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Background: Myhre syndrome, caused by pathogenic variants in SMAD4, is characterized by compact body habitus with short stature, distinctive craniofacial appearance, stiff skin, cardiovascular abnormalities (valve stenosis, coarctation, hypoplasia, or stenosis of aorta), effusions of potential spaces (pericardium, pleura, peritoneum), restricted movement of the joints (including thorax), and hearing loss. Lung and airway disease has been reported, but not always well-defined, to include interstitial lung disease, large airway obstruction, and pulmonary arterial hypertension. Excessive fibroproliferation of tissues especially following trauma or surgical instrumentation has been recognized, although these may also present spontaneously. Method: We report the pathologic features of 1 new patient with progressive choanal stenosis, and 22 literature cases, including the expanded history of 5 patients (3 who died). Results: Examination of patient tissues documents cellular fibroproliferation and deposition of excessive extracellular matrix explaining some of the observed clinical features of Myhre syndrome. Conclusion: Excessive fibrosis is noted in multiple tissues, especially heart, lung, and upper and lower airways. Our research provides the first systematic review to provide a knowledge base of gross and pathologic findings in Myhre syndrome.

BACKGROUND Video played an important role in health communication throughout the COVID-19 pandemic. It was used to communicate pandemic information to the public, with a variety of formats, presenters, and topics. Evidence regarding the effectiveness of video features is available, while how individual characteristics of recipients influence communication comprehension is still limited. OBJECTIVE The aim of this study was to test six individual characteristics and assess their effect on the comprehension of pandemic video communication. METHODS Short health communication videos were presented to a large sample of subjects, receiving questionnaire-responses from 1194 participant. Individual characteristics consisted of age, sex, living area, education level, income level, and belief in science. Communication comprehension consisted of both perceived and objective comprehension. The data was analyzed by multiple linear regression. RESULTS Age had a negative effect on both perceived and objective comprehension – increasing age is associated with lower comprehension. There were sex differences with higher perceived comprehension among women than men, while lower objective comprehension among women compared to men. Living in an urban or a rural area had no significant effect. The level of education and income had a positive effect on both subjective and objective comprehension. Finally, the belief in science had a positive effect on perceived comprehension, while no statistically significant effect on objective comprehension. CONCLUSIONS The main differences between those who think they understand pandemic communication and those who comprehend it better are gender (women have a higher perception of having comprehended, while men have higher levels of objective comprehension) and belief in science (higher belief in science leads to higher perceived comprehension, while it does not have any impact on objectively understanding the message conveyed).

BACKGROUND Obesity is a prevalent and serious chronic condition associated with abnormal or excessive fat buildup that poses significant health risks. The rates of overweight and obesity in adults and children continue to rise, with global rates of overweight or obese children aged 5–19 years growing from 4% to 18% between 1975 and 2016. Furthermore, in 2017, nearly 4 million people died due to complications arising from being overweight or obese. OBJECTIVE The present study aims to investigate the potential impact of the mobile application Heia Meg on promoting healthier lifestyle choices regarding nutrition and physical activity. A prospective longitudinal study was conducted in collaboration with the Norwegian Directorate of Health. METHODS Participants were recruited via the Heia Meg app, and were asked to complete a questionnaire before and after using the app. A total of 199 responses were included in the first (pre-intervention) questionnaire, while 99 valid responses were obtained in the second (post-intervention) questionnaire. RESULTS The majority of participants were women, and their age ranged from 18 years to 70 years and older. Men had a higher Body Mass Index (BMI) than women, but had a higher health score. The results show a reduction in BMI after the digital intervention, but a higher health score was observed in the pre-intervention group. The BMI accounted for a significant amount of variance in the individual’s health score for both groups (26.22% & 18.63%). Regression analysis showed that gender, age, education, smoking, and BMI had a statistically significant effect and accounted for a significant amount of variance (44% & 35%) in the health score. CONCLUSIONS Our study found weak evidence to support the effectiveness of the Heia Meg app in promoting healthier lifestyle choices. However, limitations and confounding factors suggest that further research is needed to confirm our findings. Keywords: lifestyle change, motivation, health, smartphone applications, Heia Meg CLINICALTRIAL Norwegian senter of research 385157

Background In the healthcare system, Teaching Hospitals(THs) not only provide care, but also train healthcare professionals and carry out research activities. Research is a fundamental pillar of THs’ mission and relevant for the healthcare system monitored by Performance Evaluation Systems. Research activities can be measured using citation index services and this paper highlights differences between two services based on bibliometrics, describes opportunities and risks when performance indicators rely on data collected, controlled and validated by external services and discusses the possible impact on health policy at a system and provider level. Methods A bibliometric analysis was done on data between 2014-2016 from ISI Web of Science and Scopus of 18.255 physicians working in 26 Italian THs. Quantity was defined as the number of publications and quality as Impact Factor or Field-Weighted Citation Impact. Results Overall, 41.233 and 66.409 documents were extracted from respectively ISI Web of Science and Scopus. While benchmarking results, significant differences in ranked position both in metrics emerged. Discussion Utilizing secondary data sources to measure research activities of THs allows benchmarking at an (inter)national level and overcoming self-referment. To utilize indicators for multiple governance purposes at the system and provider level, indicators need to be profoundly understood, require formalizations in data validation, internal analysis and a sharing process among health professionals, management and policymakers.

