Journal articles on the topic 'Pre-registration rights'

Problems in this study: (1) How is the implementation of activities in the District Land Office PTSL Kendal? (2) How the Government's policy to accelerate the legal certainty Landrights through PTSL ?. The method used in this research is the method of approach to socio-legal research, consisting of socio research and legal research. The results of this study are: (1) Implementation PTSL in Kendal District Land Office begins by planning activities PTSL by the Head of the Kendal District Land Office with pre inventory candidate and potential participants. (2) Government policy in speeding up the legal certainty of land rights through PTSL is based in Kendal land that already has a certificate covering an area of 13834.46 hectares.Suggestions in this study is consistent with the objectives of land registration is to provide certainty and legal protection to the rights holder, to reduce the escalation of disputes continues to grow, it is time for a land registration system through PTSL changed to positive land registration system.Keywords : Government Policy; Legal Certainty of Land Rights; PTSL.

The article is devoted to the study of foreign experience of improving national legislation in the field of regulation of the organization of electronic state registers. The author analyzed scientific conceptual approaches to defining the concept of state registration, on the basis of which a number of characteristic features of state registration were distinguished. Based on the scientific and legal analysis, it is concluded that the objects of state registration may include, in particular: information about natural and legal persons, things (movable and immovable), property and other rights (property rights, leases, easements, etc.), documents (regulations, court decisions, statutes, etc.), legal facts (birth, death, acquisition or loss of citizenship, formation, reorganization, liquidation of a legal entity, public association, commencement or termination of a pre-trial investigation, enforcement On proceedings, etc.). The author analyzes foreign experience of countries such as Georgia, Germany, Sweden in the field of legal relations arising in the sphere of state registration and organization of electronic state registers. Based on the analysis, it is concluded that one of the significant shortcomings of national legislation in the field of legal relations arising in the field of state registration is the lack of a single legislative approach to the formation of the list of information about the object of state registration. In order to improve the legal regulation of state registers, including in the light of foreign experience in this field, the author has developed the following proposals, in particular, to introduce a unified approach to: defining the concept of “state registry” (as an information and telecommunication system), “state registration” (as a type of state activity); the procedure of keeping state registers, if their holder is one body; Introduce the legal principle of determining the amount of information about a state registration object, in particular: extending the information contained in public registers and minimizing information in non-public registers.

Land is an important and inherent element in human life because most of life depends on the soil. The need for land registration is very important in order to secure land rights owned by someone as well as to realize the orderly administration of land in Indonesia. Efforts to accelerate the implementation of land certification have been carried out since the issuance of the LoGA in 1960 through various programs, but until 2016 only 40.07% registered land. These conditions encourage the government to create a Systematic Complete Land Registration (PTSL) policy to accelerate land registration in Indonesia, especially in Semarang Regency. The research method used is a mixture (mixed methods) to answer the research objectives, namely knowing the effectiveness of policy implementation. The theory of policy implementation used in this study tries to explore the driving and inhibiting factors of PTSL policy implementation in Semarang Regency. The results showed that the implementation of the PTSL policy in Semarang District was quite effective but there were still obstacles, namely the socio-economic conditions of the community, limited implementation of human resources, and no pre-certification budget allocation. Recommendations as a step for the government to do are continuing counseling to increase public awareness about the importance of land certificates, realignment and equitable implementation of the workload of implementers, and the allocation of pre-certification budget for weak economy communities.

Interest in underground space development is increasing owing to overcrowding in urban areas, and this trend is expected to continue in the future. Therefore, there exists a need to systematically establish and manage information on underground spaces. This information includes both the physical status, that indicates the location or shape of the space, and the status of property rights related to the ownership and use of the space. In this study, a technique to register an entire underground shopping center space including individual store spaces along with the relationship with the above-ground parcels is proposed. The study considers the current management and operation system of the underground shopping center. 3D data were acquired from the Gwangbok Underground Shopping Center in Busan Metropolitan City, Korea using terrestrial LiDAR equipment. The VWorld data of the Korean Ministry of Land, Infrastructure, and Transport were also used as pre-built data. Furthermore, a spatial information-based management system was implemented. The data used comprise registration information for establishing property rights. These have the physical status and rights status information of the ground parcels as attribute information.

This article uses a political developmental approach to examine African American poll-tax registration and voting in Virginia from 1940 to 1954. Using the concept of multiple orders, the article traces how changes in the state's political system of managed race relations created an opening for African American political mobilization. The Virginia Voters League (VVL), in alliance with other African American political, civic, and social organizations, conducted voter education and poll-tax payment campaigns in order foster political efficacy among the state's disenfranchised black voters. The VVL met with mixed success, affected by past political mobilizations, the impact of NAACP mobilization, and local and statewide political competition between the state's main political machine and insurgents. The VVL campaign was successful in achieving short-term victories, including the election of a few African Americans to local office. By 1954, the VVL's internal weakness coupled with the emergence of “massive resistance” stymied further black electoral mobilization through politics and made protest a more viable option for achieving political and civil rights for black Virginians. By tracing the path from politics to protest, this article shows how a political developmental approach can be successfully used to develop a nuanced understanding of the emergence of the civil rights movement and Southern politics in the pre–Brown v. Board of Educationera.

This study allows to present and to evaluate the formation of dental care in Voronezh province in the pre-revolutionary period. The article highlights the ways of providing dental care to residents of Voronezh province in this period. Archival documents of the State archive of the Voronezh region contain information about the first practicing dental doctors and dentists in the city of Voronezh. The training of dental dentistry by apprenticeship is presented in the documents. Documentary procedure of registration and opening of private hospitals diseases of teeth and cavity of mouth in 1905 in the town of Voronezh is demonstrated. Charter private hospitals diseases of teeth and cavity of mouth, which includes the objectives of the hospital and the basis for its device, the description of the conditions of admission of patients, rights and obligations of the founder of the institution, Governor and head of the economic part also is presented. In the documents there is information about the approved rate of private dental clinics, which gives the opportunity to present, in what amount and what fees dental care was provided in Voronezh at the beginning of the last century. The paper shows the quantitative distribution of dental surgeons and dentists in the Voronezh province and the city of Voronezh in the early XX century.

The article is devoted to the characteristics of the grounds and terms of notification of a person on suspicion of committing a criminal offense. Attention is drawn to the fact that the procedural act of reporting a suspicion consists of a system of such procedural decisions and actions: decision-making and legal registration of a report of suspicion; delivery of a written notice of suspicion; informing the suspect about his/her procedural rights and explaining them, if necessary. It is stated that actual ground for informing a person of a suspicion is availability of sufficient evidence for suspecting a person of a criminal violation. To create a suspicion and present it in a written form an investigator or a prosecutor has to state: an event of a criminal violation and define its legal characterization; a definite person’s guilt of commitment of a criminal violation; lack of grounds to close the criminal investigation. To inform a person of a suspicion it is necessary to have a system of actual, acceptable, reliable and sufficient proof that indicates the presence of corpus delicti in a definite person’s actions. Erroneous informing of a suspicion causes damage to the person who was a subject to criminal investigation as well as justice in general. Attention is drawn to the fact that the term “reasonable suspicion” is a conventional standard made up by case-law dealing of European court of human rights. It is stated that reasonable suspicion is a lower standard of proof than conviction beyond reasonable doubt and requires a smaller weight of evidence than drawing up a bill of indictment or approval of guilty verdict. It is stated that law of criminal procedure does not contain a definite requirement concerning a stage of pre-trial investigation at which the person has to be informed about the suspicion to help the instigator or the prosecutor concentrate on facts of the case. Attention is drawn to inadmissibility of informing a person of the suspicion directly before issuing an accusation to the defense.

Under the uncertainty of market conditions, top management and shareholders keep seeking evidence for whether a new product development project truly improves firm value. In an effort to find the evidence, this study examines the effect of firms innovative outcome on stock market performance. Specifically, we conduct an event study to test whether stock market reacts to pre-registration marketing campaign in online game. In the business practice, the pre-registration is often considered as an important event right before the commercialization of a new game launch. In our empirical analysis on the pre-registration events and daily stock returns of game companies in 2010-2014, we find that stock market responds to the pre-registration event of a new online game positively, with the abnormal returns up to 1.49%. In addition, the stock market rewards the pre-registration events of small firms more than that of large firms. Overall results suggest that stock investors take into account the pre-registration event as economically valuable information and perceive the uncertainty of the innovation process resolved.

IntroductionCancer-related cognitive impairment (CRCI) is a distressing and disabling side-effect of cancer treatments affecting up to 75% of patients. For some patients, their cognitive impairment may be transient, but for a subgroup, these symptoms can be long-standing and have a major impact on the quality of life. This paper describes the protocol for a study: (1) to assess the feasibility of collecting longitudinal data on cognition via self-report, neuropsychological testing, peripheral markers of inflammation and neuroimaging and (2) to explore and describe patterns of cancer-related cognitive impairment over the course of treatment and recovery in patients with newly diagnosed, aggressive lymphoma undergoing standard therapy with curative intent.Methods and analysisThis is a prospective, longitudinal, feasibility study in which 30 newly diagnosed, treatment-naive patients with aggressive lymphoma will be recruited over a 12-month period. Patients will complete comprehensive assessments at three time points: baseline (time 1, pre-treatment) and two post-baseline follow-up assessments (time 2, mid-treatment and time 3, 6–8 weeks post-treatment completion). All patients will be assessed for self-reported cognitive difficulties and objective cognitive function using Stroop Colour and Word, Trail Making Test Part A and B, Hopkins Verbal Learning Test-Revised, Controlled Oral Word Association and Digit Span. Blood cell-based inflammatory markers and neuroimaging including a positron emission tomography (PET) with 18F-labelled fluoro-2-deoxyglucose (18F-FDG) and CT (18F-FDG-PET/CT) and a MRI will explore potential inflammatory and neuroanatomical or functional mechanisms and biomarkers related to CRCI. The primary intent of analysis will be to assess the feasibility of collecting longitudinal data on cognition using subjective reports and objective tasks from patients during treatment and recovery for lymphoma. These data will inform the design of a larger-scale investigation into the patterns of cognitive change over the course of treatment and recovery, adding to an underexplored area of cancer survivorship research.Ethics and disseminationEthical approval has been granted by Austin Health Human Rights Ethics Committee (HREC) in Victoria Australia. Peer reviewed publications and conference presentations will report the findings of this novel study.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12619001649101).

Purpose – This paper aims to examine the recent jurisprudence of the Supreme Court concerning the registration of land as a town or village green (TVG). This area of law has proved contentious over the past decade and shows no sign of relenting. Most recently, in April 2014, the Supreme Court was asked to determine whether use that is pursuant to a statutory right could be qualifying use for the purposes of village green registration, which requires 20 years use “as of right”. Design/methodology/approach – The paper starts by summarising the law relating to the registration of land as a TVG and identifies the current problem that the courts are grappling with, namely the “by right” defence. After analysing the two leading authorities in relation to this point, the paper makes a judgment on the operation and conceptual underpinning of the “by right” defence. Findings – The paper concludes that the “by right” defence in the context of village green registration is a functioning concept that prevents the registration of land as a town and village green whenever the use relied upon is indulged in pursuant to a statutory right. Furthermore, the defence should also be construed with the pre-existing test for use “as of right” rather than being recognised as an additional limb to this test. Originality/value – The value of this paper is that it seeks to clarify an area of planning and property law that is fraught with conceptual uncertainty, and seeks to re-align the law of town and village greens with its prescriptive underpinnings.

