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Globally, the number of citizen science clean-up projects, such as beach cleans, is increasing in an effort to reduce the amount of plastic pollution in the environment. Such activities offer the opportunity to gather insightful data on plastic abundance, distribution and composition. This information is key for informing effective management strategies aimed at reducing input but little work has been conducted to examine the challenges faced by existing citizen science projects, or the potential opportunities for maximising their impact. Here, we present the results of a questionnaire survey and follow-up workshop to explore the opinions of representatives from 20 organisations that deal with the issue of plastic pollution in the environment. Our results show that, of the organisations that conduct clean-up activities in the United Kingdom (UK), the majority collect data on plastic pollution to some extent. To ensure these data are scientifically meaningful and the necessary levels of public engagement are maintained, participants felt that survey protocols should be standardised across organisations and data submission should be as simple and easy as possible. The participants considered communication, inclusivity and volunteer diversity to be key for enhancing citizen engagement and improving data quality. Many organisations were unclear about how the information they hold can be most effectively used to help inform policies relating to managing plastic pollution. Moving forwards, there is a clear desire from clean-up organisations to collaborate with other sectors, such as commercial, policy, waste and recycling, education and technology stakeholders, as well as other non-governmental organisations and scientific researchers, to enhance the value and impact of citizen science in tackling the issue of plastic pollution.

A growing body of evidence supports the efficacy and safety of bariatric surgery for clinically severe obesity. Despite this empirical support, bariatric surgery remains profoundly underutilized. The reasons for underutilization are likely multifactorial, including health insurance coverage and benefits design, lack of awareness about bariatric surgery by patients, and anecdotal concerns about safety. We believe that there are two other factors-the occurrence of weight stigma and bias and suboptimal communication between patients and providers-that also serve as barriers to greater utilization. The article reviews the existing literature related to these two factors. The review also highlights the science of shared medical decision-making as a potential strategy to promote appropriate conversations between patients and providers, both surgical and nonsurgical, about the efficacy and safety of bariatric surgery. Shared medical decision-making is used in other areas where complex medical decisions are required. We believe that it has great potential to contribute to the increased utilization for the millions of individuals who could benefit from bariatric surgery.

Exposed to the mystery of his father’s suspicious death, young Hamlet followed the riddle of solving it in the longest tragedy of Shakespeare. By suspension and the lengthy nature of detective works, Shakespeare seems to have initiated a new subgenre in drama which may have later on been converted into an independent subgenre in the novel by Edgar Allan Poe, Sir Arthur Conan Doyle, and Agatha Christie through their imaginative characters, Auguste Dupin, Sherlock Holmes and the pair of Hercules Poirot with Miss Marple respectively. Fyodor Dostoevsky may have also spread the net of Hamletian subtext in his Crime and Punishment. Plotting a perfect crime by the murderers and the public approval of the plan, on one hand, and the inconvincible mind of the hero which ultimately undo the seemingly unsolvable puzzle, on the other, construct the very core of all aforementioned works of Shakespeare, Poe, and Doyle. The unanticipated and unpredicted findings of either Holmes or Hamlet defeat the expectations of the audience and bring the runaway justice back to her groom.

Background The public health impact of the coronavirus disease 2019 (COVID-19) pandemic has motivated a rapid search for potential therapeutics, with some key successes. However, the potential impact of different treatments, and consequently research and procurement priorities, have not been clear. Methods Using a mathematical model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, COVID-19 disease and clinical care, we explore the public-health impact of different potential therapeutics, under a range of scenarios varying healthcare capacity, epidemic trajectories; and drug efficacy in the absence of supportive care. Results The impact of drugs like dexamethasone (delivered to the most critically-ill in hospital and whose therapeutic benefit is expected to depend on the availability of supportive care such as oxygen and mechanical ventilation) is likely to be limited in settings where healthcare capacity is lowest or where uncontrolled epidemics result in hospitals being overwhelmed. As such, it may avert 22% of deaths in high-income countries but only 8% in low-income countries (assuming R = 1.35). Therapeutics for different patient populations (those not in hospital, early in the course of infection) and types of benefit (reducing disease severity or infectiousness, preventing hospitalization) could have much greater benefits, particularly in resource-poor settings facing large epidemics. Conclusions Advances in the treatment of COVID-19 to date have been focused on hospitalized-patients and predicated on an assumption of adequate access to supportive care. Therapeutics delivered earlier in the course of infection that reduce the need for healthcare or reduce infectiousness could have significant impact, and research into their efficacy and means of delivery should be a priority.

Introduction. The lack of an appropriate methodological basis for creating agricultural cooperative system prevents the process of organizing formation of new agricultural cooperatives, which leads to an objective need to develop the organizational and economic basis for the formation and operation of agricultural cooperatives. In this regard, the research and study of theoretical aspects, analysis of objective conditions for the formation and operation of agricultural cooperatives, development of methodological provisions and practical recommendations to substantiate their organizational and economic mechanism, including matters of management, profit, price, credit, formation and distribution are topical to the issue and most of the components listed above are of great practical importance. Aim and tasks. The aim of the research is to develop scientific, organizational and economic basis for the establishment and operation of agricultural cooperatives in a multistructural economy. The objectives of the research are: identifying the essence of the cooperative, adding several principles to the formation and classification of agricultural cooperatives, determining the conditions and factors necessary for their creation. Results. Theoretical and regulatory aspects of formation and development of agricultural cooperatives were specified taking into account the introduction of new principles for their operation: mandatory creation of indivisible funds for innovative activities, agricultural producers’ interest and expediency for their participation in the associations; and classification of cooperatives in the production and service industries. Conclusions. Based on consideration of the integrated approach to the formation of cooperatives and farmers’ organizations, necessary documentation and calculation of economic efficiency, the methodological provisions developed in the process of the research on the establishment and operation of agricultural cooperatives will allow agricultural producers to approach the formation of necessary cooperatives skillfully, easily determine the absolute and specific tax burden of agricultural cooperatives.

HAMLET SANIKIDZE Batumi Shota Rustaveli State University, PhD student in Business Administration Georgia Batumi E-mail: hamleti2015@gmail.com http://orcid.org/0000-0003-1156-4840 Abstract From a development perspective, agricultural production cooperatives as cooperative farms can become, first and foremost, large-scale farms, with many economic and social advantages. In particular, large farms are increasingly striving for scientific and technological progress. It is easier for them to withstand unfavorable natural and economic factors, solve problems of rural social development, etc. Compared to other forms of management, production cooperatives are fully in line with the characteristics of agriculture and the interests of the peasants. Although the welfare of the workers, as in other enterprises with management leverage, is formed at the expense of wages and income from private land, the labor form of income in the cooperative is more clearly manifested. In the socio-economic conditions of business, we can expect a reduction in the number of CCs or their transformation into an economic society, the creation of small enterprises, peasant farms on their basis, or their other distribution among entrepreneurial entities. The study found that the main factors that negatively affect the financial condition of agricultural organizations are: low prices of products sold; Price inequality in industrial and agricultural products sold and purchased; Underdeveloped market infrastructure; Weak government support, etc.

Statement of problem Denture base resins (DBRs), such as polymethyl methacrylate, are commonly used in the fabrication of removable dentures because of their physical, mechanical, and esthetic properties. However, the denture base acts as a substrate for microorganism adherence and biofilm formation, which may lead to denture stomatitis and be further complicated by fungal infections, of especial importance with geriatric and immunosuppressed patients. Therefore, methods to enhance the antimicrobial property of DBRs will be beneficial. Purpose The purpose of this systematic review was to evaluate the literature on the antimicrobial activity of DBRs incorporating antimicrobial agents or materials. Material and methods A search of English peer-reviewed literature up to February 2019 reporting on antimicrobial activity of DBRs with respect to antimicrobial agents or materials, antimicrobial test effects and methods, and conclusion or knowledge gaps was conducted by using Embase, Google Scholar, PubMed, and Web of Science databases. Search terms included denture base resin and antibacterial, denture base resin and antifungal, and denture base resin and antimicrobial. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied for subsequent data analysis. Results Of 2536 identified articles, 28 met the inclusion criteria for the systematic review. Antimicrobial materials were divided into 3 groups: antimicrobial monomer or copolymer, phytochemical or phytomedical components, and other compounds. Strategies on how to incorporate these substances into DBRs and their impact on the reduction and prevention of the growth of microorganisms were identified. Conclusions Although many efforts have been made to improve the antimicrobial ability of DBRs, this systematic review found that the effectiveness of incorporating of antimicrobial agents into DBRs has not been demonstrated conclusively.

