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Resumen Introduccion La implementacion del diagnostico en un solo paso (DUSP) de la infeccion activa por virus de la hepatitis C (VHC) conjuntamente con la incorporacion de alertas informativas ha demostrado que reduce de forma significativa, respecto al diagnostico tradicional, la cifra de pacientes que no eran remitidos para valoracion terapeutica. Metodos A partir de la implementacion en 2018 del DUSP en los servicios de microbiologia de los hospitales del Servicio Gallego de Salud (SERGAS), se identifican y caracterizan de manera retrospectiva los nuevos diagnosticos de infeccion activa por VHC. Resultados En 2018 se identificaron mediante DUSP un total de 258 pacientes con infeccion activa por VHC desconocida (70,2% hombres, mediana de edad de 52 anos) procedentes de consultas de unidades de atencion primaria y especializada en un 54,8% y 39,8%, respectivamente, asi como de otras localizaciones en un 5,4%. De los 258 pacientes, el 81,0% fueron derivados para valoracion terapeutica, con una mediana de 54 dias desde su diagnostico. En el 58,3% de los casos se determino el DUSP mediante carga viral, el genotipo predominante fue el 1a (30,7%), un 52,1% fue tratado y se observo una respuesta viral sostenida en el 93,7% de estos. Conclusion La implementacion en toda Galicia del DUSP de la hepatitis C conjuntamente con alertas informativas ha permitido obtener, en conjunto, tasas de derivacion para tratamiento similares a las obtenidas en otros estudios. Sin embargo, existe una amplia variabilidad entre los distintos centros, que exigen la incorporacion de mejoras, como la formacion o la utilizacion de medidas de rescate para su optimizacion.

Introduction Objective Structured Clinical Examinations (OSCEs) are an accepted technique for evaluation of clinical competence in healthcare. However, the economic imperative requires faculty to control cost, using innovative educational strategies such as virtual simulation. The objective of this study was to evaluate the cost implications of implementing an online interactive learning module [Monash OSCE Virtual Experience (MOVE)]. Methods All fourth-year pharmacy students enrolled in Monash University in 2017 were provided access to MOVE. Cost-minimization analyses were performed to evaluate the cost of introducing MOVE in the pharmacy course using the smallest cohort size (Malaysia campus) of 40 students as the base case. We also determined under what circumstances MOVE would be more cost-effective, considering the different operational situations such as when student numbers increased or when the number of simulation modules created were increased. Results The overall cost of setup and implementation of MOVE in the first year of implementation among 40 students was US $94.38 per student. In comparison, the face-to-face workshop cost was US $64.14 per student. On the second year of implementation, the ongoing cost of operation of MOVE was US $32.86 per student compared with US $58.97 per student using face-to-face workshop. A net benefit using MOVE was observed after the third year of implementation. Larger savings were noted when the cohort size extends larger than 100 students. Conclusions Monash OSCE Virtual Experience was a flexible and cost-effective approach to aid students in preparation for an OSCE and enhanced students' learning experience. The wider applicability of these findings will need to be explored in other settings.

Background Total shoulder arthroplasty (TSA) is an increasingly common treatment for end-stage glenohumeral osteoarthritis. Current established radiographic measures and classification systems do not predict patient-reported outcomes from TSA. We hypothesized that the MRI-based Shoulder Osteoarthritis Severity (SOAS) Score would correlate with subjective improvement following TSA. Methods Patients undergoing TSA with preoperative shoulder MRIs and pre- and postoperative ASES scores with minimum 2-year follow-up were included from a prospectively collected institutional shoulder arthroplasty database. SOAS scores, which is measured from 0 to 100 with an increasing score reflecting greater global degenerative changes, were assessed by two independent reviewers, and Samilson-Prieto grade and Walch classification were scored by one reviewer. Average SOAS scores were correlated with demographic factors and pre-, post-, and change (Δ) in ASES scores. Statistical analysis was performed with STATA with Pearson's correlation, one-way ANOVA, and ROC analysis, with significance defined by p Results 30 patients (age 63 ± 10 years, 14 females, 16 males) who underwent primary anatomic TSA were included. The intraclass correlation coefficient (ICC) for total SOAS scores calculated by reviewers was 0.91. SOAS score correlated significantly with ΔASES (r = 0.61, p = .0003) and preoperative ASES (r = -0.37, p = .042), with greater MRI-based degenerative change associated with greater improvement after TSA and lower preoperative ASES score. No significant relationship was found between either Samilson-Prieto or Walch classification and SOAS or ASES scores. No significant relationship was found between SOAS scores and age, sex, or BMI. Using an MCID of 21 as previously reported, an ROC curve was generated and found to have an AUC of 0.96. A SOAS score cut-point of 36.25 was found to maximize sensitivity and specificity in predicting reaching MCID. Conclusion We observed a significant positive correlation between the MRI-based SOAS score and functional improvement following TSA measured using change in ASES scores, indicating that patients with more advanced degenerative changes on MRI had greater improvement after shoulder replacement surgery. We found that the correlation strength was highest when comparing total SOAS score to ΔASES as opposed to any individual sub-component of the SOAS score. The MRI-based SOAS score for shoulder osteoarthritis may be a valuable tool for predicting patient outcomes following TSA. Level of evidence Level III; Retrospective Cohort Comparison; Prognosis Study

D-dimer levels are elevated in COVID 19 and they correlate to the levels of other inflammatory markers such us ferritin, fibrinogen and C-reactive protein. It may be possible to correct D-dimer value in function of inflammatory markers, thus identifying patients at higher risk of venous thromboembolism (VTE). Our objectives are estimating a corrected value of plasma D-dimer as a linear function of ferritin, C-reactive protein and fibrinogen and stablishing a cut-off point of high probability of VTE.Age and sex matched case-control study of all patients diagnosed with COVID 19 and VTE between March and May 2020 in a tertiary hospital in Madrid (Spain). Using linear regression, the best predictive model will be estimated and residual D-dimer values will be obtained and analyzed using ROC curves to determine its discriminative performance.Thirty-eight cases and seventy-six controls were included. There was 63.2% of men and mean age was 68.2. D-dimer was best predicted by a linear model including fibrinogen, ferritin and C-reactive protein. Using residual values, the optimal cutoff point was 2165 ng/mL, with a sensitivity of 57.9% and specificity of 98.7%.It is possible to estimate a D-dimer corrected value in function of ferritin, C-reactive protein and fibrinogen. Using the observed and estimated value we can obtain a residual value that performs well as a screening method to detect patients who would benefit for further VTE diagnostic testing.El dímero-D está elevado en la COVID-19 y se correlacionan con los niveles de otros marcadores inflamatorios como ferritina, fibrinógeno y proteína C reactiva. Cabe la posibilidad de corregir el dímero-D en función de dichos marcadores inflamatorios, identificando así los pacientes con mayor riesgo de enfermedad tromboembólica venosa (ETV). Nuestros objetivos son estimar un valor corregido de dímero-D como función lineal de ferritina, proteína C reactiva y fibrinógeno, y establecer un punto de corte de alta probabilidad de ETV.Estudio de casos y controles emparejados por sexo y edad de todos los pacientes diagnosticados con COVID-19 y ETV entre marzo y mayo de 2020 en un hospital terciario de Madrid, España. Mediante regresión lineal, se estima el mejor modelo predictivo y se obtiene el valor residual de dímero-D. Este se analizará con curvas ROC para determinar su capacidad discriminativa.Se incluyeron 38 casos y 76 controles. Había un 63,2% de varones y la edad media fue de 68,2 años. El valor de dímero-D fue predicho por un modelo que incluyó fibrinógeno, ferritina y proteína C reactiva. Usando los valores residuales, el punto de corte óptimo estimado de 2.165 ng/ml, con una sensibilidad del 57,9% y una especificidad del 98,7%.Es posible estimar un valor corregido de dímero-D en función de ferritina, fibrinógeno y proteína C reactiva. Usando el valor observado y estimado podemos obtener un valor residual que funciona bien como método de cribado para detectar pacientes que podrían beneficiarse de más estudios diagnósticos de la ETV.

