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Multiple sclerosis is a chronic autoimmune inflammatory disease that affects the brain and spinal cord. The most common form of this disease according to the type of its course is relapsing-remitting multiple sclerosis. Comorbidity in multiple sclerosis is an urgent problem of modern neurology, since it can influence such factors as the time of diagnosis, the rate of disease progression and the rate of patient disability, the number of exacerbations and the patient’s quality of life. The purpose of the work was to study and characterize comorbidity in patients with relapsing multiple sclerosis. To conduct this study 105 patients with a diagnosis of relapsing-remitting multiple sclerosis were enrolled. All patients were assessed using the Multiple Sclerosis Neurological Disability Severity Scale (EDSS). Study participants were divided into two groups – Group 1 and Group 2 – based on EDSS scores. Separately, study participants were divided into groups based on the principle of receiving pain-modifying therapy. In the 1st study group, concomitant diseases were in 57 (78.1%) patients, in the 2nd group – in 100% (p=0.010). In patients who did not receive pain-modifying therapy, 57 (98.3%) of those examined had concomitant diseases, in those who received such treatment – in 32 (68.1%), which was statistically significantly less (p

Background Little is known about who uses online food delivery services and how use of these services is associated with social inequalities in food purchasing and diet-related health. This study explored associations between social position and use of online takeaway food and grocery delivery services, and its association with weight status.Methods Data were obtained from households in a consumer research panel living in London and the north of England (n=1521) in February 2019. Use of online grocery delivery services was determined via recorded purchases, and takeaway food delivery app use via survey responses. Social position was approximated through occupation-based social grade and household income. We used logistic regression to estimate the association between social position and use of online delivery services, and the relationship between online delivery service use and weight status.Results Overall, 13.2% of respondents used takeaway food delivery apps over a 7-day period and 15.6% of households used online grocery delivery services over a 4-week period. High-income households were more likely to use online grocery delivery services than low-income households (OR 2.01, 95% CI 1.22 to 3.34). In contrast, households with lower social grade were more likely to use takeaway food delivery apps compared with households in the highest grade (OR 2.31, 95% CI 1.38 to 3.87). While takeaway food delivery app use was positively associated with living with obesity (relative risk ratio 1.84, 95% CI 1.20 to 2.82), use of online grocery delivery services was not.Discussion Findings indicate that use of online food delivery services is patterned by markers of social position and weight status, which may lead to dietary inequalities. The potential impact of increased and differential usage of online delivery services on diet and dietary inequalities warrants further research.

Abstract Objective: This study examined changes food and drink purchasing during the first 3 months of the COVID-19 pandemic in England, and if changes varied by population subgroups. Design: We investigated changes in take-home food and drink purchasing and frequency of out-of-home (OOH) purchasing using an interrupted time series analysis design. The start of pandemic restrictions (the intervention) was defined as 16 March 2020, when first announced in the UK. Setting: London and the North of England. Participants: 1245 households reporting take-home and 226 individuals reporting OOH purchases between January 2019 and mid-June 2020 from the GB Kantar Fast Moving Consumer Goods Panel. Results: The marginal mean estimate of total take-home energy purchased was 17·4 % (95 % CI 14·9, 19·9) higher during the pandemic restriction period compared with the counterfactual. Increases of 35·2 % (95 % CI 23·4, 47·0) in take-home volume of alcoholic beverages and 1·2 % (95 % CI 0·1, 2·4) in foods and drinks high in fat, salt and sugar were observed. Reductions in purchased energy from fruit and vegetables (–7·3 %, 95 % CI –10·9, –3·6), ultra-processed foods (–4·0 %, 95 % CI –5·2, –2·8) and in OOH purchasing frequency (–44·0 %, 95 % CI –58·3, –29·6) were observed. Changes in chocolate and confectionery, soft drink and savoury snack purchases levelled off over time. Changes in all studied outcomes varied by sociodemographic characteristics and usual purchasing. Conclusions: Pandemic restrictions were associated with positive and negative changes in food and drink purchasing, which differed by individual characteristics. Future research should ascertain if changes persist and translate into changes in health.

