Academic literature on the topic 'Curatorial and Related Studies not elsewhere classified'

Purpose The purpose of this paper is to investigate the main causes of delay in public construction projects. This is motivated by feedback from public construction experts concerning substantive delays during the last decade. The study thus seeks to help decision makers in Jordan and elsewhere identify problems and develop mitigating strategies. Design/methodology/approach Causes of delay were identified from previous related studies and then augmented after consultation with experts. This resulted in 56 delay factors classified into eight groups. The sampling frame for the study was defined in terms of public construction projects (mostly related to roads) owned by the Ministry of Public Works and Housing in Jordan. A survey was conducted with engineers working as representatives of the owner, contractors or consultants to elicit and evaluate the importance of the 56 delay factors. Findings Overall, 113 completed questionnaire responses were returned and analyzed to rank the causes of delay using the relative importance index method. Owners and consultants showed more interest in factors related to themselves, while contractors showed highest interest in an external factor related to the owner of services. Four recommendations are put forward for decision makers to mitigate against delays. Originality/value This research investigates a relatively large number of delay factors compared to other studies and these are categorized into groups to facilitate thematic understanding. Further, compared to previous related research, this research fills a gap by exploring the opinions of different contract parties.

Objectives: To review the literature evaluating outcomes resulting from expansion of the bipolar disorder (BD) diagnostic category. We were particularly interested in identifying high-level evidence for improved clinical outcomes as documented by randomized controlled trials (RCTs) or cohort studies. Methods: The English-language literature was searched using Ovid MEDLINE for studies of BD referenced against the key word spectrum. We used bibliographies and other databases to extend this search when no relevant RCTs or relevant cohort studies were identified. Results: In the MEDLINE searches, abstracts and titles of 86 studies were examined and 48 were found to be related to the topic of bipolar spectrum disorders (BSD). No RCTs or prospective cohort studies evaluating modified diagnostic or therapeutic practices were identified. The literature about the BSD consists mostly of expert opinion emphasizing: various links between bipolar and unipolar mood disorders; a proposal that a greater proportion of the population without a mood disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders should be diagnosed under the BD category; and, proposals that syndromes currently classified elsewhere should be subsumed under the BD category. Conclusions: Our search failed to uncover high-level evidence demonstrating the clinical utility of proposed diagnostic realignments. The widespread acceptance of the expanded spectrum concept appears to be based on interpretation of descriptive epidemiologic data by high-profile experts.

Abstract. Studies of secondary aerosol-particle formation depend on identifying days in which new particle formation occurs and, by comparing them to days with no signs of particle formation, identifying the conditions favourable for formation. Continuous aerosol size distribution data has been collected at the SMEAR II station in a boreal forest in Hyytiälä, Finland, since 1996, making it the longest time series of aerosol size distributions available worldwide. In previous studies, the data have been classified as particle-formation event, nonevent, and undefined days, with almost 40% of the dataset classified as undefined. In the present study, eleven years (1996–2006) of undefined days (1628 days) were reanalyzed and subdivided into three new classes: failed events (37% of all previously undefined days), ultrafine-mode concentration peaks (34%), and pollution-related concentration peaks (19%). Unclassified days (10%) comprised the rest of the previously undefined days. The failed events were further subdivided into tail events (21%), where a tail of a formation event presumed to be advected to Hyytiälä from elsewhere, and quasi events (16%) where new particles appeared at sizes 3–10 nm, but showed unclear growth, the mode persisted for less than an hour, or both. The ultrafine concentration peaks days were further subdivided into nucleation-mode peaks (24%) and Aitken-mode peaks (10%), depending on the size range where the particles occurred. The mean annual distribution of the failed events has a maximum during summer, whereas the two peak classes have maxima during winter. The summer minimum previously found in the seasonal distribution of event days partially offsets a summer maximum in failed-event days. Daily-mean relative humidity and condensation sink values are useful in discriminating the new classes from each other. Specifically, event days had low values of relative humidity and condensation sink relative to nonevent days. Failed-event days possessed intermediate condensation sink and relative humidity values, whereas both ultrafine-mode peaks and, to a greater extent, pollution-related peaks had high values of both, similar to nonevent days. Using 96-h back trajectories, particle-size concentrations were plotted as a function of time the trajectory spent over land. Increases in particle size and number concentration during failed-event days were similar to that during the later stages of event days, whereas the particle size and number concentration for both nonevent and peaks classes did not increase as fast as for event and failed events days.

