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This column highlights the importance of language and communication skills in students with emotional and behavioral disorders (EBD). Evidence continues to point to language impairments as a co-occurring area of concern in students with EBD. This complex association is described along with recommendations for supporting students with EBD who may have documented or undocumented language impairments. The goal of this column is to promote discussion and collaborative efforts to develop solutions for best supporting outcomes of students with EBD.

Background: In ophthalmology, thickness and vessel density (VD) measurements for the 6 x 6 mm inner macular retinal area have received increasing attention in glaucomatous progression research. For this area, the Angiovue optical coherence tomography system introduced a 304 x 304 A/B scans function (classic Angio Retina scan) in 2014, and a 400 x 400 A/B scans function (high-definition [HD] Angio Retina scan) in 2017. These scan types cannot be used in combination for the software provided for progression analysis.Purpose: Since losing data for 3 years may negatively influence progression analysis, we investigated whether clinically significant differences exist between consecutive measurements acquired with these scan types on the same eyes.Methods: As a part of our noninterventional prospective glaucoma imaging study, primary-open-angle glaucoma patients (POAG group), and ocular hypertensive and healthy control participants (structurally undamaged group) were imagedusing both the classic and the HD Angio Retina scans, respectively, without changing the patients’ position. High-quality images were obtained on 12 POAG eyes of 12 consecutive POAG patients, and 10 healthy and ocular hypertensive eyes of 10 consecutive participants before the data collection had to be suspended due to the new coronavirus epidemic.Results: For Early Treatment Diabetic Retinopathy Study image area, the mean difference (classic minus HD value) was 0.02 ± 0.37 μm for inner retinal thickness (P = 0.869) and 0.33 ± 1.33 % (P = 0.452) for superficial capillary VD in the structurally normal group (between-methods difference: ≤ 0.8% of the respective normal value). In the POAG group, the corresponding figures were -0.07 ± 1.22 μm for inner retinal thickness (P = 0.854; between-methods difference: 0.6% of the normal value) and 1.12 ± 2.58 % for superficial capillary VD (P = 0.158; classic scan value minus HD scan value: 1.12 ± 2.58 %; 2.3% of the normal value).Conclusion: Our results suggest that combined use of thickness and VD values for structurally normal eyes and thickness values for POAG eyes derived from classic and HD scans, respectively, for progression analysis can be reasonable since the differences between the corresponding values are small. However, combining the corresponding VD parameters for POAG eyes is useful only when the follow-up time before the scan type change is long enough to counterbalance the effect of the change on the result.

Introduction: Disability simulation activities are commonly used for various purposes in higher education; however, instructors may be unaware of controversies regarding their use. The purpose of this research was to assess the effects of an activity using low vision goggles to simulate visual impairment in the context of an undergraduate course in special education. We highlight the need for instructors to consider the appropriateness of disability simulation activities given possible countertherapeutic effects. Methods: In this cluster-randomized trial, 11 classes (248 students) of preservice education and related services professionals were randomized to experimental (lecture + simulation) or control (lecture only) conditions. During a single class session, all students received basic information about visual impairment and watched a video on being a human guide. Students in the experimental group then practiced guiding and being guided while wearing low vision goggles. At the end of class, students completed three Likert-type surveys and later completed a quiz using publisher-developed materials. Results: Results showed individuals in the experimental group reported higher levels of interest and enjoyment than those in the control condition; however, there were no statistically significant differences in attitudes toward persons with visual impairments, confidence or self-efficacy for working with students with visual impairments, content knowledge, or perceptions of activity usefulness. Discussion: Findings of positive engagement in the absence of harmful effects indicate that disability simulation activities should be neither promoted nor denigrated wholesale; instead, instructors must weigh carefully potential benefits and drawbacks. Discussion includes considerations for professional education programs in using such simulations to promote skill acquisition via positive and respectful learning experiences. Implications for practitioners: Instructors who use disability simulation activities are encouraged to consider whether to discontinue this practice or incorporate principles recommended by the disability community and assess outcomes to ensure they are not perpetuating harmful stereotypes.

Introduction: A non-interventional, multicenter, European, prospective evaluation of the effectiveness, tolerability, and safety of a topical preservative-free tafluprost (0.0015%) and timolol (0.5%) fixed-dose combination (PF tafluprost/timolol FC) in adults with open-angle glaucoma (OAG) and ocular hypertension (OHT) demonstrating insufficient response to topical beta-receptor blockers or prostaglandin analogue (PGA) monotherapy. Methods: Mean intraocular pressure (IOP) change from baseline was measured at study visits following a switch to PF tafluprost/timolol FC. Primary endpoint was absolute mean IOP change at month 6. Change from baseline concerning ocular signs and symptoms was also explored. Results: Analyses included 577 patients (59.6% female). Mean age (SD) was 67.8 (11.67) years. Mean (SD) IOP reduction from baseline was significant at all study visits; 5.4 (3.76) mmHg (23.7%) at week 4, 5.9 (3.90) mmHg (25.6%) at week 12, and 5.7 (4.11) mmHg (24.9%) at month 6 (p < 0.0001 for all visits). At month 6, 69.2%, 53.6%, 40.0%, and 25.8% were responders based on ≥ 20%, ≥ 25%, ≥ 30%, and ≥ 35% cutoff values for mean IOP, respectively. Significant reductions were observed concerning corneal fluorescein staining (p < 0.0001), dry eye symptoms, irritation, itching, and foreign body sensation (p < 0.001 for each parameter). Conjunctival hyperemia was significantly reduced at all study visits (p < 0.0001 at each visit). Overall, 69 treatment-related adverse events (AEs) were reported, one of which was serious (status asthmaticus). Most AEs were mild to moderate in severity, and the majority had resolved or were resolving at the end of the study period. Conclusion: In clinical practice, PF tafluprost/timolol FC provided statistically and clinically significant IOP reductions in patients with OAG and OHT insufficiently controlled on or intolerant to PGA or beta-receptor blocker monotherapy. The full IOP reduction appeared at week 4 and was maintained over the 6-month study period. Key symptoms of ocular surface health improved. Trial Registration: European Union electronic Register of Post-Authorisation Studies (EU PAS) register number, EUPAS22204.

