Artykuły w czasopismach na temat „2018 a-849”

Directives 2015/849 and 2018/843 on money laundering require continuous adaptations of the legal framework to respond to threats of the use of new technologies in money laundering. Directive 2018/843 extends the scope of Directive 2015/849 to ‘providers engaged in exchange services between virtual currencies and fiat currencies, as well as custodian wallet providers’. Undoubtedly, the new payment systems facilitate money launderers’ criminal activity. These systems are better than cash for moving large sums of money, non-face to face business relationships favour the use of straw buyers and false identities, the absence of credit risk, as there is usually a prepaid option, discourages service providers from obtaining complete and accurate customer information, and the nature of the trade and the speed of transactions make it difficult to control property or freezing. However, the development of technologies, including the Internet, has unquestionable advantages involved and even provides, through online resources, verification of identity or other duty of surveillance for the prevention of money laundering. In addition, the reform of June 22, 2010 introduced in Spain the criminal liability of legal persons and incorporated money laundering, together with other crimes, to this innovative model of criminal responsibility. Soon after, Organic Law 1/2015, of March 30, modified the hitherto barely applied regulation. In conclusion, the use of dummy corporations for money laundering is frequent, as is evidenced by the judgements of the Supreme Court of June 26, 2012 and February 4, 2015, but until recently the accessory consequences and the doctrine of piercing the corporate veil were sufficient.

Directives 2015/849, and 2018/843 on Money Laundering require continuous adaptations of the legal framework to respond to threats of the use of new technologies in money laundering. Directive 2018/843 extends the scope of Directive 2015/849 to providers engaged in exchange services between virtual currencies and fiat currencies as well as custodian wallet providers. Undoubtedly, the new payment systems facilitate money launderers’ criminal activity. These systems are better than cash for moving large sums of money, non-face to face business relationships favour the use of straw buyers, and false identities, the absence of credit risk, as there is usually a prepaid payment, discourages service providers from obtaining a complete, and accurate customer information, and the nature of the trade, and the speed of transactions make it difficult to control property or freezing. However, the development of technologies, including the internet, has unquestionable advantages involved and even provides, through online resources, verification of identity, or other duty of surveillance, for the prevention of money laundering. In addition, the reform of June 22, 2010 introduced in Spain the criminal liability of legal persons, and incorporated money laundering together with other crimes to this innovative model of criminal responsibility. Soon after, Organic Law 1/2015, of March 30, modified the hereto barely applied regulation. Itis quite surprising that Organic Law 1/2015 boasts of making a technical improvement, as it incurs obvious contradictions by exempting criminal liability to legal persons for a money laundering, that should not have existed due to the adoptionand effective execution of suitable or adequate compliance programs to prevent it, as well as taking into account to limit the punishment non-serious breaches of supervisory, monitoring, and control duties, when letter b) of the first paragraph of article 31 bis only takes into consideration serious breaches of those duties. Already in 2010, in order to introduce the criminal liability of legal persons, the Spanish Legislator invoked the alleged need to comply with international commitments. However, this model of responsibility was not mandatory, because international agreements normally only require effective, proportionate, and dissuasive sanctions. In addition, managers and executives, who have not adopted an effective compliance program, will be held liable together with the company, given that now all act as police officers. In conclusion, the use of dummy corporations for money laundering is frequent, as it is evidenced by the judgments of theSupreme Court of June 26, 2012, and February 4, 2015, but until recently, the accessory consequences and the doctrine of piercing the corporate veil were sufficient.

The first article in the series describing changes in the perception of terrorist threats across the European Union focuses on illustrating the new approach of the European Union, consisting primarily in rejecting the division into physical and cyber threats and recognizing the role of private entities in preventive actions and noticing the problem of radicalization to a greater extent. In addition, strategic documents adopted at the EU level were presented in a broader context. Finally, the most important solutions resulting from the adoption of Directive 2017/541 on combating terrorism were analyzed. In the second part, the reader’s attention will focus on the issue of combating, preventing and eliminating the possibility of financing terrorism. In addition to indicating the main solutions at the EU’s level (Directive 2015/849 and 2018/843), the results of their implementation into the national legal order were also indicated.

Abstract Directive (EU) 2015/849, known as the “4th AML Directive”, introduced an obligation on all EU Member States to create and maintain registers of the beneficial owners of their companies and trusts. Prior to such measures coming into force in most member states, Directive (EU) 2018/843, known as the “5th AML Directive”, further introduced some significant changes to the functioning of such registers and, in particular, to the access to their information. This article considers the impact of the rules introduced under the 5th AML Directive on private foundations. After a brief analysis of the relevant provisions in the Directive, it focuses on three member states in particular: Austria, Malta, and Belgium.

We utilised social media listening (SML) to obtain patients' perspectives on symptoms, diagnosis and comorbidities associated with chronic obstructive pulmonary disease (COPD) and its impact on patients' quality of life (QoL).A comprehensive search on social media platforms was performed for English language content posted between July 2016 and January 2018 using COPD-related terms. Social Studio, a social media data aggregator tool, was used to capture relevant records. The content was manually curated to analyse and map psychological aspects with descriptive statistics applied on aggregated findings.A total of 849 posts from patients or caregivers (“patient insights”) were considered for the analysis, corresponding to postings of 695 unique individuals. Based on 734 mentions of symptoms from 849 posts by potential patients/caregivers, cough (27%), mucus (25%) and shortness of breath (21%) were the most frequent; analysis by perceived COPD severity indicated these to be common across all severities. Difficulty in mucus clearance (24% of 268 mentions) and sadness (40% of 129 mentions) were top among the aspects impacting physical and emotional QoL, respectively.SML from patients with COPD indicated that relief from cough, mucus production and shortness of breath would be the most desirable aspects of disease management from a patient's perspective.

Background: Cataract is generally caused due to physical aging, but in some cases, there are chances that it may develop in early ages (Pre-senile cataract). Pre-senile cataract is believed not to be primary in nature and some underlying ocular/systemic/environmental factor is causing the lens opacification at an early age. This study aim was to determine frequency and risk factors of pre-senile cataract in our populationMethods: this observational study at Outdoor Patient - Eye in Benazir Bhutto Hospital, Rawalpindi (BBH), for the period from December 2017 to June 2018. Cataract was diagnosed on slit lamp examination. Detail history, Ocular and systemic examination was done for all pre-senile cataract cases. Laboratory/radiological investigations were performed when and where required. Using the Excel spreadsheet, Statistical analysis of descriptive data was carried out.Results: A total of 11448 patients were examined, whereby cataract was found in 849 (7.41%) patients. Out of these 849, 165 (19.43%) cases were pre-senile cataract. Pre-senile cataract was most seen in age group 30-49 86 (52.13%) and among women 93 (56.36%). The identified causes were idiopathic 55 (33.3%), diabetes 45(27.3%) and Steroids and other drugs related 33 (20.0%). posterior sub-capsular cataract is 60(36.36%) was most identified type in the study among pre-senile cataract.

This publication consists of two parts: The first part concerns new challenges, which financial institutions will have to meet on the basis of the new act on counteracting money laundering and financing of terrorism (Dz.U. 2018, item 723), which came into force on 13 July 2018 and implement the provisions of Directive of the European Parliament and of the Council (EU) 2015/849 of 20 May 2015 to the Polish legal system. and introduces revised Financial Task Force (FATF) recommendations. The changes are aimed to increasing the effectiveness of the national system of counteracting money laundering and financing of terrorism and will have a significant impact on the functioning of the Polish financial institutions. The second part focuses on presenting long-term challenges in the area of AML (Anti-Money Laundering) / FTR (Financial Transaction Report) that will be faced by Polish financial institutions. The research problem is the question, which legal challenges will appear for the Polish institutions at the time of entry into force of the Act of 1 March 2018 on counteracting money laundering and financing of terrorism and what new challenges will face the legislator (and not only legislator) in the further future.