Coronavirus disease 2019 (COVID-19) is associated with cardiovascular (CV) complications including myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. The infection is more severe in patients with pre-existing cardiovascular disease (CVD), where systemic inflammation due to cytokine storm, hypercoagulation, as well as high hematocrit and platelet (PLT) count may contribute to an increased CV risk. The authors hypothesize that anticoagulants and antiplatelets prevent miocardial infarction (MI) in patients with pre-existing CVD.A cohort study enrolled patients with a confirmed diagnosis of COVID-19. Clinical and laboratory data, total and CV mortality, as well as MI incidence and treatment regimens were compared according to the time of hospitalization: 40-day period in April-May (Group 1) and in October-November (Group 2).A total of 195 patients were enrolled: 93 in Group 1, with 36.5%, and 102 in Group 2 with 38.2% pre-existing CVD. Group 1 was managed with infusion therapy; only 10.7% received anticoagulation. Group 2 received preventive anticoagulants, antiplatelets, and infusion therapy. In Group 1, seven cases of MI were recorded compared to only three in Group 2. No significant difference in overall mortality (4.3% vs 6.86%, p = 0.441) and MI incidence (7.5% vs 2.9%, p = 0.149) was found, but significant differences were seen in the incidence of severe and critically ill cases between the groups (69.9% and 7.5% vs 75.5% and 20.6%, p 0.001).Poorer outcomes in the early COVID-19 wave were associated with inadequate anticoagulation due to lack of knowledge about the new virus. Despite significantly more severe cases, there was no significant difference in overall mortality and MI incidence in patients with anticoagulation.HINTERGRUND: „Coronavirus disease 2019“ (COVID-19) ist mit kardiovaskulären (KV) Komplikationen, einschließlich Myokardinfarkt (MI), Myokarditis, Arrhythmien und venösen Thrombembolien, assoziiert. Die Infektion verläuft bei Menschen mit vorbestehenden KV-Erkrankungen schwerer, bei denen systemische Inflammation aufgrund der Hyperzytokinämie, Hyperkoagulation sowie erhöhte Hämatokrit- und Thrombozytenwerte zu einem erhöhten KV-Risiko beitragen könnten. Die Autoren stellen die Hypothese auf, dass ein Herzinfarkt bei Menschen mit präexistenten KV-Erkrankungen durch Antikoagulanzien und Thrombozytenaggregationshemmer verhindert werden kann.In die Kohortenstudie wurden Patienten mit bestätigter COVID-19-Diagnose aufgenommen. Deren klinische Parameter und Labordaten, Gesamtsterblichkeit und kardiovaskuläre Mortalität, MI-Inzidenz und die Behandlungsmodalitäten wurden, abhängig vom Zeitraum des Krankenhausaufenthalts (40-Tages-Zeitraum im April/Mai [Gruppe 1] bzw. Oktober/November [Gruppe 2]), verglichen.Insgesamt wurden 195 Patienten in die Studie aufgenommen: 93 in Gruppe 1 und 102 in Gruppe 2, davon 36,5 % (Gruppe 1) bzw. 38,2 % (Gruppe 2) mit vorbestehender KV-Erkrankung. Die Patienten in Gruppe 1 erhielten eine Infusionstherapie, nur 10,7 % wurden mit Antikoagulanzien behandelt. Bei Gruppe 2 kamen präventiv Antikoagulanzien und Thrombozytenaggregationshemmer zusätzlich zur Infusionstherapie zum Einsatz. In Gruppe 1 erlitten 7 Patienten einen MI, in Gruppe 2 nur 3. Keine signifikanten Unterschiede zwischen beiden Gruppen wurden bezüglich der Gesamtsterblichkeit (4,3 % vs. 6,86 %, p = 0,441) und MI-Inzidenz (7,5 % vs. 2,9 %, p = 0,149) festgestellt, jedoch hinsichtlich der Inzidenz schwerer und kritisch kranker Fälle (69,9 % und 7,5 % vs. 75,5 % und 20,6 %, p 0,001).Schlechtere Behandlungsresultate in der frühen COVID-19-Phase waren mit inadäquater Antikoagulation aufgrund fehlender Kenntnisse über das neue Virus assoziiert. Trotz der signifikant schwereren Verläufe ergaben sich keine signifikanten Unterschiede bezüglich der Gesamtsterblichkeit und der Herzinfarktinzidenz bei Patienten unter Antikoagulation.

OBJECTIVES: To compare the effectiveness of deproteinized bovine bone mineral with 10% collagen alone (DBBMC) or with enamel matrix derivative (DBBMC-EMD) in ridge preservation. METHODS: 42 maxillary anterior teeth were extracted and received either a DBBMC (control) or DBBMC-EMD (test) treatment protocol. CBCT taken before and 4 months after the extraction procedure was used to measure changes in alveolar ridge width (RW), buccal bone height (BH) and palatal bone height (PH). Bone cores were harvested during implant osteotomy preparation and the samples processed histomorphometrically to assess the fraction of new bone (%NB), residual graft (%RG), and soft tissue matrix (%STM). RESULTS: Overall, both treatment groups showed significant reductions in mean RW from baseline to 4 months after extraction, but no significant change in either mean BH or PH over this time. When CBCT measurements were analysed according to the initial thickness of the buccal wall (BT

The aim of the study is to demonstrate, using a clinical example, the possibility of treating a patient with a severe acetabular defect by performing a one-stage revision arthroplasty using an individual design. Materials and methods. A 45-year-old female patient was admitted with complaints of pain, limitation of movement in the right hip joint, and gait disturbance. From anamnesis at the age of 5 years, reconstructive operations of the hip joints were performed. In 1991, CITO performed primary total arthroplasty of the right hip joint with an endoprosthesis from ESKA Implants. In 1998, due to the instability of the acetabular component of the total endoprosthesis of the right hip joint, revision arthroplasty was performed, and the cup was placed with a cement fixation. In 2001, for left-sided dysplastic coxarthrosis, primary total arthroplasty of the left hip joint was performed. In 2012, due to the instability of the total endoprosthesis of the left hip joint, revision arthroplasty was performed using an ESI anti-protrusion ring (ENDOSERVICE) with a cement cup and a Zweimller-type femoral component; the femur defect was repaired using a fresh frozen cortical graft. In October 2019, instability of the total endoprosthesis of the right hip joint was revealed, for which revision endoprosthetics was performed using an individual acetabular component. Results. The HHS index before revision arthroplasty was 21 points, after 1 month after surgery 44 points, after 3 months after surgery 65, after 6 months 82. Quality of life was assessed according to the WOMAC scale: before surgery 73 points, after 1 month after surgery 54 points, after 3 months 31, after 6 months 15 points. At the time of the last consultation, the patient moves with a cane, lameness persists, associated with scar reconstruction and atrophy of the gluteal muscles. Conclusion. The use of individual structures allows to restore the support ability of the lower limb and the function of the hip joint in the case of an extensive defect of the pelvic bones of the pelvic discontinuity type.

Purpose: The aim of this study was to improve patient oral hygiene outcomes in a rehabilitation unit by implementing a nursing education package and oral hygiene assessment tool. Design: A case–control design with 50 rehabilitation patients was performed. Methods: Nursing staff received education and training in applying the Modified Oral Health Assessment Tool. Clinician assessment of patient oral hygiene occurred on admission and at days 5–7. Each patient reported their perceptions of oral hygiene and comfort prior to hospitalization, while in the hospital, and after transfer to the rehabilitation unit. Findings: Oral hygiene rating scores improved significantly from admission to the rehabilitation unit to days 5–7 (p = .00). The mean score of patient perceived cleanliness improved from hospital admission to admission to the rehabilitation unit. Conclusion: Oral hygiene was improved following admission to a rehabilitation unit with a consistent and individualized approach to oral hygiene. Clinical Relevance: The introduction of a consistent and individualized approach to oral hygiene demonstrates positive patient outcomes and high patient acceptance.

