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Aim: To investigate clinicians' psychosocial experiences navigating interdisciplinary care for children with severe neurological impairment (SNI), for example children with a developmental epileptic encephalopathy; secondarily, to identify preferences for future interventions to support clinicians caring for children with SNI. Method: We conducted a qualitative descriptive study with interdisciplinary clinicians by using a purposeful sampling recruitment strategy. Twenty‐four participants with expertise caring for children with SNI completed in‐depth, semi‐structured interviews. We transcribed the interviews, de‐identified them, and performed inductive thematic analysis. Results: Thematic analysis elicited interrelated themes. Clinicians experienced immense professional barriers providing patient‐centred care across fragmented healthcare contexts. Physical, emotional, and psychological impacts were attributed to inadequate reflective practice training and a paucity of integrated resources to support clinicians over time. Multipronged strategies were prioritized by clinicians, incorporating psychoeducation, interdisciplinary peer mentorship, and psychological resources to build reflective practice skills for clinicians providing complex care in an advancing era of medicine. Interpretation: This study provides novel and in‐depth insight into clinicians' experiences navigating care for children with SNI. The results will be used to inform future integrated and multipronged co‐developed resources tailored for clinicians, on the basis of their recommendations. [ABSTRACT FROM AUTHOR]

Rationale: Sickle cell disease (SCD) is a monogenetic condition with recurring vasoocclusive events causing lifelong pulmonary morbidity and mortality. There is increasing access to curative therapies, such as hematopoietic cell transplant (HCT), for people living with SCD. However, more information on pulmonary function in adults with SCD after HCT is needed to best guide decisions for HCT and post-HCT care. Objectives: To test the hypothesis that forced expiratory volume in 1 second (FEV1) and other pulmonary function testing (PFT) parameters remain stable 3 years after HCT. Methods: People living with SCD undergoing nonmyeloablative HCT in a prospective cohort at the NIH Clinical Center from 2004 to 2019 were evaluated for enrollment. Global Lung Function Initiative reference equations and descriptive statistics were calculated before HCT and annually for 3 years. Six-minute-walk distance (6MWD) testing was performed. Generalized estimating equations were employed to evaluate interindividual changes in PFT parameters and 6MWD. Results: Of 97 patients with SCD undergoing HCT, 41 (42%) were female with median (25th, 75th percentile) age 31.8 (24.8, 38.0) years. Each year of measurement included the following numbers of subjects available for analysis with PFTs: baseline (n = 97), Year 1 (n = 91), Year 2 (n = 72), and Year 3 (n = 55); and the following numbers of subjects available for analysis with 6MWD: baseline (n = 79), Year 1 (n = 73), Year 2 (n = 57), and Year 3 (n = 41). Pre-HCT FEV1 was median (25th, 75th percentile) 68.3% (61.3%, 80.3%) and 69.2% (60.8%, 77.7%) 3 years after HCT, and pre-HCT diffusing capacity of the lung for carbon monoxide (DlCO) was 60.5% (53.0%, 66.3%) and 64.6% (55.1%, 73.4%) 3 years after HCT. Generalized estimating equations estimated that DlCO percent predicted increased significantly by 3.7% (95% confidence interval, 1.0%, 6.3%), and the 6MWD significantly increased by 25.9 (6.6, 45.2) meters 3 years after HCT, whereas there was no significant change in percent predicted FEV1 or FVC compared with before HCT. Conclusions: Overall, PFT results remained stable and there was an improvement in DlCO and 6MWD in this predominantly adult cohort undergoing nonmyeloablative HCT for SCD. Allogeneic HCT for SCD may cease the cycle of vasoocclusive pulmonary injury and prevent continued damage. Multicenter studies are needed to evaluate the long-term lung health effects of HCT for SCD in adults and children. [ABSTRACT FROM AUTHOR]

A large linguistic distance exists between spoken Arabic and the Modern Standard Arabic (MSA) the literary language (a diglosia). Novice readers, therefore, struggle with the complex orthography of Arabic as well as the mastering of MSA. Here, we tested whether structured activities in MSA would advance kindergarteners' MSA aptitude by the end of the school year. We examined two issues: (1) whether reciting nursery rhymes in MSA would be more effective in promoting language and preliteracy skills in kindergarteners compared to listening to the same texts; and (2) whether there are additional advantages for using texts directly referring to the alphabet. Thus, 136 kindergarteners (M[subscript age] = 5:6; 61 girls), all native speakers of Arabic and with middle-low socioeconomic background, were assigned to a 10-session (2 months) program in 1 of 4 intervention conditions wherein nursery rhymes related/not related to the alphabet, were either repeatedly recited or listened to. The achievements of children in the intervention conditions were compared to those of peers that were given nonlinguistic activity of similar length (control). The four intervention groups improved their performance at the postintervention assessment in all tests of MSA aptitude and outperformed the control group in receptive and expressive vocabulary and listening comprehension. Also, the reciting groups were better than the control and listening groups in tests assessing vocabulary and morpho-syntactic sensitivity. Our results highlight the contribution of structured interventions based on rhyme repetition to MSA proficiency of kindergarteners. Moreover, the results suggest that reciting may be superior to listening in advancing language proficiency in preschoolers.

