Suicide methods in Europe: a gender-specific analysis of countries participating in the "European Alliance Against Depression"

Objective: To identify the most frequent gener-specific suicide methods in Europe. Design: Proportions of seven predominant suicide methods utilised in 16 countries participating in the European Alliance Against Depression (EAAD)were reported in total and cross-nationally. Relative risk (RR)relating to suicide methods and gender was calculated. To group countries by pattern of suicide methods, hierarchical clustering was applied. Setting and participants: Data on suicide methods for 119 122 male and 41 338 female cases in 2000-4/5 from 16 EAAD countries, covering 52% of European population were obtained. Results: Hanging was the most prevalent suicide method among both males (54.3%) and females (35.6%). For males, hanging was followed by firearms (9.7%) and poisoning by drugs (8.6%); for females, by poisoning by drugs (24.7%)and jumping from a high place (14.5%). Only in Switzerland did hanging rank as second for males after firearms. Hanging ranked first among females in eight countries, poisoning by drugs in five and jumping from a high place in three. In all countries, males had a higher risk than females of using firearms and hanging and a lower risk of poisoning by drugs, drowning and jumping. Grouping showed that countries might be divided into five main groups among males; for females, grouping did not yield clear results. Conclusions: Research on suicide methods could lead to the development of gender-specific intervention strategies. Nevertheless, other approaches, such as better identification and treatment of mental disorders and the improvement of toxicological aid should be put in place

Supporting Academic Primary Care Teams Serving Refugees: A Qualitative Study

Introduction: Primary care providers continue to experience significant challenges when caring for refugee patients, yet they are often refugees’ initial point of contact with the U.S. health care system. The purpose of this qualitative study is to expand our understanding of the experiences of academic primary care team members during clinical encounters with refugee patients. Methods: This multi-perspective, qualitative study included physicians (faculty and residents), nurse practitioners, pharmacists, nurses, and medical assistants (n=10), who have been working with refugee patients for at least one year at two family medicine residency clinics and/or a community health center. Semi-structured in-person interviews were conducted and audio-recorded, transcribed, and openly coded to identify emergent themes. Through an immersion/crystallization and consensus approach, data was categorized into domains and subthemes. Results: Major domains and subthemes emerged: Building relationships (over time, earning trust, cultural humility); Markers of success in clinical encounters (improving communication, adaptation); Knowledge of or lack of clinical resources (focused trainings, formal debriefs, access to resources, unwritten languages). Conclusion: Perceptions of success in clinical encounters with refugee patients were primarily associated with communication as opposed to achievement in numeric metrics (e.g. hypertension control). The development of any formalized trainings, tools, and resources to support primary care providers working with refugee patient populations should take these goals into consideration. Lastly, potential solutions were identified to address existing barriers for primary care providers in clinical encounters with refugee patients, but further research and development is necessary to assess their efficacy and utility

Variability in the composition of extracellular polymeric substances from a full-scale aerobic granular sludge reactor treating urban wastewater

Within the framework of the circular economy, there is a need for waste management alternatives that promote the reuse of materials produced in wastewater treatment plants (WWTP). An interesting option is the recovery of extracellular substances from sludge. The variability of characteristics of potential recovered bioproducts has to be assessed in full scale operational settings. In this study, aerobic granular sludge (AGS) from a full-scale WWTP treating urban wastewater was regularly collected for 4 months to assess variability in extracellular polymeric substances (EPS) composition and in granular morphology. Variations in the EPS composition occurred with time. Proteins and humic substances were the main EPS components (329-494 and 259-316?mg/g VSS of AGS, respectively), with polysaccharides and DNA representing minor components. The application of an extra purification step after extraction to obtain a purer EPS led to a decrease in the yield of each EPS component, particularly pronounced for the polysaccharides. The final product had a rather constant composition for the monthly samples. The granules showed morphological stability throughout the sampling period and the yield of EPS was correlated to the size of the granules, higher when there was a higher content of small granules (Deq<150?µm) comparing to intermediate (150???Deq<1500?µm) or large granules (Deq?1500?µm). This is the first time that a potential valorization strategy for surplus AGS biomass is studied in a full-scale environment. Knowledge on yield and product homogeneity is important as these features are essential for downstream application of the recovered EPS.The authors wish to thank the company SIMTEJO for supplying the granules and influent and effluent characterization data. This work was financed by FCT under the project AGeNT - PTDC/BTA-BTA/31264/2017 (POCI-01-0145-FEDER-031264). We would like to thank the scientific collaboration of CBQF under the FCT project UID/Multi/50016/2019 and NORTE-08-5369-FSE-000007 and CEB under the FCT project UID/BIO/044697/2019 and BioTecNorte operation (NORTE-01-0145-FEDER-000004).info:eu-repo/semantics/publishedVersio