Background Science communication can provide people with more accurate information on pandemic health risks by translating complex scientific topics into language that helps people make more informed choices on how to protect themselves and others. During pandemics, experts in medicine, science, public health, and communication are important sources of knowledge for science communication. This study uses the COVID-19 pandemic to explore these experts’ opinions and knowledge of what to communicate to the public during a pandemic. The research question is: What are the key topics to communicate to the public about health risks during a pandemic? Method We purposively sampled 13 experts in medicine, science, public health, and communication for individual interviews, with a range of different types of knowledge of COVID-19 risk and communication at the national, regional and hospital levels in Norway. The interview transcripts were coded and analysed inductively in a qualitative thematic analysis. Results The study’s findings emphasise three central topics pertaining to communication about pandemic health risk during the first year of the COVID-19 pandemic in Norway: 1) how the virus enters the human body and generates disease; 2) how to protect oneself and others from being infected; and 3) pandemic health risk for the individual and the society. Conclusion The key topics emerging from the expert interviews relate to concepts originating from multiple disciplinary fields, and can inform frameworks for interprofessional communication about health risks during a pandemic. The study highlights the complexity of communicating pandemic messages, due to scientific uncertainty, fear of risk amplification, and heterogeneity in public health and scientific literacy. The study contributes with insight into the complex communication processes of pandemic health risk communication.

Pandemic video communication aimed at the general public often lacks creativity and fails to reach large audiences. Yet, the scientific content should not be compromised by attempts to improve the creativity or reach. This study explores the processes utilised by various health experts and professional communicators when creating communication, to identify similarities and differences, and how pandemic video communication thus can be improved through an interdisciplinary approach. We interviewed 12 individuals from 6 different professional domains: health, public health, film/science communication, video journalism, advertising, and social media/YouTube. Semi-structured individual interviews were conducted using the same interview guide. The interview data were subjected to thematic analysis with both deductive and inductive coding, and the results were visualised in a bubble chart. Our study has highlighted both similarities and differences between health professionals and creative communicators relating to their creative processes and their approaches to pandemic video communication. We found that participants from health domains assigned great importance to and efforts on the content, but were unsure or lacked experience in how content is translated through form and creativity. Creative communicators, on the other hand, emphasise and specialise in form, yet depend on health professionals, experts, and scientists to provide and validate content. The key to improving pandemic-related video communication appears to lie in striking the right balance between high-quality and evidence-based content and creativity. This study found that both health professionals and creative communicators play crucial roles in reaching a solid end result, and we suggest a fusion model approach to interdisciplinary collaboration.

Background The nonlinear nature of contagious diseases and the potential for exponential growth can be difficult to grasp for the general public. This has strong implications for public health communication, which needs to be both easily accessible and efficient. A pandemic is an extreme situation, and the accompanying strict societal measures are generally easier to accept if one understands the underlying reasoning behind them. Bringing about informed attitude change and achieving compliance to strict restrictions requires explanations of scientific concepts and terminologies that laypersons can understand. Objective The aim of the project is to develop effective, evidence-based modes of video communication for translating complex, but important, health messages about pandemics to both the general population and decision makers. The study uses COVID-19 as a case to learn and prepare society for handling the ongoing and future pandemics, as well as to provide evidence-based tools for the science communication toolbox. Methods The project applies a mixed methods design, combining qualitative methods (eg, interviews, observational studies, literature reviews) and quantitative methods (eg, randomized controlled trials [RCTs]). The project brings together researchers from a wide range of academic fields, as well as communication industry professionals. Results This study has received funding from the Trond Mohn Foundation through the Research Council of Norway’s “COVID-19 Emergency Call for Proposals” March 2020. Recruitment and data collection for the exploratory first phase of the project ran from February 2021 to March 2021. Creative communication work started in May 2021, and the production of videos for use in the RCTs in the final phase of the project started in September 2021. Conclusions The COVCOM project will take on several grand challenges within the field of communicating science and provide evidence-based tools to the science communication toolbox. A long-term goal of the project is to contribute to the creation of a more resilient health care system by developing communication responses tailormade for different audiences, preparing society for any future pandemic. International Registered Report Identifier (IRRID) DERR1-10.2196/34275

