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Stratospheric ozone is expected to recover by the mid-century due to the success of the Montreal Protocol in regulating the emission of ozone-depleting substances (ODSs). In the Arctic, ozone abundances are projected to surpass historical levels due to the combined effect of decreasing ODSs and elevated greenhouse gases (GHGs). While long-term changes in stratospheric ozone have been shown to be a major driver of future surface climate in the Southern Hemisphere during summertime, the dynamical and climatic impacts of elevated ozone levels in the Arctic have not been investigated. In this study, we use two chemistry climate models (the SOlar Climate Ozone Links – Max Planck Ocean Model (SOCOL-MPIOM) and the Community Earth System Model – Whole Atmosphere Community Climate Model (CESM-WACCM)) to assess the climatic impacts of future changes in Arctic ozone on stratospheric dynamics and surface climate in the Northern Hemisphere (NH) during the 21st century. Under the high-emission scenario (RCP8.5) examined in this work, Arctic ozone returns to pre-industrial levels by the middle of the century. Thereby, the increase in Arctic ozone in this scenario warms the lower Arctic stratosphere; reduces the strength of the polar vortex, advancing its breakdown; and weakens the Brewer–Dobson circulation. The ozone-induced changes in springtime generally oppose the effects of GHGs on the polar vortex. In the troposphere, future changes in Arctic ozone induce a negative phase of the Arctic Oscillation, pushing the jet equatorward over the North Atlantic. These impacts of future ozone changes on NH surface climate are smaller than the effects of GHGs, but they are remarkably robust among the two models employed in this study, canceling out a portion of the GHG effects (up to 20 % over the Arctic). In the stratosphere, Arctic ozone changes cancel out a much larger fraction of the GHG-induced signal (up to 50 %–100 %), resulting in no overall change in the projected springtime stratospheric northern annular mode and a reduction in the GHG-induced delay of vortex breakdown of around 15 d. Taken together, our results indicate that future changes in Arctic ozone actively shape the projected changes in the stratospheric circulation and their coupling to the troposphere, thereby playing an important and previously unrecognized role as a driver of the large-scale atmospheric circulation response to climate change.

In the Arctic stratosphere, the combination of chemical ozone depletion by halogenated ozone-depleting substances (hODSs) and dynamic fluctuations can lead to severe ozone minima. These Arctic ozone minima are of great societal concern due to their health and climate impacts. Owing to the success of the Montreal Protocol, hODSs in the stratosphere are gradually declining, resulting in a recovery of the ozone layer. On the other hand, continued greenhouse gas (GHG) emissions cool the stratosphere, possibly enhancing the formation of polar stratospheric clouds (PSCs) and, thus, enabling more efficient chemical ozone destruction. Other processes, such as the acceleration of the Brewer–Dobson circulation, also affect stratospheric temperatures, further complicating the picture. Therefore, it is currently unclear whether major Arctic ozone minima will still occur at the end of the 21st century despite decreasing hODSs. We have examined this question for different emission pathways using simulations conducted within the Chemistry-Climate Model Initiative (CCMI-1 and CCMI-2022) and found large differences in the models' ability to simulate the magnitude of ozone minima in the present-day climate. Models with a generally too-cold polar stratosphere (cold bias) produce pronounced ozone minima under present-day climate conditions because they simulate more PSCs and, thus, high concentrations of active chlorine species (ClOx). These models predict the largest decrease in ozone minima in the future. Conversely, models with a warm polar stratosphere (warm bias) have the smallest sensitivity of ozone minima to future changes in hODS and GHG concentrations. As a result, the scatter among models in terms of the magnitude of Arctic spring ozone minima will decrease in the future. Overall, these results suggest that Arctic ozone minima will become weaker over the next decades, largely due to the decline in hODS abundances. We note that none of the models analysed here project a notable increase of ozone minima in the future. Stratospheric cooling caused by increasing GHG concentrations is expected to play a secondary role as its effect in the Arctic stratosphere is weakened by opposing radiative and dynamical mechanisms.