We describe our experiences with organizing pro bono medical genetics and neurology outreach programs on several different resource-limited islands in the West Indies. Due to geographic isolation, small population sizes, and socioeconomic disparities, most Caribbean islands lack medical services for managing, diagnosing, and counseling individuals with genetic disorders. From 2015 to 2019, we organized 2-3 clinics per year on various islands in the Caribbean. We also organized a week-long clinic to provide evaluations for children suspected of having autism spectrum disorder. Consultations for over 100 different individuals with suspected genetic disorders were performed in clinics or during home visits following referral by locally registered physicians. When possible, follow-up visits were attempted. When available and appropriate, clinical samples were shipped to collaborating laboratories for molecular analysis. Laboratory tests included karyotyping, cytogenomic microarray analysis, exome sequencing, triplet repeat expansion testing, blood amino acid level determination, biochemical assaying, and metabolomic profiling. We believe that significant contributions to healthcare by genetics professionals can be made even if availability is limited. Visiting geneticists may help by providing continuing medical education seminars. Clinical teaching rounds help to inform local physicians regarding the management of genetic disorders with the aim of generating awareness of genetic conditions. Even when only periodically available, a visiting geneticist may benefit affected individuals, their families, their local physicians, and the community at large.

EXECUTIVE SUMMARY This study examined whether usage of clinical data from the electronic health record (EHR) to create organizational- and unit-level performance dashboards and assess adherence to clinical practice guidelines is associated with hospital outcomes in risk-adjusted 30-day readmissions for patients with a principal diagnosis of heart failure (HF). It further assesses the association between the metrics of hospital financial health and the usage of those EHR-generated tools.A cross-sectional study design was used. The study used data from the 2016 American Hospital Association Annual Survey Information Technology Supplement, the Pennsylvania Health Care Cost Containment Council's (PHC4's) 2017 Hospital Performance Report, and the PHC4 General Acute Care Hospitals Financial Analysis Report for fiscal year 2017. Contingency tables, likelihood-ratio chi-square tests, and logistic regression were applied for data analysis.Usage of the EHR to assess adherence to clinical practice guidelines and create EHR-generated unit-level performance dashboards, rather than organizational performance dashboards, was more strongly associated with the hospitals' rating in risk-adjusted 30-day readmissions for HF patients. An increase in hospitals' operating margin was associated with greater odds of the usage of the discussed EHR tools, after controlling for hospital control/ownership and the total number of beds.Usage of some EHR-generated analytical tools may be more strongly associated with lower-than-expected 30-day hospital readmissions in HF patients than with other tools. Better hospital financial health is linked with greater uptake of the discussed analytical tools. Further research could help to determine which EHR-generated tools are more effective in improving hospital outcomes in HF.

Aims/Objectives: Understand the relationship between auditory input and balance motor control. Material and Methods: Twelve prelingual adolescent cochlear implant users (CIU) and 12 adult postlingu...

Summary Background COVID-19 has the potential to cause substantial disruptions to health services, due to cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions to services for HIV, tuberculosis, and malaria in low-income and middle-income countries with high burdens of these diseases could lead to additional loss of life over the next 5 years. Methods Assuming a basic reproduction number of 3·0, we constructed four scenarios for possible responses to the COVID-19 pandemic: no action, mitigation for 6 months, suppression for 2 months, or suppression for 1 year. We used established transmission models of HIV, tuberculosis, and malaria to estimate the additional impact on health that could be caused in selected settings, either due to COVID-19 interventions limiting activities, or due to the high demand on the health system due to the COVID-19 pandemic. Findings In high-burden settings, deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10%, 20%, and 36%, respectively, compared with if there was no COVID-19 pandemic. The greatest impact on HIV was estimated to be from interruption to antiretroviral therapy, which could occur during a period of high health system demand. For tuberculosis, the greatest impact would be from reductions in timely diagnosis and treatment of new cases, which could result from any prolonged period of COVID-19 suppression interventions. The greatest impact on malaria burden could be as a result of interruption of planned net campaigns. These disruptions could lead to a loss of life-years over 5 years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV and tuberculosis epidemics. Interpretation Maintaining the most critical prevention activities and health-care services for HIV, tuberculosis, and malaria could substantially reduce the overall impact of the COVID-19 pandemic. Funding Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development, and Medical Research Council.

The ongoing coronavirus disease 2019 (COVID-19) pandemic poses a severe threat to public health worldwide. We combine data on demography, contact patterns, disease severity, and health care capacity and quality to understand its impact and inform strategies for its control. Younger populations in lower-income countries may reduce overall risk, but limited health system capacity coupled with closer intergenerational contact largely negates this benefit. Mitigation strategies that slow but do not interrupt transmission will still lead to COVID-19 epidemics rapidly overwhelming health systems, with substantial excess deaths in lower-income countries resulting from the poorer health care available. Of countries that have undertaken suppression to date, lower-income countries have acted earlier. However, this will need to be maintained or triggered more frequently in these settings to keep below available health capacity, with associated detrimental consequences for the wider health, well-being, and economies of these countries.

Moebius syndrome is a congenital neurological disorder that impacts facial expression, communication and appearance. In this article, the authors will discuss the psychological and social impacts of living with this rare form of facial palsy. Existing research suggests that patients may face challenges in developing psychological wellbeing, positive body image and in communicating effectively with others. Therefore, recommendations for nursing practitioners in how to best support this patient group are discussed.

Purpose Facial palsy is a condition which can lead to significant changes in facial function and appearance. People with facial palsy often report psychosocial difficulties, including withdrawal from social activities, anxiety, negative body image, and low mood. This paper aimed to review all published research investigating the psychosocial impact of facial palsy on adults. Methods A systematic search of MEDLINE, CINAHL, EMBASE, PsycINFO, and AMED databases was performed. The quality of included studies was assessed, and data were extracted with regard to characteristics of participants; study methodology and design; outcome measures used; and psychosocial outcomes. Results Twenty‐seven studies met inclusion criteria. A high proportion of people with facial palsy reported clinically significant levels of anxiety and depression, with greater difficulties typically reported by females, compared to males. Other difficulties consistently reported include low quality of life, poor social function, and high levels of appearance‐related distress. Objective severity of facial palsy was consistently shown to not be associated with anxiety or depression, with psychological factors instead likely mediating the relationship between the severity of facial palsy and psychosocial well‐being. Conclusions Irrespective of objective symptom severity, facial palsy has the potential to have a significant impact on psychosocial well‐being and quality of life. The various methodological limitations of the included studies are discussed, along with clinical implications, including the need for greater access to psychological screening and interventions for people with facial palsy.

Following the detection of the new coronavirus1 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its spread outside of China, Europe has experienced large epidemics of coronavirus disease 2019 (COVID-19). In response, many European countries have implemented non-pharmaceutical interventions, such as the closure of schools and national lockdowns. Here we study the effect of major interventions across 11 European countries for the period from the start of the COVID-19 epidemics in February 2020 until 4 May 2020, when lockdowns started to be lifted. Our model calculates backwards from observed deaths to estimate transmission that occurred several weeks previously, allowing for the time lag between infection and death. We use partial pooling of information between countries, with both individual and shared effects on the time-varying reproduction number (Rt). Pooling allows for more information to be used, helps to overcome idiosyncrasies in the data and enables more-timely estimates. Our model relies on fixed estimates of some epidemiological parameters (such as the infection fatality rate), does not include importation or subnational variation and assumes that changes in Rt are an immediate response to interventions rather than gradual changes in behaviour. Amidst the ongoing pandemic, we rely on death data that are incomplete, show systematic biases in reporting and are subject to future consolidation. We estimate that-for all of the countries we consider here-current interventions have been sufficient to drive Rt below 1 (probability Rt

EXECUTIVE SUMMARY Cancer centers are diverse healthcare organizations comprising clinicians and researchers dedicated to understanding, treating, and controlling cancer in the populations they serve. Although many metrics are used to evaluate cancer center performance, few of these standardized measures have been identified to evaluate cancer center leadership. We performed a systematic review to identify published literature presenting metrics used to evaluate the leadership of cancer centers. Metrics were then classified using 10 a priori-defined categories of evaluation. Overall, we reviewed 34 articles (studies, editorials, interviews). The most commonly discussed leadership evaluation category was Organizational Strategy/Planning (31 of the 34 articles), followed by Leader Characteristics (25 articles), Clinical Performance (21), and Facility Characteristics (20). Organizational Strategy/Planning metrics included governance structure, strategic development, quality assurance and improvement, mission and vision, business planning, and program development. Leader Characteristic metrics included communication, vision/strategic thinking, personal skills, team coordination, leadership style, and staff development. Clinical Performance metrics focused on delivery of and outcomes from clinical services, while Facility Characteristics included space allocation and access to support services. The metrics reviewed in this article may be considered measurable outcomes in evaluating whether cancer center leadership demonstrates key competencies. Additional research should explore the linkage among metrics used to evaluate cancer center leaders, desired competencies for healthcare leaders, and objective measures of whether a cancer center is successful.

