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A Concise History of Albania charts the history of Albania and its people, within their Balkan and European contexts. It shows the country's journey from its ancient past, still shrouded in mystery and controversy, through its difficult transition from a particularly brutal form of communism to an evolving form of democracy and a market economy. Bernd Fischer and Oliver Schmitt challenge some of the traditional narratives concerning the origins of the Albanians, and the relations between Albanians and their Balkan neighbours. This authoritative and up-to-date single-volume history analyses the political, social, economic, and cultural developments which led to the creation of the Albanian state and the modern nation, as well as Albania's more recent experience with authoritarianism, war, and communism. It greatly contributes to our understanding of the challenges facing contemporary Albanians, as well as the issues confronting the region as a whole as it attempts to grapple with one of the last remaining significant ethnic issues in the Balkans.
Mental health and psychosocial support (MHPSS) staff in humanitarian settings have limited access to clinical supervision and are at high risk of experiencing burnout. We previously piloted an online, peer-supervision program for MHPSS professionals working with displaced Rohingya (Bangladesh) and Syrian (Turkey and Northwest Syria) communities. Pilot evaluations demonstrated that online, peer-supervision is feasible, low-cost, and acceptable to MHPSS practitioners in humanitarian settings.
This project will determine the impact of online supervision on i) the wellbeing and burnout levels of local MHPSS practitioners, and ii) practitioner technical skills to improve beneficiary perceived service satisfaction, acceptability, and appropriateness.
MHPSS practitioners in two contexts (Bangladesh and Turkey/Northwest Syria) will participate in 90-minute group-based online supervision, fortnightly for six months. Sessions will be run on zoom and will be co-facilitated by MHPSS practitioners and in-country research assistants. A quasi-experimental multiple-baseline design will enable a quantitative comparison of practitioner and beneficiary outcomes between control periods (12-months) and the intervention. Outcomes to be assessed include the Kessler-6, Harvard Trauma Questionnaire and Copenhagen Burnout Inventory and Client Satisfaction Questionnaire-8.
A total of 80 MHPSS practitioners will complete 24 monthly online assessments from May 2022. Concurrently, 1920 people receiving MHPSS services will be randomly selected for post-session interviews (24 per practitioner).
This study will determine the impact of an online, peer-supervision program for MHPSS practitioners in humanitarian settings. Results from the baseline assessments, pilot evaluation, and theory of change model will be presented.
The repeated return of tetrapods to aquatic life provides some of the best-known examples of convergent evolution. One comparison that has received relatively little focus is that of mosasaurids (a group of Late Cretaceous squamates) and archaic cetaceans (the ancestors of modern whales and dolphins), both of which show high levels of craniodental disparity, similar initial trends in locomotory evolution, and global distributions. Here we investigate convergence in skull ecomorphology during the initial aquatic radiations of these groups. A series of functionally informative ratios were calculated from 38 species, with ordination techniques used to reconstruct patterns of functional ecomorphospace occupation. The earliest fully aquatic members of each clade occupied different regions of ecomorphospace, with basilosaurids and early russellosaurines exhibiting marked differences in cranial functional morphology. Subsequent ecomorphological trajectories notably diverge: mosasaurids radiated across ecomorphospace with no clear pattern and numerous reversals, whereas cetaceans notably evolved toward shallower, more elongated snouts, perhaps as an adaptation for capturing smaller prey. Incomplete convergence between the two groups is present among megapredatory and longirostrine forms, suggesting stronger selection on cranial function in these two ecomorphologies. Our study highlights both the similarities and divergences in craniodental evolutionary trajectories between archaic cetaceans and mosasaurids, with convergences transcending their deeply divergent phylogenetic affinities.
The rapid spread of coronavirus disease 2019 (COVID-19) required swift preparation to protect healthcare personnel (HCP) and patients, especially considering shortages of personal protective equipment (PPE). Due to the lack of a pre-existing biocontainment unit, we needed to develop a novel approach to placing patients in isolation cohorts while working with the pre-existing physical space.
To prevent disease transmission to non–COVID-19 patients and HCP caring for COVID-19 patients, to optimize PPE usage, and to provide a comfortable and safe working environment.
An interdisciplinary workgroup developed a combination of approaches to convert existing spaces into COVID-19 containment units with high-risk zones (HRZs). We developed standard workflow and visual management in conjunction with updated staff training and workflows. The infection prevention team created PPE standard practices for ease of use, conservation, and staff safety.