This study examined the monitoring abilities of trilinguals in reading comprehension, addressing the following questions: Is comprehension monitoring related to reading comprehension across first, second, and third languages? Is comprehension monitoring shared across the languages of trilingual adults (domain-general) or rather linked to language proficiency (language-specific)? Eighty undergraduates, trilingual in Arabic, Hebrew, and English, read three texts in each language, answered multiple-choice questions, and rated their confidence in their responses. From this we derived the absolute and relative accuracy of monitoring. The results showed links between accurate monitoring and successful comprehension in all the languages of participants, but these were weaker in English, the least proficient language. Further, the results lend some support to the involvement of both domain-general and language-specific processes in comprehension monitoring. Specifically, monitoring seems to be utilized similarly by individuals to support comprehension across the first and second languages, but is less well generalized to the third language.

The morphological structure of the word has a central function in the organization of the mental lexicon and word recognition. Polymorphemic words in Arabic are composed of two non-concatenated morphemes: root and word-pattern. This study is the first to address the issue of nominal-pattern priming among young developing Arabic speakers. I examined cross-modal priming using words derived from the same nominal-pattern as the target ("/ruku:b/"-"/duxu:l/"riding-entrance) relative to prime words that included a different word-pattern than the target, while preserving phonological similarity ("/duxa:n/"-"/duxu:l/" "smoke"-"entrance") in two groups: second- and fifth-graders. The findings showed facilitation of lexical decisions about target words, in terms of accuracy but not reaction times in both grades. These findings may stem from the morpho-orthographic nature of the Arabic written word and the information conveyed by the nominal word-pattern.

Abstract Background Osteoarthritis is one of the most common musculoskeletal problems. Pain is the most common complaint and the most significant cause of decreased health-related quality of life (HRQOL) among osteoarthritic patients. The objectives of this study were to assess the impact of pain on quality of life among patients with osteoarthritis and to assess the association of sociodemographic and clinical factors with HRQOL. Methods Using a cross-sectional study design, we collected data from osteoarthritis patients in orthopedic outpatient clinics from four hospitals in the Palestine-West bank between November 2020 and March 2021. We used the Brief Pain Inventory (BPI) scale to assess pain and the Quality of Life scale five dimensions (EQ-5D) with the visual analog scale of the European Quality of Life (EQ-VAS) to assess HRQOL. Results In our study, 196 patients composed the final sample, with an average of 60.12 ± 13.63 years. The medians for the EQ-5D score and EQ-VAS score were 0.72 (0.508–0.796) and 70 (55–85), respectively. The pain severity score was found to have a significant negative association with both the EQ-5D and EQ-VAS scores with r of − 0.620, p

Background: The public health emergencies such as the COVID-19 pandemic resulted in mental and psychological ramifications on the healthcare professionals. The pre-licensure nursing students found themselves not only fighting against the baneful virus but also weak ego resilience. At this point, enriching the pre-licensure nursing students with psychological first aid (PFA) could help them to recover from the feeling of psychological distress and improve their resilience capacity to encounter any upcoming outbreaks. Methods: A quasi-experimental two groups, a pre-post-test study was used in which sixty-four pre-licensure nursing students completed a baseline survey which revealed high levels of psychological distress and low resilience capacity due to the COVID-19 crisis. The study group engaged in the Psychological First- aid Intervention (PFA) at the end of the clinical practicum course period, while the comparison group received routine psychological support. Results: A significant reduction in the psychological distress levels among students in the PFA group (FET=7.83, P = 0. 001). Likewise, significant improvements in the students' resilience capacity level immediately after the intervention (FET=3.34, P = 0.019) and during the two-month follow-up (FET=12.94, P = 0. 001). The implementation of PFA enhanced the pre-licensure nursing students' psychological health status and resilience capacity levels after their clinical training amid the ambiance of the COVID-19 crisis. Conclusion: The PFA effectively fostered the pre-licensure nursing students’ recovery from the COVID-19 related- psychological distress and improve their resilience capacity. The application of RAPID model is recommended to reduce stress and prevent burnout among novice and future nurses who show signs of psychological exhaustion.

