Success, satisfaction and scrutiny: the business benefits of involving residents

This document summarises work to develop a compelling business case for landlord investment in resident involvement. Its key argument is involvement not only assists in improving satisfaction and service delivery, but also provides value for money

Nevirapine- and efavirenz-associated hepatotoxicity under programmatic conditions in Kenya and Mozambique.

To describe the frequency, risk factors, and clinical signs and symptoms associated with hepatotoxicity (HT) in patients on nevirapine- or efavirenz-based antiretroviral therapy (ART), we conducted a retrospective cohort analysis of patients attending the ART clinic in Kibera, Kenya, from April 2003 to December 2006 and in Mavalane, Mozambique, from December 2002 to March 2007. Data were collected on 5832 HIV-positive individuals who had initiated nevirapine- or efavirenz-based ART. Median baseline CD4+ count was 125 cells/μL (interquartile range [IQR] 55-196). Over a median follow-up time of 426 (IQR 147-693) days, 124 (2.4%) patients developed HT. Forty-one (54.7%) of 75 patients with grade 3 HT compared with 21 (80.8%) of 26 with grade 4 had associated clinical signs or symptoms (P = 0.018). Four (5.7%) of 124 patients with HT died in the first six months compared with 271 (5.3%) of 5159 patients who did not develop HT (P = 0.315). The proportion of patients developing HT was low and HT was not associated with increased mortality. Clinical signs and symptoms identified 50% of grade 3 HT and most cases of grade 4 HT. This suggests that in settings where alanine aminotransferase measurement is not feasible, nevirapine- and efavirenz-based ART may be given safely without laboratory monitoring

The Interval Kicking Program (IKP) as a Reprogramming Technique for the Soccer Player in an Anterior Cruciate Ligament (ACL) Rehabilitation: A Technical Report

Introduction. We can state as technical-athletic gestural movements that we might call clinical (pivoting, cutting maneuvers, sidestep cuts, changes of direction) associated with ACL injuries. Objective. This technical report was conducted to research methods of reprogramming basic technical skills in the soccer player after anterior cruciate ligament reconstructive surgery. Technical report results. The Interval Kicking Program (IKP) is a model proposed as a neuromotor remodelling of basic gestures and techniques after an ACL injury in soccer player. The teaching progression is ordered regarding the diversified techniques of passing and receiving the ball. The volume, intensity, and progression steps are governed by 1) clinical status (i.e., type of injury, conservative/surgical treatment type, type of sport), 2) performance status, and 3) objective evaluative analysis of periodic follow-ups. The steps provid-ed by the IKP can be 15 and end with the introduction of the player into technical drills with the presence of opponents the first sessions include about 30 minutes of sport-specific, low-intensity exercises, while in the last ones, the volume remains constant, but the intensity and technical complexity of the movements increase. Conclusions. In this technical report, we have highlighted how IKP can be a teaching model for reprogramming basic technical skills in the soccer player after injury. It remains fair to point out how aberrant technical movement partners, side-to-side asymmetries, and postur-al dysfunction are predictive of the risk of compliance and second injury. Further studies and insights are needed to customize the reprogramming of the soccer player’s gestural movements during return to play. © 2023, EDRA S.p.A. All rights reserved

Arterial hypertension in aortic valve stenosis: A critical update

Aortic stenosis (AS) is a very common valve disease and is associated with high mortality once it becomes symptomatic. Arterial hypertension (HT) has a high prevalence among patients with AS leading to worse left ventricle remodeling and faster degeneration of the valve. HT also interferes with the assessment of the severity of AS, leading to an underestimation of the real degree of stenosis. Treatment of HT in AS has not historically been pursued due to the fear of excess reduction in afterload without a possibility of increasing stroke volume due to the fixed aortic valve, but most recent evidence shows that several drugs are safe and effective in reducing BP in patients with HT and AS. RAAS inhibitors and beta‐blockers provide benefit in selected populations based on their profile of pharmacokinetics and pharmacodynamics. Different drugs, on the other hand, have proved to be unsafe, such as calcium channel blockers, or simply not easy enough to handle to be recommended in clinical practice, such as PDE5i, MRA or sodium nitroprusside. The present review highlights all available studies on HT and AS to guide antihypertensive treatment