Abstract STUDY QUESTION What is the clinical-effectiveness and safety of the endometrial scratch (ES) procedure compared to no ES, prior to usual first time in vitro fertilisation (IVF) treatment? SUMMARY ANSWER ES was safe but did not improve pregnancy outcomes when performed in the mid-luteal phase prior to the first IVF cycle, with or without intracytoplasmic sperm injection (ICSI). WHAT IS KNOWN ALREADY ES is an ‘add-on’ treatment that is available to women undergoing a first cycle of IVF, with or without ICSI, despite a lack of evidence to support its use. STUDY DESIGN, SIZE, DURATION This pragmatic, superiority, open-label, multi-centre, parallel-group randomised controlled trial involving 1048 women assessed the clinical effectiveness and safety of the ES procedure prior to first time IVF, with or without ICSI, between July 2016 and October 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants aged 18–37 years undergoing their first cycle of IVF, with or without ICSI, were recruited from 16 UK fertility clinics and randomised (1:1) by a web-based system with restricted access rights that concealed allocation. Stratified block randomisation was used to allocate participants to TAU or ES in the mid-luteal phase followed by usual IVF with or without ICSI treatment. The primary outcome was live birth after completing 24 weeks gestation within 10.5 months of egg collection. MAIN RESULTS AND THE ROLE OF CHANCE In total, 1048 women randomised to TAU (n = 525) and ES (n = 523) were available for intention to treat analysis. In the ES group, 453 (86.6%) received the ES procedure. IVF, with or without ICSI, was received in 494 (94.1%) and 497 (95.0%) of ES and TAU participants respectively. Live birth rate was 37.1% (195/525) in the TAU and 38.6% (202/523) in the ES: an unadjusted absolute difference of 1.5% (95% CI −4.4% to 7.4%, P = 0.621). There were no statistical differences in secondary outcomes. Adverse events were comparable across groups. LIMITATIONS, REASONS FOR CAUTION A sham ES procedure was not undertaken in the control group, however, we do not believe this would have influenced the results as objective fertility outcomes were used. WIDER IMPLICATIONS OF THE FINDINGS This is the largest trial that is adequately powered to assess the impact of ES on women undergoing their first cycle of IVF. ES was safe, but did not significantly improve pregnancy outcomes when performed in the mid-luteal phase prior to the first IVF or ICSI cycle. We recommend that ES is not undertaken in this population. STUDY FUNDING/COMPETING INTEREST(S) Funded by the National Institute of Health Research. Stephen Walters is an National Institute for Health Research (NIHR) Senior Investigator (2018 to present) and was a member of the following during the project: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Clinical Trials and Evaluation Committee (2011–2017), NIHR HTA Commissioning Strategy Group (2012 to 2017); NIHR Programme Grants for Applied Research Committee (2020 to present); NIHR Pre doctoral Fellowship Committee (2019 to present). Dr. Martins da Silva reports grants from AstraZeneca, during the conduct of the study; and is Associate editor of Human Reproduction and Editorial Board member of Reproduction and Fertility. Dr. Bhide reports grants from Bart's Charity and grants and non-financial support from Pharmasure Pharmaceuticals outside the submitted work. TRIAL REGISTRATION NUMBER ISRCTN number: ISRCTN23800982. TRIAL REGISTRATION DATE 31 May 2016 DATE OF FIRST PATIENT’S ENROLMENT 04 July 2016

PurposeGlobally, women have been recognized as key contributors toward livelihood and poverty eradication, especially in developing countries in sub-Saharan Africa. This is due to their great involvement and participation in micro small and medium enterprises (MSMEs) that create employment and ultimately economic growth and development. Thus, the main purpose of this study is to establish the mediating role of social cohesion in the relationship between microfinance accessibility and survival of women MSMEs in post-war communities in sub-Saharan Africa, especially in Northern Uganda where physical collateral were destroyed by war.Design/methodology/approachThe data for this study were collected using a pre-tested semi-structured questionnaire from 395 women MSMEs who are clients of microfinance institutions in post-war communities in Northern Uganda, which suffered from the 20 years' Lord Resistance Army (LRA) insurgency. The Analysis of Moment Structures (AMOS) software was used to analyze the data and the measurement and structural equation models were constructed to test for the mediating role of social cohesion in the relationship between microfinance accessibility and survival of women MSMEs in post-war communities.FindingsThe results revealed that social cohesion significantly and positively mediate the relationship between microfinance accessibility and survival of women MSMEs in post-war communities in Northern Uganda. The results suggest that the presence of social cohesion as a social collateral promotes microfinance accessibility by 14.6% to boost survival of women MSMEs in post-war communities where physical collateral were destroyed by war amidst lack of property rights among women. Similarly, the results indicated that social cohesion has a significant influence on survival of women MSMEs in post-war communities in Northern Uganda. Moreover, when combined together, the effect of microfinance accessibility and social cohesion exhibit greater contribution towards survival of women MSMEs in post-war communities in Northern Uganda. Indeed, social cohesion provides the social safety net (social protection) through which women can access business loans from microfinance institutions for survival and growth of their businesses.Research limitations/implicationsThis study concentrated mainly on women MSMEs located in post-war communities in developing countries in sub-Saharan Africa with a specific focus on Northern Uganda. Women MSMEs located in other regions in Uganda were not sampled in this study. Besides, the study focused only on the microfinance industry as a major source of business finance. It ignored the other financial institutions like commercial banks that equally provide access to financial services to micro-entrepreneurs.Practical implicationsThe governments in developing countries, especially in sub-Saharan Africa where there have been wars should waive-off the registration and licensing fees for grass-root associations because such social associations may act as social protection tools through which women can borrow from financial institutions like the microfinance institutions. The social groups can provide social collateral to women to replace physical collateral required by microfinance institutions in lending. Similarly, the governments, development agencies, and advocates of post-war reconstruction programs in developing countries where there have been wars, especially in sub-Saharan Africa should initiate the provision of group business loans through the existing social women associations. This may offer social protection in terms of social collateral in the absence of physical collateral required by the microfinance institutions in lending. This may be achieved through partnership with the existing microfinance institutions operating in rural areas in post-war communities in developing countries. Additionally, advocates of post-war recovery programs should work with the existing microfinance institutions to design financial products that suit the economic conditions and situations of the women MSMEs in post-war communities. The financial products should meet the business needs of the women MSMEs taking into consideration their ability to fulfil the terms and conditions of use.Originality/valueThis study revisits the role of microfinance accessibility in stimulating survival of women MSMEs as an engine for economic growth in the presence of social cohesion, especially in post-war communities in sub-Saharan Africa where physical collateral were destroyed by war. It reveals the significant role of social cohesion as a social protection tool and safety net, which contributes to economic outcomes in the absence of physical collateral and property rights among women MSMEs borrowers, especially in post-war communities.

Purpose. Comparison of computer tomography (СT) contrast enhancement (CE) protocols for optimal visualization of cardiac chamber, definition it’s influence on results of non-invasive superficial cardiac mapping.Materials and methods. The study included 93 patients with heart rhythm disorders who planned catheter ablation of arrhythmia. Noninvasive cardiac mapping was made for topical diagnostics. It includes multichannel ECG-registration and CT with intravenous СE (1st group monophasic (50 patients), 2nd group split-bolus (18 patients), 3rd group with pre-bolus (25 patients). Qualitative and quantitative (measurement of mean blood attenuation in four chambers, calculation of ventricular-myocardial contrast-to-noise ratio VM-LV и VM-RV for left ventricle (LV) and right ventricle (RV), respectively) parameters were compared between groups. Fusion of ECG and CT data was made semi-automatic with diagnostic complex «Amycard 01К».Results. Regardless of CE technique was noted sufficient and homogeneous contrast attenuation of left atrium (LA) and LV (mean blood attenuation in LA more than 278 HU, LV 250 HU, VM-LV 0,582). Enhancement of right heart was insufficient with monophasic protocol, in most cases the average CT density was lower than 200 HU, VM-RV 0,256. Split-bolus protocol improves visualization of right atrium (RA) and RV (blood density in RA 258HU, RV 227HU, VM-RV 0,541), however there was heterogeneity of RA cavity because of artifacts from superior vena cava (VC) and unenhanced blood from inferior inferior VC. Using of pre-bolus increases contrast ratio between RA myocardium and blood due to increasing CT density of blood in inferior VC (blood density 294 HU). Quality of right ventricle CE was similar to 2nd group (blood density 264 HU, VM-RV 0,565).Conclusion. CE protocols split-bolus and with pre-bolus improve visualization of right ventricle, supporting the high level enhancement of left heart. Protocol with pre-bolus is preferable for exact differentiation of right atrial endocardial contour.

The article shows the main models of building pre-trial proceedings in the Russian Federation and foreign countries, analyzes the provision of access to justice in each of the models. A number of measures have been proposed to build pre-trial proceedings in criminal cases that effectively ensure access to justice, including abandoning the stage of initiating a criminal case and keeping a countdown of the preliminary investigation from the moment of registration of a crime report, conducting pre-trial cognitive activity (investigation) under the guidance of a prosecutor, and bringing charges by the prosecutor.based on the results of the investigation, granting participants who are not vested with authority the right to apply to the court to deposit evidence and to assist the court in protecting their interests in connection with the refusal of the preliminary investigation body to satisfy motions related to the process of proving, the introduction of effective simplified and accelerated procedures in pre-trial proceedings, the establishment of digital interaction between government agencies and the population through a single secure digital online platform; creation of a mechanism for filing reports of crime through a special online service integrated into the specified digital platform.

ObjectiveTo assess the prevalence, characteristics and prognostic value of pulmonary hypertension (PH) and right ventricular dysfunction (RVD) in hospitalised, non-intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19).MethodsThis single-centre, observational, cross-sectional study included 211 patients with COVID-19 admitted to non-ICU departments who underwent a single transthoracic echocardiography (TTE). Patients with poor acoustic window (n=11) were excluded. Clinical, imaging, laboratory and TTE findings were compared in patients with versus without PH (estimated systolic pulmonary artery pressure >35 mm Hg) and with versus without RVD (tricuspid annular plane systolic excursion <17 mm or S wave <9.5 cm/s). The primary endpoint was in-hospital death or ICU admission.ResultsA total of 200 patients were included in the final analysis (median age 62 (IQR 52–74) years, 65.5% men). The prevalence of PH and RVD was 12.0% (24/200) and 14.5% (29/200), respectively. Patients with PH were older and had a higher burden of pre-existing cardiac comorbidities and signs of more severe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (radiological lung involvement, laboratory findings and oxygenation status) compared with those without PH. Conversely, patients with RVD had a higher burden of pre-existing cardiac comorbidities but no evidence of more severe SARS-CoV-2 infection compared with those without RVD. The presence of PH was associated with a higher rate of in-hospital death or ICU admission (41.7 vs 8.5%, p<0.001), while the presence of RVD was not (17.2 vs 11.7%, p=0.404).ConclusionsAmong hospitalised non-ICU patients with COVID-19, PH (and not RVD) was associated with signs of more severe COVID-19 and with worse in-hospital clinical outcome.Trial registration numberNCT04318366

Introduction: Post-traumatic headaches (PTH) are common following mild traumatic brain injury (mTBI). There is evidence of altered central pain processing in adult PTH; however, little is known about how children with PTH process pain. The anterior cingulate cortex (ACC) plays a critical role in descending central pain modulation. In this study, we explored whether the functional connectivity (FC) of the ACC is altered in children with PTH. Methods: In this case-control study, we investigated resting-state FC of 5 ACC seeds (caudal, dorsal, rostral, perigenual, and subgenual) in children with PTH ( n = 73) and without PTH ( n = 29) following mTBI, and healthy controls ( n = 27). Post-concussion symptoms were assessed using the Post-Concussion Symptom Inventory and the Child Health Questionnaire. Resting-state functional Magnetic Resonance Imaging (fMRI) data were used to generate maps of ACC FC. Group-level comparisons were performed within a target mask comprised of pain-related regions using FSL Randomise. Results: We found decreased FC between the right perigenual ACC and the left cerebellum, and increased FC between the right subgenual ACC and the left dorsolateral prefrontal cortex in children with PTH compared to healthy controls. The ACC FC in children without PTH following mTBI did not differ from the group with PTH or healthy controls. FC between rostral and perigenual ACC seeds and the cerebellum was increased in children with PTH with pre-injury headaches compared to those with PTH without pre-injury headaches. There was a positive relationship between PTH severity and rostral ACC FC with the bilateral thalamus, right hippocampus and periaqueductal gray. Conclusions: Central pain processing is altered in children with PTH. Pre-existing headaches help to drive this process. Trial registration: The PlayGame Trial was registered in ClinicalTrials.gov database ( ClinicalTrials.gov Identifier: NCT01874847).

ObjectivesTo develop an individualised rehabilitation programme for personal and instrumental activities of daily living (ADL) tasks, enabling older adults with hip fractures to perform ADL safely and independently.DesignQualitative study inspired by the complex intervention development (Medical Research Council framework phase I) using literature search and research circles.SettingsUniversity Hospital of Copenhagen, Herlev and Gentofte, and Herlev and Gentofte municipalities.ParticipantsOne research circle with seven older adults with hip fractures, and one with seven healthcare professionals (occupational therapists and physiotherapists).ResultsThree generic categories were identified: (1) ‘Challenge older adults with goal-oriented ADL tasks’, (2) ‘Implement strategies to enhance independent and safe performance of ADL tasks’, and (3) ‘Communicate the important information to the target group and across sectors’. A programme was developed and an intervention to enhance usual rehabilitation was designed comprising: an individualised intervention component consisting of five additional therapy sessions; one during hospitalisation, four in the municipality and a follow-up phone call.ConclusionsEngaging and integrating activities into rehabilitation treatment may support rehabilitation. Our study highlighted the need for setting individual goals and challenging older adults with hip fracture by providing guidance in strategies to enhance safe and independent performance of ADL tasks. Furthermore, the need for providing older adults with hip fracture and healthcare professionals with written and oral information about goal setting during the transitional rehabilitation phase was emphasised. Including the perspectives of older adults with hip fracture and healthcare professionals added value to the rehabilitation, and thus ensured an adequate, tangible and implementable rehabilitation programme.Trial registration numberThis article is the first of three articles inspired by Medicial Research Council guidelines. The next study is a feasibility study with the trial registration: ClinicalTrials.gov ID: NCT03828240. The results are right now being written in article. The third study is a randomised controlled trial with the trial registration: ClinicalTrials.gov ID: NCT04207788; Pre-results.

