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Emotion dysregulation frequently co-occurs with chronic pain, which in turn leads to heightened emotional and physical suffering. This cycle of association has prompted a recommendation for psychological treatment of chronic pain to target mechanisms for emotion regulation. The current trial addressed this need by investigating a new internet-delivered treatment incorporating emotional skills training from dialectical behavioural therapy (DBT). Using a single-case experimental design that is suited to heterogeneous populations and can demonstrate efficacy with a small sample, three participants with chronic pain were recruited. Participants received four weeks of online DBT skills training (iDBT-Pain intervention) which incorporated one-on-one sessions over Zoom and a web app. Results revealed compelling evidence for the intervention on the primary outcome of emotion dysregulation and were promising for the secondary outcome of pain intensity. Improvement was also identified on pre-and post-measures of depression, coping behaviours, sleep problems, wellbeing, and harm avoidance, indicating that the intervention may positively influence other factors related to chronic pain. Overall, the trial provides preliminary efficacy for the intervention to improve chronic pain. However, we recommend further investigation of the iDBT-Pain intervention, either in single case trials, which when conducted with scientific rigour may be aggregated to derive nomothetic conclusions, or in a group-comparison trial to compare with usual modes of treatment. Perspective: This trial advances understanding of emotion-focused treatment for chronic pain and provides evidence for a viable new technological treatment. Importantly, as an internet-delivered approach, the iDBT-Pain intervention is accessible to those with restricted mobility and remote communities where there are often limited psychological services for people with chronic pain. Trial registration: The trial was registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12620000604909)

Pacemaker endocarditis is rare and symptoms may be misleading. If missed, it carries significant morbidity and mortality, particularly in the elderly. Advances in multi-modality imaging in recent years have emphasised its role in clinical decision making. This case highlights the ability of multi-modality imaging techniques to individualise diagnosis, management and prognosis in patients with suspected cardiovascular implantable electronic device (CIED) endocarditis.

Zusammenfassung Hintergrund Regelmäßige Bewegung und spezifisches Training sind wichtige Bausteine in der Therapie rheumatischer Erkrankungen, weil ein gesundheitlicher Nutzen für die Patient*innen nachgewiesen ist. Basierend auf den internationalen Empfehlungen der WHO für Gesunde, geben die „2018 EULAR Empfehlungen zu körperlicher Aktivität von Menschen mit entzündlich-rheumatischen und degenerativen Erkrankungen“ erstmals evidenzbasierte Empfehlungen zu Gestaltung, Durchführung und Implementierung von Bewegungsübungen bei diesen Patient*innen. Ziel Übersetzung ins Deutsche und sprachliche Validierung in Deutschland, Österreich und der Schweiz. Methoden Eine professionelle Übersetzung der EULAR Bewegungsempfehlungen ins Deutsche wurde durch deutschsprachige Experten*innen aus allen 3 Ländern überarbeitet. Die Validierung erfolgte in einem Feldtest mit Rheumatolog*innen, Ergo- und Physiotherapeut*innen, Pflegefachpersonen und medizinischen Fachangestellten aus der Rheumatologie. In den 3 Ländern wurden jeweils 8 strukturierte Interviews zu Verständlichkeit, Wortwahl, Vollständigkeit und Umsetzbarkeit durchgeführt. Die Experten*innen diskutierten die Änderungsvorschläge, bis jeweils ein Konsens erreicht wurde. Zuletzt gaben sie den Grad ihrer Zustimmung zu der finalen Übersetzungsversion an. Ergebnisse Die professionelle Übersetzung wurde substanziell überarbeitet. Aufgrund der Ergebnisse der Feldtests wurden verschiedene Änderungen einzelner Worte sowie Umformulierungen zur besseren Verständlichkeit vorgenommen. Der Grad der Zustimmung lag mit durchschnittlichen Bewertungen zwischen 10 (SD 0,0) und 8,9 (SD 1,5) insgesamt sehr hoch. Diskussion Die vorliegende sprachlich validierte deutschsprachige Version der 2018 EULAR Bewegungsempfehlungen kann und soll dazu beitragen, Fachpersonal darin zu unterstützen, körperliche Aktivität bei Menschen mit entzündlich-rheumatischen und degenerativen Erkrankungen zu fördern.

Objective: A chronic wound fails to progress through the phases of wound healing in an orderly and appropriate process, and poses a major challenge to wound care professionals. Pressure ulcers (PUs) and diabetic foot ulcers (DFUs) are classified as chronic wounds. Antiseptics, such as povidone-iodine (PVP-I), are often used to treat bacterial infections in chronic wounds; however, their efficacy and ability to accelerate wound healing has come into question. As a result, current medical research is now focusing on alternative and natural antiseptic agents, such as honey, for the treatment of chronic wounds. The aim of this study was to analyze the wound healing effects of honey in PU and DFU treatment in comparison to standard antiseptic care. Methods: A systematic literature search of PubMed, ScienceDirect, and ClinicalKey was conducted to identify all published data of clinical trials and narrative reviews that investigated or reported the use of honey and standard antiseptics in the treatment of PUs and DFUs in adults. A keyword search was then performed using the following keywords: “PUs”, “DFUs”, “antiseptics”, “PVP-I”, “honey”, “Manuka honey (MH)”, and “wound healing”. Database restrictions were implemented based on the inclusion and exclusion criteria, notably the report’s availability, completion status and language, the sample populations’ age, as well as, the date of publication. A preferred reporting item for systematic review and meta-analysis (preferred reporting items for systematic reviews and meta-analyzes) diagram was constructed illustrating the study selection process. The eligibility of articles was assessed by the screening of titles, abstracts and full texts. A total of 12 articles were included in this study comprising of 775 patients with PUs, DFUs or a combination of PUs and DFUs. Results: Results indicated that honey reduced bacterial infection, reduced pain and edema experienced by patients, reduced the odor of the wound and promoted wound healing in the treatment of chronic ulcers. Honey was also found to be effective in the process of debridement and exudate removal. Conclusion: Honey was found to be highly effective in the treatment of PUs and DFUs and should be considered as an alternative to standard antiseptic care in the treatment of chronic wounds. However, the literature in this study is limited and so further research into honey and its antiseptic-promoting activity in wound healing is recommended.

Background BNT162b2 is a lipid nanoparticle–formulated, nucleoside-modified RNA vaccine encoding a prefusion-stabilized, membrane-anchored severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) full-length spike protein. BNT162b2 is highly efficacious against coronavirus disease 2019 (Covid-19) and is currently approved, conditionally approved, or authorized for emergency use worldwide. At the time of initial authorization, data beyond 2 months after vaccination were unavailable. Methods In an ongoing, placebo-controlled, observer-blinded, multinational, pivotal efficacy trial, we randomly assigned 44,165 participants 16 years of age or older and 2264 participants 12 to 15 years of age to receive two 30-μg doses, at 21 days apart, of BNT162b2 or placebo. The trial end points were vaccine efficacy against laboratory-confirmed Covid-19 and safety, which were both evaluated through 6 months after vaccination. Results BNT162b2 continued to be safe and have an acceptable adverse-event profile. Few participants had adverse events leading to withdrawal from the trial. Vaccine efficacy against Covid-19 was 91.3% (95% confidence interval [CI], 89.0 to 93.2) through 6 months of follow-up among the participants without evidence of previous SARS-CoV-2 infection who could be evaluated. There was a gradual decline in vaccine efficacy. Vaccine efficacy of 86 to 100% was seen across countries and in populations with diverse ages, sexes, race or ethnic groups, and risk factors for Covid-19 among participants without evidence of previous infection with SARS-CoV-2. Vaccine efficacy against severe disease was 96.7% (95% CI, 80.3 to 99.9). In South Africa, where the SARS-CoV-2 variant of concern B.1.351 (or beta) was predominant, a vaccine efficacy of 100% (95% CI, 53.5 to 100) was observed. Conclusions Through 6 months of follow-up and despite a gradual decline in vaccine efficacy, BNT162b2 had a favorable safety profile and was highly efficacious in preventing Covid-19. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04368728.)

