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Purpose Methods Results Conclusions Level of Evidence Most studies about medial open‐wedge high tibial osteotomy (HTO) reported outcomes without focusing on gender differences. Therefore, the study compared the long‐term survival rate and postoperative subjective knee function after HTO in female versus male patients with symptomatic medial compartment knee osteoarthritis.The data of three cohorts with long‐term outcomes were analysed (n = 245; 32% females; age: 49 ± 7 years; Kellgren Lawrence Grade I 6.1%, II 32.7%, III 42.4%; IV 18.8%). The minimum follow‐up was at least 6 years or an earlier conversion to total knee arthroplasty (TKA). The gender‐specific survival rate after HTO was calculated after 5 and 10 years and compared using Kaplan–Meier analysis and the logrank test. Baseline characteristics and subjective knee function (International Knee Documentation Committee [IKDC]/Lysholm) were analysed between both genders.Forty of 78 (51.3%) women and 41 of 167 men (24.5%) underwent TKA. HTO survival in females was significantly lower (p = 0.0010). The 5‐ and 10‐year survival rates were 85.9% and 62.6% for females and 93.4% and 77.7% for males. In females and males, from preoperative to the last follow‐up, the IKDC (43 ± 15 to 58 ± 17; 47 ± 14 to 67 ± 18) and the Lysholm (42 ± 18 to 72 ± 18; 55 ± 22 to 77 ± 23) improved significantly (all p < 0.0001). Females had significantly lower preoperative and postoperative IKDC (p = 0.0438; p = 0.0035) and Lysholm scores (p = 0.0002; p = 0.0323). But the absolute improvements of the IKDC and Lysholm were not significantly different between genders.Females had higher conversion rates to TKA and lower knee function at the last follow‐up. However, preoperative knee function was lower in females and the absolute improvement following HTO was similar for both genders. In general, females benefit from HTO to treat medial knee arthritis, and TKA could be postponed for half of female patients for more than 10 years. However, surgeons must be aware of the described inferior outcomes in females for realistic patient expectation management.Level II. [ABSTRACT FROM AUTHOR]

The article focuses on the tragic events of the Meadow Lea disaster in 1882, where four women from the Taylor family perished in a blizzard near Marquette, Manitoba. Topics include the circumstances leading to their deaths, the aftermath and recovery efforts, and the enduring legacy of the tragedy in local history and literature.

Background: Alcohol consumption is a leading cause of morbidity and mortality worldwide, disproportionately affecting young men. Heavy episodic drinking is particularly prevalent among men, with this behavior peaking between the ages of 20 and 24. Aims: We sought to identify dimensions of decision-making in men that would predict the development of hazardous alcohol use through emerging adulthood. Methods: This prospective observational study profiled value-based decision-making in 198 healthy men at age 18 and assessed their alcohol involvement annually until age 24. Latent growth curve modeling estimated individual variability in trajectories of alcohol involvement and regressed this variability on five choice dimensions. Results: Low loss aversion predicted sustained heavy episodic drinking from age 18 to 24. Both high delay discounting and risk-seeking for gains independently predicted a considerably higher cumulative alcohol use during these 6 years, with high delay discounting indicating escalating consumption from age 21. Risk-seeking for gains additionally predicted meeting more criteria for Alcohol Use Disorder in these 6 years. Risk-seeking for losses was not significantly related to alcohol outcomes. Choice preferences were largely independent of each other but were correlated with choice consistency, with low consistency predicting heavy episodic drinking from age 18 to 24 beyond these associations. Conclusions: The predictive effects collectively suggest that overvaluing immediate and probabilistic incentives, rather than underestimating harm, drives hazardous drinking in young men. The differential relations of choice preferences and consistency to alcohol involvement through emerging adulthood provide distinct cognitive-behavioral patterns that warrant consideration in the development of harm reduction interventions. [ABSTRACT FROM AUTHOR]

Illness anxiety may amplify vulnerability to psychopathological symptoms during the COVID‐19‐pandemic—perhaps especially at the beginning of the pandemic and during high infection waves, but empirical evidence on this is lacking. In addition, considering a potentially functional facet of it, illness anxiety might be associated with higher vaccine willingness. We analyzed data of a nine‐wave longitudinal online‐survey (March 2020–October 2021) with 8148 non‐probability sampled adults of the general population in Germany (clinicaltrials.gov: NCT04331106). Using multilevel analysis, we investigated longitudinal associations of dimensionally assessed illness anxiety (worry about illness, bodily preoccupation) with mental strain and vaccine willingness and considered the dynamic of the pandemic (i.e., duration and infection rates). Higher worry about illness and bodily preoccupation were associated with higher COVID‐19‐related fears, unspecific anxiety, depressive symptoms, and vaccine willingness. Vaccine willingness increased over time and in parallel to higher infection rates. Symptoms of mental strain decreased with continuing duration of the pandemic but increased when infection rates inclined. This decrease and increase, respectively, was steeper in individuals with higher illness anxiety. Our findings suggest that individuals with higher illness anxiety are more vulnerable to experience psychopathological symptoms during the ongoing pandemic, particularly at its beginning and during times of high infection rates. Thus, illness anxiety and associated symptoms should be targeted by adaptive measures. The fluctuation of symptoms parallel to the pandemic situation implies that support should be particularly issued at the beginning of extraordinary situations as well as during phases of high infection rates. [ABSTRACT FROM AUTHOR]

Disabled populations are disproportionally affected by the current climate and environmental crises. However, they are hardly included and their knowledge is neglected in processes addressing these challenges. To achieve the UN Agenda 2030, societies should actively engage with the values, experiences and knowledge held by people with disabilities in science and policy contexts. In this paper, we suggest that addressing 'deep' leverage points by 1) recognising diverse valuations of and connections to nature by different social groups (i.e. re-connecting to nature), 2) including disabled populations in decision-making and knowledge creation (i.e. re-structuring institutions), and 3) promoting inclusive education and knowledge generation (i.e. re-thinking knowledge production) can facilitate the development of inclusive transformation pathways and foster sustainable human-nature relationships. [ABSTRACT FROM AUTHOR]

Contemplative practice has demonstrated benefits for mental health and well-being. Most previous studies, however, implemented in-person trainings containing a mix of different, mostly solitary, practices and focused on pre- to post-training outcomes. In this randomized trial, we explore the immediate differential efficacy of two daily app-delivered practices in shifting emotional (valence, arousal) and thinking patterns (thought content on future-past, self-other, positive–negative dimensions). For 10 weeks of daily training, 212 participants (18–65 years) performed either a novel 12-min partner-based socio-emotional practice (Affect Dyad) or a 12-min attention-focused solitary mindfulness-based practice. Using ordinal Bayesian multilevel modeling, we found that both practice types led to more positive affect and higher arousal. However, whereas mindfulness-based practice partly led to a decrease in active thoughts, particularly in future-, other-related and negative thoughts, the Dyad in contrast led to increases in other-related, and positive thoughts. This shift towards more social and positive thoughts may specifically support overcoming ruminative thinking patterns associated with self-related and negative thought content. Overall, these differential findings may help inform the adaptation of scalable app-based mental trainings in different segments of the population with the goal to improve mental health and well-being. [ABSTRACT FROM AUTHOR]

Background: In many developed countries, the scope of community pharmacy services has extended to include advanced applications. Unlike traditional practices that focus on pharmaceutical sales, extended community pharmacy services (ECPSs) are patient-centred and typically offered by specialised healthcare centres, which improve public health, reduce pressure imposed on healthcare professionals, and rationalise health system expenditures. However, based on the findings of several studies, community pharmacies (CPs) only provide marginalised services. Public reviews are thus crucial to effectively utilise such services. This study explored CPs use among the Saudi public in terms of knowledge, attitudes, and barriers to ECPSs. Materials and methods: We conducted a cross-sectional web-based survey of a non-probability sample between October and December 2021. Numerical and graphical descriptive statistics were employed with an additional analytical assessment using binary logistic regression to determine the association between participant characteristics and the barriers to ECPSs use. Results: A total of 563 individuals participated in this study, approximately 33% of which revealed CPs as the first place they visit for medication concerns. Most individuals were not aware of medication therapy management and health screening services (77% and 68%, respectively). Pharmacy clinics offering private counselling and receiving patient electronic medical records were unknown to the participants (78% and 63%, respectively). A substantial proportion of the cohort considered lack of privacy (58%) and inadequate communication with community pharmacists (56%) as key barriers to the use of ECPSs. Logistic regression analysis revealed that the underdeveloped infrastructure of CPs was significantly associated with almost all factors. Conclusion: Most services and facilities were found to be underutilised. Positive public attitudes were associated with concerns regarding privacy and cost of services. Consistent with Saudi Vision 2030, supporting CPs and increasing the public awareness of ECPSs have significant implications on public health. [ABSTRACT FROM AUTHOR]

Kurzfassung: Accelerating and more comprehensive legislation and litigation indicate a new significance of law in recent years within climate change politics. However, this development has been scarcely reflected upon in German-language geographical research on climate change adaptation, which primarily focuses on climate adaptation politics and policies. In order to illuminate these issues, this article engages with the political and legal scientific debates on juridification; reflects these in the context of climate adaptation; and traces the processes of juridification of climate policies in the German context from a historical perspective. Intersecting with insights from legal geography, this contribution introduces the concept of „Legal Ecologies of Climate Change Adaptation" as a novel and legally nuanced perspective. Within human geographic climate adaptation research, this perspective opens up new theoretical and conceptual interests, empirical domains, and possibilities for interdisciplinary collaboration. [ABSTRACT FROM AUTHOR]