Background Humans struggle to grasp the extent of exponential growth, which is essential to comprehend the spread of an infectious disease. Exponential growth bias is the tendency to linearize exponential functions when assessing them intuitively. Effective public health communication about the nonlinear nature of infectious diseases has strong implications for the public’s compliance with strict restrictions. However, there is a lack of synthesized knowledge on the communication of the exponential growth of infectious diseases and on the outcomes of exponential growth bias. Objective This systematic review identifies, evaluates, and synthesizes the findings of empirical studies on exponential growth bias of infectious diseases. Methods A systematic review will be conducted using the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 statement. Eligibility criteria include empirical studies of exponential growth bias of infectious diseases regardless of methodology. We include studies both with and without interventions/strategies. For information sources, we include the following five bibliographic databases: MEDLINE, Embase, Cochrane Library, PsychINFO, and Web of Science Core Collection. The risk of bias will be assessed using RoB 2 (Risk of Bias 2) and STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). Data synthesis will be achieved through a narrative synthesis. Results By February 2022, we included 11 experimental studies and 1 cross-sectional survey study. Preliminary themes identified are the presence of exponential growth bias, the effect of exponential growth bias, and communication strategies to mitigate exponential growth bias. Data extraction, narrative synthesis, and the risk of bias assessment are to be completed by February 2023. Conclusions We anticipate that this systematic review will draw some lines related to how people comprehend and misperceive exponential growth and its consequences for infectious disease mitigation and communication. Furthermore, the study will conclude with the limitations of the research and suggestions for future research. International Registered Report Identifier (IRRID) DERR1-10.2196/37441

BACKGROUND Humans have fundamental difficulties to grasp the extent of exponential growth, which is fundamental to grasp the extent of a spreading infectious disease. Exponential growth bias is the pervasive tendency to linearize exponential functions when assessing them intuitively. OBJECTIVE This systematic review aims to identify, evaluate and synthesise the findings of empirical studies concerning exponential growth bias of infectious diseases METHODS A systematic review will be conducted using the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Risk of bias will be assessed using ROBINS-2 and STROBE. Data synthesis will be achieved through a narrative synthesis RESULTS As of February 2022, we included 11 studies, see PRISMA flow diagram, figure 1. This comprises 10 quasi-experimental studies and one cross sectional survey study. Preliminary themes identified are: The presence and effect of EGB of infectious diseases, visual and educational strategies to mitigate EGB of infectious diseases. Data extraction, narrative synthesis and risk of bias assessment will be expected to be due June 2022. CONCLUSIONS This systematic review concludes on limitation of the research and drawing some lines related to how people comprehend and misperceive exponential growth and its’ consequences for mitigating infectious diseases. Furthermore, the study will give recommendations for communication of exponential growth of infectious diseases and suggestion for future research.

Genetic testing for pathogenic COL4A3-5 variants is usually undertaken to investigate the cause of persistent hematuria, especially with a family history of hematuria or kidney function impairment. Alport syndrome experts now advocate genetic testing for persistent hematuria, even when a heterozygous pathogenic COL4A3 or COL4A4 is suspected, and cascade testing of their first-degree family members because of their risk of impaired kidney function. The experts recommend too that COL4A3 or COL4A4 heterozygotes do not act as kidney donors. Testing for variants in the COL4A3-COL4A5 genes should also be performed for persistent proteinuria and steroid-resistant nephrotic syndrome due to suspected inherited FSGS and for familial IgA glomerulonephritis and kidney failure of unknown cause.

In restricted waterways, ship operation is affected by the proximity of the boundaries such as the bottom, horizontal restrictions due to banks and quay walls. Numerical simulations of the ship behavior when moving in restricted water are proposed in the present paper based on a computational fluid dynamics (CFD hereafter) investigation technique. Comparisons with the corresponding numerical solutions for the unlimited water are provided to emphasize the effects of the water depths not only on the pressure distributions on the hull, but also on the sinkage, trim and overall hydrodynamic resistance.

Roll damping is essential for describing properly the motions of a ship, particularly when operating in rough sea conditions, being determinant for parametric or synchronous roll phenomena. Roll damping is a complex process of energy transfer from the hull to the water, which affects the amplitude of motion. Roll damping is dominated by viscous effects as well as by the interaction of the ship with the free surface. Numerical simulations of the free roll decay are carried out in this paper for a double-symmetric floating hull with one or two bilge keels based on an unsteady viscous flow solver. The numerical solutions reported in here are computed with the ISIS-CFD viscous flow solver, part of the Numeca FineTM/Marine suite. Turbulent flow is simulated by solving the unsteady equations of flow. Closure to the turbulence is achieved through the Shear Stress Transport (SST hereafter) based Detached Eddy Simulation (DES), which provides the accuracy of LES for highly separated flow regions and a computational efficiency of RANS in the near-wall region. Free roll decay is studied for various initial roll angles at a given advancing speed of the main hull. The influences of the bilge keel surface and initial roll angle on the roll damping coefficient are discussed.