AimTo compare the frequently used CD138 immunohistochemistry-based method of plasma cell quantitation, to a proposed new method, using interobserver and intraobserver concordance parameters.MethodsArchival CD138 immunohistochemically stained slides made from paraffin-embedded bone marrow biopsies of 33 patients with a confirmed diagnosis of multiple myeloma were used. Light microscopic examination was performed using low magnification lenses (10×) for both the overview estimation method (method A) and the new method (method B), and high magnification lenses (50×), for method B only. For method B, reviewers selected three areas with low, intermediate and high plasma cell densities using 10× lenses. Using a well-defined technique, the 50× lens was then used to count plasma cells as a percentage of all nucleated cells. After blinded relabelling of all the slides, the nine reviewers repeated the plasma cell quantitation using both methods. The plasma cell counts were obtained, and the review times were recorded.ResultsOverall intraobserver concordance was comparable for method A (concordance correlation coefficient (CCC)=0.840) and method B (CCC=0.733). Interobserver concordance for method A (intraclass correlation coefficient (ICC)=0.793 and 0.713) and method B (ICC=0.657 and 0.658) indicated high similarity between reviewers. Method A showed poor interobserver concordance (ICC=0.105) at low plasma cell densities.ConclusionsThe new method is comparable to the frequently used overview estimation method in terms of intraobserver and interobserver concordance, and cost. The new method has superior interobserver concordance at low plasma cell densities. The new method appears more amenable to digital scanning and analysis.

The experiences of children are notoriously elusive in the sources on which historians traditionally rely. This paper will discuss several projects in which Trove has expanded the history of childhood in Australia, uncovering a nation-wide trade in children through adoption advertisements, and enriching our knowledge of out-of-home care, and the many inquiries into its failings. Trove has democratised the practice of history – allowing care leavers and abuse survivors to research their own histories – and enabled new avenues for identifying microhistories. However, this article also argues that Trove-focused history without an understanding of context can be misleading.

Awareness about current use of social media in social work and its benefits and drawbacks is lacking. An online questionnaire collected data from a sample of 569 participants within social work across different local authorities. Nearly a third (30%) of participants said that they had used social media to ‘look up’ families they support, while less than half (47%) felt adequately trained in using social media in practice. Participants felt social media helped practice by facilitating communication both with professionals and with service users, but hindered practice by disseminating a negative portrayal of social workers, and by enabling users to identify them online, making them vulnerable. Opinions varied on whether it was acceptable to ‘look up’ families. Results highlighted a digital difference in social work with both age and professional role being influential in the way social media is used. Findings indicated a need for clearer guidance to enable a standardised code of practice, awareness of this guidance needs to be raised and the guidance regularly updated.

Anastomotic leak after colorectal surgery can result in serious morbidity for certain patients. The rate of clinically significant anastomotic leak after colon resection ranges from 1.8% to 11.9%. Risk factors include male sex, steroids, smoking, perioperative blood transfusion, malnutrition, and a low anastomosis. However, the effect of pre-operative chemoradiation therapy (CRT) on rates of anastomotic leak is controversial. Specifically, late leaks, which are defined as those that occur greater than 30 days after surgery, are sparsely described in current literature. Recent evidence suggests that CRT may contribute to the presentation of late anastomotic leaks. In this case series, we report our experience with three patients who received CRT and developed varying presentations of a late anastomotic leak. Therefore, our experience supports the consideration of late anastomotic leaks as a separate entity in colorectal surgery. While pre-operative CRT may increase risk for postoperative anastomotic leak overall, further exploration into the relationship between preoperative CRT and late anastomotic leaks is warranted.

Die Mitglieder der Osterreichischen Gesellschaft fur Rheumatologie (OGR) wurden aufgefordert, die Bedeutung eines stationaren Rehabilitationsaufenthalts fur Patientinnen und Patienten mit axialer Spondylarthritis (SpA; inkl. Morbus Bechterew) in der heutigen Zeit in einer Onlinebefragung zu beurteilen. Als Vergleichsgruppe wurden die Bewertungen von Rehabilitationsexperten des Arbeitskreises (AK) fur Rehabilitation der OGR herangezogen. Zwei Themenblocke wurden ausgearbeitet und zwar 1) betreffend die Relevanz verschiedener Interventionen im Rahmen der Rehabilitation und 2) zum Nutzen der Rehabilitationsmasnahmen hinsichtlich verschiedener Erkrankungszeitpunkte bei SpA. Bei allen Fragen wurde eine 11-teilige Rating Scale (von 0 = trifft gar nicht zu bis 10 = trifft in sehr hohem Mas zu) verwendet. Am hochsten bewerteten beide Gruppen an 1. Stelle die ergo- und physiotherapeutische Bewegungstherapie (9,3 ± 1,2 bzw. 9,6 ± 0,7). Auch Gelenkschutzberatung und Ruckenschule (Rankingplatz 2) sowie Schulung/Information uber die Erkrankung und Therapie (Rankingplatz 3) erwiesen sich im Ranking bei allen als sehr bedeutsam. Auch wurde klar von allen festgehalten, dass Patienten mit Funktionseinschrankung am meisten von einem Rehabilitationsaufenthalt profitieren konnen; direkt nach einem SpA-Schub der Erkrankung wird der Nutzen am geringsten eingestuft. Auch der Nutzen einer regelmasigen Rehabilitation bei SpA im Abstand weniger Jahre wurde hoch bewertet. Insgesamt hat ein Rehabilitationsaufenthalt bei SpA auch in Zeiten moderner medikamentoser Therapieformen immer noch eine grose Bedeutung.