Morphometric maps of bilateral asymmetry in the human humerus: An implementation in the R package morphomap

In biological anthropology, parameters relating to cross-sectional geometry are calculated in paired long bones to evaluate the degree of lateralization of anatomy and, by inference, function. Here, we describe a novel approach, newly added to the morphomap R package, to assess the lateralization of the distribution of cortical bone along the entire diaphysis. The sample comprises paired long bones belonging to 51 individuals (10 females and 41 males) from The New Mexico Decedent Image Database with known biological profile, occupational and loading histories. Both males and females show a pattern of right lateralization. In addition, males are more lateralized than females, whereas there is not a significant association between lateralization with occupation and loading history. Body weight, height and long-bone length are the major factors driving the emergence of asymmetry in the humerus, while interestingly, the degree of lateralization decreases in the oldest individuals

Intra-Messinian truncation surface in the Levant Basin explained by subaqueous dissolution

The Messinian salinity crisis (MSC) is an extreme event in Earth history during which a salt giant (>1 × 106 km3) accumulated on the Mediterranean seafloor within ~640 k.y. Erosional unconformities extending from the continental margins into the deep basins are key features for reconstructing the MSC; however, the nature of the erosional processes and their subaerial versus subaqueous origin are highly controversial. This study focuses on the top erosion surface (TES) in the deep Levant Basin, which is notably flat, truncating a basinward-tilted Messinian evaporitic succession. Based on high-resolution seismic surveys and wireline logs, we show that (1) the TES is actually an intra-Messinian truncation surface (IMTS) located ~100 m below the Messinian-Zanclean boundary; (2) the topmost, post-truncation Messinian unit is very different from the underlying salt deposits and consists mostly of shale, sand, and anhydrite; and (3) the flat IMTS is a dissolution surface related to significant dilution and stratification of the water column during the transition from stage 2 to stage 3 of the MSC. Dissolution occurred upslope where salt rocks at the seabed were exposed to the upper diluted brine, while downslope, submerged in the deeper halite-saturated layer, the salt rocks were preserved. The model, which requires a stratified water column, is inconsistent with a complete desiccation of the eastern Mediterranean Sea

Knowledge, Attitude and Practices of Hand Hygiene among Students and Nurses Staff in Mwanza Tanzania: A Cross-Sectional Hospital-Based Study during Global COVID-19 Pandemic

Background: Hand hygiene (HH) is a critical component of infection prevention and control (IPC) which aims at preventing microbial transmission during patient care hence reducing the burden of healthcare associated infections (HCAIs). Information on the level of HH knowledge, attitudes and practices among healthcare workers (HCWs) from low- and middle-income countries is scarce. This study determined knowledge, attitude and practices of HH among students and staff nurses in Mwanza, Tanzania.Methods: This cross-sectional hospital-based study was conducted between August and October 2020 among student and staff nurses from 2health centres, 2district hospitals, 1regional referral hospital and 1zonal referral hospital. Self-administered pretested structured questionnaires were used for data collection. All data was transferred to Microsoft excel spreadsheet for cleaning and coding, then to STATA software version 13.0 for analysis.Results: A total of 726 nurses aged 18 to 59 years with median (IQR) age of 29(24-38) years were enrolled. About 3 quarters 76.4% (555/726) of nurses had good level of knowledge on HH as most of them 88.3% (641/726) had received rigorous IPC trainings during COVID-19 pandemic. About 42.0% (305/726) of the participants reported that, the action of HH was effortless. Majority of the participants, 81.1% (589/726) practiced hand washing more than hand rubbing routinely. Being a student nurse [OR: 0.30, 95%CI: 0.21-1.44, p<.001], working in inpatient department [OR: 0.38, 95%CI: 0.27-0.55, p<.001], high level of education i.e., degree and above [OR: 1.74, 95%CI: 1.36-2.24, p<.001] and having working experience of 5 years and above [OR: 2.41, 95%CI: 1.52-3.82, p<.001] was associated with being knowledgeable of HH.Conclusion: Majority of the participants had good level of knowledge on HH because they had received rigorous training on IPC, notably HH during the global COVID-19 pandemic

