Search

Objective The aim of this prospective pilot study is to establish an initial database to register patients diagnosed with different types of childhood glaucoma and the set-up of a national registry for childhood glaucoma (ReCG) in Germany. 28 children with different types of diagnosed childhood glaucoma, who were admitted and treated at the Childhood Glaucoma Center of the University Medical Center Mainz, Germany were included. Main outcome measures were the type of childhood glaucoma, mean intraocular pressure (IOP) and genetic data of the patients. Results The documents and questionnaires for each individual included: informed consent form of the parents, medical history form of the child, patient’s gestational history questionnaire and general anesthesia examination form. Primary congenital and secondary childhood glaucoma were revealed in 11 (39%) and 17 (61%) patients, respectively. The mean IOP measured with Perkins tonometer in all patients under general anesthesia at the time of inclusion was 17.5 ± 11.8 mmHg in the right and 17 ± 8.9 mmHg in the left eyes. In 33% of children with glaucoma mutations in the CYP1B1, FOXC1, LTBP2 and TEK genes were found. The development of specific questionnaires for childhood glaucoma provides detailed baseline data to establish a ReCG in Germany for the first time.

Background: Online educational programs for nurse preceptors have been created based on various theoretical frameworks; however, no programs using a Strengths-Based Nursing (SBN) approach could be located. Purpose: This qualitative descriptive study explored the nurse preceptors’ experiences in using a SBN approach to provide clinical teaching to nursing students after completing an online SBN clinical teaching course. Methods: Semi-structured interviews were conducted with six nurses. Data was thematically analyzed. Findings: Although their levels of familiarity with SBN varied, all preceptors acknowledged that using a SBN approach in clinical teaching benefits both students and educators. They reported that it empowered students and that it allowed them to discover their strengths. Getting to know their students helped the preceptors provide tailored learning experiences and feedback. Using the SBN approach simultaneously enhanced the preceptors’ self-confidence and created opportunities for shared learning. Conclusion: Using a strengths’ approach offers nurse preceptors a powerful tool to facilitate student learning and skills development in clinical practice.

Clinical reasoning, the application of medical knowledge to a patient’s problem, requires training in a safe environment. Learning tasks based on Virtual Patients (VP-tasks) simulate the clinical setting in a save way and integrate well into blended-learning environments, as synchronous tasks (face-to-face or online) or as asynchronous online tasks. The article presents the editorial process for developing VP-based self-study quizes (SSQ) and field-study results on students’ learning experiences and study habits. The editorial process initially only involved experienced clinical, educational and technical experts. To better match the tasks’ difficulty to students’ knowledge, junior doctors and advanced medical students joined in a later stage. Students (n = 351) rated the SSQs (n = 10) produced by the expanded team to match their knowledge better as compared to the SSQs (n = 13) developed by the initial expert editorial team. Students rated the online SSQs as more helpful as compared to similar face-to-face VP-tasks. Students’ free comments indicate their high acceptance of the SSQ-format. The SSQ-format is feasible for providing systematic online training in clinical reasoning, especially when working with a multi-level-educational editorial team and when a systematically structured blueprint of topics and learning goals drives the editorial work.

Along evolution, living organisms developed a precise timekeeping system, circadian clocks, to adapt life to the 24-h light/dark cycle and temporally regulate physiology and behavior. The transcriptional molecular circadian clock and metabolic/redox oscillator conforming these clocks are present in organs, tissues, and even in individual cells, where they exert circadian control over cellular metabolism. Disruption of the molecular clock may cause metabolic disorders and higher cancer risk. The synthesis and degradation of glycerophospholipids (GPLs) is one of the most highly regulated metabolisms across the 24-h cycle in terms of total lipid content and enzyme expression and activity in the nervous system and individual cells. Lipids play a plethora of roles (membrane biogenesis, energy sourcing, signaling, and the regulation of protein-chromatin interaction, among others), making control of their metabolism a vital checkpoint in the cellular organization of physiology. An increasing body of evidence clearly demonstrates an orchestrated and sequential series of events occurring in GPL metabolism across the 24-h day in diverse retinal cell layers, immortalized fibroblasts, and glioma cells. Moreover, the clock gene Per1 and other circadian-related genes are tightly involved in the regulation of GPL synthesis in quiescent cells. However, under proliferation, the metabolic oscillator continues to control GPL metabolism of brain cancer cells even after molecular circadian clock disruption, reflecting the crucial role of the temporal metabolism organization in cell preservation. The aim of this review is to examine the control exerted by circadian clocks over GPL metabolism, their synthesizing enzyme expression and activities in normal and tumorous cells of the nervous system and in immortalized fibroblasts.