IntroductionEvidence for the effect of neighbourhood food environment (NFE) exposures on diet in the UK is mixed, potentially due to exposure misclassification. This study used the first national COVID-19 lockdown in England as an opportunity to isolate the independent effects of the NFE exposure on food and drink purchasing, and assessed whether these varied by region.MethodsTransaction-level purchasing data for food and drink items for at-home (1,221 households) and out-of-home consumption (171 individuals) were available from the GB Kantar Fast Moving Consumer Goods Panel for London and the North of England. The study period included 23rd March to 10th May 2020 ('lockdown'), and the same period in 2019 for comparison. NFE exposures included food outlet density and proximity, and NFE composition within a 1 km network buffer around the home. Associations were estimated for both years separately, adjusted for individual and household characteristics, population density and area deprivation. Interaction terms between region and exposures were explored.ResultsThere were no consistent patterns of association between NFE exposures and food and drink purchasing in either time period. In 2019, there was some evidence for a 1.4% decrease in energy purchased from ultra-processed foods for each additional 500 m in the distance to the nearest OOH outlet (IR 0.986, 95% CI 0.977 to 0.995, p = 0.020). In 2020, there was some evidence for a 1.8% reduction in total take-home energy for each additional chain supermarket per km2 in the neighbourhood (IR 0.982, 95% CI 0.969, 0.995, p = 0.045). Region-specific effects were observed in 2019 only.DiscussionFindings suggest that the differences in exposure to the NFE may not explain differences in the patterns or healthiness of grocery purchasing. Observed pre-pandemic region-specific effects allude to the importance of geographical context when designing research and policy. Future research may assess associations for those who relied on their NFE during lockdown.

Multiple sclerosis is a chronic progressive inflammatory autoimmune disease of the central nervous system. This disease mainly affects young females and leads to disability of the patient, which causes a significant socio-economic burden which this disease causes. Clinically, multiple sclerosis is characterized by a wide variety of neurological and neuropsychological manifestations: movement disorders, sensory disturbances and cognitive dysfunction. One of the most typical psycho-emotional disorders that occur in patients with multiple sclerosis are anxiety and depression. The article is devoted to the study of the features of these disorders in patients with multiple sclerosis. The purpose of the study is to evaluate and characterize psycho-emotional disorders in patients with relapsing-remitting multiple sclerosis. The study included 105 patients with relapsing-remitting multiple sclerosis who underwent inpatient treatment in the Department of Neurology No. 1 Municipal Institution “Dnipropetrovsk Regional Clinic Hospital named after I.I. Mechnykov" Dnipropetrovsk Regional Council". Among the patients included in the study, there were 74 women (70.5%) and 31 men (29.5%). The largest proportion of those surveyed falls on the age group from 25 to 40 years – 80 (76.2%). All participants were assessed according to the generally accepted scale for multiple sclerosis patients assessment – Expanded Disability Status Scale (EDSS). All study participants were divided into two groups – group 1 and group 2 – according to the degree of disability according to EDSS. Considering that the degree of disability according to EDSS≤3.5 is defined as mild, and most patients had just this level, they were assigned into group 1, patients with a score of 3.5

The relative risk of developing depression in myasthenia gravis is 2.14 times higher than in the general population. The features of depression in myasthenia patients remain poorly understood and need to be clarified. The purpose of this work was to study the features of the development of depression in patients with myasthenia gravis. From 2014 to 2017, 182 patients with myasthenia gravis were examined. 147 (80.8%) patients had a generalized form of the disease, 35 (19.2%) had an ocular form. The clinical examination included assessment of complaints, medical history, neurological examination, as well as MGFA (Myasthenia Gravis Foundation of America) disease class and subclass of the disease determination. The severity of myasthenia gravis has been quantified according to the QMG score (Quantitative Myasthenia Gravis Score). All the patients were examined for the titer of antibodies to acetylcholine receptors (AchR) and muscle-specific tyrosine kinase (MuSK) by enzyme-linked immunosorbent assay (ELISA). Patients were also tested for the presence of antibodies to titin and SOX1 by indirect immunofluorescence. To detect depression the Beck depression inventory (BDI) was used. The mean depression score in the total sample was 16.0 (10.0; 24.0), which corresponds to a moderate depression level. The mean depression score in patients with ocular form was 6.0 (3.0; 11.0) points (ie, depression is absent), whereas in patients with generalized myasthenia gravis – 19.0 (12.0; 29.0) points (corresponds to moderate depression) (p