Paradoxical adipose hyperplasia (PAH) following cryolipolysis is a rare but deforming complication. This likely underreported adverse event has been described as being refractory to both traditional tumescent liposuction and repeated cryolipolysis treatments. Here, we present 3 isolated cases with PAH deformity created by cryolipolysis. Management of PAH on the abdomen and flanks involved 2 key elements: ultrasound-assisted liposuction (UAL) technology and helium-activated radiofrequency (RF) energy subdermal coagulation. We observed complete resolution and definitive correction of PAH deformities at 2 weeks, 1 month, and 3 months postoperatively. UAL combined with helium-activated RF subdermal coagulation is a viable surgical modality to correct contour irregularities seen in PAH following cryolipolysis.

Along with sciences, alchemical activity heavily influenced literature and art, and the images of alchemists were widely reflected in the works of poets, writers, artists, philosophers, and scientists. In Eastern and Western literature of ancient, medieval, and modern times, alchemy, together with the intriguing images of alchemists, was used also as a source of vivid metaphors. This article is devoted to the subject of alchemy in Russian literature, investigating which writers were interested in it and how it was developed in Russia. Prominent Russian authors’ poetic and prosaic writings have been perused throughout the research paper and it is believed that the images of alchemists portrayed by Alexander Pushkin, Nikolai Gogol, Alexander Herzen, Nikolai Ogarev, Alexei Tolstoy, and Mikhail Bulgakov were of European origin.

The anti-angiogenic effects of bisphosphonates have been hypothesized as one of the major etiologic factors in the development of medication-related osteonecrosis of the jaw (MRONJ), a severe debilitating condition with limited treatment options. This study evaluated the potential of a gelatine-hyaluronic acid hydrogel loaded with the angiogenic growth factor, vascular endothelial growth factor (VEGF), as a local delivery system to aid in maintaining vascularization in a bisphosphonate-treated (Zoledronic Acid) rodent maxillary extraction defect. Healing was assessed four weeks after implantation of the VEGF-hydrogel into extraction sockets. Gross examination and histological assessment showed that total osteonecrosis and inflammatory infiltrate was significantly reduced in the presence of VEGF. Also, total vascularity and specifically neovascularization, was significantly improved in animals that received VEGF hydrogel. Gene expression of vascular, inflammatory and bone specific markers within the defect area were also significantly altered in the presence of VEGF. Furthermore, plasma cytokine levels were assessed to determine the systemic effect of locally delivered VEGF and showed similar outcomes. In conclusion, the use of locally delivered VEGF within healing extraction sockets assists bone healing and prevents MRONJ via a pro-angiogenic and immunomodulatory mechanism.

The solid oxide fuel cell (SOFC) is widely accepted for clean and distributed power generation use. The model of SOFC is belongs to highly nonlinear systems where perfect knowledge of their parameters is unattainable by conventional modelling techniques. The expected progress on these devices requires studies on components and their integration. The core of these systems is the solid oxide electrochemical cell whose structure is a multi-layer with complex behaviour involving different areas of physics. The electrochemistry of solids, the physics and chemistry of ceramics, thermal or the mechanics of materials are all areas to be considered to properly describe and analyze the response of such systems.

Introduction The Eliminate Yellow fever Epidemics (EYE) strategy was launched in 2017 in response to the resurgence of yellow fever in Africa and the Americas. The strategy relies on several vaccination activities, including preventive mass vaccination campaigns (PMVCs). However, by how much PMVCs are associated with a decreased risk of outbreak to occur has not yet been quantified. Methods and Findings We used the self-controlled case series (SCCS) method to assess the association between the occurrence of yellow fever outbreaks and the implementation of PMVCs at the province level in the African endemic region. As all time-invariant confounders are implicitly controlled for, the SCCS method is an alternative to classical cohort or case-control study designs when the risk of residual confounding is high, in particular confounding by indication. The location and dates of outbreaks were identified from international epidemiological records, and information on PMVCs was provided by coordinators of vaccination activities and international funders. The study sample consisted of provinces that were both affected by an outbreak and targeted for a PMVC between 2005 and 2018. We compared the relative incidence of outbreaks before and after the implementation of a PMVC. The sensitivity of our estimates to a range of assumptions was explored, and the results of the SCCS method were compared to those obtained through a retrospective cohort study design. We further derived the number of yellow fever outbreaks that have been prevented by PMVCs. The study sample consisted of 33 provinces from 11 African countries. Among these, outbreaks occurred during the pre-PMVC period in 26 (79%) provinces versus 7 (21%) occurring in the post-PMVC period. At the province level, the post-PMVC period was associated with a 86% reduction (95% Confidence interval 66% to 94%, p-value A limitation of our study is the fact that it does not account for potential time-varying confounders, such as changing environmental drivers of yellow fever or possibly improved disease surveillance. Conclusion In this study, we provide new empirical evidence of the high preventive impact of PMVCs on yellow fever outbreaks. This study illustrates that the SCCS method can be advantageously applied at the population level in order to evaluate a public health intervention. AUTHOR SUMMARY Why Was This Study Done? Yellow fever is a mosquito-borne vaccine-preventable disease that may cause large urban outbreaks, especially in tropical African regions. Since 2006, Preventive Mass Vaccination Campaigns (PMVCs) have been implemented in many African provinces. These are large scale vaccination campaigns targeting all or most age group in a specific area. The preventive impact PMVCs may have on the risk of yellow fever outbreak has not been quantified yet. What Did the Researchers Do and Find? We used the self-controlled case series (SCCS) method to assess the association between PMVCs and outbreak risk at the province level over 34 African countries between 2005 and 2018. Using this method, we compared pre- and post-PMVC period are compared within each province individually, thus controlling for all possible confounders that do not vary in time, especially the fact that provinces indicated for PMVCs are generally those considered at highest baseline risk of yellow fever (ie confounding by indication). At the province level, we estimated that implementation of PMVCs was associated with an 86% reduction (66% to 94%) in the risk of yellow fever outbreak. Results from a complete cohort analysis provided less reliable results than the SCCS method, likely because of confounding by indication that was not entirely controlled for by adjusting on known drivers of yellow fever. We further estimated that all PMVCs conducted between 2006 and 2018 in Africa may have reduced the total number of yellow fever outbreaks by 34% (22% to 45%). What Do These Findings Mean? These results provide new empirical evidence of the high preventive impact of PMVCs on yellow fever outbreaks. These results may encourage rapid re-scheduling of yellow fever PMVCs that have been postponed due to the COVID-19 pandemic. The SCCS design may be advantageously applied at the population level to assess the impact of public health interventions.

BackgroundThe unprecedented public health impact of the COVID-19 pandemic has motivated a rapid search for potential therapeutics, with some key successes. However, the potential impact of different treatments, and consequently research and procurement priorities, have not been clear.Methods and FindingsWe develop a mathematical model of SARS-CoV-2 transmission, COVID-19 disease and clinical care to explore the potential public-health impact of a range of different potential therapeutics, under a range of different scenarios varying: i) healthcare capacity, ii) epidemic trajectories; and iii) drug efficacy in the absence of supportive care. In each case, the outcome of interest was the number of COVID-19 deaths averted in scenarios with the therapeutic compared to scenarios without. We find the impact of drugs like dexamethasone (which are delivered to the most critically-ill in hospital and whose therapeutic benefit is expected to depend on the availability of supportive care such as oxygen and mechanical ventilation) is likely to be limited in settings where healthcare capacity is lowest or where uncontrolled epidemics result in hospitals being overwhelmed. As such, it may avert 22% of deaths in high-income countries but only 8% in low-income countries (assuming R=1.35). Therapeutics for different patient populations (those not in hospital, early in the course of infection) and types of benefit (reducing disease severity or infectiousness, preventing hospitalisation) could have much greater benefits, particularly in resource-poor settings facing large epidemics.ConclusionsThere is a global asymmetry in who is likely to benefit from advances in the treatment of COVID-19 to date, which have been focussed on hospitalised-patients and predicated on an assumption of adequate access to supportive care. Therapeutics that can feasibly be delivered to those earlier in the course of infection that reduce the need for healthcare or reduce infectiousness could have significant impact, and research into their efficacy and means of delivery should be a priority.