Understanding the main drivers of biodiversity loss in Europe's agricultural landscapes has been a research priority in the last decades. One of the most important factors promoting biodiversity in farmed landscapes is habitat heterogeneity, which has often proved crucial for avian species and communities. Birds are highly sensitive to environmental changes and make use of a broad range of ecological niches, thus being exceptionally sensitive to the loss of habitat heterogeneity. Remote sensing data are particularly suited to quantify habitat heterogeneity at fine scales over relatively large extents, allowing to consider how different measures of heterogeneity may affect biotic communities at a regional scale. Here, we used airborne LiDAR (Light Detection And Ranging) and satellite multispectral data to derive vegetation canopy height and primary productivity for 118 sites in complex agricultural landscapes in a region in the Central Alps. We computed different bird diversity indices and classified bird species into guilds according to specific traits to analyse the relationship between avian communities and different facets of habitat heterogeneity. Results confirmed that habitat heterogeneity is essential in shaping rich and diverse bird communities, and it is particularly important for several farmland birds. By comparing the effects of canopy height, primary productivity, and specific vegetation features (e.g., cover of grassland, shrub, and tree layers), we showed how different habitat characteristics as well as landscape heterogeneity affected bird richness, diversity, functional entropy, and trait patterns. Landscape and height heterogeneity, estimated by NDVI and LiDAR Rao's Q indices, strongly influenced all response variables, for example, high NDVI values promoted species diversity and ground-understory nesters, and shrub layer was important for ground-understory nesters and forest specialists. Finally, we provide recommendations for conservation practices and mitigation measures to improve bird diversity in agricultural landscapes.

Abstract Polybromo-1 (PBRM1) loss of function mutations are present in a fraction of biliary tract cancers (BTCs). PBRM1, a subunit of the PBAF chromatin-remodeling complex, is involved in DNA damage repair. Herein, we aimed to decipher the molecular landscape of PBRM1 mutated (mut) BTCs and to define potential translational aspects. Totally, 1848 BTC samples were analyzed using next-generation DNA-sequencing and immunohistochemistry (Caris Life Sciences, Phoenix, AZ). siRNA-mediated knockdown of PBRM1 was performed in the BTC cell line EGI1 to assess the therapeutic vulnerabilities of ATR and PARP inhibitors in vitro. PBRM1 mutations were identified in 8.1% (n = 150) of BTCs and were more prevalent in intrahepatic BTCs (9.9%) compared to gallbladder cancers (6.0%) or extrahepatic BTCs (4.5%). Higher rates of co-mutations in chromatin-remodeling genes (e.g., ARID1A 31% vs. 16%) and DNA damage repair genes (e.g., ATRX 4.4% vs. 0.3%) were detected in PBRM1-mutated (mut) vs. PBRM1-wildtype (wt) BTCs. No difference in real-world overall survival was observed between PBRM1-mut and PBRM1-wt patients (HR 1.043, 95% CI 0.821–1.325, p = 0.731). In vitro, experiments suggested that PARP ± ATR inhibitors induce synthetic lethality in the PBRM1 knockdown BTC model. Our findings served as the scientific rationale for PARP inhibition in a heavily pretreated PBRM1-mut BTC patient, which induced disease control. This study represents the largest and most extensive molecular profiling study of PBRM1-mut BTCs, which in vitro sensitizes to DNA damage repair inhibiting compounds. Our findings might serve as a rationale for future testing of PARP/ATR inhibitors in PBRM1-mut BTCs.

Abstract Converging evidence of high stress levels in the nursing profession as well as their detrimental effects on the execution of nursing actions, quality indicators of care, and self-reported job satisfaction justify the need for test environments that assess stress coping competences in dealing with domain-specific stress factors. Reliable and valid information on the test takers’ stress coping competence can help to identify individual deficits and supportive needs and thus, to design training measures that may contribute to job retention and a skilled workforce. This article describes the development and validation of a digital assessment that ensures authenticity by means of video-based situational judgement tests. Analyses of the performance data were conducted in four steps: (1) the scaling of the data with a partial credit model in order to identify items that are subject to measurement error, (2) differential-item-function analyses for different specializations in nursing education, (3) dimensionality tests, and (4) correlations between test performance and perceived psychological work stress in order to gauge criterion validity. The total sample consisted of n = 300 German nursing apprentices. The results show that the developed test instrument can be used for a reliable and valid measurement of coping skills of (prospective) nurses, covering two essential dimensions. Limitations of the current study and related objectives of future research are discussed together with questions of practical applicability.

