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Background: The modifiable risk factor exerting the most substantial influence on the development and disease course of multiple sclerosis (MS) is cigarette smoking. Furthermore, smoking is associated with a higher risk of suffering from one or more comorbidities and potentially contributes to polypharmacy. We aimed to use personality tests to explore health-promoting and harmful patient characteristics. Objective: To investigate two important factors influencing the course of MS – the degree of smoking dependence and the status of polypharmacy – in association with personality traits. Design: This is a bicentric, cross-sectional study. Methods: We collected sociodemographic, clinical and medical data from patients with MS (n = 375) at two German neurological clinics. The participants were asked to complete the NEO Five-Factor Inventory (NEO-FFI) and the Temperament and Character Inventory-Revised (TCI-R). Relationships between variables were examined using correlation analyses, and differences between groups were examined using linear models. Current smokers with MS were also asked to complete the Fagerström questionnaire to categorize them into patients with mild, moderate and severe smoking dependence. Results: In our sample, 67.5% were women, and the mean age was 48.1 years. The patients had a median Expanded Disability Status Scale of 3.0 at a median disease duration of 10 years. Patients with MS with severe smoking dependence had on average a significantly higher neuroticism score in the NEO-FFI compared to those with mild or moderate smoking dependence. Patients with MS and polypharmacy had significantly higher neuroticism scores than those without. In the extraversion scale of the NEO-FFI, patients with MS and polypharmacy had significantly lower scores on average. Significant differences were also found when analysing the TCI-R in patients with MS and heavy smoking dependence, with higher scores for harm avoidance (HA) and lower scores for reward dependence, self-directedness (S-D) and cooperativeness (CO) in various subscales. Polypharmacy in patients with MS was associated with higher scores for HA and self-transcendence. Furthermore, patients with polypharmacy showed lower values than patients without polypharmacy in individual subscales of the dimensions of persistence, S-D and CO. Conclusion: Using the NEO-FFI, we were able to show that neuroticism is a detrimental trait and extraversion a protective trait in patients with MS in relation to nicotine dependence and polypharmacy. In addition, the evaluation of the TCI-R showed that high HA as well as low S-D and CO scores were more common in patients with MS and nicotine dependence or polypharmacy. With this knowledge, the risk of polypharmacy and smoking can be understood in the context of personality characteristics and targeted treatment and counselling can be provided. [ABSTRACT FROM AUTHOR]

Children with mathematical difficulties need to spend more time than typically achieving children on solving even simple equations. Since these tasks already require a larger share of their cognitive resources, additional demands imposed by the need to switch between tasks may lead to a greater decline of performance in children with mathematical difficulties. We explored differential task switch costs with respect to switching between addition versus subtraction with a tablet-based arithmetic verification task and additional standardized tests in German elementary school children in Grades 1 to 4. Two independent studies were conducted. In Study 1, we assessed the validity of a newly constructed tablet-based arithmetic verification task in a controlled classroom-setting (n = 165). Then, effects of switching between different types of arithmetic operations on accuracy and response latency were analyzed through generalized linear mixed models in an online-based testing (Study 2; n = 3,409). Children with mathematical difficulties needed more time and worked less accurately overall. They also exhibited a stronger performance decline when working in a task-switching condition, when working on subtraction (vs. addition) items and in operations with two-digit (vs. one-digit) operations. These results underline the value of process data in the context of assessing mathematical difficulties. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess subjective and objective parameters of stress among nurses during the COVID-19 pandemic and to examine the recovery effect of a day off. Methods: In this prospective observational trial, we measured heart rate variability (using a wearable device) and perceived stress levels on 3 working days and 1 day off. We obtained the following data using an online questionnaire: working conditions, COVID-19-related problems, depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), effort-reward imbalance, and work-family conflict in a sample of German nurses (N = 41). Results: When comparing working days with a day off, we observed a significant difference for physical load (Cohen's d = 0.798, P <.001), mental load (Cohen's d = 0.660, P =.001), emotional exhaustion (Cohen's d = 0.945, P <.001), and overburdening (Cohen's d = 0.585, P =.002) with higher scores on working days. Regarding heart rate variability, we did not find a difference. Correlational analyses revealed a significant association between being afraid to get infected with COVID-19 and lower heart rate variability (r = −0.336, P =.045) and between being afraid to infect relatives and lower heart rate variability (r = −0.442, P =.007). Furthermore, a higher total sum score of work-family conflict was significantly associated with lower heart rate variability (r = −0.424, P =.01). Conclusion: As heart rate variability observations were different from those regarding subjectively perceived stress, further studies are needed to evaluate and differentiate the influence of work stress and other types of stress on heart rate variability. [ABSTRACT FROM AUTHOR]

First Enoch, a pseudepigraphical work from the Second Temple period, contains visions of the natural and supernatural world that cause the visionary, Enoch, to understand anew the beyond-human world. Written during a time of environmental devastation, 1 Enoch can be a resource for helping today's readers rewild our religious imaginations, our understanding of worship, and our relationship with nonhuman creation. This essay offers a reflection on how the Book of the Watchers in 1 Enoch and the author's failed attempts to reach a mountain peak helped the author better understand the unseating of humanity as the center of creation as an experience of grace. [ABSTRACT FROM AUTHOR]