Legionella pneumophila is the primary causative agent of Legionnaires' disease. The mutant-type strain interrupted in the ORF7 gene region responsible for the lipopolysaccharide biosynthesis of the L. pneumophila strain Heysham-1, lacking the O-acetyl groups attached to the rhamnose of the core part, showed a higher surface polarity compared with the wild-type strain. The measurement of excitation energy transfer between fluorophores located on the surface of bacteria and eukaryotic cells showed that, at an early stage of interaction with host cells, the mutant exhibited weaker interactions with Acanthamoeba castellanii cells and THP-1-derived macrophages. The mutant displayed reduced adherence to macrophages but enhanced adherence to A. castellanii, suggesting that the O-acetyl group of the LPS core region plays a crucial role in facilitating interaction with macrophages. The lack of core rhamnose O-acetyl groups made it easier for the bacteria to multiply in amoebae and macrophages. The mutant induced TNF-α production more strongly compared with the wild-type strain. The mutant synthesized twice as many ceramides Cer(t34:0) and Cer(t38:0) than the wild-type strain. The study showed that the internal sugars of the LPS core region of L. pneumophila sg 1 can interact with eukaryotic cell surface receptors and mediate in contacting and attaching bacteria to host cells as well as modulating the immune response to infection. [ABSTRACT FROM AUTHOR]

Contemplative practice has demonstrated benefits for mental health and well-being. Most previous studies, however, implemented in-person trainings containing a mix of different, mostly solitary, practices and focused on pre- to post-training outcomes. In this randomized trial, we explore the immediate differential efficacy of two daily app-delivered practices in shifting emotional (valence, arousal) and thinking patterns (thought content on future-past, self-other, positive–negative dimensions). For 10 weeks of daily training, 212 participants (18–65 years) performed either a novel 12-min partner-based socio-emotional practice (Affect Dyad) or a 12-min attention-focused solitary mindfulness-based practice. Using ordinal Bayesian multilevel modeling, we found that both practice types led to more positive affect and higher arousal. However, whereas mindfulness-based practice partly led to a decrease in active thoughts, particularly in future-, other-related and negative thoughts, the Dyad in contrast led to increases in other-related, and positive thoughts. This shift towards more social and positive thoughts may specifically support overcoming ruminative thinking patterns associated with self-related and negative thought content. Overall, these differential findings may help inform the adaptation of scalable app-based mental trainings in different segments of the population with the goal to improve mental health and well-being. [ABSTRACT FROM AUTHOR]

Background: As a big European city famous for its party scene, Berlin attracts college students that are a high-risk population for cannabis use and use disorder. College years are often associated with new behavior patterns, but the factors leading to cannabis initiation are rarely studied past adolescence. This study describes the longitudinal evolution of college students' cannabis use over two years and its correlates. Method: Data was collected among all students of Berlin's public colleges via two online surveys (N = 1,201, mean interval = 16 months). Multivariable binary logistic regressions were performed on four outcomes: regular use, use initiation, use reduction and use cessation. Several dimensions of covariates were used: socio-demographic factors, psychological (locus of control, impulsivity, psychiatric diagnosis), behavioral (other substance use), perceived harm, declared intention to reduce and setting of cannabis use. Results: Overall, the majority of respondents did not change their cannabis use. The factors for use initiation (impulsivity, tobacco and alcohol use) were not fully symmetric to the factors leading to cutting down/quitting (locus of control, perceived harm, tobacco use). Perceived harm had an impact on quitting, but not on reducing use. The intention to reduce did not significantly predict subsequent use behavior. Most regular users use cannabis at home, which was associated with a low probability to reduce. Conclusions: No simple symmetry exists between correlates of initiation and cessation: tobacco co-use is important for both, while impulsivity and alcohol use lead to initiation and internal locus of control facilitates cessation. [ABSTRACT FROM AUTHOR]

Introduction/Aims: In myasthenia gravis, prolonged muscle denervation causes muscle atrophy. We re‐visited this observation using a biomarker hypothesis. We tested if serum neurofilament heavy chain levels, a biomarker for axonal degeneration, were elevated in myasthenia gravis. Methods: We enrolled 70 patients with isolated ocular myasthenia gravis and 74 controls recruited from patients in the emergency department. Demographic data were collected alongside serum samples. Serum samples were analyzed by enzyme‐linked immunosorbent assay (ELISA) for the neurofilament heavy chain (NfH‐SMI35). The statistical analyses included group comparisons, receiver operator characteristic (ROC) curves, area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values. Results: Serum neurofilament heavy chain levels were significantly (p < 0.0001) higher in individuals with myasthenia gravis (0.19 ng/mL) than in healthy control subjects (0.07 ng/mL). A ROC AUC optimized cutoff level of 0.06 ng/mL gave a diagnostic sensitivity of 82%, specificity of 76%, positive predictive value of 0.77 and a negative predictive value of 0.81. Discussion: The increase of serum neurofilament heavy chain levels in myasthenia gravis is consistent with observations of muscle denervation. We suggest that there is ongoing remodeling of the neuromuscular junction in myasthenia gravis. Longitudinal quantification of neurofilament isoform levels will be needed to investigate the prognostic value and potentially guide treatment decisions. [ABSTRACT FROM AUTHOR]

Concert programmes are at the heart of the rituals of Western classical music concerts. Providing information on musical works and more, they are invaluable objects of study for music scholars. This article investigates how ensembles engage in the production of these documents--a dimension so far neglected in much of concert programme scholarship, yet vital to understanding what these objects contain, look like, and do. In doing so, it approaches concert programmes as agents that help orchestras explore their musical and institutional identities. It compares, through a combination of archival research and interviews, two major European orchestras: the London Symphony Orchestra and the Vienna Philharmonic Orchestra. The investigation focuses on the programmes' design and appearance, their contents and structures, and the programme notes. Drawing on the concept of 'sociomateriality'--taking these documents' situated and highly specific materialities into account, thus questioning their commonly assumed ephemerality--this article demonstrates how concert programmes maintain particular tokens of musical tradition and knowledge whilst renewing others. It thereby opens up discussions on the role that concert programmes play in opening up and manifesting musical knowledge resulting from processes of orchestral identity formation, and it proposes a practice-based methodology to how concert programmes may be studied. [ABSTRACT FROM AUTHOR]

Increasing physical activity is essential to improve psychiatric patients' physical and mental health. This study aimed to characterise the physical activity levels of inpatients in a general psychiatric clinic and to determine the feasibility of using a simple tool in everyday practice to assess physical activity levels in standard patient documentation. We assessed the level of physical activity undertaken by patients treated on an inpatient basis in a psychiatric hospital over 20 months. A total of 328 patients were included in the analysis. Physical activity was measured using a slightly altered version of the Exercise as a vital sign (EVS) questionnaire. All information was extracted from letters of discharge. During inpatient treatment, moderate to vigorous activity levels increased, and more patients engaged in physical activity. Patients with mood or anxiety disorders displayed the most considerable increase in physical activity. Patients with other diagnoses, such as schizophrenia, benefitted less or not at all. Factors associated with physical activity included—among others—history of substance use, education and month of admission. Investigating the feasibility of standardised documentation of physical activity showed fluctuation in documentation rates throughout the study. The level of physical activity performed by psychiatric patients can be increased during inpatient treatment. Implementing physical activity level as part of standard patient documentation is a first step in gathering data to assess the need for interventions to achieve an optimal physical activity in psychiatric patients throughout inpatient treatment. [ABSTRACT FROM AUTHOR]

The foundation of successful treatment is good cooperation between the physician and the patient. In this context, it is of particular importance to understand the patient's motivation regarding their desire for treatment. Various fundamental motivational systems, such as approach motivation and avoidance/aversion motivation, have been described. Motivation is the product of complex information processing. An overall goal of the different types of motivation is achieving coherence. If a health goal is formulated positively, health motivation can be stimulated as a component of the patient's overall motivation for coherence as the foundation of treatment. Within the framework of professional communication, this development can be promoted and serve to achieve the treatment goals. [ABSTRACT FROM AUTHOR]

Neural networks have the ability to serve as universal function approximators, but they are not interpretable and do not generalize well outside of their training region. Both of these issues are problematic when trying to apply standard neural ordinary differential equations (ODEs) to dynamical systems. We introduce the polynomial neural ODE, which is a deep polynomial neural network inside of the neural ODE framework. We demonstrate the capability of polynomial neural ODEs to predict outside of the training region, as well as to perform direct symbolic regression without using additional tools such as SINDy. [ABSTRACT FROM AUTHOR]