BACKGROUND: Sickle cell disease (SCD) is a rare hemoglobinopathy which can result in chronic liver disease and cirrhosis. Patients with SCD have an increased risk of hematologic malignancy, but the prevalence of hepatocellular carcinoma (HCC) in this population is unknown. Herein, the association of SCD with HCC was examined using registry data. METHODS: The SEER-Medicare database was queried to identify patients diagnosed with HCC between 2000 and 2015, and further stratified by SCD status. Propensity matching was performed to examine cancer-related survival and treatment outcomes. RESULTS: Overall 56,934 patients with HCC were identified, including 81 patients with SCD. Patients with SCD more frequently had cirrhosis [48.1% (39/81) vs 23.5% (13,377/56,853), p

The pathogenesis of primary focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) remains unknown to date. Some circulating permeability factors are being discussed. This work assessed molecule candidates for permeability in serum samples of patients with nephrotic syndrome (NS). MATERIALS AND METHODS 41 patients with chronic glomerulonephritis (CGN) were included in our study. 17 patients had FSGS, 7 patients had MCD, 5 patients had membranoproliferative glomerulonephritis (MPGN), 6 patients had IgA nephropathy, and 6 patients had membranous nephropathy (MN). The laboratory data were compared with the clinical and histological features of nephritis. Serum levels of plasminogen activator urokinase receptor (uPAR) and cardiotrophin-like cytokine factor 1 (CLCF-1)were measured by ELISA. RESULTS The serum levels of uPAR were higher in FSGS patients before treatment than in patients with other morphological forms (MCD, IgA nephropathy, MN, and MPGN). The levels of uPAR in serum did not correlate with daily proteinuria, serum creatinine/eGFR, arterial hypertension, the number of sclerosed glomeruli, or tubulointerstitial fibrosis. No correlations were found between the levels of CLCF-1 in serum and creatinine levels/glomerular filtration rate, the percentage of sclerosed glomeruli, or the severity of tubulointerstitial fibrosis. There were no significant differences between the histological variants of nephritis. However, we found correlations between CLCF-1 levels and proteinuria and lipid levels. CONCLUSION The data indicate an increase in the serum uPAR levels of FSGS before treatment. CLCF-1 levels in serum do not depend on histological forms of CGN, kidney function, or immunosuppressive treatment, but they correlate with proteinuria and serum lipids in patients with NS.

Background The safety and immunogenicity profile of COVID-19 vaccines when administered concomitantly with seasonal influenza vaccines have not yet been reported. We therefore aimed to report the results of a substudy within a phase 3 UK trial, by evaluating the safety, immunogenicity, and efficacy of NVX-CoV2373 when co-administered with licensed seasonal influenza vaccines. Methods We did a planned exploratory substudy as part of the randomised, observer-blinded, placebo-controlled, phase 3 trial of the safety and efficacy of the COVID-19 vaccine (NVX-CoV2373) by co-administrating the influenza vaccine at four study hospitals in the UK. Approximately, the first 400 participants meeting the main study entry criteria—with no contraindications to influenza vaccination—were invited to join the substudy. Participants of the main study were randomly assigned (1:1) to receive two intramuscular injections of either NVX-CoV2373 (5 μg) or placebo (normal saline) 21 days apart; participants enrolled into the substudy were co-vaccinated with a single (0·5 mL) intramuscular, age-appropriate (quadrivalent influenza cell-based vaccine [Flucelvax Quadrivalent; Seqirus UK, Maidenhead] for those aged 18–64 years and adjuvanted trivalent influenza vaccine [Fluad; Seqirus UK, Maidenhead] for those ≥65 years), licensed, influenza vaccine on the opposite deltoid to that of the first study vaccine dose or placebo. The influenza vaccine was administered in an open-label manner and at the same time as the first study injection. Reactogenicity was evaluated via an electronic diary for 7 days after vaccination in addition to monitoring for unsolicited adverse events, medically attended adverse events, and serious adverse events. Immunogenicity was assessed with influenza haemagglutination inhibition and SARS-CoV-2 anti-spike protein IgG assays. Vaccine efficacy against PCR-confirmed, symptomatic COVID-19 was assessed in participants who were seronegative at baseline, received both doses of study vaccine or placebo, had no major protocol deviations affecting the primary endpoint, and had no confirmed cases of symptomatic COVID-19 from the first dose until 6 days after the second dose (per-protocol efficacy population). Immunogenicity was assessed in participants who received scheduled two doses of study vaccine, had a baseline sample and at least one post-vaccination sample, and had no major protocol violations before unmasking (per-protocol immunogenicity population). Reactogenicity was analysed in all participants who received at least one dose of NVX-CoV2373 or placebo and had data collected for reactogenicity events. Safety was analysed in all participants who received at least one dose of NVX-CoV2373 or placebo. Comparisons were made between participants of the substudy and the main study (who were not co-vaccinated for influenza). This study is registered with ClinicalTrials.gov, number NCT04583995. Findings Between Sept 28, 2020, and Nov 28, 2020, a total of 15 187 participants were randomised into the main phase 3 trial, of whom 15 139 received treatment (7569 received dose one of NVX-CoV2373 and 7570 received dose one of placebo). 431 participants were co-vaccinated with a seasonal influenza vaccine in the substudy (217 received NVX-CoV2373 plus the influenza vaccine and 214 received placebo plus the influenza vaccine). In general, the substudy participants were younger, more racially diverse, and had fewer comorbid conditions than those in the main study. Reactogenicity events were more common in the co-administration group than in the NVX-CoV2373 alone group: tenderness (113 [64·9%] of 174 vs 592 [53·3%] of 1111) or pain (69 [39·7%] vs 325 [29·3%]) at injection site, fatigue (48 [27·7%] vs 215 [19·4%]), and muscle pain (49 [28·3%] vs 237 [21·4%]). Incidences of unsolicited adverse events, treatment-related medically attended adverse events, and serious adverse events were low and balanced between the co-administration group and the NVX-CoV2373 alone group. No episodes of anaphylaxis or deaths were reported within the substudy. Co-administration resulted in no change to influenza vaccine immune response although a reduction in antibody responses to the NVX-CoV2373 vaccine was noted. NVX-CoV2373 vaccine efficacy in the substudy (ie, participants aged 18 to