African tropical rainforest net carbon dioxide fluxes in the twentieth century

The African humid tropical biome constitutes the second largest rainforest region, significantly impacts global carbon cycling and climate, and has undergone major changes in functioning owing to climate and land-use change over the past century. We assess changes and trends in CO2 fluxes from 1901 to 2010 using nine land surface models forced with common driving data, and depict the inter-model variability as the uncertainty in fluxes. The biome is estimated to be a natural (no disturbance) net carbon sink (−0.02 kg C m−2 yr−1 or −0.04 Pg C yr−1, p < 0.05) with increasing strength fourfold in the second half of the century. The models were in close agreement on net CO2 flux at the beginning of the century (σ1901 = 0.02 kg C m−2 yr−1), but diverged exponentially throughout the century (σ2010 = 0.03 kg C m−2 yr−1). The increasing uncertainty is due to differences in sensitivity to increasing atmospheric CO2, but not increasing water stress, despite a decrease in precipitation and increase in air temperature. However, the largest uncertainties were associated with the most extreme drought events of the century. These results highlight the need to constrain modelled CO2 fluxes with increasing atmospheric CO2 concentrations and extreme climatic events, as the uncertainties will only amplify in the next century

Non-invasive diagnostic tests for Helicobacter pylori infection

BACKGROUND: Helicobacter pylori (H pylori) infection has been implicated in a number of malignancies and non-malignant conditions including peptic ulcers, non-ulcer dyspepsia, recurrent peptic ulcer bleeding, unexplained iron deficiency anaemia, idiopathic thrombocytopaenia purpura, and colorectal adenomas. The confirmatory diagnosis of H pylori is by endoscopic biopsy, followed by histopathological examination using haemotoxylin and eosin (H & E) stain or special stains such as Giemsa stain and Warthin-Starry stain. Special stains are more accurate than H & E stain. There is significant uncertainty about the diagnostic accuracy of non-invasive tests for diagnosis of H pylori. OBJECTIVES: To compare the diagnostic accuracy of urea breath test, serology, and stool antigen test, used alone or in combination, for diagnosis of H pylori infection in symptomatic and asymptomatic people, so that eradication therapy for H pylori can be started. SEARCH METHODS: We searched MEDLINE, Embase, the Science Citation Index and the National Institute for Health Research Health Technology Assessment Database on 4 March 2016. We screened references in the included studies to identify additional studies. We also conducted citation searches of relevant studies, most recently on 4 December 2016. We did not restrict studies by language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA: We included diagnostic accuracy studies that evaluated at least one of the index tests (urea breath test using isotopes such as13C or14C, serology and stool antigen test) against the reference standard (histopathological examination using H & E stain, special stains or immunohistochemical stain) in people suspected of having H pylori infection. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the references to identify relevant studies and independently extracted data. We assessed the methodological quality of studies using the QUADAS-2 tool. We performed meta-analysis by using the hierarchical summary receiver operating characteristic (HSROC) model to estimate and compare SROC curves. Where appropriate, we used bivariate or univariate logistic regression models to estimate summary sensitivities and specificities. MAIN RESULTS: We included 101 studies involving 11,003 participants, of which 5839 participants (53.1%) had H pylori infection. The prevalence of H pylori infection in the studies ranged from 15.2% to 94.7%, with a median prevalence of 53.7% (interquartile range 42.0% to 66.5%). Most of the studies (57%) included participants with dyspepsia and 53 studies excluded participants who recently had proton pump inhibitors or antibiotics.There was at least an unclear risk of bias or unclear applicability concern for each study.Of the 101 studies, 15 compared the accuracy of two index tests and two studies compared the accuracy of three index tests. Thirty-four studies (4242 participants) evaluated serology; 29 studies (2988 participants) evaluated stool antigen test; 34 studies (3139 participants) evaluated urea breath test-13C; 21 studies (1810 participants) evaluated urea breath test-14C; and two studies (127 participants) evaluated urea breath test but did not report the isotope used. The thresholds used to define test positivity and the staining techniques used for histopathological examination (reference standard) varied between studies. Due to sparse data for each threshold reported, it was not possible to identify the best threshold for each test.Using data from 99 studies in an indirect test comparison, there was statistical evidence of a difference in diagnostic accuracy between urea breath test-13C, urea breath test-14C, serology and stool antigen test (P = 0.024). The diagnostic odds ratios for urea breath test-13C, urea breath test-14C, serology, and stool antigen test were 153 (95% confidence interval (CI) 73.7 to 316), 105 (95% CI 74.0 to 150), 47.4 (95% CI 25.5 to 88.1) and 45.1 (95% CI 24.2 to 84.1). The sensitivity (95% CI) estimated at a fixed specificity of 0.90 (median from studies across the four tests), was 0.94 (95% CI 0.89 to 0.97) for urea breath test-13C, 0.92 (95% CI 0.89 to 0.94) for urea breath test-14C, 0.84 (95% CI 0.74 to 0.91) for serology, and 0.83 (95% CI 0.73 to 0.90) for stool antigen test. This implies that on average, given a specificity of 0.90 and prevalence of 53.7% (median specificity and prevalence in the studies), out of 1000 people tested for H pylori infection, there will be 46 false positives (people without H pylori infection who will be diagnosed as having H pylori infection). In this hypothetical cohort, urea breath test-13C, urea breath test-14C, serology, and stool antigen test will give 30 (95% CI 15 to 58), 42 (95% CI 30 to 58), 86 (95% CI 50 to 140), and 89 (95% CI 52 to 146) false negatives respectively (people with H pylori infection for whom the diagnosis of H pylori will be missed).Direct comparisons were based on few head-to-head studies. The ratios of diagnostic odds ratios (DORs) were 0.68 (95% CI 0.12 to 3.70; P = 0.56) for urea breath test-13C versus serology (seven studies), and 0.88 (95% CI 0.14 to 5.56; P = 0.84) for urea breath test-13C versus stool antigen test (seven studies). The 95% CIs of these estimates overlap with those of the ratios of DORs from the indirect comparison. Data were limited or unavailable for meta-analysis of other direct comparisons. AUTHORS' CONCLUSIONS: In people without a history of gastrectomy and those who have not recently had antibiotics or proton ,pump inhibitors, urea breath tests had high diagnostic accuracy while serology and stool antigen tests were less accurate for diagnosis of Helicobacter pylori infection.This is based on an indirect test comparison (with potential for bias due to confounding), as evidence from direct comparisons was limited or unavailable. The thresholds used for these tests were highly variable and we were unable to identify specific thresholds that might be useful in clinical practice.We need further comparative studies of high methodological quality to obtain more reliable evidence of relative accuracy between the tests. Such studies should be conducted prospectively in a representative spectrum of participants and clearly reported to ensure low risk of bias. Most importantly, studies should prespecify and clearly report thresholds used, and should avoid inappropriate exclusions

