Graves' ophthalmopathy: the clinical and psychosocial outcomes of different medical interventions - a systematic review.

Background Graves’ ophthalmopathy is a complex autoimmune disorder that can significantly affect quality of life (QoL), vision and physical appearance. Recently, a deeper understanding of the underlying pathogenesis has led to the development of novel treatment options. Aims The purpose of this review is to explore the current literature on conventional and novel treatment modalities and to evaluate which interventions provide the most favourable psychological and clinical outcomes in patients with moderate to severe, active Grave’s ophthalmopathy. For example, QoL is an important psychosocial outcome of disease management. However, available literature demonstrates that not all clinically effective treatment options improve patients’ QoL. Methods A systematic literature review was conducted to assess the clinical and psychosocial outcomes of different therapies for Graves’ ophthalmopathy. An extensive database search of Ovid Medline, Ovid Embase and Cochrane Central Register of Controlled Trials was conducted. Studies generated were reviewed and the relevant selected data were retrieved and analysed. Results Results showed intravenous steroids, rituximab (RTX), tocilizumab and teprotumumab were all significantly effective in improving Clinical Activity Scores. Orbital radiotherapy showed a slight improvement in proptosis and diplopia. All interventions were safe with few serious adverse events being reported across all studies. All treatment modalities demonstrated beneficial improvements in both components of the Graves’ Ophthalmopathy-QoL (QoL) questionnaire, apart from orbital radiotherapy which only demonstrated improvements in the visual functioning subscale. Teprotumumab was identified to be the most effective intervention for improving both clinical and psychosocial outcomes. However, further research needs to be conducted to evaluate its side effect profile and cost-effectiveness. Nonetheless, with time it has the potential to be a first-line treatment option in the management of active moderate to severe Graves’ ophthalmopathy

Electrolysers for the hydrogen revolution: challenges, dependencies, and solutions

Due to Europe's gas crisis and the Russian invasion of Ukraine, ramping up the hydro­gen market has become more urgent than ever for European and German policymakers. However, ambitious targets for green hydrogen present an enormous challenge for the European Union (EU) and its young hydrogen economy. Apart from the demand for electricity, there is above all a lack of production capacities for electrolysers. The envisioned production scaling of electrolysers is almost impossible to achieve, and it also conflicts with import efforts and cements new dependencies on suppliers of key raw materials and critical components. Although a decoupling from Russia’s raw ma­terial supply is generally possible, there is no way for the EU to achieve its goals with­out China. Aside from loosened regulations and the active management of raw material supply, Europe should also reconsider its biased preference for green hydrogen. (author's abstract

Anxiety Depression and Quality of Life among Working Married and Unmarried Women: A Comparative Study

Background: Anxiety and depression are the most common problems that we face in our daily life and both affect our quality of life. So, the present study was done to assess and compare anxiety, depression and quality of life among working married and unmarried women. Methods and Materials: Purposive sampling technique was used for recruiting 100 working women (an equal number of married and unmarried), with their informed consent. The tools used for the present study were Hamilton Anxiety Rating Scale, Beck Depression Inventory-II and WHO Quality of Life-Bref for anxiety, depression and quality of life assessment respectively. Results: Result shows significant differences in the levels of anxiety, depression and quality of life of working married and unmarried women. Conclusion: The present study also concludes that married working women do experience a higher level of anxiety and depression as well as a lower quality of life in comparison to unmarried working women. Keywords:  Anxiety, depression, quality of life, working wome

Recommendations for coronavirus infection in rheumatic diseases treated with biologic therapy.

The Coronavirus-associated disease, that was first identified in 2019 in China (CoViD-19), is a pandemic caused by a bat-derived beta-coronavirus, named SARS-CoV2. It shares homology with SARS and MERS-CoV, responsible for past outbreaks in China and in Middle East. SARS-CoV2 spread from China where the first infections were described in December 2019 and is responsible for the respiratory symptoms that can lead to acute respiratory distress syndrome. A cytokine storm has been shown in patients who develop fatal complications, as observed in past coronavirus infections. The management includes ventilatory support and broad-spectrum antiviral drugs, empirically utilized, as a targeted therapy and vaccines have not been developed. Based upon our limited knowledge on the pathogenesis of CoViD-19, a potential role of some anti-rheumatic drugs may be hypothesized, acting as direct antivirals or targeting host immune response. Antimalarial drugs, commonly used in rheumatology, may alter the lysosomal proteases that mediates the viral entry into the cell and have demonstrated efficacy in improving the infection. Anti-IL-1 and anti-IL-6 may interfere with the cytokine storm in severe cases and use of tocilizumab has shown good outcomes in a small cohort. Baricitinib has both antiviral and anti-inflammatory properties. Checkpoints inhibitors such as anti-CD200 and anti-PD1 could have a role in the treatment of CoViD-19. Rheumatic disease patients taking immunosuppressive drugs should be recommended to maintain the chronic therapy, prevent infection by avoiding social contacts and pausing immunosuppressants in case of infection. National and international registries are being created to collect data on rheumatic patients with CoViD-19