BACKGROUND Higher neuroticism and lower conscientiousness are risk factors for Alzheimer's disease and related dementias, but the underlying neuropathological correlates remain unclear. Our aim was to examine whether personality traits are associated with amyloid and tau neuropathology in a new sample and meta-analyses. METHODS Participants from the BLSA (Baltimore Longitudinal Study of Aging) completed the Revised NEO Personality Inventory and underwent amyloid (11C-labeled Pittsburgh compound B) and tau (18F-flortaucipir) positron emission tomography. RESULTS Among cognitively normal BLSA participants, neuroticism was associated with higher cortical amyloid burden (odds ratio 1.68, 95% confidence interval 1.20-2.34), and conscientiousness was associated with lower cortical amyloid burden (odds ratio 0.61, 95% confidence interval 0.44-0.86). These associations remained significant after accounting for age, sex, education, depressive symptoms, hippocampal volume, and APOE e4. Similar associations were found with tau in the entorhinal cortex. Random-effects meta-analyses of 12 studies found that higher neuroticism (N = 3015, r = 0.07, p = .008) and lower conscientiousness (N = 2990, r = -0.11, p

PURPOSE: Abiraterone and enzalutamide are commonly used oral cancer therapies for patients with prostate cancer, both with potentially high out-of-pocket costs for patients. We investigated the prevalence of financial assistance mechanisms used to alleviate out-of-pocket costs and the association of these mechanisms with timing of treatment initiation of abiraterone or enzalutamide. METHODS: Using data from the medical center's specialty pharmacy, we identified first prescriptions for abiraterone or enzalutamide between January 1, 2017, and March 31, 2019. Prescriptions dispensed at an external pharmacy or that were discontinued for reasons unrelated to cost were excluded. Patient demographics, insurance coverage, out-of-pocket cost, and number of days between prescribed date and pill-to-mouth date were collected. RESULTS: Among 220 prescriptions in our final cohort, 185 were filled through our internal specialty pharmacy, 23 through a manufacturer-sponsored patient assistance program (PAP), and 12 were never filled because of cost. One third of the prescriptions in our final cohort (n = 66) were filled with financial assistance: PAP (10%), copay cards (9%), and grants (11%). The median amount of assistance received for the first fill was $2,860 US dollars (USD) (interquartile range $1,856-$10,717 USD). Prescriptions with an out-of-pocket cost < $100 USD were filled in the shortest time (median 5 days), whereas those filled through a PAP had the longest time to initiation (median 30.5 days). CONCLUSION: Among patients prescribed oral therapies for prostate cancer at a single institution, one third of patients received financial assistance. Although receiving assistance is likely to improve financial toxicity, waiting for assistance may lead to longer time to initiation of medication.

There is no regulation in emerging markets, i.e. Indonesia imposing the gender diversity quota. Therefore, based on the different characteristics and attributes between developed and emerging markets, this study aims to analyze the impact of the boardroom’s gender diversity on the quality of accruals, i.e. earnings in big Indonesian firms. This study used a sample of 100 big manufacturing firms in Indonesia. Moreover, this paper utilized a widely used proxy for the quality of earnings and the boardroom’s gender diversity. Data panel with fixed effect method was used to compute the quality of accruals while path analysis was utilized for hypotheses testing. Furthermore, the results showed evidence that the boardroom’s gender diversity indirectly influenced the quality of accruals through cash flow variability. However, the presence of female directors is not a significant inducement for managers to report better quality of earnings. The managerial implication of this study is that the boardroom’s gender diversity is good for the emerging markets since it supports better accounting accruals indirectly. Future studies should incorporate many industries and consider the potential of endogeneity, which has not been tackled in this paper.

Background Increases in mental health problems have been observed during the COVID-19 pandemic. The objectives were to examine the extent to which mental health symptoms changed during the pandemic in 2020, whether changes were persistent or short lived, and if changes were symptom specific. Methods Systematic review and meta-analysis of longitudinal cohort studies examining changes in mental health among the same group of participants before vs. during the pandemic in 2020. Results Sixty-five studies were included. Compared to pre-pandemic outbreak, there was an overall increase in mental health symptoms observed during March-April 2020 (SMC = .102 [95% CI: .026 to .192]) that significantly declined over time and became non-significant (May-July SMC = .067 [95% CI: -.022 to .157]. Compared to measures of anxiety (SMC = 0.13, p = 0.02) and general mental health (SMC = -.03, p = 0.65), increases in depression and mood disorder symptoms tended to be larger and remained significantly elevated in May-July [0.20, 95% CI: .099 to .302]. In primary analyses increases were most pronounced among samples with physical health conditions and there was no evidence of any change in symptoms among samples with a pre-existing mental health condition. Limitations There was a high degree of unexplained heterogeneity observed (I2s > 90%), indicating that change in mental health was highly variable across samples. Conclusions There was a small increase in mental health symptoms soon after the outbreak of the COVID-19 pandemic that decreased and was comparable to pre-pandemic levels by mid-2020 among most population sub-groups and symptom types.

Pharmacotherapy may be indicated to treat a variety of conditions for patients living with human immunodeficiency virus. It is important for nurse practitioners (NPs) to be aware of clinically significant interactions involving antiretroviral therapy and other prescribed drugs or over-the-counter products, herbal therapies, and dietary supplements. Drug interactions may result in adverse clinical outcomes by increasing or decreasing drug levels, which subsequently may compromise viral control, enhance risk of toxicity, or have other unintended effects. Various clinical resources are available for NPs to make safer prescribing decisions.

Nowadays, transactions on e-commerce platforms (e-payment) utilizing a credit card are popular. Using credit cards for electronic purchases over the Internet is much different from offline purchases in traditional stores; only online transactions do not include either physical credit card or a signature. The e-payment has become a common mode of payment for online transactions made. It is an electronic billing system that gives clients the ability to make payments using the Internet. The objective of this paper was to analyze the associations among continuance intention e-payment, effort expectancy, facilitating conditions, performance expectancy, social influence, and actual usage of e-payment. The data was tested empirically on data collected from 667 Generation Z e-payment users in Malaysia. The results found that facilitating conditions, performance expectancy, and social influence impacted the actual usage of e-payment. Surprisingly, effort expectancy was not significantly associated with the actual e-payment usage. The findings of this study have several implications for managers and point the way towards future research. No prior empirical study has investigated the role of the Unified Theory of Acceptance and Use of Technology model on e-payment usage among Generation Z in Malaysia to the best of the authors’ knowledge. These results provide valuable contributions that can help decision-makers formulate or adjust their strategies associated with e-payments.

Second-generation COVID-19 vaccines could contribute to establish protective immunity against SARS-CoV-2 and its emerging variants. We developed COH04S1, a synthetic multiantigen modified vaccinia Ankara-based SARS-CoV-2 vaccine that co-expresses spike and nucleocapsid antigens. Here, we report COH04S1 vaccine efficacy in animal models. We demonstrate that intramuscular or intranasal vaccination of Syrian hamsters with COH04S1 induces robust Th1-biased antigen-specific humoral immunity and cross-neutralizing antibodies (NAb) and protects against weight loss, lower respiratory tract infection, and lung injury following intranasal SARS-CoV-2 challenge. Moreover, we demonstrate that single-dose or two-dose vaccination of non-human primates with COH04S1 induces robust antigen-specific binding antibodies, NAb, and Th1-biased T cells, protects against both upper and lower respiratory tract infection following intranasal/intratracheal SARS-CoV-2 challenge, and triggers potent post-challenge anamnestic antiviral responses. These results demonstrate COH04S1-mediated vaccine protection in animal models through different vaccination routes and dose regimens, complementing ongoing investigation of this multiantigen SARS-CoV-2 vaccine in clinical trials.