Purpose This paper aims to focus on the role of reporting entities, e.g. banks, other financial institutions, legal professionals, in the prevention of criminal offenses connected with money laundering in Croatia and Slovenia. Design/methodology/approach The methodology of the economic analysis of law is used to analyze the effectiveness of laws in Croatia and Slovenia regarding the definition and the role of reporting entities in money laundering prevention in these two countries. A comparative approach is also used as the authors compare the effectiveness of Slovenian and Croatian legal systems and their compatibility with EC Directive (2015/849). Findings The authors find that banks have long clinged to the guaranteed confidentiality of deposits, which means that money laundering has undoubtedly brought them some benefits in the short term. The prevention of money laundering for banks is not free. The measures imposed on the bank by legislation (encouraging these banks to a higher level of demand for preventive behavior) entail costs that go beyond the direct, visible benefits of the implemented measures. However, a functioning and stable financial system has a number of externalities, of course, which are also enjoyed by banks. Originality/value The paper focuses on economic analysis of Croatian and Slovenian legal systems with regards of the regulation of role of reporting entities in the prevention of money laundering which produce certain costs and benefits for the financial system and reporting entities as whole. The paper also uses the comparative approach to address the problem of compatibility of Croatian and Slovenian legal system with the EC Directive (2015/849).

The results of the study of 30 flax samples of different ecological and geographical origin from the collection of the N.I. Vavilov All-Russian Institute of Plant Genetic Resources (VIR) are presented. The varieties of the Russian selection 14, Chinese 6, Ukrainian 5, French 4, Belarusian 1 have been investigated. The influence of genotypes and weather conditions on the manifestation of economic traits by multivariate analysis of variance has been established. Field studies were conducted in the sub taiga zone of the Tomsk region in 2015-2017. Natural and climatic conditions met the requirements for the cultivation of fiber flax. By total and technical stem length the best varieties of the Chinese selection Heiya 4 (K-8485), Sxy 7 (K-8689), the Russian hybrid Tomsk 16 * Success (K-8544), the French variety Drakkar (K-8493), the Ukrainian Glazur (K-8695), 66-72 and 60-66 cm respectively, were significantly higher than the standard Tomsk 16. According to the fiber content in the technical part of the stems (38-40%) the following varieties were the leaders: the Russian selection P-3989 (K-8672), A-236 (K-8692), M-249 (K-8693), the French selection Alizee (K-8494), Agatha (K-8492), Melina (K-8495), and the Ukrainian selection Vruchy (K-8694), were significantly above the Tomsk 16 standard. By the fiber mass (91-104 mg) the French varieties Drakkar (K-8493) and Alizee (K-8494), the Ukrainian varieties Vruchii (K-8694) and Glazur (K8695), the Russian varieties A-236 (K-8692) and M-249 (K-8693) reliably exceeded the Tomsk 16 standard by 6-44 mg. The flax varieties of the Russian selection P-3989 (K-8672), Dobrynya (K8504), A-236 (K-8692), the Chinese Heiya 4 (K-8485), Heiya 13 (K-8486), Tyy 13 (K-8687), the French Agatha (K-8492), Drakkar (K-8493), Alizee (K-8494), Melina (K-8495), and the Ukrainian Gladiator (K-8505) and Vruchiy (K-8694) were recognized as promising and were included in the breeding process as male seed parents. The resulting hybrid material has been on trial in the selection nursery from 2017 and the second year of breeding from 2021.

Abstract. The late Pliocene/early Pleistocene intensification of Northern Hemisphere glaciation (iNHG) ∼2.5 million years ago (marine isotope stages, MIS, 100–96) stands out as an important tipping point in Earth's climate history, which strongly influenced oceanographic and climatic patterns including trade wind and upwelling strength in the eastern equatorial Pacific (EEP). The thermocline depth in the EEP, in turn, plays a pivotal role in the Earth's climate system: small changes in its depth associated with short-term climate phenomena such as the El Niño–Southern Oscillation can affect surface-water properties and the ocean–atmosphere exchange. However, thermocline dynamics in the EEP during the iNHG still remain unclear. While numerous studies have suggested a link between a thermocline shoaling in the EEP and Northern Hemisphere ice growth, other studies have indicated a stable thermocline depth during the iNHG; consequently, a causal relationship between thermocline dynamics and ice-sheet growth has been excluded. In light of these contradictory views, we have generated geochemical (planktic foraminiferal δ18O, δ13C and Mg ∕ Ca), sedimentological (sand accumulation rates) and faunal (abundance data of thermocline-dwelling foraminifera) records for Ocean Drilling Program Site 849 located in the central region of the EEP. Our records span the interval from ∼2.75 to 2.4 Ma (MIS G7–95), which is critical for understanding thermocline dynamics during the final phase of the iNHG. Our new records document a thermocline shoaling from ∼2.64 to 2.55 Ma (MIS G2–101) and a relatively shallow thermocline from ∼2.55 Ma onwards (MIS 101–95). This indicates a state change in thermocline depth at Site 849 shortly before the final phase of the iNHG. Ultimately, our data support the hypothesis that (sub-)tropical thermocline shoaling may have contributed to the development of large Northern Hemisphere ice sheets.

This article focuses on the issue of tax evasion and approach of compliance officers in payment institutions thereto. As tax evasion represents a phenomenon that remains attractive globally and certain percentage of economic activities will still remain connected to such illegal acting, it’s necessary that attention will be paid to it. The primary aim of this article is to identify and define effective methods of compliance officers or departments in relation to their clients or their transactions where certain elements or aspects of tax evasion activities can be detected, in particular based on the obligations vested in national acts, covered by the Directive (EU) 2018/843 of the European Parliament and of the Council of 30 May 2018 amending Directive (EU) 2015/849 on the prevention of the use of the financial system for the purposes of money laundering or terrorist financing, and amending Directives 2009/138/EC and 2013/36/EU (hereinafter referred to only as the “AML Directive”). Hypothesis of this article will test the statement that compliance department applies adequate methodology and properly worded questions may differentiate between clients that are putting their efforts into money laundering, in particular tax evasion, and clients with legal intentions. First part of this article will describe existing legal framework covering the area of money laundering where the method of analysis, synthesis and descriptive method will be applied. Second part of this article focuses on respective approaches to different tax evasion efforts with the main methods of deduction, synthesis and empirical research. Certain element of comparative analysis will be applied as well. Weakness of this topic is the insufficiency of expert literature for this area when majority of sources come mainly from the publishing of international organisations and partially from the monographies of different authors covering this area only in a form of a side topic. Based on this fact, this work is mostly based on sources from international organisations as from monographies.

This cross-sectional study examined associations of local social engagement with walking and sitting, and whether these associations were modified by local environmental attributes. Older residents (aged 65–84 years, n = 849), recruited from a regional city in Japan, reported walking frequency, sitting time, local social engagement, and local environmental attributes. Walk Score® was also used as an environmental measure. Analysis of data from 705 participants found that engaging in community activities was significantly associated with more frequent walking, but not with prolonged sitting. Interaction analyses between social engagement and environmental attributes did not show any significant interactions, suggesting that promoting local social engagement may increase walking frequency among older adults, regardless of local environmental characteristics. Community-level social initiatives that encourage older adults to participate in local meetings, events, and activities may be an effective physical activity promotion strategy among older adults.