Biopolymers obtained from natural macromolecules are noteworthy among materials presenting high biocompatibility and adequate biodegradability, as is the case of chitosan (CS), making this biopolymeric compound a suitable drug delivery system. Herein, chemically-modified CS were synthetized using 2,3-dichloro-1,4-naphthoquinone (1,4-NQ) and the sodium salt of 1,2-naphthoquinone-4-sulfonic acid (1,2-NQ), producing 1,4-NQ-CS and 1,2-NQ-CS by three different methods, employing an ethanol and water mixture (EtOH:H2O), EtOH:H2O plus triethylamine and dimethylformamide. The highest substitution degree (SD) of 0.12 was achieved using water/ethanol and triethylamine as the base for 1,4-NQ-CS and 0.54 for 1,2-NQ-CS. All synthesized products were characterized by FTIR, elemental analysis, SEM, TGA, DSC, Raman, and solid-state NMR, confirming the CS modification with 1,4-NQ and 1,2-NQ. Chitosan grafting to 1,4-NQ displayed superior antimicrobial activities against Staphylococcus aureus and Staphylococcus epidermidis associated with improved cytotoxicity and efficacy, indicated by high therapeutic indices, ensuring safe application to human tissue. Although 1,4-NQ-CS inhibited the growth of human mammary adenocarcinoma cells (MDA-MB-231), it is accompanied by cytotoxicity and should be considered with caution. The findings reported herein emphasize that 1,4-NQ-grafted CS may be useful in protecting injured tissue against bacteria, commonly found in skin infections, until complete tissue recovery. [ABSTRACT FROM AUTHOR]

In engineering and architecture, different approaches have been developed that share the use of graph transformation to automate design processes or to search for design solutions by means of computational design synthesis. In order to give an overview of these approaches, we provide a review of articles published in the last decade. Forty-eight articles were reviewed to determine similarities and differences of these approaches. Research fields in method development for the representation of design problems and the processing of graph transformations, as well as the application of graph transformations in engineering, architecture, and shape grammars were identified. Different approaches for the documentation of the vocabulary and the rules were examined. Finally, different approaches for rule applications were analyzed. Based on found limitations, future research directions are suggested. [ABSTRACT FROM AUTHOR]

There is no consensus regarding the classification of optic neuritis, and precise diagnostic criteria are not available. This reality means that the diagnosis of disorders that have optic neuritis as the first manifestation can be challenging. Accurate diagnosis of optic neuritis at presentation can facilitate the timely treatment of individuals with multiple sclerosis, neuromyelitis optica spectrum disorder, or myelin oligodendrocyte glycoprotein antibody-associated disease. Epidemiological data show that, cumulatively, optic neuritis is most frequently caused by many conditions other than multiple sclerosis. Worldwide, the cause and management of optic neuritis varies with geographical location, treatment availability, and ethnic background. We have developed diagnostic criteria for optic neuritis and a classification of optic neuritis subgroups. Our diagnostic criteria are based on clinical features that permit a diagnosis of possible optic neuritis; further paraclinical tests, utilising brain, orbital, and retinal imaging, together with antibody and other protein biomarker data, can lead to a diagnosis of definite optic neuritis. Paraclinical tests can also be applied retrospectively on stored samples and historical brain or retinal scans, which will be useful for future validation studies. Our criteria have the potential to reduce the risk of misdiagnosis, provide information on optic neuritis disease course that can guide future treatment trial design, and enable physicians to judge the likelihood of a need for long-term pharmacological management, which might differ according to optic neuritis subgroups. [ABSTRACT FROM AUTHOR]

Aerosol intensive optical properties, including Ångström exponents for aerosol light extinction (EAEs), scattering (SAEs) and absorption (AAEs) as well as and the single-scattering albedo (SSA), are indicators for aerosol size, chemical composition, radiative behaviour and particle sources. Derivation of these parameters requires the measurement of aerosol optical properties at multiple wavelengths, which usually involves the use of several instruments. Our study aims to quantify the uncertainties in the determination of these intensive properties using an optical closure approach. In our laboratory closure study, we measured the full set of optical properties for a range of light-absorbing particles with different properties externally mixed with ammonium sulfate to generate aerosols with controlled SSA values. The investigated absorbing particle types were fresh combustion soot emitted by an inverted flame soot generator (SOOT; fractal agglomerates), Aquadag (AQ; compact aggregates), Cabot black (BC; compact agglomerates) and an acrylic paint (magic black, shape unknown). The instruments used in this study were two cavity attenuated phase shift particle monitors for single-scattering albedo (CAPS PM SSA 's; λ=450 , 630 nm) for measuring light-extinction and light-scattering coefficients, one integrating nephelometer (λ=450 , 550, 700 nm) for light-scattering coefficients, and one tricolour absorption photometer (TAP; λ=467 , 528, 652 nm) for filter-based light-absorption coefficients. One key finding is that the coefficients of light absorption, scattering and extinction derived from combing the measurements of two independent instruments agree with measurements from single instruments; the slopes of regression lines are equal within reported uncertainties (i.e. closure is observed). Despite closure for measured absorption coefficients, we caution that the estimated uncertainties for absorption coefficients, propagated for the differential method (DM; absorption = extinction minus scattering), can exceed 100 % for atmospherically relevant SSA values (>0.9). This increasing estimated uncertainty with increasing SSA yields AAE values that may be too uncertain for measurements in the range of atmospheric aerosol loadings. We recommend using the DM for measuring AAE values when the SSA < 0.9. EAE- and SAE-derived values achieved closure during this study within stated uncertainties for extinction coefficients greater than 15 Mm -1. SSA values for 450 and 630 nm wavelengths internally agreed with each other within 10 % uncertainty for all instrument combinations and sampled aerosol types, which fulfils the defined goals for measurement uncertainty of 10 % proposed by Laj et al. (2020) for GCOS (Global Climate Observing System) applications. [ABSTRACT FROM AUTHOR]

In this work, analysis and simulation of all experimentally observed switching modes in hafnium oxide based resistive random access memories are carried out using a simplified electrical conduction model. To achieve switching mode variation, two metal-insulator-metal cells with identical stack combination, but varying oxygen stoichiometry of the hafnia layer, namely, stoichiometric vs highly deficient, are considered. To access the individual switching modes, the devices were subjected to a variety of cycling conditions comprising different voltage and current ranges. For modeling the device behavior, a single or two antiserially connected memdiodes (diode with memory) were utilized. In this way, successful compact simulation of unipolar, bipolar, threshold, and complementary resistive switching modes is accomplished confirming the coexistence of two switching mechanisms of opposite polarity as the basis for all observable switching phenomena in this material. We show that only calibration of the outer current–voltage loops with the memdiode model is necessary for predicting the device behavior in the defined region revealing additional information on the switching process. The correspondence of each memdiode device with the conduction characteristics of the individual top and bottom metal-oxide contacts allows one to assess the role played by each interface in the switching process separately. This identification paves the path for a future improvement of the device performance and functionality by means of appropriate interface engineering. [ABSTRACT FROM AUTHOR]

Background: Dengue is not included explicitly in the WHO Integrated Management of Childhood Illness (IMCI) algorithm. However, the assessment, classification and management of dengue has been incorporated into several IMCI country adaptations. We aimed to evaluate the dengue algorithms incorporated into IMCI guidelines and discuss the need for harmonization, including an extension of the age range for IMCI. Methods: This study included three steps. First, we investigated dengue algorithms incorporated into five Southeast-Asian (Myanmar, Philippines, Vietnam, Indonesia, Cambodia) country IMCI guidelines through a desk-based analysis. Second, we conducted an expert survey to elicit opinions regarding the integration of dengue and extension of the age range in IMCI. Third, we compared our findings with data from a large multicentric prospective study on acute febrile illness. Results: We found considerable heterogeneity between the country specific IMCI guidelines in the dengue algorithms as well as classification schemes. Most guidelines did not differentiate between diagnostic algorithms for the detection of dengue versus other febrile illness, and warning signs for progression to severe dengue. Our expert survey resulted in a consensus to further integrate dengue in IMCI and extend the age range for IMCI guidelines beyond 5 years of age. Most of the interviewees responded that their country had a stand-alone clinical guideline for dengue, which was not integrated into the IMCI approach and considered laboratory testing for dengue necessary on day three of consecutive fever. Using data from a large multicentric study of children 5–15 years of age, we could confirm that the likelihood of dengue increased with consecutive fever days. However, a significant proportion of children (36%) would be missed if laboratory testing was only offered on the third consecutive day of fever. Conclusions: This study supports the extension of the IMCI age range beyond 5 years of age as well as the inclusion of dengue relevant content in the algorithm. Because of the challenge of distinguishing dengue from other febrile illnesses, simple laboratory testing (e.g., full blood count) should be offered at an early stage during the course of the illness. Testing only children with consecutive fever over 3 days may lead to an underdiagnosis of dengue among those with acute febrile illness in children 5–15 years of age. In addition, specific laboratory testing for dengue should be made available to peripheral health facilities. Author summary: The Integrated Management of Childhood Illness (IMCI) was developed for the identification and treatment of major childhood illnesses based on a syndromic approach that can be applied by local health care workers in rural health facilities. Dengue represents an important differential diagnosis for children and adolescents with acute febrile illness in Southeast Asia but is not officially included in the fever module of IMCI. Local adaptations in different countries, however, have integrated dengue into their guidelines. We analysed the available local IMCI guidelines in Southeast Asia, conducted an expert survey, and investigated out findings using data from a large multicentric prospective study on acute febrile illness. Our findings support the extension of the age range for IMCI and the inclusion of dengue relevant content. When children presented with fever, the likelihood of dengue increased with consecutive fever days. We were able to quantify how likely dengue is as a cause of fever in children living in endemic areas, stratified by duration of fever. This evidence is useful for policy makers to consider the effect of more specific diagnostic tools for the monitoring of early dengue. [ABSTRACT FROM AUTHOR]