Background: The consideration of patient preference for a certain drug route of administration (RoA) plays an important role in promoting patient adherence in chronic diseases. Natalizumab is an established treatment for relapsing-remitting multiple sclerosis (RRMS) and can be administered as intravenous (IV) infusion or subcutaneous (SC) injection developed to enable a shorter and easier administration versus IV RoA. Study objectives: Primary objective is to compare patients' preference for RoA and satisfaction with SC versus IV natalizumab at baseline and subsequent visits up to 12 months. Secondary objectives include drug utilization, clinical outcomes, safety, and treatment satisfaction in a usual care setting. Design and methods: SISTER (Subcutaneous: Non-Interventional Study for Tysabri Patient Preference – Experience from Real World) is an ongoing, prospective, observational study where natalizumab is utilized according to local label. RRMS patients are included in three natalizumab cohorts: Patients switching from current IV to SC administration (switcher) and patients newly starting natalizumab on either SC or IV route (starter SC/IV). This interim analysis includes 262 patients (184 switchers, 39 SC starters, and 39 IV starters), median observation period was 9 months. Results: 80.8% IV starters and 93.9% SC starters reported at baseline that they prefer the assigned RoA. Although initial satisfaction with chosen RoA was maintained over time from baseline through Month 12 in all three cohorts, the wish for change of the current RoA after 6 and 12 months was more frequently expressed among IV starters than in either SC cohort. Consistently, six patients (23.1%) starting with IV changed their RoA from IV to SC route. Mean global treatment satisfaction according to TSQM-II score at baseline remained high in the switcher group and increased through Month 12 in both IV and SC starter cohorts. Conclusion: Based on current data, there is a trend toward patients' preference for the natalizumab SC route over the IV route, which provides valuable insights into patients' preference for natalizumab RoA in routine care and complements available data from clinical studies with real-world data on SC natalizumab. Trial registration: This observational (non-interventional) study was registered in the local German PEI register for non-interventional studies (NIS-No. 611) and in the international CTgov register (NCT05304520). [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to evaluate the outcomes after prosthetic arthroplasty of the proximal interphalangeal joint. Of 73 prostheses, 67 were available for follow-up at a median of 35 months (range 10–78 months). The median brief Michigan Hand Questionnaire score was 88/100 (interquartile range [IQR] 69–98), quickDASH 11 (IQR 1–29), pain on the visual analogue scale during activity 0 (IQR 0–2) and at rest 0 (IQR 0). Median range of motion improved from 50° (IQR 40°–70°) to 70° (IQR 53°–88°; p < 0.001). Preoperatively, there was axial deviation of >15° in 15 (23%) joints, with none postoperatively. There were no signs of loosening or migration of the prostheses. Two cases required revision with the implant staying in situ. In two cases, the prosthesis was removed and the joint was fused. Prosthetic arthroplasty of the proximal interphalangeal joint using a modular surface gliding implant is a good option for patients with primary osteoarthritis achieving acceptable pain relief, range of motion and axial stability. : Level of evidence: IV [ABSTRACT FROM AUTHOR]

Background: Sepsis-associated destruction of the pulmonary microvascular endothelial glycocalyx (EGCX) creates a vulnerable endothelial surface, contributing to the development of acute respiratory distress syndrome (ARDS). Constituents of the EGCX shed into circulation, glycosaminoglycans and proteoglycans, may serve as biomarkers of endothelial dysfunction. We sought to define the patterns of plasma EGCX degradation products in children with sepsis-associated pediatric ARDS (PARDS), and test their association with clinical outcomes. Methods: We retrospectively analyzed a prospective cohort (2018-2020) of children (≥1 month to <18 years of age) receiving invasive mechanical ventilation for acute respiratory failure for ≥72 h. Children with and without sepsis-associated PARDS were selected from the parent cohort and compared. Blood was collected at time of enrollment. Plasma glycosaminoglycan disaccharide class (heparan sulfate, chondroitin sulfate, and hyaluronan) and sulfation subtypes (heparan sulfate and chondroitin sulfate) were quantified using liquid chromatography tandem mass spectrometry. Plasma proteoglycans (syndecan-1) were measured through an immunoassay. Results: Among the 39 mechanically ventilated children (29 with and 10 without sepsis-associated PARDS), sepsis-associated PARDS patients demonstrated higher levels of heparan sulfate (median 639 ng/mL [interquartile range, IQR 421-902] vs 311 [IQR 228-461]) and syndecan-1 (median 146 ng/mL [IQR 32-315] vs 8 [IQR 8-50]), both p = 0.01. Heparan sulfate subtype analysis demonstrated greater proportions of N -sulfated disaccharide levels among children with sepsis-associated PARDS (p = 0.01). Increasing N- sulfated disaccharide levels by quartile were associated with severe PARDS (n = 9/29) with the highest quartile including >60% of the severe PARDS patients (test for trend, p = 0.04). Higher total heparan sulfate and N- sulfated disaccharide levels were independently associated with fewer 28-day ventilator-free days in children with sepsis-associated PARDS (all p < 0.05). Conclusions: Children with sepsis-associated PARDS exhibited higher plasma levels of heparan sulfate disaccharides and syndecan-1, suggesting that EGCX degradation biomarkers may provide insights into endothelial dysfunction and PARDS pathobiology. [ABSTRACT FROM AUTHOR]

The purpose of this mixed methods, cross-sectional patient survey was to characterize patient experience, to explore the frequency of and reasons for infertility treatment discontinuation and return to infertility treatments. Participants were recruited from United States patient support groups. Participants had received or were receiving ovulation induction (OI) with or without intrauterine insemination (IUI), with or without subsequent in vitro fertilization (IVF), or IVF with no other previous infertility treatment. Live birth was achieved by 62% of participants. Compared with participants treated with OI/IUI only, participants who underwent OI/IUI followed by ≥1 IVF cycle were less likely to consider discontinuing care (64% vs 77%; P =.014) or to discontinue treatment without achieving a pregnancy (40% vs 58%; P =.004). The most commonly cited reasons for treatment discontinuation were financial (62%) and psychological burden/treatment fatigue (58%). Expected versus actual time to pregnancy differed greatly. Continued desire for a child (60%) was the most frequently cited reason for continuing or resuming treatment. Expanded access to treatment, counseling and fostering realistic expectations regarding cumulative time to pregnancy may reduce treatment discontinuation. [ABSTRACT FROM AUTHOR]

The life-long acquisition of knowledge is a major research topic in educational psychology. Many approaches based on the idea of learning as information processing treat learning primarily as the expansion of knowledge and the enrichment of existing knowledge structures with new information. In this article, we argue for a slightly different conceptualization of learning as an epistemic activity. Our proposal builds on the classical cognitive view of learning as information processing but relies on a stronger notion of knowledge, according to which knowledge is construed as justified true belief. Understanding and evaluating arguments is central to learning as an epistemic activity, particularly as many learning materials are structured around arguments. Furthermore, learning as an epistemic activity requires using source information for credibility evaluations, and the avoidance of belief biases in the selection, comprehension and evaluation of information during learning. We discuss examples of learning as an epistemic activity within the framework of the Two-Step Model of Validation and outline how this perspective on learning can guide future research. [ABSTRACT FROM AUTHOR]