Concursurile pentru ocuparea funcțiilor de conducători ai instituțiilor medico-sanitare publice desfășurate în ultima perioadă au coincis în mare parte cu evoluțiile crizei politice la nivel național și local. Hotărârea Parlamentului RM nr.89/2021 pentru aprobarea listei ministerelor, precum și decretul Președintelui RM nr.129-IX din 06.08.2021 privind numirea Guvernului au dat posibilitate Ministerului Sănătății să anuleze concursurile pentru ocuparea funcției de director al mai multor instituții medico-sanitare aflate în desfășurare, dar nu și rezultatele concursurilor deja afișate, chiar dacă unele dintre ele au semne vădite de viciere. Aprecierea legalității și temeiniciei rezultatelor concursurilor ține de competența instanței de judecată și doar ca urmare a exercitării dreptului subiectiv al unuia dintre candidați la contestarea lor. Cu regret, cadrul normativ care reglementează numirea în funcţie pe bază de concurs a conducătorilor instituţiilor medico-sanitare publice implică și multiple carențe care se răsfrâng negativ asupra: activității instituțiilor medico-sanitare publice; colectivelor de muncă ale respectivelor instituții; beneficiarilor de servicii de sănătate, inclusiv asupra raporturilor dintre administrația publică centrală de specialitate și administrația publică locală. În consecință, Ministerul Sănătății al Republicii Moldova în cel mai scurt timp urmează să promoveze modificări și completări, în vederea eliminării respectivelor lacune din legislație.

BackgroundA worldwide pandemic of a new and unknown virus is characterised by scientific uncertainty. Yet, health authorities still need to communicate complex health risk information to the public – despite this uncertainty. The mental models approach to risk communication describes how people perceive and make decisions regarding complex risks, with the aim of identifying decision-relevant information that can be targeted in risk communication interventions. This study used COVID-19 as a case to explore how people make sense of scientific information and apply it to their lives and behaviour using the concept of mental models.MethodsThis qualitative study included 15 male and female participants of different ages and from different geographical regions in Norway, occupational areas and with different education levels. The participants were interviewed individually, and the interview data analysed via directed content analysis, with predetermined themes and codes derived the Norwegian Institute of Public Health’s official website. Materials in the interview data not represented by deductive codes were coded inductively. The participants’ perceptions and behaviours related to health risk information were analysed across three themes: virus transmission, exposure to risk and consequences of COVID-19. ResultsThe results imply that people put different meanings to the medical and scientific words used by experts to explain the pandemic, e.g. virus transmission and the reproduction number. And while some people expressed the need to comprehend why certain behavior and activities involve a high risk, others preferred simple, clear messages focusing on what to do and how to protect themselves. Similarly, information about health consequences caused panic for some and awareness for others. ConclusionThere is no one-size fits all to public health risk communication, and empowering people with decision-relevant information necessitates targeted and balanced risk communication.

BACKGROUND The nonlinear nature of contagious diseases and the potential for exponential growth can be difficult to grasp for the general public. This has strong implications for public health communication, which needs to be both easily accessible and efficient. A pandemic is an extreme situation, and the accompanying strict societal measures are generally easier to accept if one understands the underlying reasoning behind them. Bringing about informed attitude change and achieving compliance to strict restrictions requires explanations of scientific concepts and terminologies that laypersons can understand. OBJECTIVE The aim of the project is to develop effective, evidence-based modes of video communication for translating complex, but important, health messages about pandemics to both the general population and decision makers. The study uses COVID-19 as a case to learn and prepare society for handling the ongoing and future pandemics, as well as to provide evidence-based tools for the science communication toolbox. METHODS The project applies a mixed methods design, combining qualitative methods (eg, interviews, observational studies, literature reviews) and quantitative methods (eg, randomized controlled trials [RCTs]). The project brings together researchers from a wide range of academic fields, as well as communication industry professionals. RESULTS This study has received funding from the Trond Mohn Foundation through the Research Council of Norway’s “COVID-19 Emergency Call for Proposals” March 2020. Recruitment and data collection for the exploratory first phase of the project ran from February 2021 to March 2021. Creative communication work started in May 2021, and the production of videos for use in the RCTs in the final phase of the project started in September 2021. CONCLUSIONS The COVCOM project will take on several grand challenges within the field of communicating science and provide evidence-based tools to the science communication toolbox. A long-term goal of the project is to contribute to the creation of a more resilient health care system by developing communication responses tailormade for different audiences, preparing society for any future pandemic. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/34275