Proventricular dilatation disease (PDD) caused by parrot bornavirus (PaBV) infection is an often-fatal disease known to infect Psittaciformes. The impact of age at the time of PaBV infection on organ lesions and tissue distribution of virus antigen and RNA remains largely unclear. For this purpose, tissue sections of 11 cockatiels intravenously infected with PaBV-4 as adults or juveniles, respectively, were examined via histology, immunohistochemistry applying a phosphoprotein (P) antibody directed against the bornaviral phosphoprotein and in situ hybridisation to detect viral RNA in tissues. In both groups of adult- and juvenile-infected cockatiels, widespread tissue distribution of bornaviral antigen and RNA as well as histologic inflammatory lesions were demonstrated. The latter appeared more severe in the central nervous system in adults and in the proventriculus of juveniles, respectively. During the study, central nervous symptoms and signs of gastrointestinal affection were only demonstrated in adult birds. Our findings indicate a great role of the age at the time of infection in the development of histopathological lesions and clinical signs, and thus provide a better understanding of the pathogenesis, possible virus transmission routes, and the development of carrier birds posing a risk to psittacine collections. [ABSTRACT FROM AUTHOR]

Methamphetamine use is surging globally as a cause of morbidity and mortality. Treatment is typically sought in early abstinence, when craving and depressive symptoms are intense, contributing to relapse and poor outcomes. To advance an understanding of this problem and identify therapeutic targets, we conducted a retrospective analysis of brain structure in 89 adults with Methamphetamine Use Disorder who were in early abstinence and 89 healthy controls. Unlike most prior research, the participants did not significantly differ in age, sex and recent use of alcohol and tobacco (p-values ≥ 0.400). We analysed thickness across the entire cerebral cortex by fitting a general linear model to identify differences between groups. Follow-up regressions were performed to determine whether cortical thickness in regions showing group differences was related to craving, measured on a visual analogue scale, or to the Beck Depression Inventory score. Participants in early methamphetamine abstinence (M ± SD = 22.1 ± 25.6 days) exhibited thinner cortex in clusters within bilateral frontal, parietal, temporal, insular, and right cingulate cortices relative to controls (p-values < 0.001, corrected for multiple comparisons). Unlike craving (β = 0.007, p = 0.947), depressive symptoms were positively correlated with cortical thickness across clusters (β = 0.239, p = 0.030) and with thickness in the anterior cingulate cluster (β = 0.246, p = 0.027) in the methamphetamine-dependent group. Inasmuch as anterior cingulate pathology predicts response to antidepressants for Major Depressive Disorder, cingulate structure may also identify patients with Methamphetamine Use Disorder who can benefit from antidepressant medication. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. The prevalence in patients with type 2 diabetes mellitus is between 55–80%. The spectrum of NALFD ranges from simple steatosis to aggressive steatohepatitis with potentially progressive liver fibrosis up to cirrhosis and hepatocellular carcinoma. In clinical practice, there are two important aims: First to make the diagnosis of NAFLD, and second, to identify patients with advanced fibrosis, because extent of fibrosis is strongly associated with overall mortality, cardiovascular disease, hepatocellular carcinoma, and extrahepatic malignancy. Histology by liver biopsy can deliver this information, but it is an invasive procedure with rare, but potentially severe, complications. Therefore, non-invasive techniques were developed to stage fibrosis. Ultrasound is the primary imaging modality in the assessment of patients with confirmed or suspected NAFLD. This narrative review focus on different ultrasound methods to detect and graduate hepatic steatosis and to determine grade of fibrosis using elastography-methods, such as transient elastography and 2-dimensional shear wave elastography in patients with NAFLD. Particular attention is paid to the application and limitations in overweight patients in clinical practice. Finally, the role of B-mode ultrasound in NAFLD patients to screen for hepatocellular carcinoma is outlined. [ABSTRACT FROM AUTHOR]

Impairments of object recognition are core features of neurodegenerative syndromes, in particular posterior cortical atrophy (PCA; the ‘visual-variant Alzheimer’s disease’). These impairments arise from damage to higher-level cortical visual regions and are often missed or misattributed to common ophthalmological conditions. Consequently, diagnosis can be delayed for years with considerable implications for patients. We report a new test for the rapid measurement of cortical visual loss – the Graded Incomplete Letters Test (GILT). The GILT is an optimised psychophysical variation of a test used to diagnose cortical visual impairment, which measures thresholds for recognising letters under levels of increasing visual degradation (decreasing "completeness") in a similar fashion to ophthalmic tests. The GILT was administered to UK Biobank participants (total n=2,359) and participants with neurodegenerative conditions characterised by initial cortical visual (PCA, n=18) or memory loss (typical Alzheimer’s disease, n=9). UK Biobank participants, including both typical adults and those with ophthalmological conditions, were able to recognise letters under low levels of completeness. In contrast, participants with PCA consistently made errors with only modest decreases in completeness. GILT sensitivity to PCA was 83.3% for participants reaching the 80% accuracy cut-off, increasing to 88.9% using alternative cut-offs (60% or 100% accuracy). Specificity values were consistently over 94% when compared to UK Biobank participants without or with documented visual conditions, regardless of accuracy cut-off. These first-release UK Biobank and clinical verification data suggest the GILT has utility in both rapidly detecting visual perceptual losses following posterior cortical damage and differentiating perceptual losses from common eye-related conditions. [ABSTRACT FROM AUTHOR]

Background: In light of the dynamic COVID-19 pandemic, the exposure to pandemic-related media coverage may change over time and may be particularly relevant due to associations with psychopathological symptoms. The aims of the present study were to examine changes in media consumption over time and to analyze its prospective associations with psychological strain.The study uses a longitudinal observational design with ten periods of online data collection from March 2020 to April 2022 in an adult convenience sample (N = 8337) of the general population in Germany.Our data revealed that the frequency and duration of pandemic-related media exposure as well as their subjective critical evaluation showed the highest levels at the beginning of the pandemic and peaked again in autumn 2020 and spring 2021. The primarily used media formats changed only slightly over time. The amount of media exposure at baseline was associated with more impairing pandemic-related anxiety 1 month, 1 year, and 2 years later.Our results hint to potentially problematical and long-lasting associations of pandemic-related media consumption with mental strain. Our findings could serve as an orientation for recommendations, further research, and adequate interventions for a responsible dealing with media coverage.The authors have pre-registered this research at clinicaltrials.gov without an analysis plan; retrievable at: https://clinicaltrials.gov/ct2/show/NCT04331106.Method: In light of the dynamic COVID-19 pandemic, the exposure to pandemic-related media coverage may change over time and may be particularly relevant due to associations with psychopathological symptoms. The aims of the present study were to examine changes in media consumption over time and to analyze its prospective associations with psychological strain.The study uses a longitudinal observational design with ten periods of online data collection from March 2020 to April 2022 in an adult convenience sample (N = 8337) of the general population in Germany.Our data revealed that the frequency and duration of pandemic-related media exposure as well as their subjective critical evaluation showed the highest levels at the beginning of the pandemic and peaked again in autumn 2020 and spring 2021. The primarily used media formats changed only slightly over time. The amount of media exposure at baseline was associated with more impairing pandemic-related anxiety 1 month, 1 year, and 2 years later.Our results hint to potentially problematical and long-lasting associations of pandemic-related media consumption with mental strain. Our findings could serve as an orientation for recommendations, further research, and adequate interventions for a responsible dealing with media coverage.The authors have pre-registered this research at clinicaltrials.gov without an analysis plan; retrievable at: https://clinicaltrials.gov/ct2/show/NCT04331106.Results: In light of the dynamic COVID-19 pandemic, the exposure to pandemic-related media coverage may change over time and may be particularly relevant due to associations with psychopathological symptoms. The aims of the present study were to examine changes in media consumption over time and to analyze its prospective associations with psychological strain.The study uses a longitudinal observational design with ten periods of online data collection from March 2020 to April 2022 in an adult convenience sample (N = 8337) of the general population in Germany.Our data revealed that the frequency and duration of pandemic-related media exposure as well as their subjective critical evaluation showed the highest levels at the beginning of the pandemic and peaked again in autumn 2020 and spring 2021. The primarily used media formats changed only slightly over time. The amount of media exposure at baseline was associated with more impairing pandemic-related anxiety 1 month, 1 year, and 2 years later.Our results hint to potentially problematical and long-lasting associations of pandemic-related media consumption with mental strain. Our findings could serve as an orientation for recommendations, further research, and adequate interventions for a responsible dealing with media coverage.The authors have pre-registered this research at clinicaltrials.gov without an analysis plan; retrievable at: https://clinicaltrials.gov/ct2/show/NCT04331106.Conclusion: In light of the dynamic COVID-19 pandemic, the exposure to pandemic-related media coverage may change over time and may be particularly relevant due to associations with psychopathological symptoms. The aims of the present study were to examine changes in media consumption over time and to analyze its prospective associations with psychological strain.The study uses a longitudinal observational design with ten periods of online data collection from March 2020 to April 2022 in an adult convenience sample (N = 8337) of the general population in Germany.Our data revealed that the frequency and duration of pandemic-related media exposure as well as their subjective critical evaluation showed the highest levels at the beginning of the pandemic and peaked again in autumn 2020 and spring 2021. The primarily used media formats changed only slightly over time. The amount of media exposure at baseline was associated with more impairing pandemic-related anxiety 1 month, 1 year, and 2 years later.Our results hint to potentially problematical and long-lasting associations of pandemic-related media consumption with mental strain. Our findings could serve as an orientation for recommendations, further research, and adequate interventions for a responsible dealing with media coverage.The authors have pre-registered this research at clinicaltrials.gov without an analysis plan; retrievable at: https://clinicaltrials.gov/ct2/show/NCT04331106.Trial Registration: In light of the dynamic COVID-19 pandemic, the exposure to pandemic-related media coverage may change over time and may be particularly relevant due to associations with psychopathological symptoms. The aims of the present study were to examine changes in media consumption over time and to analyze its prospective associations with psychological strain.The study uses a longitudinal observational design with ten periods of online data collection from March 2020 to April 2022 in an adult convenience sample (N = 8337) of the general population in Germany.Our data revealed that the frequency and duration of pandemic-related media exposure as well as their subjective critical evaluation showed the highest levels at the beginning of the pandemic and peaked again in autumn 2020 and spring 2021. The primarily used media formats changed only slightly over time. The amount of media exposure at baseline was associated with more impairing pandemic-related anxiety 1 month, 1 year, and 2 years later.Our results hint to potentially problematical and long-lasting associations of pandemic-related media consumption with mental strain. Our findings could serve as an orientation for recommendations, further research, and adequate interventions for a responsible dealing with media coverage.The authors have pre-registered this research at clinicaltrials.gov without an analysis plan; retrievable at: https://clinicaltrials.gov/ct2/show/NCT04331106. [ABSTRACT FROM AUTHOR]