Instagram has become a place of work for many content creators, including influencers; however, the inherent power imbalance between creator and platform dictating influencers' success, requires creators to negotiate user expectations and the platform environment for their potential (commercial) success. Therefore, this article proposes approaching the influencer industry from the framework of platform imaginaries by developing a mixed qualitative method approach to visualize the precarity of Instagram influencers through their Instagram imaginaries with a cross-national comparison of US, German, and Japanese influencers. The results reflect a constant renegotiation of their own positions in relation to platform features and algorithms, follower interaction, as well as commercial partners, within three main imaginaries around Instagram's use, namely, Instagram as a social space, Instagram as a workplace, and Instagram as a marketplace. The analysis highlights the interdependencies with and situatedness within Instagram's platform environment, which need to be considered to understand the precarious working conditions of influencers. [ABSTRACT FROM AUTHOR]

Borna disease is a progressive meningoencephalitis caused by spillover of the Borna disease virus 1 (BoDV-1) to horses and sheep and has gained attention due to its zoonotic potential. New World camelids are also highly susceptible to the disease; however, a comprehensive description of the pathological lesions and viral distribution is lacking for these hosts. Here, the authors describe the distribution and severity of inflammatory lesions in alpacas (n = 6) naturally affected by this disease in comparison to horses (n = 8) as known spillover hosts. In addition, the tissue and cellular distribution of the BoDV-1 was determined via immunohistochemistry and immunofluorescence. A predominant lymphocytic meningoencephalitis was diagnosed in all animals with differences regarding the severity of lesions. Alpacas and horses with a shorter disease duration showed more prominent lesions in the cerebrum and at the transition of the nervous to the glandular part of the pituitary gland, as compared to animals with longer disease progression. In both species, viral antigen was almost exclusively restricted to cells of the central and peripheral nervous systems, with the notable exception of virus-infected glandular cells of the Pars intermedia of the pituitary gland. Alpacas likely represent dead-end hosts similar to horses and other spillover hosts of BoDV-1. [ABSTRACT FROM AUTHOR]

Listening effort and fatigue are common experiences when conversing in noisy environments. Much research has investigated listening effort in relation to listening demand using the speech-in-noise paradigm. Recent conceptualizations of listening effort postulate that mental fatigue should result in decreased arousal and a reluctance to invest further effort, particularly when the effort is not worthwhile. The aim of the study was to investigate the influence of fatigue on listening effort, in interaction with listening demands and motivation. To induce fatigue 30 adults with normal hearing completed a 40-minute long speech-in-noise task ("load sequence"). Pre- and post-load sequence listening effort was probed in easy and hard listening demands (individually adjusted signal-to-noise ratios); with high and low motivation (manipulated with monetary incentives). Subjective effort, estimated performance, and tendency to quit listening were collected using rating scales. Baseline pupil diameter and mean pupil dilation were recorded as indices of anticipatory arousal and objective effort. Self-reported effort and mean pupil dilation were overall larger during hard SNR as compared to easy SNR. Baseline pupil diameter declined from pre- to post-load sequence, suggesting an overall decrease in arousal. Monetary incentives had no influence on the baseline pupil diameter for the easy SNR condition, but for the hard SNR condition larger incentives led to larger baseline pupil diameter. These results suggest that anticipatory arousal may be influenced by fatigue and motivation effects. Models of listening effort should account for the independent influence of motivation and previous load on anticipatory arousal and effort in distinct parameters. [ABSTRACT FROM AUTHOR]

Background: Retrieval practice promotes retention of learned information more than restudying the information. However, benefits of multiple-choice testing over restudying in real-world educational contexts and the role of practically relevant moderators such as feedback and learners' ability to retrieve tested content from memory (i.e., retrievability) are still underexplored. Objective: The present research examines the benefits of multiple-choice questions with an experimental design that maximizes internal validity, while investigating the role of feedback and retrievability in an authentic educational setting of a university psychology course. Method: After course sessions, students answered multiple-choice questions or restudied course content and afterward could choose to revisit learning content and obtain feedback in a self-regulated way. Results: Participants on average obtained corrective feedback for 9% of practiced items when practicing course content. In the criterial test, practicing retrieval was not superior to reading summarizing statements in general but a testing effect emerged for questions that targeted information that participants could easily retrieve from memory. Conclusion: Feedback was rarely sought. However, even without feedback, participants profited from multiple-choice questions that targeted easily retrievable information. Teaching Implications: Caution is advised when employing multiple-choice testing in self-regulated learning environments in which students are required to actively obtain feedback. [ABSTRACT FROM AUTHOR]

Intergenerational relations have received close attention in the context of population aging and increased childcare provision by grandparents. However, few studies have investigated the psychological consequences of becoming a grandparent. In a preregistered test of grandparenthood as a developmental task in middle and older adulthood, we used representative panel data from the Netherlands (N = 563) and the United States (N = 2210) to analyze first-time grandparents' personality and life satisfaction development. We tested gender, employment, and grandchild care as moderators. To address confounding, we employed propensity score matching using two procedures: matching grandparents with parents and nonparents to achieve balance in different sets of carefully selected covariates. Multilevel models demonstrated mean-level stability of the Big Five personality traits and life satisfaction over the transition to grandparenthood, and no consistent moderation effects—contrary to the social investment principle. The few small effects of grandparenthood on personality development did not replicate across samples. We found no evidence of larger inter-individual differences in change in grandparents compared to the controls or of lower rank-order stability. Our findings add to recent critical re-examinations of the social investment principle and are discussed in light of characteristics that might moderate grandparents' personality development. [ABSTRACT FROM AUTHOR]