Floods are among the devastating types of disasters in terms of human life, social and financial losses. Authoritative data from flood gauges are scarce in arid regions because of the specific type of dry climate that dysfunctions these measuring devices. Hence, social media data could be a useful tool in this case, where a wealth of information is available online. This study investigates the reliability of flood related data quality collected from social media, particularly for an arid region where the usage of flow gauges is limited. The data (text, images and videos) of social media, related to a flood event, was analyzed using the Machine Learning approach. For this reason, digital data (758 images and 1413 video frames) was converted into numeric values through ResNet50 model using the VGG-16 architecture. Numeric data of images, videos and text was further classified using different Machine Learning algorithms. Receiver operating characteristics (ROC) curve and area under curve (AUC) methods were used to evaluate and compare the performance of the developed machine learning algorithms. This novel approach of studying the quality of social media data could be a reliable alternative in the absence of real-time flow gauges data. A flash flood that occurred in the United Arab Emirates (UAE) from March 7–11, 2016 was selected as the focus of this study. Random forest showed the highest accuracy of 80.18% among the five other classifiers for images and videos. Precipitation/rainfall data were used to validate social media data, which showed a significant relationship between rainfall and the number of posts. The validity of the machine learning models was assessed using the area under the curve, precision-recall curve, root mean square error, and kappa statistics to confirm the validity and accuracy of the model. The data quality of YouTube videos was found to have the highest accuracy followed by Facebook, Flickr, Twitter, and Instagram. These results showed that social media data could be used when gauge data is unavailable.

Introduction: Evidence for the effect of neighbourhood food environment (NFE) exposures on diet in the UK is mixed, potentially due to exposure misclassification. This study used the first national COVID-19 lockdown in England as an opportunity to isolate the independent effects of the NFE exposure on food and drink purchasing, and assessed whether these varied by region. Methods: Transaction-level purchasing data for food and drink items for at-home (1,221 households) and out-of-home consumption (171 individuals) were available from the GB Kantar Fast Moving Consumer Goods Panel for London and the North of England. The study period included 23rd March to 10th May 2020 ('lockdown'), and the same period in 2019 for comparison. NFE exposures included food outlet density and proximity, and NFE composition within a 1 km network buffer around the home. Associations were estimated for both years separately, adjusted for individual and household characteristics, population density and area deprivation. Interaction terms between region and exposures were explored. Results: There were no consistent patterns of association between NFE exposures and food and drink purchasing in either time period. In 2019, there was some evidence for a 1.4% decrease in energy purchased from ultra-processed foods for each additional 500 m in the distance to the nearest OOH outlet (IR 0.986, 95% CI 0.977 to 0.995, p = 0.020). In 2020, there was some evidence for a 1.8% reduction in total take-home energy for each additional chain supermarket per km2 in the neighbourhood (IR 0.982, 95% CI 0.969, 0.995, p = 0.045). Region-specific effects were observed in 2019 only. Discussion: Findings suggest that the differences in exposure to the NFE may not explain differences in the patterns or healthiness of grocery purchasing. Observed pre-pandemic region-specific effects allude to the importance of geographical context when designing research and policy. Future research may assess associations for those who relied on their NFE during lockdown. [ABSTRACT FROM AUTHOR]

Myasthenia gravis is a relatively rare autoimmune disease with an undetermined aetiology which affects neuromuscular junctions. Currently, the following approaches to the treatment of myasthenia gravis are mainly distinguished: symptomatic treatment with anticholinesterase inhibitors (AChEIs), immunomodulatory therapy (“basic” therapy) with glucocorticoids, cytostatics, monoclonal antibodies; surgical treatment — thymectomy; short-term treatment with plasmapheresis and intravenous administration of immuno­globulin. The efficiency of treatment approaches to myasthenia gravis in Ukraine remains insufficiently studied. The purpose of this work is to analyse the therapeutic approaches in patients with myasthenia gravis depending on the clinical form and severity of the disease. Between 2014 and 2017, 182 patients with myasthenia gravis have been examined, out of which 147 (80.8%) were the patients with the generalized form of the disease and 35 (19.2%) — with its ocular form. The clinical neurological examination included the collection of complaints, an anamnesis of disease and life as well as a neurological examination. In all the patients, the level of antibodies to acetylcholine receptors (AchR) and to muscle-specific tyrosine kinase (MuSK) has been measured, in terms of quantity as well, using the enzyme-linked immunosorbent assay (ELISA), and the presence of antibodies to titin and SOX1 has also been detected by means of indirect immunofluorescence. Of the total sample, less than a third (28.0%) of the patients examined received basic therapy; among them, there were no patients with the ocular form and only 34.7% — with the generalized form (p

