetuses (controls) and 240 were of fetuses with CHD. In each case, the CAx was measured at end systole (just before the atrioventricular (AV) valve opened) and at end diastole (just before the AV valve closed). CAx measurements of fetuses with CHD were compared to those of controls. Results The mean CAx in the control group was 45.9 ± 8.5° at end systole and 38.3 ± 8.4° at end diastole (P

The method of benchmarking provides an opportunity to learn from better performing territories to improve the effectiveness and efficiency of activities in a particular field of interest. Such a field of interest could be road safety. Road safety benchmarking can include several indicators, ranging from performance indicated by crash statistics, to indicators that also account for consequences in costs or the underlying state of the road safety system and relevant organisation and processes at actor level. The structure and culture of a territory is identified as a basic context of road safety performance. This is regarded as important information to use in grouping of territories to get more homogenous or equal and comparable conditions to learn from ‘the best in class’. The main aim of this study is to assess the usability of different groupings using the physical structure for benchmarking road safety performance at local territorial level. A traditional grouping of municipalities in the Netherlands was compared with a simple grouping of these municipalities based on their level of urbanisation and an advanced grouping in which more indicators such as differences in demography, growth and road structure were taken into account. As in other studies, urbanisation showed to be the most predominant structural factor for grouping local territories and related to differences in road safety performance. However, if information would be needed for specific target groups, other factors like age and gender distribution or the distribution of the road network can provide valuable additional insight and better homogenous starting points for benchmarking. Especially benchmarking of rural territories may profit from such extra distinctive characteristics.

Cystic echinococcosis (CE) is an important helminthic zoonotic disease that commonly affects the liver and lungs. Imaging methods and serology establish the diagnosis in most cases. Chest x-ray can diagnose uncomplicated pulmonary hydatid cysts, whereas superinfection and/or rupture of the hydatid cyst (complicated cysts) may change the radiographic appearance and lead to delayed diagnosis and treatment. We report the case of a patient with hemoptysis and chest pain, where computer tomography scan of the lung suggested a large, ruptured hydatid cyst. However, serological tests with indirect hemagglutination (IHA)for Echinococcus granulosus antibodies were negative, and there was massive growth of Streptococcus pneumoniae in sputum. Based on this, we concluded that the patient had a bacterial lung abscess. The diagnosis of CE was only made after surgical removal of the cyst followed by microscopy and polymerase chain reaction.

Background Early and intensive targeted treatment with disease modifying anti-rheumatic drugs (DMARDs) has been shown to lead to substantial reductions in disease activity and radiograph damage in patients with early rheumatoid arthritis (RA). The aim of this quasi-experimental study was to compare the first-year radiographic progression rates between a treat-to-target (T2 T) strategy with initial combination therapy (strategy II, started in 2012) versus an initial step-up monotherapy (strategy I, started in 2006). Methods A total of 128 patients from strategy II was individually matched with 128 patients from strategy I on sex, age (± 5 yrs.) and baseline disease activity (± 0.5 on the DAS28). Differences in radiographic progression (Sharp/van der Heijde) scores (SHS) and the number of patients experiencing a minimal clinically important difference (MCID; ≥ 5 SHS points) between both strategies were tested with Mann Whitney U and chi-square tests. Next, linear and logistic regression analyses were performed to examine which baseline variables were associated with radiographic progression scores and the probability of experiencing an MCID within 1 year. Results Patients with initial combination therapy had slightly higher baseline disease activity scores and pain scores, but better mental health scores. Patients with initial monotherapy had significantly more, and more frequently clinically relevant, radiographic progression after 1 year. Experiencing a MCID was independently associated with fewer tender joints (p = 0.050) and higher erythrocyte sedimentation rate (p = 0.015) at baseline. Conclusion Treating early RA patients with initial combination therapy results in better radiographic outcomes than initial monotherapy in daily clinical practice. Trial registration Netherlands Trial Register NTR578, 12 January 2006.