A limited liability company is a company with share capital. Each member of an LLC can freely transfer his share to one, more or all other members by inter vivos and mortis causa transactions (mainly contracts). If share is transferred to a third party, all LLC members have the right of preemption. It is a rule of dispositive nature and, therefore, it can be excluded by the Memorandum of Association. A member of an LLC who plans to transfer his share to a third party shall previously send an offer to the other members in the form of LLC membership share transfer agreement. The signature of the transferee on an offer must be authenticated by a notary. The notary shall confirm that offer if share of the transferee includes real estate or when it is governed by the special act. If a LLC member believes his right of pre-emption has been violated, he can bring a complaint to the relevant court demanding: 1) that the contract or any other act related to the transfer of share should be cancelled, or 2) the obligation of the defendant (member against whom the claim is brought) to transfer his share to the plaintiff, i.e. that a judgment of the court replaces share transfer agreement between the plaintiff and the defendant. The complaint can be brought within 30 days (subjective term) from the moment when LLC member had been informed about the conclusion of share transfer agreement, but not later than six months after share transfer registration in Business Registers Agency (objective term). After the expiration of these terms, the complaint will be rejected, and therefore disposal of shares will be strengthened.

Abstract Patients with a variety of blood cancers and metabolic diseases may require a stem cell transplant as part of their treatment. However, 70% of patients do not have a suitable genetic match in their family. Stem cell donor-databases are used to match potential unrelated donors to patients worldwide. In Canada, individuals aged 17-35 years can register as donors online or at a stem cell drive where they provide consent and a tissue sample (buccal-swab) for Human Leukocyte Antigen (HLA) allele typing. To date, no guidelines have been published to recommend a process for stem cell donor recruitment at drives. Here, I outline a Canadian approach to stem cell drive design, which features evidence-based strategies to identify and recruit the most-needed stem cell donors and to minimize donor ambivalence and withdrawal from the registry. This model of stem cell drive design includes five stations: pre-screening, informed consent, registration, swabbing, and reconciliation. Registrant confidentiality and privacy is maintained at each station, and quality control is emphasized throughout. Registrants are first pre-screened to ensure donor eligibility. Recruiters at the prescreening station target the most-needed stem cell donors according to the literature: young, healthy, and ethnically-diverse males. Non-optimal and ineligible registrants are redirected to help out in other ways. Recruiters then explain the principles of stem cell donation and educate registrants about the stem cell donation process. Next, registrants proceed to the informed consent station, which is designed to meet the requirements of the World Marrow Donor Association's suggested procedures for procurement of informed consent at time of recruitment (2003). Here, recruiters hand registrants an information pamphlet, and explain blood and marrow stem cell collection procedure diagrams. The risks of donation are outlined, and registrants are informed of their right to withdraw at any time and about donor and patient anonymity. Registrants are subsequently guided through registration, where they provide their contact/demographic information, complete a health questionnaire, and sign a consent form to join the registry. Recruiters at this station error check registrants' forms to ensure correct completion, and educate registrants about the data collection, storage, usage, and confidentiality. Following registration, registrants proceed to swabbing, where they swab their cheeks to provide a tissue/DNA sample. Recruiters at this station affix barcode stickers to each swab kit component. While registrants swab their cheeks, volunteers perform an informed consent checkpoint by asking registrants if they understand the donation process, the risks involved, and the right to withdraw at any time. Finally, registrants visit reconciliation, where their paperwork is error checked again, their understanding of the donation process is assessed a final time to verify informed consent, and their kit processed for shipping. In summary, the five-station approach to stem cell drive design outlined in this presentation represents a new model for effective stem cell donor recruitment. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

BackgroundElectroconvulsive therapy (ECT) is the treatment of choice for severe mental illness including treatment-resistant depression (TRD). Increases in volume of the hippocampus and amygdala following ECT have consistently been reported.AimsTo investigate neuroplastic changes after ECT in specific hippocampal subfields and amygdala nuclei using high-resolution structural magnetic resonance imaging (MRI) (trial registration: clinicaltrials.gov – NCT02379767).MethodMRI scans were carried out in 14 patients (11 women, 46.9 years (s.d. = 8.1)) with unipolar TRD twice before and once after a series of right unilateral ECT in a pre–post study design. Volumes of subcortical structures, including subfields of the hippocampus and amygdala, and cortical thickness were extracted using FreeSurfer. The effect of ECT was tested using repeated-measures ANOVA. Correlations of imaging and clinical parameters were explored.ResultsIncreases in volume of the right hippocampus by 139.4 mm3 (s.d. = 34.9), right amygdala by 82.3 mm3 (s.d. = 43.9) and right putamen by 73.9 mm3 (s.d. = 77.0) were observed. These changes were localised in the basal and lateral nuclei, and the corticoamygdaloid transition area of the amygdala, the hippocampal–amygdaloid transition area and the granule cell and molecular layer of the dentate gyrus. Cortical thickness increased in the temporal, parietal and insular cortices of the right hemisphere.ConclusionsFollowing ECT structural changes were observed in hippocampal subfields and amygdala nuclei that are specifically implicated in the pathophysiology of depression and stress-related disorders and retain a high potential for neuroplasticity in adulthood.Declaration of interestS.K. has received grants/research support, consulting fees and/or honoraria within the past 3 years from Angelini, AOP Orphan Pharmaceuticals AG, AstraZeneca, Celegne GmbH, Eli Lilly, Janssen-Cilag Pharma GmbH, KRKA-Pharma, Lundbeck A/S, Neuraxpharm, Pfizer, Pierre Fabre, Schwabe and Servier. R.L. received travel grants and/or conference speaker honoraria from Shire, AstraZeneca, Lundbeck A/S, Dr. Willmar Schwabe GmbH, Orphan Pharmaceuticals AG, Janssen-Cilag Pharma GmbH, and Roche Austria GmbH.

IntroductionPacing-induced cardiomyopathy occasionally occurs in patients undergoing pacemaker implantation. Although compared with right ventricular (RV) apical pacing, RV septal pacing can attenuate left ventricular dyssynchrony; the success rate of lead placement on the RV septum using the stylet system is low. Additionally, no randomised controlled trial has addressed the issue regarding the accuracy of RV lead placement on the RV septum using the stylet and delivery catheter systems. This study hypothesises that a newly available delivery catheter system can improve the accuracy of RV lead placement on the RV septum.Methods and analysisIn a multicentre, prospective, randomised, single-blind, controlled trial, 70 patients with pacemaker indication owing to atrioventricular block will be randomised to either the delivery catheter or stylet group before the pacemaker implantation procedure. The position of the RV lead tip will be assessed using ECG-gated cardiac CT in all patients within 4 weeks after pacemaker implantation. Lead tip positions are classified into three groups: (1) RV septum, (2) anterior/posterior edge of the RV septal wall and (3) RV free wall. The primary endpoint will be the success rate of RV lead tip placement on the RV septum, which will be evaluated using cardiac CT.Ethics and disseminationThis study will be conducted according to the stipulations of the Helsinki Declaration and the institutional review board of Hamamatsu University School of Medicine. The results of the study will be disseminated at several research conferences and will be published in peer-reviewed journals.Trial registration numberjRCTs042200014; Pre-results.

This paper focusses on onshore exploration and production because the right to negotiate does not apply offshore. However, the Native Title Act can be relevant to offshore oil and gas explorers and producers. First, where their area of interest includes an island within the jurisdiction of Western Australia. Secondly, in respect of land required for the facilities to treat petroleum piped ashore.Under the original Native Title Act the right to negotiate proved unworkable, the expedited procedure failed to facilitate the grant of exploration titles and titles granted after 1 January 1994 were probably invalid.The paper examines the innovations introduced by the amended Native Title Act to consider whether it will be more 'workable' for petroleum explorers and producers. It examines some of categories of future acts in respect of which the right to negotiate does not apply (specifically indigenous land use agreements, renewals and extensions of titles, procedures for infrastructure titles, reserve land, water resources, low impact future acts, approved exploration etc acts and the expedited procedure).Other innovations include the new registration test for native title claims, the validation of pre-Wik titles, the amended right to negotiate procedure, the State implementation of the right of negotiate procedure and the objection and adjudication procedure for grants on pastoral land.The response of each state and territory parliament to the amended Act is considered, as is the Federal Court decision in the Miriuwung Gajerrong land claim (particularly the finding that native title includes resources, questioning whether these resources extend to petroleum).The paper observes that the full impact of the new Act cannot be determined until the states and territories have passed complementary legislation and it is all in operation. However, the paper's preliminary conclusion is that it does not provide a workable framework for the interaction between petroleum companies and native title claimants.The writer's view is that the right to negotiate procedure is unworkable if relied upon to obtain the grant of a title. If a proponent wishes to develop a project in any commercially acceptable timeframe, it will have to negotiate an agreement with native title claimants. The paper's conclusion is that a negotiated agreement is the only way to cope with native title issues.

e15033 Background: The clinical ability of pre- and post neoadjuvant MRI to predict the necessary extension of TME (ETME) in evaluation of the areas at risk in locally advanced rectal cancer (LARC). Evaluation of treatment response to chemo/ radiation in T4 tumours is difficult. MRI cannot discriminate between different tissue components within a voxel. Increasing rate of late local relapses are reported from different studies. Methods: Prospective registration of 92 MRI evaluated T4a cancers undergoing multimodal treatment for rectal cancer between 2002 and 2007 in a tertiary referral cancer centre. MRI was found to predict T- downstaging in 10% after neoadjuvant treatment. In 35% both MRI and histopathological examination staged the patients as T4 after treatment. 55% (n=51) of the patients were downstaged after the routine postoperative pathology work-up. A new technique with MRI- based sampling of areas of infiltration was introduced and dedicated histopathological evaluation of these threatened areas was performed. Results: ETME was performed in 95% of the patients, mostly as en-bloc resections. After MRI focused pathology 50% were reclassified and up scaled to have pT4. Accordingly, at least 2/3 of the MRI staged T4 tumours before treatment still were pT4 after multimodal treatment. Conclusions: The tumours were downsized, but to lesser amount downstaged. If cure is the goal of the treatment, extended TME as en-bloc resections has to be performed. It is necessary to remove tumour as shown in pre-treatment MRI, as well as tumour, fibrosis and mucus as shown in MRI after post neoadjuvant treatment. MRI assisted pathology is an important option for right T-stage classification and for planning the extent of surgical resection. No significant financial relationships to disclose.

Shelter medicine is a veterinary discipline of growing importance. Formally accepted as a clinical specialty in the US in 2014, the practice of shelter medicine worldwide is expanding. As a topic in veterinary pre-registration (undergraduate) education, it is frequently used as an opportunity to teach primary care skills, but increasingly recognized as a subject worthy of teaching in its own right. The aim of this study was to use a Delphi consensus methodology to identify learning outcomes relevant to shelter medicine education. Shelter medicine educators worldwide in a variety of settings, including universities, non-governmental organizations and shelters were invited to participate. Participants were initially invited to share shelter medicine teaching materials. These were synthesized and formatted into Learning Outcomes (LOs) based on Bloom’s taxonomy and organized into five subject-specific domains. Participants were then asked to develop and evaluate the identified LOs in two rounds of online surveys. Consensus was determined at > 80% of panelists selecting “agree” or “strongly agree” in response to the statement “please indicate whether you would advise that it should be included in a shelter medicine education program” for each LO. In the second survey, where re-wording of accepted LOs was suggested, preference was determined at > 50% agreement. Through this method, 102 agreed LOs have been identified and refined. These LOs, as well as those which did not reach consensus, are presented here. These are intended for use by shelter medicine educators worldwide, to enable and encourage the further development of this important veterinary discipline.

IntroductionType 2 diabetes mellitus (T2DM) is a highly prevalent chronic disease in the Spanish population. Typically, T2DM is associated with other chronic conditions. Intensive medication at the time of diagnosis has proven effective in reducing cardiovascular risk, improving glycaemic control and preventing T2DM complications. However, it has not yet been demonstrated that a comprehensive and intensive health education protocol at the time of diagnosis has the benefits described previously. Currently, there is great variability in the practices of primary care nurses regarding health education at the time of disease diagnosis.We aimed to evaluate the effectiveness of a systematic protocol with a comprehensive care programme in people with newly diagnosed T2DM with associated comorbidities.Methods and analysisA multicentre quasi-experimental design comparing a group of individuals taking part in the intervention (intervention group (IG)) with a similar group receiving standard diabetes care (comparison group (CG)) is planned. The intervention will take place during the 3 months after study enrolment. Data will be collected at baseline and at 3, 6 and 12 months. Ten primary care centres in Barcelona city will be selected for participation: 5 for the IG and 5 for the CG. The IG will include five structured individual visits postdiagnosis with the primary care nurse, during which aspects of diabetes education will be discussed with the patient and his/her family. The results will be measured in terms of health-related quality of life and the change in main outcomes (glycated haemoglobin and weight).Ethics and disseminationThe study fully met the requirements of the Ethical Committee of Clinical Investigation of the IDIAP Jordi Gol (approval code: P13/118). Patients will be informed that their data are confidential, and they have the right to withdraw at any time without penalty. Dissemination will include publishing the findings in peer-reviewed journals and sharing our findings at scientific conferences.Trial registration numberNCT03990857; Pre-results.