Background: The posterior tibial slope has been identified as an anatomic risk factor for anterior cruciate ligament insufficiency and reruptures after anterior cruciate ligament reconstruction. Anterior tibial closing wedge osteotomy for correction of sagittal plane deformities has the potential to cause an unintended change in coronal plane alignment. Purpose: To evaluate the effects of anterior tibial closing wedge osteotomies for correction of posterior tibial slope on coronal plane alignment using an infratuberosity surgical approach and to identify predictive factors for a change in medial proximal tibial angle (MPTA). Study Design: Case series; Level of evidence, 4. Methods: This study reports on retrospectively obtained data from radiographic measurements of 38 anterior tibial closing wedge osteotomies. All patients underwent revision anterior cruciate ligament reconstruction and had undergone ≥1 previous anterior cruciate ligament reconstruction. In all patients, an infratuberosity approach was used with angular stable plate fixation. Pre- and postoperative radiographs were examined retrospectively to detect changes in the sagittal and coronal plane alignment (posterior tibial slope and MPTA). A multivariate regression analysis was used to identify predictors for a change in MPTA. Results: The study group consisted of 14 women and 24 men whose mean ± SD age at the index procedure was 31.6 ± 8.7 years (range, 17-51 years). Posterior tibial slope decreased significantly (by 7.2° ± 2.3°; P <.001) from 14.6° ± 2.0° preoperatively to 7.4° ± 2.1° postoperatively. MPTA decreased significantly by 1.3° ± 1.5° (P =.005) from pre- to postoperative measurement. Mean wedge height was 9.3 ± 1.1 mm. A lower preoperative MPTA (coefficient = 0.32; P =.017; 95% CI, 0.06-0.59) and larger wedge height (coefficient = 0.48; P =.029; 95% CI, 0.05-0.9) were significant predictive factors for a decrease in MPTA. Conclusion: Anterior tibial closing wedge osteotomy for posterior tibial slope reduction resulted in a slight but significant decrease of the MPTA in the coronal plane. These changes were dependent on the preoperative MPTA and the wedge height. [ABSTRACT FROM AUTHOR]

Background: Understanding the effects of the N-methyl-D-aspartate receptor (NMDA-R) antagonist ketamine on brain function is of considerable interest due to the discovery of its fast-acting antidepressant properties. It is well known that gamma oscillations are increased when ketamine is administered to rodents and humans, and increases in the auditory steady-state response (ASSR) have also been observed. Aims: To elucidate the cellular substrate of the increase in network activity and synchrony observed by sub-anesthetic doses of ketamine, the aim was to investigate spike timing and regularity and determine how this is affected by the animal's motor state. Methods: Single unit activity and local field potentials from the auditory cortex of awake, freely moving rats were recorded with microelectrode arrays during an ASSR paradigm. Results: Ketamine administration yielded a significant increase in ASSR power and phase locking, both significantly modulated by motor activity. Before drug administration, putative fast-spiking interneurons (FSIs) were significantly more entrained to the stimulus than putative pyramidal neurons (PYRs). The degree of entrainment significantly increased at lower doses of ketamine (3 and 10 mg/kg for FSIs, 10 mg/kg for PYRs). At the highest dose (30 mg/kg), a strong increase in tonic firing of PYRs was observed. Conclusions: These findings suggest an involvement of FSIs in the increased network synchrony and provide a possible cellular explanation for the well-documented effects of ketamine-induced increase in power and synchronicity during ASSR. The results support the importance to evaluate different motor states separately for more translational preclinical research. [ABSTRACT FROM AUTHOR]

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Background: Multi-ligament knee injuries and knee dislocations are potentially devastating injuries that typically result in injury to both cruciate ligaments and variable injury to collateral ligament complexes. Indications: Surgical intervention typically leads to better patient outcomes than nonoperative management. We describe our preferred technique for bicruciate ligament reconstruction with a focus on double-bundle posterior cruciate ligament (PCL) reconstruction. Technique Description: A transtibial approach is used to drill the PCL tibial tunnel. A safety incision on the proximal medial tibia, which may incorporate the distal aspect of a medial-sided incision for medial collateral ligament (MCL) reconstruction, allows palpation of the PCL fovea for anatomic tunnel placement, protection of the posterior neurovascular structures, and egress of arthroscopic fluid during the case. This technique uses an inside-out approach for creation of the 2 femoral sockets to recreate the 2 PCL bundles. The grafts are passed in antegrade fashion, with passage and femoral fixation of the posteromedial (PM) bundle followed by the anterolateral (AL) bundle. After passage of the anterior cruciate ligament (ACL) graft and fixation on the femur in standard fashion, attention is turned to PCL tibia-sided fixation. We use a screw and spiked washer to fix the AL bundle at 90° of flexion with an anterior drawer maneuver. The PM bundle is then fixed with a polyetheretherketone (PEEK) interference screw in near full extension. Fixation of the ACL on the tibia in standard fashion completes the bicruciate ligament reconstruction. Results: In biomechanical cadaveric studies, double-bundle PCL reconstruction has been shown to more closely approximate native knee kinematics, with more restraint to posterior translation at all knee flexion angles and less internal rotation laxity at higher knee flexion angles. In clinical results, both single-bundle and double-bundle reconstructions improve knee stability and patient-reported outcomes. Double-bundle PCL reconstruction may provide improved objective posterior tibial stability and objective International Knee Documentation Committee (IKDC) scores. Discussion: Double-bundle PCL reconstruction can be performed efficiently with good outcomes and potentially less residual posterior translation or internal rotation laxity than single-bundle PCL reconstruction. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. [ABSTRACT FROM AUTHOR]

Background: Despite tremendous development in the treatment of neuromyelitis optica spectrum disorder (NMOSD), less is known about the characteristics of hospitalized patients and inpatient care utilization. Objective: To investigate the development of inpatient NMOSD case numbers and implemented immunotherapies in the last decade in Germany. Methods: We conducted a nationwide retrospective study using an administrative database of all hospitalized NMOSD patients between 2010 and 2021. We evaluated yearly data on case numbers, demographics, treatment regimens, and seasonal variations of apheresis therapy as a surrogate marker of severe relapse incidence. Results: During the observational period case number of inpatients substantially increased (2010: n = 463, 2021: n = 992). The mean age was 48.1 ± 2.5 years (74% females). The pooled yearly rate of plasmapheresis/immunoadsorption was 14% (95% CI [13–15%]), without seasonal variations. Its application peaked in 2013 (18%, 95% CI [15–21%]) with decreasing trend since. Predominant immunotherapy was rituximab (40%, 95% CI [34–45%]), followed by tocilizumab (4%, 95% CI [3–5%]) since 2013 and eculizumab (4%, 95% CI [3–5%]) since 2020. Inpatient mortality ranged between 0% and 1% per year. Conclusions: Inpatient case numbers of NMOSD substantially increased during the past decade, probably reflecting improving disease awareness. In parallel with the administration of highly effective therapies rate of apheresis therapies decreased. A stable apheresis rate over the year makes seasonal variations of the steroid-refractive relapses unlikely. [ABSTRACT FROM AUTHOR]