OBJECTIVE To evaluate the effect and safety of topical anti-human vascular endothelial growth factor bevacizumab in dogs with persistent corneal vascularization. ANIMALS STUDIED Prospective case series of 15 adult dogs (20 eyes). PROCEDURES Dogs received 0.25% bevacizumab eye drops BID for 28 days. Follow-ups were scheduled 28 days and 6-7 months after treatment start. Macroscopic findings were scored for conjunctival hyperemia, chemosis, ocular discharge, corneal edema, vascularization, and pigmentation. Vascularized area was assessed by analyzing photographs using an imaging software. RESULTS The treatment response was variable. Some cases showed a marked reduction in vascularized area and edema, while other eyes had subtle signs of improvement. Vascularization score decreased from 1.5 to 1.1 and vascularized area was reduced by 48.8% after 28 days. A thinning of vessels, consolidation of areal bleedings into fine vascular networks, decrease in distal vessel branching, and a change from blurry vascularized beds into demarcated thin vessels were observed. One dog developed a SCCED 6 months after the last bevacizumab administration. Two dogs died 4 and 4.5 months after the last bevacizumab administration, aged 16 and 12 years, respectively. In all events, a causal relationship is unlikely but cannot be ruled out with certainty. CONCLUSIONS Our findings suggest that topical 0.25% bevacizumab may be an effective treatment option for corneal vascularization in dogs. Further long-term placebo-controlled studies with larger patient cohorts are recommended to provide scientific evidence of efficacy and to investigate dosage, safety, possible use as a single treatment, and routes of administration.

Background Little is known about complications after major duodenopancreatic surgery for duodenopancreatic neuroendocrine tumors (dpNETs) in multiple endocrine neoplasia type 1 (MEN1). Therefore, the incidence and severity of complications after major surgery for MEN1-related dpNETs were assessed. Methods Patients were selected from the population-based Dutch MEN1 database if they had undergone a Whipple procedure or total pancreatectomy from 2003 to 2017. Complications were graded according to the Clavien–Dindo classification (grade III or higher complications were considered a severe complication) and definitions from the International Study Group of Pancreatic Surgery. The Cumulative Complication Index (CCI®) was calculated as the sum of all complications weighted for their severity. Univariable logistic regression was performed to assess potential associations between predictor candidates and a severe complication. Results Twenty-seven patients (median age 43 years) underwent a major duodenopancreatic resection, including 14 Whipple procedures and 13 total pancreatectomies. Morbidity and mortality were 100% (27/27) and 4% (1/27), respectively. A severe complication occurred in 17/27 (63%) patients. The median CCI® was 47.8 [range 8.7–100]. Grade B/C pancreatic fistulas, delayed gastric emptying, bile leakage, hemorrhage, and chyle leakage occurred in 7/14 (50%), 10/27 (37%), 1/27 (4%), 7/27 (26%), 3/27 (11%) patients, respectively. Patients with a severe complication had longer operative time and higher blood loss. After Whipple, new-onset endocrine and exocrine insufficiency occurred in 1/13 and 9/14 patients, respectively. Conclusions Major duodenopancreatic surgery in MEN1 is associated with a very high risk of severe complications and cumulative burden of complications and should therefore be reserved for a select subgroup of patients with MEN1-related dpNETs.

This essay reconstructs an early chapter in the history of theorizing the diverse Rāmāyaṇa and Mahābhārata literature of South Asia. Drawing upon the tenth-century literary theorist Kuntaka’s discussions of the Udāttarāghava, Uttararāmacarita, Veṇīsaṃhāra, Kirātārjunīya, and Abhijñānaśākuntala—all Sanskrit poetic (kāvya) compositions that depict stories from the Rāmāyaṇa or the Mahābhārata—I show how, in Kuntaka’s understanding, these works repair certain narrative inconsistencies and ethical ambiguities in the epics themselves. Building on the foundation laid by his predecessor, Ānandavardhana, Kuntaka illuminates the various layers of meaning that a work of literature can encompass. He shows that the epics’ different narrative layers send conflicting messages about proper conduct. He suggests, moreover, that an audience experiences a kāvya retelling of an epic story as a layered entity—a layer of epic narrative beneath a layer of kāvya—and argues that an awareness of these layers can contribute to the audience’s ethical self-cultivation. Kuntaka’s theory of retelling (truly re-telling: telling again, purposefully, and differently from a previous accepted telling) represents an important theoretical account of the relationships between South Asia’s many Rāmāyaṇas and many Mahābhāratas.

PURPOSE Pulmonary rehabilitation (PR) has been shown to be an effective intervention in patients with very severe chronic obstructive pulmonary disease (COPD) awaiting lung transplantation (LTx). The objective of this study was to characterize the prevalence of acute exacerbations (AEs) during PR and their impact on the outcomes of pre-LTx PR. METHODS In this retrospective analysis, 559 patients with COPD awaiting LTx who were referred to a 4-wk inpatient PR program were evaluated. A total of 114 patients (20%) acquired an AE during PR and continued in an adapted fashion. Pulmonary function testing, 6-min walk test (6MWT), and a health-related quality-of-life questionnaire (SF-36) were administered on admission and on discharge of PR. RESULTS Following PR, both groups, patients with and without AE, increased their 6MWT significantly (P < .001) to a clinically relevant amount (58 ± 72 and 52 ± 64 m, respectively). The sum scores of the SF-36 also improved significantly without any between-group differences. No observed changes were different between the two groups. No relevant predictors for PR outcomes could be detected by logistic regression. CONCLUSIONS Our data show that patients with end-stage COPD listed for LTx can achieve clinically relevant improvements in functional exercise capacity and quality of life even if they develop an AE during PR.

Objective Transplantation of minor salivary glands (MSGs) to the conjunctiva is a treatment option for patients suffering from dry eye disease. As there is not enough information about labial and buccal MSGs in dogs, the aim of this study was to provide evidence of the presence of these glands and to investigate their spatial arrangement and excretory ducts. Methods The oral mucosa of the lower lip of 4 dogs and the whole lower jaw of 1 dog were used for histological and microCT analysis. Presence, number, volumes and the tissue depth of MSGs were assessed. Results Histological analysis showed that compact tubulo‐acinar glands were located in the submucosal connective tissue. MicroCT images revealed that 9 to 21 MSGs were arranged in a single row at the level of the dental alveolae. The volume of the MSGs increased from rostral to caudal and the total volume of glandular tissue per animal ranged from 35.01 mm3 to 549.43 mm3. The mean tissue depth of MSGs ranged from 0.57 mm to 1.37 mm (upper surface of glands) and between 1.43 mm and 3.09 mm (lower surface of the glands). Excretory ducts left the dorsal part of the glands and ran in dorso‐rostral direction. Conclusions The location, number and volume of the labial and buccal MSGs in the dog could be detected and described using microCT scans and histology. The present results can provide valuable information for future transplantation of labial MSGs as therapeutic measure against keratoconjunctivitis sicca.

International student mobility has increased in the past years. The inclusion of a highly heterogeneous group of students requires updated recruitment and admission strategies. A particularly vulnerable group of international students are refugees, who have an exceptionally high risk of dropping out of their studies. We present an entrance assessment of incoming international students from 77 countries who are at the beginning of their studies in Germany. Based on this unique sample, we examine (i) whether there are systematic country-specific effects on the economic literacy of beginning students of business and economics and (ii) whether refugee students differ from the group of international students. The results show that refugee students have a higher level of economic literacy although their country-specific prerequisites are worse. Hence, the results highlight the high relevance of an international assessment of heterogeneous vulnerable learner groups to promote their integration into the increasingly internationalized higher education sector.