Estimation of the spread and advancement of Plasmodium falciparum artemisinin-resistant parasites can be done by probing polymorphisms in the kelch (Pfk13) domain (a validated molecular marker). This study aimed to provide baseline information for future artemisinin surveillance by analyzing the k13-propeller domain in P. falciparum field isolates collected from 24 study areas in 14 malaria hot spots of Odisha (previously Orissa) during July 2018-January 2019. A total of 178 P. falciparum mono infections were assessed. An 849-base pair fragment encoding the Pfk13 propeller was amplified by nested polymerase chain reaction and sequenced in both directions (PCR). After DNA alignment with the 3D7 reference sequence, all samples were found to be wild type. It can be anticipated that malaria public health is not under direct threat in Odisha relating to ART resistance.

ImportanceUS rural vs nonrural populations have striking disparities in diabetes care. Whether rurality contributes to disparities in diabetes mortality is unknown.ObjectiveTo examine rates and trends in diabetes mortality based on county urbanization.Design, Setting, and ParticipantsIn this observational, cross-sectional study, the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was searched from January 1, 1999, to December 31, 2018, for diabetes as a multiple cause and the underlying cause of death among residents aged 25 years or older in US counties. County urbanization was categorized as metro, medium-small, and rural. Weighted multiple linear regression models and jackknife resampling, with a 3-segment time component, were used. The models included exposures with up to 3-way interactions and were age standardized to the 2009-2010 population. The analyses were conducted from July 1, 2020, to February 1, 2022.ExposuresCounty urbanization (metro, medium-small, or rural), gender (men or women), age group (25-54, 55-74, or ≥75 years), and region (Midwest, Northeast, South, or West).Main Outcomes and MeasuresAnnual diabetes mortality rate per 100 000 people.ResultsFrom 1999-2018, based on 4 022 238 309 person-years, diabetes was a multiple cause of death for 4 735 849 adults aged 25 years or older. As a multiple cause, diabetes mortality rates in 2017-2018 vs 1999-2000 were highest and unchanged in rural counties (157.2 [95% CI, 150.7-163.7] vs 154.1 [95% CI, 148.2-160.1]; P = .49) but lower in medium-small counties (123.6 [95% CI, 119.6-127.6] vs 133.6 [95% CI, 128.4-138.8]; P = .003) and urban counties (92.9 [95% CI, 90.5-95.3] vs 109.7 [95% CI, 105.2-114.1]; P < .001). In 2017-2018 vs 1999-2000, mortality rates were higher in rural men (+18.2; 95% CI, 14.3-22.1) but lower in rural women (−14.0; 95% CI, −17.7 to −10.3) (P < .001 for both). In the 25- to 54-year age group, mortality rates in 2017-2018 vs 1999-2000 showed a greater increase in rural counties (+9.4; 95% CI, 8.6-10.2) compared with medium-small counties (+4.5; 95% CI, 4.0-5.0) and metro counties (+0.9; 95% CI, 0.4-1.4) (P < .001 for all). Of all regions and urbanization levels, the mortality rate in 2017-2018 vs 1999-2000 was higher only in the rural South (+13.8; 95% CI, 7.6-20.0; P < .001).Conclusions and RelevanceIn this cross-sectional study, US rural counties had the highest overall diabetes mortality rate. The determinants of persistent rural disparities, in particular for rural men and for adults in the rural South, require investigation.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a serious threat to patient safety due to limited treatment options and propensity to spread in healthcare settings. Using Emerging Infections Program (EIP) data, we describe changes in CRAB incidence and epidemiology. Methods: During January 2012 to December 2018, 9 sites (Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee) participated in active laboratory- and population-based surveillance. An incident case was defined as the first isolation of A. baumannii complex, in a 30-day period, resistant to ≥1 carbapenem (excluding ertapenem) from a normally sterile site or urine of a surveillance area resident. Cases were considered hospital-onset (HO) if the culture was collected >3 days after hospital admission; all others were community-onset (CO). Cases were classified as device-associated (DA) if the patient had 1 or more medical devices (ie, urinary catheter, central venous catheter (CVC), endotracheal/nasotracheal tube, tracheostomy, or another indwelling device) present in the 2 days prior to culture collection. Temporal trends were estimated using generalized linear models adjusted for age, race, sex, and EIP site. Results: Overall, 984 incident CRAB cases were identified, representing 849 patients. Among these patients, 291 (34%) were women, 510 (61%) were nonwhite, and the median age was 62 years (mean, 59; range, 0–102). Among the cases, 226 (23%) were HO; 758 (77%) were CO; and 793 (81%) were DA. Overall incidence rates in 2012 and 2018 were 1.58 (95% CI, 1.29–1.90) and 0.60 (95% CI, 0.40–0.67) per 100,000 population, respectively. There was a 15% annual decrease in incidence (adjusted rate ratio [aRR] 0.85; 95% CI: 0.82-0.88, P < .0001). Decreases were observed among sterile site (aRR 0.88; 95% CI, 0.84–0.93) and urine cases (aRR 0.83; 95% CI, 0.80–0.87). Annual decreases occurred for HO cases (aRR, 0.78; 95% CI, 0.73–0.85) and CO cases (aRR, 0.86; 95% CI, 0.83–0.9). The DA cases decreased 16% annually overall (aRR, 0.84; 95% CI, 0.81–0.88). Decreases among cases in patients with CVC (aRR, 0.85; 95% CI, 0.80–0.90) and urinary catheters (aRR, 0.84; 95% CI, 0.80–0.88) were smaller than what was seen in patients with other indwelling devices (aRR, 0.81; 95% CI, 0.77–0.86). Discussion: Overall, from 2012 to 2018, the incidence of CRAB decreased >60%. Decreases were observed in all case groups, regardless of source, infection onset location, or types of devices. Smaller annual decreases in rates of CO-CRAB than HO-CRAB suggest that there may be opportunities to accelerate prevention outside the hospital to further reduce the incidence of these difficult-to-treat infections.Funding: NoneDisclosures: None

Purpose of the studyThe aim of this study was to perform a meta-analysis to derive precise estimation of the association of interleukin-23 receptor (IL-23R), IL-1 receptor 2 (IL-1R2), IL-12 beta (IL-12B), IL-10 and tumour necrosis factor (TNF)-α polymorphisms with ankylosing spondylitis (AS) susceptibility.Study designA systematic literature search was conducted to identify the relevant studies. Pooled OR with 95% CI was calculated to assess the strength of the association in a fixed or random-effects model.ResultsA total of 13 917 cases and 19 849 controls in 43 eligible studies were included in the meta-analysis. Seventeen single-nucleotide polymorphisms (SNPs) in the abovementioned five cytokine genes were evaluated. The results indicate that the nine SNPs (rs11209026, rs1004819, rs10489629, rs11465804, rs1343151, rs11209032, rs1495965, rs7517847, rs2201841) of IL-23R are associated with AS susceptibility in all study subjects in the allelic model. Moreover, stratification by ethnicity identified a significant association between seven SNPs of IL-23R and AS susceptibility in Europeans and Americans, but not in Asians. In addition, the IL-10–819 C/T and TNF-α−857 C/T polymorphisms also confer susceptibility to AS, especially in Asian population.ConclusionThe results suggested that the genetic susceptibility for AS is associated with the nine SNPs of IL-23R in overall population. In the subgroup analysis, significant associations were shown in European and American population, but not in Asian population. Our results also suggest that IL-10–819 C/T and TNF-α−857 C/T polymorphism might be associated with AS risk, especially in Asian population.