PurposeNew nodules after baseline are regularly found in low-dose CT lung cancer screening and have a high lung cancer probability. It is unknown whether morphological and location characteristics can improve new nodule risk stratification by size.MethodsSolid non-calcified nodules detected during incidence screening rounds of the randomised controlled Dutch-Belgian lung cancer screening (NELSON) trial and registered as new or previously below detection limit (15 mm3) were included. A multivariate logistic regression analysis with lung cancer as outcome was performed, including previously established volume cut-offs (<30 mm3, 30–<200 mm3 and ≥200 mm3) and nodule characteristics (location, distribution, shape, margin and visibility <15 mm3 in retrospect).ResultsOverall, 1280 new nodules were included with 73 (6%) being lung cancer. Of nodules ≥30 mm3 at detection and visible <15 mm3 in retrospect, 22% (6/27) were lung cancer. Discrimination based on volume cut-offs (area under the receiver operating characteristic curve (AUC): 0.80, 95% CI 0.75 to 0.84) and continuous volume (AUC: 0.82, 95% CI 0.77 to 0.87) was similar. After adjustment for volume cut-offs, only location in the right upper lobe (OR 2.0, P=0.012), central distribution (OR 2.4, P=0.001) and visibility <15 mm3 in retrospect (OR 4.7, P=0.003) remained significant predictors for lung cancer. The Hosmer-Lemeshow test (P=0.75) and assessment of bootstrap calibration curves indicated adequate model fit. Discrimination based on the continuous model probability (AUC: 0.85, 95% CI 0.81 to 0.89) was superior to volume cut-offs alone, but when stratified into three risk groups (AUC: 0.82, 95% CI 0.78 to 0.86), discrimination was similar.ConclusionContrary to morphological nodule characteristics, growth-independent characteristics may further improve volume-based new nodule lung cancer prediction, but in a three-category stratification approach, this is limited.Trial registration numberISRCTN63545820; pre-results.

e20050 Background: To monitor the range of motion in SBRT treatment of lung tumors by using BODYFIX combined with four-dimensional cone beam CT (4D-CBCT), and provide evidence for delineating the reasonable internal target area (ITV) of lung cancer, and observe the short-term outcom of treatment and treatment of complications. Methods: 4D-CT was used to locate CT scan, delineate the GTV of the tumor, make a simple radiation treatment planning, determine the treatment center point, and then use line accelerator 4D-CBCT to perform pre-SBRT treatment on 4 patients with lung malignant tumor. The system automatically reconstructs the image and matches the CT image of the treatment plan to obtain the placement error of the patient in the head and foot (SI), left and right (LR), and front and rear (AP) directions. The double registration technique is used to correct the correction first. Positioning error, the 4D-CBCT dynamic image is again registered with the target area, the range of motion within the tumor is observed, and the time-weighted 4D-CBCT image is transmitted back to the Monaco planning system to delineate the target area to accurately determine the range of the ITV. According to this target area, a radiation treatment planning was developed, GTV 20Gy/f, 1 to 3 fractions, and then 4D-CBCT scan was performed in each SBRT treatment to observe the range of tumor motion in real time. Results: 3 of the 4 patients the lung tumors were CR at 3 months after treatment, and 1 patient was SD. No serious complications occurred during the treatment or within 3 months after radiotherapy. Conclusions: The BODYFIX plus 4D-CBCT image can more accurately outline the ITV range of lung cancer. The patient is well tolerated and the short-term outcom is good.

Abstract Background Preventive health checks targeted at the at-risk population can be a way of preventing noncommunicable diseases. However, evidence on patient preferences for preventive health checks is limited, especially among patients with a high risk of noncommunicable diseases. Objective To examine patient preferences for preventive health checks in Danish general practice, targeting persons at high risk of a noncommunicable disease. Methods The method used in this study was a discrete choice experiment (DCE) with five attributes: assess, advice, agree, assist and arrange. The attributes were inspired by the 5A model for behaviour change counselling but was altered for the purpose of this study to grasp the entirety of the general practice-based intervention. Moreover, the attribute levels were defined to resemble daily clinical practice. The experimental design of the DCE was an efficient Bayesian main effects design and the results were analysed using a random utility theory framework. Results A total of 148 patients completed the DCE. Patients at high risk of a noncommunicable disease have positive preferences for: giving brief explanations about own lifestyle, practicing shared decision-making with the general practitioner (GP), follow-up counselling with the GP after the preventive health check and scheduling a new appointment right after the preventive health check. Conclusions The results provide Danish GPs with evidence on their patients’ preferences towards preventive health checks which will enable the GPs to tailor these consultations. Moreover, the results suggest that pre-appointment measures, such as a health profile, may mediate a preference for more action-oriented attributes. Trial registration Registered at Clinical Trial Gov (Unique Protocol ID: TOFpilot2016, https://clinicaltrials.gov/ct2/show/NCT02797392?term=TOFpilot2016&rank=1). Prospectively registered on the 29th of April 2016.

Abstract Background Abnormal Cerebral Blood Flow (CBF) has been found in patients with chronic schizophrenia (SCZ), first-episode psychosis patients (FEP) and individuals at clinical high-risk (CHR). In particular, previous studies using Arterial Spin Labelling (ASL) found that SCZ have a global reduction of CBF in the cortex and increased CBF in the basal ganglia, the hippocampus, and the amygdala as compared with controls. To date, only one study investigated CBF using ASL in a small cohort of medicated FEP reporting increased CBF in the striatum and reduced frontal CBF as compared with controls. However, it is still not clear whether these abnormalities are related to antipsychotic treatment or rather they reflect a disease state independent from medication. Critically, clinical and pre-clinical evidence suggests that antipsychotics increase CBF, especially in the basal ganglia through dopamine D2 receptors blockade. Here, we assessed CBF differences between FEP and controls in a larger cohort of unmedicated or minimally treated patients. In addition, we tested the association between CBF abnormalities and clinical features. Methods 26 FEP (13 medication-free, 9 antipsychotics naïve, 4 minimally treated) and 22 healthy controls (HC) were recruited. FEP and HC were matched for age and gender. Among FEP, 11 had a diagnosis of affective psychosis and 15 of non-affective psychosis. MRI scans were acquired using a GE MR750 3T scanner and a 12-channel head coil. ASL data was acquired using a pseudo-continuous ASL sequence (pCASL). Four control-label pairs were used. Quantification of the CBF data was made using a coil sensitivity map and a proton density image. CBF maps were normalized using non-linear registration and smoothed using a 6 mm full width at half maximum (FWHM) kernel. Grey matter CBF and regional CBF values in each Region of Interest (ROI) were extracted using individual grey matter images and WFU-Pickatlas ROIs with the MarsBar toolbox. Based on previous studies the following ROIs were selected: right and left hippocampus, right and left striatum, right and left frontal cortex. Whole-brain voxel-wise analysis was performed using a non-parametric independent t-test as implemented in FSL randomize (Threshold Free Cluster Enhancement, TFCE, and 5000 permutations). Bonferroni method was used to correct ROI analysis for multiple comparisons (alpha = 0.05, n = 7). Results Significantly reduced CBF was found in FEP as compared with controls in total grey matter CBF (p = 0.004). Whole-brain voxel-wise analysis FEP-HC comparison revealed a widespread cortical reduction in large cortical clusters that encompass the occipital, parietal and frontal cortices (pFWE TFCE corrected &lt; 0.05). ROI analysis revealed a significant reduction in CBF in the right frontal cortex (p = 0.002). A nominal significant reduction was also detected in the left frontal cortex (p = 0.014). No statistically significant differences were found in the other ROI considered (all p &gt; 0.1). Sub-analysis after removing minimally treated patients did not change the results. Both global grey matter CBF and right frontal CBF were reduced in both affective and non-affective psychosis as compared with controls (p &lt; 0.05), whereas no differences were detected between the two clinical groups. Discussion Our results confirm earlier evidence on reduction of cortical perfusion in FEP. However, in contrast with previous studies, we did not detect any difference in striatal perfusion in our cohort of unmedicated/minimally treated patients. Hence, our results support the hypothesis that alteration in striatal perfusion are likely due to medication. Finally, our results suggest that CBF alterations might have a trans-diagnostic role in the pathophysiology of psychosis.

IntroductionCardiac adipose tissue is a source of progenitor cells with regenerative capacity. Studies in rodents demonstrated that the intramyocardial delivery of cells derived from this tissue improves cardiac function after myocardial infarction (MI). We developed a new reparative approach for damaged myocardium that integrates the regenerative properties of cardiac adipose tissue with tissue engineering. In the adipose graft transposition procedure (AGTP), we dissect a vascularised flap of autologous pericardial adipose tissue and position it over the myocardial scarred area. Following encouraging results in acute and chronic MI porcine models, we performed the clinical trial (NCT01473433, AdiFLAP trial) to evaluate safety in patients with chronic MI undergoing coronary artery bypass graft. The good safety profile and trends in efficacy warranted a larger trial.Study designThe AGTP II trial (NCT02798276) is an investigator initiated, prospective, randomised, controlled, multicentre study to assess the efficacy of the AGTP in 108 patients with non-revascularisable MI. Patients will be assigned to standard clinical practice or the AGTP. The primary endpoint is change in necrotic mass ratio by gadolinium enhancement at 91 and 365 days. Secondary endpoints include improvement in regional contractibility by MRI at 91 and 365 days; changes in functional MRI parameters (left ventricular ejection fraction, left and right ventricular geometric remodelling) at 91 and 365 days; levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) at 7, 91 and 365 days; appearance of arrhythmias from 24 hour Holter monitoring at 24 hours, and at 91 and 365 days; all cause death or re-hospitalisation at 365 days; and cardiovascular death or re-hospitalisation at 365 days.Ethics and disseminationThe institutional review board approved the trial which will comply with the Declaration of Helsinki. All patients will provide informed consent. It may offer a novel, effective and technically simple technique for patients with no other therapeutic options. The results will be submitted to indexed medical journals and national and international meetings.Trial registration numberClinicalTrials.gov:NCT02798276, pre-results.

Background Recent studies in the Sub-Saharan countries in Africa have indicated gaps and challenges for voluntary medical male circumcision (VMMC) quality of service. Less has focused on the changes in quality of service after implementation of continuous quality improvement (CQI) action plans. This study aimed to evaluate the impact of coaching, provision of standard operating procedures (SOPS) and guidelines, mentoring and on-site in-service training in improving quality of VMMC services across four Right to Care (RTC) supported provinces in South Africa. Method This was a pre- and post-interventional study on RTC supported VMMC sites from July 2018 to October 2019. All RTC-supported sites that were assessed at baseline and post-intervention were included in the study. Data for baseline CQI assessment and re-assessments was collected using a standardized National Department of Health (NDoH) CQI assessment tool for VMMC services from routine RTC facility level VMMC programme data. Quality improvement support was provided through a combination of coaching, provision of standard operating procedures and guidelines, mentoring and on-site in-service training on quality improvement planning and implementation. The main outcome measure was quality of service. A paired sample t-test was used to compare the difference in mean quality of service scores before and after CQI implementation by quality standard. Results A total of 40 health facilities were assessed at both baseline and after CQI support visits. Results showed significant increases for the overall changes in quality of service after CQI support intervention of 12% for infection prevention (95%CI: 7–17; p<0.001) and 8% for male circumcision surgical procedure, (95%CI: 3–13; p<0.01). Similarly, individual counselling, and HIV testing increased by 14%, (95%CI: 7–20; p<0.001), group counselling, registration and communication by 8%, (95%CI: 3–14; p<0.001), and 35% for monitoring and evaluation, (95%CI: 28–42; p<0.001). In addition, there were significant increases for management systems of 29%, (95%CI: 22–35; p<0.001), leadership and planning 23%, (95%CI: 13–34; p<0.001%) and supplies, equipment, environment and emergency 5%, (95%CI: 1–9; p<0.01). The overall quality of service performance across provinces increased by 18% (95%CI: 14–21; p<0.001). Conclusion The overall quality of service performance across provinces was significantly improved after implementation of CQI support intervention program. Regular visits and intensive CQI support are required for sites that will be performing below quality standards.