Background Insurance-mandated precertification requirements are barriers to bariatric surgery. The value of their prescription, based on insurance type rather that the clinical necessity, is unclear. Objectives To determine whether there is an association between insurance-mandated precertification criteria for bariatric surgery and short-term inpatient healthcare utilization. Setting Pennsylvania Health Care Cost Containment Council's inpatient care databases for the years 2016-2017. Methods The study included 2717 adults who underwent bariatric surgery in Southeastern Pennsylvania in 2016. Postoperative length of stay and rehospitalizations for these individuals were followed using clinical and claims data during the first year after bariatric surgery. Results The requirements for 3- to 6-month preoperative medical weight management, as well as pulmonology and cardiology examinations, were not associated with the patient length of stay, number of all-cause rehospitalizations, or number of all-cause rehospitalization days after adjusting for patient age, sex, race, ethnicity, the Elixhauser comorbidity score, type of the surgery, facility where the surgery was performed, primary payer type, and the estimated median household income. Among commercially insured individuals (n = 1499), the mean number of all-cause rehospitalizations during the study period was lower in patients with no medical weight management requirement by a factor of .57 (lower by 43.1%; 95% confidence interval, .35-.94, P = .03) and higher in patients with no requirement for preoperative cardiology and pulmonology evaluations by a factor of 2.09 (95% confidence interval 1.09-4.02, P = .03). Conclusion The findings suggest that the precertification requirement for preoperative medical weight management is not associated with a reduction in inpatient healthcare utilization in the first postoperative year.

Background Long-term durability of weight loss is a prerequisite for a greater acceptance of bariatric surgery. Objective To examine long-term weight trajectory in patients undergoing Roux-en-Y gastric bypass (RYGB) and determine factors predicting long-term follow-up and weight outcomes. Setting University Hospital. Methods A retrospective cohort of adults who underwent RYGB during 1997-2010 were identified and followed until 2017. Predictors for attendance at periodic follow-up visits, reduction in body mass index (BMI), and percent excess BMI lost were determined using multivariable logistic regression and linear mixed-effects models. The latter was used to predict long-term weight outcomes for a typical patient. Results The study included 1,104 patients with a mean age of 45.5 (standard deviation, SD, 9.9) years and a pre-operative BMI of 54.7 (SD 10.9) kg/m2. Follow-up data were available for 92.8% of the patients after 1 year, 50.0% after 5 years, and 35.2% after 10 years post-surgery. Black patients, compared to White individuals, were less likely to attend follow-up visits. Attendance at follow-up visits at least every other year was not associated with larger weight loss, but higher pre-operative BMI, being White (vs. Black), and female sex were. Predicted BMI reduction for a typical patient, a 45-year-old White female with a pre-operative BMI of 54.7 kg/m2 and private health insurance, undergoing laparoscopic RYGB in 2004, was 18.3 (standard error, SE, 0.36) kg/m2 at year 5 and 17.6 (SE 0.49) kg/m2 at year 10, respectively. Conclusions RYGB results in clinically significant and durable weight loss. Attendance at periodic follow-up visits does not appear to be associated with long-term weight loss outcomes. Future work should focus on strategies to remove barriers to post-operative care.

IntroductionNon-pharmaceutical interventions (NPIs) are a crucial suite of measures to prevent and control infectious disease outbreaks. They are particularly important for crisis-affected populations that typically reside in settings characterised by overcrowding, inadequate access to healthcare and resource limitations. To describe the landscape of research and identify evidence gaps concerning the acceptability, feasibility, and effectiveness of NPIs among crisis-affected populations and informal settings, we conducted a systematic scoping review of the published evidence.MethodsWe systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility, acceptability, and effectiveness of NPIs in crisis-affected populations and informal settlements. We performed quality assessments of each study using a standardised questionnaire.ResultsOur review included 158 studies published in 85 peer-reviewed articles. Most research used low quality study designs. The acceptability, feasibility, and effectiveness of NPIs was highly context dependent. In general, simple and cost-effective interventions such as community-level environmental cleaning and provision of water, sanitation and hygiene services, and distribution of items for personal protection such as insecticide-treated nets, were both highly feasible and acceptable. Logistical, financial, and human resource constraints affected both the implementation and sustainability of measures. Community engagement emerged as a strong factor contributing to the effectiveness of NPIs. Conversely, measures that involve potential restriction on personal liberty such as case isolation were found to be less acceptable to the community.ConclusionOverall, the evidence base was patchy, with substantial knowledge gaps between differing between settings and pathogens. Although implementation of NPIs presents unique practical challenges, it is critical that the lessons learned are shared with the wider community to build a robust evidence base.Summary boxWhat is already known?- NPIs are a crucial suite of tools for the prevention and control of infectious diseases, either as a complement to, or in the absence of, effective pharmaceutical interventions (i.e., therapeutics and vaccination).- Despite being disproportionately vulnerable, crisis-affected populations and those living in informal settlements are often neglected by research and guidance. NPIs are, however, vital and adaptation is necessary within these settings due to poor living conditions and resource limitations that intensify disease transmission risk.What are the new findings?- We conducted a scoping review to produce a landscape analysis of the existing evidence concerning NPIs within crisis-affected settings and informal settlements.- The existing evidence is patchy, uneven, occasionally contradictory, and of generally low quality, but building over time.- Although limited, some findings are generalisable across settings, populations and NPIs.What do the new findings imply?- There is a need for greater investments in research to strengthen the guidance and policies on NPIs in these settings.- In particular, upstream pilot feasibility and acceptability studies should be conducted prior to the widespread roll-out of interventions to ensure they are feasible, acceptable, and ultimately effective for the target populations.

The application of emerging technologies and robotics incites the growth of productivity on repetitive and exhaustive tasks. An example of emerging technology is the Unmanned Aerial Systems (UAS). It presents opportunities to contribute and carry out urban planning tasks in less time and risks. However, the field of UAS is still under development by the challenge of regulation and UAS capabilities. Therefore, a case study is presented to illustrate the process of UAS data collection to make better decisions in urban communities.

Yellow fever virus (YFV) is a zoonotic arbovirus affecting both humans and non-human primates (NHP’s) in Africa and South America. Previous descriptions of YF’s seasonality have relied purely on climatic explanations, despite the high proportion of cases occurring in people involved in agriculture. We use a series of random forest classification models to predict the monthly occurrence of YF in humans and NHP’s across Brazil, by fitting four classes of covariates related to the seasonality of climate and agriculture (planting and harvesting), crop output and host demography. We find that models captured seasonal YF reporting in humans and NHPs when they considered seasonality of agriculture rather than climate, particularly for monthly aggregated reports. These findings illustrate the seasonality of exposure, through agriculture, as a component of zoonotic spillover. Additionally, by highlighting crop types and anthropogenic seasonality, these results could directly identify areas at highest risk of zoonotic spillover., Yellow fever virus (YFV) is an arbovirus affecting humans and non-human primates (NHPs) with seasonal transmission. Here Hamlet et al. model the monthly occurrence of YF in humans and NHPs across Brazil and show that seasonality of agriculture is an important predictor of seasonal YF transmission.

The implementation of UAS is bringing easiness and time saving activities into the currently construction site task. In the construction industry, diverse and relevant benefits of the technology have been identified through the project life cycle, such as monitoring project progress report, faster and low-cost land measurements and 3D modelling. Currently, the most valuable benefits of the UAS in the construction industry are related to automation the construction process, low cost, greater speed and safer real-time data collection compare with the traditional methods, and a reliable replacement over satellites and manned vehicles in terms of high-resolution images. However, there is a lack of exemplification and clarity of the actual implementation of the UAS in the construction industry in terms of adoption process and impacted usage. Therefore, a systematic literature review was carried out in order to explore the literature available of the topic related to implementation of unmanned aerial system in the construction industry, the most relevant tasks, cases, areas of usage and the reasons of applying it. The finding of this paper is providing exemplification models of current usage such as visualisation and disaster management, evolution map of the UAS according to the publication numbers and construction project stages when to use the UAS.