Background Diffuse intrinsic pontine glioma (DIPG) remains a clinico-radiologic diagnosis without routine tissue acquisition. Reliable imaging distinction between DIPG and other pontine tumors with potentially more favorable prognoses and treatment considerations is essential. Methods Cases submitted to the International DIPG registry (IDIPGR) with histopathologic and/or radiologic data were analyzed. Central imaging review was performed on diagnostic brain MRIs (if available) by two neuro-radiologists. Imaging features suggestive of alternative diagnoses included nonpontine origin, Results Among 286 patients with pathology from biopsy and/or autopsy, 23 (8%) had histologic diagnoses inconsistent with DIPG, most commonly nondiffuse low-grade gliomas and embryonal tumors. Among 569 patients with centrally-reviewed diagnostic MRIs, 40 (7%) were classified as non-DIPG, alternative diagnosis suspected. The combined analysis included 151 patients with both histopathology and centrally-reviewed MRI. Of 77 patients with imaging classified as characteristic of DIPG, 76 (99%) had histopathologic diagnoses consistent with DIPG (infiltrating grade II-IV gliomas). Of 57 patients classified as likely DIPG with some unusual imaging features, 55 (96%) had histopathologic diagnoses consistent with DIPG. Of 17 patients with imaging features suggestive of an alternative diagnosis, eight (47%) had histopathologic diagnoses inconsistent with DIPG (remaining patients were excluded due to nonpontine tumor origin). Association between central neuro-imaging review impression and histopathology was significant (p < 0.001), and central neuro-imaging impression was prognostic of overall survival. Conclusions The accuracy and important role of central neuro-imaging review in confirming the diagnosis of DIPG is demonstrated.

PurposeMajor crises such as the global financial crisis 2007–08 or the COVID-19 crisis increase the level and likelihood of supplier financial distress. This research expands the understanding of how cooperatively, respectively, uncooperatively buying firms might respond to suppliers who suffer from financial distress in the course of major crises.Design/methodology/approachThe authors build on a collaborative project with a German automotive OEM, analyze OEM internal “financial quick check data”, questionnaire data and longitudinal supplier financial data and apply regression, mediation and difference-in-difference estimation analyses.FindingsThe results show that the stronger the dependence on the distressed supplier, the more cooperative the buying firm's response. Furthermore, a more cooperative response of the buying firm has a strong positive influence on the suppliers' financial performance and hence recovery from the distress situation. Insights from supplier financial distress in the course of the financial crisis 2007–2008 can serve as learnings for the COVID-19 crisis.Research limitations/implicationsThe study fills a gap in the scholarly literature on “response to risk incidents” and response formation. Resource dependence theory and resource dependence dynamics offer a strong rationale for the type of response buying firms are likely to choose.Practical implicationsBesides offering the first menu of response options, this study can help practitioners in figuring out the most appropriate response to distressed suppliers. The findings can assist buying firms in their decisions how to deal with suppliers during major economic and financial crises.Originality/valueThis research is the first to conceptualize buying firms' response options to financially distressed suppliers, to investigate the influence of dependence on buying firm's response and to reveal the consequences of the buying firm's response for the supplier's financial recovery.

Successful inter-organisational new product development (NPD) is a key source of competitive advantage, yet many NPD projects are still failing. To generate new insights on the phenomenon, we examine the performance implications of knowledge inputs among collaborating organisations, both in terms of external input ratio and input concentration. We test a set of hypotheses using multi-industry primary and secondary data on 210 inter-organisational NPD projects. Results support our hypotheses about the negative effect of input concentration on design quality, which in turn is positively associated with product market performance. Although we surprisingly find a negative linear effect of external input ratio on design quality, our post-hoc analysis confirms the relationship to be an inverse U-shaped relationship. We also find support for the roles of technology interdependence in moderating the performance implications of external input ratio and input concentration. By clarifying how knowledge inputs affect project outcomes under different levels of technology interdependence, the study provides managerial implications regarding how to select innovation partners in order to create a knowledge portfolio that best improves NPD project performance., International Journal of Production Research, 60 (20), ISSN:0020-7543, ISSN:1366-588X

What does it mean to think and act radically, and how does this relate to forms of radicalism connected to earlier moments, for example, in the 20th century? What can be the role of radical art and scholarship under the conditions of late capitalism? More generally, how can art and artists serve the ongoing struggle for social justice and the agendas of emancipatory social change? Finally, what kinds of art criticism and art historical scholarship are necessary to address the great challenges of our uncertain future?