Abstract Background Postoperative rehabilitation after primary total hip arthroplasty (p-THA) differs between the Netherlands and Germany. Aim is to compare clinical effectiveness and to get a first impression of cost effectiveness of Dutch versus German usual care after p-THA. Methods A transnational prospective controlled observational trial. Clinical effectiveness was assessed with self-reported questionnaires and functional tests. Measurements were taken preoperatively and 4 weeks, 12 weeks, and 6 months postoperatively. For cost effectiveness, long-term economic aspects were assessed from a societal perspective. Results 124 working-age patients finished the measurements. German usual care leads to a significantly larger proportion (65.6% versus 47.5%) of satisfied patients 12 weeks postoperatively and significantly better self-reported function and Five Times Sit-to-Stand Test (FTSST) results. German usual care is generally 45% more expensive than Dutch usual care, and 20% more expensive for working-age patients. A scenario analysis assumed that German patients work the same number of hours as the Dutch, and that productivity costs are the same. This analysis revealed German care is still more expensive but the difference decreased to 8%. Conclusions German rehabilitation is clinically advantageous yet more expensive, although comparisons are less straightforward as the socioeconomic context differs between the two countries. Trial registration The study is registered in the German Registry of Clinical Trials (DRKS00011345, 18/11/2016).

Abstract Introduction Clinical trials investigating efficacy of immune checkpoint inhibitors (ICI) revealed sex-specific divergent outcomes in urothelial cancer (UC), suggesting that sex hormones might play an important role in gender-specific dimorphisms of response upon ICI. However, further clinical investigations are still needed to understand the influence of sex hormones in UC. The aim of this study was to get further insights on the prognostic and predictive value of sex hormone levels in patients with metastatic UC (mUC) who underwent ICI. Material and methods Sex hormone levels of patients with mUC including luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH/FSH ratio, prolactin, testosterone and 17β-estradiol (E2) were evaluated at baseline and during ICI at 6/8 weeks and 12/14 weeks. Results Twenty-eight patients (10 women, 18 men) with a median age of 70 years were included. Metastatic disease was confirmed in 21 patients (75%) after radical cystectomy while seven patients showed mUC at first diagnosis. Twelve patients (42.8%) received first line and 16 patients second line pembrolizumab. The objective response rate (ORR) was 39% (CR in 7%). The median progression-free survival (PFS) and overall survival (OS) was 5.5 and 20 months. Focusing on changes of sex hormone levels during ICI, a significant increase in FSH levels and decrease of the LH/FSH ratio was noticed in responders (p = 0.035), yet without sex-specific significance. When adjusted for sex and treatment line, a significant increase of FSH levels was confirmed in men during second line pembrolizumab. Focusing on baseline levels, LH/FSH ratio was significantly higher in female responders (p = 0.043) compared to non-responders. In women, increased LH levels and LH/FSH ratio were associated with better PFS (p = 0.014 for LH, p = 0.016 for LH/FSH ratio) and OS (p = 0.026 and p = 0.018). In male patients, increased E2 levels were linked with improved PFS (p

Toxoplasma gondii is a zoonotic protozoan parasite and one of the most successful foodborne pathogens. Upon infection and dissemination, the parasites convert into the persisting, chronic form called bradyzoites, which reside within cysts in muscle and brain tissue. Despite their importance, bradyzoites remain difficult to investigate directly, owing to limited in vitro models. In addition, the need for new drugs targeting the chronic stage, which is underlined by the lack of eradicating treatment options, remains difficult to address since in vitro access to drug-tolerant bradyzoites remains limited. We recently published the use of a human myotube-based bradyzoite cell culture system and demonstrated its applicability to investigate the biology of T. gondii bradyzoites. Encysted parasites can be functionally matured during long-term cultivation in these immortalized cells and possess many in vivo–like features, including pepsin resistance, oral infectivity, and antifolate resistance. In addition, the system is scalable, enabling experimental approaches that rely on large numbers, such as metabolomics. In short, we detail the cultivation of terminally differentiated human myotubes and their subsequent infection with tachyzoites, which then mature to encysted bradyzoites within four weeks at ambient CO2 levels. We also discuss critical aspects of the procedure and suggest improvements.Key features• This protocol describes a scalable human myotube-based in vitro system capable of generating encysted bradyzoites featuring in vivo hallmarks.• Bradyzoite differentiation is facilitated through CO2 depletion but without additional artificial stress factors like alkaline pH.• Functional maturation occurs over four weeks.Graphical overview