Objective In the 50 years since a premature partial physeal arrest (a physeal bar) was first excised from an epiphysis there have been no large in-depth studies reporting the results in patients followed to skeletal maturity. This paper reports the results of physeal bar resection surgery in a group of patients followed to skeletal maturity, documenting the restored growth of the affected physis, the affected bone, and the final limb-length discrepancy. Methods Forty-eight patients underwent physeal bar resection of the distal femur (21), proximal tibia (9), and distal tibia (18) by 1 surgeon (H.A.P.) from 1968 through 1996, and were followed prospectively to skeletal maturity with clinical and radiologic examinations. Factors such as sex, age at time of injury, etiology of the bar, physeal bar location and size, age at time of bar excision, interposition material, and additional surgical procedures were analyzed with respect to physis, bone, and limb growth following bar resection. Results The mean growth for the entire bone following physeal bar excision was 7.6 cm for the distal femur, 4.7 cm for the proximal tibia, and 7.5 cm for the distal tibia, compared with growth in the contralateral control bone of 6.8 cm in the femur, 5.0 cm in the proximal tibia, and 7.8 cm in the distal tibia. The maximum bone growth following bar excision in a single patient was 21.3 cm for the distal femur, 10.3 cm for the proximal tibia, and 18.6 cm for the distal tibia. The mean limb-length discrepancy at maturity was -1.7 cm for the distal femur, -1.3 cm for the proximal tibia, and -1.1 cm for the distal tibia (all sites combined -1.4 cm). Fourteen patients (29%) had only the 1 bar excision with no other accompanying or subsequent surgery. Thirty-four patients (71%) had 1 to 4 accompanying or subsequent leg length or angular correcting procedures. Conclusions Physeal bar excision to restore growth when applied to the appropriate patient is a useful, rewarding procedure, reducing the number of surgical limb length equalizing procedures. It is a demanding surgical procedure and requires diligent and careful follow-up until maturity. Additional limb length equalizing surgery is frequently needed. Level of evidence Case series, level IV.

Aim To evaluate the influence of systemic zoledronate administration on the osseointegration of titanium implants with different surface topography in rat maxillae. Methods Twenty Sprague‐Dawley rats were divided into two groups—test (bisphosphonate) and control (healthy). Bisphosphonate administration began three weeks prior to implant placement, and the animals received zoledronate (66 μg/kg) three times per week. Forty endosseous implants with a moderately rough (20 implants) or a turned surface (20 implants) were immediately placed bilaterally into extraction sockets of maxillary first molars. Animals were sacrificed after 14 and 28 days of healing, and en bloc specimens were harvested for histological and histomorphometric analysis. Osseointegration was quantified by measuring the percentage of bone‐to‐implant contact. Results Bone‐to‐implant contact (BIC) (mean ± SD) values of moderately rough and turned implants at day 14 in test group were 17.62 ± 6.68 and 10.69 ± 1.48, respectively, while in the control group, they were 46.36 ± 5.08 and 33.29 ± 8.89, respectively. At day 28, BIC values of moderately rough and turned implants in the test group were 25.94 ± 7.87 and 7.83 ± 4.30, respectively, while in the control group, they were 72.99 ± 6.60 and 47.62 ± 18.19, respectively. Statistically significant higher BIC values were measured on moderately rough implants compared to turned implants at 28 days, and the control group compared to the test group for both implant surfaces. Histological observations for the control and the test groups demonstrated initial bone formation around moderately rough implants not only on the surface of the parent bone, as was the case with the turned surfaced implants, but also along the implant surface itself. Conclusions Systemic zoledronate administration negatively influences osseointegration. Osseointegration was enhanced adjacent to moderately rough compared to turned implants in both the presence and absence of systemic zoledronate administration. Therefore, topographical surface modification may partially offset the negative impact of zoledronate administration.

The use of untrusted design tools, components, and designers, coupled with untrusted device fabrication, introduces the possibility of malicious modifications being made to integrated circuits (ICs) during their design and fabrication. These modifications are known as hardware trojans. The widespread use of commercially purchased 3rd party intellectual property (3PIP) and commercial design tools extends even into trusted design flows. Unfortunately, due to the theoretical result that there is no program that can decide whether any other program will eventually halt, we know that the properties of a program, or circuit, cannot be known in advance of running it. While we can design a circuit to meet some functional specification and generate a simulation or test suite to obtain at least probabilistic confidence that the circuit implements the intended functionality, we cannot test a circuit for unintended functionality due to the combinatorially large state space. To address these concerns, we have developed a design-time method for automatically and systematically modifying portions of a design that exhibit characteristics of hardware trojans. After each modification, the functionality of the design is verified against a comprehensive simulation suite to ensure that the intended circuit functionality has not been changed. This approach can be applied to any digital circuit and does not rely on secret keys or obfuscation.

Background Information about the role of auditory input and motor control is limited. Objectives Assessment the relationship between auditory and vestibular information with specific motor and cognitive functions. Methods Posturography in 17 Pre-lingual Cochlear Implant Adolescents, (PCIA) age 14.06 ± 3.05 in four sensory conditions was analyzed: (A) eyes open, cochlear implant (CI) on, (B) eyes open, CI off, (C) eyes closed standing on a foam over a platform (ECFP) with CI on, and (D) ECFP, CI off. Gait velocity (GV) was registered by inertial sensors using a 10-meter test. Vestibulo-ocular reflex (VOR) was evaluated with the video head impulse test (VHIT) and visual spatial skill (VS) assessed with the WISC-V test. Results SV had no significant difference between conditions A and B (p = .2461). Comparing C and D, SV values decreased when CI was turned on (p = .0036). A significant linear relationship between VOR and GV (p = .0064) generating the VOR gain loss lower gait. Relationship between VOR and VS scores was no significant (p = .685). Conclusions and significance Auditory information is a relevant cue when somatosensory and visual inputs are modified and range of vestibular function influence in a dynamic motor activity as gait, facts which must be considered in the neurodevelopment control.

Despite the effectiveness of bariatric surgery, both with respect to weight loss and improvements in obesity-related co-morbidities, it remains underused. Only 1% of the currently eligible population undergoes surgical treatment for obesity, with roughly 228,000 individuals receiving bariatric surgery in the United States each year. Several barriers to bariatric surgery have been identified, including limited patient and referring physician knowledge and attitudes regarding the effectiveness and safety of bariatric surgery. However, the role of insurance coverage and benefit design as a barrier to access to care has received less attention to date. Bariatric surgery is cost-effective compared with nonsurgical treatments among individuals with extreme obesity and type 2 diabetes. While it may not result in cost savings among all bariatric surgery eligible patients, for certain patient subgroups, bariatric surgery may be cost neutral compared with traditional treatment options. In addition, longer-term outcomes of bariatric surgery suggest decreased or stable costs in the long run. The purpose of this review paper was to synthesize the existing knowledge on why bariatric surgery remains largely underused in the United States with a focus on health insurance benefits and design. In addition, the review discusses the applicability of value-based insurance design to bariatric surgery. Value-based insurance design has been previously applied to bariatric surgery coverage with use of incentive-based cost-sharing adjustments. Its application could be further extended because the postoperative clinical outcomes and costs vary among the different subgroups of bariatric surgery eligible patients.

Despite the potential negative impact of facial palsy, major gaps in understanding persist surrounding the treatment and care of those affected. This collaborative three-round Delphi process aimed to identify priorities for future facial palsy research, from the perspective of clinicians, researchers, patients and carers. It also determined whether the research priorities of patients and carers aligned with those of health professionals and researchers. In Round 1, participants (n = 85) were asked to generate research questions by focus groups or an online or postal survey. In Rounds 2 (n = 72) and 3 (n = 78), participants were asked to rate the priorities identified on a 5-point ordinal scale. Thirty-six questions reached the definition of 'high priority' consensus. Seven of each groups' top ten research priorities were shared. Prioritised questions included the provision and pathways of care, the psychosocial impact of living with facial palsy and the effective management of side effects. Establishing the research priorities in the field of facial palsy is a significant first step in ensuring that the future research agenda is focussed on topics that are considered important by both patients and health professionals.

Recent literature suggests that suppressed bone healing and angiogenesis contributes significantly to the pathogenesis of Medication induced osteonecrosis of jaws (MRONJ), a complex condition commonly associated with anti-resorptive agents. This in vitro study evaluated the effect of locally delivered angiogenic growth factor (VEGF165) with or without osteogenic growth factor (BMP-7) to enhance bone healing, thereby preventing the occurrence of MRONJ. A chemically defined hydrogel (HyStem-HP, Glycosan Biosciences) containing a combination of thiolmodified hyaluronan, heparin and denatured collagen was crosslinked with thiol-reactive, PEGDA. To establish the in vitro release kinetics, 100 and 200 ng of rat VEGF165 (Biovision) or BMP-7 (250 and 500 ng/mL) was loaded into a 500 lL hydrogel prior to crosslinking (Hystem-HP).