Objective We aimed to ascertain whether the risk of adverse pregnancy outcomes in the United States among individuals with chronic hypertension differed by maternal race and ethnicity and to assess the temporal trend. Study Design Population-based retrospective study using the U.S. Vital Statistics datasets evaluated pregnancies with chronic hypertension, singleton live births that delivered at 24 to 41 weeks. The coprimary outcomes were a composite maternal adverse outcome (preeclampsia, primary cesarean delivery, intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy) and a composite neonatal adverse outcome (preterm birth, small for gestational age, Apgar's score 6 hours, seizure, or death). Multivariable Poisson regression models were used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs). Results Between 2014 and 2019, the rate of chronic hypertension in pregnancy increased from 1.6 to 2.2%. After multivariable adjustment, an increased risk for the composite maternal adverse outcome was found in Black (aRR = 1.10, 95% CI = 1.09–1.11), Hispanic (aRR = 1.04, 95% CI = 1.02–1.05), and Asian/Pacific Islander (aRR = 1.07, 95% CI = 1.05–1.10), compared with White individuals. Compared with White individuals, the risk of the composite neonatal adverse outcome was higher in Black (aRR = 1.39, 95% CI = 1.37–1.41), Hispanic (aRR = 1.15, 95% CI = 1.13–1.16), Asian/Pacific Islander (aRR = 1.34, 95% CI = 1.31–1.37), and American Indian (aRR = 1.12, 95% CI = 1.07–1.17). The racial and ethnic disparity remained unchanged during the study period. Conclusion We found a racial and ethnic disparity with maternal and neonatal adverse outcomes in pregnancies with chronic hypertension that remained unchanged throughout the study period. Key Points

To assess the elements necessary to be a successful learning community (ClinCalc) mentor to medical students from the mentee’s perspective. Few such studies have utilized the in-depth and richness of detail obtained in qualitative studies. This qualitative study analyzed four focus group discussions lasting 45–90 min conducted at the University of Texas Southwestern Medical School, which has an established LC, in the year 2018. The groups included 14 pre-clerkship and 8 clerkship students. Investigators evaluated transcriptions of the focus group discussions using ATLAS.ti software. Three overarching categories of discussion emerged from the group discussions: (1) Relationship Competence, (2) Teaching Competence, and (3) Ethical and Compassionate Medical Practice Competence. Relationship Competence themes included “walk with me,” relationship is most important, and one-on-one. Teaching Competence themes included above and beyond, recognize and address mentor limitations, and safe and enriching environment. Ethical and Compassionate Medical Practice Competence themes included ethical decision making and compassionate care for diverse patient populations. Mentees focused on various aspects of the mentor-mentee relationship as the single most essential competence. Themes mentees discussed as important qualities of a successful mentor may denote qualities to be prioritized in faculty development and mentor recruitment. Future studies could investigate how the LC environment informs former medical students and promotes patient outcomes.

The voltage-gated sodium NaV1.7 channel plays a key role as a mediator of action potential propagation in C-fiber nociceptors and is an established molecular target for pain therapy. ProTx-II is a potent and moderately selective peptide toxin from tarantula venom that inhibits human NaV1.7 activation. Here we used available structural and experimental data to guide Rosetta design of potent and selective ProTx-II-based peptide inhibitors of human NaV1.7 channels. Functional testing of designed peptides using electrophysiology identified the PTx2-3127 and PTx2-3258 peptides with IC50s of 7 nM and 4 nM for hNaV1.7 and more than 1000-fold selectivity over human NaV1.1, NaV1.3, NaV1.4, NaV1.5, NaV1.8, and NaV1.9 channels. PTx2-3127 inhibits NaV1.7 currents in mouse and human sensory neurons and shows efficacy in rat models of chronic and thermal pain when administered intrathecally. Rationally designed peptide inhibitors of human NaV1.7 channels have transformative potential to define a new class of biologics to treat pain.