Background: Regular physical activity comes with multiple benefits for physical but also mental health and can be a pivotal element in the prevention and treatment of mental disorders. Clinical psychologists play an important role in supporting their patients in increasing physical activity levels. Up to date, there is only little research on recommendation of physical activity in psychologists worldwide and no such research for psychologists in Germany. Aim of this study was to assess knowledge, attitudes, beliefs and behaviors regarding physical activity in psychologists in Germany.We assessed knowledge, attitudes, beliefs and behaviors regarding physical activity among a sample of clinical psychologists in Germany using the “Exercise in Mental Illness Questionnaire-German” (EMIQ-G) in a cross-sectional online survey.454 participants were included in the analysis. Participants reported moderate levels of knowledge and self-confidence in recommending physical activity. Only 14% of the participants received formal training regarding physical activity recommendation. Most participants recommended physical activity to their patients, primarily through personal discussions and referrals to exercise professionals. About one third did not give any recommendations regarding intensity. Strength training was only recommended by a minority.There is a need for greater integration of information and instructions regarding the recommendation of physical activity in the treatment of people with mental disorders in the training and further education of psychologists.Methods: Regular physical activity comes with multiple benefits for physical but also mental health and can be a pivotal element in the prevention and treatment of mental disorders. Clinical psychologists play an important role in supporting their patients in increasing physical activity levels. Up to date, there is only little research on recommendation of physical activity in psychologists worldwide and no such research for psychologists in Germany. Aim of this study was to assess knowledge, attitudes, beliefs and behaviors regarding physical activity in psychologists in Germany.We assessed knowledge, attitudes, beliefs and behaviors regarding physical activity among a sample of clinical psychologists in Germany using the “Exercise in Mental Illness Questionnaire-German” (EMIQ-G) in a cross-sectional online survey.454 participants were included in the analysis. Participants reported moderate levels of knowledge and self-confidence in recommending physical activity. Only 14% of the participants received formal training regarding physical activity recommendation. Most participants recommended physical activity to their patients, primarily through personal discussions and referrals to exercise professionals. About one third did not give any recommendations regarding intensity. Strength training was only recommended by a minority.There is a need for greater integration of information and instructions regarding the recommendation of physical activity in the treatment of people with mental disorders in the training and further education of psychologists.Results: Regular physical activity comes with multiple benefits for physical but also mental health and can be a pivotal element in the prevention and treatment of mental disorders. Clinical psychologists play an important role in supporting their patients in increasing physical activity levels. Up to date, there is only little research on recommendation of physical activity in psychologists worldwide and no such research for psychologists in Germany. Aim of this study was to assess knowledge, attitudes, beliefs and behaviors regarding physical activity in psychologists in Germany.We assessed knowledge, attitudes, beliefs and behaviors regarding physical activity among a sample of clinical psychologists in Germany using the “Exercise in Mental Illness Questionnaire-German” (EMIQ-G) in a cross-sectional online survey.454 participants were included in the analysis. Participants reported moderate levels of knowledge and self-confidence in recommending physical activity. Only 14% of the participants received formal training regarding physical activity recommendation. Most participants recommended physical activity to their patients, primarily through personal discussions and referrals to exercise professionals. About one third did not give any recommendations regarding intensity. Strength training was only recommended by a minority.There is a need for greater integration of information and instructions regarding the recommendation of physical activity in the treatment of people with mental disorders in the training and further education of psychologists.Conclusion: Regular physical activity comes with multiple benefits for physical but also mental health and can be a pivotal element in the prevention and treatment of mental disorders. Clinical psychologists play an important role in supporting their patients in increasing physical activity levels. Up to date, there is only little research on recommendation of physical activity in psychologists worldwide and no such research for psychologists in Germany. Aim of this study was to assess knowledge, attitudes, beliefs and behaviors regarding physical activity in psychologists in Germany.We assessed knowledge, attitudes, beliefs and behaviors regarding physical activity among a sample of clinical psychologists in Germany using the “Exercise in Mental Illness Questionnaire-German” (EMIQ-G) in a cross-sectional online survey.454 participants were included in the analysis. Participants reported moderate levels of knowledge and self-confidence in recommending physical activity. Only 14% of the participants received formal training regarding physical activity recommendation. Most participants recommended physical activity to their patients, primarily through personal discussions and referrals to exercise professionals. About one third did not give any recommendations regarding intensity. Strength training was only recommended by a minority.There is a need for greater integration of information and instructions regarding the recommendation of physical activity in the treatment of people with mental disorders in the training and further education of psychologists. [ABSTRACT FROM AUTHOR]

A cancer diagnosis and subsequent treatment can trigger distress, negatively impact coping resources, and affect well-being as well as quality of life. The aim of this pilot study was to investigate feasibility and clinical effects of a VR intervention on quality of life, well-being and mood in cancer patients undergoing surgery compared to a non-VR intervention and a control group. 54 patients with colorectal cancer or liver metastases from colorectal cancer undergoing elective curatively intended surgery were recruited and randomised to one of two intervention groups or a control group receiving standard treatment. Participants assigned to one of the intervention groups either received a VR-based intervention twice daily or listened to music twice daily. Adherence to the intervention was 64.6% in the music group and 81.6% in the VR group. The VR intervention significantly reduced heart rate (− 1.2 bpm; 95% CI − 2.24 to − 0.22; p = 0.02) and respiratory rate (− 0.7 brpm; 95% CI − 1.08 to − 0.25; p = 0.01). Self-reported overall mood improved in both groups (VR: + 0.79 pts; 95% CI 0.37–1.21; p = 0.001; music: + 0.59 pts; 95% CI 0.22–0.97; p = 0.004). There was no difference in quality of life between the three groups. Both interventions groups reported changes in feelings. Adherence rates favoured the VR intervention over the music group. Observed clinical outcomes showed stronger intragroup effects on mood, feelings, and vital signs in the VR group. The study demonstrated feasibility of a VR intervention in cancer patients undergoing surgery and should encourage further research investigating the potential of VR interventions to positively influence well-being and mood in cancer patients. [ABSTRACT FROM AUTHOR]

Background Congenital abnormalities of the kidney and urinary tract (CAKUT) are characterized by vast phenotypic heterogeneity and incomplete penetrance. Although CAKUT represent the main cause of pediatric chronic kidney disease, only ∼20% can be explained by single-gene disorders to date. While pathogenic alterations of PBX1 were recently associated with a severe form of syndromic CAKUT, most CAKUT patients survive childhood and adolescence to reach end-stage kidney disease later in life. Although somatic mosaicism is known to attenuate severity in other kidney diseases, it has rarely been described or systematically been assessed in CAKUT. Methods We conducted an in-depth phenotypic characterization of the index patient and his family using targeted next-generation sequencing, segregation analysis and workup of mosaicism with DNA isolated from peripheral blood cells, oral mucosa and cultured urinary renal epithelial cells (URECs). Results Somatic mosaicism was identified in a 20-year-old male with sporadic but mild syndromic renal hypoplasia. He was found to carry a novel de novo truncating variant in PBX1 [c.992C>A, p.(Ser331*)]. This variant was detected in 26% of sequencing reads from blood cells, 50% from oral mucosa and 20% from cultured URECs. Conclusions PBX1 -associated CAKUT is characterized by a wealth of de novo mutations. As in de novo cases, mutations can occur intra- or post-zygotically and genetic mosaicism might represent a more common phenomenon in PBX1 disease, accounting for variable expressivity on a general basis. Consequently we suggest ruling out somatic mosaicism in sporadic CAKUT, notably in attenuated and atypical clinical courses. [ABSTRACT FROM AUTHOR]