During the course of COVID-19 pandemic, a wide range of scientific projects was implemented worldwide, including studies focusing on infection fatality rate (IFR). The value of IFR depends on the number of COVID-19 deaths in a population in a given period and the number of infected people in this population, usually provided by seropepidemiological studies (anti-SARS-CoV-2 IgG in the case of COVID-19). The objective of our study was to estimate IFR in the course of COVID-19 pandemic in 2020, in the general population of Upper Silesia Metropolitan Area (USMA).The seroepidemiological study was conducted in October-November 2020. Among randomly selected inhabitants of Katowice, Gliwice, and Sosnowiec (N = 1167), the presence of SARS-CoV-2 virus infection was assessed based on a positive IgG test result performed with the ELISA method. Data on deaths due to COVID-19 were obtained from the Registry Offices of each city. The infection fatality rate was calculated using the formula IFR (%) = [number of deaths/number of infected] × 100.Results of our study showed the prevalence of infection at 11.4% (95% CI: 9.5-13.2). In three examined towns, in the period January-November 2020, there was a total of 516 COVID-19 deaths. The resulting crude IFR was 0.65% (95% CI: 0.56-0.78). The IgG test had 88% sensitivity and 99% specificity and these figures were used to adjust IFR. The adjusted IFR value was similar to the crude value: IFR = 0.62% (95% CI: 0.53-0.74).The value of IFR estimated for the USMA population was similar to average values obtained in other countries and can be used as the background for monitoring the course and impact of COVID-19 pandemic in the Upper Silesian Industrial Area. Med Pr. 2021;72(6):671-6.W trakcie pandemii COVID-19 wszczęto w skali globalnej szerokie spektrum badań, w tym także ukierunkowanych na oszacowanie wskaźnika śmiertelności infekcji (Badanie seroepidemiologiczne przeprowadzono w październiku i listopadzie 2020 r. Wśród losowo wybranych mieszkańców Katowic, Gliwic i Sosnowca (N = 1167) oceniano obecność zakażenia wirusem SARS-CoV-2 na podstawie dodatniego wyniku testu IgG wykonanego metodą ELISA. Dane o zgonach z powodu COVID-19 uzyskano z Urzędów Stanu Cywilnego każdego z miast. Wskaźnik śmiertelności infekcji obliczono, stosując formułę: IFR (%) = (liczba zgonów / liczba zakażonych) × 100.Wyniki badania potwierdziły obecność przeciwciał anty-SARS-CoV-2 (klasa IgG) na poziomie 11,4% (95% CI: 9,5–13,2). Do listopada 2020 r. w populacji ww. miast zarejestrowano 516 zgonów, a tym samym surowy współczynnik IFR wyniósł 0,65% (95% CI: 0,56–0,78). Test diagnostyczny (IgG) odznaczał się czułością na poziomie 88% i swoistością wynoszącą 99%. Parametry te pozwoliły na oszacowanie skorygowanej pod względem trafności diagnostycznej testu wartości IFR. Skorygowany IFR miał podobną wartość: 0,62% (95% CI: 0,53–0,74).Oszacowana dla populacji AG wartość IFR jest zbliżona do przeciętnych poziomów obserwowanych w innych państwach i stanowi podstawę monitorowania przebiegu i skutków pandemii COVID-19 w tym regionie. Med. Pr. 2021;72(6):671–676.

Saat ini kita ketahui bahwa seluruh dunia sedang mengalami dampak dari pandemi COVID–19, baik dari segi ekonomi maupun sosial. Salah satu sektor masyarakat yang terkena dampak ekonomi adalah Persaudaraan Muda-mudi Vihara Dharma Loka (PMVDL) yang berlokasi di Kota Pekanbaru, Provinsi Riau. Banyaknya kerugian secara ekonomi yang didapatkan oleh masyarakat Kota Pekanbaru berdampak pada semakin berkurangnya donatur yang membantu kegiatan keorganisasian PMVDL. Oleh karena itu melalui kegiatan Kuliah Kerja Nyata (KKN) yang dilakukan secara online, Kelompok KKN 68 memberikan program berupa pengenalan teh kombucha dalam rangka memberdayakan masyarakat yang tergabung di PMVDL untuk memulai bisnis secara mandiri sehingga diharapkan dapat meningkatkan perekonomian. Kegiatan yang dilakukan dimulai dari pengenalan dan pembuatan teh kombucha, pengemasan produk agar layak dipasarkan pada platform social media dan perhitungan biaya yang dibutuhkan dalam proses produksi sehingga masyarakat mengetahui keuntungan yang diperoleh dari bisnis tersebut. Kegiatan ini dilakukan melalui seminar online dan pemantauan praktek pembuatan produk secara mandiri yang dilakukan oleh anggota PMVDL. Hasil akhir yang didapatkan yaitu produk teh kombucha yang diproduksi dan dibranding oleh peserta, terbentuknya akun Instagram Ads. sebagai sarana promosi online, serta adanya rancangan buku anggaran. Keterlibatan peserta secara aktif serta antusiasme dalam pelaksanaan program menunjukkan bahwa kegiatan yang dilakukan oleh Kelompok KKN 68 dapat diterima dengan baik serta memberikan manfaat sebagai salah satu ide bisnis di masa pandemi untuk mengatasi permasalahan ekonomi.

Background Acute febrile illnesses (AFIs), including dengue, scrub typhus and leptospirosis, cause significant morbidity and mortality in Southeast Asia. Serological surveillance can be used to investigate the force and distribution of infections. Dried blood spot (DBS) samples are an attractive alternative to serum because they are easier to collect and transport and require less cold storage. We conducted a pilot study to determine the feasibility of integrating serological surveillance for dengue, scrub typhus and leptospirosis into a population-representative lymphatic filariasis seroprevalence survey in Timor-Leste using DBSs. Methods A total of 272 DBSs were collected from healthy community participants. DBSs were analysed at the National Health Laboratory using commercially available enzyme-linked immunosorbent assays. To validate assays for DBSs, 20 anonymised serum samples of unknown serostatus were used to create dried serum spots (DSSs). These were analysed with optical densities compared with those of serum. Where low variance was observed (dengue assay) the published kit cut-offs for serum were applied to the analysis of DBSs. For the other assays (scrub typhus and leptospirosis), index values (IVs) were calculated and cut-offs were determined to be at 2 standard deviations (SDs) above the mean. Results Of the 272 samples analysed, 19 (7.0% [95% confidence interval {CI} 4.3 to 10.7]) were positive for dengue immunoglobulin G (IgG), 11 (4.0% [95% CI 2.1 to 7.1]) were positive for scrub typhus IgG and 16 (5.9% [95% CI 3.4 to 9.4%]) were positive for leptospira IgG. Conclusions While dengue seroprevalence was lower than in nearby countries, results represent the first evidence of scrub typhus and leptospirosis transmission in Timor-Leste. Integrated programmes of serological surveillance could greatly improve our understanding of infectious disease epidemiology in remote areas and would incur minimal additional fieldwork costs. However, when planning such studies, the choice of assays, their validation for DBSs and the laboratory infrastructure and technical expertise at the proposed location of analysis must be considered.