Abstract STUDY QUESTION Do uterine arteries Doppler studies show different pulsatility index (UtA-PI) measurements in IVF/ICSI pregnancies with oocyte donation (OD) as compared to natural conceptions? SUMMARY ANSWER In IVF/ICSI pregnancies with OD, UtA-PI is reduced by an average of about 40% as compared to pregnancies with natural conception. WHAT IS KNOWN ALREADY OD pregnancies present worse pregnancy outcomes as compared to natural conception, particularly for increased incidence of pre-eclampsia (PE). Recent evidence shows that IVF/ICSI pregnancies with frozen blastocyst transfer also present higher prevalence of PE and 15% lower UtA-PI as compared to pregnancies after fresh blastocyst transfers. STUDY DESIGN, SIZE, DURATION Prospective, longitudinal matched cohort study performed in the Fetal Medicine and Obstetric Departments of San Raffaele Hospital in Milan, between 2013 and 2018. The analysis is based on 584 Doppler observations collected from 296 women with different method of conception (OD n = 122; natural conception n = 174). PARTICIPANTS/MATERIALS, SETTING, METHODS IVF/ICSI viable singleton pregnancies with OD and natural conception control pregnancies matched for BMI and smoking, performing repeated UtA-PI measurements at 11–34 weeks. Miscarriages, abnormalities, twins, significant maternal diseases and other types of ARTs were excluded. Log mean left–right UtA-PI was used for analysis with linear mixed model (LMM) and correction for significant confounders. Pregnancy outcome was also analyzed. MAIN RESULTS AND THE ROLE OF CHANCE Participants after OD were older and more frequently nulliparous (mean age: OD 43.4, 95% CI from 42.3 to 44.6; natural conception 35.1, 95% CI from 34.5 to 35.7; P-value &lt; 0.001; nulliparous: OD 96.6%; natural conception 56.2%; P-value &lt; 0.001). Mean pulsatility index was lower in OD (UtA-PI: natural conception 1.22; 95% CI from 1.11 to 1.28; OD 1.04; 95% CI from 0.96 to 1.12; P-value &lt; 0.001). A significant effect of parity, gestational age (GA) modeled with a cubic polynomial and BMI was described in the LMM. The mean Log UtA-PI was on average 37% lower in OD as compared to natural conception pregnancies at LMM (P-value &lt; 0.001). We also found a significant interaction between longitudinal UtA-PI Doppler and GA. Therefore, at 11 weeks’ gestation the Log UtA-PI was 42% lower and, at 34 weeks, the differences reduced to 32%. GA at delivery and birth weight were statistically lower in OD group; however, birthweight centile was not statistically different. Preeclampsia was 11-fold more common in the OD group (0.6% and 6.6%, P-value = 0.003). No other significant difference in pregnancy outcome was shown in the study groups (gestational diabetes mellitus, small or large for GA). LIMITATIONS, REASONS FOR CAUTION It was not possible to properly match for maternal age and to blind the assessment given the major differences between cohorts; however, we did not find significant within-groups effects related to maternal age. Future research is needed to reassess outcomes and correct them for maternal characteristics (e.g. cardiovascular function). WIDER IMPLICATIONS OF THE FINDINGS This finding reproduces our previous discovery of lower UtA-PI in frozen as compared to fresh blastocyst transfer. The vast majority of OD is obtained by the use of cryopreservation. We speculate that increased uterine perfusion may be the physiological response to compensate dysfunctions both in the mother and in the placenta. STUDY FUNDING/COMPETING INTEREST(S) This is a non-funded study. The authors do not declare competing interest. TRIAL REGISTRATION NUMBER N/A.

An improved corner detection algorithm for medical image based on USAN is proposed in this paper. The algorithm firstly defines the concept of end line which through the core of the circular template, and analyses the number of end lines in the corner point, thus obtains an initial response function of the corner. Then puts forward a non-maxima suppression method by defining the concept of uniformity coefficient of the non-end line. Finally, compared with existing algorithms, experiments indicates that the improved algorithm has the fast and accurate advantages. I.IntroductionCorner detection based on grayscale images has been widely used in medical image registration. Medical image registration techniques can be divided into two categories, which is based on pixels (voxels) and the feature-based methods. Feature-based registration method is matched by extracting the structural features of different images (the common features including points, contours, curves and surfaces, etc.) , in which the registration based on feature points is the most widely applied method[1]. Corner points as the feature of image has rich information content and a little calculation, matching simple and rotation, translation, scaling invariant properties. In recent years, some improved methods for Harris algorithm[2,3] and USAN (Univalue Segment Assimilating Nucleus, with the value of the shrinking core) algorithm[4] method have been applied in image registration. In 2002, Zhou Peng, etc. developed a new corner detection method based on the model proposed in the USAN[5].Experimental results show that image registration based on the method without restrictions on the rotation of the image, it improves the registration accuracy and has less computation. In 2006, Rae etc. built a new multi-scale Harris corner detection algorithm[6]. The new corner-detection method can obtain corner points at different scales corner, improved the detection performance of detection operators, advanced the registration accuracy of corner-based image registration algorithm. In 2007, Huashun Gang, etc. absorbed and improved the SUSAN , proposed a dense image matching algorithm[7], using Sobel operator and the feature similarity to initially match the corner on the left and right image, achieved dense matching of all the pixels of two images which without calibration. At present, image corner detection based on gray, in particular the method based on template made great development. However, the accuracy of these methods are mostly poor, algorithm complexity, time-consuming, so have some limits in real-time applications. Based on the USAN, a new improved algorithm was proposed and has been applied to medical image corner detection, the new algorithm in terms of speed and accuracy has a larger increase.II.Susan Corner Detection PrincipleSUSAN algorithm [4] defines a circular template, as shown in Fig. 1, the center of circular template is called the core, if some pixel's brightness of the circular template is the same or similar to the core, the region composed with these pixels will be defined USAN region ,at the corner point and non-corner point, USAN region area is different, and the USAN area of the corner point is the smallest.Fig. 1 The circular template of SUSAN algorithmDoing the specific defection, a circular template with 37 pixel will be used to scan the entire image, and to calculate the gray intensity’s minus between each pixel and the core of the template, if the absolute value is less than the given threshold t ,which will be considered to belong to USAN ,the commonly used similarity comparison function is as follows: (1)in this formula,is the discriminate result，is the gray value of the core of circular template， is the gray value of the arbitrary pixel in addition to the core of the template.Apply the formula (1) to each pixel, then the size of the USAN area can be expressed as: (2)In this formula, is the circular template whose core is [8].After getting the USAN area of all the pixels, then according to the following corner response function to generate the initial corner response: (3)In this formula, g is the geometric threshold value of the noise suppression, which decides the maximum value of output corners’ USAN area.SUSAN algorithms do not need the beforehand edge detection, which avoid the calculation of the gradient and not depend on the results of image segmentation, with integral characteristics, good anti-noise performance, and is not influenced by the type of the corner point, so it is widely used in image processing. However, a fixed threshold value will also make the positioning accuracy is not satisfactory, easy to produce pseudo-response, or easy to lose the true corner point, the process of integration has also led to more time-consuming.III.Description of the Improved AlgorithmA. Corner Detection Based On Non-end LineUse the circular template in SUSAN algorithm ,in the circular template start a axle-box whose origin is the core, if the pixels at the axis positive direction are all located in the USAN outside, there is the pixels within the USAN in the negative direction, state the core as the end point at the direction of the axis ,state the axis as the end line of the core, otherwise state it as the non-end line, as shown in Fig. 2,is the end point at the direction of ,is the end line. Due to that there are no pixels at the negative direction of within the USAN, so is not the end point at the direction of ,is non-end line, as the same, is not the end point at the direction of , , , is non-end line ,is the end point at the direction of , but is not the end point at the direction of , is the end line, is the non-end line.By analysing of the fig.2, we can get the following laws: there are numerous end lines and non-end lines inner the circular template whose core is the corner point; there are numerous end lines inner the circular template whose core is the edge point; but there is only one non-end line, which is the axis down the direction of USAN area edge; there are numerous non-end lines, but there is no end line inner the circular template whose core is inner point. That is to say, the corner point has numerous end lines and non-end lines; the edge point has numerous end points, but there is only one non-end line; the inner point has numerous non-end line, but no end lines.Fig. 2 The end line and non-end line of the circular templateFig. 3 The corner inspection based on the number of the end linesAccording to the above rules, you can filter out some of the non-corner points by the way of judging the number of the end lines and non-end lines inner the circular mask, and generate an initial response of the corner points. In Fig. 3(a), eight straight lines which pass through the circle are distributed in the circular mask, it can be respectively stated as , it is the USAN area shown by the shaded area, Stated from the Fig., the number of the end lines and non-end lines are respectively five and three, according the above rules, we can judge O is the corner point . In actual detections, considering of a circular template including 37 pixels, shown in Fig.3(b), each edge pixel and the pixel on the symmetry of the core constitute a line straight passing through the core. for example, the two pixels numbered g constitute the straight line g-g, the same as Fig.3(a), all pixels were composed of eight straight lines. Using a circular template to scan the entire image, to calculate the number of the end lines and non-end lines in each template to produce a candidate corner points.In Fig. 3 (a) , the line constituted by two symmetrical edge pixels is (), the collection of the end lines within the round templates is and the collection of the non-end lines is , then the judging formula of the end line is: (4)In this formula, 、 respectively stands for the similarity values of the two symmetrical edge pixels with the core ,and is the non-end line rejection threshold. For easy to calculate, the definition of the degree of the end line is: (5)Then the number of end line within a circular template is: (6)So the initial response function of the corner point is: (7)In this formula, is the geometric threshold for restraining edge points.Only the relationship between the edge pixel and the core is considered in the introduction of the new algorithms, which will generate some pseudo-response at the corner points, a number of suppression methods should be adopted to filter, but based on that the calculation amount can be greatly reduced because of the edge points’ initial response, which makes it more applicable for real-time applications.B. Non-maxima Suppression Based on Non-end Line’s uniformity coefficientAs a result of adapting the similarity between the edge pixels and core to generate the initial response of the corner points, pseudo-response will be produced in a certain range near the corner, as shown in Fig. 4, in the circular template 1, A corner points can be got by, , in the circular template 2, B corner points can be got by, , apparently B is a pseudo-response. The following non-maxima suppression method based on the non-end line’s uniformity can be adopted to filter the false responses.Fig. 4 The uniformity degree of the non-end lineAccording to Section 3.1, non-end line has two forms, the one is the direction line which is not passing through the USAN area (assuming that a small neighbor area near the core of the USAN area is negligible), the other is the direction line which is passing through the USAN area but the two intersection with the circular template is located outside USAN area. If a non-end lines do not pass through USAN region, we call it is uniform, or else call it a non-uniform, and according to the length of the segment inner USAN area to define the degree of non-uniform, the longer is, the greater the degree of non-uniform is, shown in Fig. 4, the degree of non-uniform 、 is greater than 、(, is uniform), it is easy to prove, the degree of non-uniform at the corner point is the greatest, but the degree of non-uniform at the non-corner point is the smallest, so according to this feature, pseudo-response suppression can be operated.While actually use it, first use the judging formula of the end lines to get the non-end lines, then through calculating the length of the line segment in the USAN region to get the degree of non-uniform, suppose the degree of non-uniform of the non-end line as ,so (8) is the non-end line which is passing through the core of the circular template, thus, the degree of non-uniform of all the non-end lines that have passed through is :(9)represent all the non-end lines that passes through the core of the circular template. Finally, the non-maxima suppression function is as follows: (10) in this formula, is the geometric value of pseudo-response suppression, which determines the sharp degree of the output corner points.IV. Experimental VerificationTo test the effectiveness of the new algorithm, this paper compared the improved algorithm with the present algorithm in accuracy and computational complexity .First, through adopting artificial typical corner-point image to test, shown as Fig. 5, (a) is the initial image, (b)~(d) is the effective image which respectively adopted Harris algorithm, SUSAN algorithm and the improved algorithm, through analysing, Harris algorithm has positioning bias in some corner points, there is also a small amount of pseudo-response, while SUSAN and the improved algorithm has greater effect. (a) Initial image (b) Harris (c) SUSAN (d) Improved algorithmFig. 5 The detection results in artificial corner detection of the improved algorithm and the initial algorithmFig. 6 is the detection test results of the three kinds of algorithm in medical image, you can see, Harris has stronger ability to process actual image processing ,but has a large number of pseudo-response points and there are few undetected corner. SUSAN has not very good processing effect to process actual image and has a lot of pseudo-response points. The new algorithm also has a little pseudo-response points, but on the whole there is a better detection result than the SUSAN algorithm .TableⅠ shows the average detection rate of the three algorithms in a variety samples. (a) Initial image (b) Harris (c) SUSAN (d) Improved algorithmFig. 6 The test results of the improved algorithm and the initial algorithm in medical imageTABLEⅠTHE AVERAGE DETECTION RATE OF THE THERE ALGORITHMWe can know from the former analysis of the algorithm, the improved algorithm do the complex calculations only on the most likely place for the corner points, but do little calculations on the easily judge where is the non-corner points, and the new algorithm is not based on a very abstract theory, which makes that the improved algorithm simple and easy to understand, with low computational complexity. The author adapted a variety samples to add up the detection time of the three algorithm using own computer, shown in the TableⅡ, we can know, the detection time of the improved algorithm is significantly lower than other algorithm.TABLEⅡ THE AVERAGE DETECTION TIME OF THE THERE ALGORITHMV.ConclusionsIn order to improve detection speed, the improved algorithm uses a progressive layer by layer mechanism, the basic idea is: first, through the most simple calculation to exclude certain non-corner points, followed the possible areas for the corner point will be implement the more sophisticated detection algorithm, due to the proportion of the corner point in image is small, this mechanism greatly increased the detection rate. For the pre-processing of the exclusion of the non-corner point, this paper proposed a method based on the smallest circular template with small amount of calculation, and can retain all the characteristics of corner points. In the corner detection algorithm, using the number characteristics of the corner points’ end line, and according to the non-end lines’ uniformity coefficient to perform non-maxima suppression, experiments show that the improved algorithm is effective in the speed and accuracy of calculation is better than the SUSAN method .ReferencesVanden P, Evert Jan D P, Viergever M, ”Medical image matching-a review with classification,” IEEE Engineering in Medicine and Biology, vol.12, no.1, pp. 26-39, January 1993.Jianhui Hou, Yi Lin, ” Harris checkerboard corner detection algorithm with self-adapting,”Computer Engineering and Design, vol.30, no.20, pp.4741 -4743, October 2009Harris C, Stephens M. A Combined Corner and Edge Detector. In Proceedings of the 4thAlvey Vision Conference, pp. 147-151,1988.Smith S M, Brady M. SUSAN, ”A new approach to low level image processing,” International Journal of Computer Vision, vol.23, no.1, pp.45-48, January 1997.Peng Zhou, Yong Tan, Shoushi Xu, ”A new image registration algorithm based on the corner detection ,”College journal of China University of Science and Technology, vol. 32, no. 4, pp. 455-461, August 2002. Bo Li, Dan Yang, Xiaohong Zhang,”A new image registration algorithm based on Harris multi-scale corner detection , ”Computer Engineering and Applications, no. 35, pp. 37-40, December 2006.Gang Huashun,Yi Zeng ,”A new image dense registration algorithm based on corner detection ,” Computer Engineering and Design, vol. 28, no.5, pp. 1092-1095, March 2007.Haixia Guo, Kai Xie.,” An improved corner detection algorithm based on USAN,”Computer Engineering, vol. 33, no. 22, pp. 232-234, November 2007.