To analyze in-hospital complications in patients with acute ST-elevation myocardial infarction (STEMI) depending on renal function.Observational study in patients with STEMI.The study included 169 patients undergoing primary percutaneous coronary intervention. In all patients glomerular filtration rate (GRF) was calculated using the Modification of Diet in Renal Disease Study (MDRD) equation. Of these patients, 84 had a GFR ≥ 90 ml/min/1.73 m2 (Group 1) and 85 90 ml/min/1.73 m2 (Group 2). Other parameters in both groups were comparable. Study groups were followed to compare Killip class 2 acute heart failure, in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation, new onset atrial fibrillation, and high grade atrioventricular block. All patients were treated according to European Society of Cardiology (ESC) guidelines for the management of acute myocardial infarction in patients presenting with ST elevation.Mean GFR in Group 1 was 107.6 [Formula: see text] and in Group 2 75.3 [Formula: see text] 11.2 (p 0.0001). The incidence of atrial fibrillation was higher in Group 2: in Group 1 and Group 2 the atrial fibrillation rate was 1.12% (one of 84) vs 8.24% (seven of 85) (p = 0.031), respectively. Group 1 revealed significantly lower rates of acute heart failure (Killip class 2): in Group 1 and Group 2 0% (0 of 84 patients) vs 5.88% (five of 85 patients) (p = 0.024), respectively. The authors found no significant differences for other complications: in Group 1 and Group 2 ventricular tachycardia or ventricular fibrillation was 4.76% (four of 84 patients) vs 5.89% (five of 85 patients) (p = 0.75), high grade atrioventricular block was 2.38% (two of 84 patients) vs 4.71% (four of 85 patients) (p = 0.41), and the in-hospital pneumonia rate was 2.38% (two of 84 patients) vs 4.71% (four of 85 patients) (p = 0.41), respectively.Patients with lower GFR were more likely to suffer from in-hospital acute heart failure (Killip class 2) and atrial fibrillation in STEMI despite primary percutaneous coronary intervention. Renal function did not affect in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation rates. The evaluation of kidney function through GFR in STEMI patients may make in-hospital complications more predictable.HINTERGRUND: Die sich stationär bei Patienten mit akutem ST-Hebungsinfarkt (STEMI [„ST-elevation myocardial infarction“]) ereignenden Komplikationen wurden bezüglich ihrer Abhängigkeit von der Nierenfunktion analysiert.Es handelte sich um eine Beobachtungsstudie bei STEMI-Patienten.In die Studie wurden 169 Patienten, die einer primären perkutanen koronaren Intervention unterzogen worden waren, eingeschlossen. Bei allen Probanden wurde die glomeruläre Filtrationsrate (GFR) mittels der Gleichung der MRDR-Studie (MDRD: „modification of diet in renal disease“) ermittelt. Von ihnen hatten 84 eine GFR ≥ 90 ml/min/1,73 m2 (Gruppe 1) und 85 eine GFR 90 ml/min/1,73 m2 (Gruppe 2). Andere Parameter beider Gruppen waren vergleichbar. Die Studiengruppen wurden bezüglich der Häufigkeit des Auftretens von akuter Herzinsuffizienz (Killip-Klasse 2), im Krankenhaus auftretender Pneumonie, pulsloser ventrikulärer Tachykardie oder Kammerflimmern, neu auftretendem Vorhofflimmern und hochgradigem atrioventrikulärem (AV) Block verglichen. Alle Patienten wurden nach den ESC-Leitlinien (ESC: „European Society of Cardiology“) zum Management des akuten Myokardinfarkts bei ST-Hebung behandelt.Die mittlere GFR in Gruppe 1 bzw. 2 war 107,6 [Formula: see text] bzw. 75,3 [Formula: see text]11,2 (p 0,0001). Die Inzidenz von Vorhofflimmern war in Gruppe 2 höher: In Gruppe 1 betrug diese 1,12 % (1 von 84), in Gruppe 2 8,24 % (7 von 85; p = 0,031). Bei den Probanden von Gruppe 1 kam es signifikant seltener zur akuten Herzinsuffizienz (Killip-Klasse 2): In Gruppe 1 trat diese bei 0 % (0 von 84 Patienten) auf vs. 5,88 % (5 von 85 Patienten) in Gruppe 2 (p = 0,024). Für die anderen Komplikationen wurden keine signifikanten Unterschiede festgestellt: Ventrikuläre Tachykardie oder Kammerflimmern traten in Gruppe 1 bei 4,76 % (4 von 84 Patienten), in Gruppe 2 bei 5,89 % (5 von 85 Patienten) auf (p = 0,75), ein hochgradiger AV-Block bei 2,38 % (2 von 84 Patienten) vs. 4,71 % (4 von 85 Patienten; p = 0,41), und stationär eine Pneumonie wurde bei 2,38 % (2 von 84 Patienten) bzw. 4,71 % (4 von 85 Patienten) beobachtet (p = 0,41).Bei Patienten mit STEMI und niedriger GFR kam es trotz primärer perkutaner koronarer Intervention eher zur akuten Herzinsuffizienz (Killip-Klasse 2) im Krankenhaus und Vorhofflimmern. Die Häufigkeiten des Auftretens von Pneumonie im Krankenhaus, pulsloser ventrikulärer Tachykardie oder Kammerflimmern waren nicht mit der Nierenfunktion assoziiert. Die Beurteilung der Nierenfunktion mittels GFR-Bestimmung bei STEMI-Patienten kann das Auftreten von Komplikationen im Krankenhaus vorhersehbarer machen.

The worldwide endeavour to develop safe and effective COVID-19 vaccines has been extraordinary, and vaccination is now underway in many countries. However, the doses available in 2021 are likely to be limited. We extended a mathematical model of SARS-CoV-2 transmission across different country settings to evaluate the public health impact of potential vaccines using WHO-developed target product profiles. We identified optimal vaccine allocation strategies within- and between-countries to maximise averted deaths under constraints on dose supply. We found that the health impact of SARS-CoV-2 vaccination depends on the cumulative population-level infection incidence when vaccination begins, the duration of natural immunity, the trajectory of the epidemic prior to vaccination, and the level of healthcare available to effectively treat those with disease. Within a country we find that for a limited supply (doses for

In the Caribbean region, there is a significant yearly number of natural events incidents. The impact of those events has affected the well-being, social and economic structures of the countries in this region. The investment in disaster management strategies is a fundamental decision to the region for improving capabilities, understanding the liabilities, dealing with the disaster stages, and integrating systems and tools to obtain greater results in resilience strategies. Therefore, information technology and robotics have played an effective role bringing innovation to the traditional approaches by improving the capabilities of personnel and serving as a catalyst to rapid data collection tools for effective decision-making during disastrous situation, as has been the case of the Dominican Republic. The organic adoption process of Unmanned Aerial System (UAS) has represented a large step forward regarding this matter. Examples of the adoption process occur based on their flexibility in their regulatory context, funding investments in testing the applications of UAS, such as surveying, delivering medical samples and spray disinfection during the COVID-19 pandemic. However, there are only some mature applications that address a future-proofing concept as well as the integration into a typical institutional workflow. Therefore, this paper aims to be an introductory guide for decision and policymakers, educators and technicians to reduce the scepticism, lack of knowledge and know-how in the adoption of reliable, practical and effective tools by providing a combination of theories from socio-technical systems (socio-technical change impact model (SCI)) and organisational level (technology-organisational-environmental) frameworks of the UAS adoption process for natural events, tasks and critical roles in disaster management taking into account the Dominican Republic context. Qualitative case of study was evaluated from 7 organisations involved to disaster management in the Dominican Republic, and a semi-structured interview were used to approach the adoption process of Unmanned Aerial System (UAS) in these organisations. The findings of these studies reveal the lessons learned from the internal strategies and policies in the adoption process between public and private institutions. The task of capturing images and videos has been shown to be a faster way to acquire data, which allow infrastructure projects to tend to be a significant benefit at the moment of applying UAS for 3D reconstructions and simulations of seismic behaviour, and finally, identification of inaccessible vulnerable areas after disasters. Other tasks, such as search and rescue, are also mentioned. Recommendations for policymakers are related to establish guidance for learning organisations approaches on focusing on digitalisation of cities through UAS applications. Other context can be benefit from the lessons and can also beas an additional complement of the Regional Comprehensive Disaster Management Framework of 2014–2024.