The objective of the study was to establish the influence of utilisation of project budget as a monitoring and evaluation tool and sustainability of community agricultural projects supported by Caritas in Meru County, Kenya. A pragmatic research paradigm was adopted and a descriptive survey research design was utilised. A pragmatic research paradigm was adopted and a descriptive survey research design was utilised. The target population was 59 smallholder farmer groups and 24 Caritas Meru staff. The sample size was 51 smallholder farmer groups and the total sample size was 177 respondents. The data collection tools were questionnaires and interview guides. The collected data were coded and entered into the SPSS version 26 program for analysis. The qualitative data was analysed by way of grouping similar responses together and identifying the main themes from them. The linear regression and Pearson’s correlation (r) methods were utilised to evaluate the link between various variables. The multiple linear regression models determined the link between dependent and independent variables together with the moderating effect of the moderating variable. It is also used as the inferential statistics that inform the decision to reject or not reject the alternative hypothesis for the research study. The study found out that an increase in the utilisation of project budgets leads to an increase in the sustainability of the community agricultural project by Caritas in Meru County and vice versa. The study concludes that there is a significant relationship between utilisation of project budget as monitoring & evaluation and sustainability of community agriculture projects. The study recommends that to ensure the sustainability of community-based agricultural projects, the organisation should train farmers’ group leaders on leadership and management skills. The organisation should train farmers on best farming practices, record keeping and conflict management practices to avoid the collapse of groups.

Today, most of the business transactions carried out by an economic entity, including in the process of settlements with counterparties, are associated with cash flows. Therefore, the issues of internal control are of particular relevance, which contributes to information and consulting support and optimization of the financial and economic activities of the enterprise. The purpose of the work is to develop methodological tools for internal control of funds at the enterprise. In the course of the study, forms of working documents for internal control were developed. To determine a general strategy and a detailed approach to conducting effective control procedures, it was proposed to use an internal control program, which should take into account its resource support, namely, the personnel who will carry out the audit; normative and informational support of the audit; methodological support of verification. The proposed working document of internal control “Test for assessing the accounting system for cash transactions” is designed to collect complete and reliable information about the organization of the accounting system of cash flows, assess the degree of ensuring their safety and intended use at the enterprise. To summarize the results of checking cash flow operations at the cash desk of the enterprise and in bank accounts, their expediency and validity, as well as fixing violations identified in the process of internal control, reports on the results of the audit and detected violations were developed such working documents as: “Report on results checks of cash transactions”, “Checking operations on the movement of funds on settlement accounts in the bank” and “Revealed violations in the accounting of banking operations”. Based on the results of the audit, summarized in the proposed working documents of internal control, the company's management can make managerial decisions to improve the efficiency of the use of funds based on the creation of a liquidity management system.

Relevance: The use of fixed orthodontic structures increases the risk of developing dental diseases. An effective way to prevent dental diseases is personalized training and monitoring of individual oral hygiene. Purpose of the work: To increase the effectiveness of the prophylaxy of dental diseases in patients undergoing orthodontic treatment. Materials and Methods: The analysis of 60 medical records in the municipal and private clinics of Saratov was carried out. The age of the patients was 13–18 years old. There also was a survey among 15 orthodontists on the subject of the identifying difficulties of using the personification of an integrated approach. A questionnaire was given to the patients. The age of the respondents was 13–18 years old. Results: According to the analysis of data from medical records in municipal and private clinics, a low prevalence of the use of an individual approach in the prescription of personal oral hygiene products in patients undergoing treatment with the use of fixed orthodontic structures was revealed, which is associated with an insufficient amount of time for admission within the framework of the compulsory medical insurance system, and also with low compliance of patients and their parents, as well as low hygienic education of patients, insufficient government attention to preventive dentistry, and lack of labor rates for dental hygienists. When questioning patients, difficulties in adhering to recommendations for personal oral hygiene was revealed. Conclusions. We have developed an algorithm of actions to improve the effectiveness of individual oral hygiene among adolescents undergoing orthodontic treatment. The proposed measures will increase the level of motivation and compliance of patients.

The growth in the number of road transport is an integral part of Ukraine's development. At the same time, this is a significant negative factor affecting urban ecosystems. In the paper, the most significant aspects and criteria for their evaluation were identified to assess the negative impact of the transport company on the urban ecosystem. The impact of the Kremenchuk Motor Transport Enterprise on the urban ecosystem of the city of Kremenchuk (Poltava region) was assessed. The main pollutants in the region's air basin are stationary sources. However, the predominant sources of air pollution are emissions from mobile sources. The criteria for assessing the level of environmental safety of a motor transport enterprise were improved. The "Comprehensive assessment of the level of environmental safety of the motor transport enterprise" software tool was developed. It was established that under modern conditions, the level of environmental safety of the motor transport enterprise corresponds to the level of average safety. Comprehensive measures were proposed to ensure the regulatory status of the components of the urban ecosystem and environmental safety on the territory of the Kremenchuk Motor Transport Enterprise.

The rapid development of trade along the Belt and Road Initiative (BRI) directly affect economic growth and influence carbon emission. This study used fifty-two BRI countries out of the sixty-five countries that signed onto the BRI in 2013 for the empirical study. The panel data extracted is from the period 1993 to 2018. The study utilized the Common Correlated Effects Mean Group (CCEMG) and the Augmented Mean Group (AMG) estimation techniques for the empirical analysis. The findings revealed a positive link between imports and carbon emissions. Contrarily, exports revealed an inverse relationship with carbon emission, while foreign direct investment inflow revealed a positive but insignificant relationship with consumption-based carbon emission. Therefore, it is recommended that to control the environment and maintain ecological balance, there is the need to establish environmental protection clauses in many international treaties and domestic legislation while promoting international trade.

This prospective study examined the association between self-rated health and incident dementia in two large cohorts of middle-aged and older adults. Participants were drawn from the Health and Retirement Study (HRS, N = 13,839, Mean Age = 64.32, SD = 9.04) and the English Longitudinal Study of Ageing (ELSA, N = 4649, Mean Age = 64.44, SD = 9.97). Self-rated health and covariates were assessed at baseline in 1998 and 2002, and cognitive status was tracked for up to 21 years in HRS and 17 years in ELSA, respectively. Controlling for demographic factors, poorer self-rated health was associated with higher risk of incident dementia in HRS (HR: 1.18, 95%CI: 1.12-1.24, p .001) and ELSA (HR: 1.38, 95%CI: 1.23-1.55, p .001). These associations remained significant when diabetes, hypertension, smoking, physical inactivity, depressive symptoms, personality, and polygenic risk for Alzheimer's Disease were included as additional covariates or when cases occurring within the first ten years of follow-up were excluded from the analyses. There was no replicable evidence that age, sex, education, race or ethnicity moderated the association. Self-rated health is a long-term, replicable predictor of incident dementia that is independent of genetic, clinical, and behavioral risk factors.