For all children and youth, language underpins success in academic, social, and behavioral interactions. For students with language deficits, even seemingly simple tasks can be challenging and frustrating. Perhaps not surprising, children with language deficits often exhibit high rates of problem behavior, and children with behavior disorders tend to have low language ability. Because language and behavior are fundamental to success in school, teachers need to understand the comorbidity of these challenges, recognize signs that a student may be struggling with language delays, and have strategies to support students who struggle with behavior and language. In the present article, we (a) introduce and address co-occurring language and behavioral deficits, (b) overview common types of language difficulties in school, and (c) provide classroom management and instructional strategies to support students with these dual deficits.

Background. The real impact of septic shock-associated acute kidney injury (AKI) on the long-term renal outcome is still debated, and little is known about AKI-burn patients. In a cohort of burn survivors treated by continuous renal replacement therapy (CRRT) and sorbent technology (CPFA-CRRT), we investigated the long-term outcome of glomerular and tubular function. Methods. Out of 211 burn patients undergoing CRRT from 2001 to 2017, 45 survived, 40 completed the clinical follow-up (cumulative observation period 4067 months, median 84 months, IR 44-173), and 30 were alive on 31 December 2020. Besides creatinine and urine albumin, in the 19 patients treated with CPFA-CRRT, we determined the normalized GFR by 99mTc-DTPA (NRI-GFR) and studied glomerular and tubular urine protein markers. Results. At the follow-up endpoint, the median plasma creatinine and urine albumin were 0.99 (0.72–1.19) and 0.0 mg/dL (0.0–0.0), respectively. NRI-GFR was 103.0 mL/min (93.4–115). Four patients were diabetic, and 22/30 presented at least one risk factor for chronic disease (hypertension, dyslipidemia, and overweight). Proteinuria decreased over time, from 0.47 g/day (0.42–0.52) at 6 months to 0.134 g/day (0.09–0.17) at follow-up endpoint. Proteinuria positively correlated with the peak of plasma creatinine (r 0.6953, p 0.006) and the number of CRRT days (r 0.5650, p 0.035) during AKI course, and negatively with NRI–GFR (r −0.5545, p 0.049). In seven patients, urine protein profile showed a significant increase of glomerular marker albumin and glomerular/tubular index. Conclusions. Burn patients who experienced septic shock and AKI treated with CRRT had a long-term expectation of preserved renal function. However, these patients were more predisposed to microalbuminuria, diabetes, and the presence of risk factors for intercurrent comorbidities and chronic renal disease.

Background The goal of this study was to evaluate whether plating and cortical bone grafting of shortened clavicular nonunions would restore clavicular length and enable bone healing. The association between the clavicular length difference (CLD) between sides and long-term functional outcome was also explored. Methods For this retrospective 2-center study, patients who underwent plate fixation with cortical bone grafting of a clavicular nonunion were assessed after ≥2 years. The CLD and bone union were assessed using radiography and navigation ultrasound. The functional outcome was determined by the Constant score, Simple Shoulder Test score, and Subjective Shoulder Value, as well as local pain (0-10 numeric rating scale). Results Between 2 and 13 years after surgery, 25 patients (mean age, 53 years; 13 female patients) were examined. The median CLD was 0 mm (range, –17 to 13 mm) on ultrasound measurements and 2 mm (range, –32 to 9 mm) on radiographs. At follow-up, the median Constant score, Simple Shoulder Test score, Subjective Shoulder Value, and pain level were 82 points (range, 38-95 points), 12 points (range, 3-12 points), 95% (range, 60%-100%), and 0 (range, 0-8), respectively. There was no correlation between the CLD and all functional outcome scores. Bone union was achieved in all patients. After plate removal, 4 refractures occurred, 3 of which required revision. Conclusions Plate fixation with cortical bone grafting of clavicular nonunions is associated with restoration of clavicular length and a high rate of bone union. There is, however, a considerable risk of refracture following plate removal. There was no association between the CLD and clinical outcome.

Background Coupled-plasma filtration adsorption (CPFA) is a sorbent-based technology aimed at removing soluble mediators of septic shock. We present our experience on the use of CPFA in septic shock severe burn patients with acute kidney injury (AKI) needing renal replacement therapy (RRT) with the main goal to evaluate efficacy and safety of CPFA in this specific subset of septic shock patients. Methods In this observational study, we retrospectively reviewed the medical notes of all burn patients admitted to our adult Burn Center who received CPFA, as part of the septic shock treatment requiring RRT, between January 2001 and December 2017 (CPFA group). We compared CPFA group with all the burn patients admitted to our Center in the same period of time, with the same range of relevant clinical characteristics, who developed AKI and were treated with RRT, but not CPFA (control group). We collected demographic characteristics, burn size, Sequential Organ Assessment Failure (SOFA) score, microbiological data, and patient outcome, in terms of in-hospital mortality rate and the probability of survival calculated using the revised Baux score. We also collected data regarding CPFA safety (hemorrhagic episodes, catheter associated-complications, hypersensitivity reactions) and efficiency (number and duration of CPFA sessions, plasma treated amount, plasma processed dose). Results 39 severe burn patients were treated with CPFA (CPFA group) (mean age 46.0 years, range 40.0–56.0 years; mean burn size 48.0% TBSA, range 35.0–60.0% TBSA), and 87 patients treated with RRT, but not CPFA, who had similar clinical characteristics (control group). Observed mortality rate was 51.3% in the CPFA group and 77.1% in the control group (p 0.004). Regarding factors affecting survival in the CPFA group, SOFA score on the 1st day of CPFA resulted significant (OR 2.016, 95% CI, 1.221–3.326; p Conclusions CPFA treatment for burn patients with AKI-RRT and septic shock, sustained by bacterial strains non or poorly responsive to therapy, was associated with a lower mortality rate, compared to RRT alone. However, further research, such as large prospective studies, is required to clarify the role of CPFA in the treatment of burns with septic shock and AKI-RRT.