The level and features of fatigue development in patients with myasthenia gravis remain not well studied, but their research is promising in order to improve the therapeutic tactics, social, domestic, professional adaptation and, as a consequence, the quality of life of patients in general. The purpose of this work was to quantify the fatigue parameters in patients with myasthenia gravis depending on the form and class of the disease, as well as on the immunological type of the disease. Object and methods. 182 patients with myasthenia were examined (147 (80.8%) patients with a generalized form of the disease, 35 (19.2%) with ocular form). Clinical and neurological examination included complaints collection, history of disease and life, neurological examination. To evaluate the clinical form of myasthenia, the MGFA classification was used. For a quantitative assessment of fatigue, the Fatigue Severity Scale (FSS) was used. The assessment of the level of antibodies to acetylcholine receptors (AchR) and muscle-specific tyrosine kinase (MuSK) by ELISA was performed to all patients, as well as determination of antibodies to titin and SOX1 by indirect immunofluorescence method. In mathematical processing of data, methods of parametric and nonparametric statistics were used. Results and discussion. Among the surveyed patients by gender, women predominated 128 (70.3%), the number of men was 54 (29.7%), the ratio of women to men 2.37:1. Antibodies to acetylcholine receptors were detected in 68.1% of the patients in the general sample (in 73.5% patients with generalized form and in 45.7% - with an ocular form). Antibodies to muscle-specific tyrosine-kinase were detected in 16% of the total number of patients. These antibodies were not detected in patients with ocular myasthenia. Antibodies to titin were detected in almost a third of all subjects - 53 (29.1%). These antibodies were not detected in patients with ocular form of myasthenia gravis. Antibodies to SOX1 were not detected in patients with ocular myasthenia, but diagnosed in 5.5% patients with generalized form. The level of fatigue in patients increases with the increase of the MGFA class of the disease. The median fatigue rate in the general sample corresponded to a mild fatigue level (FSS:36- 44 points), and in patients with generalized myasthenia, it was consistent with moderate fatigue (FSS: 45-53 points). In patients with ocular myasthenia, median fatigue was significantly lower in comparison with the general sample and with the generalized form and did not reach the clinical value (p 0,05; ? = 0,08; p> 0,05, respectively), as well as the presence of antibodies to SOX1 (? = 0.06; p> 0.05). Fatigue significantly correlated with the clinical form of myasthenia (generalized) (? = -0,55; p

Objectives: This research aimed to explore the health behaviours of health sciences students over time and across different settings.Methods: A health behaviour surveillance system has been implemented in Hamburg and Manchester among under- and postgraduate health sciences students. Trends among the Hamburg sample were described. In a cross-sectional assessment, health behaviours across both universities were examined using multivariate regression analysis.Results: Between 2014 and 2018, increasing trends in physical activity and cannabis and alcohol consumption were observed in Hamburg (n = 1,366). While fruit and vegetable intake was constantly low, tobacco smoking decreased. No clear trend was observed for stress perception. The comparison (n = 474) revealed that Manchester students had higher odds of smoking, excessive alcohol consumption, and fruit and vegetable consumption; and lower odds of being physically active, and consuming cannabis. No difference in stress perception was observed.Conclusions: Varying trends and potential areas of intervention were identified for health behaviours in Hamburg. The comparison with Manchester students revealed differences in behaviours, which could be further explored to help inform health promotion strategies in both settings.

IntroductionDengue fever is the most prevalent arboviral disease in the Brazilian Amazon and places a major health, social and economic burden on the region. Its association with deforestation is largely unknown, yet the clearing of tropical rainforests has been linked to the emergence of several infectious diseases, including yellow fever and malaria. This study aimed to explore potential drivers of dengue emergence in the Brazilian Amazon with a focus on deforestation.MethodsAn ecological study design using municipality-level secondary data from the Amazonas state between 2007 and 2017 (reported rural dengue cases, incremental deforestation, socioeconomic characteristics, healthcare and climate factors) was employed. Data were transformed according to the year with the most considerable deforestation. Associations were explored using bivariate analysis and a multivariate generalised linear model.ResultsDuring the study period 2007-2017, both dengue incidence and deforestation increased. Bivariate analysis revealed increased incidences for some years after deforestation (e.g. mean difference between dengue incidence before and three years after deforestation was 55.47 cases per 100,000, p = 0.002), however, there was no association between the extent of deforestation and dengue incidence. Using a negative binomial regression model adjusted for socioeconomic, climate and healthcare factors, deforestation was not found to be related to dengue incidence. Access to healthcare was found to be the only significant predictor of dengue incidence.DiscussionPrevious research has shown that deforestation facilitates the emergence of vector-borne diseases. However, no significant dose-response relationships between dengue incidence and deforestation in the Brazilian Amazonas state were found in this study. The finding that access to healthcare was the only significant predictor of dengue incidence suggests that incidence may be more dependent on surveillance than transmission. Further research and public attention are needed to better understand environmental effects on human health and to preserve the world's largest rainforest.