The interventions resulted in 1 possible case of patient-to-HCP transmission and zero cases of patient-to-patient transmission. PPE usage decreased with the HRZ model while maintaining a safe environment of care. Staff on the COVID-19 units were extremely satisfied with PPE availability (76.7%) and efforts to protect them from COVID-19 (72.7%). Moreover, 54.8% of HCP working in the COVID-19 unit agreed that PPE monitors played an essential role in staff safety.
The HRZ model of containment unit is an effective method to prevent the spread of COVID-19 with several benefits. It is easily implemented and scaled to accommodate census changes. Our experience suggests that other institutions do not need to modify existing physical structures to create similarly protective spaces.
Background: Eye movements reveal neurodegenerative disease processes due to overlap between oculomotor circuitry and disease-affected areas. Characterizing oculomotor behaviour in context of cognitive function may enhance disease diagnosis and monitoring. We therefore aimed to quantify cognitive impairment in neurodegenerative disease using saccade behaviour and neuropsychology. Methods: The Ontario Neurodegenerative Disease Research Initiative recruited individuals with neurodegenerative disease: one of Alzheimer’s disease, mild cognitive impairment, amyotrophic lateral sclerosis, frontotemporal dementia, Parkinson’s disease, or cerebrovascular disease. Patients (n=450, age 40-87) and healthy controls (n=149, age 42-87) completed a randomly interleaved pro- and anti-saccade task (IPAST) while their eyes were tracked. We explored the relationships of saccade parameters (e.g. task errors, reaction times) to one another and to cognitive domain-specific neuropsychological test scores (e.g. executive function, memory). Results: Task performance worsened with cognitive impairment across multiple diseases. Subsets of saccade parameters were interrelated and also differentially related to neuropsychology-based cognitive domain scores (e.g. antisaccade errors and reaction time associated with executive function). Conclusions: IPAST detects global cognitive impairment across neurodegenerative diseases. Subsets of parameters associate with one another, suggesting disparate underlying circuitry, and with different cognitive domains. This may have implications for use of IPAST as a cognitive screening tool in neurodegenerative disease.
Health services research (HSR) is affected by a widespread problem related to service terminology including non-commensurability (using different units of analysis for comparisons) and terminological unclarity due to ambiguity and vagueness of terms. The aim of this study was to identify the magnitude of the terminological bias in health and social services research and health economics by applying an international classification system.
This study, that was part of the PECUNIA project, followed an ontoterminology approach (disambiguation of technical and scientific terms using a taxonomy and a glossary of terms). A listing of 56 types of health and social services relevant for mental health was compiled from a systematic review of the literature and feedback provided by 29 experts in six European countries. The disambiguation of terms was performed using an ontology-based classification of services (Description and Evaluation of Services and DirectoriEs – DESDE), and its glossary of terms. The analysis focused on the commensurability and the clarity of definitions according to the reference classification system. Interrater reliability was analysed using κ.
The disambiguation revealed that only 13 terms (23%) of the 56 services selected were accurate. Six terms (11%) were confusing as they did not correspond to services as defined in the reference classification system (non-commensurability bias), 27 (48%) did not include a clear definition of the target population for which the service was intended, and the definition of types of services was unclear in 59% of the terms: 15 were ambiguous and 11 vague. The κ analyses were significant for agreements in unit of analysis and assignment of DESDE codes and very high in definition of target population.
Service terminology is a source of systematic bias in health service research, and certainly in mental healthcare. The magnitude of the problem is substantial. This finding has major implications for the international comparability of resource use in health economics, quality and equality research. The approach presented in this paper contributes to minimise differentiation between services by taking into account key features such as target population, care setting, main activities and type and number of professionals among others. This approach also contributes to support financial incentives for effective health promotion and disease prevention. A detailed analysis of services in terms of cost measurement for economic evaluations reveals the necessity and usefulness of defining services using a coding system and taxonomical criteria rather than by ‘text-based descriptions’.