Background The Eliminate Yellow fever Epidemics (EYE) strategy was launched in 2017 in response to the resurgence of yellow fever in Africa and the Americas. The strategy relies on several vaccination activities, including preventive mass vaccination campaigns (PMVCs). However, to what extent PMVCs are associated with a decreased risk of outbreak has not yet been quantified. Methods and findings We used the self-controlled case series (SCCS) method to assess the association between the occurrence of yellow fever outbreaks and the implementation of PMVCs at the province level in the African endemic region. As all time-invariant confounders are implicitly controlled for in the SCCS method, this method is an alternative to classical cohort or case–control study designs when the risk of residual confounding is high, in particular confounding by indication. The locations and dates of outbreaks were identified from international epidemiological records, and information on PMVCs was provided by coordinators of vaccination activities and international funders. The study sample consisted of provinces that were both affected by an outbreak and targeted for a PMVC between 2005 and 2018. We compared the incidence of outbreaks before and after the implementation of a PMVC. The sensitivity of our estimates to a range of assumptions was explored, and the results of the SCCS method were compared to those obtained through a retrospective cohort study design. We further derived the number of yellow fever outbreaks that have been prevented by PMVCs. The study sample consisted of 33 provinces from 11 African countries. Among these, the first outbreak occurred during the pre-PMVC period in 26 (79%) provinces, and during the post-PMVC period in 7 (21%) provinces. At the province level, the post-PMVC period was associated with an 86% reduction (95% CI 66% to 94%, p < 0.001) in the risk of outbreak as compared to the pre-PMVC period. This negative association between exposure to PMVCs and outbreak was robustly observed across a range of sensitivity analyses, especially when using quantitative estimates of vaccination coverage as an alternative exposure measure, or when varying the observation period. In contrast, the results of the cohort-style analyses were highly sensitive to the choice of covariates included in the model. Based on the SCCS results, we estimated that PMVCs were associated with a 34% (95% CI 22% to 45%) reduction in the number of outbreaks in Africa from 2005 to 2018. A limitation of our study is the fact that it does not account for potential time-varying confounders, such as changing environmental drivers of yellow fever and possibly improved disease surveillance. Conclusions In this study, we provide new empirical evidence of the high preventive impact of PMVCs on yellow fever outbreaks. This study illustrates that the SCCS method can be advantageously applied at the population level in order to evaluate a public health intervention., In this cohort study, Kévin Jean and colleagues correlate lower risk of disease outbreaks with mass vaccination against yellow fever., Author summary Why was this study done? Yellow fever is a mosquito-borne, vaccine-preventable disease that may cause large urban outbreaks, especially in tropical African regions. Since 2006, preventive mass vaccination campaigns (PMVCs) have been implemented in many African provinces. These are large-scale vaccination campaigns targeting all or most age groups in a specific area. The preventive impact PMVCs may have on the risk of yellow fever outbreak has not been quantified yet. What did the researchers do and find? We used the self-controlled case series (SCCS) method to assess the association between PMVCs and outbreak risk at the province level in 34 African countries between 2005 and 2018. We compared pre- and post-PMVC periods within each province individually, thus implicitly controlling for all possible confounders that do not vary in time, especially the fact that provinces indicated for PMVCs are generally those considered at highest baseline risk of yellow fever (confounding by indication). At the province level, we estimated that implementation of PMVCs was associated with an 86% reduction (95% CI 66% to 94%) in the risk of yellow fever outbreak. A complete cohort analysis provided less reliable results than the SCCS method, likely because of confounding by indication that was not entirely controlled for by adjusting for known drivers of yellow fever. We further estimated that all PMVCs conducted between 2006 and 2018 in Africa may have reduced the total number of yellow fever outbreaks by 34% (95% CI 22% to 45%). What do these findings mean? These results provide new empirical evidence of the high preventive impact of PMVCs on yellow fever outbreaks. These results may encourage rapid rescheduling of yellow fever PMVCs that have been postponed due to the COVID-19 pandemic. The SCCS design may be advantageously applied at the population level to assess the impact of public health interventions.

Background Bariatric surgery is underutilized in the United States. Objective To examine temporal changes in patient characteristics and insurer type mix among adult bariatric surgery patients in southeastern Pennsylvania and to investigate the associations between payor type, insurance plan type, cost-sharing arrangements (among traditional Medicare beneficiaries), and bariatric surgery utilization. Setting Pennsylvania Health Care Cost Containment Council's databases in southeastern Pennsylvania during 2014-2018. Methods All adult patients who underwent the most common types of bariatric surgery and a 1:1 matched sample of surgery patients and those who were eligible for surgery but did not undergo surgery were identified. Contingency tables, Pearson χ2 tests, and logistic regression were used for statistical analysis. Results Over the 5 years, there was an increase in the proportion of Black individuals (37.1% in 2014 versus 43.0% in 2018), Hispanics (5.4% versus 8.0%), and Medicaid beneficiaries (19.2% in 2014 versus 28.5% in 2018) who underwent surgery. The odds of undergoing bariatric surgery based on payor type only between Medicare beneficiaries were statistically different (22% smaller odds) compared with privately insured individuals. There were significantly different odds of undergoing surgery based on insurance plan type within Medicare and private insurance payor categories. Individuals with traditional Medicare plans with no supplementary insurance and those with dual eligibility had smaller odds of undergoing surgery (42% and 32%, respectively) compared with those with private secondary insurance. Conclusions Insurance plan design may be as important in determining the utilization of bariatric surgery as the general payor type after controlling for confounding socio-demographic factors.

In response to the COVID-19 pandemic, countries have sought to control SARS-CoV-2 transmission by restricting population movement through social distancing interventions, thus reducing the number of contacts. Mobility data represent an important proxy measure of social distancing, and here, we characterise the relationship between transmission and mobility for 52 countries around the world. Transmission significantly decreased with the initial reduction in mobility in 73% of the countries analysed, but we found evidence of decoupling of transmission and mobility following the relaxation of strict control measures for 80% of countries. For the majority of countries, mobility explained a substantial proportion of the variation in transmissibility (median adjusted R-squared: 48%, interquartile range - IQR - across countries [27–77%]). Where a change in the relationship occurred, predictive ability decreased after the relaxation; from a median adjusted R-squared of 74% (IQR across countries [49–91%]) pre-relaxation, to a median adjusted R-squared of 30% (IQR across countries [12–48%]) post-relaxation. In countries with a clear relationship between mobility and transmission both before and after strict control measures were relaxed, mobility was associated with lower transmission rates after control measures were relaxed indicating that the beneficial effects of ongoing social distancing behaviours were substantial., Social distancing policies aiming to reduce COVID-19 transmission have been reflected in reductions in human mobility. Here, the authors show that reduced mobility is correlated with decreased transmission, but that this relationship weakened over time as social distancing measures were relaxed.

Objectives Facial palsy (FP) is a highly visible appearance-affecting condition and can have a significant impact on facial function. Qualitative research focussing on adults' experiences of living with acquired FP is limited. This study aimed to explore the psychosocial impact of acquired FP and to gain a greater understanding of patients' experiences of treatment and care in the United Kingdom. Design A qualitative interview study with individuals living with acquired FP. Methods Ten adults with acquired FP were recruited. Their experiences were explored using semi-structured telephone interviews. Data were analysed using thematic analysis. Results Five master themes were identified through the thematic analysis: 1) grappling with a new identity, 2) the psychosocial impact of living with facial palsy, 3) isolation: dealing with 'one hell of a problem on your own', 4) a life on hold, 5) coping strategies. Findings indicated high levels of distress and significant challenges in managing the functional and psychosocial changes associated with acquiring FP. Participants expressed grief for their former appearance and identity, with photographs and mirrors acting as agonizing reminders. Many reported a sense of abandonment due to uncoordinated care and, as a result, engaged in an endless and often fruitless pursuit to gain control over FP by experimenting with their own treatment. Many reported the negative impact of their altered facial expressions on social interactions and a fear of being negatively evaluated. Conclusions This study highlights a pressing need to review how FP is managed in the UK. To improve patient well-being, health care professionals could benefit from FP education, and patients from timely access to psychological support and clearer standards of care following diagnosis.