Background COVID-19 has resulted in significant morbidity and mortality worldwide. Lateral flow assays can detect anti-Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) antibodies to monitor transmission. However, standardized evaluation of their accuracy and tools to aid in interpreting results are needed. Methods We evaluated 20 IgG and IgM assays selected from available tests in April 2020. We evaluated the assays’ performance using 56 pre-pandemic negative and 56 SARS-CoV-2-positive plasma samples, collected 10–40 days after symptom onset, confirmed by a molecular test and analyzed by an ultra-sensitive immunoassay. Finally, we developed a user-friendly web app to extrapolate the positive predictive values based on their accuracy and local prevalence. Results Combined IgG + IgM sensitivities ranged from 33.9 to 94.6%, while combined specificities ranged from 92.6 to 100%. The highest sensitivities were detected in Lumiquick for IgG (98.2%), BioHit for both IgM (96.4%), and combined IgG + IgM sensitivity (94.6%). Furthermore, 11 LFAs and 8 LFAs showed perfect specificity for IgG and IgM, respectively, with 15 LFAs showing perfect combined IgG + IgM specificity. Lumiquick had the lowest estimated limit-of-detection (LOD) (0.1 μg/mL), followed by a similar LOD of 1.5 μg/mL for CareHealth, Cellex, KHB, and Vivachek. Conclusion We provide a public resource of the accuracy of select lateral flow assays with potential for home testing. The cost-effectiveness, scalable manufacturing process, and suitability for self-testing makes LFAs an attractive option for monitoring disease prevalence and assessing vaccine responsiveness. Our web tool provides an easy-to-use interface to demonstrate the impact of prevalence and test accuracy on the positive predictive values.

Dawn Tladi,1 Lucky Mokgatlhe,2 Theo Nell,3 Sheila Shaibu,4 Ronel Mitchell,5 Comfort Mokgothu,1 Tebogo Gabonthone,1 Omphile Hubona1 1Department of Sport Science, University of Botswana, Gaborone, Botswana; 2Department of Statistics, University of Botswana, Gaborone, Botswana; 3Centre for Cardio-metabolic Research in Africa (CARMA), Integrated Metabolic Research Group, Department of Physiological Sciences, Faculty of Natural Sciences, University of Stellenbosch, Stellenbosch, 7600, South Africa; 4School of Nursing and Midwifery, The Aga Khan University, Nairobi, Kenya; 5Gaborone Biokinetics, Gaborone, BotswanaCorrespondence: Dawn TladiDepartment of Sport Science, Private Bag 00702, Gaborone, BotswanaTel +267 71896028Fax +267 3185096Email tladidm@ub.ac.bwPurpose: The metabolic syndrome (MetS) is on the rise in Sub-Saharan Africa, attributed to increased and uncontrollable urbanization accompanied by its lifestyle changes. Non-communicable diseases, such as hypertension, diabetes, and obesity, which are components of the (MetS) are also on the increase in Botswana. To date, no study has determined the prevalence of the MetS in the apparently healthy Batswana adults. The objective of the study was to determine the prevalence of the MetS among the 25– 65-year-old Batswana residing in urban and neighboring semi-urban areas of Gaborone.Participants and Methods: A cross-sectional study was used to collect data from N=794 participants, n=383 men and n=411 women, residing in Gaborone and two surrounding semi-urban areas. Data collected included demographic, anthropometric measurements, blood pressure (BP), blood glucose, triglycerides, high-density lipoprotein cholesterol (HDL-C) and total cholesterol.Results: A high prevalence of 26.8% was reported, with women mostly afflicted (35.0% vs 18.0%). The MetS risk factors found to be common in women were low HDL-C at (50% vs 48.7%) compared to men, while proportions with elevated BP (50.3% vs 39.4%) were prominent in men. The prevalence increased with age, with the oldest age group showing a higher prevalence in both women and men, respectively (55– 65 years; 38.5% vs 41.2%).Conclusion: An unprecedented high MetS prevalence was revealed among perceived to be healthy Batswana adults, with women at a higher risk. This public health concern creates an opportunity to establish evidence of risk factors, develop guidelines and strategies with appropriate public health measures to prevent and control the MetS.Keywords: abdominal obesity, HDL-C, blood pressure, age, public health

Canine African Trypanosomosis (CAT) is a rarely described disease with frequently lethal outcome. A 5-year-old female mongrel dog weighing 22 kg was presented in Austria due to unilateral uveitis, pancytopenia, and anorexia 4 months after return from a trip through Western Africa. Trypanosoma spp. flagellates were detected in a blood smear and identified as Trypanosoma congolense forest type by PCR. Initial treatment with imidocarb and miltefosine led to clinical improvement but only isometamidium chloride hydrochloride applied intramuscularly led to complete eradication of the pathogen from the dog’s blood 4 months later.

Succession planning is a broadly cited concept applied across multiple disciplines to recruit, select, retain, and develop motivated individuals who eventually assume leadership roles in an organization. Although succession planning is widely accepted and is acknowledged in the literature as a prevalent organizational practice, succession planning has not been implemented by some institutions of higher education for the nurse administrator role. Recognizing the impact effective succession planning has on the continuity of nursing education and the potential impact on the future of nursing, this article explores the importance of a framework for and components of succession plans. Unlike other articles related to succession planning, this article correlates succession planning with selected ACEN Criteria.

Zusammenfassung Hintergrund und Ziele Alpha-2-Makroglobulin (A2 M) ist ein Plasmaprotein mit proteolytischer Wirkung auf viele Proteasen. Bei Patienten mit einem angeborenen Alpha-1-Antitrypsinmangel (AATM) liegt ein funktioneller Protease-Überschuss vor. Ziel dieser Studie war es, die Hypothese zu prüfen, dass bei Patienten mit AATM ein erhöhter A2M-Spiegel nachweisbar ist. Methoden Patienten mit AATM (Genpolymorphismus Pi*ZZ, Pi*SZ, Pi*MZ und seltene Genvarianten) wie auch Probanden mit einem normwertigen AAT-Spiegel (gesunde Probanden, Pi*MM) wurden der A2M- und AAT-Testung unterzogen. Die Serumkonzentrationen der Proteine wurden mittels Nephelometrie bestimmt. Die Polymorphismen Pi*Z und Pi*S wurden durch Polymerase-Kettenreaktion (PCR) nachgewiesen, seltene Genvarianten wurden durch Sequenzierung ermittelt. Ergebnisse In unsere Studie wurden insgesamt 291 Individuen eingeschlossen. Es konnte gezeigt werden, dass es bei Vorliegen eines Genpolymorphismus (Pi*ZZ) und einem Alpha-1-Antitrypsin-Serumspiegel Schlussfolgerungen In dieser Studie konnte eine inverse Korrelation zwischen den Serumspiegeln von AAT und A2M bei Vorliegen eines Genpolymorphismus (Pi*ZZ) nachgewiesen werden. Weitere Studien sind erforderlich, um zu erfassen, welche klinische Bedeutung erhöhte A2M-Serumpiegel bei Patienten mit einem schweren AAT-Mangel Pi*ZZ und seltenen Genvarianten, deren AAT-Serumspiegel unter 50 mg/dl liegt, haben könnten.