Abstract. Studies of secondary aerosol-particle formation depend on identifying days in which new particle formation occurs and, by comparing them to days with no signs of particle formation, identifying the conditions favourable for formation. Continuous aerosol size distribution data has been collected at the SMEAR II station in a boreal forest in Hyytiälä, Finland, since 1996, making it the longest time series of aerosol size distributions available worldwide. In previous studies, the data have been classified as particle-formation event, nonevent, and undefined days, with almost 40% of the dataset classified as undefined. In the present study, eleven years (1996–2006) of undefined days (1630 days) were reanalyzed and subdivided into three new classes: failed events (37% of all previously undefined days), ultrafine-mode concentration peaks (34%), and pollution-related concentration peaks (19%). Unclassified days (10%) comprised the rest of the previously undefined days. The failed events were further subdivided into tail events (21%), where a tail of a formation event presumed to be advected to Hyytiälä from elsewhere, and quasi events (16%) where new particles appeared at sizes 3–10 nm, but showed unclear growth, the mode persisted for less than an hour, or both. The ultrafine concentration peaks days were further subdivided into nucleation-mode peaks (24%) and Aitken-mode peaks (10%), depending on the size range where the particles occurred. The mean annual distribution of the failed events has a maximum during summer, whereas the two peak classes have maxima during winter. The summer minimum previously found in the seasonal distribution of event days partially offsets a summer maximum in failed-event days. Daily-mean relative humidity and condensation sink values are useful in discriminating the new classes from each other. Specifically, event days had low values of relative humidity and condensation sink relative to nonevent days. Failed-event days possessed intermediate condensation sink and relative humidity values, whereas both ultrafine-mode peaks and, to a greater extent, pollution-related peaks had high values of both, similar to nonevent days. Using 96-h back trajectories, particle-size concentrations were plotted as a function of time the trajectory spent over land. Increases in particle size and number concentration during failed-event days were similar to that during the later stages of event days, whereas the particle size and number concentration for both nonevent and peaks classes did not increase as fast as for event and failed events days.

Viruses that are normally safely contained within their host spe­cies can emerge due to intense livestock farming, trade, travel, climate change and encroachment of human activities into new environments. The unexpected emergence of bluetongue virus (BTV), the prototype species of the genus Orbivirus, in economi­cally important livestock species (sheep and cattle) across the whole of Europe (since 1998), indicates that other orbiviruses represent a potential further threat to animal and human popula­tions in Europe and elsewhere. The genus Orbivirus is the largest within the family Reoviridae, containing 22 virus species, as well as 14 unclassified orbiviruses, some of which may repre­sent additional or novel species. The orbiviruses are transmitted primarily by arthropod vectors (e.g. Culicoides, mosquitoes or ticks). Viral genome sequence data provide a basis for virus taxonomy and diagnostic test development, and make it possible to address fundamental questions concerning virus biology, pathogenesis, virulence and evolution, that can be further explored in mutation and reverse genetics studies. Genome sequences also provide criteria for the classification of novel isolates within individual Orbivirus species, as well as the identification of different sero­types, topotypes, reassortants and even closely related but dis­tinct virus lineages. Full-length genome characterization of Tilligerry virus (TILV), a member of the Eubenangee virus species, and Mitchell River virus (MRV), a member of the Warrego virus species, have revealed highly conserved 5’ and 3’ terminal hexanucleotide sequences. Phylogenetic analyses of orbivirus T2 ‘sub-core-shell’ protein sequences reinforce the hypothesis that this protein is an important evolutionary marker for these viruses. The T2 protein shows high levels of amino acid (AA) sequence identity (> 91%) within a single Orbivirus species / serogroup, which can be used for species identification. The T2-protein gene has therefore been given priority in sequencing studies. The