The geopolitics of hydrogen: technologies, actors and scenarios until 2040

The transition to a hydrogen-based economy is gaining momentum in both Germany and the European Union (EU). Used as an energy carrier, hydrogen holds the promise of freeing hard-to-decarbonise sectors like heavy industry, aviation, and maritime trade from their emissions. At the same time, policymakers hope that hydrogen will promote Europe's energy independence, push sustainable development, and strengthen value-based trade. This study presents three plausible yet disruptive scenarios for the geo­politics of hydrogen up to the year 2040 (developed with a team of experts in a multi-stage foresight process). "Hydrogen Realignment" considers the possibility of an eastward shift of industry, power, and technological lead­er­ship; "Hydrogen (In)Dependence" depicts a future, in which Europe pur­sues hydrogen self-sufficiency but becomes dependent on raw material supply; and "Hydrogen Imperialism" delves into the dystopian scenario of a hydrogen transition dominated by hegemons and despots. The transition to hydrogen is likely to shift and complicate Europe's exter­nal dependence rather than eliminate it; the role of supply chains will become more important. Moreover, the potential of hydrogen trade for global sustainable development is limited and requires targeted efforts. Resource distribution, production potential, current geopolitical power dynamics, and their interplay will influence hydrogen policy and deci­sion-making along the entire value chain, with actors often giving priority to socioeconomic, geopolitical, and technopolitical considerations. Germany and the EU must pursue a proactive hydrogen strategy, acknowl­edge the preferences of external actors, and form pragmatic partnerships to keep sight of climate goals, retain industry, and avoid losing global influence. In addition to promoting targeted technologies, decision-makers must manage dependencies across sectors and do so in an anticipatory way. Pursuing diversification is indispensable, and instituting targeted diplomacy and development assistance would be helpful. The new hydrogen sector also needs governing institutions - for example a "Hydrogen Alli­ance" - to mitigate geopolitical risks and allocate investments correctly. (author's abstract

Effectiveness of stretching of the flexor retinaculum with ultrasonic therapy in the management of carpal tunnel syndrome

Aims & Objective: The objective of study was to compare the effectiveness of manual stretching of the flexor retinaculum with or without ultrasonic therapy. Methods: The study was started by selecting the 50 patients from the out patients department of Al-nafees Hospital AlipurFarash and National institute of Rehabilitation Medicine Islamabad with history of carpal tunnel syndrome. The 25 patients in experimental group were treated with manual stretching of flexor retinaculum and ultrasound and 25 patients of control group were treated with manual stretching of flexor retinaculum. Every session was started by assessment of improvement of the symptoms in each patient. Data was collected through Numeric pain rating scale, point Paresthesia assessment scale and muscle strength by hydraulic hand dynamometer. Independent sample t-test was used to analyze the data with p ≤ 0.05. Results: The mean age of subjects was 1.78±0.64 and 41 subjects have CTS of Right hand remaining 9 subjects were left handed. After the completion of the treatment program it was observe that there was no difference in the effectiveness of manual Stretching of flexor retinaculum with ultra sound therapy and manual stretching of flexor retinaculum alone. The NPRS, paresthesia and muscle stretch showed p≥0.05 between experimental and control groups. Conclusion: This study proved that manual stretching of the flexor retinaculum along with ultra sonic therapy have same affects as manual stretching of the flexor retinaculum alone

Migration and social networks: evidence from Bangladesh

Social networks play a key role in mitigating the risks of migration, with migrants typically making use of network and kinship capital in the decision of whether to migrate and to which destination. This paper adds to the empirical literature on the role of networks in migration decisions in Bangladesh using household survey data collected in Bangladesh in 2013. Our survey captures information on households and their migrant and resident members, migrant destinations and contacts at their destination. We distinguish between internal networks and international networks and analyse the importance of these in affecting the migration decision and destination choice. We also explore the gender dimensions of these decisions, finding that while male migration decisions are very sensitive to the existence and nature (internal or international), and even suggestive of a step-migration patterns of rural to urban to international destinations, women’s migration decisions are much more influenced by household characterises, such as household wealth

Intermicrobial interaction: Aspergillus fumigatus siderophores protect against competition by Pseudomonas aeruginosa