Biodiversity loss is a global issue, particularly in mountain regions, where land-use/land-cover and climate change dramatically impact on species and communities. Sound ecological research and up-to-date information on biodiversity are needed to support conservation efforts. However, this information is often difficult and costly to obtain. Therefore, bioindicators serve as surrogates to provide information on the entire biocenosis. Birds are considered excellent bioindicators as they occupy different ecological niches and trait spaces.We present a study about the efficiency of birds as bioindicators for the diversity of other taxa in a mountain region in the Central Alps. We surveyed bird communities at 115 sites across a gradient of different grasslands and crops and compared them with the diversity of other taxa (bats, butterflies, grasshoppers, arachnids, and vascular plants). We aimed to identify indicator bird species for grasslands and crops, to assess cross-community concordance between birds and other taxa, and to model the efficiency of bird indices and indicator species as bioindicators of the diversity across habitat types and taxa.We identified indicator bird species for different grassland and crop types and found that efficiency of bird indices and single species varied for habitat types and taxa. We highlight the importance of using carefully selected bioindicators in biodiversity monitoring and conservation planning, and the need for an integrated and interdisciplinary approach for biodiversity research. Moreover, by looking at a combination of different indices we can gain a more comprehensive understanding of ecosystem functioning. We also provide a framework for the use of bird-based monitoring programs and bird-derived indices to guide biodiversity conservation, and emphasise the importance of incorporating different bioindicators into biodiversity research and monitoring to provide a more comprehensive understanding of ecological biodiversity patterns and trends.

Background The C-C motif chemokine receptor 5 (CCR5)/C-C motif chemokine ligand 5 (CCL5) axis plays a major role in colorectal cancer (CRC). We aimed to characterize the molecular features associated with CCR5/CCL5 expression in CRC and to determine whether CCR5/CCL5 levels could impact treatment outcomes.Methods 7604 CRCs tested with NextGen Sequencing on DNA and RNA were analyzed. Molecular features were evaluated according to CCR5 and CCL5 tumor gene expression quartiles. The impact on treatment outcomes was assessed in two cohorts, including 6341 real-world patients and 429 patients from the Cancer and Leukemia Group B (CALGB)/SWOG 80405 trial.Results CCR5/CCL5 expression was higher in right-sided versus left-sided tumors, and positively associated with consensus molecular subtypes 1 and 4. Higher CCR5/CCL5 expression was associated with higher tumor mutational burden, deficiency in mismatch repair and programmed cell death ligand 1 (PD-L1) levels. Additionally, high CCR5/CCL5 were associated with higher immune cell infiltration in the tumor microenvironment (TME) of MMR proficient tumors. Ingenuity pathway analysis revealed upregulation of the programmed cell death protein 1 (PD-1)/PD-L1 cancer immunotherapy pathway, phosphatase and tensin homolog (PTEN) and peroxisome proliferator-activated receptors (PPAR) signaling, and cytotoxic T-lymphocyte antigen 4 (CTLA-4) signaling in cytotoxic T lymphocytes, whereas several inflammation-related pathways were downregulated. Low CCR5/CCL5 expression was associated with increased benefit from cetuximab-FOLFOX treatment in the CALGB/SWOG 80405 trial, where significant treatment interaction was observed with biologic agents and chemotherapy backbone.Conclusions Our data show a strong association between CCR5/CCL5 gene expression and distinct molecular features, gene expression profiles, TME cell infiltration, and treatment benefit in CRC. Targeting the CCR5/CCL5 axis may have clinical applications in selected CRC subgroups and may play a key role in developing and deploying strategies to modulate the immune TME for CRC treatment.

In mountain regions, available agricultural land is often limited by the rugged topography and therefore an efficient and small-scale land use is needed to ensure food and fodder security. In the European Alps, mountain meadows at mid-elevations were created in medieval times by clearing and are therefore often still embedded in forest areas. The transition between these two habitats is mostly smooth due to the presence of a shrub strip, but sometimes sharp, as it is the case in our study. It is not well known whether such abrupt shrub-free habitat shifts affect the exchange of ground-dwelling macro-invertebrates between habitats and whether this may affect local biodiversity. We set up nine straight transects with five pitfall traps each, running from montane open extensive meadows through the sharp ecotone lines to mixed forest plots in South Tyrol, Northern Italy. Invertebrate activity densities, distribution, and biodiversity patterns were assessed. We found well separated invertebrate communities for the meadows and forests, with the ecotone communities being similar to those of the forests and not forming a distinct intermediate cluster. Araneae were significantly more abundant in the meadows and decreased towards the meadow edges and forests. In contrast, Diplopoda and Isopoda were significantly more abundant in the ecotone and forest plots. The meadow plots and partly the edge plots were inhabited by threatened Red List species. In heterogeneous mountain regions such as South Tyrol, where agricultural land is scarce and therefore must be used efficiently, sharp shifts between habitat types result in distinct invertebrate communities impeding species exchange. Maintaining the extensive management of grasslands and the establishment of buffering shrub strips are therefore desirable measures to support the local soil invertebrate biodiversity, as species may not be able to spill over the abrupt ecotone borders and seek shelter during management activities.