Late watergrass is a competitive weed of rice that is well adapted to both aerobic and anaerobic environments. Cultural controls such as a stale-seedbed and alternating from wet- to dry-seeding have been proposed as management options. However, the effects of these systems on its emergence and early growth are unknown. The objective of this study was to modify a previously developed population-based threshold model (PBTM) to predict emergence and early growth under field conditions. In 2013, a series of experiments were conducted at the California Rice Experiment Station (CRES) in Biggs, CA, to evaluate emergence and early growth of multiple herbicide–resistant and -susceptible late watergrass at four burial depths (0.5, 2, 4, and 6 cm) under three irrigation regimes: continuously flooded (CF), daily flush (DF), and intermittent flush (IF). Resistant plants emerged at a significantly higher rate under the IF treatment (P < 0.05). Both biotypes showed decreasing emergence with increasing depth, and no plants emerged from the 4- or 6-cm depths in the CF treatment. Using the Gompertz growth curve, resistant plants had greater predicted growth rates (k), lower predicted maximum heights (hmax), and a shorter time to predicted maximum growth rate (tm) than susceptible plants under the CF and DF treatments. Under the IF treatment, the susceptible plants had greater k, lower hmax, and shorter time to predicted tm. Information about burial depth and irrigation was incorporated into a previously developed PBTM for late watergrass, and validated at the CRES in a field with a susceptible late watergrass population in 2013 and 2014, under two irrigation systems, CF and IF. Model fit was best in the CF treatments (average Akaike information criteria [AIC] = 199.05) compared to the IF treatments (average AIC = 208.6).
The last meal of Tollund Man, a bog body from Early Iron Age Denmark, has been re-examined using new analyses of plant macrofossils, pollen, non-pollen palynomorphs, steroid markers and proteins found in his gut. Some 12–24 hours before he was killed, he ate a porridge containing barley, pale persicaria and flax, and probably some fish. Proteins and eggs from intestinal worms indicate that he was infected with parasites. Although the meal may reflect ordinary Iron Age fare, the inclusion of threshing waste could possibly relate to ritual practices. This re-analysis illustrates that new techniques can throw fresh light on old questions and contribute to understanding life and death in the Danish Early Iron Age.
Rabies post-exposure prophylaxis (R-PEP) including wound treatment, vaccination and application of rabies immunoglobulin (RIG) is essential in preventing rabies mortality. Today, Germany is officially declared free from terrestrial rabies and rabies is only found in bats. However, physicians in A&E Departments are frequently consulted on the need for R-PEP. We retrospectively analysed patients who received R-PEP at the A&E Department of the University Hospital Bonn between 01.01.2013 and 30.06.2019. Demographic data, travel history, clinical and laboratory findings, previous rabies vaccinations and R-PEP vaccination regimen were recorded. During the study period, 90 patients received R-PEP at the University Hospital Bonn, in 10 cases without indication for R-PEP. Altogether, we found deviations from R-PEP guidelines in 51% (n = 41/80). Infiltration of RIG was missed in 12 patients and incorrectly administrated in 24 patients. Furthermore, vaccination scheme was incorrect in 11 patients. Correct wound washing and documentation of tetanus status was missing in 14% and 63% of patients, respectively. Despite rabies elimination in Germany patients frequently seek advice for R-PEP, the majority returning from foreign travel. Our data show that there is a high need for education on indication for R-PEP before and after travel and for implementation of precise R-PEP guidelines in daily clinical practice.
Barriers to research participation by racial and ethnic minority group members are multi-factorial, stem from historical social injustices and occur at participant, research team, and research process levels. The informed consent procedure is a key component of the research process and represents an opportunity to address these barriers. This manuscript describes the development of the Strengthening Translational Research in Diverse Enrollment (STRIDE) intervention, which aims to improve research participation by individuals from underrepresented groups.
We used a community-engaged approach to develop an integrated, culturally, and literacy-sensitive, multi-component intervention that addresses barriers to research participation during the informed consent process. This approach involved having Community Investigators participate in intervention development activities and using community engagement studios and other methods to get feedback from community members on intervention components.
The STRIDE intervention has three components: a simulation-based training program directed toward clinical study research assistants that emphasizes cultural competency and communication skills for assisting in the informed consent process, an electronic consent (eConsent) framework designed to improve health-related research material comprehension and relevance, and a “storytelling” intervention in which prior research participants from diverse backgrounds share their experiences delivered via video vignettes during the consent process.
The community engaged development approach resulted in a multi-component intervention that addresses known barriers to research participation and can be integrated into the consent process of research studies. Results of an ongoing study will determine its effectiveness at increasing diversity among research participants.