Abstract Background People with intellectual disabilities have been historically excluded from decision-making processes. Previous literature indicates that increasing social participation may be an effective way to address this exclusion, but no systematic review of interventions designed to increase social participation of people with intellectual disabilities have been conducted. This study aims to identify and organize the factors associated with interventions that increase the social participation of people with intellectual disabilities and to provide a set of best of practices for future interventions. Methods/design The databases Web of Science, Scopus, LILACS, and PubMed will be searched for articles from January 2004 onwards; grey literature search will be identified through searching additional databases (such as Google Scholar and EBSCO databases). Randomized controlled trials, nonrandomized controlled trials, and controlled pre–post studies will be included. Noncontrolled pre–post studies will also be included. Observational or qualitative studies will be excluded. The primary outcomes are measures of social participation. Secondary outcomes include measures of well-being, stigma, knowledge about rights, and advocacy processes. Two reviewers will independently screen articles, extract relevant data, and assess the quality of the studies. We will provide a meta-analysis of included studies if possible, or a quantitative narrative synthesis otherwise. Discussion This systematic review will add to our understanding of effective social participation interventions for people with intellectual disability. It will allow us to identify and organize which factors lead to an increase in social participation and help us define a set of best practices to be followed by future interventions. Systematic review registration PROSPERO CRD42020189093

The University of Groningen (UG) and the University Medical Centre Groningen (UMCG) have committed themselves to the Dutch National Open Science Plan. In addition, external research funders are increasingly demanding that research articles are published open access (e.g. through Plan S). In 2018, 50% of UG/UMCG-scientific articles were published open access. However, have we used all options for publishing open access in venues chosen by researchers, thereby maintaining the researchers’ quality standards, and reducing the costs as much as possible? The answer is "no." To maximize the open access uptake, while making the workflow as smooth as possible for researchers, the University Library and Central Medical Library have started an Open Access Services (OAS) project with the following objectives: Implementation of services for the provision of practical information and advice for researchers Establish communication channels to increase the overall visibility of open access services and to issue regular updates on changes and innovations in scholarly communication and open science; Provide information on available options, costs, copyright, licences, re-use rights and funders’ requirements, pre-funded open access deals and submission workflows; Establishment of expert networks for the provision of strategic information and advice: open access ambassadors (academic staff and/or research policy officers) within faculties to multiply and disseminate between the OAS project team and individual researchers, research committees and faculty boards; support staff (research policy officers, funding officers, financial controllers), e.g. to include open access budgeting in grant applications; open access experts to identify obstacles to publish open access, and advise to eliminate them and advocate for policy changes with regard to research evaluation practices. Establishment of an open access training programme for young researchers Create and implement a programme of regular presentations and tutorials for young researchers about publication strategies and open access; Development of optimal workflows for monitoring and registering open access uptake and expenditures Registration of open access expenditures, including cost of pre-funded deals, support for diamond OA initiatives, unnecessary paid APCs and reimbursed by funders (grant budgets). Identification of missed opportunities to publish open access using pre-funded read and publish deals and repair them retroactively whenever possible. Improvement of standards for the registration of open access publications in the university’s CRIS system. Organization of UG’s participation in the Taverne Amendment pilot project i.e. the implementation of Article 25fa of the Dutch Copyright Act. Provision of extra support for open access publishing services offered by the UG Press Professionalize and improve the publishing services offered, to support diamond open access initiatives, with special emphasis on the humanities and social sciences. We will present on the main outcomes of this project.

Abstract Background Biological changes underlying the sexual and reproductive maturation of school-age children are linked with various sexual and reproductive health and rights risks. SRHR risks are predictors of poor SRHR outcomes, such as poor knowledge of sexually transmitted diseases and early sexual initiation occurring predominantly among school-age children. The aim of this proposed review, therefore, is to identify educational interventions that have proven to be effective in promoting or supporting the sexual and reproductive health and rights of school-aged children in low- and middle-income countries. Methods A systematic review of studies on the strategies promoting the SRHR of school-aged children shall be conducted. Electronic searches will be conducted from January 2000 onwards on the following databases: MEDLINE(R) ALL (Ovid), Embase (Ovid), CINAHL (EBSCOHost), APA PsycInfo (Ovid), ERIC (Ovid), Cochrane Central Register of Controlled Trials (Ovid), Education Source (EBSCOHost), Web of Science (Clarivate Analytics), SciELO Citation Index (Clarivate Analytics), Global Health (Ovid), and Sociological Abstract (Proquest). Studies eligible for inclusion will be randomized control trials (RCTs), non-randomized trials, quasi-experimental studies (e.g., pre-post tests), and observational studies (cross-sectional and cohort studies). Peer-reviewed studies published in English and/or French and involving school-aged children 5–10 years old will be included. The primary outcomes of interest will include knowledge, awareness, or attitudes about SRHR topics. The secondary outcomes of interest will include sexual and reproductive behaviors. Two reviewers will independently screen all citations, abstract data, and full-text articles, and the methodological quality of each study will be appraised using JBI critical appraisal tools. A narrative synthesis of extracted data will be conducted. Discussion The systematic review will synthesize the evidence on existing educational interventions targeting SRHR outcomes of school-aged children in low- and middle-income countries. It will identify which interventions have proven to be effective, and which interventions have not proven to be effective in promoting or supporting their SRHR. Review findings will provide a useful reference for policy-makers, program developers, global health leaders, and decision makers who wish to support the SRHR of school-age children. Systematic review registration The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO CRD42020173158).

Abstract Background Child marriage is a human rights violation disproportionately impacting girls in low- and middle-income countries. In the Middle East region, conflict and displacement have prompted concerns that families are increasingly resorting to child marriage to cope with economic insecurity and fears from sexual violence. This study set out to examine child marriage among Syrian refugees residing in Egypt with the aim of understanding drivers of child marriage in this context of displacement as well as how child marriage affects refugee girls’ wellbeing. Methods This analysis draws from 15 focus group discussions (FGD) conducted with married and unmarried girls, as well as parents of adolescent girls in three governorates in Egypt. FGDs included a participatory ranking exercise and photo-elicitation. Additionally, we conducted 29 in-depth interviews with girls and mothers, as well as 28 key informant interviews with health providers, community leaders, and humanitarian actors. The data was thematically analyzed using a combination of inductive and deductive coding. Results A prevalent phenomenon in pre-war Syria, child marriage has been sustained after the influx of Syrian refugees into Egypt by pre-existing cultural traditions and gender norms that prioritize the role of girls as wives and mothers. However, displacement into Egypt engendered different responses. For some families, displacement-specific challenges such as disruptions to girls’ education, protection concerns, and livelihood insecurity were found to exacerbate girls’ vulnerability to child marriage. For others, however, displacement into urban areas in Egypt may have contributed to the erosion of social norms that favored child marriage, leading to marriage postponement. Among girls who were married early, we identified a range of negative health and social consequences, including lack of family planning use, disruption to schooling and curtailment of girls’ mobility as well as challenges with marriage and birth registration which accentuated their vulnerability. Conclusion Efforts to address child marriage among Syrian refugees must acknowledge the different ways in which displacement can influence child marriage attitudes and practices and should capitalize on positive changes that have the potential to catalyze social norm change. Moreover, targeted, focused and contextualized interventions should not only focus on preventing child marriage but also on mitigating its impacts.

Abstract Background Pasung is the term used in Indonesia and a number of other countries for seclusion and restraint of people with mental illness in the community, usually at home by their family. While pasung has been banned because it is contrary to human rights, its practice continues to exist within the community, particularly where community mental health services are limited, and in the absence of adequate social support, and pervasive negatives beliefs about mental illness. It is essential to understand the reasons for the ongoing use of pasung and to examine potential solutions. Methods A systematic review and narrative synthesis of peer-reviewed international literature was conducted to identify the socio-cultural contexts for pasung use, and interventions to address it. The analysis draws on the socio-ecological framework, which focused on relationships between the individual and their environment. Result Fifty published articles were included in the review; all studies were conducted in Asia and Africa, with 32 undertaken in Indonesia. Most studies were qualitative (n = 21). Others included one case–control study, one cross-sectional study, and seven surveys; only four studies examined the application of an intervention, and each used a pre and post methodology. Of these, two studies tested psychoeducational interventions which aimed to overcome family burden due to pasung, and each suggested a community mental health approach. The remaining two studies evaluated the intervention of ‘unlocking’; one study used a community-based culturally sensitive approach, and the other used a community-based rehabilitation program. Reasons for pasung given by family appear to be as a last resort and in the absence of other supports to help them care for the person with severe mental illness. Conclusion The findings highlight that a mixture of individual, interpersonal, community and policy interventions are needed to reduce the use of pasung. While consumer and carer involvement as part of a socio-ecological approach is understood to be effective in reducing pasung, an understanding of how to elaborate this in the management of pasung remains elusive. Review Registration CRD42020157543: CRD

Abstract Background Metabolic syndrome and its individual components lead to wide-ranging consequences, many of which affect the central nervous system. In this study, we compared the [18F]FDG regional brain metabolic pattern of participants with type 2 diabetes mellitus (T2DM) and non-DM obese individuals. Methods In our prospective study, 51 patients with controlled T2DM (ages 50.6 ± 8.0 years) and 45 non-DM obese participants (ages 52.0 ± 9.6 years) were enrolled. Glucose levels measured before PET/CT examination (pre-PET glucose) as well as laboratory parameters assessing glucose and lipid status were determined. NeuroQ application (NeuroQTM 3.6, Syntermed, Philips) was used to evaluate regional brain metabolic differences. [18F]FDG PET/CT (AnyScan PC, Mediso) scans, estimating brain metabolism, were transformed to MNI152 brain map after T1 registration and used for SPM-based group comparison of brain metabolism corrected for pre-PET glucose, and correlation analysis with laboratory parameters. Results NeuroQ analysis did not reveal significant regional metabolic defects in either group. Voxel-based group comparison revealed significantly (PFWE<0.05) decreased metabolism in the region of the precuneus and in the right superior frontal gyrus (rSFG) in the diabetic group as compared to the obese patients. Data analysis corrected for pre-PET glucose level showed a hypometabolic difference only in the rSFG in T2DM. Voxel-based correlation analysis showed significant negative correlation of the metabolism in the following brain regions with pre-PET glucose in diabetes: precuneus, left posterior orbital gyrus, right calcarine cortex and right orbital part of inferior frontal gyrus; whilst in the obese group only the right rolandic (pericentral) operculum proved to be sensitive to pre-PET glucose level. Conclusions To our knowledge, this is the first study to perform pre-PET glucose level corrected comparative analysis of brain metabolism in T2DM and obesity. We also examined the pre-PET glucose level dependency of regional cerebral metabolism in the two groups separately. Large-scale future studies are warranted to perform further correlation analysis with the aim of determining the effects of metabolic disturbances on brain metabolism.

Abstract Background Premenstrual syndrome (PMS) is a prevalent gynecological disease and is significantly associated with abnormal neural activity. Acupuncture is an effective treatment on PMS in clinical practice. However, few studies have been performed to investigate whether acupuncture might modulate the abnormal neural activity in patients with PMS. Thereby, the aim of the study was to assess alterations of the brain activity induced by acupuncture stimulation in PMS patients. Methods Twenty PMS patients were enrolled in this study. All patients received a 6-min resting-state functional magnetic resonance imaging (rs-fMRI) scan before and after electro-acupuncturing stimulation (EAS) at Sanyinjiao (SP6) acupoint in the late luteal phase of menstrual. Fractional amplitude of low-frequency fluctuation (fALFF) method was applied to examine the EAS-related brain changes in PMS patients. Results Compared with pre-EAS at SP6, increased fALFF value in several brain regions induced by SP6, including brainstem, right thalamus, bilateral insula, right paracentral lobule, bilateral cerebellum, meanwhile, decreased fALFF in the left cuneus, right precuneus, left inferior temporal cortex. Conclusions Our findings provide imaging evidence to support that SP6-related acupuncture stimulation may modulate the neural activity in patients with PMS. This study may partly interpret the neural mechanisms of acupuncture at SP6 which is used to treat PMS patients in clinical. Trial registration: The study was registered on http://www.chictr.org.cn. The Clinical Trial Registration Number is ChiCTR-OPC-15005918, registry in 29/01/2015.