Introduction Hospital-acquired thrombosis (HAT) is defined as any venous thromboembolism (VTE)-related event during a hospital admission or occurring up to 90 days post discharge, and is associated with significant morbidity, mortality and healthcare-associated costs. Although surgery is an established risk factor for VTE, operations with a short hospital stay (

Abstract Background Obesity is associated with an increased risk of morbidity and mortality, so weight reduction is important. Bariatric surgery is a well-tolerated approach for reducing body weight, with laparoscopic sleeve gastrectomy commonly performed. An uncommon and potentially fatal sequela of laparoscopic sleeve gastrectomy is portomesenteric vein thrombosis, which may result in severe bowel ischemia. Case report A 32-year-old Middle Eastern obese man (body mass index 33) presented to the emergency department with severe, generalized abdominal pain 2 weeks after laparoscopic sleeve gastrectomy. Computed tomography of the abdomen and pelvis revealed extensive acute on chronic portosplenic and superior mesenteric vein thrombosis with associated small bowel ischemia. Laparoscopic exploration was converted to midline laparotomy and an extensive ischemic small bowel resection. Conclusion Laparoscopic sleeve gastrectomy carries a risk of both morbidity and mortality. Venous thromboembolism is a well-known risk of bariatric surgery, but portomesenteric vein thrombosis is also a rare but sometimes serious complication. A high index of suspicion for portomesenteric vein thrombosis to prompt early detection is essential in patients who have undergone laparoscopic sleeve gastrectomy to minimize complications and optimize outcomes. Uncertainty still remains around the optimal dose and duration of anticoagulation after laparoscopic sleeve gastrectomy.

PURPOSEBreast cancer is the most common cancer in women worldwide, representing 25.4% of the newly diagnosed cases in 2018. The past two decades have seen advancements in screening technologies, guidelines, and newer modalities of treatment. Our study reports and compares trends in breast cancer mortality in the European Union and the United Kingdom.MATERIALS AND METHODSWe used the WHO Mortality Database. We extracted breast cancer mortality data from 2001 to 2017 on the basis of the International Classification of Diseases, 10th revision system. Crude mortality rates were dichotomized by sex and reported by year. We computed age-standardized death rates (ASDRs) per 100,000 population using the world standard population. Breast cancer mortality trends were compared using joinpoint regression analysis.RESULTSWe analyzed data from 24 EU countries, including the United Kingdom. For women, breast cancer mortality was observed to be downtrending in all countries except Croatia, France, and Poland. For the most recent female data, the highest ASDR for breast cancer was identified in Croatia (19.29 per 100,000), and the lowest ASDR was noted in Spain (12.8 per 100,000). Denmark had the highest change in ASDR and the highest estimated annual percentage change of −3.2%. For men, breast cancer mortality decreased in 18 countries, with the largest relative reduction observed in Denmark with an estimated annual percentage change of −27.5%. For the most recent male data, the highest ASDR for breast cancer was identified in Latvia (0.54 per 100,000).CONCLUSIONBreast cancer mortality rates have down trended in most EU countries between 2001 and 2017 for both men and women. Given the observational nature of this study, causality to the observed trends cannot be reliably ascribed. However, possible contributing factors should be considered and subject to further study.

Introduction Peripheral arterial disease (PAD) is a key risk factor for cardiovascular disease, foot ulceration and lower limb amputation in people with diabetes. Early diagnosis of PAD can enable optimisation of therapies to manage these risks. Its diagnosis is fundamental, though challenging in the context of diabetes. Although a variety of diagnostic bedside tests are available, there is no agreement as to which is the most accurate in routine clinical practice.The aim of this study is to determine the diagnostic performance of a variety of tests (audible waveform assessment, visual waveform assessment, ankle brachial pressure index (ABPI), exercise ABPI and toe brachial pressure index (TBPI)) for the diagnosis of PAD in people with diabetes as determined by a reference test (CT angiography (CTA) or magnetic resonance angiography (MRA)). In selected centres, we also aim to evaluate the performance of a new point-of-care duplex ultrasound scan (PAD-scan).Methods and analysis A prospective multicentre diagnostic accuracy study (ClinicalTrials.gov Identifier NCT05009602). We aim to recruit 730 people with diabetes from 18 centres across the UK, covering primary and secondary healthcare. Consenting participants will undergo the tests under investigation. Reference tests (CTA or MRA) will be performed within 6 weeks of the index tests. Imaging will be reported by blinded consultant radiologists at a core imaging lab, using a validated scoring system, which will also be used to categorise PAD severity. The presence of one or more arterial lesions of ≥50% stenosis, or tandem lesions with a combined value of ≥50%, will be used as the threshold for the diagnosis of PAD. The primary outcome measure of diagnostic performance will be test sensitivity.Ethics and dissemination The study has received approval from the National Research Ethics Service (NRES) (REC reference 21/PR/1221). Results will be disseminated through research presentations and papers.Trial registration number NCT05009602.