Digitalisierung stellt Lehrkräfte beruflicher Schulen vor vielfältige neue Herausforderungen. Zum Erhalt ihrer Professionalisierung müssen sie sich laufend fortbilden, wollen sie die Qualität des Unterrichts sicherstellen. Studien zeigen, dass die Erfolgserwartungen an Fortbildungen (FB) von Lehrkräften insbesondere im Hinblick auf das Potenzial digitaler Medien noch nicht voll ausgeschöpft sind. Dies scheint mit vielfältigen administrativen und gesetzlichen Vorgaben, mit dem Wirken unterschiedlicher Akteure sowie funktionalen Zuständigkeiten zu korrespondieren. Somit ist die Professionalisierung der Lehrkräfte nicht nur von ihren individuellen Entscheidungen, sondern auch von denen anderer Akteure und den dabei auftretenden Interaktionen abhängig. Dabei kommt es nicht selten zu Spannungen auch in der Form von ‹Double Bind›-Phänomenen, die sich nur in einem grösseren Systemkontext identifizieren, verbalisieren, interpretieren, aufbrechen und lösen lassen. In dieser Studie zeichnen wir die Struktur und Interaktionen der Akteure der FB für Lehrkräfte an beruflichen Schulen mittels der Kulturhistorischen Tätigkeitstheorie sowie aktueller Forschungsergebnisse nach, verorten darin die in einer Interviewstudie mit 46 Lehrkräften wahrgenommenen Interaktionen und analysieren diese im Hinblick auf ‹Double Bind›-Phänomene. Die Ergebnisse zeigen, dass Lehrkräfte im Rahmen ihrer FB mit kritischen Entscheidungen i. S. v. ‹Double Binds› konfrontiert sind, sowohl auf struktureller Ebene als auch im Hinblick auf ihr Professionsverständnis wie auch auf einstellungs- und interessensbezogene Aspekte.

Abstract Background To determine the effectiveness and therapeutic validity of physiotherapeutic exercise after total and unicompartmental knee arthroplasty for osteoarthritis. It was hypothesized that interventions of high therapeutic validity result in superior functional recovery after total and unicompartmental knee arthroplasty versus interventions of low therapeutic validity. Methods A systematic review incorporating a comprehensive database search of five major databases relevant to the topic was conducted. Randomized controlled trials were reviewed if they included studies that compared postoperative physiotherapeutic exercise with usual care or compared two types of postoperative physiotherapeutic interventions. All included studies were assessed for risk of bias (using the Cochrane Collaboration’s tool) and therapeutic validity (using the Consensus on Therapeutic Exercise Training scale). The characteristics of the included articles and their results on joint and muscle function, functional performance, and participation were extracted. Results Of the 4343 unique records retrieved, 37 articles were included. Six of them showed good therapeutic validity, suggesting low therapeutic validity in 31 studies. Three articles showed a low risk of bias, 15 studies scored some concerns for risk of bias and 19 studies scored high risk of bias. Only one article scored well on both methodological quality and therapeutic validity. Conclusion Due to heterogeneity of outcome measures and length of follow-up, as well as limited reporting of details of the physiotherapeutic exercises and control interventions, no clear evidence was found on effectiveness of physiotherapeutic exercises after total and unicompartmental knee arthroplasty. Homogeneity in intervention characteristics and outcome measures would enhance comparability of clinical outcomes between trials. Future studies should incorporate similar methodological approaches and outcome measures. Researchers are encouraged to use the Consensus on Therapeutic Exercise Training scale as a template to prevent insufficient reporting.