The Effects of Explicit and Implicit Interaction on User Experiences in a Mixed Reality Installation: The Synthetic Oracle

Virtual and mixed reality environments (VMRE) often imply full-body human-computer interaction scenarios. We used a public multimodal mixed reality installation, the Synthetic Oracle, and a between-groups design to study the effects of implicit (e.g., passively walking) or explicit (e.g., pointing) interaction modes on the users' emotional and engagement experiences, and we assessed it using questionnaires. Additionally, real-time arm motion data was used to categorize the user behavior and to provide interaction possibilities for the explicit interaction group. The results show that the online behavior classification corresponded well to the users' interaction mode. In addition, contrary to the explicit interaction, the engagement ratings from implicit users were positively correlated with a valence but were uncorrelated with arousal ratings. Interestingly, arousal levels were correlated with different behaviors displayed by the visitors depending on the interaction mode. Hence, this study confirms that the activity level and behavior of users modulates their experience, and that in turn, the interaction mode modulates their behavior. Thus, these results show the importance of the selected interaction mode when designing users' experiences in VMRE

Scalar turbulent behavior in the roughness sublayer of an Amazonian forest.

An important current problem in micrometeorology is the characterization of turbulence in the roughness sublayer (RSL), where most of the measurements above tall forests are made. There, scalar turbulent fluctuations display significant departures from the predictions of Monin?Obukhov similarity theory (MOST). In this work, we analyze turbulence data of virtual temperature, carbon dioxide, and water vapor in the RSL above an Amazonian forest (with a canopy height of 40&#8239;m), measured at 39.4 and 81.6&#8239;m above the ground under unstable conditions. We found that dimensionless statistics related to the rate of dissipation of turbulence kinetic energy (TKE) and the scalar variance display significant departures from MOST as expected, whereas the vertical velocity variance follows MOST much more closely. Much better agreement between the dimensionless statistics with the Obukhov similarity variable, however, was found for the subset of measurements made at a low zenith angle Z, in the range 0°&#8239;&#8201;<&#8201;&#8239;|Z|&#8239;&#8201;<&#8201;&#8239;20°. We conjecture that this improvement is due to the relationship between sunlight incidence and the ?activation?deactivation? of scalar sinks and sources vertically distributed in the forest. Finally, we evaluated the relaxation coefficient of relaxed eddy accumulation: it is also affected by zenith angle, with considerable improvement in the range 0°&#8239;&#8201;<&#8201;&#8239;|Z|&#8239;&#8201;<&#8201;&#8239;20°, and its values fall within the range reported in the literature for the unstable surface layer. In general, our results indicate the possibility of better stability-derived flux estimates for low zenith angle ranges

Strontium and oxygen isotopes as indicators of Longobards mobility in Italy: an investigation at Povegliano Veronese

The arrival of the Longobards in Northern Italy in 568 CE marked a period of renewed political stability in the Peninsula after the collapse of the Western Roman Empire. The trajectory of the spread of Longobards in Italy across the Alps and into the South is known from many literary sources. However, their mobility and residence patterns at a population level remain to be fully understood. Here we present a multi-isotopic analysis (87Sr/86Sr and 18O/16O) of 39 humans and 14 animals buried at the Longobard necropolis of Povegliano Veronese (VR, Italy; 6th—8th century CE), to address mode and tempo of the spread of this population in the Peninsula. The geographical location of Povegliano Veronese plays a key role: the site lies along the Via Postumia, which was one of the main ancient Roman roads of Northern Italy, representing an important route in post-classical Italy. The integration of isotopic data with the archaeological evidence allowed us to determine the presence of individuals from at least three different regions of origin, building a diachronic map of the dynamics of mobility of this group in northern Italy