This study aimed to identify prognostic factors in patients with metastatic uveal melanoma (UM) that were associated with long-term survival in a real-world setting. A total of 94 patients with metastatic UM were included from German skin cancer centers and the German national skin cancer registry (ADOReg). Data were analyzed for the response to treatment, progression-free survival, and overall survival (OS). Prognostic factors were explored with univariate Cox regression, log-rank, and χ2-tests. Identified factors were subsequently validated after the population was divided into two cohorts of short-term survival (< 2 years OS, cohort A, n = 50) and long-term survival (> 2 years OS, cohort B, n = 44). A poor ECOG performance status (hazard ratio [HR] 2.0, 95% confidence interval [CI] 1.0–3.9) and elevated serum LDH (HR 2.0, 95% CI 1.0–3.8) were associated with a poor OS, whereas a good response to immune checkpoint blockade (ICB, p < 0.001), radiation therapy (p < 0.001), or liver-directed treatments (p = 0.01) were associated with a prolonged OS. Long-term survivors (cohort B) showed a higher median number of organs affected by metastasis (p < 0.001), while patients with liver metastases only were more common in cohort A (40% vs. 9%; p = 0.002). A partial response to ICB was observed in 16% (12/73), being 21% (8/38) for combined ICB, 17% (1/6) for single CTLA4 inhibition, and 10% (3/29) for single PD1 inhibition. One complete response occurred in cohort B with combined ICB. We conclude that the response to ICB and the presence of extrahepatic disease were favorable prognostic factors for long-term survival. [ABSTRACT FROM AUTHOR]

Actinic keratosis (AK) are precancerous lesions of the skin which may progress to invasive squamous cell carcinoma. However, single lesions may also persist or even regress and heal spontaneously. Until now, evidence on the natural course of AK including spontaneous regression is limited. We aimed to synthesize regression rates of AK. We performed a systematic literature research in Medline, Embase, and CENTRAL for eligible trials until 3rd March 2020. Spontaneous regression rates were pooled using a random-effects model to calculate pooled proportions of participant-specific and lesion-specific complete clearance rates reported for the placebo arms of randomized controlled trials. Subgroup analyses were performed to dissect differences according to the type of placebo, immunocompetence of the participants, and localization of the lesions. Data from 38 records was included. The pooled participant-specific clearance rate was 8% (95% CI 6–10%, I2 = 71%) while the lesion-specific clearance rate was 23% (95% CI 16–31%, I2 = 97%). The highest participant- and lesion-specific clearance rates were achieved 12 weeks after the end of treatment (12% and 33%, respectively). Subgroup analysis revealed participant- as well as lesion-specific clearance rates of 0% for organ transplant recipients (OTR). We conclude that only a few participants achieve complete regression of their AK without any active treatment. Besides, the results underline that lesion clearance without active treatment is unlikely in OTR. Thus, early and consequent treatment of AK is recommended. Special attention should be paid when treating AK of OTR. [ABSTRACT FROM AUTHOR]

The aim of this work was to compare the fragmentation efficiency of a novel, pulsed Thulium solid-state laser (p-Tm:YAG) to that of a chopped Thulium fibre laser (TFL) and a pulsed Holmium solid-state laser (Ho:YAG). During the fragmentation process, we used a silicone mould to fixate the hemispherical stone models under water in a jar filled with room-temperature water. Each laser device registered the total energy applied to the stone model to determine fragmentation efficiency. Our study examined laser settings with single pulse energies ranging from 0.6 to 6 J and pulse frequencies ranging from 5 to 15 Hz. Similar laser settings were applied to explicitly compare the fragmentation efficiency of all three devices. We experimented with additional laser settings to see which of the three devices would perform best. The fragmentation performance of the three laser devices differed statistically significantly (p < 0.05). The average total energy required to fragment the stone model was 345.96 J for Ho:YAG, 372.43 J for p-Tm:YAG and 483.90 J for TFL. To fragment the stone models, both Ho:YAG and p-Tm:YAG needed similar total energy (p = 0.97). TFL's fragmentation efficiency is significantly lower than that of Ho:YAG and p-Tm:YAG. Furthermore, we found the novel p-Tm:YAG's fragmentation efficiency to closely resemble that of Ho:YAG. The fragmentation efficiency is thought to be influenced by the pulse duration. TFL's shortest possible pulse duration was considerably longer than that of Ho:YAG and p-Tm:YAG, resulting in Ho:YAG and p-Tm:YAG exhibiting better fragmenting efficiency. [ABSTRACT FROM AUTHOR]

Recently, forest management faces new challenges resulting from increasing temperatures and drought occurrences. For sustainable, site-specific management strategies, the availability of up to date soil information is crucial. Proximal soil sensing techniques are a promising approach for rapid and inexpensive collection of data, and could facilitate the provision of the necessary information. This study evaluates the potential of visual and near-infrared spectroscopy (vis-NIRS) for estimating soil parameters relevant for humus mapping in Saxon forests. Therefore, soil samples from the organic layer are included. So far there is little knowledge about the applicability of vis-NIRS in the humus layer of forests. We investigate the spectral behaviour of samples from organic (Oh) and mineral (0–5 cm, Ah) horizons, pointing out differences in the occurring absorption features. Further, we identify and assess the accuracy of selected soil properties based on vis-NIRS for forest sites, compare the outcome of different regression methods, investigate the implications for forest soils due to the presence and different composition of the humus layer and organic horizons and interpret the results regarding their usefulness for soil mapping and monitoring purposes. For this, we used retained humus soil samples of forests from Saxony. Regression models were built with Partial Least Squares Regression, Support Vector Machine and Cubist. Investigated properties were carbon (C) and nitrogen (N) content, C/N ratio, pH value, cation exchange capacity (CEC) and base saturation (BS) due to their importance for assessing humus conditions in forests. In organic Oh horizons, prediction results for C and N content achieved R2 values between 0.44 and 0.58, with corresponding RPIQ ranging from 1.58 to 2.06 depending on the used algorithm. Estimations of C/N ratio were more precise with R2 = 0.65 and RMSE = 2.16. Best results were reported for pH value, with R2 = 0.90 and RMSE = 0.20. Regarding BS, the best model accuracy was R2 = 0.71, with RMSE = 13.97. In mineral topsoil, C and N content models achieved higher values of R2 = 0.59 to 0.72, with RPIQ values between 2.22 and 2.54. However, prediction accuracy was lower for C/N ratio (R2 = 0.50, RMSE = 3.52) and pH values (R2 = 0.62, RMSE = 0.29). Models for CEC achieved R2 = 0.65, with RPIQ = 2.81. In general, prediction precision varied dependent on the used algorithm, without showing clear tendencies. Classification into pH classes was exemplified since this offers a new perspective for humus mapping on forest soils. Balanced accuracy for the defined classes ranged from 0.50 to 0.87. We show that vis-NIR spectroscopy is suitable for assessing humus conditions in Saxon forests (Germany), in particular not only for mineral horizons but also for organic Oh horizons. [ABSTRACT FROM AUTHOR]

Previously, optic neuritis was thought to be typical, i.e. idiopathic or multiple sclerosis (MS) related, associated with a good visual prognosis, or atypical, i.e. not associated with MS and requiring corticosteroids or plasma exchange for vision to recover. More recently, the importance of optic neuritis in neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein (MOG) antibody disease has become more appreciated. The results of the Optic Neuritis Treatment Trial (ONTT) has influenced how optic neuritis is treated around the world. For this review we surveyed the international literature on optic neuritis in adults. Our aims were first to find the reported incidence of optic neuritis in different countries and to ascertain what percentage of cases were seropositive for anti-aquaporin 4 and anti-MOG antibodies, and second, to document the presenting features, treatment, and outcomes from a first episode of the different types of optic neuritis from these countries, and to compare the results with the outcomes of the ONTT cohort. From these data we have sought to highlight where ambiguities currently lie in how to manage optic neuritis and have made recommendations as to how future treatment trials in optic neuritis should be carried out in the current antibody testing era. [ABSTRACT FROM AUTHOR]

The reaction-diffusion master equation is a stochastic model often utilized in the study of biochemical reaction networks in living cells. It is applied when the spatial distribution of molecules is important to the dynamics of the system. A viable approach to resolve the complex geometry of cells accurately is to discretize space with an unstructured mesh. Diffusion is modeled as discrete jumps between nodes on the mesh, and the diffusion jump rates can be obtained through a discretization of the diffusion equation on the mesh. Reactions can occur when molecules occupy the same voxel. In this paper, we develop a method for computing accurate reaction rates between molecules occupying the same voxel in an unstructured mesh. For large voxels, these rates are known to be well approximated by the reaction rates derived by Collins and Kimball, but as the mesh is refined, no analytical expression for the rates exists. We reduce the problem of computing accurate reaction rates to a pure preprocessing step, depending only on the mesh and not on the model parameters, and we devise an efficient numerical scheme to estimate them to high accuracy. We show in several numerical examples that as we refine the mesh, the results obtained with the reaction-diffusion master equation approach those of a more fine-grained Smoluchowski particle-tracking model. [ABSTRACT FROM AUTHOR]