Although successful trial of labor after cesarean (TOLAC) resulting in vaginal birth after cesarean (VBAC) can lead to improved maternal and neonatal outcomes, an unsuccessful TOLAC is associated with increased risk of uterine rupture, higher blood loss, and increased risk of infection. Data remain limited in terms of whether differences in gestational age of patients who attempt TOLAC affect maternal morbidity. Out objective was to examine the association between gestational age and maternal adverse outcomes in women undergoing trial of labor after cesarean.This population-based cross-sectional study used birth data from the U.S. National Vital Statistics from 2014 to 2018. Women with liveborn singleton gestation who underwent TOLAC at 23 - 41 weeks' gestation were included in the analytic population. The primary outcome was a composite of maternal adverse outcomes: admission to the intensive care unit, blood transfusion, uterine rupture, or unplanned hysterectomy. Secondary outcomes were individual measures within the primary composite outcome. Outcomes were compared between patients who underwent TOLAC at term (37-41 weeks gestational age) and those who underwent TOLAC at preterm (23-36 weeks gestational age). Multivariable analyses adjusted for demographic and obstetric differences between the two groups.455,284 patients met inclusion criteria for the study; 39,589 (8.7%) were at a preterm gestational age (GA) and 415,695 (91.3%) were at a term GA. The overall composite maternal adverse outcome was significantly higher for patients undergoing TOLAC at preterm GA (12.0 per 1,000 live births) compared to term GA (8.0 per 1,000 live births; aRR1.42; 95% CI 1.29-1.56). Among individual conditions within the primary composite outcome, preterm gestational age was associated with increased risk of admission to the intensive care unit, blood transfusion, and unplanned hysterectomy.In patients who underwent TOLAC, preterm gestational age was associated with increased risk of adverse maternal outcomes.

Microplastics (MP) are perceived as a threat to aquatic ecosystems but bear many similarities to suspended sediments which are often considered less harmful. It is, therefore pertinent to determine if and to what extent MPs are different from other particles occurring in aquatic ecosystems in terms of their adverse effects. We applied meta-regressions to hazard data extracted from the literature and harmonized the data to construct Species Sensitivity Distributions (SSDs) for both types of particles. The results demonstrate that the average toxicity of MPs is approximately one order of magnitude higher than that of suspended solids. However, the estimates were associated with large uncertainties and did not provide very strong evidence. In part, this is due to the general lack of comparable experimental studies and dose-dependent point estimates. We, therefore, argue that a precautionary approach should be used and MP in the 1–1000 µm size range should be considered moderately more hazardous to aquatic organisms capable of ingesting such particles. Organisms inhabiting oligotrophic habitats like coral reefs and alpine lakes, with naturally low levels of non-food particles are likely more vulnerable, and it is reasonable to assume that MP pose a relatively higher risk to aquatic life in such habitats.SynopsisA meta-analysis indicates that microplastics are one order of magnitude more toxic than suspended sediments/solids, an estimate surrounded by considerable uncertainty.Graphical abstract

Partial nitritation anammox (PNA) membrane-aerated biofilm reactors (MABRs) can be used in mainstream nitrogen removal to help facilities reduce their energy consumption. Previous PNA MABR research has not investigated the impacts of staging, i.e. arraying MABRs in series, on their nitrogen removal performance, operation, and ability to suppress nitrite oxidizing bacteria. In this paper, a mathematical model simulated PNA MABR performance at different influent total ammonia concentrations and loadings. A design methodology for staging PNA MABRs was created and found that the amount of membrane surface area is dependent upon the total ammonia-nitrogen concentration and loading, and the air loading to the membrane must be proportional to the total ammonia-nitrogen loading to maximize the total inorganic nitrogen (TIN) removal rate. This led to approximately equal-sized stages that each had a TIN removal percentage of 71% of the influent total ammonia nitrogen. Staging a treatment train resulted in 9.8% larger total ammonia and 9.3% larger total nitrogen removal rates when compared with an un-staged reactor. The un-staged reactor also was not able to produce an effluent total ammonia concentration below 5 mg N/L which would be necessary for many facilities’ permits.

The goal of this study was to assess the efficiency of antibiotic degradation applying different chemical treatment methods and their combinations. Thus, improvement in the efficiency of these methods when combined was quantified. The methods tested to degrade/mineralize the antibiotics amoxicillin (AMX) and ciprofloxacin (CIP) under different pH conditions (4, 7 and 10) were ultra-violet irradiation (UV

O ambiente atual dos negócios demanda pesquisas associando o uso das tecnologias da Indústria 4.0 para apoio às decisões de gestão. Este artigo tem o objetivo de apresentar a versão inicial de um simulador aplicado à gestão, utilizando gamificação para criar cenários virtuais que representem situações reais da gestão organizacional. A metodologia proposta consiste no projeto, desenvolvimento e avaliação do simulador. Espera-se a simulação de diversas ações e seleção das mais adequadas aos casos reais de gestão, provendo decisões assertivas e facilitando o aprendizado dos stakeholders.