Objective: To assess whether a healthy lifestyle is associated to beneficial effects on various systemic lupus erythematosus (SLE) health domains. Methods: In a cross-sectional study, Mediterranean Diet Adherence Score (MEDAS), physical activity energy expenditure (PAEE), and smoking status were assessed by questionnaires, along with clinical parameters and various health domains including Systemic Lupus Disease Activity Score (SLEDAI), Depression Scale (CES-D), Fatigue Severity (FSS), functional status (FFbH), physical and mental quality of life (PCS, MCS). Lifestyle choices were assessed with respect to health domains by linear regression modeling. Additionally, SLE patients with a healthy lifestyle (MEDAS ≥ 4, ≥ 1 h sport per week, no smoking) were compared to those without by Wilcoxon's signed-rank test. Results: 49 of 145 SLE patients (44.3 ± 31.7 years, 87.6% female) followed a healthy lifestyle and showed a higher physical quality of life (β = 4.5 (95%-CI 1.5–7.9) p = 0.01), lower depression (β = −5.0 (−8.2 to −0.2) p = 0.02) and lower fatigue (β = −0.8 (−1.5 to −0.2) p = 0.01) independently of SLE disease activity. Furthermore, dsDNA-antibodies were lower (146 ± 540 vs 266 ± 146 U/mL, p = 0.049). In a more detailed analysis, physical activity had the highest impact on the various health domains when compared to smoking or diet adherence, which was consistent even after adjusting for multiple potential confounders. Each 1,000 kcal of weekly PAEE was associated to a 1.8 (0.9–2.6) point increase in the PCS (p = 0.0001), a 0.2 (0.03–0.4) point decrease in the CES-D (p = 0.01) and a 2.8 (1.2–4.4) point increase in the FFbH (p = 0.0006). Conclusion: A healthy lifestyle, especially physical activity is associated with beneficial effects including quality of life, depression and fatigue in SLE. [ABSTRACT FROM AUTHOR]

Background: The global health sector strategy on viral hepatitis aims to reduce new hepatitis B infections by 90% by 2030. Yet, hepatitis B birth dose (HepB-BD) vaccination, which is effective in preventing mother-to-child transmission of hepatitis B, remains low in sub-Saharan Africa. Given the essential role that midwives play in infants' birth dose immunisation, we explore their perspectives on the reasons for delays and non-administration of HepB-BD to eligible neonates in Ghana. Methods: We conducted interviews with 18 midwives, stratified by region (Greater Accra and Northern regions). Participants were selected purposively. The data were transcribed, coded, and analysed following the Braun and Clarke data analysis procedure. Results: The participants conveyed a broad range of barriers to HepB-BD vaccination in Ghana. These include the mother's denial of hepatitis B seropositivity; the mother's ignorance of the impact of hepatitis B on their newborn; partners' non-involvement in post-test counselling; and the high cost of hepatitis B immunoglobulin and hepatitis B monovalent vaccine. Other reasons included vaccine unavailability and midwives' oversight and documentation lapses. Conclusion: We recommend educating expectant mothers on the importance and effectiveness of HepB-BD vaccination during antenatal care (ANC) visits, as well as educating midwives on HepB-BD vaccination procedures. In addition, ensuring sufficient supplies and administering hepatitis B vaccines in the delivery ward should be done to guarantee that babies receive the vaccines on time. Importantly, Ghana needs policies that require HepB-BD vaccination as part of the Expanded Programme on Immunisation (EPI) to ensure the investments and funding it needs. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to describe child health in relation to housing renovations in more than 800 rental units, consisting of repairs of dilapidated kitchens and bathrooms, in the disadvantaged neighbourhood of Herrgården in Rosengård, Malmö, Sweden. Methods: Data on housing conditions and self-reported health were collected during home visits to families living in Herrgården (building renovations area) and a comparison area (neighbouring Törnrosen, with generally better housing conditions). At baseline, 130 families with 359 children participated, while 51 families with 127 children participated at follow-up. All data were collected between 2010 and 2012. Additionally, regional register data on health-care usage/in- and outpatient contacts within the public health-care system between 2008 and 2013 were also collected for all 8715 children registered as living in the two areas. Results: Self-reported health seemed to somewhat improve in both areas, with 74% versus 86% and 78% versus 88% reporting good or very good health in Herrgården and in the comparison area at baseline and follow-up, respectively. In Herrgården, crowdedness increased, while it decreased in the comparison area. The number of health-care contacts remained stable over time in Herrgården, while it decreased in the comparison area. Conclusions: Partial housing renovations did not seem to result in clear health improvements as measured with the indicators used in the present study. This could possibly be due to persisting health effects due to increased crowdedness or persisting poor housing conditions, as only kitchens and bathrooms were renovated. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the impact of steroids on postoperative tonsillectomy recovery and implement findings for improvement in postoperative management. Methods: Institutional review board approved prospective study with retrospective analysis of private practice setting tonsillectomy patients (November 2015 to January 2017). A questionnaire was provided postoperatively to patients undergoing tonsillectomy with or without adenoidectomy. The study population was separated into 2 groups: patients who received steroids (3 days of either dexamethasone or prednisolone), postoperative steroid (POS), versus patients who did not receive steroids (PONS). Results: The questionnaire had a return rate of 27.3% (254/931). Nine of the 254 responses were disqualified for lack of information; therefore, the total number of responses was 245. Of these, 115 were POS and 130 were PONS. The groups were similar in mean age (POS: 13.2 ± 10.4 years, PONS: 14.7 ± 12.1 years, P =.32) and sex (POS: Male 40.0%, PONS: Male 40.0%, P =.97). There was an overall decrease of pain and nausea/vomiting (N/V) in the steroid group (P =.0007). There was reduction in pain (P <.05) from postoperative day (POD) 2, 3, 4, and 6 in the POS group. Otherwise, there was no significant reduction in pain from POD 7 to 14, day-by-day rate of N/V, bleeding, or rate of emergency department (ED) or clinic visit (P >.05). Conclusion: Postoperative steroid reduced overall pain and N/V, as well as daily pain on POD 2, 3, 4, and 6. Pain from POD 7 to 14, rate of ED or clinic visit, or daily N/V and bleeding rate were not significantly different between cohorts. [ABSTRACT FROM AUTHOR]