Although global associations between language and behavioral development are well established, relations among components and subgroups within these disorders remain unclear. The primary aim of this study was to explore whether language components differed by behavioral subtypes: internalizing only, externalizing only, or both. To control for confounding factors identified in prior studies related to sampling and measurement, we conducted profile analyses of receptive, expressive, pragmatic, semantic, syntactic, or higher order language skills in 46 boys with emotional disturbance (ED) using one comprehensive language measure. On average, the internalizing-only group outperformed all other behavioral subgroups. Absence of interaction effects indicated similar patterns of performance, with all groups performing lowest in pragmatic language. We also report prevalence rates of language deficits in the sample and analyze results using two different grouping strategies. Discussion includes the importance of considering comorbidity and establishing independent behavioral subgroups in research, as well as implications for assessment and intervention in practice.

Interdisciplinary multimodal pain therapy is the gold standard in the treatment of chronic pain. Due to an overall increase in case numbers, the number of MDK examinations leading to the assessment of primary incorrect occupancy is also increasing. This results in a multitude of social court disputes in which medical assessments are required. With knowledge of the legal norms and relevant guidelines or other recommendations, the expert can take this topic step by step. The starting point here is the evaluation of the patient file, followed by the examination of the medical indication, the implementation of the therapy and, finally, the answers to the questions of proof. A test scheme based on the Schröter concept can further simplify this process.Interdisziplinäre multimodale Schmerztherapie ist der Goldstandard in der Therapie chronischer Schmerzen. Aufgrund insgesamt steigender Fallzahlen steigt auch die Zahl an MDK-Prüfungen, die zu der Beurteilung primärer Fehlbelegung kommen. Hieraus resultieren eine Vielzahl sozialgerichtlicher Auseinandersetzungen, in denen medizinische Sachverständigengutachten angefordert werden. Unter Kenntnis der juristischen Normen und relevanten Leitlinien bzw. sonstigen Empfehlungen kann der Gutachter sich Schritt für Schritt dieser Thematik stellen. Beginnend steht hierbei die Auswertung der Patientenakte, gefolgt von der Prüfung der ärztlichen Indikationsstellung, der Therapiedurchführung und abschließend der Beantwortung der Beweisfragen. Ein an das Konzept von Schröter angelehntes Prüfschema kann diesen Vorgang weiter vereinfachen.

Students with and at risk for emotional and behavioral disorders (EBD) often have unidentified co-occurring language deficits, but few studies have evaluated communication-based interventions for this population. Functional communication training (FCT) teaches a communicative response (CR) as a replacement for problem behavior. FCT is an evidence-based practice for students with intellectual and developmental disabilities; however, preliminary literature searches revealed limited evidence to support its use for students without developmental delays. We hypothesized researchers may use similar practices but different terminology to teach and reinforce functionally equivalent CRs. Therefore, we replicated systematic search procedures from previous reviews of functional assessment–based interventions (FABI) for students with or at risk for EBD in school settings and mapped intervention strategies incorporating features of FCT. Results identified 113 published reports describing FABI for 243 students. Subsequent screening and coding procedures revealed 43 (38.05%) of the studies included a CR in interventions for 77 students. Additional analyses revealed antecedent and consequent procedures included in interventions for 58 students mirrored those used in FCT. That is, approximately one in four interventions developed for students with or at risk for EBD included key elements of FCT, despite few references to the term FCT in published reports.

Der gutachterlich tatige Arzt bewegt sich in einem schwierigen Grenzbereich zwischen Medizin und Recht. Neben dem medizinischen Wissen muss er daher auch uber Kenntnisse des Sozialrechts verfugen. Die vorliegende Abhandlung erlautert die wichtigsten sozialrechtlichen Grundbegriffe in alphabetischer Reihenfolge.

Teachers’ oral language use may be an important factor in student achievement, particularly for students who struggle with language, learning, and behavior. This study examined features of teacher talk during whole-class instruction in 14 general education (GE) and 14 self-contained special education (SE) elementary classrooms that included students with or at risk for emotional and behavioral disorders. Across settings, 74% of teachers’ utterances contained vagueness markers that may hinder comprehension. Within teachers, the quantity, complexity, and clarity of oral language tended to remain stable across lessons, regardless of lesson content. Teacher-rated severity of behavior did not differ by setting, but students in self-contained SE classrooms had significantly lower language and reading skills than their counterparts in GE settings. Analyses of multilevel models revealed no significant differences in form or content of teacher talk between groups of teachers across settings (GE or SE) or g...

Introduction: Isoniazid (INH) is an essential drug for tuberculosis (TB) treatment. Resistance to INH may increase the likelihood of negative treatment outcome. Aim: We aimed to determine the impact of INH mono-resistance on TB treatment outcome in the European Union/European Economic Area and to identify risk factors for unsuccessful outcome in cases with INH mono-resistant TB. Methods: In this observational study, we retrospectively analysed TB cases that were diagnosed in 2002–14 and included in the European Surveillance System (TESSy). Multilevel logistic regression models were applied to identify risk factors and correct for clustering of cases within countries. Results: A total of 187,370 susceptible and 7,578 INH mono-resistant TB cases from 24 countries were included in the outcome analysis. Treatment was successful in 74.0% of INH mono-resistant and 77.4% of susceptible TB cases. In the final model, treatment success was lower among INH mono-resistant cases (Odds ratio (OR): 0.7; 95% confidence interval (CI): 0.6–0.9; adjusted absolute difference in treatment success: 5.3%). Among INH mono-resistant TB cases, unsuccessful treatment outcome was associated with age above median (OR: 1.3; 95% CI: 1.2–1.5), male sex (OR: 1.3; 95% CI: 1.1–1.4), positive smear microscopy (OR: 1.3; 95% CI: 1.1–1.4), positive HIV status (OR: 3.3; 95% CI: 1.6–6.5) and a prior TB history (OR: 1.8; 95% CI: 1.5–2.2). Conclusions: This study provides evidence for an association between INH mono-resistance and a lower likelihood of TB treatment success. Increased attention should be paid to timely detection and management of INH mono-resistant TB.