Speed strength performances are substantially dependent on maximum strength. Due to their importance, various methods have been utilized to measure maximum strength (e.g., isometric or dynamic) with discussed differences regarding transferability to sport-specific movements dependent upon the testing procedure. The aim of this study was to analyze whether maximum isometric force (MIF) during isometric back squats correlates with maximum strength measurements of the one repetition maximum (1RM) in the squat, with countermovement jump (CMJ) performance, and with drop jump (DJ) performances in elite youth soccer players (n = 16, 18.4 ± 1.5 [range: 17–23] years old). Additionally, concordance correlation coefficients (CCC, [ρc]) between isometric and dynamic measurements were calculated to verify whether one measurement can actually reproduce the results of the other. To improve comprehension, differences between isometric and dynamic testing values were illustrated by providing differences between both testing conditions. For this, the mean absolute error (MAE) and the mean absolute percentage error (MAPE) were calculated. To reach equality in scale, the 1RM measures were multiplicated by 9.81 to obtain a value of N. The 1RM demonstrated correlations of τ = |0.38| to |0.52| with SJ and CMJ performances, while MIF demonstrated correlations of τ = |0.21| to |0.32|. However, the correlations of both 1RM and MIF with the DJ reactive strength index (RSI = jump height/contact time) from different falling heights were of no statistical significance. The data showed significant correlations between both the absolute (τ = |0.54|) and the relative (τ = |0.40|) performances of 1RM and MIF, which were confirmed by CCC of ρc= |0.56| to |0.66|, respectively. Furthermore, the MAE and MAPE showed values of 2080.87 N and 67.4%, respectively. The data in this study show that, despite good correlations, there is no exact coincidence between isometric and dynamic strength measurements. Accordingly, both measurements may only represent an estimation of maximal strength capacity and cannot be substituted for each other. Therefore, maximal strength should be tested by using high similarity in the contraction condition, as it is used in the training process to counteract underestimation in strength because of unfamiliarity with the testing condition.

The natriuretic peptide receptors NPR1 and NPR2, also known as guanylyl cyclase A and guanylyl cyclase B, have critical functions in many signaling pathways, but much remains unknown about their localization and function in vivo. To facilitate studies of these proteins, we developed genetically modified mouse lines in which endogenous NPR1 and NPR2 were tagged with the HA epitope. To investigate the role of phosphorylation in regulating NPR1 and NPR2 guanylyl cyclase activity, we developed mouse lines in which regulatory serines and threonines were substituted with glutamates, to mimic the negative charge of the phosphorylated forms (NPR1-8E and NPR2-7E). Here we describe the generation and applications of these mice. We show that the HA-NPR1 and HA-NPR2 mice can be used to characterize the relative expression levels of these proteins in different tissues. We describe studies using the NPR2-7E mice that indicate that dephosphorylation of NPR2 transduces signaling pathways in ovary and bone, and studies using the NPR1-8E mice that indicate that the phosphorylation state of NPR1 is a regulator of heart, testis, and adrenal function.

Many sports injuries result in surgery and prolonged periods of immobilization, which may lead to significant atrophy accompanied by loss of maximal strength and range of motion and, therefore, a weak-leg/strong-leg ratio (as an imbalance index ∆ ) lower than 1. Consequently, there are common rehabilitation programs that aim to enhance maximal strength, muscle thickness and flexibility; however, the literature demonstrates existing strength imbalances after weeks of rehabilitation. Since no study has previously been conducted to investigate the effects of long-duration static stretch training to treat muscular imbalances, the present research aims to determine the possibility of counteracting imbalances in maximal strength and range of motion. Thirty-nine athletic participants with significant calf muscle imbalances in maximal strength and range of motion were divided into an intervention group (one-hour daily plantar flexors static stretching of the weaker leg for six weeks) and a control group to evaluate the effects on maximal strength and range of motion with extended and bent knee joint. Results show significant increases in maximal strength (d = 0.84–1.61, p < 0.001–0.005) and range of motion (d = 0.92–1.49, p < 0.001–0.002) following six weeks of static stretching. Group * time effects (p < 0.001–0.004, η² = 0.22–0.55) revealed ∆ changes in the intervention group from 0.87 to 1.03 for maximal strength and from 0.92 to 1.11 in range of motion. The results provide evidence for the use of six weeks of daily, one hour stretching to counteract muscular imbalances. Related research in clinical settings after surgery is suggested.