In postmodern area, flexible and innovative management should become an integral part of the European education system as every knowledge-based society demands to educate high-quality specialists. The present research combines two dimensions: structural and administrative, including a dual fringe of both management and teacher education environments in the Nordic democratic space. The article offers a comparative analysis of the structural model, administrative principles, and new management initiatives in teacher professional training within the tertiary education system of neo-liberal Denmark. The Danish context is the most essential because this country has gained a unique experience in creating an effective system of self-governing teacher education institutions existing on a relevant background of centralized and decentralized management principles. The methodological contribution of this research is based on a case study approach that includes methods of qualitative analysis, critical induction, information reinterpretation, and generalization. Neo-liberal management initiatives of the Danish democratic state aimed at improving pedagogical education after postmodern period are considered to be a part of the response to the ongoing need for high-quality professional training of teachers based on a solid foundation of autonomy and effective innovative practices.

Anggaran infrastruktur di Indonesia pada tahun 2015 mengalami peningkatan pesat hingga 62,7% dibandingkan tahun sebelumnya. Selama lima tahun, angka ini terus tumbuh hingga tahun 2019 meningkat sebesar 62%. Melonjaknya peningkatan anggaran infrastruktur era pemerintahan Presiden Jokowi dilakukan demi mempercepat pertumbuhan ekonomi di Indonesia. Namun, hingga akhir periode pertama pemerintahannya, sepertiga wilayah di Indonesia masih memiliki pertumbuhan ekonomi di bawah 5%. Selain itu, hampir 60% pertumbuhan ekonomi di Indonesia disumbang dari Pulau Jawa. Penelitian ini bertujuan untuk menganalisis pengaruh infrastruktur ekonomi dan sosial, yaitu infrastruktur jalan, listrik, air, kesehatan, dan TIK terhadap pertumbuhan ekonomi di Indonesia pada periode 2015-2019. Analisis yang dilakukan menggunakan regresi data panel dengan metode estimasi Fixed Effect Model SUR. Hasil penelitian menunjukkan bahwa kelima variabel infrastruktur berpengaruh positif dan signifikan terhadap pertumbuhan ekonomi di Indonesia pada tahun 2015-2019.

India and the Association of Southeast Asian Nations’ (ASEAN) partnership began in the early 1990s mainly in the economic domain. Reeling from a major internal crisis, India wanted to tap onto the region’s economic vibrancy to strengthen its own waning economy. Since then, amidst India’s domestic constraints, economic ties have largely sustained the India–ASEAN partnership on a steady course. India’s withdrawal from the ASEAN-led Regional Comprehensive Economic Partnership (RCEP) negotiations in 2019, therefore, was an important inflection point in the partnership. This study, hence, discusses the prospects for the India–ASEAN partnership moving forward beyond the RCEP. This is undertaken by first examining the main challenges India faces with the ASEAN Free Trade Arrangement and the RCEP. After which, relevant developments pertaining to India’s multilateral partnership within the Indo-Pacific theatre as well as to India’s economic trajectory are deliberated in relation to ASEAN. Based on this analysis, this study argues that the outlook for India–ASEAN ties remains optimistic since the external and internal pressures needed for important economic reforms has not diminished for India. In addition, there are prospects for wider engagements with ASEAN due to Indo-Pacific-related strategic recalibrations in the region. Therefore, collectively these factors will provide crucial thrusts for the partnership to move forward strongly sans RCEP.

Zusammenfassung Ziel der Studie Die Evaluation komplexer Interventionen wie Versorgungsformen ist methodisch herausfordernd. Ziel dieser Analyse ist anhand generalisierter Schätzungsgleichungen (GEE) zu prüfen, wie sich die Qualitätsunterschiede zwischen der Hausarztzentrierten Versorgung (HZV) und der Regelversorgung über die Zeit entwickeln. Methoden Auf der Basis von Routinedaten der AOK Baden-Württemberg wurde eine längsschnittliche Sekundärdatenanalyse der Jahre 2011 bis 2018 durchgeführt. Versicherte mit passenden Einschlusskriterien wurden im Sinne einer dynamischen Kohorte zu Beginn des jeweiligen Beobachtungsjahres in die Analyse eingeschlossen, sodass der Umfang und die Zusammensetzung der Kohorte von Jahr zu Jahr variierten. Mithilfe von GEE wurden Qualitätsunterschiede in dichotomen Indikatoren zwischen der HZV und der Regelversorgung untersucht, wobei für Mehrfachmessungen eine autoregressive Kovarianzstruktur (AR1) zugrunde gelegt wurde. An Variablen wurden berücksichtigt: Eine Gruppenvariable für die Versorgungsformen, eine Variable für das betrachtete Jahr sowie eine Wechselwirkung zwischen den beiden Variablen. Die aus der Modellierung resultierenden Schätzer lieferten Auskunft darüber, wie das Verhältnis der beiden Gruppen zu Beginn der Beobachtungsstudie war und wie sich die Gruppentrends sowohl individuell als auch im Verhältnis zueinander über die Zeit entwickelten. Ergebnisse GEE wird beispielhaft auf den Qualitätsindikator Verordnung von potenziell inadäquater Medikation (PIM) bei älteren Versicherten angewandt. Die Chance einer PIM-Verordnung bei über 65-jährigen (Jahr 2018; N=628 523) war zu Beginn der Beobachtungszeit innerhalb der HZV signifikant niedriger als in der Regelversorgungsgruppe (Odds Ratio 0,978; 95%-Konfidenzintervall: 0,968–0,987). In beiden Gruppen nahm die Chance einer PIM-Verordnung in den betrachteten 7 Beobachtungsjahren ab, in der HZV-Gruppe stärker als in der Regelversorgungsgruppe. Schlussfolgerung Eine Trendanalyse mit GEE basierend auf Sekundärdaten, die die Qualitätsunterschiede zwischen Vergleichsgruppen abbildet, bietet großes Potenzial zur Evaluation neuer und bestehender Versorgungsformen über die Zeit.

Introduction: Guided single implant placement ensures an optimal implant position, enables in-surgery immediate loading, and creates a predisposition for predictable treatment results. Aim: This article aims to present the surgical and loading protocols and assess the accuracy of two guided implant systems. Materials and methods: Ten patients missing a single molar were included. The semi-guided procedures with the two implant systems – AB Dental and Alpha Bio-Tec, were randomly assigned to each participant. The computer-assisted planning was performed with Implant Studio (3Shape, Denmark). Surgical guides and long-term, temporary, screw-retained restorations were virtually generated within the 3Shape system. Surgical appliances were printed from SG resin (Formlabs, USA), and crowns were milled from Telio CAD (Ivoclar Vivadent, Lichtenstein). Planning accuracy was evaluated based on the crown’s fit and relation to the adjacent teeth and antagonists. Results and discussion: The patients included for preliminary analysis (6 female and 4 male) were with a mean age of 33.42. The youngest was 24, and the oldest 49 years old. There were no surgical and technical complications for the period of evaluation, which ranged from 1 to 3 months. The crown’s fit was excellent in 8 cases. In two cases, minor adjustments were necessary – 1 in relation to the antagonists and 1 to the adjacent teeth. In one case, a healing screw was placed for 48 hours to facilitate adequate soft-tissue space for the Ti-base. Conclusion: The preliminary results presented in this report suggest that the clinical and laboratory protocols used for guided implantation and immediate loading are highly efficient.