Isoniazid (INH) is an essential drug for tuberculosis (TB) treatment and resistance to INH may increase the likelihood of negative treatment outcomes. We aimed to determine the impact of INH mono-resistance on TB treatment outcomes in the European Union/European Economic Area (EU/EEA) and identify factors associated with unsuccessful treatment of patients with INH mono-resistant TB. We analysed TB cases reported in EU/EEA countries with information on treatment outcome and drug susceptibility that were diagnosed between 2002-2014 and included in the European Surveillance System. Multilevel logistic regression models were applied to correct for clustering of cases within countries. A total of 187,370 fully susceptible and 7,578 INH mono-resistant TB cases from twenty-four EU/EEA countries were included in the analysis. Treatment was successful at 12 months after diagnosis in 67.7% of INH mono-resistant and in 75.8% of fully susceptible TB cases (P This study confirms the adverse impact of INH mono-resistance on TB treatment success. Increased efforts are needed to improve treatment and management of INH mono-resistant cases.

Purpose: To analyze the appropriateness of referrals for incisional glaucoma-surgery in Europe. Methods: Referrals for the first open-angle glaucoma surgery between January and October 2017 were analyzed in 18 countries: 8 “old” European Union, 7 “new” European Union and 3 non-European Union European countries. Results: Most eyes had primary open-angle or exfoliative glaucoma. The average mean deviation was −13.8 dB with split fixation in 44.3%. No structural progression analysis was made before the referrals. The most common medications were the combination of a prostaglandin analog, timolol and a carbonic anhydrase inhibitor (30.0%), and all other combinations comprising ⩾ 3 molecules (33.8%). Laser trabeculoplasty was reported in only 18.4%. Of the 294 referrals, 41.5% were appropriate and timely, 35.0% appropriate but later than optimal, and 17.6% appropriate but too late (minimal vision maintained). The treatment period was significantly longer (median: 7 years) in the “old” European Union countries than in the other groups (3 and 2 years, respectively). No between-group differences were seen in intraocular pressure and mean deviation, but the non-European Union group referred the patients at significantly lower cup/disk ratio and eye drop usage than the other groups. Split fixation was significantly more common in the “old” (60.6%) than the “new” European Union countries (38.7%), and in both EU country-groups than in the non-European Union countries (13.6%). Conclusions: Of 294 European open-angle glaucoma referrals for first glaucoma-surgery, 41.5% were completely satisfactory. The damage was typically advanced, and the care varied considerably among the countries. This suggests that further efforts are necessary to improve glaucoma care in Europe.

PURPOSE The purpose of this work was to explore two novel operation modalities of the rotating gamma systems (RGS) that could expand its clinical application to lesions in close proximity to critical organs at risk (OAR). METHODS The approach taken in this study consists of two components. First, a Geant4-based Monte Carlo (MC) simulation toolkit is used to model the dosimetric properties of the RGS Vertex 360™ for the normal, intensity modulated radiosurgery (IMRS), and speed modulated radiosurgery (SMRS) operation modalities. Second, the RGS Vertex 360™ at the Rotating Gamma Institute in Debrecen, Hungary is used to collect experimental data for the normal and IMRS operation modes. An ion chamber is used to record measurements of the absolute dose. The dose profiles are measured using Gafchromic EBT3 films positioned within a spherical water equivalent phantom. RESULTS A strong dosimetric agreement between the measured and simulated dose profiles and penumbra was found for both the normal and IMRS operation modes for all collimator sizes (4, 8, 14, and 18 mm diameter). The simulated falloff and maximum dose regions agree better with the experimental results for the 4 and 8 mm diameter collimators. Although the falloff regions align well in the 14 and 18 mm collimators, the maximum dose regions have a larger difference. For the IMRS operation mode, the simulated and experimental dose distributions are ellipsoidal, where the short axis aligns with the blocked angles. Similarly, the simulated dose distributions for the SMRS operation mode also adopt an ellipsoidal shape, where the short axis aligns with the angles where the orbital speed is highest. For both modalities, the dose distribution is highly constrained with a sharper penumbra along the short axes. CONCLUSIONS Dose modulation of the RGS can be achieved with the IMRS and SMRS modes. By providing a highly constrained dose distribution with a sharp penumbra, both modes could be clinically applicable for the treatment of lesions in close proximity to critical OARs.

Background In the European Union and European Economic Area only 38% of multidrug-resistant tuberculosis patients notified in 2011 completed treatment successfully at 24 months’ evaluation. Socio-economic factors and patient factors such as demographic characteristics, behaviour and attitudes are associated with treatment outcomes. Characteristics of healthcare systems also affect health outcomes. This study was conducted to identify and better understand the contribution of health system components to successful treatment of multidrug-resistant tuberculosis. Methods We selected four European Union countries to provide for a broad range of geographical locations and levels of treatment success rates of the multidrug-resistant tuberculosis cohort in 2009. We conducted semi-structured interviews following a conceptual framework with representatives from policy and planning authorities, healthcare providers and civil society organisations. Responses were organised according to the six building blocks of the World Health Organization health systems framework. Results In the four included countries, Austria, Bulgaria, Spain, and the United Kingdom, the following healthcare system factors were perceived as key to achieving good treatment results for patients with multidrug-resistant tuberculosis: timely diagnosis of drug-resistant tuberculosis; financial systems that ensure access to a full course of treatment and support for multidrug-resistant tuberculosis patients; patient-centred approaches with strong intersectoral collaboration that address patients’ emotional and social needs; motivated and dedicated healthcare workers with sufficient mandate and means to support patients; and cross-border management of multidrug-resistant tuberculosis to secure continuum of care between countries. Conclusion We suggest that the following actions may improve the success of treatment for multidrug-resistant tuberculosis patients: deployment of rapid molecular diagnostic tests; development of context-specific treatment guidance and criteria for hospital admission and discharge in the European context; strengthening patient-centred approaches; development of collaborative mechanisms to ensure cross-border care, and development of long-term sustainable financing strategies. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4216-9) contains supplementary material, which is available to authorized users.

To estimate trends in tuberculosis (TB) notification rates by geographical origin, we retrieved surveillance data from 2010 to 2015 for 29 European Union and European Economic Area countries. The TB notification rate decreased at an annual rate of 5.3%. The decrease in notification rate was higher in native residents (7.0%) than in those of foreign origin (3.7%). Targeted screening and facilitated access to care and treatment could help prevent and control TB in migrants.