Background Health inequalities are well documented empirically. However, it is unclear whether health inequalities persist in very old age (continuity), whether they accumulate steadily (accumulation), or whether they even attenuate in old age (convergence) - not least because of social inequalities in life expectancy, which make it less likely for individuals with lower social status to reach old age at all. The aim of this study is to empirically test these three hypotheses. Methods The analyses are based on representative cross-sectional data from 1,863 very old people and panel data from 912 participants in the 1st and 2nd wave (W1, W2) living in North Rhine-Westphalia the largest federal state in Germany (NRW80+ study). Health outcomes of the analyses are subjective health, multimorbidity and need for long-term care. Indicators of socioeconomic status (SES) are education, occupational status, and net equivalent income. Regression models (linear, logistic, ordinal) are used to analyze cross-sectional and longitudinal data. Panel selectivity is also considered by means of a failure model. Results Cross-sectional findings show health inequalities for all SES variables: persons with low education and low income have poorer subjective health and higher need for care. Low status is associated with higher need for care. Preliminary results from longitudinal analyses show a slight increase in health inequality: low income and low status are associated with higher multimorbidity and low education with higher dependency on long-term care at W2. Conclusions Despite the socially conditioned unequal chances of reaching old age, health inequality is still present in very old age and even increases slightly over time. The results argue against the convergence hypothesis and in favor of the continuity or even the accumulation hypothesis. A better understanding of the mechanisms leading to the persistent inequality is needed to development targeted interventions also in old age. Key messages • Health inequalities persist and even increase in very old age (80+). • It is imperative that the oldest old – an increasingly large population group – be considered when designing strategies to reduce health inequalities.

Two spirochetes (designated strains LGVF01 and LGVF02T) were isolated from soil samples in San Juan, Puerto Rico in HAN media after selection using a combination of ELISA, agar plating, and colony screening by Fluorescent Antibody Testing (FAT) and PCR for lipL32 and secY. Isolates were helix-shaped, aerobic, fast-growing, and highly motile. Genome sequence analysis indicated that both strains should be classified as members of a novel species within the pathogenic (P1) clade of the genus Leptospira . The average nucleotide identity between the two strains was 99.2 %, but below 93.2 % when compared to any previously described leptospiral species. Serotyping of strain LGVF02T indicates that it does not belong within any serogroup of Leptospira suggesting it also represents a new serovar. Collectively, strains LGVF01 and LGVF02T represent a new species of pathogenic leptospires for which the name Leptospira sanjuanensis sp. nov. is proposed. The type strain is LGVF02T (=NVSL-LGVF02T=KIT0302T).

In the present article, we explore the hopes that immigrant parents of Mexican origin have for their children and the strategies they employ to foster such hopes in light of immigration status, immigration climate, and transnational lived experiences. We conducted six focus groups with 42 immigrant parents of Mexican origin living in Arizona and Texas to explore their hopes and strategies used to foster hopes. Parents, the majority of whom were mothers, defined hopes in terms of what they can provide to their children, including (a) a better life through education and economic opportunities, (b) a strong moral and civic upbringing, and (c) safety from neighborhood crime and hostile immigrant climates. Parents fostered these hopes through the strategies of using self as example, parental involvement and monitoring, self-sacrifice, and family unity. Mothers of unauthorized immigration status raising children in a harsh immigration climate also avoided undue public exposure to ensure their children's safety, a task that was difficult for fathers as breadwinners. Immigration status and climate influenced parents' ability to provide opportunities for their children to pursue educational and career opportunities. We discuss parents' hopes and parenting strategies in the context of different immigration climates, highlight emerging gender differences, and provide recommendations for research and practice.En el presente artículo, analizamos las esperanzas que tienen los padres inmigrantes de origen mexicano para sus hijos y las estrategias que emplean para alimentar dichas esperanzas teniendo en cuenta la situación migratoria, el ambiente de inmigración y las experiencias transnacionales vividas. Organizamos seis grupos de análisis con 42 padres inmigrantes de origen mexicano que viven en Arizona y Texas con el fin de analizar sus esperanzas y estrategias utilizadas para alimentar esperanzas. Los padres, la mayoría de los cuales eran madres, definieron las esperanzas desde el punto de vista de lo que les pueden facilitar a sus hijos, por ejemplo, una vida mejor mediante oportunidades educativas y económicas, una fuerte educación cívica y moral, y protección contra la delincuencia barrial y los ambientes hostiles de inmigrantes. Los padres alimentaron estas esperanzas mediante las estrategias de uso de su propio ejemplo, su participación y supervisión, el sacrificio propio y la unidad familiar. Las madres de situación migratoria no autorizada que criaron hijos en un ambiente hostil de inmigrantes también evitaron la exposición pública excesiva para garantizar la seguridad de sus hijos, una tarea que fue difícil para los padres como sostenes de la familia. La situación y el ambiente migratorios influyeron en la capacidad de los padres de brindar posibilidades a sus hijos de seguir oportunidades educativas y profesionales. Explicamos las esperanzas de los padres y las estrategias de crianza en el contexto de diferentes ambientes de inmigración, destacamos las diferencias de género que surgieron, y ofrecemos recomendaciones para la investigación y la práctica.