Objectives: Patients with Systemic Lupus Erythematosus are known to have dysregulated immune responses and may have reduced response to vaccination against COVID-19 while being at risk of severe COVID-19 disease. The aim of this study was to identify whether vaccine responses were attenuated in SLE and to assess disease- and treatment-specific associations. Methods: Patients with SLE were matched by age, sex and ethnic background to healthcare worker healthy controls (HC). Anti-SARS-CoV-2 spike glycoprotein antibodies were measured at 4–8 weeks following the second COVID-19 vaccine dose (either BNT162b2 or ChAdOx1 nCoV-19) using a CE-marked combined ELISA detecting IgG, IgA and IgM (IgGAM). Antibody levels were considered as a continuous variable and in tertiles and compared between SLE patients and HC and associations with medication, disease activity and serological parameters were determined. Results: Antibody levels were lower in 43 SLE patients compared to 40 HC (p < 0.001). There was no association between antibody levels and medication, lupus disease activity, vaccine type or prior COVID infection. Higher serum IgA, but not IgG or IgM, was associated with being in a higher anti-SARS-CoV-2 antibody level tertile (OR [95% CI] 1.820 [1.050, 3.156] p = 0.033). Similarly, higher lymphocyte count was also associated with being in a higher tertile of anti-SARS-CoV-2 (OR 3.330 [1.505, 7.366] p = 0.003) Conclusion: Patients with SLE have lower antibody levels following 2 doses of COVID-19 vaccines compared to HC. In SLE lower lymphocyte counts and serum IgA levels are associated with lower antibody levels post vaccination, potentially identifying a subgroup of patients who may therefore be at increased risk of infection. [ABSTRACT FROM AUTHOR]

The proximal interphalangeal joint is critical for good hand function. Its anatomical complexities often predispose it to stiffness, involving damage to one or more structures. Improving or resolving the stiffness and increasing the range of motion require an accurate assessment and understanding of the pathogenesis. The surgical strategy can then be tailored accordingly. In some cases, restoration to pre-injury level may not be possible and this condition still represents an unsolved problem in hand surgery. Level of evidence: V [ABSTRACT FROM AUTHOR]

Purpose: The construct of social participation is still not clearly defined. To reach a better understanding of social participation, the perspectives of adolescents must be taken into account. This study explores the adolescent concept of social participation and expands knowledge of the meaning of subjective components of the term. Methods: Thirty-four semi-structured interviews were conducted with adolescents with and without physical disabilities or chronic diseases between the ages of 12 and 17 and analyzed according to grounded theory. Results: Adolescents describe social participation as involving reflexive interaction with their social environment. Furthermore, forming a social environment plays an important role. All components of the concept are embedded in a context that influences the ways adolescents participate. Adolescents differentiate between active and passive forms of social participation. The concept of reflexive interaction is situated within an interdependent structure of components such as the "feeling of belonging" and the feeling of "well-being" among adolescents. Conclusion: The results expand the current state of knowledge regarding the theoretical differentiation of social participation by exploring subjective components of the term. This offers the possibility of supplementing the theoretical frameworks of social participation and supports the understanding of the critical importance of social participation for adolescents. [ABSTRACT FROM AUTHOR]

Natural disasters affect the health and well-being of mothers with young children. During natural disasters, this population is at risk of discontinuation of their breastfeeding practices. Pakistan is a middle-income country that is susceptible to natural disasters. This study intended to examine sociocultural factors that shape the breastfeeding experiences and practices of internally displaced mothers in Pakistan. This critical ethnographic study was undertaken in disaster-affected villages of Chitral, Pakistan. Data were collected utilizing multiple methods, including in-depth interviews with 18 internally displaced mothers and field observations. Multiple sociocultural factors were identified as either barriers or facilitators to these mothers' capacities to breastfeed their children. Informal support, formal support, breastfeeding culture, and spiritual practices facilitated displaced mothers to sustain their breastfeeding practices. On the other hand, lack of privacy, cultural beliefs, practices and expectations, covert oppression, and lack of healthcare support served as barriers to the breastfeeding practices of displaced mothers. [ABSTRACT FROM AUTHOR]

The music genres reggaeton and dembow have attained worldwide popularity. Their song lyrics and music videos often display sexually explicit contents, conveying the sexual objectification and degradation of women. To test possible effects of this content on sexually harassing behaviour, Dominican males were randomly assigned to watch reggaeton music videos (n = 34), dembow music videos (n = 31) or no videos (n = 32). Afterwards, two forms of sexually harassing behaviour towards a (computer-simulated) woman, gender harassment and unwanted sexual attention, were assessed using a computer chat paradigm. Participants' short-term mating orientation, hostile and benevolent sexist attitudes, acceptance of modern myths about sexual aggression (AMMSA), music preferences and previous exposure to sexist music were also assessed. Results did not show any effects of the music video manipulation on harassing behaviour but revealed correlational links among music preferences, short-term mating orientation, AMMSA, sexist attitudes and displays of unwanted sexual attention. Results are discussed in relation to previous research on the effects of music and attitudinal predictors of sexual harassment conducted in Europe and the USA. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare outcome (clinical, patient-reported outcome measures, radiologic, joint motion and pedographic) of total joint replacement with Roto-Glide (RG) and arthrodesis (A) for severe osteoarthritis of the first metatarsophalangeal joint (MTP1). Methods: All consecutive patients with arthrodesis and RG from January 23, 2011, until September 18, 2019, at the authors' institution were considered for inclusion in the study. Preoperatively and at follow-up (FU), radiographs, and/or weightbearing computed tomographic imaging were obtained. Standard dynamic pedography was performed. Visual analog scale foot and ankle (VASFA), European Foot and Ankle Society (EFAS) score, MTP1 range of motion for dorsiflexion/plantarflexion (DF/PF) were registered and compared preoperatively and at FU. Results: Seventy RG and 72 arthrodesis patients were included. Preoperative VASFA and EFAS scores did not differ between the RG and arthrodesis groups (average scores: VASFA, 50.6 and 45.6; EFAS score, 10.7 and 10.6, respectively; each P >.05). Wound healing delays without further operative measures were registered in 4 patients (6%) for RG and 5 (7%) for arthrodesis (P =.67), and 5 revisions in 5 patients (7%) for RG and 12 in 8 (11%) for arthrodesis (P =.05). The longest available FU was higher in RG than in arthrodesis (47 vs 37 months on average, P <.001). Pedography showed higher first metatarsal head or sesamoids and lower great toe force percentage from force of entire foot in RG than in arthrodesis (P =.05) resulting in physiological pattern in RG only. VASFA and EFAS scores at FU was higher in RG than in arthrodesis (average scores: VASFA, 72.6 and 63.6; EFAS score, 16.1 and 14.1, respectively; each P <.05). DF/PF measurement was only possible in RG (average value: DF/PF, 36.1/14.0). Conclusion: We found marginally lower revision rates and higher patient-reported outcome measures, joint motion (DF/PF), and more physiologic force distribution at slightly longer FU for the RG group than the arthrodesis group. Longer follow-up and broader clinical reporting are needed to identify the potential deficits of RG. Level of Evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Natural disasters affect the health and well-being of mothers with young children. During natural disasters, this population is at risk of discontinuation of their breastfeeding practices. Pakistan is a middle-income country that is susceptible to natural disasters. This study intended to examine sociocultural factors that shape the breastfeeding experiences and practices of internally displaced mothers in Pakistan. This critical ethnographic study was undertaken in disaster-affected villages of Chitral, Pakistan. Data were collected utilizing multiple methods, including in-depth interviews with 18 internally displaced mothers and field observations. Multiple sociocultural factors were identified as either barriers or facilitators to these mothers’ capacities to breastfeed their children. Informal support, formal support, breastfeeding culture, and spiritual practices facilitated displaced mothers to sustain their breastfeeding practices. On the other hand, lack of privacy, cultural beliefs, practices and expectations, covert oppression, and lack of healthcare support served as barriers to the breastfeeding practices of displaced mothers. [ABSTRACT FROM AUTHOR]

