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Abstract Sleep is a complex and conserved biological process that affects several body functions and behaviors. Evidence suggests that there is a reciprocal interaction between sleep and immunity. For instance, fragmented sleep can increase the probability of parasitic infections and reduce the ability to fight infections. Moreover, viral and bacterial infections alter the sleep patterns of infected individuals. However, the effects of macro-parasitic infections on sleep remain largely unknown, and measuring sleep in non-model organisms remains challenging. In this study, we investigated whether macro-parasite infections could alter sleep-like behavior of their hosts. We experimentally infected three-spined sticklebacks (Gasterosteus aculeatus), a freshwater fish, with the tapeworm Schistocephalus solidus and used a hidden Markov model to characterize sleep-like behavior in sticklebacks. One to four days after parasite exposure, infected fish showed no difference in sleep-like behavior compared with non-exposed fish, and fish that were exposed-but-not-infected only showed a slight reduction in sleep-like behavior during daytime. Twenty-nine to 32 days after exposure, infected fish showed more sleep-like behavior than control fish, while exposed-but-not-infected fish showed overall less sleep-like behavior. Using brain transcriptomics, we identified immune- and sleep-associated genes that potentially underlie the observed behavioral changes. These results provide insights into the complex association between macro-parasite infection, immunity, and sleep in fish and may thus contribute to a better understanding of reciprocal interactions between sleep and immunity.

Abstract Dual-energy computed tomography (DECT) is an imaging technique that combines nondestructive morphological cross-sectional imaging of objects and the quantification of their chemical composition. However, its potential to assist investigations in paleontology has not yet been explored. This study investigates quantitative DECT for the nondestructive density- and element-based material decomposition of fossilized bones. Specifically, DECT was developed and validated for imaging-based calcium and fluorine quantification in bones of five fossil vertebrates from different geological time periods and of one extant vertebrate. The analysis shows that DECT material maps can differentiate bone from surrounding sediment and reveals fluorine as an imaging marker for fossilized bone and a reliable indicator of the age of terrestrial fossils. Moreover, the jaw bone mass of Tyrannosaurus rex showed areas of particularly high fluorine concentrations on DECT, while conventional CT imaging features supported the diagnosis of chronic osteomyelitis. These findings highlight the relevance of radiological imaging techniques in the natural sciences by introducing quantitative DECT imaging as a nondestructive approach for material decomposition in fossilized objects, thereby potentially adding to the toolbox of paleontological studies.

Abstract Tracking studies of juveniles are rare compared to those of adults, and consequently little is known about the influence of intrinsic and extrinsic factors on activity during this critical life stage. We used hourly GPS data, collected from 66 Antarctic fur seal pups from birth until moulting, to investigate the explanatory power of multiple individual-based and environmental variables on activity levels. Pups were sampled from two nearby breeding colonies of contrasting density during two subsequent years, and a two-state hidden Markov model was used to identify modalities in their movement behaviour, specifically ‘active’ and ‘inactive’ states. We found that movement was typified by central place exploration, with active movement away from and subsequent return to a location of inactivity. The probability of such directed exploration was unaffected by several factors known to influence marine mammal movement including sex, body condition, and temperature. Compared to pups born at the high-density colony, pups at low-density were more active, increased their activity with age, and transitioned earlier into the tussock grass, which offers protection from predators and extreme weather. Our study illustrates the importance of extrinsic factors, such as colony of birth, to early-life activity patterns and highlights the adaptive potential of movement.

Carbon monoxide (CO) poisoning is an important clinical problem. The symptoms of poisoning are non-specific, particularly in the paediatric population. Currently, the use of hyperbaric oxygen (HBO) is considered to be more justified with increasing severity of the patient’s clinical status and with shorter time elapsed from CO exposure. Aim of the study: The aim of this study was to assess the efficacy of hyperbaric oxygen therapy in children with symptoms of carbon monoxide poisoning. Material and methods: The study was a retrospective analysis of medical records of children hospitalised for carbon monoxide poisoning at the Department of Paediatrics, Paediatric Nephrology and Allergology of the Military Institute of Medicine, Poland, between January and December 2018. The following data were analysed: laboratory test results, CO poisoning circumstances, the manner of reporting to the Department, the number of hyperbaric chamber sessions needed to relieve the symptoms completely, the occurrence of complications and the duration of stay at the Department after treatment completion. Results: The analysis of the results did not demonstrate any relationship between carboxyhaemoglobin level and poisoning manifestations and CO poisoning severity. However, a statistically significant positive correlation was demonstrated between carboxyhaemoglobin level and HCO3− level and a statistically significant negative correlation was found between carboxyhaemoglobin level and capillary pH. No statistically significant differences were found between children with mild poisoning and those with severe poisoning in terms of potassium level, capillary pH, and HCO3− and glucose levels. At the same time, it was demonstrated that hyperbaric therapy is a highly effective and safe method. Conclusion: Regardless of the causes of CO poisoning in the paediatric population, hyperbaric therapy is a highly effective and safe method. One session in a hyperbaric chamber is sufficient to relieve the symptoms completely and prevent delayed sequelae of poisoning and CO side effects.