T2 protein of TILV is closely related to that of Eubenangee virus (~91% identity), con­firming that they are both members of the same Eubenangee virus species. Although TILV is reported to be related to BTV in serological assays, the TILV T2 protein shows only 68-70% AA identity to BTV. This supports its current classification within a different serogroup (Eubenangee). Warrego virus and MRV are currently classified as two distinct members (different serotypes) within the Warrego virus species. However, they show only about 79% AA identity in their T2 pro­tein (based on partial sequences). It is therefore considered likely that they could be reclassified as members of distinct Orbivirus species. The taxonomic classification of MRV will be reviewed after generating full length sequences for the entire genomes of both viruses. The taxonomic status of each of these viruses will also be tested further by co-infections and attempts to create reassortants between them (only viruses belonging to the same species can reassort their genome segments). TILV and MRV are the first viruses from their respective serogroups / virus species to be genetically fully characterized, and will provide a basis for the further characterization / identification of additional viruses within each group / species. These data will assist in the devel­opment of specific diagnostic assays and potentially in control of emerging diseases. The sequences generated will also help to evaluate current diagnostic [reverse transcriptase - polymerase chain reaction (RT-PCR)] tests for BTV, African horse sickness virus, epizootic haemorrhagic disease virus, etc., in silico, by identifying any possibility of cross reactivity.

Abstract Efficacy, safety, together with molecular and immunological biomarkers were studied in a sequential clinical trial of neoadjuvant immunotherapy, surgery and adjuvant immunotherapy in locally advanced or oligometastatic melanoma patients (pts), within an open label, single arm and two sites study. Treatment schedule consisted in four primary cycles of inverted dose ipilimumab 1 mg/kg and nivolumab 3 mg/kg every 3 weeks, followed by radical surgery and adjuvant nivolumab 480 mg every 4 weeks for 6 cycles. Primary objective was pathological complete remission (pCR) rate, according to International Neoadjuvant Melanoma Consortium (INMC) criteria, while secondary objectives were: safety, feasibility and efficacy; QoL; identification of biomarkers of response and resistance; degree of immune activation; longitudinal evaluation of the gut microbiome. From March 2019 to April 2021, 43 pts were enrolled in the trial and, with an intent to treat of 35 pts, 34 completed the primary phase, 31 received surgery and 28 completed the adjuvant phase. Four pts were withdrawn during primary phase for progression (2), toxicity (1) and consent withdrawal (1). Study primary endpoint has been met since 20/31 pts undergoing surgery reached a pCR/near pCR (65%), 4/31 (13%) a pathological partial remission (pPR) and 7/31 (22%) pts a pathological no response. With a median follow-up of 17 months, 33/35 pts are alive. Treatment failure occurred in 9 pts: 2 pts progressed during primary phase and did not undergo surgery; 7 pts progressed during adjuvant (3 pts) or follow-up phase (4 pts). Six out of these 7 pts were classified as pNR at surgery, while the other, classified as pCR, did not receive adjuvant therapy. Both pts in stage IV relapsed. Unfortunately, one pt died for ischemic stroke after 5 months from adjuvant therapy while on CR. Treatment related toxicities were mainly G1-2 and only 6 pts (17%) developed G3-4 adverse events (AE): 3 transaminitis, 1 pneumonitis, 1 myocarditis, 1 CPK increase and 1 dermatomyositis. Translational studies on samples collected before, during therapy and at progression have been performed: whole exome sequencing and gut microbiota dynamics on longitudinal samples showed some relationships with responses and developing resistances. These data, never presented elsewhere previously, are in part new and in part confirmatory of immunological or molecular signatures described by other groups. In conclusion, primary immunotherapy with Ipilimumab/Nivolumab in pts affected by locally advanced/oligometastatic melanoma is able to achieve an elevated pCR/near pCR rate which appears to be predictive of long term relapse free survival. Translational data analyzed longitudinally on each patient can allow for a better selection of pts, giving new insight on the mechanisms of melanoma progression and resistance. Citation Format: Pier Francesco Ferrucci, Bruno Achutti Duso, Luigi Nezi, Luca Mazzarella, Fiorenza Lotti, Sara Gandini, Gianmarco Orsolini, Elisabetta Pennacchioli, Patrizia Gnagnarella, Teresa Manzo, Simone Ribero, Maria Teresa Fierro, Rebecca Senetta, Concetta Riviello, Virginia Caliendo, Pietro Quaglino, Massino Barberis, Giuseppina Bonizzi, Emilia Cocorocchio. Neoadjuvant ipilimumab/nivolumab in locally advanced or oligometastatic melanoma: An open label, single arm, multi-institutional clinical study with molecular and immunological biomarker’s analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT167.