Background A worldwide pandemic of a new and unknown virus is characterised by scientific uncertainty. However, despite this uncertainty, health authorities must still communicate complex health risk information to the public. The mental models approach to risk communication describes how people perceive and make decisions about complex risks, with the aim of identifying decision-relevant information that can be incorporated into risk communication interventions. This study explored how people use mental models to make sense of scientific information and apply it to their lives and behaviour in the context of COVID-19. Methods This qualitative study enrolled 15 male and female participants of different ages, with different levels of education and occupational backgrounds and from different geographical regions of Norway. The participants were interviewed individually, and the interview data were subjected to thematic analysis. The interview data were compared to a expert model of COVID-19 health risk communication based on online information from the Norwegian Institute of Public Health. Materials in the interview data not represented by expert model codes were coded inductively. The participants’ perceptions of and behaviours related to health risk information were analysed across three themes: virus transmission, risk mitigation and consequences of COVID-19. Results The results indicate that people placed different meanings on the medical and scientific words used by experts to explain the pandemic (e.g., virus transmission and the reproduction number). While some people wanted to understand why certain behaviour and activities were considered high risk, others preferred simple, clear messages explaining what to do and how to protect themselves. Similarly, information about health consequences produced panic in some interviewees and awareness in others. Conclusion There is no one-size-fits-all approach to public health risk communication. Empowering people with decision-relevant information necessitates targeted and balanced risk communication.

IntroductionScholars, healthcare practitioners and policymakers have increasingly focused their attention on patient-centredness. Patient-reported metrics support patient-driven improvement actions in healthcare systems. Despite the great interest, patient-reported outcome measures (PROMs) are still not extensively collected in many countries and not integrated with the collection of patient-reported experience measures (PREMs). This protocol describes the methodology behind an innovative observatory implemented in Tuscany, Italy, aiming at continuously and longitudinally collecting PROMs and PREMs for elective hip and knee total replacement.Methods and analysisThe Observatory is digital. Enrolled patients are invited via SMS or email to online questionnaires, which include the Oxford Hip Score or the Oxford Knee Score. Data are real-time reported to healthcare professionals and managers in a raw format, anonymised and aggregated on a web platform. The data will be used to investigate the relationship between the PROMs trend and patients’ characteristics, surgical procedure, hospital characteristics, and PREMs. Indicators using patient data will be computed, and they will integrate the healthcare performance evaluation system adopted in Tuscany.Ethics and disseminationThe data protection officers of local healthcare organisations and the regional privacy office framed the initiative referring to the national and regional guidelines that regulate patient surveys. The findings will be reported both in real time and for publication in peer-reviewed journals.

Background Responses from the H1N1 swine flu pandemic and the recent COVID-19 coronavirus pandemic provide an opportunity for insight into the role of health authorities’ ways of communicating health risk information to the public. We aimed to synthesise the existing evidence regarding different modes of communication used by health authorities in health risk communication with the public during a pandemic. Methods We conducted a rapid scoping review. MEDLINE and EMBASE were searched for publications in English from January 2009 through October 2020, covering both the full H1N1 pandemic and the response phase during the COVID-19 pandemic. The search resulted in 1440 records, of which 48 studies met our eligibility criteria. Results The present review identified studies across a broad interdisciplinary field of health risk communication. The majority focused on the H1N1 pandemic and the COVID-19 pandemic. A content analysis of the studies identified three categories for modes of communication: i) communication channels, ii) source credibility and iii) how the message is communicated. The identified studies on social media focused mainly on content and engagement, while studies on the effect of the use of social media and self-protective behaviour were lacking. Studies on the modes of communication that take the diversity of receivers in the field into account are lacking. A limited number of studies of health authorities’ use of graphic and audio-visual means were identified, yet these did not consider/evaluate creative communication choices. Conclusion Experimental studies that investigate the effect of health authorities’ videos and messages on social media platforms and self-protective behaviour are needed. More studies are needed across the fields of health risk communication and media studies, including visual communication, web design, video and digital marketing, at a time when online digital communication is central to reaching the public.