Low language proficiency and problem behavior often co-occur, yet language deficits are likely to be overlooked in children with emotional and behavioral disorders (EBD). Random effects meta-analyses were conducted to determine prevalence and severity of the problem. Across 22 studies, participants included 1,171 children ages 5–13 with formally identified EBD and no history of developmental, neurological, or language disorders. Results indicated prevalence of below-average language performance was 81%, 95% CI [76, 84]. The mean comprehensive language score was 76.33 [71, 82], which was significantly below average. Implications include the need to (a) require language screening for all students with EBD, (b) clarify the relationship between language and behavior, and (c) develop interventions to ameliorate the effects of these dual deficits.

PURPOSE Cervical cancer is a major public and global health problem. According to the WHO, it is the fourth leading cancer among women worldwide, with most women being from low- or middle-income countries. It is the leading cause of cancer-related morbidity and mortality among women of reproductive age in Tanzania, where approximately 4,216 women die as a result of the disease annually. Women with HIV/AIDS, multiple sexual partners, history of human papillomavirus infections, contraceptive use, and early onset of sexual activity have increased risk of the disease, including among university students. Poor knowledge and limited screening programs are major contributors. This study was aimed at assessing the level of knowledge and use of cervical cancer screening among university female students in Moshi municipality. METHODS A cross-sectional study was conducted from June to July 2018 involving undergraduate female students age 18 years and older at three different universities in the Moshi municipality. A total of 322 participants were identified using multistage sampling; data were collected through a self-administered semistructured questionnaire and analyzed using SPSS version 20. RESULTS Ninety-two participants (28.6%) had good knowledge, 104 (32.3%) had satisfactory knowledge, and 126 (39.1%) had poor knowledge. About 299 (92.9%) had heard about cervical cancer. The most frequent sources of information were the media (168 [52.2%]); family, neighbors, and friends (106 [32.9%]), health workers (102 [31.7%]); and teachers (75 [23.3%]). Few reported other sources of information. Only 31 women (9.6%) had been screened for cervical cancer. The reasons given for not attending cervical cancer screening were “I have just not decided” (114 [30.4%]), “I am healthy” (81 [21.6%]), “I’m not informed” (49 [13.0%]), and “It may be painful” (42 [11.2%]); 89 women (23.7%) reported other reasons. CONCLUSION Lack of proper knowledge about cervical cancer contributes to low-screening use. Promotion to increase awareness about cervical cancer screening through radio, television, social media, and clubs would be of great importance. Although a lot has been done by the government and other stakeholders regarding screening, the campaigns should focus not only on women but also on university students specifically, who are more likely to have multiple sexual partners and to have engaged in sexual activity at younger than 18 years.

Background: The Eastern border of the European Union (EU) consists of 10 countries after the expansion of the EU in 2004 and 2007. These 10 countries border to the East to countries with high tuberculosis (TB) notification rates. We analyzed the notification data of Europe to quantify the impact of cross-border TB at the Eastern border of the EU. Methods: We used TB surveillance data of 2010 submitted by 53 European Region countries to the European Centre for Disease Prevention and Control and the World Health Organization Regional Office for Europe. Notified TB cases were stratified by origin of the case (national/foreign). We calculated the contribution of foreign to overall TB notification. Results: In the 10 EU countries located at the EU Eastern border, 618 notified TB cases (1.7% of all notified TB cases) were of foreign origin. Of those 618 TB cases, 173 (28.0%) were from countries bordering the EU to the East. More specifically, 90 (52.0%) were from Russia, 33 (19.1%) from Belarus, 33 (19.1%) from Ukraine, 13 (7.5%) from Moldova and 4 (2.3%) from Turkey. Conclusions: Currently, migrants contribute little to TB notifications in the 10 EU countries at the Eastern border of the EU, but changes in migration patterns may result in an increasing contribution. Therefore, EU countries at the Eastern border of the EU should strive to provide prompt diagnostic services and adequate treatment of migrants.

The 2012 combined tuberculosis (TB) surveillance and monitoring report for the European Union and European Economic Area identifies a mean annual decline in TB notification rate by 4.4% from 2006 to 2010. Culture confirmation for new pulmonary cases and drug susceptibility testing have increased to 65.6% and 70.8%, but remain under their targets of 80% and 100%, respectively. Reporting of treatment outcome and coinfection with human immunodeficiency virus also remain suboptimal. Strengthened control practices are needed to allow progress towards TB elimination.

Language development is the foundation for competence in social, emotional, behavioral, and academic performance. Although language impairment (LI) is known to co-occur with behavioral and mental health problems, LI is likely to be overlooked in school-age children with emotional and behavioral disorders (EBD; Hollo, Wehby, & Oliver, in press). Because language deficits may contribute to the problem behavior and poor social development characteristic of children with EBD, the consequences of an undiagnosed language disorder can be devastating. Implications include the need to train school professionals to recognize communication deficits. Further, it is critically important that specialists collaborate to provide linguistic and behavioral support for students with EBD and LI.

Objective: To better understand the epidemiology of tuberculosis (TB)/HIV coinfection in the European Union (EU) and European Economic Area (EEA) for planning of prevention and control measures. Design: Analysis of surveillance data. Methods: We performed an analysis of the 2014 TB and AIDS data to assess the burden of TB/HIV coinfection and we applied multivariable logistic regression to evaluate predictors for coinfection. Results: Twenty-one of 31 EU/EEA countries reported HIV testing results for 64.6% of the 32 892 notified TB cases. Of those, 1051 (4.9%) were reported as HIV-positive. Males [adjusted odds ratio (aOR) 1.25; 95% confidence interval (CI) 1.07–1.46] and those in age group 25–44 years were more frequently coinfected. TB cases originating from the WHO African region had the highest proportion of coinfection (aOR 3.28 versus origin in EU/EEA; 95% CI 2.35–4.57). TB treatment was completed successfully by 57.9% of HIV-positive TB cases and 83.5% of HIV-negative cases. In 2014, 3863 cases of AIDS were reported by 29 EU/EEA countries; 691 (17.9%) of these cases presented with TB as an AIDS-defining illness. Persons who had acquired HIV through injecting drug use had higher odds of TB as an AIDS-defining illness (aOR 1.78 versus heterosexual route of transmission; 95% CI 1.37–2.32). Conclusion: TB/HIV coinfection is a substantial problem in the EU/EEA. The occurrence of TB in HIV-positive cases and the low TB treatment success rate suggest that international guidelines for prevention and treatment of TB in HIV-infected adults need to be better implemented.