The paper deals with the effects of prescriptivism on the Lithuanian language. The research includes one domain of language use – radio and television, and one aspect of language – lexicon, in the period between 1960 and 2010. The investigation is corpus-based and focuses on the use of words that are classified as “incorrect” by the Lithuanian norm-setters. The study is important both as a discussion of the impact of prescriptivism on language change in general, as well as of the indirect influence of media on language, since media can affect the symbolic evaluation of specific language forms.The paper consists of five chapters. The first chapter “Review of the research” discusses the theoretical assumptions and concepts needed for further analysis: it gives an overview of studies on the effects of prescriptivism conducted in Lithuania and elsewhere, presents the concepts of second-level indexicality and style, and outlines the key characteristics of media change in Lithuania that are relevant to the study. Studies on the success of prescriptivism do not give a definite answer as to whether prescriptivism works. Institutionalisation and a high degree of stigmatisation of the corrected language forms can be listed among the factors that increase its success; prescriptivism is likely to be less successful when the “forbidden” language forms are too convenient to be given up, or when prescriptivist rules are too complicated for lay language users and the rules contradict each other. In the case of media, the effect of prescriptivism is said to be weakened by media commercialisation.When applied to the analysis of non-standard words, first-order indexicality refers to situations when the non-standard forms are used as value-free instances of ordinary speech, in already established meanings; in these cases, the speakers are not aware that they are using “incorrect” forms. Second-order indexicality refers to cases when non-standard words are used for additional function, e.g., to express a speaker’s particular identity or to construct a certain (informal, friendly) speech style. The concept of style, referring to the social differences between individual speakers, is used to analyse the use of words in concrete situations. The paper gives an overview of three sociolinguistic concepts of style that are relevant in this study: style as a degree of formality (e.g., when the speaker accommodates to the formal context of the media and uses less non-standard words); as audience and referee design (e.g., use of non-standard words in programmes for young audiences); and as a speaker design (e.g., play with language by the programme host in order to construct a fun persona).In the study of non-standard lexis, it is important to account for certain features of Lithuanian media development, such as the Soviet period, which was characterised by the use of newspeak, and the commercialisation of the media in the contemporary period. Accordingly, the paper analyses the uses of incorrect words as a part of newspeak and their use for the entertainment-related purposes such as language plays in present times. The paper also addresses the transitory period of radio and TV development, which has features from both the previous and the later periods, as well as some unique characteristics of language use.The second chapter “Radio and TV speech in the prescriptive discourse” presents an analysis of the metalinguistic discourse on media speech produced by Lithuanian prescriptivists from the pre-war period up to now. The analysis shows how this discourse preserved the same dominant idea about media’s role in language standardisation. On the one hand, during this whole time, radio and television were approached as responsible for teaching listeners and viewers the “correct language”; on the other hand, simultaneously, the language of radio and television was perceived as failing to conform to the prescriptive norms set by the norm-setters. The huge societal shifts that happened during this time did not make a major influence on this discourse. It remained