For example, collective or community hope is more than the sense of individual hope of the members of a particular community. The destruction of property, theft and violence that occurred in South Africa, particularly in KZN and Gauteng in the week of 12 July 2021 had a significant impact on the national psyche. [Extracted from the article] Copyright of South African Journal of Psychology is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

As of 10 March 2021, coronavirus disease 2019 (COVID-19) has resulted in more than 0.1 billion laboratory-confirmed cases and more than 2.5 million deaths globally [1]. Both the economic impact and disease burden of COVID-19 far exceeded those of severe acute respiratory syndrome and Middle East Respiratory Syndrome. The number of patients who have recovered from COVID-19 is increasing [2] despite an escalation of total number of cases worldwide., This editorial reviews the evidence supporting benefits of pulmonary rehabilitation in #COVID19 patients, as well as some unanswered research questions https://bit.ly/39JY3SU

Background The Blastomyces antigen concentration in urine (BACU) test is used to diagnose blastomycosis and monitor treatment in dogs. It is unknown if a higher BACU is associated with shorter survival. Objectives To determine if the magnitude of BACU before treatment is associated with survival in dogs with blastomycosis. Animals Fifty‐two dogs with blastomycosis. Methods Retrospective case review. BACU, radiographic lung severity (RLS) score (0‐4 scale), and survival time up to 1 year after diagnosis were obtained through medical record review of dogs with Blastomyces dermatitidis. Results The overall survival was: discharge, 87%; 1 week, 85%; 2 months, 74%; and 6 months, 69%. BACU correlated with RLS score (r s = 0.33, P = .02). BACU and RLS scores were lower in survivors to 2 months than nonsurvivors (average BACU difference of 2.5 ng/mL, 95% confidence interval [CI]: 0.2‐4.8 ng/mL, P = .04; median RLS difference of 2; range, 0‐4, P = .02). Dogs with BACU 5 ng/mL (P = .03) and dogs with severe (3‐4) RLS scores (P = .04). All dogs with a BACU

Strong for Surgery (S4S) is a public health campaign focused on optimizing patient health prior to surgery by identifying evidence-based modifiable risk factors. The potential impact of S4S bundled risk factors on outcomes after major surgery has not been previously studied. This study tested the hypothesis that a higher number of S4S risk factors is associated with an escalating risk of complications and mortality after major elective surgery in the VA population. The Veterans Affairs Surgical Quality Improvement Program (VASQIP) database was queried for patients who underwent major non-emergent general, thoracic, vascular, urologic, and orthopedic surgeries between the years 2008 and 2015. Patients with complete data pertaining to S4S risk factors, specifically preoperative smoking status, HbA1c level, and serum albumin level, were stratified by number of positive risk factors, and perioperative outcomes were compared. A total of 31,285 patients comprised the study group, with 16,630 (53.2%) patients having no S4S risk factors (S4S0), 12,323 (39.4%) having one (S4S1), 2,186 (7.0%) having two (S4S2), and 146 (0.5%) having three (S4S3). In the S4S1 group, 60.3% were actively smoking, 35.2% had HbA1c > 7, and 4.4% had serum albumin 7, and 27.4% had albumin

Traditional, limited purpose grey infrastructure has failed to address the world's interrelated water challenges. Improving water security will increasingly require more integrated responses. This paper examines large-scale green infrastructure (LSGI), planned natural or hybrid systems that materially affect water security at the watershed scale, as one such response. This paper examines key challenges for governing and financing LSGI, which hinder its broader use. We report on four case studies located in the United States where LSGI is being employed to improve water security. Through analysis of these case studies and related literature, we identify three themes important for LSGI governance: cost sharing, performance monitoring, and legitimization. First, we hypothesize that formal cost sharing based on the multiple benefits LSGI provides could enable wider adoption, but find that in these examples cost sharing is limited and informal. Second, our research suggests that expanding performance monitoring to encompass key secondary benefits could help clarify how the benefits and burdens of a project are distributed across stakeholders, facilitate cost sharing, and enhance project legitimacy. Finally, LSGI will require further legitimization – developing a broader perception that LSGI is an appropriate alternative or complement to grey infrastructure – to develop as a viable contributor to water security. HIGHLIGHTS Large-scale green infrastructure (LSGI) has promise to address complex water security challenges.; LSGI represents a paradigm shift from traditional grey infrastructure.; Case studies suggest that governance of LSGI lacks maturity, gating wider adoption and diffusion.; Novel funding models, improved performance monitoring, and legitimization at multiple scales must be addressed to increase the adoption and diffusion of LSGI.

Background Diphtheria has re-emerged over the past several years. There is a paucity of data on the administration and safety of diphtheria antitoxin (DAT), the standard treatment for diphtheria. The 2017–2018 outbreak among Rohingya refugees in Bangladesh was the largest in decades. We determined the outcomes of DAT-treated patients and describe the occurrence and risk factors associated with adverse reactions to DAT. Methods We conducted a retrospective study at the Médecins Sans Frontières Rubber Garden Diphtheria Treatment Center from December 2017–September 2018. Diphtheria was diagnosed based on the World Health Organization clinical case criteria. High-acuity patients were eligible for DAT. Safety precautions were meticulously maintained. We calculated the presence of adverse events by age, duration of illness, and DAT dosage using bivariate comparisons. Results We treated 709 patients with DAT; 98% (n = 696) recovered and were discharged. One-fourth (n = 170) had at least 1 adverse reaction. Common reactions included cough (n = 115, 16%), rash (n = 66, 9%), and itching (n = 37, 5%). Three percent (n = 18) had severe hypersensitivity reactions. Five patients died during their DAT infusion or soon afterwards, but no deaths were attributed to DAT. Conclusions Outcomes for DAT-treated patients were excellent; mortality was

Light matter interactions are greatly enhanced in two-dimensional (2D) semiconductors because of strong excitonic effects. Many optoelectronic applications would benefit from creating stacks of atomically thin 2D semiconductors separated by insulating barrier layers, forming multiquantum-well structures. However, most 2D transition metal chalcogenide systems require serial stacking to create van der Waals multilayers. Hybrid metal organic chalcogenolates (MOChas) are self-assembling hybrid materials that combine multiquantum-well properties with scalable chemical synthesis and air stability. In this work, we use spatially resolved linear and nonlinear optical spectroscopies over a range of temperatures to study the strongly excitonic optical properties of mithrene, that is, silver benzeneselenolate, and its synthetic isostructures. We experimentally probe s-type bright excitons and p-type excitonic dark states formed in the quantum confined 2D inorganic monolayers of silver selenide with exciton binding energy up to ∼0.4 eV, matching recent theoretical predictions of the material class. We further show that mithrene's highly efficient blue photoluminescence, ultrafast exciton radiative dynamics, as well as flexible tunability of molecular structure and optical properties demonstrate great potential of MOChas for constructing optoelectronic and quantum excitonic devices.