Summary Background The addition of cisplatin or cetuximab to radiotherapy in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) has significantly improved the outcome. While the superiority of cisplatin over cetuximab in combination with radiotherapy has been shown in a definitive setting, we set out to compare postoperative chemoradiotherapy with cisplatin to radioimmunotherapy with cetuximab and radiotherapy alone within the Austrian head and neck cancer registry of the Working Group on Pharmaceutical Tumor Treatment (AGMT) study group. Material and methods In the AGMT head and neck cancer registry, data of 557 patients with SCCHN from five Austrian cancer centers were prospectively collected between 2012 and 2017. Of these patients 120 received postoperative chemoradiotherapy with cisplatin, 26 patients received postoperative radioimmunotherapy with cetuximab and 56 patients were treated with adjuvant radiotherapy only. Patient characteristics, stage of disease, details on treatment as well as survival were analyzed by a chart-based review. Results In patients treated with postoperative radiotherapy the addition of cisplatin significantly improved progression-free survival (PFS) and overall survival (OS) compared to cetuximab (PFS 84.2 months vs. 17.0 months, p = 0.04, OS not reached vs. 46.0 months, p = 0.02) and PFS compared to radiotherapy alone (PFS 84.2 months vs. 28.5 months, p Conclusion This study confirmed the importance of multimodal treatment concepts in patients with locally advanced SCCHN. Postoperative cetuximab might be an option in patients not eligible for high-dose cisplatin but cisplatin should remain the standard of care.

There is a considerable body of research suggesting that social media may be a primary vehicle for both the dissemination of politically dissident information and for organizing protest activity in contexts of weak governance. Researchers are beginning to focus on building a more nuanced understanding of how new media shape these processes. Using original survey data from the Philippines, we offer the first large N individual level study to directly examine the relationship between religion, social media exposure, and political protest. Specifically, we argue that the degree to which citizens support religious leaders’ authority in politics can mitigate the effects dissident flows of information on social media have on their inclination to protest, at least in an environment characterized by hierarchical religious authority structures and limited religious endorsement of widespread protest. The evidence we present supports the theoretical claim that support for religious authority can at times dampen the link between critical social media and public protest. We discuss the implications of these results for the broader study of governance, technology and religious authority.

PurposeStartups are associated with innovation, emerging technologies, digitalization and disruptive business models. This article aims to provide a better understanding of startups in logistics and supply chain management, organizes the contemporary discussion around startups in the supply chain ecosystem and outlines opportunities for future research.Design/methodology/approachThis study draws on the prior supply chain, logistics and entrepreneurship literature and discusses key themes along the six identified startup issues. Furthermore, it proposes several perspectives and theories for grounding future research.FindingsThis study discusses the roles and success factors of startups in the supply chain ecosystem. It lays out how startups need to organize their own supply chains, how supply chain management (SCM) startups incubate and accelerate their ventures, the financing of SCM startups, as well as their positions as service providers, suppliers and customers.Originality/valueThis research brings together the sparse and dispersed literature on startups in the supply chain ecosystem, motivating scholars to increase the involvement of startups as important stakeholders in SCM research.