very stable during different periods of time. The social, cultural and political changes in society and the media were taken into account only by adjusting the argumentation – by presenting patriotic, moral, ideological or legal motives that were meant to justify the language prescriptions.The third chapter “Research methods and data” presents the Corpus of Radio and TV speech, the concept of non-standard words, and the sources of prescriptivist corrections used in the analysis. The corpus of radio and TV speech includes data from 1960 to 2011 and is constructed in a balanced way to represent the periods of Lithuanian radio and TV development (Soviet, transitory, contemporary), as well as programme genres (talk programmes, information programmes, journals/features/documentaries). The speakers are coded into six types: news reader/voice-over, talk show host, expert, celebrity, hero and vox populi. For the analysis, the non-standard words that are classified as “incorrect” in the normative tradition of the Lithuanian language were coded. These include old (mainly, Slavic) and new (mainly, English) loans, the so-called hybrid words (that have a borrowed part), semantic loans, translations, as well as some lexicalised uses of words and some lexicalised syntactic constructions. Two types of words are analysed – individual lexical words and functional words. The latter include various fillers and discourse markers, as well as pronoun constructions with tai (e.g. kažkas tai ‘some(body)’). Non-standard words were identified from older and present style guides, including the database of language corrections created by the State Commission of the Lithuanian Language.The fourth chapter “Change in the number of non-standard words: a quantitative analysis” investigates development of the use of non-standard words on radio and TV, as well as the frequency of usage of the non-standard lexical forms. According to the corpus data, the average frequency of non-standard words by one speaker is 17 per thousand words, which makes up about 2–3 “incorrect” words per minute. Non-standard discourse markers and fillers (9.8/1000 words) are used most frequently, whereas individual lexical words (5.6/1000 words) are much less frequent, and pronoun constructions with tai (1.6/1000 words) are rarer still. Closer analysis revealed that the only statistically significant change between the analysed periods (Soviet, transitory and contemporary) was a decrease of the frequency of non-standard lexical words in the contemporary period compared to the previous ones. The frequency of discourse markers/fillers and pronoun constructions with tai did not change. Regarding the speaker types, the uses of non-standard words decreased in those groups that are within easier reach of prescriptivism – news readers/voice-overs and talk show hosts. Also, to a lesser extent, in the group of experts. Those groups of speakers that are less likely to be subjected to language correction practices (ordinary people) did not seem to change their behaviour: the number of non-standard words in their speech did not decrease, on the contrary, a slight increase has been noticed. These findings confirm the effects of institutionalised prescriptivism. Regarding genres, non-standard words are least frequent in information programmes, which are mostly based on the reading of written texts. Lists of the most frequent non-standard words during the three periods overlap to a great extent, which means that despite prescriptivist practices, the most frequent non-standard words do not disappear from the air.The fifth chapter “Change in the functions of non-standard words: a qualitative analysis” investigates specific communicative situations of the usage of non-standard words and takes into account the media-related and societal contexts, as well as the stylistic and social functions of the corrected lexis. A common trait of the use of non-standard words during all periods, interpreted as the first level of indexicality, is the use of common, everyday vocabulary, most likely without being aware of the “incorrect” status of the chosen forms. Also, non-standard words are used as a part of professional language, in this case the speaker might be aware that he or she is using an ‘incorrect’ word, but chooses to use it nevertheless for convenience or because of its indexical value for professional identity. During all the periods, non-standard words are also used as indices of informal and authentic communication between close acquaintances; this function is performed by all types of the studied non-standard words, particularly old borrowings