BACKGROUND The importance of effective communication during public health emergencies has been highlighted by the World Health Organization, and it has published guidelines for effective communication in such situations. With video being a popular medium, video communication has been a growing area of study over the past decades and is increasingly used across different sectors and disciplines, including health. Health-related video communication gained momentum during the SARS-CoV-2 pandemic, and video was among the most frequently used modes of communication worldwide. However, although much research has been done regarding different characteristics of video content (the message) and its delivery (the messenger), there is a lack of knowledge about the role played by the characteristics of the recipients for the creation of effective communication. OBJECTIVE The aim of this review is to identify how health video communication outcomes are shaped by recipient characteristics, as such characteristics might affect the effectiveness of communication. The main research question of the study is as follows: do the characteristics of the recipients of health videos affect the outcomes of the communication? METHODS A scoping review describing the existing knowledge within the field was conducted. We searched for literature in 3 databases (PubMed, Scopus, and Embase) and defined eligibility criteria based on the relevance to the research question. Recipient characteristics and health video communication outcomes were identified and classified. RESULTS Of the 1040 documents initially identified, 128 (12.31%) met the criteria for full-text assessment, and 39 (3.75%) met the inclusion criteria. The included studies reported 56 recipient characteristics and 42 communication outcomes. The reported associations between characteristics and outcomes were identified, and the potential research opportunities were discussed. Contributions were made to theory development by amending the existing framework of the Integrated-Change model, which is an integrated model of motivational and behavioral change. CONCLUSIONS Although several recipient characteristics and health video communication outcomes were identified, there is a lack of robust empirical evidence on the association between them. Further research is needed to understand how the preceding characteristics of the recipients might affect the various outcomes of health video communication.

The recent Chandos House meeting of the Alport Variant Collaborative extended the indications for screening for pathogenic variants in the COL4A5, COL4A3 and COL4A4 genes beyond the classical Alport phenotype (haematuria, renal failure; family history of haematuria or renal failure) to include persistent proteinuria, steroid-resistant nephrotic syndrome, focal and segmental glomerulosclerosis (FSGS), familial IgA glomerulonephritis and end-stage kidney failure without an obvious cause. The meeting refined the ACMG criteria for variant assessment for the Alport genes (COL4A3–5). It identified ‘mutational hotspots’ (PM1) in the collagen IV α5, α3 and α4 chains including position 1 Glycine residues in the Gly-X-Y repeats in the intermediate collagenous domains; and Cysteine residues in the carboxy non-collagenous domain (PP3). It considered that ‘well-established’ functional assays (PS3, BS3) were still mainly research tools but sequencing and minigene assays were commonly used to confirm splicing variants. It was not possible to define the Minor Allele Frequency (MAF) threshold above which variants were considered Benign (BA1, BS1), because of the different modes of inheritances of Alport syndrome, and the occurrence of hypomorphic variants (often Glycine adjacent to a non-collagenous interruption) and local founder effects. Heterozygous COL4A3 and COL4A4 variants were common ‘incidental’ findings also present in normal reference databases. The recognition and interpretation of hypomorphic variants in the COL4A3–COL4A5 genes remains a challenge.

In about 30% of infantile, juvenile, or adolescent patients with steroid-resistant nephrotic syndrome (SRNS), a monogenic cause can be identified. The histological finding in SRNS is often focal segmental glomerulosclerosis (FSGS). Genetic data on adult patients are scarce with low diagnostic yields. Exome sequencing (ES) was performed in patients with adult disease onset and a high likelihood for hereditary FSGS. A high likelihood was defined if at least one of the following criteria was present: absence of a secondary cause, ≤25 years of age at initial manifestation, kidney biopsy with suspicion of a hereditary cause, extrarenal manifestations, and/or positive familial history/reported consanguinity. Patients were excluded if age at disease onset was

ObjectiveThe aim of this study is to determine the odds of caesarean section in all births in teaching hospitals as compared with non-teaching hospitals.SettingOver 3600 teaching and non-teaching hospitals in 22 countries. We searched CINAHL, The Cochrane Library, PubMed, sciELO, Scopus and Web of Science from the beginning of records until May 2020.ParticipantsWomen at birth. Over 18.5 million births.InterventionCaesarean section.Primary and secondary outcome measuresThe primary outcome measures are the adjusted OR of caesarean section in a variety of teaching hospital comparisons. The secondary outcome is the crude OR of caesarean section in a variety of teaching hospital comparisons.ResultsIn adjusted analyses, we found that university hospitals have lower odds than non-teaching hospitals (OR=0.66, 95% CI 0.56 to 0.78) and other teaching hospitals (OR=0.46, 95% CI 0.24 to 0.89), and no significant difference with unspecified teaching status hospitals (OR=0.92, 95% CI 0.80 to 1.05, τ2=0.009). Other teaching hospitals had higher odds than non-teaching hospitals (OR=1.23, 95% CI 1.12 to 1.35). Comparison between unspecified teaching hospitals and non-teaching hospitals (OR=0.91, 95% CI 0.50 to 1.65, τ2=1.007) and unspecified hospitals (OR=0.95, 95% CI 0.76 to 1.20), τ2ConclusionsWith smaller sample of participants and studies, in clearly defined hospitals categories under comparison, we see that university hospitals have lower odds for caesarean. With larger sample size and number of studies, as well as less clearly defined categories of hospitals, we see no significant difference in the likelihood of caesarean sections between teaching and non-teaching hospitals. Nevertheless, even in groups with no significant effect, teaching hospitals have a lower or higher likelihood of caesarean sections in several analysed subgroups. Therefore, we recommend a more precise examination of forces sustaining these trends.PROSPERO registration numberCRD42020158437.