Uterine cancers are associated with a high risk of venous thromboembolism. The American Society of Clinical Oncology practice guidelines recommend all patients undergoing pelvic surgery for cancer receive extended pharmacological thromboprophylaxis with the duration dependent on risk. However, risk stratification for patients with uterine cancer is not clearly defined. The Caprini score is the most widely used risk assessment model but it has been found to have limited utility in the gynecologic oncology population. A modified Caprini score has been explored in other populations. The Khorana score is an additional risk assessment model which has not been studied in this context.Our objective was to evaluate the ability of a modified Caprini model as well as the Khorana score to risk stratify patients with uterine cancer for postoperative venous thromboembolism within 90 days of surgery.Following IRB approval, a retrospective cohort study was performed and all patients with uterine cancer who underwent a hysterectomy over a 4-year period were included. The Caprini and Khorana scores were calculated for each patient. The Caprini score cutoff for highest risk was evaluated at ≥7, ≥8 and ≥9 ("modified Caprini") and the Khorana score cutoff was evaluated at ≥2 and ≥3. To determine the prognostic utility of each score as well as other clinico-pathologic criteria on development of venous thromboembolism, univariate analysis was performed using independent t test, chi-square test or Fisher's exact test; multivariate analysis was performed using logistic regression.A total of 954 patients were included, the rate of venous thromboembolism was 1.7% (16/954). Minimally invasive surgical approach was utilized in 90.5% (863/954) of patients. The mean Caprini score of patients with venous thromboembolism was 10.3 compared to 8.1 for the patients without (p0.0001, 95%CI 1.17-3.33). The mean Khorana score of the venous thromboembolism group was 2.4 versus 1.9 (p=0.03, 95%CI 0.04-0.82). Both the Caprini and Khorana scores were found to be associated with venous thromboembolism, but only a Caprini score with cutoff ≥8 or ≥9 was statistically significant (RR 31.25, 95%CI 1.88-519.49; RR 4.59, 95%CI 1.49-14.13 respectively), with high accuracy based on area under the curve (0.75 and 0.68, respectively). Of the minimally invasive subgroup, 11.7% (101/863) had same-day discharge with no postoperative thromboprophylaxis; none of these patients developed venous thromboembolism. Despite laparotomy patients receiving extended prophylaxis (30 days), the rate of venous thromboembolism was more than three times that of the minimally invasive group (5.49% vs 1.7%). Advanced stage and leukocytosis were noted to be independent risk factors for venous thromboembolism.Our study suggests that using a modified Caprini score could help identify the highest risk patients who would benefit from prolonged thromboprophylaxis, reduce the incidence of postoperative venous thromboembolism as well as minimize the cost and harm of overtreatment. These findings need to be validated in a prospective manner and further research is needed to determine the optimal duration of therapy.

The authors aimed to identify factors associated with long-acting reversible contraception (LARC) usage.The current cross-sectional study used data from the National Survey of Family Growth from 2011 to 2019. Respondents aged 15 to 44 years were included. Those with previous sterilization, infertility, or pregnant were excluded. The outcome evaluated was use of a LARC.Of 61 543 814 women, 44 287 911 (72.0%) met inclusion criteria. The rate of LARC use was 13.4%. Factors associated with an increased likelihood of LARC usage were married/living with a partner (adjusted relative risk [aRR], 1.18 [95% CI, 1.02-1.37]), perceived good health (aRR, 1.44 [95% CI, 1.13-1.84]), year of survey 2017 to 2019 (aRR, 1.53, [95% CI, 1.28-1.83]), one or two past pregnancies (aRR, 1.62 [95% CI, 1.24-2.12]) or three or more past pregnancies (aRR, 1.67 [95% CI, 1.22-2.28]), age at first live birth20 years (aRR, 1.58 [95% CI, 1.20-2.08]) or 20 to 24 years (aRR, 1.45 [95% CI, 1.13-1.87]), age at onset of sexual activity 13-19 years (aRR, 1.50 [95% CI, 1.26-1.78]), and a 0- to 5-month period of nonintercourse in the past year (aRR, 1.63 [95% CI, 1.40-1.90]). Factors associated with decreased LARC usage were age ≥ 35 years (aRR, 0.74 [95% CI, 0.65-0.85]), being non-Hispanic Black (aRR, 0.75 [95% CI, 0.62-0.89]) or non-Hispanic other (aRR, 0.72 [95% CI, 0.59-0.88]), intending to have children (aRR, 0.65 [95% CI, 0.57-0.74]), and never being sexually active (aRR, 0.10 [95% CI, 0.06-0.16]).Using a nationally representative sample of women in the United States, the authors identified modifiable factors associated with LARC use. Results may be used to plan interventional trials to increase LARC usage.