and frequent fillers.The study identified a few style- and social meaning-related uses of non-standard lexis that explain the choice of the corrected forms instead of the required equivalents. In the Soviet period, some non-standard words were used as a part of Soviet newspeak; old borrowings were used in references to the ideological enemies of Soviet rule, mainly the ones from pre-war Lithuania. In certain cases, these words were employed due to their stylistic value in an intimate and authentic discourse. The late Soviet period saw the first use of non-standard words as markers of informal communication. The use of non-standard words in the transitory period shows some of the functions from the Soviet period, e.g., they are used as an element of newspeak, albeit without the Soviet ideological value, or as expressions of informality. A particular feature of this period is the use of non-standard words as an index of live and authentic speech, which was not allowed during Soviet times, as a means of authentic communication, and the criticism and violation of Soviet taboos. The contemporary period is marked by a huge variety of functions of non-standard words. It brings in a number of new style-related functions of non-standard words: construction of youth-oriented identity and youth-oriented referee design, reference to past times (e.g., by using non-standard words reflecting the Soviet reality), or quoting. Perhaps the most distinctive features of this period are the use of non-standard words in the speech of professional journalists, as well as their use for the purposes of humour and entertainment (for the construction of certain personas), e.g., in language plays and stylisations. These uses can be explained by commercial media requirements, increasing trends of the informalisation of public speech and conversationalisation.The study concluded that the effect of prescriptivism on the use of non-standard words in radio and TV in Lithuania is limited. Firstly, the frequency of non-standard words decreased mainly in those groups of speakers that are subject to the formal, institutionalised power of language gatekeepers (media professionals). Secondly, the data shows a decrease only of those non-standard words that are easier to control by the speakers themselves – lexical words. The frequency of various function words that are more difficult to be aware of when speaking did not decrease. Thirdly, the largest decrease in non-standard lexical forms occurred in those speech situations where a prepared written text is used; this means that prescriptivist requirements have a greater effect when the speakers and the language are controlled, and less effect in spontaneous communication situations. The above-mentioned difference between professional and non-professional speakers demonstrates that speakers are able to control the lexical forms they choose.Analysis of the most frequently used non-standard words during different periods also demonstrates the limits of prescriptivism. The lists of the most frequently used non-standard words during different periods overlap to a great extent, which means that despite prescriptivist efforts, they were not eliminated from being used on air.Finally, the limited success of prescriptivism is demonstrated by the discussed social values of non-standard words, when they are used for various social and stylistic functions not possessed by a ‘correct’ equivalent. The qualitative analysis revealed the particular strength of old borrowings, which are used to create a sincere, friendly speech style, as well as a ludic speaker identity. On the one hand, it can be interpreted as a sign of the ineffectiveness of prescriptivism – if the words are needed, it is likely that they will be further used despite their ‘illegal’ status. On the other hand, when the speakers purposefully (e.g., on account of a particular association, stylistic value) choose a particular language form and are at the same time aware about its “incorrectness”, it is an effect of prescriptivism, only with the opposite outcome.The study is based on the analysis of spoken language on radio and TV, therefore it cannot be used to draw conclusions about the Lithuanian language in general. It is likely that the effect of prescriptivism on written language (because of its more formal style and particularly because of language editing practices) would be stronger. Nevertheless, broadcast media speech constitutes a considerable and important part of language use, thus we can conclude that the impact of prescriptivism on the Lithuanian language does not have far-reaching effects.