OBJECTIVE Spread through air spaces (STAS) is a pattern of invasion present in some adenocarcinomas (ADC). The goal of this study was to assess the impact of STAS in patients treated with different types of surgical resections and on the clinical outcome in patients with ADC of different diameters and with different degrees of nodal involvement. METHODS A total of 109 patients were reviewed. Complete surgical resection with systematic nodal dissection was achieved in all patients. The median follow-up was 65 months (3–90 months). RESULTS STAS was observed in 70 cases (64.2%); 13 patients (18.5%) had lymph node involvement (N1 and N2). Overall survival and progression-free survival were higher in patients without STAS (P = 0.042; P = 0.027). The presence of STAS in tumours ≤2 cm was a predictor of worse progression-free survival following sublobar resection compared to major resections (P = 0.011). Sublobar resection of N0 STAS-positive tumours was associated with worse long-term survival compared to a major resection (P = 0.04). Statistical analyses showed that age >70 years and recurrence were independent variables for survival; smoking pack-years >20, sublobar resection and nodal involvement were independent variables for recurrence; and smoking pack-years >20 were independent variables for a history of cancer and pleural invasion for local recurrence. CONCLUSIONS STAS seems to play a role in long-term survival, particularly for patients with N0 and tumours smaller than 2 cm. Further studies are necessary to validate this hypothesis.

According to global data, there is a male reproductive potential decrease. Pathogenesis of male infertility is often associated with autoimmunity towards sperm antigens essential for fertilization. Antisperm autoantibodies (ASAs) have immobilizing and cytotoxic properties, impairing spermatogenesis, causing sperm agglutination, altering spermatozoa motility and acrosomal reaction, and thus preventing ovum fertilization. Infertility diagnosis requires a mandatory check for the ASAs. The concept of the blood–testis barrier is currently re-formulated, with an emphasis on informational paracrine and juxtacrine effects, rather than simple anatomical separation. The etiology of male infertility includes both autoimmune and non-autoimmune diseases but equally develops through autoimmune links of pathogenesis. Varicocele commonly leads to infertility due to testicular ischemic damage, venous stasis, local hyperthermia, and hypoandrogenism. However, varicocelectomy can alter the blood–testis barrier, facilitating ASAs production as well. There are contradictory data on the role of ASAs in the pathogenesis of varicocele-related infertility. Infection and inflammation both promote ASAs production due to “danger concept” mechanisms and because of antigen mimicry. Systemic pro-autoimmune influences like hyperprolactinemia, hypoandrogenism, and hypothyroidism also facilitate ASAs production. The diagnostic value of various ASAs has not yet been clearly attributed, and their cut-levels have not been determined in sera nor in ejaculate. The assessment of the autoimmunity role in the pathogenesis of male infertility is ambiguous, so the purpose of this review is to show the effects of ASAs on the pathogenesis of male infertility.

The purpose of this study was to examine the effect of tunneling incentives, bonus mechanisms and leverage on transfer pricing decisions. This research includes causative research. The population used in this study are manufacturing, mining and plantation companies listed on the Indonesia Stock Exchange for the 2015-2019 period. The sampling technique used in this research is purposive sampling technique. There are 54 manufacturing, mining and plantation companies that are used as research samples. The type of data used is secondary data obtained from the official website of the Indonesia Stock Exchange and the official website of each company. The analytical method used is a quantitative method. The results show that the bonus and leverage mechanisms do not have a positive effect on transfer pricing, but the tunneling incentive variable has a positive effect on transfer pricing.

This study is a quantitative research that aims to obtain empirical evidence about the influence of financial factors (effectiveness ratio, efficiency ratio, solvency ratio and growth ratio) and characteristics of local government (decentralization degree, complexity of local government, area size and audit opinion) on local government financial distress in districts and cities in Aceh Province for the period 2015-2019 for 5 years. The data was obtained from the BPK and BPS. This research used a total sampling method with total sample of 23 districts / cities and used binary logistic regression analysis for analysis of the data. The value of desentralization degree and complexity of local government has a negative and significant effect on financial distress and the value of growth ratio has a positive and significant effect on financial distress. While the value of solvency ratio and area size has no significant effect and positive on financial distress and the value of effectiveness ratio, efficiency ratio and audit opinion has no significant effect and negative on financial distress.

Background Asymptomatic patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) can develop hypercoagulable conditions and acute vascular events. The objective of this study is to determine whether SARS‐CoV‐2 was present in resected specimens from patients with acute bowel ischemia, but asymptomatic for Coronavirus Disease 2019 (COVID‐19) and with persistently real‐time polymerase chain reaction negative pharyngeal swab. Methods Three consecutive patients presented severe abdominal symptoms due to extensive ischemia and necrosis of the bowel, with co‐existent thrombosis of abdominal blood vessels. None had the usual manifestations of COVID‐19, and repeated pharyngeal swabs tested negative. They underwent emergency surgery with intestinal resection. Immunohistochemical testing for SARS‐CoV‐2 on resected tissue was performed. Results All tested samples were strongly positive for SARS‐CoV‐2. Conclusions This is the first case report in which patients with severe intestinal symptoms presented a marked SARS‐CoV‐2 positivity in the resected tissues, without any usual clinical manifestations of COVID‐19. These results suggest that the patients might be infected with SARS‐CoV‐2 presenting acute abdominal distress but without respiratory or constitutional symptoms.

This research aims to examine the effect of profitability, firm size, and KAP size on audit delay. The population in this study are mining companies listed on the Indonesia Stock Exchange (IDX) in 2017-2020. The research sample was determined using the purposive sampling method with a total sample of 29 companies. The data used is secondary data from the company's annual report. The analytical method used is multiple linear regression analysis. The results showed that the profitability had a negative effect on audit delay, the firm size had a positive effect on audit delay, while the KAP size did not affect on audit delay.

This article presents a case of the successful use of dupilumab in a 21-year-old patient with severe atopic dermatitis, concomitant bronchial asthma, and allergic rhinitis. The patient was observed in the allergological department of the Krasnoyarsk Clinical Regional Hospital for 2 years. The disease was characterized by constant skin symptoms, frequent exacerbations, resistance to standard therapy, including systemic glucocorticosteroids and immunosuppressors. Considering the above factors, targeted therapy was started with dupilumab, registered in the Russian Federation for use in atopic dermatitis resistant to standard therapy. Against the background of biological therapy (13 injections were carried out), a stable significant decrease in skin syndrome activity was achieved (SCORAD index decreased from 72 to 9 points), and the patients quality of life significantly improved.