Abstract Background An increasing number of patients are surviving sarcoma after lower limb-salvage surgery (LSS) and are left with functional limitations. This systematic review aimed to determine the therapeutic validity and effectiveness of exercise interventions after lower limb-salvage surgery (LSS) for sarcoma. Methods A systematic review was conducted using formal narrative synthesis of intervention studies (with and without control group) identified through PubMed, Embase, Cochrane Library, CINAHL, and PEDro databases. Studies were included if participants were treated with LSS for unilateral lower limb sarcoma and followed an exercise intervention using active exercise, physical training, or rehabilitation before and/or after surgery. This review’s outcome measures were interventions’ therapeutic validity, assessed using the CONTENT scale (0 to 9); methodological quality, identified using the Downs & Black checklist (0 to 28); interventions’ effectiveness, assessed based on differences in outcome measures between intervention and control groups; and certainty of evidence, classified according to the GRADE approach. Results Seven studies involving 214 participants were included. None of the included interventions were therapeutically valid (median 5, range 1–5). All but one study were of at least fair methodological quality (median 18, range 14–21). There was very low-quality evidence that exercise interventions resulted in increased knee range of motion (MD 10–15°) or compliance (MD 30%), and reduced functionality scores (MD -5%) compared to usual care. Conclusions We found overall low therapeutic validity of interventions, performed in overall low-quality studies. Combined with the very low certainty of evidence, the results prevent drawing valid conclusions on the interventions’ effectiveness. Future studies should aim for uniformity among their methodological approaches and outcome measures, using the CONTENT scale as a template to avert insufficient reporting. Trial registration PROSPERO CRD42021244635.

Abstract Metataxonomy has become the standard for characterizing the diversity and composition of microbial communities associated with multicellular organisms and their environment. Currently available protocols for metataxonomy assume a uniform DNA extraction, amplification and sequencing efficiency for all sample types and taxa. It has been suggested that the addition of a mock community (MC) to biological samples before the DNA extraction step could aid identification of technical biases during processing and support direct comparisons of microbiota composition, but the impact of MC on diversity estimates of samples is unknown. Here, large and small aliquots of pulverized bovine fecal samples were extracted with no, low or high doses of MC, characterized using standard Illumina technology for metataxonomics, and analysed with custom bioinformatic pipelines. We demonstrated that sample diversity estimates were distorted only if MC dose was high compared to sample mass (i.e. when MC > 10% of sample reads). We also showed that MC was an informative in situ positive control, permitting an estimation of the sample 16S copy number, and detecting sample outliers. We tested this approach on a range of sample types from a terrestrial ecosystem, including rhizosphere soil, whole invertebrates, and wild vertebrate fecal samples, and discuss possible clinical applications.

• Purpose: A systematic review to determine the effect of different types of joint preparation, joint fixation, and postoperative weight-bearing protocols on non-union frequency in first metatarsophalangeal joint (MTPJ) arthrodesis in patients with moderate-to-severe hallux valgus. • Material and methods: A systematic literature search (PubMed and EMBASE), adhering to PRISMA guidelines. Data on MTPJ preparation, fixation, weight-bearing, and non-union in patients with moderate-to-severe hallux valgus were collected. Quality assessment was performed using the Coleman Methodology Score. • Results: Sixteen studies (934 feet) were included, generally of medium quality. Overall nonunion rate was 7.7%. At 6.3%, convex/concave joint preparation had the lowest non-union rate vs 12.2% for hand instruments and 22.2% for planar cuts. Non-union of 2.8% was found for joint fixation with a plate combined with a lag screw vs 6.5% for plate fixation, 11.1% for crossed screw fixation, and 12.5% for a plate with a cross plate compression screw. A 5.1% non-union frequency was found following postoperative full weight-bearing on a flat shoe vs 9.3% for full weight-bearing on a heel weight-bearing shoe and 0% for a partial weight-bearing regimen. • Conclusion: Based on medium-quality papers, joint preparation with convex/concave reamers and joint fixation with a plate using a lag screw show the lowest non-union rate. Full postoperative weight-bearing in a stiff-soled postoperative shoe is safe and not associated with non-union vs a more protective load-bearing regimen. Further research should focus on larger sample sizes, longer follow-ups, and stronger study designs.

A growing literature addresses the experiences of international students in higher education. However, limited attention has been paid to how satisfied international students are with their educational experience (gown) and their non-educational experiences related to, e.g. culture, transportation, administrative matters and housing (town). This paper presents findings from a study on 392 international students that have spent a period in one of the higher education institutions located in the city of Ghent, Belgium. We explore which socio-demographic variables and students' motivations predict their overall satisfaction and satisfaction regarding specific dimensions: housing, culture/lifestyle, education and administration. The findings illustrate that financial security and academic motivation positively predict general satisfaction as well as all or most of the four specific dimensions of satisfaction. Socio-demographic variables hardly play a role, apart from religion and the difference between the home and host country's level of educational development.