Selective demolition of building components and recycling construction demolition waste is a growing tendency as we move towards a circular construction. This study investigates the feasibility of using demolition waste from calcium silicate brick masonry as an aggregate in concrete and mortar. The purpose is to assess its impact on concrete and mortar properties, including compressive strength, durability, and workability. Silicate bricks from two demolished buildings were processed into aggregate, and laboratory experiments were conducted to evaluate concrete and mortar made with varying proportions of recycled aggregate. Results indicate that replacing natural aggregate (limestone rubble and sand) with recycled silicate brick aggregate up to 50% does not significantly compromise concrete performance, with no significant decrease in compressive strength observed. Frost resistance of the concrete made with recycled aggregate even surpasses that of reference concrete, possibly due to the lower density and higher (closed) porosity of the recycled aggregate. However, challenges such as increased water demand and loss of workability over time are noted with higher proportions of recycled aggregate. Further research is recommended to explore strategies for mitigating these challenges and to assess the effects of chemical admixtures on concrete properties. Overall, the findings suggest that recycled calcium silicate brick holds promise as a sustainable alternative for aggregate in concrete production. [ABSTRACT FROM AUTHOR]

Groundwater constitutes an important part of the available water resources in arid areas. Knowledge of the quantitative and qualitative status of groundwater is a key aspect in optimal groundwater management. The purpose of this study was to provide technical information on the groundwater in the sand aquifer of two neighboring areas in the United Arab Emirates to support stakeholders working towards sustainable groundwater development. The chemical characteristics of the groundwater have been used to identify the processes controlling groundwater chemistry and assess the suitability of the groundwater for agricultural purposes. Despite tapping into the same aquifer, considerable differences in groundwater quality were found between the two study areas. The area with a shallower water table showed clear indications of irrigation return flow deteriorating the groundwater quality. Using standard agricultural indices, the groundwater at both study areas is classified as unfit for agricultural purposes. However, considering that groundwater is the only available water source for irrigation, it will continue to be used for agriculture. This indicates the need for improved irrigation management and the development of new strategies for sustainable groundwater development in arid areas in the context of food security.

Provides a personal account of experiences of discrimination against an Asian American female educator as she attempted to obtain a county superintendency position. Uses the concept of faultlines to address issues of social similarity and differences and explores policy implications and practices intended to bring about change. (SLD)

The spatial distribution of groundwater fluxes through a streambed can be highly variable, most often resulting from a heterogeneous distribution of aquifer and streambed permeabilities along the flow pathways. Using a groundwater flow and heat transport model, we defined four scenarios of aquifer and streambed permeability distributions to simulate and assess the impact of subsurface heterogeneity on the distribution of groundwater fluxes through the streambed: (a) a homogeneous low-K streambed within a heterogeneous aquifer; (b) a heterogeneous streambed within a homogeneous aquifer; (c) a well connected heterogeneous low-K streambed within a heterogeneous aquifer; and (d) a poorly connected heterogeneous low-K streambed within a heterogeneous aquifer. The simulation results were compared with a base case scenario, in which the streambed had the same properties as the aquifer, and with observed data. The results indicated that the aquifer has a stronger influence on the distribution of groundwater fluxes through the streambed than the streambed itself. However, a homogeneous low-K streambed, a case often implemented in regional-scale groundwater flow models, resulted in a strong homogenization of fluxes, which may have important implications for the estimation of peak mass flows. The flux distributions simulated with heterogeneous low-K streambeds were similar to the flux distributions of the base case scenario, despite the lower permeability. The representation of heterogeneous distributions of aquifer and streambed properties in the model has been proven to be beneficial for the accuracy of flow simulations.

Explores leadership succession by studying an elected county school superintendent's experience. Extends the Gordon and Rosen theoretical model by identifying factors triggering succession, examining interim appointments, and identifying succession and organizational elements affected by the nature of elected leadership positions. The superintendent's early retirement activated challenges to his successor. (65 references) (MLH)

The spectrophotometric method assists in the study of potassium permanganate-oxalate reaction. Basic analytical techniques and rules are implemented in the experiment, which can also include the examination of other compounds oxidized by permanganate.

Interactions between groundwater and surface water play a fundamental role in the functioning of riparian ecosystems. In the context of sustainable river basin management it is crucial to understand and quantify exchange processes between groundwater and surface water. Numerous well-known methods exist for parameter estimation and process identification in aquifers and surface waters. Only in recent years has the transition zone become a subject of major research interest; thus, the need has evolved for appropriate methods applicable in this zone. This article provides an overview of the methods that are currently applied and described in the literature for estimating fluxes at the groundwater – surface water interface. Considerations for choosing appropriate methods are given including spatial and temporal scales, uncertainties, and limitations in application. It is concluded that a multi-scale approach combining multiple measuring methods may considerably constrain estimates of fluxes between groundwater and surface water.