Background Insulinomas are found in 10–15 per cent of patients with multiple endocrine neoplasia type 1 (MEN1) and lead to life‐threatening hypoglycaemia. Surgical outcome and the optimal surgical strategy for MEN1‐related insulinoma are unknown. Methods Patients with MEN1‐related insulinomas were identified in 46 centres in Europe and North America between 1990 and 2016. Insulinomas were considered localized if the lesion was in the pancreatic head or body/tail. Patients with pancreatic neuroendocrine tumours throughout the pancreas were suspected of having multifocal insulinoma. The primary outcome was postoperative hypoglycaemia, defined as persistent hypoglycaemia, or recurrent hypoglycaemia caused by a new insulinoma or insulin‐producing liver metastases. Hypoglycaemia‐free survival was estimated by the Kaplan–Meier method. Results Ninety‐six patients underwent resection for MEN1‐related insulinoma. Sixty‐three and 33 patients had localized and multifocal insulinomas respectively. After a median follow‐up of 8 (range 1–22) years, one patient (1 per cent) had persistent disease and six (6 per cent) had developed recurrent disease, of whom four had a new insulinoma. The 10‐year hypoglycaemia‐free survival rate was 91 (95 per cent c.i. 80 to 96) per cent. Of those with localized disease, 46 patients underwent pancreatic resection and 17 enucleation. One of these patients had persistent disease and one developed recurrent insulinoma. Among patients with multifocal disease, three developed new insulinomas and two developed insulin‐producing liver metastases. Conclusion Surgery for MEN1‐related insulinoma is more successful than previously thought., In this cohort of 96 patients with resected multiple endocrine neoplasia 1 (MEN1)‐related insulinomas, seven patients (7 per cent) developed postoperative persistent or recurrent hypoglycaemia after a median follow‐up of 8 years. The 10‐year hypoglycaemia‐free survival rate was 91 (95 per cent c.i. 80 to 96) per cent. For patients with localized insulinoma, enucleation seems the preferred procedure. PPPD, pylorus‐preserving pancreatoduodenectomy. Outcomes good

Es wird uber den Fall einer 29-jahrigen Patientin mit einer unilateralen Mydriasis nach Anwendung eines Scopolaminpflasters bei ausgepragter PONV-Anamnese berichtet. Das Pflaster wurde zur Narkoseeinleitung erganzt und vor Verlegung auf die Station entfernt. Nach einer elektiven Metallentfernung und Narkose mittels TIVA trat am ersten postoperativen Tag eine unilaterale Mydriasis des linken Auges mit Akkommodationsstorung auf. In der Folge wurden zur Abklarung der Symptomatik neurologische sowie augenarztliche Untersuchungen durchgefuhrt. Zusatzlich erfolgte eine MRT mit Kontrastmittel zum Ausschluss eines zentralen Geschehens. Es wurden keine Ursachen fur das klinische Bild erfasst, sodass die Verdachtsdiagnose einer pharmakologisch induzierten Anisokorie durch den Wirkstoff Scopolamin erhoben wurde. Der Ausloser schien dabei ein Verwischen des Wirkstoffs von der Klebestelle in das betroffene Auge zu sein. Die Symptomatik und das klinische Bild hoben sich bei der Patientin nach 24 h ohne weitere Therapiemasnahmen wieder auf. Fruhe emetische Symptome konnen durch ein Scopolaminpflaster signifikant reduziert werden. Viele Kliniker raten jedoch aufgrund der oben beschriebenen Problematik von der Verwendung von Scopolaminpflastern zur PONV-Prophylaxe ab, da eine intraoperative oder postoperative Anisokorie bei einem neurologisch nichtbeurteilbaren Patienten den zwingenden Ausschluss eines zentralen Ereignisses zur Folge hat.

There is little research on the study success factors of refugee students in higher education. One approach to meeting the growing global demands is to provide online education specifically for refugees. This study examines specific personal characteristics of refugee students and their influence on success and retention in online education. Individual factors such as intrinsic motivation and language proficiency, cognitive functioning, and sociodemographic factors such as gender and country of residence influence retention of refugee students during online studies. The results indicate that sociodemographic factors (e.g., gender), cognitive factors (e.g., English proficiency), and external factors (e.g., country of residence) have a significant influence on study retention on refugee students.

Through a close reading of Freud’s last major work, Moses and Monotheism (1939), this article considers the socio-political and literary stakes of a central element of Freud’s oeuvre, which reaches its fullest elaboration in the Moses text: belatedness. Belatedness, or deferred action (Nachträglichkeit), which structures the movement of repression and return in the individual psychology of Freud’s earlier work, is aggravated and intensified in this late modernist text. Now, it is an entire people (the Jews) and (Judeo-Christian) civilization founded upon the temporal predicament of trauma, latency, and the return of the repressed. What is most innovative about Moses—its fragmentary style, its rewriting of biblical origins, its daring conjectures and methods of recording history—gestures back, after all, to the singular problem that both Freudian psychoanalysis and modernism are destined to repeat: the constitutive belatedness of all experience.

This article reads Hope Mirrlees’s Paris: A Poem as an epic—that is, as “a poem including history” to use Pound’s formulation—that reconfigures the act of including history as a particularl...

Background: The BenchMarket Medical (BMM) Vertebral Compression Fracture (VCF) Registry, now known as Talosix, is a collaborative effort between Talosix (the authorized registry vendor), Noridian Healthcare Solutions, and clinicians to gather outcomes evidence for cement augmentation treatments in patients with acute painful osteoporotic VCFs. The VCF Registry was designed to provide outcomes evidence to inform the Medicare payer’s “coverage with evidence development” decision to authorize reimbursement for cement augmentation treatments. Objectives: The purpose of this article was to present a pathway for appropriate use of vertebral augmentation based on the findings of the VCF Registry. Study Design: Prospective observational data, including patient characteristics, diagnosis, process of care, and patient-reported outcomes (PROs) for pain and function, were collected from patients undergoing cement augmentation treatment. The PROs were collected at baseline, 1, 3, and 6 months following the procedure. Setting: The VCF Registry is a national ongoing registry with no specified end time or designated sample size. Methods: Primary outcomes were pain improvement measured using the Numeric Rating Scale and function improvement, measured using the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes included cement leakage, new neurologic deficits, adverse events, readmissions, and death. Results: The VCF Registry delivered outcomes data to support Noridian’s “coverage with evidence development” decision. A total of 732 patients were included in this study. Registry outcomes confirmed postmarket evidence of highly significant pain relief with mean pain score improvement of 6.5/10 points at 6 months. Function also improved significantly with mean RMDQ score change of 11.4/24 points 6 months after surgery. Results also showed the safety and reliability of cement augmentation. Limitations: The nature of the registry data is that it contains nonrandomized, nonplacebo controlled data and should not be perceived as such. The real-world setting and the large number of patients within the dataset should increase the external validity of the findings. Conclusions: Cement augmentation treatments of patients with acute painful VCFs reliably results in highly significant benefits of pain decrease and functional improvement for this Medicare population. Key words: Vertebral compression fractures, osteoporosis, kyphoplasty, back pain, registry

High-throughput sequencing (HTS) is central to the study of population genomics and has an increasingly important role in constructing phylogenies. Choices in research design for sequencing projects can include a wide range of factors, such as sequencing platform, depth of coverage and bioinformatic tools. Simulating HTS data better informs these decisions, as users can validate software by comparing output to the known simulation parameters. However, current standalone HTS simulators cannot generate variant haplotypes under even somewhat complex evolutionary scenarios, such as recombination or demographic change. This greatly reduces their usefulness for fields such as population genomics and phylogenomics. Here I present the R package jackalope that simply and efficiently simulates (i) sets of variant haplotypes from a reference genome and (ii) reads from both Illumina and Pacific Biosciences platforms. Haplotypes can be simulated using phylogenies, gene trees, coalescent-simulation output, population-genomic summary statistics, and Variant Call Format (VCF) files. jackalope can simulate single, paired-end or mate-pair Illumina reads, as well as reads from Pacific Biosciences. These simulations include sequencing errors, mapping qualities, multiplexing and optical/PCR duplicates. It can read reference genomes from fasta files and can simulate new ones, and all outputs can be written to standard file formats. jackalope is available for Mac, Windows and Linux systems.