In May 2016, the World Health Organization (WHO) updated its treatment guidelines for drug-resistant tuberculosis (TB) and included a recommendation for the use of the shorter multidrug-resistant (MDR) TB regimen [1]. The WHO update is based on information provided by observational studies coordinated by the International Union Against Tuberculosis and Lung Disease, Médecins sans Frontières and the Damien Foundation which showed that the shorter treatment regimen resulted in a higher likelihood of treatment success compared to the longer conventional treatment in the study settings [2–5]. The shorter MDR-TB regimen consists of a standardised treatment course lasting 9–12 months and includes kanamycin, moxifloxacin, prothionamide, clofazimine, pyrazinamide, isoniazid and ethambutol. It is recommended for patients with rifampicin-resistant (RR) or MDR-TB (cases with TB bacilli resistant to at least isoniazid and rifampicin) who have not been treated previously with second-line drugs and in whom resistance to fluoroquinolones and second-line injectable agents has been excluded or is considered highly unlikely. It is not recommended for pregnant women and patients with extrapulmonary TB., In the European Union, 11% of all MDR-TB cases are eligible for the shorter MDR-TB regimen http://ow.ly/kukg306AcFl

BACKGROUND The effect of HIV on tuberculosis (TB) treatment outcomes has not been well established. We aimed to assess the impact of HIV infection on TB treatment outcomes by using data from notifiable disease surveillance in Europe. METHODS We analyzed the treatment outcomes of TB cases reported from nine European countries during 2010-2012. We investigate the effect of HIV on TB treatment outcomes using a multilevel and a multinomial logistic model, and considering the interaction between HIV and multidrug-resistant (MDR) TB. RESULTS A total of 61,138 TB cases including 5.5% HIV-positive were eligible for our analysis. In the multilevel model adjusted for age and an interaction with MDR TB, HIV was significantly associated with lower treatment success in all MDR strata [non-MDR TB: odds ratio (OR) 0.24 CI (confidence interval) 0.20-0.29; unknown MDR TB status: OR 0.26 CI 0.23-0.30; MDR TB: OR 0.57 CI 0.35-0.91]. In the multinomial regression model, HIV-positive cases had significantly higher relative risk ratio (RRR) for death (non-MDR TB: RRR 4.30 CI 2.31-7.99; unknown MDR TB status: 5.55 CI 3.10-9.92; MDR TB: 3.59 CI 1.56-8.28) and being 'still on treatment' (non-MDR TB: RRR 7.27 CI 3.00-17.6; unknown MDR TB status: 5.36 CI 2.44-11.8; MDR TB: 3.76 CI 2.48-5.71). We did not find any significant association between HIV and TB treatment failure (non-MDR TB: RRR 0.50 CI 0.15-1.67; unknown MDR TB status: 1.51 CI 0.86-2.64; MDR TB: 0.51 CI 0.13-1.87). CONCLUSION This large study confirms that HIV is a strong risk factor for an adverse TB treatment outcome, which is mainly manifested by an increased risk of death and still being on TB treatment.

To advance research evaluating the relationship between social information processing (Crick & Dodge) and youth aggression, this meta-analytic study examined associations between social goals and aggression in children in 21 separate research reports. Eligible studies provided descriptive or preintervention measurement of children's aggression and social goals, and were reported in English by March 1, 2010. Findings from two random-effects meta-analyses utilizing clustered data analysis techniques (i.e., effect sizes nested within samples) supported an expected (1) negative association between prosocial goals and aggression, and (2) positive association between antisocial goals and aggression. Little heterogeneity in these associations was observed across studies, and no moderating variables were revealed. The findings extend existing meta-analytic research on social information processing and aggression to include social goals as meaningful correlates of youth aggression.

Monitoring the treatment outcome (TO) of tuberculosis (TB) is essential to evaluate the effectiveness of the intervention and to identify potential barriers for TB control. The global target is to reach a treatment success rate (TSR) of at least 85%. We aimed to assess the TB TO in the European Union and European Economic Area (EU/EEA) between 2002 and 2011, and to identify factors associated with unsuccessful treatment. Only 18 countries reported information on TO for the whole observation period accounting for 250,854 new culture-confirmed pulmonary TB cases. The 85% target of TSR was not reached in any year between 2002 and 2011 and was on average 78%. The TSR for multidrug-resistant (MDR)-TB cases at 24-month follow-up was 49%. In the multivariable regression model, unsuccessful treatment was significantly associated with increasing age (odds ratio (OR) = 1.02 per a one-year increase, 95% confidence interval (CI): 1.02–1.02), MDR-TB (OR = 8.7, 95% CI: 5.09–14.97), male sex (OR = 1.40, 95% CI: 1.28–1.52), and foreign origin (OR = 1.32, 95% CI: 1.03–1.70). The data highlight that special efforts are required for patients with MDR-TB and the elderly aged ≥65 years, who have particularly low TSR. To allow for valid monitoring at EU level all countries should aim to report TO for all TB cases.

BACKGROUND Multidrug-resistant tuberculosis programs in DOTS-Plus pilot sites in five countries. OBJECTIVES To calculate sputum conversion time and its relationship to treatment outcome, document the frequency of culture reversions and examine concordance of smear and culture to assess the potential consequences of monitoring by smear microscopy alone. DESIGN Retrospective cohort analysis of 1926 patients receiving individualized, second-line therapy. RESULTS Among 1385 sputum culture-positive cases at baseline, 1146 (83%) experienced at least one culture conversion during treatment. Conversion, however, was not sustained in all patients: 201 (15%) experienced initial culture conversion and at least one subsequent culture reversion to positive; 1064 (77%) achieved sustained culture conversion. Median time to culture conversion was 3 months. Among 206 patients whose nal conversion occurred 7-18 months after the initiation of therapy, 71% were cured or had completed treatment. CONCLUSIONS Prolonged treatment for patients with delayed conversion may be beneficial, as 71% of late converters still achieved cure or completed treatment. This has implications for programs with de ned end points for treatment failure. The interval between rst and nal conversion among patients whose initial con- version is not sustained raises concern with respect to the ongoing debate regarding duration of treatment and the definition of cure.