Objectives The aims of our study were to describe the disease spectrum of refugees, to analyse to what extent their healthcare needs could be met in an outpatient primary care walk-in clinic and which cases required additional services from secondary care (ie, outpatient specialists or hospitals).Design Retrospective longitudinal observational study.Setting The study was based on routine data from a walk-in clinic in the largest central first reception centre in Hamburg, Germany between 4 November 2015 and 21 July 2016.Participants 1467 asylum seekers with 4006 episodes of care (ie, distinctive health problems) resulting in 5545 consultations. The patients were 60% men and had a mean age of 23.2 years. About 90% of the patients were from Central Asia or from the Middle East and North Africa.Primary and secondary outcome measures The endpoint of our analyses was referral to secondary care. Time to event was defined as days under treatment until the first referral. Predictor variables were the patients’ diagnoses grouped in 46 categories. The data set was analysed by Cox regression allowing for multiple failure times per patient. This analysis was adjusted for age, sex and country of origin.Results Referrals to secondary care occurred in 15.5% of the episodes. The diagnosis groups with the highest referral rates were ‘eye’ (HR 4.9; 95% CI 3.12 to 7.8; p≤0.001), ‘teeth/gum symptom/complaint or disease’ (3.51; 2.52 to 4.9; p≤0.001) and ‘urological system/female or male genital’ (2.50; 1.66 to 3.77; p≤0.001). Age, sex and country of origin had no significant effect on time until referral.Conclusions In most cases, the walk-in clinic physicians could provide first-line medical care for the health problems of patients not integrated in the German healthcare system. Additional resources were needed particularly not only for visual impairment and dental problems but also for psychological disorders, antenatal care and certain infections and injuries.

Introduction Healthcare systems around the world are looking for solutions to the growing problem of mental disorders. RECOVER is the synonym for an evidence-based, stepped and cross-sectoral coordinated care service model for mental disorders. RECOVER implements a cross-sectoral network with managed care, comprehensive psychological, somatic and social diagnostics, crisis resolution and a general structure of four severity levels, each with assigned evidence-based therapy models (eg, assertive community treatment) and therapies (eg, psychotherapy). The study rationale is the investigation of the effectiveness and efficiency of stepped and integrated care in comparison to standard care.Methods and analysis The trial is conducted in accordance to the Standard Protocol Items: Recommendations for Interventional Trials Statement. The study aims to compare the RECOVER model with treatment as usual (TAU). The following questions are examined: Does RECOVER reduce healthcare costs compared with TAU? Does RECOVER improve patient-relevant outcomes? Is RECOVER cost-effective compared with TAU? A total sample of 890 patients with mental disorders will be assessed at baseline and individually randomised into RECOVER or TAU. Follow-up assessments are conducted after 6 and 12 months. As primary outcomes, cost reduction, improvement in symptoms, daily functioning and quality of life as well as cost-effectiveness ratios will be measured. In addition, several secondary outcomes will be assessed. Primary and secondary outcomes are evaluated according to the intention-to-treat principle. Mixed linear or logistic regression models are used with the direct maximum likelihood estimation procedure which results in unbiassed estimators under the missing-at-random assumption. Costs due to healthcare utilisation and productivity losses are evaluated using difference-in-difference regressions.Ethics and dissemination Ethical approval from the ethics committee of the Hamburg Medical Association has been obtained (PV5672). The results will be disseminated to service users and their families via the media, to healthcare professionals via professional training and meetings and to researchers via conferences and publications.Trial registration number and registry name ClinicalTrials.gov (NCT03459664), RECOVERProtocol version 19 March 2020 (V.3.0)

Abstract We show that the highly conductive polymer poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) (PEDOT:PSS) can successfully be applied as a hole selective front contact in silicon heterojunction (SHJ) solar cells. In combination with a superior electron selective heterojunction back contact based on amorphous silicon (a-Si), mono-crystalline n-type silicon (c-Si) solar cells reach power conversion efficiencies up to 14.8% and high open-circuit voltages exceeding 660 mV. Since in the PEDOT:PSS/c-Si/a-Si solar cell the inferior hybrid junction is determining the electrical device performance we are capable of assessing the recombination velocity (v I ) at the PEDOT:PSS/c-Si interface. An estimated v I of ~400 cm/s demonstrates, that while PEDOT:PSS shows an excellent selectivity on n-type c-Si, the passivation quality provided by the formation of a native oxide at the c-Si surface restricts the performance of the hybrid junction. Furthermore, by comparing the measured external quantum efficiency with optical simulations, we quantify the losses due to parasitic absorption of PEDOT:PSS and reflection of the device layer stack. By pointing out ways to better passivate the hybrid interface and to increase the photocurrent we discuss the full potential of PEDOT:PSS as a front contact in SHJ solar cells.