This paper examines the purpose of the Socratic case for the immortality of the soul as it is presented in Plato's Phaedo, considering the dialogue through four distinct lenses that show different ...

The accurate computation of multi-coupled electric drive systems is a complex process. In order to consider a variety of physical effects, their interactions as well as the interactions of different components, multiple fields of science have to be addressed. Numerical simulations help to compute these complex systems and to design machines in the best possible way for its specific application. The numerical computation scheme proposed in this study consists of six main sectors: the rough machine design, the preparation of the finite element method including the characterisation and modelling of materials, the electromagnetic simulation, the mechanical simulation, the control and power electronics and the thermal design and simulation. In each of the main sectors, different effects affecting the machine and the system behaviour can be considered and calculated. Depending on the application, they can be added or removed modularly in order to adapt the simulation effort and the simulation accuracy to the application. A detailed insight into the computation methods and approaches in each of these main sectors and their coupling is given in this study.

Author(s): Gianella, Sara; Moser, Carlee; Vitomirov, Andrej; McKhann, Ashley; Layman, Laura; Scott, Brianna; Caballero, Gemma; Lada, Steven; Bosch, Ronald J; Hoenigl, Martin; Lurain, Nell; Landay, Alan; Lederman, Michael M; Hunt, Peter W; Smith, Davey | Abstract: BACKGROUND:Even with antiretroviral therapy (ART), persons with HIV (PWH) experience increased morbidity/mortality. Cytomegalovirus (CMV) and Epstein-Barr-Virus (EBV) co-infections likely exacerbate inflammatory-related diseases. OBJECTIVE:To determine if presence of detectable CMV or EBV DNA in peripheral blood mononuclear cells (PBMC) is associated with non-AIDS events among PWH receiving modern ART. DESIGN:We performed a case-control study of PWH starting ART and HIV-suppressed at year 1 and thereafter, 140 cases who experienced non-AIDS events and 305 matched controls. Events included myocardial infarction, stroke, malignancy, serious bacterial infection or death. METHODS:Blood samples were studied pre-ART, 1-year post-ART and pre-event. Controls had an event-free follow-up equal or greater than cases. CMV and EBV levels were measured in PBMC. Conditional logistic regression analysis assessed associations and adjusted for relevant covariates; Spearman's correlations compared CMV and EBV levels with other biomarkers. RESULTS:CMV was detected in PBMC of 25% of participants, EBV was detected in g 90%. Higher EBV levels were associated with increased risk of events at all time points (odds ratio (OR) per one IQR = 1.5-1.7, all p l 0.009). At year 1, detectable CMV was associated with increased risk of events in most adjusted models (OR = 1.4-1.8, p-values ranging 0.03-0.17). Higher levels of CMV and EBV correlated with multiple inflammatory markers and lower CD4/CD8 ratio. CONCLUSIONS:In PWH starting ART, CMV and EBV in PBMC were associated with development of non-AIDS events. Clinical trials will be needed to understand causal mechanisms and ways to interrupt them.

Non-healing corneal ulcers (NHCU) are a common problem in equine practice and several treatment options are available with different success and healing times. The aim of this retrospective study was to evaluate and to compare treatment protocols, clinical courses, corneal healing time and outcomes of NHCU.From December 2001 to December 2017, a total of 57 horses with NHCU were presented at the Vetmeduni Vienna. Recorded data included affected eye, signalment, clinical symptoms, season of diagnosis, treatment protocols, complications and corneal healing rate.Sixty-three eyes were diagnosed with a NHCU. Follow-up information was available for 48/63 eyes. For those treated medically mean corneal healing time was 15.7 days (± SD 12.0). Medical treatment included topical antibiotics, antimycotics, cycloplegics, and systemic anti-inflammatory drugs. Twelve eyes received treatment with a poly-carboxymethylglucose-sulfate regenerating agent (CacicolResults correlated with those previously described and thus demonstrated the difficulty and complexity of this disease. Further research is needed to determine an optimal treatment protocol for non-healing ulcers in horses.Since NHCUs are a commonly encountered problem in equine practice a reliable treatment protocol is required. This study reflects the problems with those ulcers and provides several protocols for possible treatments.Nicht oder schwer heilende Hornhautdefekte (NHHD) sind ein häufig auftretendes Problem in der Pferdepraxis. Es gibt dafür verschiedenste Behandlungsmethoden mit unterschiedlichem Erfolg und variierenden Heilungszeiträumen. Ziel dieser retrospektiven Studie war, Behandlungsmethoden, klinische Verläufe, korneale Heilungsdauer und Erfolgsraten bei NHHD zu untersuchen und zu vergleichen.eb Von Dezember 2001 bis Dezember 2017 wurden 57 Pferde mit einem NHHD an der Vetmeduni Vienna vorgestellt. Die aufgenommenen Patientendaten umfassten das betroffene Auge, Signalement, klinische Symptome, die Jahreszeit zum Zeitpunkt der Diagnose, Behandlungsprotokolle, Komplikationen und die korneale Heilungsdauer.Bei 63 Augen wurde die Diagnose NHHD gestellt. Verlaufskontrollen lagen bei 48/63 Augen vor. Medikamentös behandelte Augen wiesen eine Heilungsdauer von 15,7 Tagen (± SD 12,0) auf. Diese Behandlung beinhaltete die topische Gabe von Antibiotika, Antimykotika und Zykloplegika sowie systemisch verabreichte Antiphlogistika. Zwölf Augen wurden mit einem Poly-Carboxymethylglukose-Sulfat-Regenerationsmittel (CacicolDie Ergebnisse korrelieren mit den Daten publizierter Studien und demonstrieren dennoch die Problematik und Komplexität dieser Erkrankung. Weitere Forschung ist notwendig, um ein optimales Behandlungsschema für nicht heilende Hornhautdefekte bei Pferden zu entwickeln.Da NHHD ein häufig auftretendes Problem in der Pferdepraxis darstellen, ist ein verlässliches Behandlungsprotokoll dringend notwendig. Diese Studie zeigt die Probleme und Komplikationen mit diesen Ulzerationen auf und beschreibt zusätzlich verschiedene Behandlungsmethoden.

Middle aortic syndrome (MAS) is a rare vascular disease occurring in pediatric patients. MAS describes narrowing of the abdominal aorta, often referred to as abdominal coarctation. Extra-aortic vessels are commonly involved, including the renal and mesenteric arteries. Pediatric patients with MAS frequently present with severe hypertension, and medical management often is insufficient. Many of these patients require endovascular or open surgical intervention. This review article discusses the etiology, symptoms, and management of pediatric MAS. It highlights the preoperative, intraoperative, and postoperative anesthetic management of these patients. It is important that anesthesiologists be aware of this rare disease and its special anesthetic considerations when caring for children with MAS because of its high morbidity.