Objective: A reproduction management strategy is an essential component of any cattle production operation. Options include palpation per rectum, transrectal sonography, or biochemical blood tests. To determine the best method, veterinary costs must be weighed against operational costs of maintaining open cattle. Materials and Methods: An online literature search using PubMed, Medline, CINAHL, EBSCO, and Google Scholar was completed to find relevant articles regarding pregnancy detection in cattle, costs of reproductive management in cattle, and pregnancy loss in cattle. Priority was given to original research articles pertaining to palpation per rectum, transrectal ultrasound, fetal gender, and pregnancy loss. Results: Transrectal sonography can detect a pregnancy up to 15 days earlier than palpation per rectum and has sensitivities and specificities as high as 97% when performed between days 21 and 35 post artificial insemination. Conclusion: Cattle producers can be confident that transrectal sonography is a useful tool in the beef and dairy cattle industry. Its use facilitates reproductive management decisions, such as re-breeding or culling, thus reducing expenses, and increasing profitability. [ABSTRACT FROM AUTHOR]

The "Study of Personality Architecture and Dynamics" (SPeADy) aims at testing theory-based differences between core dispositions and surface characteristics of personality and examining their associations across time and in the context of major life experiences. For this purpose, SPeADy encompasses several constructs, such as Big Five domains and facets, motives, values, religiosity, self-concepts, and life events. SPeADy contains an age groups and an extended twin family study, with the former being this paper's focus. The longitudinal and multi-rater design of the age groups study allows the empirical examinations of core dispositions of personality on the basis of six criteria. Cutting-edge findings are described. First (2016-2018) and second wave (2018-2020) data are available as a scientific use file. Self-reports were provided by 3,026 participants (60% female; age: 14-89 years). The third data-collection wave ends in 2022. This paper provides an overview of SPeADy's scientific issues and use for the research community. [ABSTRACT FROM AUTHOR]

Introduction: The standard of care consolidation therapy for acute myeloid leukemia is high-dose cytarabine or intermediate-dose cytarabine, which are traditionally given inpatient. At Moffitt Cancer Center, we have moved the administration of high-dose cytarabine and intermediate-dose cytarabine to the outpatient setting through the inpatient/outpatient program. To facilitate outpatient administration, high-dose cytarabine and intermediate-dose cytarabine are given in a shorter interval of every 10 h instead of 12 h. The safety of a shorter duration interval of high-dose cytarabine and intermediate-dose cytarabine is unknown. This study aims to assess the safety and feasibility of administering high-dose cytarabine and intermediate-dose cytarabine consolidation therapy in the inpatient/outpatient setting. Methods: This is a retrospective chart review to analyze acute myeloid leukemia patients treated with inpatient/outpatient high-dose cytarabine or intermediate-dose cytarabine consolidation therapy at Moffitt Cancer Center from January 1, 2015, through November 1, 2018. The primary objective was to determine the incidence of hospitalization during the inpatient/outpatient administration of high-dose cytarabine or intermediate-dose cytarabine. Results: Two hundred fifty-three of 255 cycles of high-dose cytarabine/intermediate-dose cytarabine were delivered outpatient over the reviewed time period to 118 patients. No patients receiving outpatient high-dose cytarabine/intermediate-dose cytarabine consolidation required hospitalization during chemotherapy. Our incidence of hospitalization (24%) after chemotherapy is consistent with the reported literature. Through the inpatient/outpatient administration of high-dose cytarabine and intermediate-dose cytarabine, 1265 inpatient days were saved with an approximate revenue of $3,135,176 generated in our study period. Conclusion: Inpatient/outpatient administration of high-dose cytarabine and intermediate-dose cytarabine is both safe and feasible. Moving high-dose cytarabine/intermediate-dose cytarabine administration to the outpatient setting resulted in significant additional revenue vs. inpatient administration. [ABSTRACT FROM AUTHOR]