Background. Citrate anticoagulation is gaining popularity in renal replacement therapies (RRT) for critically ill patients. In order to study whether citrate accumulates in septic shock patients, we determined citrate in plasma and dialysate during continuous venovenous haemodiafiltration (CVVHDF). Methods. An automated routine determination of citrate was set up using a commercial kit (citrate lyase method). Twelve patients with septic shock on CVVHDF and citrate anticoagulation were studied ex vivo for citrate levels in systemic and circuit blood and in the ultrafiltrate (at 0, 0.5, 1, 3, 6, 9, 12, 24, 48 and 72 h). Results. In vitro blood studies showed a near unit correlation between the plasma measured and predicted citrate concentrations for an exclusive extracellular distribution of citrate. Median systemic arterial citratemias were 0.09 (0.06–0.12) mmol/L (Time 0) and 0.23 (0.18–0.31) mmol/ L during treatment; median sieving coefficient for citrate was 0.95 (0.88–1.02) and did not change with different volumes of CVVHDF effluent (from 1350 to 5100 mL/h). Net citrate and calcium removal by filter significantly correlated with effluent volume (r ¼ 0.85 and 0.78, respectively). Median citrate load entering in the patients’ bloodstream was 13.60 (9.1–19.6, n ¼ 68) mmol/h. Although cost analysis of the citrate test demonstrated a minimally increased daily cost (from 2.96 to 3.51V), saving costs could be potentially relevant with more extended use of citrate anticoagulation. Conclusions. In septic shock patients with liver dysfunction citratemia is useful in guiding clinical application of RRT, where the citrate losses in the ultrafiltrate can be efficiently modulated by increasing the effluent volume.

In 1991, the Peacock Hill Working Group provided the field of emotional and behavioral disorders (EBD) a roadmap for improving the quality of services provided to students with EBD. The working group considered issues at every level of the educational system, from the classroom to federal policy. Although many strides have been made in the past 20 years regarding the education and treatment of students with EBD, the gap has persisted between empirically validated practices and the classroom routines of teachers serving students from this population. In the authors’ view, the field of EBD would benefit greatly from conceptual and empirical developments to improve the mechanisms required to bring science to the classroom. Using the theoretical underpinnings of implementation science, the authors describe a transactional model for integrating research, policy, and practice to close the research-to-practice gap. Recommendations for researchers, policy makers, and practitioners are provided.

To investigate whether anxiety plays a role in self-recruitment for non-population-based glaucoma screening. In a non-population-based pre-publicised trial, self-recruited Caucasian participants were screened for glaucoma, and also completed the Trait Anxiety Inventory and Shortened Health Anxiety Inventory questionnaires. In pre-publicity for the trial, information on risk factors for glaucoma was given. Participants classified as possible glaucoma cases later underwent a detailed glaucoma investigation. Of the 120 total participants (72 females, 48 males), 12 were considered glaucoma suspects at the screening, although only three (2.5%) were ultimately diagnosed with glaucoma. Health anxiety showed significant correlation with trait anxiety (r=0.525, P

Background Patients with severe chronic hand eczema (CHE) refractory to topical corticosteroids currently have limited treatment options suited for chronic use, and few controlled clinical studies have investigated new therapies in this setting.Objectives To assess the efficacy and safety of oral alitretinoin (9-cis retinoic acid) taken at 10 mg or 30 mg once daily for up to 24 weeks, compared with placebo control, in the treatment of severe CHE refractory to topical corticosteroids.Methods A randomized, double-blind, placebo-controlled, prospective, multicentre trial was conducted in 111 dermatology outpatient clinics in Europe and Canada. A total of 1032 patients with severe refractory CHE were randomized in a 1 : 2 : 2 ratio to placebo, or 10 mg or 30 mg of oral alitretinoin once daily for up to 24 weeks. Safety was assessed for all patients during a follow-up period of 4 weeks, and responders were observed for relapse for 24 weeks after the end of therapy. The primary efficacy parameter was Physician Global Assessment of overall CHE severity, with response defined as clear or almost clear hands.Results Responses, defined as clear or almost clear hands, were achieved in up to 48% of patients treated with alitretinoin, compared with 17% for placebo (P Conclusions Alitretinoin given at well-tolerated doses induced clearing of CHE in a substantial proportion of patients with severe disease refractory to standard therapy.

No information is currently available on the influence of injectable second-line drugs on treatment outcomes of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) patients. To investigate this issue, a large series of MDR- and XDR-TB cases diagnosed in Estonia, Germany, Italy and the Russian Federation (Archangels Oblast) between 1999 and 2006 were analysed. All study sites performed drug susceptibility testing for first- and second-line anti-TB drugs, laboratory quality assurance and treatment delivery according to World Health Organization recommendations. Out of 4,583 culture-confirmed cases, 240 MDR- and 48 XDR-TB cases had a definitive outcome recorded (treatment success, death, failure). Among MDR- and XDR-TB cases, capreomycin resistance yielded a higher proportion of failure and death than capreomycin-susceptible cases. Resistance to capreomycin was independently associated with unfavourable outcome (logistic regression analysis: odds ratio 3.51). In the treatment of patients with multidrug-resistant and extensively drug-resistant tuberculosis, resistance to the injectable drug capreomycin was an independent predictor for therapy failure in this cohort. As Mycobacterium tuberculosis drug resistance is increasing worldwide, there is an urgent need for novel interventions in the fight against tuberculosis.

Immigration from tuberculosis (TB) high-incidence countries is known to contribute notably to the TB burden in low-incidence countries. However, the effect of migration enabled by the free movement of persons within the European Union (EU)/European Economic Area (EEA) on TB notification has not been analysed. We analysed TB surveillance data from 29 EU/EEA countries submitted for the years 2007–2013 to The European Surveillance System. We used place of birth and nationality as proxy indicators for native, other EU/EEA and non-EU/EEA origin of the TB cases and analysed the characteristics of the subgroups by origin. From 2007–2013, a total of 527,467 TB cases were reported, of which 129,781 (24.6%) were of foreign origin including 12,566 (2.4%) originating from EU/EEA countries other than the reporting country. The countries reporting most TB cases originating from other EU/EEA countries were Germany and Italy, and the largest proportion of TB cases in individuals came from Poland (n=1,562) and Romania (n=6,285). At EU/EEA level only a small proportion of foreign TB cases originated from other EU/EEA countries, however, the uneven distribution of this presumed importation may pose a challenge to TB programmes in some countries.