We investigate the adoption of operational management “best practices” in multinational corporation (MNC) subsidiary plants in the Western Balkans. Building on the Practice-Based View (PBV), we suggest that subsidiary plants are more likely to operate according to widely recognized best practices, if these practices are already common in the MNC home country. We also examine the degree to which the MNC can facilitate best practices in their plants by allocating organizational and human resources. We test our hypotheses using survey data from subsidiary managers and secondary company data (n = 129), supplemented with manager interviews (n = 14), collected from European, U.S., and Asian MNCs with subsidiary plants in Bosnia and Herzegovina, Croatia, Serbia, and North Macedonia. Results indicate that the subsidiary plants adopt practices that are common in the MNC home country. They do so to a greater extent when the MNC commits organizational resources to the plants, such as codified written procedures and trainings. Contrary to our expectations, there is no benefit to allocating human resources, such as expatriates and business travelers. We provide insights into the transfer and implementation of best practices in the Western Balkan context, enhance our understanding of the PBV by presenting a specific application of this theoretical perspective, and provide practically relevant results for managers and policymakers.

Background and objectives A Nurse Line (NL) is a resource that is commonly used by patients and hospitals to assist in the triage of patient medical complaints. We sought to determine whether patients with chief complaint of chest pain who presented to the ED after calling a NL were different from patients who presented directly to the ED. The primary aim was to test for differences in the severity of the causes of chest pain between the two groups. Methods This was a retrospective case-control chart review study. Data collected included demographic data, comorbidities, ED orders, ED interventions, patient primary diagnosis and disposition. Results 350 patients were included in the analysis: 175 patients called the NL and 175 age/sex matched patients did not call the NL. The mean age was 58.3 (SD 16.4; range 19.1–93.3) and 53.7% of patients were female. Race was similar between the groups. Patients were more likely to go directly to the ED without calling a NL if they had comorbidities. Among the total cohort, 36 patients were deemed to have a serious diagnosis related to the pain; this did not differ between groups (16 NL, 20 non-NL; OR = 1.11 95%CI 0.55–2.23). There were no differences of ED work-up or hospital admission (50 NL, 67 non-NL; OR = 0.85 95%CI 0.51–1.42) between the groups. Conclusion NL call was not associated with differences in severity of diagnosis, work-up, hospital admission or patient demographics. Patients who presented to the ED with chest pain without calling a NL had more comorbidities.

Objectives The 14-item Oral Health Impact Profile (OHIP-14) is the most frequently used instrument to measure oral health-related quality-of-life (OHRQoL) in adults. Despite its popularity, its psychometric properties have been predominantly investigated based on the classical test theory while the fundamental principles of measurement have not been fully assessed. Therefore, our aim was to investigate to what extent the OHIP-14 meets the fundamental requirments of measurements. Methods We used the Rasch model to explore person-item-targeting, unidimensionality, local independence of items, invariance (differential-item-functioning, DIF), and the order of thresholds between response-options in the German version OHIP-14. We used data from osteoarthritis patients because hand disabilities and joint pain might influence oral hygiene. Furthermore, osteoarthritis in the temporomandibular-joint directly affects oral functioning. Results Five-hundred sixteen patients were included (mean age 66.5 years [±10.2; ranging from 34 to 89]; 71.3% [368] females). The OHIP-14 median total score was 0 (interquartile-range from 0 to 4), indicating a right-skewed distribution because many patients reported good OHRQoL. The instrument was found unidimensional. However, there was strong evidence of local dependency, disordered thresholds between response-options, and age-related DIF for item 5. A revised scoring scheme with three instead of five answer-options in all items and eliminating two items resolving local dependency, the newly adapted OHIP-12, showed better reliability and item-fit to the Rasch model than the original OHIP-14. Conclusions This study assesses, for the first time, the OHIP-14 in terms of fundamental principles of measurement and proposes an item-reduced OHIP-12 as a psychometrically more accurate version of the instrument. Clinical significance The Rasch model is essential to ensure instruments' precision and clinical meaningfulness when measuring OHRQoL in clinical practice and research. The OHIP-12, derived from the OHIP-14 by deleting two items due to local dependency, with a revised scoring scheme for all items distinguishing three answer-options instead of five, represents a psychometrically improved version of the instrument.

Many countries in sub-Saharan Africa have experienced lower COVID-19 caseloads and fewer deaths than countries in other regions worldwide. Under-reporting of cases and a younger population could partly account for these differences, but pre-existing immunity to coronaviruses is another potential factor. Blood samples from Sierra Leonean Lassa fever and Ebola survivors and their contacts collected before the first reported COVID-19 cases were assessed using enzyme-linked immunosorbent assays for the presence of antibodies binding to proteins of coronaviruses that infect humans. Results were compared to COVID-19 subjects and healthy blood donors from the United States. Prior to the pandemic, Sierra Leoneans had more frequent exposures than Americans to coronaviruses with epitopes that cross-react with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), SARS-CoV, and Middle Eastern respiratory syndrome coronavirus (MERS-CoV). The percentage of Sierra Leoneans with antibodies reacting to seasonal coronaviruses was also higher than for American blood donors. Serological responses to coronaviruses by Sierra Leoneans did not differ by age or sex. Approximately a quarter of Sierra Leonian pre-pandemic blood samples had neutralizing antibodies against SARS-CoV-2 pseudovirus, while about a third neutralized MERS-CoV pseudovirus. Prior exposures to coronaviruses that induce cross-protective immunity may contribute to reduced COVID-19 cases and deaths in Sierra Leone.

Introduction Excessive daytime sleepiness (EDS) persists in some positive airway pressure (PAP)-treated patients with obstructive sleep apnoea (OSA). This study examined prevalence and severity of EDS in a real-world population with OSA to understand how EDS, PAP adherence, and patient satisfaction with care relate. Methods US-resident adults (self-reported clinician OSA diagnosis [1/1/2015-31/3/2020]) were surveyed (Epworth Sleepiness Scale [ESS], PAP usage, and patient satisfaction) in Evidation Health’s Achievement app. Self-reported PAP use was categorised: nonuse, nonadherent ( 10 defined EDS. In PAP users, a linear model tested whether PAP use and ESS score relate; logistic regression models tested how PAP use (nonadherence=0, adherence=1) and EDS impact satisfaction with healthcare providers (HCPs) and overall OSA care. Due to no adjustments for multiplicity, P-values are nominal. Results Of 2289 participants (50.3% female; mean±SD 44.8±11.1 years old; 42.5% ESS>10), 72% were satisfied with HCPs and 65% with OSA care. In the nonuse (n=700), nonadherent (n=153), intermediate (n=225), and highly adherent (n=1211) groups, 47%, 52%, 53%, and 36% had EDS, respectively. An additional h/night PAP use was associated with lower ESS scores (n=1589, β=–0.28; 95% confidence interval [CI]=–0.40, –0.16; P Discussion In this real-world study, EDS was prevalent among highly adherent PAP users. PAP adherence was associated with greater patient satisfaction with HCPs and overall care, whereas persistent EDS was associated with lower patient satisfaction with HCPs and overall OSA care.