O artigo discute a formação profissional ligada à Política Nacional de Práticas Integrativas e Complementares (PNPIC) do Sistema Único Saúde (SUS), por meio de uma revisão da literatura e da análise de cursos oferecidos no Ambiente Virtual de Aprendizagem do SUS (AVASUS). Contextualiza no cenário nacional e internacional a implementação das práticas integrativas no SUS. São apontadas diferenças significativas, quanto à formação e aos profissionais autorizados a praticá-las, entre a Portaria nº 971/2006 que instituiu a PNPIC e as de número 849/2017 e 702/2018 que incluem novas práticas integrativas a esta política. A oferta pelo Ministério da Saúde de cursos sobre praticas integrativas por meio do AVASUS é entendida como necessária, mas insuficiente para a formação de profissionais. Conclui-se que, apesar dos recentes avanços no debate e considerando o modo como foi ampliado o quadro de práticas pelas últimas portarias, é possível identificar importantes desafios para a consolidação da PNPIC entre os quais se destaca a formação profissional. Considera-se a defesa da formação e normatização das PICS como uma luta pelo reconhecimento social de práticas de trabalho não hegemônicas e como caminho para garantir a realização segura para realização de tais práticas. Palavras-chave: Política de saúde, Política pública, Terapias complementares, Medicina tradicional, Capacitação de Recursos Humanos em Saúde

ObjectiveUsing primary care data obtained from the UK Clinical Practice Research Datalink, this retrospective cohort study examined the relationships between medication adherence and clinical outcomes in patients with type 2 diabetes.Research design and methodsData were extracted for patients treated between 2008 and 2016, and stratified by oral antihyperglycemic agent (OHA) line of therapy (mono, dual or triple therapy). Patients were monitored for up to 365 days; associations between medication possession ratio (MPR) and outcomes at 1 year (glycated hemoglobin A1c (HbA1c), weight and hypoglycemia incidence) were assessed using linear regression modeling and descriptive analyses.ResultsIn total, 33 849 patients were included in the study (n=23 925 OHA monotherapy; n=8406 OHA dual therapy; n=1518 OHA triple therapy). One-year change in HbA1c was greater among adherent (−0.90 to −1.14%; −9.8 to −12.5 mmol/mol) compared with non-adherent patients (−0.49 to −0.69%; −5.4 to −7.5 mmol/mol). On average, adherent patients had higher hypoglycemia event rates than non-adherent patients (rate ratios of 1.24, 1.10 and 2.06 for OHA mono, dual and triple therapy cohorts, respectively) and experienced greater weight change from baseline. A 10% improvement in MPR was associated with −0.09% (−1.0 mmol/mol), −0.09% (−1.0 mmol/mol) and −0.21% (−2.3 mmol/mol) changes in HbA1c for OHA mono, dual and triple therapy cohorts, respectively.ConclusionsFor patients with type 2 diabetes, increasing medication adherence can bring about meaningful improvements in HbA1c control as the requirement for treatment escalation increases. Regimens associated with weight loss and the avoidance of hypoglycemia were generally associated with better medication adherence and improved glycemic control.

459 Background: In May 2017, atezolizumab and pembrolizumab (IO) received accelerated approval for first-line treatment of cisplatin-ineligible patients with mUC, irrespective of PDL1 test status. In June 2018, the FDA and EMA restricted IO to cisplatin-ineligible patients with PDL1 positive tumors based on early review of data from confirmatory trials which suggested decreased overall survival in patients with PDL1 negative tumors treated with IO. We assessed the impact of the FDA label change on clinical outcomes of mUC patients in routine care. Methods: We conducted a controlled interrupted time series analysis using the US Flatiron Health electronic health record-derived de-identified database. The study sample included patients from 280 cancer clinics nationwide diagnosed with mUC and compared patients potentially impacted by the label change (cisplatin ineligible patients initiating first-line IO or carboplatin-based chemotherapy) to a comparator group who would have been unaffected by the label change (patients initiating first-line cisplatin-based chemotherapy) from 01 April 2017 to 17 May 2018 (pre-label change) and 20 June 2018 to 01 March 2020 (post-label change), excluding a 30-day wash out period encompassing the time-period between the initial FDA safety alert (18 May 2018) and the official FDA label change (19 June 2018). We used Cox regression to estimate adjusted pre-/post-label change related mortality differences in patients receiving carboplatin-chemotherapy or IO, accounting for secular changes in survival through comparison with the cisplatin comparator group. Results: The study included 829 patients with mUC initiating treatment in the pre-label change period (582 IO or carboplatin, 247 cisplatin) and 1,184 patients in the post-label change period (849 IO or carboplatin, 336 cisplatin), respectively. The use of IO, carboplatin, and cisplatin was similar across time-periods (pre-label change: 44.4%, 25.8%, and 29.8%; post-label change: 48%, 23.6%, 28.4%); while PD-L1 testing increased (6.6% to 28.1%). In adjusted models, there were no differences in survival in any of the groups following the FDA label change policy (table). Conclusions: The U.S. FDA label restriction on first-line immunotherapy was associated with increased PD-L1 testing but was not associated with changes in treatment patterns or improved mortality among patients with mUC.[Table: see text]

A high prevalence of suboptimal asthma control is attributable to known evidence–practice gaps. We developed a computerised clinical decision support system (the Electronic Asthma Management System (eAMS)) to address major care gaps and sought to measure its impact on care in adults with asthma.This was a 2-year interrupted time-series study of usual care (year 1)versuseAMS (year 2) at three Canadian primary care sites. We included asthma patients aged ≥16 years receiving an asthma medication within the last 12 months. The eAMS consisted of a touch tablet patient questionnaire completed in the waiting room, with real-time data processing producing electronic medical record-integrated clinician decision support.Action plan delivery (primary outcome) improved from zero out of 412 (0%) to 79 out of 443 (17.8%) eligible patients (absolute increase 0.18 (95% CI 0.14–0.22)). Time-series analysis indicated a 30.5% increase in physician visits with action plan delivery with the intervention (p<0.0001). Assessment of asthma control level increased from 173 out of 3497 (4.9%) to 849 out of 3062 (27.7%) eligible visits (adjusted OR 8.62 (95% CI 5.14–12.45)). Clinicians escalated controller therapy in 108 out of 3422 (3.2%) baseline visitsversus126 out of 3240 (3.9%) intervention visits (p=0.12). At baseline, a short-acting β-agonist alone was added in 62 visits and a controller added in 54 visits; with the intervention, this occurred in 33 and 229 visits, respectively (p<0.001).The eAMS improved asthma quality of care in real-world primary care settings. Strategies to further increase clinician uptake and a randomised controlled trial to assess impact on patient outcomes are now required.

ObjectivesThe Norwegian Cardiac Arrest Registry (NorCAR) was established in 2013 when cardiac arrest became a mandatory reportable condition. The aim of this cohort study is to describe how the world’s first mandatory, population-based cardiac arrest registry evolved during its first 6 years.SettingNorway has a total population of 5.3 million inhabitants with a population density that varies considerably. All residents are assigned a unique identifier number, giving nationally approved registries access to information about all births and deaths in the country. Data in the registry are entered by data processors; public employees with close links to the emergency medical services. All data processors undergo a standardised training and meet for yearly retraining and updates.ParticipantsAll events of cardiac arrest where bystanders or healthcare professionals have started cardiopulmonary resuscitation or performed defibrillation are included into the NorCAR.Primary and secondary outcome measuresSince the establishment of the registry, the number of reporting health trusts, the number of reported events and the corresponding population at risk were followed year by year. Outcome is measured as changes in inclusion rate, incidence per 100 000 inhabitants and survival to 30 days after cardiac arrest.ResultsIn total, 14 849 cases were registered over 6 years, between 2013 and 2018. The number of health trusts reporting rose steadily from 2013. Within 3 years, all trusts reported to the registry with an increasing number of events reported; going from 1101 to 3400 per year. The prevalence of bystander cardiopulmonary resuscitation increased slightly, but the population incidence of survival did not change.ConclusionDeclaring cardiac arrest as a reportable condition and close follow-up of all reporting areas is essential when building a national registry.