Postural defect is a set of postural abnormalities defined as minor single deviations from correct posture, which may be repaired with the use of appropriate exercises, passive or active. Studies concerning the evaluation of children and teenagers’ health condition have shown that the incidence of postural defects in the population ranges from 30 to 60%. The greatest threat for the development of incorrect body posture is present in the period of fast growth, namely between the age of 5 and 7 and in the period of adolescence. The most common postural defects in the population of children in Poland include: scoliosis, juvenile kyphosis of the spine (Scheuermann’s disease) and static deformations of lower extremities. Owing to the common nature of the issue and the possibility to apply effective preventive measures, it is necessary to early detect postural defects through appropriate examinations. Preventive healthcare for children is aimed at early diagnosis of irregularities in a child’s development. Screening tests among children detect three types of the motor system disorders: scoliosis, excessive thoracic kyphosis and static deformations of lower extremities and asymmetry in the length of lower extremities. Early detection of the defect prevents against its further development or the development of further abnormalities. The results of a report Health Behaviour in School-aged Children concerning the health of children clearly show that recently, there has been a substantive increase in the number of factors causing the creation of postural defects. School period is the most optimum one to carry out preventive actions in this respect. Postural defects develop in some children, despite preventive measures carried out. In accordance with the recommendations of experts, it is then necessary to perform secondary prophylaxis, which prevents further development of the defect, the creation of muscular contracture and is aimed at the so-called postural re-education. The selection of physical activity should be adequate to the type of postural defect.

Introduction: Routine medical care in Germany, Austria and Switzerland is being increasingly impacted by the cultural and linguistic diversity of an ever more complex world. Both at home and as part of international student exchanges, medical students are confronted with different ways of thinking and acting in relation to health and disease. Despite an increasing number of courses on cultural competence and global health at German-speaking medical schools, systematic approaches are lacking on how to integrate this topic into medical curricula.Methodological approach: This paper is based on a structured consensus-building process by a multidisciplinary committee composed of faculty and students. In a first step, a qualitative online survey was carried out in order to establish an inventory of definitions and concepts. After the second step, in which a literature search was conducted and definitions of global health and transcultural and intercultural competence were clarified, recommendations were formulated regarding content, teaching and institutional infrastructure. Based on small-group work and large-group discussions, different perspectives and critical issues were compiled using multiple feedback loops that served to ensure quality.Results: An inventory on the national and international level showed that great heterogeneity exists in regard to definitions, teaching strategies, teaching formats and faculty qualification. Definitions and central aspects considered essential to medical education were thus established for the use of the terms “cultural competence” and “global health”. Recommendations are given for implementation, ranging from practical realization to qualification of teaching staff and education research.Outlook: High-quality healthcare as a goal calls for the systematic internationalization of undergraduate medical education. In addition to offering specific courses on cultural competence and global health, synergies would be created through the integration of cultural competence and global health content into the curricula of already existing subject areas. The NKLM (the national competence-based catalogue of learning objectives for undergraduate medical education) would serve as a basis for this.

Structured management programmes deliver optimized care in heart failure patients and improve outcome. We examined the feasibility of including patients with migration background speaking little or no German in a heart failure management programme.After adaption of script material and staff to Turkish language we aimed to recruit 300 Turkish and 300 German (control group) patients within 18 months using the operational basis of a local heart failure management programme for screening, contact and inclusion. Of 488 and 1,055 eligible Turkish and German patients identified through screening, 165 Turkish (34%) and 335 German (32%) patients consented on participation (p = 0.46). General practitioners contributed significantly more of the Turkish (84%) than of the German patients (16%, p

Currently, radiography is the only imaging technique used to diagnose bone pathology in wild animals situated under "field conditions". Nevertheless, while chronic foot disease in captive mega-herbivores is widely reported, foot radiographic imaging is confronted with scarcity of studies. Numerous hindrances lead to such limited numbers and it became very clear that the traditional perspective on bone imaging in domestic animals based on extensive studies and elaborated statistical evaluations cannot be extrapolated to their non-domestic relatives. For these reasons, the authors initiated a multi-modality imaging study and established a pioneering approach of synchronized computed tomography (CT) and digital radiography (DR), based on X-ray projections derived from three-dimensional CT reconstructed images. Whereas this approach can be applied in any clinical field, as a case of outstanding importance and great concern for zoological institutions, we selected foot bone pathologies in captive rhinoceroses to demonstrate the manifold applications of the method. Several advances were achieved, endowing the wildlife clinician with all-important tools: prototype DR exposure protocols and a modus operandi for foot positioning, advancing both traditional projections and, for the first-time, species-related radiographic views; assessment of radiographic diagnostic value for the whole foot and, in premiere, for each autopodial bone; together with additional insights into radiographic appearance of bone anatomy and pathology with a unique, simultaneous CT-DR correlation. Based on its main advantages in availing a wide range of keystone data in wildlife imaging from a limited number of examined subjects and combining advantages of CT as the golden standard method for bone diseases' diagnostic with DR's clinical feasibility under field conditions, synchronized CT-DR presents a new perspective on wildlife's health management. With this we hope to provide veterinary clinicians with concrete imaging techniques and substantial diagnostic tools, which facilitate straightforward attainment and interpretation of field radiography images taken worldwide.