Quasi-market reforms have been increasingly implemented in tax-funded health care, but their effects in terms of equity, quality and socioeconomic differentials in quality remain sparsely studied. We create a natural experiment setup exploiting the differential timing of a set of quasi-market reforms – including patient choice, free establishment of providers and changes in provider remuneration –, implemented in primary care in the two largest Swedish regions (Stockholm and Västra Götaland) in 2008–2009. Using a database with individual level data from 2005 to 2009, we construct a difference-in-difference-in-differences model that compares pre to post reform changes in avoidable hospitalizations (AHs) for low-income elders and a matched comparison group, in the region exposed to, versus unexposed to, reform (total N ∼ 200 000). The results show that for low-income elders – a group dominated by older women – reform led to higher AH rates, i.e., worse primary health care quality, than what would have been the case in absence of reform. Specifically, low-income elders exposed to reform missed out on improvements in AHs seen simultaneously in the unexposed region. At the same time, the reform had on average no effect for comparable, non-low-income, peers. The fact that this pattern was specific for avoidable hospitalizations – judged as amenable to interventions in primary care –, but not present for total hospitalizations, supports that it was driven by reform implementation rather than other factors. The study contributes with high-quality empirical evidence to a policy relevant but sparsely researched area and highlights the necessity to consider differential effects of organizational changes across socioeconomic groups. • Quasi-market reforms have been increasingly implemented in Swedish primary care. • These reforms dampened declines in avoidable hospitalizations for low-income elders. • This suggests that for this patient group the reforms worsened care quality. • Similar trends were not seen for matched peers, nor for total hospitalizations. • Future studies are needed to disentangle what reform element induced the effect. [ABSTRACT FROM AUTHOR]

Methamphetamine use is surging globally. It has been linked to premature stroke, Parkinsonism, and dementia, suggesting that it may accelerate brain aging. We performed a retrospective study to determine if structural indices of brain aging were more prevalent prior to old age (26 – 54 years) in individuals with Methamphetamine Use Disorder (MUD), who were in early abstinence (M ± SD = 22.1 ± 25.6 days) than in healthy control (HC) participants. We compared T1-weighted MRI brain scans in age- and sex-matched groups (n = 89/group) on three structural features of brain aging: the brain volume/cerebrospinal fluid (BV/CSF) index, volume of white matter hypointensities/lesions, and choroid plexus volume. The MUD group had a lower mean BV/CSF index and larger volumes of white matter hypointensities and choroid plexus (p-values < 0.01). Regression analyses showed significant age-by-group effects, indicating different age trajectories of the BV/CSF index and choroid plexus volume, consistent with abnormal global brain atrophy and choroid plexus pathology in the MUD group. Significant age and group main effects reflected a larger volume of white matter hypointensities for older participants across groups and for the MUD group irrespective of age. None of the three measures of brain aging correlated significantly with recent use or duration of recent abstinence from methamphetamine. Premature brain pathology, which may reflect cerebrovascular damage and dysfunction of the choroid plexus, occurs in people with MUD. Such pathology may affect cognition and thereby efficacy of behavioral treatments for MUD. • Brain age exceeds chronological age in Methamphetamine Use Disorder. • Abnormal brain atrophy and choroid plexus pathology in Methamphetamine Use Disorder. • Methamphetamine Use Disorder linked to larger volume of white matter lesions. • Choroid plexus dysfunction may contribute to methamphetamine-induced neurotoxicity. • Methamphetamine-related brain aging may cause mental decline and early death.. [ABSTRACT FROM AUTHOR]

Purpose: To objectively determine whether there is potential thermal tissue damage during Tm:YAG laser-based LUTS treatment. Methods: Our experimental model was comprised of a prostatic resection trainer placed in a 37 °C water bath. In a hollowed-out central area simulating the urethral lumen, we placed a RigiFib 800 fibre, irrigation inflow regulated with a digital pump, and a type K thermocouple. A second thermocouple was inserted 0.5/1 cm adjacently and protected with an aluminum barrier to prevent it from urethral fluid. We investigated continuous and intermittent 120 W and 80 W laser application with various irrigation rates in eight measurement sessions lasting up to 14 min. Thermal measurements were recorded continuously and in real-time using MatLab. All experiments were repeated five times to balance out variations. Results: Continuous laser application at 120 W and 125 ml/min caused a urethral ∆T of ~ 15 K and a parenchymal temperature increase of up to 7 K. With 50 ml/min irrigation, a urethral and parenchymal ∆T of 30 K and 15 K were reached, respectively. Subsequently and in absence of laser application, prostatic parenchyma needed over 16 min to reach baseline body temperature. At 80 W lower temperature increases were reached compared to similar irrigation but higher power. Conclusions: We showed that potentially harming temperatures can be reached, especially during high laser power and low irrigation. The heat generation can also be conveyed to the prostate parenchyma and deeper structures, potentially affecting the neurovascular bundles. Further clinical studies with intracorporal temperature measurement are necessary to further investigate this potentially harming surgical adverse effect. [ABSTRACT FROM AUTHOR]

International student mobility (ISM) is considered increasingly important for professional careers. Referring to theories of human capital and job market signalling, we assume that different forms of ISM experience can serve as signals for general, specific and transnational human capital. To test this idea, we use a factorial survey experiment to investigate the weights HR managers of German employers allocate to ISM experience in hiring decisions, both generally and conditionally to other characteristics of the application. A screening situation was simulated by randomly presenting hypothetical applicants, thereby systematically varying ISM experience (no experience, private sojourn, studying abroad, internship abroad) and other graduates' characteristics ascribed and achieved. In contrast to the usual graduate and employer surveys, the experimental approach allows us to investigate employers' evaluations directly while capturing problems of endogeneity. Results show that while an internship abroad is more rewarded by employers than studying abroad or a private sojourn, good grades and occupation-specific professional experience are still the most important. Though the effects of ISM experience are partly independent of those of other characteristics, graduates with migration background and those with a master's degree benefit less from ISM experience. Moreover, ISM experience is more rewarded by employers who operate in international contexts. Overall, the analysis uncovers a heterogeneous signalling power of ISM experience, conditional to different types of human capital and to characteristics of applicants and employers. [ABSTRACT FROM AUTHOR]

Aerosol intensive optical properties like the Ångström exponents for aerosol light extinction, scattering and absorption, or the single-scattering albedo are indicators for aerosol size distributions, chemical composition and radiative behaviour and contain also source information. The observation of these parameters requires the measurement of aerosol optical properties at multiple wavelengths which usually implies the use of several instruments. Our study aims to quantify the uncertainties of the determination of multiple-wavelengths intensive properties by an optical closure approach, using different test aerosols. In our laboratory closure study, we measured the full set of aerosol optical properties for a range of light-absorbing aerosols with different properties, mixed externally with ammonium sulphate to generate aerosols of controlled single-scattering albedo. The investigated aerosol types were: fresh combustion soot emitted by an inverted flame soot generator (SOOT, fractal aggregates), Aquadag (AQ, spherical shape), Cabot industrial soot (BC, compact clusters), and an acrylic paint (Magic Black, MB). One focus was on the validity of the Differential Method (DM: absorption = extinction minus scattering) for the determination of Ångström exponents for different particle loads and mixtures of light-absorbing aerosol with ammonium sulphate, in comparison to data obtained from single instruments. The instruments used in this study were two CAPS PMssa (Cavity Attenuated Phase Shift Single Scattering Albedo, ? = 450, 630 nm) for light extinction and scattering coefficients, one Integrating Nephelometer (? = 450, 550, 700 nm) for light scattering coefficient and one Tricolour Absorption Photometer (TAP, ? = 467, 528, 652 nm) for filter-based light absorption coefficient measurement. Our key finding is that the coefficients of light absorption sap, scattering ssp and extinction sep from the Differential Method agree with data from single reference instruments, and the slopes of regression lines equal unity within the precision error. We found, however, that the precision error for the DM exceeds 100% for sap values lower than 10-20 Mm-1 for atmospheric relevant single scattering albedo. This increasing uncertainty with decreasing sap yields an absorption Ångström exponent (AAE) that is too uncertain for measurements in the range of atmospheric aerosol loadings. We recommend using DM only for measuring AAE values for sap > 50 Mm-1. Ångström exponents for scattering and extinction are reliable for extinction coefficients from 20 up to 1000 Mm-1 and stay within 10% deviation from reference instruments, regardless of the chosen method. Single-scattering albedo (SSA) values for 450 nm and 630 nm wavelengths agree with values from the reference method ssp (NEPH)/sep (CAPS PMSSA) with less than 10% uncertainty for all instrument combinations and sampled aerosol types which fulfil the defined goals for measurement uncertainty of 10% proposed by Laj et al., 2020 for GCOS (Global Climate Observing System) applications. [ABSTRACT FROM AUTHOR]