The characteristics that predict progression to overt chronic obstructive pulmonary disease (COPD) in smokers without spirometric airflow obstruction are not clearly defined.We conducted a post hoc analysis of 849 current and former smokers (≥20 pack–years) with preserved spirometry from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) cohort who had baseline computed tomography (CT) scans of lungs and serial spirometry. We examined whether CT-derived lung volumes representing air trapping could predict adverse respiratory outcomes and more rapid decline in spirometry to overt COPD using mixed-effect linear modelling.Among these subjects with normal forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio, CT-measured residual volume (RVCT) to total lung capacity (TLCCT) ratio varied widely, from 21% to 59%. Over 2.5±0.7 years of follow-up, subjects with higher RVCT/TLCCT had a greater differential rate of decline in FEV1/FVC; those in the upper RVCT/TLCCT tertile had a 0.66% (95% CI 0.06%–1.27%) faster rate of decline per year compared with those in the lower tertile (p=0.015) regardless of demographics, baseline spirometry, respiratory symptoms score, smoking status (former versus current) or smoking burden (pack–years). Accordingly, subjects with higher RVCT/TLCCT were more likely to develop spirometric COPD (OR 5.7 (95% CI 2.4–13.2) in upper versus lower RVCT/TLCCT tertile; p<0.001). Other CT indices of air trapping showed similar patterns of association with lung function decline; however, when all CT indices of air trapping, emphysema, and airway disease were included in the same model, only RVCT/TLCCT retained its significance.Increased air trapping based on radiographic lung volumes predicts accelerated spirometry decline and progression to COPD in smokers without obstruction.

The rapid economic growth and nutritional changes in China have brought an increased burden of type 2 diabetes mellitus (T2DM). This study aimed to assess the effects of hypertriglyceridemic-waist (HTW) and its dynamic transitions on incident T2DM among middle-aged and older Chinese. Data were extracted from the China Health and Retirement Longitudinal Study (CHARLS). Participants were classified into three HTW phenotypes, namely NTNW (normal triglyceride (TG) and waist circumference (WC)), NTEW/ETNW (normal TG and enlarged WC, or elevated TG and normal WC) and ETEW (elevated TG and enlarged WC). Multivariable Cox frailty models were used to assess the associations of HTW phenotypes and their transitions over time with the risk of T2DM. A total of 7397 subjects without T2DM were included, of which 849 developed T2DM during 2011–2018. Compared with individuals with NTNW, people in the NTEW/ETNW group and ETEW group were at a significantly higher risk of T2DM (HRNTEW/ETNW = 1.28, 95% CI: 1.06–1.54 and HRETEW = 1.61, 95% CI: 1.26–2.06). For subjects with NTNW at baseline, the risk of developing T2DM increased by 38% and 83% if their metabolic status changed to NTEW/ETNW and ETEW, respectively. For subjects with NTEW/ETNW, the risk of T2DM decreased by 33% when their metabolic status changed to normal (NTNW); but the risk increased by 49% if the status became more serious (ETEW). NTEW/ETNW, ETEW and their transitions to adverse states were risk factors for T2DM.

Afrina, Y., Tasneem, S., & Fatema, K. (2015). Effectiveness of digital marketing in the challenging age: an empirical study. International Journal of Management Science And Business Administration, 1(5), 69-80. Agreda, L. (2016). Análisis de la estrategia de marketing digital mediante herramientas de analítica web. Investigation Research Review, 7, 81-97. Albarrán, E., & Salzman, R. (2011). News media consumption in Latin America: Who does It? Journal of Spanish Language Media, 4, 23-39. Almuiñas, J., González, F., & Morales, D. (2013). El control estratégico: una perspectiva en construcción en las instituciones de educación superior. España: Congreso Universidad. Álvarez, F. (2007). Planificación estratégica de marketing. Perspectivas, 67-104. Ancu, M. (2009). Myspace politics: uses and gratifications of befriending candidates. Journal of Broadcasting & Electronic Media, 53(4), 567–583. doi:https://doi.org/doi:10.1080/08838150903333064 Ballesteros, P., González, M., & Fernández, D. (2012). Human resource allocation management in multiple projects using sociometric techniques. International Journal of Project Management, 901–913. Blank, S., & Dorf, B. (2012). The startup owner’s manual: the step-by-step guide for building a great company. Chicago: K&S Ranch. Blythe, J., & Jane, M. (2019). Essentials of marketing. Estados Unidos: Pearson. Booth, J., & Seligson, M. (2009). The legitimacy puzzle in Latin America: political support and democracy in eight nations (Vol. 3). Inglaterra: Cambridge University Press. Burke, S., Stagl, K., Cameron, K., Goodwin, G., Salas, E., & Halpin, S. (2006). What type of leadership behaviors are functional in teams? A meta-analysis. The Leadership Quarterly, 17(3), 288–307. Burrow, J., & Fowler, A. (2015). Marketing. Estados Unidos: Cengage Learning. Cai, L., Jing, Y., Qi, Q., & Xu, X. (2018). A comprehensive study on smart beta strategies in the a-share market. Applied Economics, 1-10. doi:https://doi.org/10.1080/00036846.2018.1489113 Camps, A. (2019). Out of the dominant political agenda: translation and interpreting networks for social activism. Transfer, 9-23. Etzel, M., & Walker, B. (2017). Fundamentos de marketing. México: McGraw-Hill. Eveland, W., Morey, A., & Hutchens, M. (2011). Beyond deliberation: new directions for the study of informal political conversation from a communication perspective. Journal of Communication, 61, 1082–1103. doi:https://doi.org/10.1111/j.1 Ford, R., & Piccolo, R. (2016). Strategies for building effective virtual teams: trust is key. Business Horizons, 10, 25-34. doi:http://dx.doi.org/10.1016/j.bushor.2016.08.009 García, B. (2016). Cibercultura, tic y redes sociales: nuevas formas de comunicación para las familias. Revista de Medios y Educación, 195-206. Gómez, C., & Mejía, J. (2012). La gestión del Marketing que conecta con los sentidos. Revista EAN, 47-78. González, N. (2015). Qué entendemos por usuario como centro del servicio. Estrategia y táctica en marketing. El profesional de la información, 24(1), 9. Greenberg, P. (2010). Customer relationship management, social CRM strategies, tools, and techniques for engaging your customers, at the speed of light. Washington: McGraw-Hill. Gronroos, C. (1993). Toward a third phase in service quality research: challenges and future directions. Advances in Services Marketing and Management, 49–64. Hill, R. (2016). What’s love got to do with it? Examining millennials’ attitudes towards relationships and intimacy. Alabama Argicultural and Mechanical University, 7-11. Jenkins, H. (2008). Convergence cultura: la cultura de la convergencia de los medios de comunicación. México: Paidós Ibérica. Jeong, O., & Lee, S. (2010). On social web sites. Information Systems, 35, 215-236. Kim, J., Yoo, F., & Zuñiga, G. (2017). Cognitive benefits for senders: antecedents and effects of political expression on social media. Journalism & Mass Communication Quarterly, 94(1), 17–37. Kumar, M., & Kumar, U. (2004). A conceptual framework for the development of a service delivery strategy for industrial systems and products. Journal of Business & Industrial Marketing, 19, 310–319. Lyons, J., & Sokhey, A. (2014). Emotion, motivation, and social information seeking about politics. Political Communication, 31, 237-258. doi:https://doi.org/10.1080/10584609.2013.828138 Manzano, B. (2015). The development ofthe digital competence in the Spanish basiceducational law. Opción, 828-853. Moreira, W. (2019). Análise sobre o desempenho de evaristo costa em campanhas publicitárias por meio do Instagram. Temática, 15(3), 23-45. doi:https://doi.org/10.22478/ufpb.1807-8931.2019v15n3.44975 Norris, P. (2000). A virtuous circle: political communications in postindustrial societies. Estados Unidos: Cambridge University Press. Salzman, R. (2015). Understanding social media use in Latin America . Palabra Clave, 18(3), 842-858. doi:https://doi.org/doi:10.5294/pacla.2015.18.3.9 Sheldon, P., & Bryant, K. (2016). Instagram: motives for its use and relationship to narcissism and contextual age. Computers in Human Behavior, 58, 89-97. doi:http://dx.doi.org/10.1016/j.chb.2015.12.059 Sheng, Q., & Xian, G. (2008). Developing a framework for business intelligence systems based on rosettaNet frame. 2008 4th International Conference on Wireless Communications, Networking and Mobile Computing, 1-4. doi:https://doi.org/10.1109/WiCom.2008.2130 Stieglitz, S., & Dang, L. (2013). Social media and political communication: a social media analytics framework. Social Network Analysis and Mining, 3(4), 1277-1291. doi:https://doi.org/10.1007/s13278-012-0079-3 Zuñiga, H. (2018). Medios sociales y democracia. El Profesional de la Información, 27(6), 1172.