OBJECTIVE The renin-angiotensin-aldosterone system (RAAS) plays a relevant role in regulating blood pressure and thus maintaining cardiovascular homeostasis. While it was recently shown that RAAS parameters are responsive to acute psychosocial stress, the psychobiological determinants of the acute stress-induced RAAS activation have not yet been investigated so far. In a randomized placebo-controlled design, we investigated potential psychological and physiological determinants of the RAAS response and underlying mechanisms. METHODS 57 young healthy male participants underwent either an acute standardized psychosocial stress test or a non-stress placebo task. We measured aldosterone in plasma and saliva, as well as renin, and the stress-reactive endocrine measures adrenocorticotropic hormone (ACTH), epinephrine, and norepinephrine in plasma at rest, immediately after the task and several times up to 3 h thereafter. Moreover, we assessed stress-reactive psychological (anticipatory cognitive stress appraisal, mood, physical discomfort) and basal demographic-physiological measures (age, BMI, blood pressure). RESULTS Acute psychosocial stress elicited changes in all assessed endocrine (p's ≤ .028, ηp2's ≥ .07) and stress-reactive psychological measures (p's ≤ .003, ηp2's ≥ .15). The basal parameter BMI, the stress-reactive endocrine parameters ACTH and norepinephrine, and the psychological parameter anticipatory stress appraisal were identified as determinants of higher RAAS parameter reactivity to acute psychosocial stress. The association between anticipatory cognitive stress appraisal and plasma RAAS measures was fully mediated by ACTH increases (p's ≤ .044, ηp2's ≥ .05). CONCLUSIONS Cognitive stress appraisal processes seem to modulate RAAS stress reactivity. This points to potential clinical implications for psycho-educative therapeutical interventions targeting stress appraisal processes in order to reduce endocrine stress reactivity.

Both incidence and mortality of uterine cancer are on the rise and mortality is higher for African American women. The aim of our study was to evaluate how Next Generation Sequencing (NGS) may facilitate identification of and intervention for treatment disparities when integrated into clinical workflows.Our cohort included 159 uterine cancer patients with recurrent/progressive and newly diagnosed advanced stage and/or high-risk histology. The most common tumor histological subtypes included EEC (n = 67), SEC (n = 34), UCS (n = 20), and mixed (n = 14). Black patients were most likely to present with aggressive histology: (SEC, 34.0%) and carcinosarcoma (UCS, 14.0%). The four most common mutations across all subtypes were TP53, PIK3CA, PTEN, and ARID1A. There was racial disparity between Black versus non-Black patients who were initiated on targeted therapy (28.2% vs. 38.2%, respectively) and clinical trial (15% vs. 22.6%, respectively). Compared to non-Black patients, Black patients had a significantly higher percentage TP53 mutations (p0.05) and a significantly lower percentage ARID1A mutations (p0.05).NGS for uterine malignancies provides actionable information for targetable mutations and/or clinical trial enrollment in most patients; further investigation is necessary to identify potentially modifiable factors contributing to current disparities that may improve targeted therapy uptake and clinical trial participation.

Two vascular endothelial growth factor (VEGF) receptors, FLT-1 and KDR, are expressed preferentially in proliferating endothelium. There is increasing evidence that recombinant, soluble VEGF receptor domains interfering with VEGF signaling may inhibit in vivo neoangiogenesis, tumor growth and metastatic spread. We hypothesized that a soluble form of FLT-1 receptor (sFLT-1) could inhibit the growth of pre-established tumors via an anti-angiogenic mechanism. A replication-deficient adenovirus (Ad) vector carrying the sflt-1 cDNA (Adsflt) was used to overexpress the sFLT-1 receptor in a breast cancer animal model. MCF-7 cells, which produce VEGF, were used to establish solid tumors in the mammary fat pads of female nude mice. After six weeks tumors were injected either with Adsflt, or a negative control virus (AdCMV.βgal). After six months, average tumor volume in the Adsflt-infected group (33 ± 22 mm3) was decreased by 91% relative to that of the negative control group (388 ± 94 mm3; Psflt-infected tumors exhibited complete regression. The vascular density in Adsflt-infected tumors was reduced by 50% relative to that of negative controls (Psflt–infected tumors were preceded by apoptosis of tumor vascular endothelial cells. Mice treated with Adsflt intratumorally showed no delay in the healing of cutaneous wounds, providing preliminary evidence that Ad-mediated sFLT-1 overexpression may be an effective anti-angiogenic therapy for cancer without the risk of systemic anti-angiogenic effects.

T he purpose of this research to determine the effect of implementing the CSR strategy carried out by PT. Pertamina (Persero) through various programs owned by the company's image. The method used in this research is a qualitative method / approach. This research was made not to test the hypothesis between the two variables, but to describe the extent of CSR programs that have been run by PT. Pertamina (Persero) can play a role in improving the company's image. The data collected is data obtained from the annual report of PT. Pertamina (Persero) in 2018 taken from IDX, articles and other documents. Data analysis techniques used in this study use comparative analysis (comparing the findings of researchers with the theory used) and include data reduction, data presentation and drawing conclusions. Based on the results of the analysis of the data obtained, the strategy embodied in the CSR program of PT. Pertamina (Persero) has been carried out in accordance with the company's vision, mission, principles and strategy set by the company itself. The results obtained from this study indicate that the overall implementation of CSR strategies carried out by PT. Pertamina (Persero) basically has an influence and plays an active role in improving the image, reputation and credibility of the company. In this case, things that must be done by PT. Pertamina (Persero) is considering expanding the scope of the area of the recipients of the CSR programs they have, so that not only the people in the vicinity of the head office or its subsidiaries can benefit from each CSR program that is carried out, but also the community as a whole.

Introduction. The prevalence of bronchial asthma and other allergic diseases, in particular atopic dermatitis and allergic rhinitis, nowadays can be estimated by global population studies, such as the International Study of Asthma and Allergy in Childhood (ISAAC), and the Global Asthma Network (GAN). There are some difficulties in epidemiological surveillance, diagnosis, treatment and prevention of these nosologies in most of the countries, especially in developing countries with low availability of medical care. Thanks to the GAN program, therapeutic recommendations were made to reduce the global burden of allergic pathology. Purpose of the study. To study the prevalence of clinical symptoms of allergic diseases in children 13–14 years old in the city of Tyumen, as well as highlight the main risk factors that contribute to the disease development. Materials and methods. This cross-sectional study was carried out in 2019 as part of the Global Asthma Network (GAN) project among adolescents 13–14 years of age in the city of Tyumen. The respondents filled out standardized Russified questionnaires, which contained 48 questions concerning the symptoms of allergic diseases and environmental factors. According to the results of the analysis of 3007 questionnaires, it was found that asthma-like symptoms were ever observed in 19,2% of participants, current asthma-like symptoms were noted in 8,5% of respondents, 5,1% of adolescents had medical-verified bronchial asthma. The prevalence of lingering allergic rhinitis and current allergic rhinoconjunctivitis was 28,9% and 12,2% respectively, while only 5,4% of respondents had a verified diagnosis of allergic rhinitis. A quarter of the respondents had symptoms of atopic dermatitis at some point (25,6%), only 4,5% had symptoms of current atopic dermatitis, 3,8% had been diagnosed with atopic dermatitis. The negative impact of heavy freight traffic in the city of Tyumen, as well as the use of paracetamol, revealed the increase in the prevalence of allergic diseases. Conclusion. As a result of data analysis, it was found that the prevalence of current asthma-like symptoms, symptoms of atopic dermatitis and allergic rhinitis significantly exceed the numbers of official statistics. Often, adolescents with symptoms of an allergic disease do not have a correct diagnosis, which is confirmed by a low percentage of positive answers regarding the verification of the diagnosis by a doctor. Among children 13–14 years old in the city of Tyumen there is a high percentage of the prevalence of symptoms of allergic rhinitis, which is probably associated with climatic, geographical and environmental factors.