International audiencePseudomonas aeruginosa and Aspergillus fumigatus are pathogens frequently co-inhabiting immunocompromised patient airways, particularly in people with cystic fibrosis. Both microbes depend on the availability of iron, and compete for iron in their microenvironment. We showed previously that the P. aeruginosa siderophore pyoverdine is the main instrument in battling A. fumigatus biofilms, by iron chelation and denial of iron to the fungus. Here we show that A. fumigatus siderophores defend against anti-fungal P. aeruginosa effects. P. aeruginosa supernatants produced in the presence of wildtype A. fumigatus planktonic supernatants (Afsup) showed less activity against A. fumigatus biofilms than P. aeruginosa supernatants without Afsup, despite higher production of pyoverdine by P. aeruginosa. Supernatants of A. fumigatus cultures lacking the sidA gene (AfΔsidA), unable to produce hydroxamate siderophores, were less capable of protecting A. fumigatus biofilms from P. aeruginosa supernatants and pyoverdine. AfΔsidA biofilm was more sensitive towards inhibitory effects of pyoverdine, the iron chelator deferiprone (DFP), or amphothericin B than wildtype A. fumigatus biofilm. Supplementation of sidA-deficient A. fumigatus biofilm with A. fumigatus siderophores restored resistance to pyoverdine. The A. fumigatus siderophore production inhibitor celastrol sensitized wildtype A. fumigatus biofilms towards the anti-fungal activity of DFP. In conclusion, A. fumigatus hydroxamate siderophores play a pivotal role in A. fumigatus competition for iron against P. aeruginosa

Elektrolyseure für die Wasserstoffrevolution: Herausforderungen, Abhängigkeiten und Lösungsansätze

Angesichts der Gaskrise und der russischen Invasion der Ukraine ist der Markthochlauf von Wasserstoff noch dringlicher geworden für die europäische und die deut­sche Energiepolitik. Die ehrgeizigen Ziele für grünen Wasserstoff stellen die Europäische Union (EU) und die junge Was­serstoffökonomie allerdings vor enorme Probleme. Abgesehen vom Strombedarf fehlen vor allem Produktionskapazitäten für Elektrolyseure. Die an­visierte Pro­duktionsskalierung von Elektrolyseuren ist kaum zu schaffen, außerdem steht sie im Konflikt zu Importbestrebungen und zementiert neue Ab­hängig­keiten von Lieferanten wich­tiger Rohstoffe und kritischer Komponenten. Wäh­rend eine Ent­koppelung von Russ­lands Rohstofflieferungen zumindest möglich ist, führt an China kein Weg vorbei, will die EU ihre Ziele erreichen. Nebst erleichter­ten Regularien, einem aktiven Rohstoffmanagement und neuen Partnerschaften sollte Europa auch die einseitige Beschränkung auf grünen Wasserstoff überdenken. (Autorenreferat

Die Geopolitik des Wasserstoffs: Technologien, Akteure und Szenarien bis 2040

Die Wasserstoffwende gewinnt für Deutschland und die Europäische Union (EU) immens an Bedeutung, da Wasserstoff Möglichkeiten bietet, schwer zu dekarbonisierende Bereiche wie Schwerindustrie, Luftfahrt und maritimen Handel in eine klimafreundliche Welt einzubinden. Zugleich besteht der Anspruch, Abhängigkeiten zu verringern, nachhaltige Entwicklung auszubauen und werteorientierten Handel zu etablieren. Drei radikale, aber plausible Szenarien illustrieren die Geopolitik des Wasserstoffs: H2-Neuordnung skizziert eine Verschiebung von Macht, Industrie und Technologieführerschaft gen Osten, H2-(Un-)Abhängigkeit zeigt auf, wie ein europäischer Alleingang im Hinblick auf Wasserstoff zu neuen Abhängigkeiten führt, und H2-Imperialismus beschreibt die Dystopie einer von Hegemonen und Despoten dominierten Wasserstoffwende. Mit der Umstellung auf Wasserstoff werden sich Abhängigkeiten vermut­lich nicht verringern, sondern verschieben und verkomplizieren. Insbeson­dere die Rohstoffliefer- und Wertschöpfungsketten bekommen mehr Ge­wicht. Auch das entwicklungspolitische Potential des Wasserstoffhandels ist begrenzt, und seine Realisierung bedarf gezielter Anstrengungen. Die Wechselwirkungen zwischen Ressourcenverteilung, Produktions­potential und aktuellen geopolitischen Machtverhältnissen beeinflussen die Wasserstoffpolitik ebenso wie die Rolle von Akteuren entlang der Wertschöpfungskette. Relevante Akteure priorisieren oft sozioökonomische sowie geo- und industriepolitische Überlegungen. Deutschland und die EU müssen eine proaktive Wasserstoffstrategie ver­folgen, Präferenzen externer Akteure anerkennen und Partnerschaften pragmatisch gestalten, um Klimaziele durchzusetzen, die Industrie zu schützen und ihren globalen Einfluss zu bewahren. Unter den zu empfehlenden konkreten Maßnahmen geht es neben einer gezielten Technologieförderung darum, Abhängigkeiten sektorübergrei­fend und antizipativ zu managen. Diversifizierung ist dabei unerlässlich, flankierende Entwicklungspolitik wäre hilfreich. Wasserstoff-Governance, etwa im Rahmen einer "Wasserstoffallianz", ist insbesondere nötig, um geopolitische Risiken zu mindern und Investitionen am richtigen Ort zu platzieren. (Autorenreferat