Helicobacter pylori is the leading cause of peptic ulcer disease. The infection has been implicated in more than 75% of duodenal ulcer cases and 17% of gastric ulcer cases. H. pylori has been classified as a human carcinogen, since it is the main cause of distal gastric adenocarcinoma and B cell mucosa-associated lymphoid tissue lymphoma. Evidence also links H. pylori with extragastric conditions including iron deficiency anemia, idiopathic thrombocytopenic purpura, and vitamin B12 deficiency. Studies indicate that H. pylori may be protective against other conditions of the gastrointestinal tract (e.g., reflux esophagitis and related pathologies) and elsewhere in the body (e.g., asthma). The infection is asymptomatic in the vast majority of cases; more serious outcomes occur in only 10–15% of infected individuals. Despite extensive research over the past 3 decades, there is no effective vaccine, and the circumstances leading to disease development remain unclear. In addition, there is now a growing prevalence of antimicrobial resistance in H. pylori. This review discusses these important issues. Expected final online publication date for the Annual Review of Pathology: Mechanisms of Disease, Volume 16 is January 25, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Abstract Case report - Introduction Scleritis is severe vision-threatening scleral inflammation, commonly presenting with a red, painful eye and can be classified using the Watson system. Posterior scleritis may present with associated anterior uveitis in many cases. Steroid therapy is often successful initially; however, further immunomodulation is usually required to control subsequent episodes which can be challenging. We present an 18-year-old, Caucasian girl with a left eye, sight-threatening, steroid-dependent posterior uveitis who required escalation of treatment to tocilizumab before inflammation could be suppressed. Case report - Case description Our patient was diagnosed elsewhere with ulcerative colitis at the age of 12 and subsequently developed recurrent episodes of uveitis and scleritis which could be controlled with topical steroids. At the age of 16 she presented with an inflammatory arthritis and was treated with intravenous methylprednisolone before commencing sulfasalazine therapy. Due to persistent systemic and ophthalmic inflammation she was changed to adalimumab; however, this was also unsuccessful and methotrexate was added. By the age of 18 she had been steroid-dependent for 2 years and could not reduce daily prednisolone below 15mg without a deterioration in her left eye posterior scleritis with visual acuity compromise including episodes of complete visual loss causing high levels of anxiety. Due to the pain and deterioration in vision she struggled with her studies and school attendance, and withdrew from her passion for competitive sailing. With ongoing sight-threatening inflammatory changes she was referred for further tertiary assessment in 2019. During the following 4 months treatment was escalated rapidly. Methotrexate dose was increased, and adalimumab frequency reduced to weekly. There was a limited response, with further episodes of sight deterioration as a result of flares in inflammation. Response to tocilizumab treatment was seen after only two doses with good control of scleritis by 3 months of treatment when steroids were successfully weaned and stopped. Over 18 months of tocilizumab therapy the patient has only required one course of topical steroids for mild ocular inflammation which resolved without any other treatment required. She has successfully completed her degree, can complete daily gym training sessions and participate in regular sailing competitions. Case report - Discussion Posterior scleritis is the most common scleritis in children and can be associated with anterior uveitis, concurrent anterior scleritis, disc swelling or retinal striae. Posterior scleritis has a higher rate of complications therefore is treated aggressively. Refractory cases such as this require biologic therapy and rituximab is often used. Despite the preference of two adult eye units for treatment with rituximab the rationale for tocilizumab included; recent high quality studies showing successful treatment of inflammatory bowel disease, its known benefit for anterior uveitis and case studies in adults with posterior scleritis. Tocilizumab is a recombinant monoclonal antibody that causes a blockade of interleukin-6 receptors. It is currently only approved by the Food and Drug Administration (FDA) for use in children with polyarticular or systemic onset Juvenile Idiopathic Arthritis (JIA). Our patient had a very positive experience with this drug, no side effects and rapid clinical improvement seen. As a result her quality of life and mental health improved quickly. Case report - Key learning points This is a case of refractory, sight-threatening, steroid-dependent posterior scleritis on a background of inflammatory bowel disease and arthritis. As a result of this case our team reviewed current literature from other paediatric populations and adults with scleritis, informing the clinical decision to proceed with tocilizumab after control was unsuccessful with previous agents. The remarkable response demonstrated for our patient highlights the value tocilizumab can offer to the treatment options for similar refractory cases. This adds to the growing positive data published surrounding tocilizumab in children but further studies in paediatric populations are required to evaluate this in greater detail.