Property as both an idea and a practice has been interpreted through the prism of a liberal, law and economics paradigm since at least the 18th century. This dominant (and domineering) perspective stresses the primacy of individualism, the power of exclusion, and the values of private commodity. By contrast, concepts of property that evolved out of the counterculture of the 1960s and early 1970s challenged this hegemony. Countercultural, or Aquarian, ideas of property stressed pre-liberal, long forgotten property norms such as sociability, community, inclusion and personhood, and contested a private uniformity that seemed “totalizing and universalizing” (Blomley, Unsettling 102). This paper situates what it terms “Aquarian property” in the context of emergent property theory in the 1960s and 1970s, and the propertied practices these new theories engendered. Importantly, this paper also grounds Aquarian ideas of property to location. As legal geographers observe, the law inexorably occurs in place as well as time. “Nearly every aspect of law is located, takes place, is in motion, or has some spatial frame of reference” (Braverman et al. 1). Property’s radical yet simultaneously ancient alter-narrative found fertile soil where the countercultural experiment flourished. In Australia, one such place was the green, sub-tropical landscape of the New South Wales Northern Rivers, home of the 1973 Australian Union of Student’s Aquarius Festival at Nimbin. The Counterculture and Property Theory Well before the “Age of Aquarius” entered western youth consciousness (Munro-Clark 56), and 19 years before the Nimbin Aquarius Festival, US legal scholar Felix Cohen defined property in seminally private and exclusionary terms. To the world: Keep off X unless you have my permission, which I may grant or withhold.Signed: Private citizenEndorsed: The state. (374) Cohen’s formula was private property at its 1950s apogee, an unambiguous expression of its centrality to post-war materialism. William Blackstone’s famous trope of property as “that sole and despotic dominion” had become self-fulfilling (Rose, Canons). Why had this occurred? What had made property so narrow and instrumentalist to a private end? Several property theorists identify the enclosure period in the 17th and 18th centuries as seminal to this change (Blomley, Law; Graham). The enclosures, and their discourse of improvement and modernity, saw ancient common rights swept away in favour of the liberal private right. Property diversity was supplanted by monotony, group rights by the individual, and inclusion by exclusion. Common property rights were rights of shared use, traditionally agrarian incidents enjoyed through community membership. However, for the proponents of enclosure, common rights stood in the way of progress. Thus, what was once a vested right (such as the common right to glean) became a “mere practice”, condemned by its “universal promiscuity” and perceptions of vagrancy (Buck 17-8). What was once sited to context, to village and parish, evolved into abstraction. And what had meaning for person and place, “a sense of self; […] a part of a tribe’ (Neeson 180), became a tradable commodity, detached and indifferent to the consequences of its adverse use (Leopold). These were the transformed ideas of property exported to so-called “settler” societies, where colonialists demanded the secure property rights denied to them at home. In the common law tradition, a very modern yet selective amnesia took hold, a collective forgetting of property’s shared and sociable past (McLaren). Yet, property as commodity proved to be a narrow, one-sided account of property, an unsatisfactory “half right” explanation (Alexander 2) that omits inconvenient links between ownership on the one hand, and self and place on the other. Pioneering US conservationist Aldo Leopold detected as much a few years before Felix Cohen’s defining statement of private dominance. In Leopold’s iconic A Sand County Almanac, he wrote presciently of the curious phenomenon of hardheaded farmers replanting selected paddocks with native wildflowers. As if foreseeing what the next few decades may bring, Leopold describes a growing resistance to the dominant property paradigm: I call it Revolt – revolt against the tedium of the merely economic attitude towards land. We assume that because we had to subjugate the land to live on it, the best farm is therefore the one most completely tamed. These […] farmers have learned from experience that the wholly tamed farm offers not only a slender livelihood but a constricted life. (188)By the early 1960s, frustrations over the constrictions of post-war life were given voice in dissenting property literature. Affirming that property is a social institution, emerging ideas of property conformed to the contours of changing values (Singer), and the countercultural zeitgeist sweeping America’s universities (Miller). Thus, in 1964, Charles Reich saw property as the vanguard for a new civic compact, an ambitious “New Property” that would transform “government largess” into a property right to address social inequity. For Joseph Sax, property scholar and author of a groundbreaking citizen’s manifesto, the assertion of public property rights were critical to the protection of the environment (174). And in 1972, to Christopher Stone, it seemed a natural property incident that trees should enjoy equivalent standing to legal persons. In an age when “progress” was measured by the installation of plastic trees in Los Angeles median strips (Tribe), jurists aspired to new ideas of property with social justice and environmental resonance. Theirs was a scholarly “Revolt” against the tedium of property as commodity, an act of resistance to the centuries-old conformity of the enclosures (Blomley, Law). Aquarian Theory in Propertied Practice Imagining new property ideas in theory yielded in practice a diverse Aquarian tenure. In the emerging communes and intentional communities of the late 1960s and early 1970s, common property norms were unwittingly absorbed into their ethos and legal structure (Zablocki; Page). As a “way out of a dead-end future” (Smith and Crossley), a generation of young, mostly university-educated people sought new ways to relate to land. Yet, as Benjamin Zablocki observed at the time, “there is surprisingly little awareness among present-day communitarians of their historical forebears” (43). The alchemy that was property and the counterculture was given form and substance by place, time, geography, climate, culture, and social history. Unlike the dominant private paradigm that was placeless and universal, the tenurial experiments of the counter-culture were contextual and diverse. Hence, to generalise is to invite the problematic. Nonetheless, three broad themes of Aquarian property are discernible. First, property ceased being a vehicle for the acquisition of private wealth; rather it invested self-meaning within a communitarian context, “a sense of self [as] a part of a tribe.” Second, the “back to the land” movement signified a return to the country, an interregnum in the otherwise unidirectional post-enclosure drift to the city. Third, Aquarian property was premised on obligation, recognising that ownership was more than a bundle of autonomous rights, but rights imbricated with a corresponding duty to land health. Like common property and its practices of sustained yield, Aquarian owners were environmental stewards, with inter-connected responsibilities to others and the earth (Page). The counterculture was a journey in self-fulfillment, a search for personal identity amidst the empowerment of community. Property’s role in the counterculture was to affirm the under-regarded notion of property as propriety; where ownership fostered well lived and capacious lives in flourishing communities (Alexander). As Margaret Munro-Clark observed of the early 1970s, “the enrichment of individual identity or selfhood [is] the distinguishing mark of the current wave of communitarianism” (33). Or, as another 1970s settler remarked twenty years later, “our ownership means that we can’t liquefy our assets and move on with any appreciable amount of capital. This arrangement has many advantages; we don’t waste time wondering if we would be better off living somewhere else, so we have commitment to place and community” (Metcalf 52). In personhood terms, property became “who we are, how we live” (Lismore Regional Gallery), not a measure of commoditised worth. Personhood also took legal form, manifested in early title-holding structures, where consensus-based co-operatives (in which capital gain was precluded) were favoured ideologically over the capitalist, majority-rules corporation (Munro-Clark). As noted, Aquarian property was also predominantly rural. For many communitarians, the way out of a soulless urban life was to abandon its difficulties for the yearnings of a simpler rural idyll (Smith and Crossley). The 1970s saw an extraordinary return to the physicality of land, measured by a willingness to get “earth under the nails” (Farran). In Australia, communities proliferated on the NSW Northern Rivers, in Western Australia’s southwest, and in the rural hinterlands behind Queensland’s Sunshine Coast and Cairns. In New Zealand, intentional communities appeared on the rural Coromandel Peninsula, east of Auckland, and in the Golden Bay region on the remote northwestern tip of the South Island. In all these localities, land was plentiful, the climate seemed sunny, and the landscape soulful. Aquarians “bought cheap land in beautiful places in which to opt out and live a simpler life [...] in remote backwaters, up mountains, in steep valleys, or on the shorelines of wild coastal districts” (Sargisson and Sargent 117). Their “hard won freedom” was to escape from city life, suffused by a belief that “the city is hardly needed, life should spring out of the country” (Jones and Baker 5). Aquarian property likewise instilled environmental ethics into the notion of land ownership. Michael Metzger, writing in 1975 in the barely minted Ecology Law Quarterly, observed that humankind had forgotten three basic ecological laws, that “everything is connected to everything else”, that “everything must go somewhere”, and that “nature knows best” (797). With an ever-increasing focus on abstraction, the language of private property: enabled us to create separate realities, and to remove ourselves from the natural world in which we live to a cerebral world of our own creation. When we act in accord with our artificial world, the disastrous impact of our fantasies upon the natural world in which we live is ignored. (796)By contrast, Aquarian property was intrinsically contextual. It revolved around the owner as environmental steward, whose duty it was “to repair the ravages of previous land use battles, and to live in accord with the natural environment” (Aquarian Archives). Reflecting ancient common rights, Aquarian property rights internalised norms of prudence, proportionality and moderation of resource use (Rose, Futures). Simply, an ecological view of land ownership was necessary for survival. As Dr. Moss Cass, the Federal environment minister wrote in the preface to The Way Out: Radical Alternatives in Australia, ‘”there is a common conviction that something is rotten at the core of conventional human existence.” Across the Tasman, the sense of latent environmental crisis was equally palpable, “we are surrounded by glistening surfaces and rotten centres” (Jones and Baker 5). Property and Countercultural Place and Time In the emerging discipline of legal geography, the law and its institutions (such as property) are explained through the prism of spatiotemporal context. What even more recent law and geography scholarship argues is that space is privileged as “theoretically interesting” while “temporality is reduced to empirical history” (Braverman et al. 53). This part seeks to consider the intersection of property, the counterculture, and time and place without privileging either the spatial or temporal dimensions. It considers simply the place of Nimbin, New South Wales, in early May 1973, and how property conformed to the exigencies of both. Legal geographers also see property through the theory of performance. Through this view, property is a “relational effect, not a prior ground, that is brought into being by the very act of performance” (Blomley, Performing 13). In other words, doing does not merely describe or represent property, but it enacts, such that property becomes a reality through its performance. In short, property is because it does. Performance theory is liberating (Page et al) because it concentrates not on property’s arcane rules and doctrines, nor on the legal geographer’s alleged privileging of place over time, but on its simple doing. Thus, Nicholas Blomley sees private property as a series of constant and reiterative performances: paying rates, building fences, registering titles, and so on. Adopting this approach, Aquarian property is described as a series of performances, seen through the prism of the legal practitioner, and its countercultural participants. The intersection of counterculture and property law implicated my family in its performative narrative. My father had been a solicitor in Nimbin since 1948; his modest legal practice was conducted from the side annexe of the School of Arts. Equipped with a battered leather briefcase and a trusty portable typewriter, like clockwork, he drove the 20 miles from Lismore to Nimbin every Saturday morning. I often accompanied him on his weekly visits. Forty-one years ago, in early May 1973, we drove into town to an extraordinary sight. Seen through ten-year old eyes, surreal scenes of energy, colour, and longhaired, bare-footed young people remain vivid. At almost the exact halfway point in my father’s legal career, new ways of thinking about property rushed headlong and irrevocably into his working life. After May 1973, dinnertime conversations became very different. Gone was the mundane monopoly of mortgages, subdivisions, and cottage conveyancing. The topics now ranged to hippies, communes, co-operatives and shared ownerships. Property was no longer a dull transactional monochrome, a lifeless file bound in pink legal tape. It became an idea replete with diversity and innovation, a concept populated with interesting characters and entertaining, often quirky stories. If property is a narrative (Rose, Persuasion), then the micro-story of property on the NSW Northern Rivers became infinitely more compelling and interesting in the years after Aquarius. For the practitioner, Aquarian property involved new practices and skills: the registration of co-operatives, the drafting of shareholder deeds that regulated the use of common lands, the settling of idealistic trusts, and the ever-increasing frequency of visits to the Nimbin School of Arts every working Saturday. For the 1970s settler in Nimbin, performing Aquarian property took more direct and lived forms. It may have started by reading the open letter that festival co-organiser Graeme Dunstan wrote to the Federal Minister for Urban Affairs, Tom Uren, inviting him to Nimbin as a “holiday rather than a political duty”, and seeking his support for “a community group of 100-200 people to hold a lease dedicated to building a self-sufficient community [...] whose central design principles are creative living and ecological survival” (1). It lay in the performances at the Festival’s Learning Exchange, where ideas of philosophy, organic farming, alternative technology, and law reform were debated in free and unstructured form, the key topics of the latter being abortion and land. And as the Festival came to its conclusion, it was the gathering at the showground, titled “After Nimbin What?—How will the social and environmental experiment at Nimbin effect the setting up of alternative communities, not only in the North Coast, but generally in Australia” (Richmond River Historical Society). In the days and months after Aquarius, it was the founding of new communities such as Co-ordination Co-operative at Tuntable Creek, described by co-founder Terry McGee in 1973 as “a radical experiment in a new way of life. The people who join us […] have to be prepared to jump off the cliff with the certainty that when they get to the bottom, they will be all right” (Munro-Clark 126; Cock 121). The image of jumping off a cliff is a metaphorical performance that supposes a leap into the unknown. While orthodox concepts of property in land were left behind, discarded at the top, the Aquarian leap was not so much into the unknown, but the long forgotten. The success of those communities that survived lay in the innovative and adaptive ways in which common forms of property fitted into registered land title, a system otherwise premised on individual ownership. Achieved through the use of outside private shells—title-holding co-operatives or companies (Page)—inside the shell, the norms and practices of common property were inclusively facilitated and performed (McLaren; Rose, Futures). In 2014, the performance of Aquarian property endures, in the dozens of intentional communities in the Nimbin environs that remain a witness to the zeal and spirit of the times and its countercultural ideals. Conclusion The Aquarian idea of property had profound meaning for self, community, and the environment. It was simultaneously new and old, radical as well as ancient. It re-invented a pre-liberal, pre-enclosure idea of property. For property theory, its legacy is its imaginings of diversity, the idea that property can take pluralistic forms and assert multiple values, a defiant challenge to the dominant paradigm. Aquarian property offers rich pickings compared to the pauperised private monotone. Over 41 years ago, in the legal geography that was Nimbin, New South Wales, the imaginings of property escaped the conformity of enclosure. The Aquarian age represented a moment in “thickened time” (Braverman et al 53), when dissenting theory became practice, and the idea of property indelibly changed for a handful of serendipitous actors, the unscripted performers of a countercultural narrative faithful to its time and place. References Alexander, Gregory. Commodity & Propriety: Competing Visions of Property in American Legal Thought 1776-1970. Chicago: U of Chicago P, 1999. Aquarian Archives. "Report into Facilitation of a Rural Intentional Community." Lismore, NSW: Southern Cross University. Blomley, Nicholas. Law, Space, and the Geographies of Power. New York: Guildford Press, 1994. Blomley, Nicholas. Unsettling the City: Urban Land and the Politics of Property. New York: Routledge, 2004. 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Abstract Background Heart failure with preserved ejection fraction (HFpEF) is frequently complicated by pulmonary hypertension (PH). A pulmonary vascular contribution could be considered as a substantial therapeutic target in HFpEF and PH and combined pre- and postcapillary PH (Cpc-PH). Methods We enrolled 50 patients with HFpEF and Cpc-PH who were determined by echocardiography to have pulmonary artery systolic pressure (PASP) > 40 mmHg, pulmonary vascular resistance > 3 Wood units, and/or transpulmonary gradient > 15 mmHg. Results The patients were assigned to the phosphodiesterase 5 (PDE5) inhibitor sildenafil group (25 mg TID for 3 months followed by 50 mg TID for 3 months; n = 30) or the control group (n = 20). In the sildenafil group after 6 months, the 6-min walk distance increased by 50 m (95% CI, 36 to 64 m); substantial improvement in NYHA functional class and exercise capacity during diastolic stress test were revealed; decreases in early mitral inflow to mitral annulus relaxation velocities ratio by 2.4 (95% CI, − 3.3 to − 1.4) and PASP by 17.0 mmHg (95% CI, 20.4 to 13.5) were observed; right ventricular systolic function (M-mode tricuspid annular plane systolic excursion) increased by 0.42 cm (95% CI, 0.32 to 0.52 cm; P < 0.01 for all). No changes occurred in the control group. Conclusions In a subset of patients with HFpEF and Cpc-PH assessed by echocardiography, PDE5 inhibition was associated with an improvement in exercise capacity, pulmonary haemodynamic parameters, and right ventricular function. The role of sildenafil needs to be considered in randomized trials in selected patients with HFpEF with invasively confirmed Cpc-PH. Trial registration Russian National Information System of Research, Development and Technology Data of Civilian Usage (NIS, https://rosrid.ru), registration number 01201257849. Registered 20 April 2012. This manuscript adheres to the CONSORT guidelines.