Abstract This observational study aimed to assess trends in type 2 diabetes mellitus (T2DM) disease burden in European Union countries for the years 1990–2019. Sex specific T2DM age-standardised prevalence (ASPRs), mortality (ASMRs) and disability-adjusted life-year rates (DALYs) per 100,000 population were extracted from the Global Burden of Disease (GBD) Study online results tool for each EU country (inclusive of the United Kingdom), for the years 1990–2019. Trends were analysed using Joinpoint regression analysis. Between 1990 and 2019, increases in T2DM ASPRs were observed for all EU countries. The highest relative increases in ASPRs were observed in Luxembourg (males + 269.1%, females + 219.2%), Ireland (males + 191.9%, females + 165.7%) and the UK (males + 128.6%, females + 114.6%). Mortality trends were less uniform across EU countries, however a general trend towards reducing T2DM mortality was observed, with ASMRs decreasing over the 30-year period studied in 16/28 countries for males and in 24/28 countries for females. The UK observed the highest relative decrease in ASMRs for males (− 46.9%). For females, the largest relative decrease in ASMRs was in Cyprus (− 67.6%). DALYs increased in 25/28 countries for males and in 17/28 countries for females between 1990 and 2019. DALYs were higher in males than females in all EU countries in 2019. T2DM prevalence rates have increased across EU countries over the last 30 years. Mortality from T2DM has generally decreased in EU countries, however trends were more variable than those observed for prevalence. Primary prevention strategies should continue to be a focus for preventing T2DM in at risk groups in EU countries.

BackgroundTechnological advances have transformed vascular intervention in recent decades. In particular, improvements in imaging and data processing have allowed for the development of increasingly complex endovascular and hybrid interventions. Augmented reality (AR) is a subject of growing interest in surgery, with the potential to improve clinicians’ understanding of 3D anatomy and aid in the processing of real-time information. This study hopes to elucidate the potential impact of AR technology in the rapidly evolving fields of vascular and endovascular surgery. ObjectiveThe aim of this review is to summarize the fundamental concepts of AR technologies and conduct a scoping review of the impact of AR and mixed reality in vascular and endovascular surgery. MethodsA systematic search of MEDLINE, Scopus, and Embase was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All studies written in English from inception until January 8, 2021, were included in the search. Combinations of the following keywords were used in the systematic search string: (“augmented reality” OR “hololens” OR “image overlay” OR “daqri” OR “magic leap” OR “immersive reality” OR “extended reality” OR “mixed reality” OR “head mounted display”) AND (“vascular surgery” OR “endovascular”). Studies were selected through a blinded process between 2 investigators (JE and AS) and assessed using data quality tools. ResultsAR technologies have had a number of applications in vascular and endovascular surgery. Most studies (22/32, 69%) used 3D imaging of computed tomography angiogram–derived images of vascular anatomy to augment clinicians’ anatomical understanding during procedures. A wide range of AR technologies were used, with heads up fusion imaging and AR head-mounted displays being the most commonly applied clinically. AR applications included guiding open, robotic, and endovascular surgery while minimizing dissection, improving procedural times, and reducing radiation and contrast exposure. ConclusionsAR has shown promising developments in the field of vascular and endovascular surgery, with potential benefits to surgeons and patients alike. These include reductions in patient risk and operating times as well as in contrast and radiation exposure for radiological interventions. Further technological advances are required to overcome current limitations, including processing capacity and vascular deformation by instrumentation.

Objective To compare the trends in age-standardised incidence and mortality from interstitial lung diseases (ILD) in the UK and the European Union (EU). Methods This was an observational study using data obtained from the Global Burden of Disease Study on residents of the UK and of the 27 EU countries. The main outcome measures were ILD age-standardised incidence rates per 100 000 (ASIR), age-standardised death rates per 100 000 (ASDR) and mortality-to-incidence ratios (MIRs), which are presented for men and women separately for each country for the years 2001–2017. Trends were analysed using joinpoint regression analysis. Results In 2017, the median incidence of ILD was 7.22 (IQR 5.57–8.96) per 100 000 population for men and 4.34 (IQR 3.36–6.29) per 100 000 population for women. In 2017, the median ASDR attributed to ILD was 2.04 (IQR 1.13–2.71) per 100 000 population for men and 1.02 (0.68–1.37) per 100 000 population for women. There was an overall increase in ASDR during the observation period, with a median increase of +20.42% (IQR 5.44–31.40) for men and +15.44% (IQR −1.01–31.52) for women. Despite increases in mortality over the entire observation period, there were decreasing mortality trends in the majority of countries at the end of the observation period (75% for men and 86% for women). Conclusion Over the past two decades, there have been increases in the incidence and mortality of ILD in Europe. The most recent trends, however, demonstrate decreases in mortality from ILD in the majority of European countries for both men and women. These data support the ongoing improvements in the diagnosis and management of ILD.