Abstract Background Patients calling for an emergency ambulance and assessed as presenting with ‘unclear problem’ account for a considerable part of all emergency calls. Previous studies have demonstrated that these patients are at increased risk for unfavourable outcomes. A deeper insight into the underlying diagnoses and outcomes is essential to improve prehospital treatment. We aimed to investigate which of these diagnoses contributed most to the total burden of diseases in terms of numbers of deaths together with 1- and 30-day mortality. Methods A historic regional population-based observational cohort study from the years 2016 to 2018. Diagnoses were classified according to the World Health Organisation ICD-10 System (International Statistical Classification of Diseases and Related Health Problems, 10th edition). The ICD-10 chapters, R (‘symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified)’ and Z (‘factors influencing health status and contact with health services”) were combined and designated “non-specific diagnoses”. Poisson regression with robust variance estimation was used to estimate proportions of mortality in percentages with 95% confidence intervals, crude and adjusted for age, sex and comorbidities. Results Diagnoses were widespread among the ICD-10 chapters, and the most were ‘non-specific diagnoses’ (40.4%), ‘circulatory diseases’ (9.6%), ‘injuries and poisonings’ (9.4%) and ‘respiratory diseases’ (6.9%). The diagnoses contributing most to the total burden of deaths (n = 554) within 30 days were ‘circulatory diseases’ (n = 148, 26%) followed by ‘non-specific diagnoses’ (n = 88, 16%) ‘respiratory diseases’ (n = 85, 15%), ‘infections’ (n = 54, 10%) and ‘digestive disease’ (n = 39, 7%). Overall mortality was 2.3% (1-day) and 7.1% (30-days). The risk of mortality was highly associated with age. Conclusion This study found that almost half of the patients brought to the hospital after calling 112 with an ‘unclear problem’ were discharged with a ‘non-specific diagnosis’ which might seem trivial but should be explored more as these contributed the second-highest to the total number of deaths after 30 days only exceeded by ‘circulatory diseases’.

This thesis examines the spirituality and participation in faith-based activities of young Catholics in Whangarei, New Zealand. Six youth aged 16-17 years have shared their experiences in several areas of Catholicism such as religious attendance, Catholic identity and Catholic faith, morals and values, peer group socialisation and religious commitment. Using a qualitative mixed-methodological approach with the underlying philosophical stance of interpretivism, the intent of the study is to discover ways in which these young Catholics integrate their faith into their daily lives and make meaning out of it. It also compares the religious beliefs and values of Catholic youth in Whangarei to those reported worldwide. The findings reveal many similar themes to those from international studies. Although all of the participants in this study possessed a distinct sense of ‘spirituality’ and being ‘Catholic’ was a very important part of their identity, not all of them seemed to consider it practical to live out their Catholic beliefs. Similarly, although they did not face any insurmountable challenges in practicing their faith in daily life, only a few of them had strong convictions about their faith and, like their peers in other countries, only a few could concretely list the core Catholic beliefs. Concepts of moralistic therapeutic deism were found to affect half the participants while nuances of moralistic relativism were also prevalent. Results also showed a growing disinterest in attending Mass, participating in the sacrament of Confession, leading an active prayer life, being a part of church youth activities and some difficulty in finding similar peer group support. Overall, the findings presented in this thesis suggested that the participants involved in the study could be separated into two groups on the basis of their differing spiritual levels and commitment to the Catholic faith The findings suggest a need for Catholic youth in Whangarei to be supported in their spiritual development in order to help them grow in their Catholic faith. Accordingly, the main recommendations are for community-based services such as providing a variety of youth programmes/groups to engage young people and finding ways to facilitate the secure engagement of youth in a dialogue about their faith and religion, in order to spiritually encourage, nourish and sustain them at whatever stage they might be at.