ObjectivesA number of publications have demonstrated the cost-effectiveness of sofosbuvir plus ribavirin (SOF+RBV) compared with the former standard therapy with interferon (IFN)-containing regimens. Unlike these cost-effective analyses, where efficacy parameters were obtained from registration trials for drug approval, this analysis is a cost-effectiveness analysis of SOF+RBV for genotype (GT) 2 non-cirrhosis (NC) and compensated cirrhosis (CC) patients using efficacy parameters obtained from a multicentre cohort study (Kyushu University Liver Disease Study; KULDS) in Kyushu area in Japan in order to reflect real-world clinical practice in Japan.MethodA Markov model followed 10 000 patients (62 years old) over their lifetime. Four populations were followed: treatment-naïve (TN)-NC, treatment-experienced (TE)-NC, TN-CC and TE-CC. Comparators were Peg-IFNα2b+RBV for TN-NC and CC patients and telaprevir (TVR)+Peg-IFNα2b+RBV for TE-NC patients. The sustained virological response (SVR) rates of SOF+RBV were taken from KULDS and those of comparators were obtained from systematic literature reviews. There were nine states (NC, CC, decompensated cirrhosis [DC], hepatocellular carcinoma [HCC], SVR [NC], SVR [CC], liver transplantation [LT], post-LT and death) in this model, and an increase in the progression rate to HCC due to ageing was also considered. The analysis was conducted from the perspective of a public healthcare payer, and a discount rate of 2% was set for both cost and effectiveness.ResultsIncremental cost-effectiveness ratios (ICERs) of SOF+RBV versus Peg-IFNα2b+RBV were ¥323 928 /quality-adjusted life year (QALY) for TN-NC patients, ¥92 256/QALY for TN-CC patients and ¥1 519 202/QALY for TE-CC patients. The ICER of SOF+RBV versus TVR+Peg-IFNα2b+RBV was ¥849 138/QALY for TE-NC patients. The robustness of the results was determined by sensitivity analysis.ConclusionsThe results of this analysis strongly demonstrate the robustness of our previous findings that SOF+RBV regimens are cost-effective in the real world and clinical trial settings for Japanese GT2 NC and CC patients.

AGYEMAN, J. et al. Trends and Directions in Environmental Justice: From Inequity to Everyday Life, Community, and Just Sustainabilities. Annual Review of Environmental Resources, v. 41, p. 6.1-6.20, 2016.BOYLE, A. Human rights and the environment: where next? The European Journal of International Law, v. 23, n. 3, p. 613-642, 2012.CRUTZEN, P. J.; STOERMER, E. F. The ‘Anthropocene’. Global Change Newsletter, v. 41, p. 17-18, 2000.DRYZEK, J. S.; NORGAARD, R. B.; SCHLOSBERG, D. Climate-Challenged Society. Oxford: Oxford University Press, 2013.GONÇALVES, A.; GUERRA, J. Experimentar ciência e cidadania: o caso EuroLifeNet. Atas do VI Congresso Português de Sociologia: Mundos Sociais: Saberes e Práticas. Lisboa: Associação Portuguesa de Sociologia, 2008.GUERRA, J.; LOURENÇO, L. C. The 2030 Agenda: trends of transition toward sustainability. In: DELICADO, A.; DOMINGOS, N.; SOUSA, L. (org.). The Diverse Worlds of Sustainability. Lisboa: Imprensa de Ciências Sociais, 2018. p. 53-85.GUDOWSKYA, N.; ROSA, A. Bridging epistemologies – Identifying uniqueness of lay and expert knowledge for agenda setting. Futures, v. 109, p. 24-38, 2019.GUIVANT, J. S. O Legado de Ulrich Beck. Ambiente & Sociedade, v. 19, n. 1, p. 229-240, 2016.HOLANDA, S. B. Raízes do Brasil. São Paulo: Cia. das Letras, 2006.IPCC. Climate Change 2014: Synthesis Report. Contribution of Working Groups I, II and III to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Genebra: IPCC, 2014.IPCC. Global warming of 1.5°C. An IPCC Special Report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty. Genebra: World Meteorological Organization, 2018.KAISER J. Ecologists on a mission to save the world. Science, v. 287, p. 1188-1192, 2000.LIKENS, G. E. The role of science in decision making: does evidence-based science drive environmental policy? Frontiers in Ecology and the Environment, v. 8, n. 6, p. e1-e9, 2010.LIMA, S. et al. Produção e consumo de produtos orgânicos no mundo e no Brasil. Rio de Janeiro: Instituto de Pesquisa Econômica Aplicada, 2020.PIKETTY, T.; SAEZ, E. Inequality in the long run. Science, v. 344, n. 6186, p. 838-843, 2014.PNUD. Relatório de Desenvolvimento Humano 2011 – Sustentabilidade e Equidade: um Futuro Melhor para Todos. Lisboa: IPAD/PNUD, 2011.REGANOLD, J.; WACHTER, J. Organic agriculture in the twenty-first century. Nature Plants, v. 2, Article 15221, 2016. DOI: 10.1038/NPLANTS.2015.221.TAYLOR, D. Is Environmental Health a Basic Human Right? Environmental Health Perspectives, v. 112, n. 17, p. A1006-A1009, 2004.UN GENERAL ASSEMBLY. Transforming our World: the 2030 Agenda for Sustainable Development - Resolution adopted by the General Assembly on 25 September 2015. Genebra: ONU, 2015.UNCHE. Report of the United Nations Conference of the Human Environment. Stockholm: United Nations Publication, 5-16 June 1972.