Background: Researches have recently shifted from functional/structural imaging studies to functional connectivity (FC) studies in major depressive disorder (MDD). We aimed to compare treatment response of two treatment groups before and after treatment, in terms of both with psychiatric evaluation scales and resting-state functional connectivity (RSFC) changes in order to objectively demonstrate the possible contribution of the non-dominant hand-writing exercise (NHE) effect on depression treatment.Methods: A total of 26 patients who were right-handed women with similar sociodemographic characteristics were enrolled. Their pre-treatment resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychiatric tests were recorded, and then, patients were divided into two groups randomly. A standard treatment (ST) (fix sertraline 50 mg/day) was given to both groups. One randomly selected group was given the NHE in addition to the ST. After 8 weeks of treatment, all patients were reevaluated with rs-fMRI and neuropsychiatric tests. Pre- and post-treatment FC changes within the groups and post-treatment connectivity changes between groups were evaluated.Results: Post-treatment neuropsychiatric tests were significantly different in both groups. Post-treatment, two brain regions' connectivity changed in the ST group, whereas 10 brain regions' connectivity changed significantly in the ST + NHE group. When treatment groups were compared with each other after the treatment, the FC of 13 regions changed in the ST + NHE group compared to the ST group (p-unc/p-PFD &lt;0.05). The density of connectivity changes in the frontal and limbic regions, especially connectivities shown to change in depression treatment, in the ST + NHE group indicates a positive contribution to depression treatment, which is also supported by neuropsychiatric scale changes.Conclusion: NHE, which we developed with inspiration from the Eye Movement Desensitization and Reprocessing (EMDR) method, showed significantly more connecitivity changes related with MDD treatment. Beyond offering a new additional treatment method, our study will also contribute to the current literature with our efforts to evaluate all brain regions and networks that may be related to MDD and its treatment together, without being limited to a few regions.Trial Registration: The rs-fMRI and treatment registers were recorded in the BizMed system, which is the patient registration system of Bezmialem Vakif University Medicine Faculty, under the BAP support project approval code and the registration number 3.2018/8.

Abstract Background Left hemispatial neglect (LHN) is a neuropsychological syndrome often associated with right hemispheric stroke. Patients with LHN have difficulties in attending, responding, and consciously representing the right side of space. Various rehabilitation protocols have been proposed to reduce clinical symptoms related to LHN, using cognitive treatments, or on non-invasive brain stimulation. However, evidence of their benefit is still lacking; in particular, only a few studies focused on the efficacy of combining different approaches in the same patient. Methods In the present study, we present the SMART ATLAS trial (Stimolazione MAgnetica Ripetitiva Transcranica nell’ATtenzione LAteralizzata dopo Stroke), a multicenter, randomized, controlled trial with pre-test (baseline), post-test, and 12 weeks follow-up assessments based on a novel rehabilitation protocol based on the combination of brain stimulation and standard cognitive treatment. In particular, we will compare the efficacy of inhibitory repetitive-transcranial magnetic stimulation (r-TMS), applied over the left intact parietal cortex of LHN patients, followed by visual scanning treatment, in comparison with a placebo stimulation (SHAM control) followed by the same visual scanning treatment, on visuospatial symptoms and neurophysiological parameters of LHN in a population of stroke patients. Discussion Our trial results may provide scientific evidence of a new, relatively low-cost rehabilitation protocol for the treatment of LHN. Trial registration ClinicalTrials.gov NCT04080999. Registered on September 2019.

Background: Current mapping systems use simultaneous displays of overlapping 3D maps and pre-acquired CT images of the LA to “pseudo-register” data sets rather than specifically “register” each point of one mapping data set to the other. The appropriateness of the 2 data set match has not been validated. Since significant surface to surface mismatch errors may occur, this study was undertaken to quanititatively validate NavX map to CT registration and determine its suitability for guiding AF ablation. Methods: Sixty-four slice, multidetector CT scans were acquired in 8 dogs and segmented to establish subject-specific LA/PV volumes for importation into the EnSite mapping system. A detailed multi-surface geometry (NavX map) was collected by navigating a mapping catheter in target LA and PVs. Using a novel developmental registration algorithm the map was registered to LA/PV CT volume. Validation was performed using the registered 3D CT model for the guidance of ablation at the location of multiple implanted radio-opaque markers. Results: A total of 39 radio-opaque markers were implanted before CT including 9 LSPV, 8 RSPV, 7 RIPV, 9 LIPV, 3 roof, and 3 LAA locations. Subsequent registration of individual NavX maps to acquired 3D CT volume was successfully completed in all animals. RF ablations were performed at the predicted 3D registered model locations of the radio-opaque markers using 5 mm tip RF ablation catheter. Resulting mean lesion size was 5.3 x 6.5 mm. The lesions enveloped the point of marker attachment to the myocardium in 31/36 (86%) ablations. The average distance from the center of the RF lesion to the targeted site was 2.5 ± 1.5mm. 47 points were successfully navigated under fluorscopic and ICE guidance. All points were accurately portrayed on the 3D registered model. 3 points in the region of the RSPV floor did have minor offsets on the model due to technically difficult segmentation of the RSPV from the right pulmonary artery. Conclusion: These data demonstrate the feasibility of registering NavX derived geometries to CT data sets accommodating sources of cardiac, respiratory, and translational cycle dependent error. Catheter navigation precisely conducted using the registered model demonstrates accuracy within the range required for RF ablation.

Background: Angiographic detection of thrombus in STEMI is associated with adverse outcomes. However, routine thrombus aspiration failed to demonstrate the anticipated benefit. Hence, management of high coronary thrombus burden remains challenging. We sought to assess for the first time extracted thrombotic material characteristics utilizing micro-computed tomography (micro-CT).Methods: One hundred thirteen STEMI patients undergoing thrombus aspiration were enrolled. Micro-CT was undertaken to quantify retrieved thrombus volume, surface, and density. Correlation of these indices with angiographic and electrocardiographic outcomes was performed.Results: Mean aspirated thrombus volume, surface, and density (±standard deviation) were 15.71 ± 20.10 mm3, 302.89 ± 692.54 mm2, and 3139.04 ± 901.88 Hounsfield units, respectively. Aspirated volume and surface were significantly higher (p &lt; 0.001) in patients with higher angiographic thrombus burden. After multivariable analysis, independent predictors for thrombus volume were reference vessel diameter (RVD) (p = 0.011), right coronary artery (RCA) (p = 0.039), and smoking (p = 0.027), whereas RVD (p = 0.018) and RCA (p = 0.019) were predictive for thrombus surface. Thrombus volume and surface were independently associated with distal embolization (p = 0.007 and p = 0.028, respectively), no-reflow phenomenon (p = 0.002 and p = 0.006, respectively), and angiographically evident residual thrombus (p = 0.007 and p = 0.002, respectively). Higher thrombus density was correlated with worse pre-procedural TIMI flow (p &lt; 0.001). Patients with higher aspirated volume and surface developed less ST resolution (p = 0.042 and p = 0.023, respectively).Conclusions: Angiographic outcomes linked with worse prognosis were more frequent among patients with larger extracted thrombus. Despite retrieving larger thrombus load in these patients, current thrombectomy devices fail to deal with thrombotic material adequately. Further studies of novel thrombus aspiration technologies are warranted to improve patient outcomes.Clinical Trial Registration: QUEST-STEMI trial ClinicalTrials.gov number: NCT03429608 Date of registration: February 12, 2018. The study was prospectively registered.

Abstract Background This study aimed to investigate the relationship between stiffness of the bicep brachii muscle (BBM) and distal bicep tendon (DBT) and effects of weight lifting (pre- to post-workout changes) among groups with different body mass indexes (BMI). Methods Participants were divided into four groups according to BMI: A, underweight (< 18.5 kg/m2); B, normal (18.5–24.9 kg/m2); C, overweight (25.0–29.9 kg/m2); and D, obese (> 30.0 kg/m2). All participants were males who were untrained and had sedentary lifestyle without involvement in sports activities for the past 12 months. Ultrasonographic measurements to determine muscle and tendon stiffness was performed on the dominant side (i.e., right side) of the upper extremities in all participants. Results Twenty-one healthy and untrained males volunteered to participate in this study; 14 were nonsmokers and 7 were smokers. The mean age and BMI were 22.5 ± 1.5 years and 23.8 ± 6.3 kg/m2, respectively. Groups A, B, C, and D had four, ten, four, and three participants, respectively. The BBM thickness did not increase with increase in BMI and was not significantly different (P > .05) between groups. The BBM stiffness was significantly different (all P < .05) from pre- to post-workout values in all groups, whereas DBT stiffness did not follow the same trend. Conclusions Our study revealed that the BBM thickness is independent of BMI. After weight lifting, BBM stiffness in groups A and B increased for BBM compared to those in groups C and D. A similar trend was also recorded for DBT. Weight lifting in concentric and eccentric motions affects the stiffness of the BBM and DBT, thus weight lifting plays a role in adjusting the stiffness of the BBM and DBT. Trial registration The study was approved by ethics committee of the College of Applied Medical Sciences (CAMS 080-3839; March 14, 2018).