Das Alien Tort Statute | Rechtsprechung, dogmatische Entwicklung und deutsche Interessen

Aufgrund des sog. »Alien Tort Statute« (ATS), eines kleinen und etwa 100 Jahre lang vergessenen Satzes des US-amerikanischen Gerichtsverfassungsgesetzes von 1789, gründeten die US-Gerichte ein amerikanisches Forum mit weltweit reichender Gerichtsbarkeit für milliardenschwere Schadensersatzklagen wegen Menschenrechtsverletzungen. Dabei wurden insbesondere deutsche Gesellschaften in Anspruch genommen und Fälle, in denen deutsche Konzerne zu den Hauptbeklagten gehörten, mündeten in Leitentscheidungen der dogmatischen Expansion der ATS-Rechtsprechung. Daniel Felz arbeitet die enorme Masse an US-Entscheidungen auf, um die breitgefächerten dogmatischen Fundamente der ATS-Rechtsprechung zu ordnen. Alsdann widmet er sich der Behauptung der deutschen Bundesregierung, für derlei Klagen stünden die deutschen Gerichte offen, indem Felz einer Untersuchung der mit länderübergreifenden Menschenrechtsklagen verbundenen materiell- und prozessrechtlichen Fragen des deutschen Rechts nachgeht.»The Alien Tort Statute«Until recently, US courts treated the Alien Tort Statute (ATS) as creating an American forum for civil suits involving human rights violations, regardless of where violations occurred. German companies were especially hard-hit by ATS lawsuits. This book provides a comprehensive account of the case law that led to seemingly universal jurisdiction in US courts. It then evaluates the German government's claim that German law provides an equivalent forum for human rights suits before German courts

(Not) Everything is Good and Easy: Language-related Healthcare Experiences of Two Groups of Low-income Latina Mothers

This cross-sectional, comparative, qualitative study explored language-related issues experienced by low-income Spanish-speaking mothers navigating pediatric care for their children in Hillsborough County, Florida. Hospitals, pediatric clinics, specialists, and dental care have differing degrees of linguistic accessibility and accommodations for limited English proficient families. Two groups of mothers were interviewed: bilingual (n=9) and Spanish-speaking limited-English proficient (SSLEP) mothers (n=21). These groups perceived the effect of language on navigating pediatric healthcare differently, creating tension in perceptions and experience between them. Such tensions included SSLEP mothers expressing satisfaction with pediatric care simultaneously with shortcomings in communication. SSLEP mothers said that everything was easy, at the same time stating that navigating healthcare, and other aspects of their family life would be far easier if they spoke English. SSLEP expressions of self-sufficiency were countered by bilingual mothers who provided language support to SSLEP family members, friends, and strangers. This research points toward the need for consistent language services in healthcare settings as well as facilitation of effective English language acquisition opportunities for families