Patients with inflammatory bowel disease (IBD) have a high risk of venous thromboembolism (VTE) events in both hospitalized patients and outpatients. Although thromboprophylaxis is recommended for hospitalized patients with IBD, implementation is not universal, especially for non IBD-related hospitalizations. Our objective was to present VTE and thromboprophylaxis adherence rates among hospitalized patients with IBD. An electronic data repository was created of all patients with IBD who visited the emergency department (ED) of our tertiary medical center between 2012 and 2018. The data included tabular variables and free-text physician records. We searched the data for VTE events, using ICD10 coding. Overall, there were 7009 ED visits of 2405 patients with IBD, 1556 (64.7%) with Crohn’s disease (CD) and 849 (35.3%) with ulcerative colitis (UC). Thromboprophylaxis was administered in 463 hospitalizations (12.4% of IBD-related and 10.9% of non IBD-related hospitalizations, p = 0.13). Nineteen VTEs were diagnosed in the ED and seventeen were diagnosed during hospitalization (11 non IBD-related and 6 IBD-related hospitalizations, 0.6% and 0.28% respectively, p = 0.12). One patient died during hospitalization and an additional two in the 90 days post-discharge from hospitalization (unrelated to VTEs). In conclusion, thromboprophylaxis rates in hospitalized patients with IBD are low, despite possible implications and established guidelines. Thromboprophylaxis should be implemented in patients with IBD hospitalized for all indications.

ObjectiveRecent data on sustained hypertension and obesity among school-going children and adolescents in India are limited. This study evaluates the prevalence of sustained hypertension and obesity and their risk factors among urban and rural adolescents in northern India.SettingA school-based, cross-sectional survey was conducted in the urban and rural areas of Ludhiana, Punjab, India using standardised measurement tools.ParticipantsA total of 1959 participants aged 11–17 years (urban: 849; rural: 1110) were included in this school-based survey.Primary and secondary outcome measuresTo measure sustained hypertension among school children, two distinct blood pressure (BP) measurements were recorded at an interval of 1 week. High BP was defined and classified into three groups as recommended by international guidelines: (1) normal BP: <90th percentile compared with age, sex and height percentile in each age group; (2) prehypertension: BP=90th–95th percentile; and (3) hypertension: BP >95th percentile. The Indian Academy of Pediatrics classification was used to define underweight, normal, overweight and obesity as per the body mass index (BMI) for specific age groups.ResultsThe prevalence of sustained hypertension among rural and urban areas was 5.7% and 8.4%, respectively. The prevalence of obesity in rural and urban school children was 2.7% and 11.0%, respectively. The adjusted multiple regression model found that urban area (relative risk ratio (RRR): 1.7, 95% CI 1.01 to 2.93), hypertension (RRR: 7.4, 95% CI 4.21 to 13.16) and high socioeconomic status (RRR: 38.6, 95% CI 16.54 to 90.22) were significantly associated with an increased risk of obesity. However, self-reported regular physical activity had a protective effect on the risk of obesity among adolescents (RRR: 0.4, 95% CI 0.25 to 0.62). Adolescents who were overweight (RRR: 2.66, 95% CI 1.49 to 4.40) or obese (RRR: 7.21, 95% CI 4.09 to 12.70) and reported added salt intake in their diet (RRR: 4.90, 95% CI 2.83 to 8.48) were at higher risk of hypertension.ConclusionHigh prevalence of sustained hypertension and obesity was found among urban school children and adolescents in a northern state in India. Hypertension among adolescents was positively associated with overweight and obesity (high BMI). Prevention and early detection of childhood obesity and high BP should be strengthened to prevent the risk of cardiovascular diseases in adults.

Introducción: El cuidado de enfermería en áreas clínicas requiere conocimiento, habilidad y experiencia. El tratamiento de una persona hospitalizada usualmente necesita un acceso venoso, en este procedimiento pueden presentarse complicaciones, siendo la flebitis e infiltración las principalmente reportadas. Objetivo: Determinar la incidencia de flebitis en pacientes pediátricos con catéter corto periférico de acuerdo con el grado de la misma y diversos factores implicados en su aparición. Materiales y métodos: Estudio cuantitativo, prospectivo, observacional y documental realizado entre octubre 2018 a febrero 2019. Resultados: Se encontró una tasa de incidencia de flebitis de 18,5%. De 849 niños con catéter venoso periférico, 157 reportaron flebitis; de ellos 52,2% presentaron flebitis grado I; 29,9%, grado II; 15,3% grado III y 2,5% grado IV. El 78% de los niños presentó peso y talla adecuados para la edad. La flebitis identificada se relacionó al catéter preventivo y asociado a medicamentos como cefalotina y dipirona, así como la presentación en la etapa de infancia y adolescencia de flebitis grado I. Conclusiones: La identificación de la flebitis, sus grados y correlación con las variables sociodemográficas y clínicas, permiten establecer acciones de cuidado y fomento de estrategias para mejorar la atención y los estándares de alta calidad.

The discussion of the South African case law on the quantification of damages arising from wrongful arrest and detention which commenced in part (1) of this series, continues in the present part. In part (1), the Constitutional Court judgment in Zealand v Minister of Justice and Constitutional Development 2008 (4) SA 458 (CC) which emphasised the respect and reverence for the constitutional guarantee of personal liberty, and De Klerk v Minister of Police 2018 (2) SACR 28 (SCA) as well as the recent Constitutional Court judgment in the same case – De Klerk v Minister of Police 2020 (1) SACR 1 (CC); [2019] ZACC 32 (22 August 2019) – were among a host of important cases discussed. The Supreme Court of Appeal cases on quantification of damages for wrongful arrest and detention also discussed include: Mashilo v Prinsloo 2013 (2) SACR 648 (SCA); Minister of Police v Zweni (842/2017) [2018] ZASCA 97 (1 June 2018); Minister of Safety and Security v Magagula (991/2016) [2017] ZASCA 103 (6 September 2017). The first section of this part continues with the discussion of the other instances not involving failure to take the detainee to court within 48 hours or consequences of the accused person’s first appearance in court whereby Hendricks v Minister of Safety and Security (CA&R/2015) [2015] ZAECGHC 61 (4 June 2015); Mrasi v Minister of Safety and Security 2015 (2) SACR 28 (ECG); and Ramphal v Minister of Safety and Security 2009 (1) SACR 211 (E) are among the cases discussed. The second limb of the discussion in this part concerns the issue of wrongful arrest and detention under the Domestic Violence Act 116 of 1998 where the law has developed side by side with the traditional law of wrongful arrest and police negligence as illustrated by the case of Naidoo v Minister of Police 2016 (1) SACR 468 (SCA).