Pilot randomized double-blind-controlled trial of repetitive paired associative stimulation (rPAS), a paradigm that combines transcranial magnetic stimulation (TMS) of the dorsolateral prefrontal cortex (DLPFC) with peripheral median nerve stimulation.
To study the impact of rPAS on DLPFC plasticity and working memory performance in Alzheimer’s disease (AD).
Thirty-two patients with AD (females = 16), mean (SD) age = 76.4 (6.3) years were randomized 1:1 to receive a 2-week (5 days/week) course of active or control rPAS. DLPFC plasticity was assessed using single session PAS combined with electroencephalography (EEG) at baseline and on days 1, 7, and 14 post-rPAS. Working memory and theta–gamma coupling were assessed at the same time points using the N-back task and EEG.
There were no significant differences between the active and control rPAS groups on DLPFC plasticity or working memory performance after the rPAS intervention. There were significant main effects of time on DLPFC plasticity, working memory, and theta–gamma coupling, only for the active rPAS group. Further, on post hoc within-group analyses done to generate hypotheses for future research, as compared to baseline, only the rPAS group improved on post-rPAS day 1 on all three indices. Finally, there was a positive correlation between working memory performance and theta–gamma coupling.
This study did not show a beneficial effect of rPAS for DLPFC plasticity or working memory in AD. However, post hoc analyses showed promising results favoring rPAS and supporting further research on this topic. (Clinicaltrials.gov-NCT01847586)
The pharmacotherapy of epilepsy is a complex process guided by evidence-based research and clinical experience. Some patients achieve seizure freedom upon treatment with the first anti-seizure medication (ASM) prescribed, whereas others may be treated with two or three medications before one (or a combination) is found that reduces seizure frequency and/or severity with minimal side effects. Many patients demonstrate a partial response to treatment, leading to reduced seizure frequency and/or severity, but do not become completely seizure free. It is often stated that ~30% of epilepsy patients have seizures that cannot be controlled pharmacologically, and these patients are defined as having medication-resistant epilepsy (MRE). The International League Against Epilepsy (ILAE) published the following definition of MRE: ‘drug resistant epilepsy may be defined as failure of adequate trials of two tolerated and appropriately chosen and used ASM schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom’. Treatment success or sustained seizure freedom is defined as one year without seizures or three times the inter-seizure interval (whichever is longer). The ILAE definition provides a useful standard from which to work, and MRE can be clinically identified in patients that fail to achieve seizure freedom after multiple ASM trials. However, the ILAE definition of successful treatment does not account for partial response to pharmacotherapy. Indeed, many partial responders have improved quality of life, even if they are not seizure-free for one year or more.
Rush skeletonweed is an aggressive perennial weed that establishes itself on land in the Conservation Reserve Program (CRP), and persists during cropping following contract expiration. It depletes critical soil moisture required for yield potential of winter wheat. In a winter wheat/fallow cropping system, weed control is maintained with glyphosate and tillage during conventional fallow, and with herbicides only in no-till fallow. Research was conducted for control of rush skeletonweed at two sites in eastern Washington, Lacrosse and Hay, to compare the effectiveness of a weed-sensing sprayer and broadcast applications of four herbicides (aminopyralid, chlorsulfuron + metsulfuron, clopyralid, and glyphosate). Experimental design was a split-plot with herbicide and application type as main and subplot factors, respectively. Herbicides were applied in the fall at either broadcast or spot-spraying rates depending on sprayer type. Rush skeletonweed density in May was reduced with use of aminopyralid (1.1 plants m−2), glyphosate (1.4 plants m−2), clopyralid (1.7 plants m−2), and chlorsulfuron + metsulfuron (1.8 plants m−2) compared with the nontreated check (2.6 plants m−2). No treatment differences were observed after May 2019. There was no interaction between herbicide and application system. Area covered using the weed-sensing sprayer was, on average, 52% (P < 0.001) less than the broadcast application at the Lacrosse location but only 20% (P = 0.01) at the Hay location. Spray reduction is dependent on foliar cover in relation to weed density and size. At Lacrosse, the weed-sensing sprayer reduced costs for all herbicide treatments except aminopyralid, with savings up to US$6.80 per hectare. At Hay, the weed-sensing sprayer resulted in economic loss for all products because of higher rush skeletonweed density. The weed-sensing sprayer is a viable fallow weed control tool when weed densities are low or patchy.