Since the 1980s, the international literature has reported variations for healthcare services, especially for elective ones. Variations are positive if they reflect patient preferences, while if they do not, they are unwarranted, and thus avoidable. Benign hysterectomy is among the most frequent elective surgical procedures in developed countries, and, in recent years, it has been increasingly delivered through minimally invasive surgical techniques, namely laparoscopic or robotic. The question therefore arises over what the impact of these new surgical techniques on avoidable variation is. In this study we analyze the extent of unwarranted geographical variation of treatment rates and of the adoption of minimally invasive procedures for benign hysterectomy in an Italian regional healthcare system. We assess the impact of the surgical approach on the provision of benign hysterectomy, in terms of efficiency (by measuring the average length of stay) and efficacy (by measuring the post-operative complications). Geographical variation was observed among regional health districts for treatment rates and waiting times. At a provider level, we found differences for the minimally invasive approach. We found a positive and significant association between rates and the percentage of minimally invasive procedures. Providers that frequently adopt minimally invasive procedures have shorter average length of stay, and when they also perform open hysterectomies, fewer complications.

Background The importance of effective communication during public health emergencies has been highlighted by the World Health Organization, and it has published guidelines for effective communication in such situations. With video being a popular medium, video communication has been a growing area of study over the past decades and is increasingly used across different sectors and disciplines, including health. Health-related video communication gained momentum during the SARS-CoV-2 pandemic, and video was among the most frequently used modes of communication worldwide. However, although much research has been done regarding different characteristics of video content (the message) and its delivery (the messenger), there is a lack of knowledge about the role played by the characteristics of the recipients for the creation of effective communication. Objective The aim of this review is to identify how health video communication outcomes are shaped by recipient characteristics, as such characteristics might affect the effectiveness of communication. The main research question of the study is as follows: do the characteristics of the recipients of health videos affect the outcomes of the communication? Methods A scoping review describing the existing knowledge within the field was conducted. We searched for literature in 3 databases (PubMed, Scopus, and Embase) and defined eligibility criteria based on the relevance to the research question. Recipient characteristics and health video communication outcomes were identified and classified. Results Of the 1040 documents initially identified, 128 (12.31%) met the criteria for full-text assessment, and 39 (3.75%) met the inclusion criteria. The included studies reported 56 recipient characteristics and 42 communication outcomes. The reported associations between characteristics and outcomes were identified, and the potential research opportunities were discussed. Contributions were made to theory development by amending the existing framework of the Integrated-Change model, which is an integrated model of motivational and behavioral change. Conclusions Although several recipient characteristics and health video communication outcomes were identified, there is a lack of robust empirical evidence on the association between them. Further research is needed to understand how the preceding characteristics of the recipients might affect the various outcomes of health video communication.

Video communication has played a key role in relaying important and complex information on the COVID-19 pandemic to the general public. The aim of the present study is to compare Norwegian health authorities’ and WHO’s use of video communication during the COVID-19 pandemic to the most viewed COVID-19 videos on YouTube, in order to identify how videos created by health authorities measure up to contemporary video content, both creatively and in reaching video consumers. Through structured search on YouTube we found that Norwegian health authorities have published 26 videos, and the WHO 29 videos on the platform. Press briefings, live videos, news reports, and videos recreated/translated into other languages than English or Norwegian, were not included. A content analysis comparing the 55 videos by the health authorities to the 27 most viewed videos on COVID-19 on YouTube demonstrates poor reach of health authorities’ videos in terms of views and it elucidates a clear creative gap. While the videos created by various YouTube creators communicate using a wide range of creative presentation means (such as professional presenters, contextual backgrounds, advanced graphic animations, and humour), videos created by the health authorities are significantly more homogenous in style often using field experts or public figures, plain backgrounds or PowerPoint style animations. We suggest that further studies into various creative presentation means and their influence on reach, recall, and on different groups of the population, are carried out in the future to evaluate specific factors of this creative gap.