Objectives: Human papillomavirus (HPV) vaccination coverage in the United States is far below coverage for other routine adolescent vaccines. We examined whether missed opportunities for HPV vaccination among adolescents differ by parental nativity (country of origin) in Minnesota. Methods: We retrospectively analyzed birth record and immunization information data for adolescents in Minnesota born during 2004-2007 using data from January 1, 2015, through December 31, 2018. Using logistic regression, we assessed the association between parental nativity and missed opportunities for HPV vaccine initiation, or receipt of other vaccines without receipt of the HPV vaccine. We adjusted for parent/child demographic and vaccination characteristics. We defined nativity as the number of non–US-born parents and maternal region of birth. Results: Adolescents with mothers born in Eastern Europe (adjusted odds ratio [aOR] = 2.33; 95% CI, 2.01-2.73) and Africa (aOR = 1.36; 95% CI, 1.28-1.43) had greater adjusted odds of missed opportunities for HPV vaccination than adolescents with US-born mothers. However, adolescents with mothers from Latin America and the Caribbean had lower odds of missed opportunities than adolescents with US-born mothers (aOR = 0.61; 95% CI, 0.58-0.65). Adolescents with 1 or 2 non–US-born parents had lower odds of missed opportunities for HPV vaccination than adolescents with 2 US-born parents (1 parent: aOR = 0.92; 95% CI, 0.88-0.96; 2 parents: aOR = 0.90; 95% CI, 0.87-0.94). Conclusions: Future studies should evaluate outreach to groups with HPV vaccination disparities and identify other drivers of missed opportunities among adolescents with US-born parents, such as multiparity. [ABSTRACT FROM AUTHOR]

Cerebral blood flow is a finely tuned process dependent on coordinated changes in arterial tone. These changes are strongly tied to smooth muscle membrane potential and inwardly rectifying K+ (KIR) channels are thought to be a key determinant. To elucidate the role of KIR2.1 in cerebral arterial tone development, this study examined the electrical and functional properties of cells, vessels and living tissue from tamoxifen-induced smooth muscle cell (SMC)-specific KIR2.1 knockout mice. Patch-clamp electrophysiology revealed a robust Ba2+-sensitive inwardly rectifying K+ current in cerebral arterial myocytes irrespective of KIR2.1 knockout. Immunolabeling clarified that KIR2.1 expression was low in SMCs while KIR2.2 labeling was remarkably abundant at the membrane. In alignment with these observations, pressure myography revealed that the myogenic response and K+-induced dilation were intact in cerebral arteries post knockout. At the whole organ level, this translated to a maintenance of brain perfusion in SMC KIR2.1−/− mice, as assessed with arterial spin-labeling MRI. We confirmed these findings in superior epigastric arteries and implicated KIR2.2 as more functionally relevant in SMCs. Together, these results suggest that subunits other than KIR2.1 play a significant role in setting native current in SMCs and driving arterial tone. [ABSTRACT FROM AUTHOR]

Objectives: Diffusion-weighted imaging (DWI) MRI is increasingly available in veterinary medicine for investigation of the brain. However, apparent diffusion coefficient (ADC) values have only been reported in a small number of cats or in research settings. The aim of this study was to investigate the ADC values of different anatomical regions of the morphologically normal brain in a feline patient population. Additionally, we aimed to assess the possible influence on the ADC values of different patient-related factors, such as sex, body weight, age, imaging of the left and right side of the cerebral hemispheres and white vs grey matter regions. Methods: This retrospective study included cats undergoing an MRI (3T) examination with DWI sequences of the head at the Vetsuisse Faculty of the University Zurich between 2015 and 2021. Only cats with morphologically normal brains were included. On the ADC maps, 10 regions of interest (ROIs) were manually drawn on the following anatomical regions: caudate nucleus; internal capsule (two locations); piriform lobe; thalamus; hippocampus; cortex cerebri (two locations); cerebellar hemisphere; and one ROI in the centre of the cerebellar vermis. Except for the ROI at the cerebellar vermis, each ROI was drawn in the left and right hemisphere. The ADC values were calculated by the software and recorded. Results: A total of 129 cats were included in this study. The ADC varied in the different ROIs, with the highest mean ADC value in the hippocampus and the lowest in the cerebellar hemisphere. ADC was significantly lower in the white cerebral matter compared with the grey matter. ADC values were not influenced by age, with the exception of the hippocampus and the cingulate gyrus. Conclusion and relevance: ADC values of different anatomical regions of the morphologically normal feline brain in a patient population of 129 cats in a clinical setting are reported for the first time. [ABSTRACT FROM AUTHOR]

Background: In September 2018, pharmacy antimicrobial stewardship (AMS) services were expanded to include weekends at this academic medical center. Activities performed by AMS pharmacists on the weekends include blood culture rapid diagnostic (RDT) review, antiretroviral therapy (ART) review, prospective audit and feedback (PAF) utilizing clinical decision support, vancomycin dosing, and operational support. The purpose of this study was to assess the operational and clinical impact of these expanded AMS services. Methods: This single-center, quasi-experimental study included data from weekends before (9/2017–11/2017) and after (9/2018–11/2018) implementation. The descriptive primary outcome was the number of activities completed for each AMS activity type in the post-implementation group only. Secondary outcomes were time to AMS opportunity resolution, time to escalation or de-escalation following PAF or RDT alert, time to resolution of miscellaneous AMS related opportunities, length of stay (LOS), and antimicrobial use outcomes. Results: During the post-implementation period 1258 activities were completed, averaging 97/weekend. Inclusion criteria for time to resolution outcomes were met by 72 patients pre-implementation and 59 patients post. The median (IQR) time to AMS opportunity resolution decreased from 18.5 hours pre-intervention (7.7-35.7) to 8.5 hours post-intervention (IQR 1.8-14.0), p < 0.01. Time to escalation was 11.6 hours compared to 1.7 hours (p = 0.1), de-escalation 16.7 hours compared to 10.8 hours (p = 0.03), and miscellaneous opportunity 40.8 hours compared to 13.2 hours (p = 0.01). No differences were observed in LOS or antimicrobial use outcomes. Conclusion: Presence of pharmacist-driven weekend AMS services significantly reduced time to resolution of AMS opportunities. These data support the value of weekend AMS services. [ABSTRACT FROM AUTHOR]

Empirical research considers teacher collaboration to be an important predictor of outcome variables at the student, teacher, and school level. Principals are responsible for shaping teachers' work environments, and in doing so, they can strengthen and support teacher collaboration. Drawing on social interdependence theory, we hypothesized that teachers' collective efficacy has a mediating effect on the relationship between principal leadership and teacher collaboration. We collected data from 630 teachers in 29 primary and secondary schools in Germany and found, based on structural equation modeling, that principal leadership had a significant indirect effect on teacher collaboration, mediated by teachers' collective efficacy. We discuss the implications of these results for supporting school improvement. [ABSTRACT FROM AUTHOR]