BACKGROUND The heparin requirement for coupled plasma filtration adsorption (CPFA) is usually high. Heparin administration often cannot be adherent to prescription, leading to a premature clotting of circuit and an insufficient volume of treated plasma. Regional citrate anticoagulation (RCA) could be an attractive alternative; however, no data are available on citrate pharmacokinetics at high levels of circuit citratemia. METHODS Fifteen septic shock patients with acute kidney injury undergoing CPFA with RCA at target circuit citratemia of 6 mmol/L were treated with CPFA-haemofiltration in pure predilution (CPFA-HF predilution group, n = 5 patients), or predilution haemodiafiltration (CPFA-HDF predilution group, n = 5 patients) or pre- and postdilution haemofiltration (CPFA-HF pre/postdilution group, n = 5 patients). Citrate pharmacokinetics was carried out through its determination in systemic and circuit blood, and effluent at time 0, 0.2, 1, 3, 6 and 9 h. RESULTS The systemic concentrations of citrate in the CPFA-HF predilution group significantly increased over the sessions (from basal level of 0.21 to 0.76 mmol/L at 3 h), whereas they did not change in CPFA-HDF predilution and CPFA-HF pre/postdilution groups. Circuit plasma citrate concentrations (from 3 to 8 mmol/L) correlated strongly with circuit iCa++ levels (Spearman R = -0.7022, P < 0.01). Sieving coefficients of citrate were near the unit in all three groups and unrelated to blood and infusion flow rates in predilution. However, the amount of citrate removed by effluent was ∼40% for the CPFA-HF predilution group and reached 60% for both the CPFA-HDF predilution and CPFA-HF pre/postdilution groups (P < 0.05). As for the efficiency of plasmafiltration, the plasmafiltrate volume (from 17 to 20 mL/kg/day) was not significantly different among the groups. CONCLUSIONS These results demonstrated that in refractory septic shock patients on CPFA at circuit citratemia of 6 mmol/L both HDF predilution and HF pre/postdilution were the best dialysis modalities to maintain a normal systemic citratemia through a high rate of citrate loss in the effluent.

Managing MDRTB through national programs can yield results similar to those seen in wealthier settings., Evidence of successful management of multidrug-resistant tuberculosis (MDRTB) is mainly generated from referral hospitals in high-income countries. We evaluate the management of MDRTB in 5 resource-limited countries: Estonia, Latvia, Peru, the Philippines, and the Russian Federation. All projects were approved by the Green Light Committee for access to quality-assured second-line drugs provided at reduced price for MDRTB management. Of 1,047 MDRTB patients evaluated, 119 (11%) were new, and 928 (89%) had received treatment previously. More than 50% of previously treated patients had received both first- and second-line drugs, and 65% of all patients had infections that were resistant to both first- and second-line drugs. Treatment was successful in 70% of all patients, but success rate was higher among new (77%) than among previously treated patients (69%). In resource-limited settings, treatment of MDRTB provided through, or in collaboration with, national TB programs can yield results similar to those from wealthier settings.

The aim of this study was to explore the cranial nerve symptoms, speech disorders and communicative effectiveness of Finnish patients with diagnosed or possible amyotrophic lateral sclerosis (ALS) at their first assessment by a speech-language pathologist. The group studied consisted of 30 participants who had clinical signs of bulbar deterioration at the beginning of the study. They underwent a thorough clinical speech and communication examination. The cranial nerve symptoms and ability to communicate were compared in 14 participants with probable or definitive ALS and in 16 participants with suspected or possible ALS. The initial type of ALS was also assessed. More deterioration in soft palate function was found in participants with possible ALS than with diagnosed ALS. Likewise, a slower speech rate combined with more severe dysarthria was observed in possible ALS. In both groups, there was some deterioration in communicative effectiveness. In the possible ALS group the diagnostic delay was longer and speech therapy intervention actualized later. The participants with ALS showed multidimensional decline in communication at their first visit to the speech-language pathologist, but impairments and activity limitations were more severe in suspected or possible ALS. The majority of persons with bulbar-onset ALS in this study were in the latter diagnostic group. This suggests that they are more susceptible to delayed diagnosis and delayed speech therapy assessment. It is important to start speech therapy intervention during the diagnostic processes particularly if the person already shows bulbar symptoms. (C) 2016 Published by Elsevier Inc.

Background: Monitoring the retinal nerve fibre layer thickness (RNFLT) is essential in the diagnosis and treatment of glaucoma. In a previous study we found that a decrease of the polarimetric RNFLT observed in the early period after laser-assisted in situ keratomileusis (LASIK) disappears or tends to disappear by the third post-LASIK month. Purpose: To study the stability of the “recovered” polarimetric retardation values between the third and twelfth month after LASIK. Methods: Scanning laser polarimetry (SLP) with the classic GDx Nerve Fiber Analyzer was performed on 13 consecutive healthy subjects with no eye disease who underwent LASIK for ametropia correction. Measurements were performed preoperatively, then at 3 and 12 months postoperatively. Results: Inferior, temporal and nasal average thickness as well as ellipse average thickness and average thickness showed no difference among the three time points (ANOVA, p > 0.05). Superior average thickness was significantly smaller both at three months (Sheffe test, p = 0.008) and 12 months (p = 0.006) than before LASIK. However, no difference was seen between the values measured at three months and at 12 months after LASIK (p = 0.997). A statistically significant interaction between treatment type (myopic or hyperopic correction) and the change of retardation was found for the superior average thickness (two-way ANOVA, p = 0.016). In this quadrant the RNFLT values of the myopic eyes decreased between the baseline and the month 3 measurements but became stable after that; the retardation of the hyperopic eyes remained unchanged throughout. Conclusion: RNFLT measured with the classic GDx device after LASIK shows transient changes probably due to the LASIK-induced alteration of the polarization and the healing process. The polarimetric RNFLT values, however, become stable by the third post-LASIK month, and show no further change until the end of the first year after LASIK. Baseline SLP measurements for long-term glaucoma follow-up can be obtained from the third post-LASIK month