Objectives: When pandemic events arise, there are complex decisions to take under pressure, such as the prioritization of cases While there are international examples of using PROMs to organize waiting lists, there are no such experiences in Italy Italy was the first European country to be hit hard by the COVID-19 outbreak, and a selection of patients was necessary Could PROMs be used in a prioritization process? Methods: We focused on robotic oncological surgery for prostate cancer in three different surgical units (SU) in Tuscany (Italy) We selected all patients who replied to the baseline PROMs questionnaire (EORTC-QLQ-C30) and received surgery during the COVID-19 crisis (March-May 2020) (n=86) We comparatively analyzed, for each SU, their baseline score with their position both in the real weekly surgical list and the simulation of an optimized list by using the PROMs, considering ±3 positions of tolerance We discussed the findings with healthcare professionals Results: More than 65 7% of cases were not operated accordingly to the severity perceived by patients In one SU, the two surgical lists did not significantly differ In the others, those who underwent later the surgery reported a worse condition (mean PROMs score 69/100;mean n positions in surgical list SU1 +16 on 40) Healthcare professionals discussed the limits and potential of integrating PROMs-scores among the prioritization criteria, reaching a consensus on specific PROMs indicators to be tested to this eds Conclusions: PROMs may represent a key tool to prioritize patients in oncological surgery Surgical activities are still organized from a provider perspective We proposed the use of PROMs as a tool to consider patient-reported needs to prioritize procedures Further analysis should be done to estimate the value of using PROMs for the prioritization of most severe cases

Patient Reported Outcome and Experience Measures (PROMs and PREMs) play an increasingly important role in monitoring the quality of the oncological pathway. The aim of this study is to describe the case of five hospitals a year after the adoption of PROMs and PREMs for robotic oncological colorectal surgery in Tuscany and to investigate how the clinicians can impact the process of implementation and the efficacy of such measures. We used 14 months of data from the five robotic centers in Tuscany. Above all, the physician's personal motivation to improve the treatment of patients, the teamwork, and the possibility to use data for research purposes proved to be the essential factors for their engagement and the successful implementation of patient reported measures. Physicians play a key role in the adoption of systematic PROMs and PREMs. The higher their level of engagement, the higher the collection success, both in terms of number of patients enrolled and response rates. Moreover, the collection of patient reported measures may become part of physicians' daily practice and may lead to a change in their relationship and communication with patients, as clinicians accept to have their job reviewed and are not afraid to be evaluated by their patients.

The paper proposes a series of numerical investigations performed to test and demonstrate the capabilities of a Reynolds-averaged Navier–Stokes equation (RANSE) solver in the area of complex ship flow simulations. The focus is on a complete numerical model for hull, propeller, and rudder that can account for the mutual interaction between these components. The paper presents the results of a complex investigation of the flow computations around the hull model of the 3600 TEU MOERI containership (KCS hereafter). The resistance for the hull equipped with a rudder, the propeller open-water (POW hereafter) computations, as well as the self-propulsion simulation are presented. Comparisons with the experimental data provided at the Tokyo 2015 Workshop on Computational Fluid Dynamics (CFD) in Ship Hydrodynamics are given to validate the numerical approach in terms of the total and wave resistance coefficients, sinkage and trim, thrust and torque coefficients, propeller efficiency, and local flow features. Verification and validation based on the grid convergence tests are performed for each computational case. Discussions on the efficiency of the turbulence models used in the computations as well as on the main flow features are provided aimed at clarifying the complex structure of the flow around the ship stern.

Carbon layers are deposited on 100 nm thick atomically clean (001) lead zirconate titanate (PZT) in ultrahigh vacuum, ruling out the presence of any contaminants. X-ray photoelectron spectroscopy is used to assess the substrate surface or interface composition, substrate polarization and the thickness of carbon layers, which ranges from less than one monolayer (1 ML) of graphene to several monolayers. Atomically clean PZT(001) exhibit inwards polarization, and this polarization reverses the sign upon carbon deposition. Cationic vacancies are detected near the PZT surface, consistent with heavy p doping of these films near the surface. The carbon layers exhibited a consistent proportion of atoms forming in-plane sp

Background Pay for performance (P4P) programs have been widely analysed in literature, and the results regarding their impact on performance are mixed. Moreover, in the real-life setting, reward schemes are designed combining multiple elements altogether, yet, it is not clear what happens when they are applied using different combinations. Objectives To provide insights on how P4P programs are influenced by 5 key elements: whom, what, how, how many targets, and how much to reward. Methods A qualitative longitudinal analysis of 10 years of P4P reward schemes adopted by the regional administrations of Tuscany and Lombardy (Italy) was conducted. The effects of the P4P features on performance are discussed considering both overall and specific indicators. Results Both regions applied financial reward schemes for General Managers by linking the variable pay to performance. While Tuscany maintained a relatively stable financial incentive design and governance tools, Lombardy changed some elements of the design and introduced, in 2012, a P4P program aimed to reward the providers. The main differences between the 2 cases regard the number of targets (how many), the type (what), and the method applied to set targets (how). Conclusion Considering the overall performance obtained by the 2 regions, it seems that whom, how, and how much to reward are not relevant in the success of P4P programs; instead, the number (how many) and the type (what) of targets set may influence the performance improvement processes driven by financial reward schemes.