Background: Some earlier studies have found indications of significant changes in cardiometabolic risk factors in children born after assisted reproductive technology (ART). Most of these studies are based on small cohorts with high risk of selection bias. In this study, we compared the risk of cardiovascular disease, obesity, and type 2 diabetes between singleton children born after ART and singleton children born after spontaneous conception (SC).Methods and Findings: This was a large population-based cohort study of individuals born in Norway, Sweden, Finland, and Denmark between 1984 and 2015. Data were obtained from national ART and medical birth registers and cross-linked with data from national patient registers and other population-based registers in the respective countries. In total, 122,429 children born after ART and 7,574,685 children born after SC were included. Mean (SD) maternal age was 33.9 (4.3) years for ART and 29.7 (5.2) for SC, 67.7% versus 41.8% were primiparous, and 45.2% versus 32.1% had more than 12 years of education. Preterm birth (<37 weeks 0 days) occurred in 7.9% of children born after ART and 4.8% in children born after SC, and 5.7% versus 3.3% had a low birth weight (<2,500 g). Mean (SD) follow-up time was 8.6 (6.2) years for children born after ART and 14.0 (8.6) years for children born after SC. In total, 135 (0.11%), 645 (0.65%), and 18 (0.01%) children born after ART were diagnosed with cardiovascular disease (ischemic heart disease, cardiomyopathy, heart failure, or cerebrovascular disease), obesity or type 2 diabetes, respectively. The corresponding values were 10,702 (0.14%), 30,308 (0.74%), and 2,919 (0.04%) for children born after SC. In the unadjusted analysis, children born after ART had a significantly higher risk of any cardiovascular disease (hazard ratio [HR] 1.24; 95% CI 1.04-1.48; p = 0.02), obesity (HR 1.13; 95% CI 1.05-1.23; p = 0.002), and type 2 diabetes (HR 1.71; 95% CI 1.08-2.73; p = 0.02). After adjustment, there was no significant difference between children born after ART and children born after SC for any cardiovascular disease (adjusted HR [aHR]1.02; 95% CI 0.86-1.22; p = 0.80) or type 2 diabetes (aHR 1.31; 95% CI 0.82-2.09; p = 0.25). For any cardiovascular disease, the 95% CI was reasonably narrow, excluding effects of a substantial magnitude, while the 95% CI for type 2 diabetes was wide, not excluding clinically meaningful effects. For obesity, there was a small but significant increased risk among children born after ART (aHR 1.14; 95% CI 1.06-1.23; p = 0.001). Important limitations of the study were the relatively short follow-up time, the limited number of events for some outcomes, and that the outcome obesity is often not considered as a disease and therefore not caught by registers, likely leading to an underestimation of obesity in both children born after ART and children born after SC.Conclusions: In this study, we observed no difference in the risk of cardiovascular disease or type 2 diabetes between children born after ART and children born after SC. For obesity, there was a small but significant increased risk for children born after ART.Trial Registration Number: ISRCTN11780826. [ABSTRACT FROM AUTHOR]

Purpose: To investigate retropulsion forces generated by two laser lithotripsy devices, a standard Ho:YAG and a new pulsed solid-state Thulium laser device. Materials and methods: Two different Dornier laser devices were assessed: a Medilas H Solvo 35 and a pulsed solid-state Thulium laser evaluation model (Dornier MedTech Laser GmbH, Wessling, Germany). We used a 37 °C water bath; temperature was monitored with a thermocouple/data-logger. Representative sets of settings were examined for both devices, including short and long pulse lengths where applicable. For each setting, ten force values were recorded by a low-force precision piezo sensor whereby the laser fibre was either brought into contact with the sensor or placed at a 3 mm distance. Results: The mean retropulsion forces resulting from the new Tm:YAG device were significantly lower than those of the Ho:YAG device under all pulse energy and frequency settings, ranging between 0.92 and 19.60 N for Thulium and 8.09–39.67 N for Holmium. The contact setups yielded lower forces than the distance setups. The forces increased with increasing pulse energy settings while shorter pulse lengths led to 12–44% higher retropulsive force in the 2.0 J/5 Hz comparisons. Conclusion: The Tm:YAG device not only significantly generated lower retropulsion forces in all comparisons to Holmium at corresponding settings but also offers adjustment options to achieve lower energy pulses and longer pulse durations to produce even lower retropulsion. These advantages are a promising add-on to laser lithotripsy procedures and may be highly relevant for improving laser lithotripsy performance. [ABSTRACT FROM AUTHOR]

Objective: We undertook a systematic review of the literature to explore the prevalence of post-traumatic stress disorder (PTSD) in Palestinian children and adolescents exposed to political violence. This is the first systematic review and meta-analysis of the prevalence of PTSD in this population. Methods: PubMed, Embase, PsycInfo, Google Scholar and Cochrane library were searched until June 2020. To estimate the prevalence of PTSD, sub-group and meta-analysis were conducted. Results: The search resulted in 2786 studies, of which 28 articles representing 32 samples with a total of 15,121 participants from Gaza Strip and West Bank met either the DSM-4 or DSM-5 criteria and were included. The pooled prevalence of PTSD was 36% (95% CI 30–41%; I2 98.6%) and ranged from 6% to 70%. Sub-group analysis showed that the PTSD prevalence did not differ according to region (West Bank, Gaza Strip) and tended to decrease after including only studies using a representative sample (p<0.001), and among those with low risk of bias (p<0.001). Visual inspection of the included studies revealed significant discrepancies in study design and assessment measures. Conclusion: We identified high prevalence of PTSD among Palestinian children and adolescents exposed to political violence. However, the pooled results should be interpreted with caution, due to the high heterogeneity and risk of bias in the included studies. These limitations also reflect the challenge in conceptualizing and measuring PTSD in the Palestinian context with a background of continuous and cumulative trauma. Understanding the contextual factors and developing locally adapted survey measures are of relevance to future research, public health planning, and the provision of mental healthcare in Palestine. [ABSTRACT FROM AUTHOR]

The design of a liquid/liquid contact apparatus necessitates the knowledge of fluid dynamics and mass transfer in the dispersion. Prediction of process parameters is challenging due to swarm and interfacial effects. Single drop investigations are suitable to enable a sophisticated dimensioning based on few simple experiments combined with published theories and correlations. In the first part of this article, the fundamentals of fluid dynamics and mass transfer in absence of interfacial effects were explained. Here, an overview of relevant interfacial phenomena and the influence of different substances typically occurring in technical applications as impurities or accompanying components is given. [ABSTRACT FROM AUTHOR]

We describe the first electrochemical activation of D–A cyclopropanes and D–A cyclobutanes leading after C(sp3)−C(sp3) cleavage to the formation of highly reactive radical cations. This concept is utilized to formally insert molecular oxygen after direct or DDQ‐assisted anodic oxidation of the strained carbocycles, delivering β‐ and γ‐hydroxy ketones and 1,2‐dioxanes electrocatalytically. Furthermore, insights into the mechanism of the oxidative process, obtained experimentally and by additional quantum‐chemical calculations are presented. The synthetic potential of the reaction products is demonstrated by diverse derivatizations. [ABSTRACT FROM AUTHOR]

We describe the first electrochemical activation of D–A cyclopropanes and D–A cyclobutanes leading after C(sp3)−C(sp3) cleavage to the formation of highly reactive radical cations. This concept is utilized to formally insert molecular oxygen after direct or DDQ‐assisted anodic oxidation of the strained carbocycles, delivering β‐ and γ‐hydroxy ketones and 1,2‐dioxanes electrocatalytically. Furthermore, insights into the mechanism of the oxidative process, obtained experimentally and by additional quantum‐chemical calculations are presented. The synthetic potential of the reaction products is demonstrated by diverse derivatizations. [ABSTRACT FROM AUTHOR]

Purpose: To examine gas bubbles generated by two laser lithotripsy devices, a pulsed thulium solid-state laser and a holmium:yttrium-aluminum-garnet (Ho:YAG) device, and their possible effects in lithotripsy. Materials and Methods: We investigated two Dornier laser devices, a Medilas H Solvo 35 and a pulsed solid-state thulium laser evaluation model (Dornier MedTech Laser GmbH, Wessling, Germany). Our setup consisted of a water-filled glass tank heated to 37/60/70°C. Different laser power/frequency settings and short/long pulses were examined for both laser devices. We analyzed the impact of degraded, cut, and broken fibers on gas bubble anatomy. Furthermore, high-speed recordings of BegoStone ablation were analyzed. For all recordings, we used a Photron Nova S12 camera. Results: These two devices produced differently shaped gas bubbles under different fiber conditions, temperatures, power settings, and short and long pulse settings, which explain the differing repulsive force and pressure values. Inside the gas bubble, a cone was visible whose angle correlates with the protruding jet. We observed turbulences and swirls moving back and forth the fiber tip. During fragmentation, sparks are generated that demonstrate the photothermal effect, and we recorded stone fragments being pulled toward the fiber. Both devices showed comparable results with differences mainly due to pulse lengths. Conclusion: The shapes of the vapor bubbles formed during laser lithotripsy depend on several factors. Excessive transoperative fiber cleavage seems to be unnecessary. Due to the large gas bubbles observed and because of the amount of potential pressure generated, only low energies should be applied in the ureter. [ABSTRACT FROM AUTHOR]