ObjectiveTo quantitate the 2016 global and national burden of chronic kidney disease (CKD) attributable to ambient fine particulate matter air pollution ≤ 2.5 μm in aerodynamic diameter (PM2.5).DesignWe used the Global Burden of Disease (GBD) study data and methodologies to estimate the 2016 burden of CKD attributable to PM2.5in 194 countries and territories. Population-weighted PM2.5levels and incident rates of CKD for each country were curated from the GBD study publicly available data sources.SettingGBD global and national data on PM2.5and CKD.Participants194 countries and territories.Main outcome measuresWe estimated the attributable burden of disease (ABD), years living with disability (YLD), years of life lost (YLL) and disability-adjusted life-years (DALYs).ResultsThe 2016 global burden of incident CKD attributable to PM2.5was 6 950 514 (95% uncertainty interval: 5 061 533–8 914 745). Global YLD, YLL and DALYs of CKD attributable to PM2.5were 2 849 311 (1 875 219–3 983 941), 8 587 735 (6 355 784–10 772 239) and 11 445 397 (8 380 246–14 554 091), respectively. Age-standardised ABD, YLL, YLD and DALY rates varied substantially among geographies. Populations in Mesoamerica, Northern Africa, several countries in the Eastern Mediterranean region, Afghanistan, Pakistan, India and several countries in Southeast Asia were among those with highest age-standardised DALY rates. For example, age-standardised DALYs per 100 000 were 543.35 (391.16–707.96) in El Salvador, 455.29 (332.51–577.97) in Mexico, 408.41 (283.82–551.84) in Guatemala, 238.25 (173.90–303.98) in India and 178.26 (125.31–238.47) in Sri Lanka, compared with 5.52 (0.82–11.48) in Sweden, 6.46 (0.00–14.49) in Australia and 12.13 (4.95–21.82) in Canada. Frontier analyses showed that Mesoamerican countries had significantly higher CKD DALY rates relative to other countries with comparable sociodemographic development.ConclusionsOur results demonstrate that the global toll of CKD attributable to ambient air pollution is significant and identify several endemic geographies where air pollution may be a significant driver of CKD burden. Air pollution may need to be considered in the discussion of the global epidemiology of CKD.

ObjectivesTo explore how the time of delivery influences childbirth experience.DesignA retrospective cohort study.SettingChildbirth in the four Helsinki and Uusimaa Hospital District hospitals, Finland, from 2012 to 2018.Participants105 847 childbirths with a singleton live fetus.Main outcome measuresChildbirth experience measured by Visual Analogue Scale (VAS).ResultsThe major difference in average childbirth experience measured by VAS was between primiparas (8.03; 95% CI 8.01 to 8.04) and multiparas (8.47; 95% CI 8.45 to 8.48). Risk ratio (RR) of the low VAS (≤5) was 2.3 when primiparas were compared with multiparas. Differences in VAS between distinct periods were found in two stages: annual and time of day. The decrease in VAS from 2012–2016 to 2017–2018 in primiparas was from 7.97 (95% CI 7.95 to 7.99) to 7.80 (95% CI 7.77 to 7.83) and from 2014–2016 to 2017–2018 in multiparas from 8.60 (95% CI 8.58 to 8.61) to 8.49 (95% CI 8.47 to 8.52). Corresponding RRs of low VAS were 1.3 for primiparas and 1.2 for multiparas. Hourly differences in VAS were detected in primiparas between office hours 08:00–15:59 (7.97; 95% CI 7.94 to 7.99) and other times (night 00:00–07:59; 7.91; 95% CI 7.88 to 7.94; and evening 16:00–23:59; 7.90; 95% CI 7.87 to 7.92). In multiparas differences in VAS were detected between evening (8.52; 95% CI 8.50 to 8.54) and other periods (night; 8.56; 95% CI 8.54 to 9.58; and office hours; 8.57; 95% CI 8.55 to 8.59).ConclusionThe maternal childbirth experience depended on the time of delivery. Giving birth during the evening led to impaired childbirth experience in both primiparas and multiparas, compared with delivery at other times. The impact of labour induction on childbirth experience should be further examined. The reorganisation of delivery services and the reduction of birth preparations might affect annual VAS. VAS is a simple method of measuring the complex entity of childbirth experience, and our results indicate its ability to capture temporal variation.

performance of current athletes by building confidence and contributing to favorable conditions of retired athletes. This study investigated the influences of the years of retirement and physical self-inventory on human sufferings experienced by the retired athletes. Based on the literature review, there were limited empirical studies on the conditions of former athletes after years of retirement, their glory, physical inventory, and sufferings, and the relationships among these characteristics. Using mixed research methods, this research studied the conditions of retired athletes in Metro Manila. The study confirmed that physical self-inventory influenced post-retirement human suffering. Post-retirement athletic identity, financial status and decisions to voluntary retire were observed to be the most prevalent experiences related to human suffering. However, retired athletes enjoy experiences with their educational status, other career benefits, health condition, control of lives, management of changes, and the warm support of their families and colleagues. References Bernes, K. B. (2009). Life after sport: Athletic career transition and transferable skills. Journal of Excellence, 13, 63-77. Retrieved from http://opus.uleth.caBlanco, D. V. (2016). Sports governance stakeholders, actors and policies in the Philippines: Current issues, challenges and future directions. Asia Pacific Journal of Sport and Social Science, 1-9. http://dx.doi.org/10.1080.21640599.2016.1227544Brinkman, S. (2014). Languages of suffering. Theory and Psychology, 24 (5), 630-648. DOI: 10.1177/0959354314531523Brand, S., Gerber, M., Beck, J., Hatzinger, M., Puhse, U., & Holsboer-Trachsler, E. (2010). High exercise levels are favorable to sleep patterns and psychological functioning in adolescents: A comparison of athletes and control. Journal of Adolescent Health, 46, 133-141. DOI:10.1016/j.jadohealth.2009.06.018Beehr, T. A. & Bennett, M. M. (2015). Working after retirement: Features of bridge employment and research directions. Work,Aging and Retirement, 1(1), 112–128. DOI:10.1093/workar/wau007Bollousa, D. A., Abreu, L., Varela-Sanz, A. & Mujica I. (2013). Do Olympic Athletes train in the Paleolithic era? Sports Medicine,43, 909-917. DOI: 10.1007/s40279-013-0086-1Cloninger, C. R. & Zohar, A. H. (2011). Personality and the perception of health and happiness. Journal of Affective Disorders, 128, 24-32. Doi:10.1016/j.jad.2010.06.012Cosh, S., Crabb, S. & LeCouteur, A. (2012). Elite athletes and retirement: Identity, choice and agency. Australian Journal of Psychology, 2012, 1-9. DOI: 10.1111/j.1742-9536.2012.00060.xCosh, S., Crabb, S. & Tully, P. J. (2015). A champion out of the pool? A discursive exploration of two Australian Olympic swimmers'transition from elite sport to retirement. Psychology of Sport and Exercise 19(2015), 33-41. http://dx.doi.org/10.1016/j.psychsport.2015.02.006Cover, R. (2017). The lived experience of retired college athletes with a history of 1 or more concussions. South Dakota State University Open PRAIRIE: Open Public Research Access Institutional Repository and Information Exchange. Retrieved from: h8p://openprairie.sdstate.edu/etdDaigle, B. (2016). Longitudinal examination of perceived stress and depression symptomology in Division I Student- Athletes. South Dakota State University Open PRAIRIE: Open Public Research Access Institutional Repository and Information Exchange. Retrieved from: h8p://openprairie.sdstate.edu/etdDebois, N., Ledon, A. & Wylleman, P. (2014). A lifespan perspective on the dual career of elite male athletes. Psychology of Sport and Exercise, 2014, 1-12. http://dx.doi.org/10.1016/j.psychsport.2014.07.011De Bosscher, V., Shibli, S., Van Bottenburg, M., De Knop, P. & Truyens, J. (2010). Developing a method for comparing the elite sport systems and policies of nations: A mixed research methods approach. Journal of Sport Management, 24, 567-600. Retrieved from https://dspace.library.uu.nl/bitstream/handle/1874/203933/567-600[1].pdf?sequence=1DosSantos, A. L. P., Nogueira, M. DP. G. R. & Bohme, M. T. S. (2016). Elite athletes’ perception of retirement support systems. International Journal of Physical Education, Sports and Health, 3(1), 192-199. P-ISSN: 2394-1685Effelsberg, D., Solga, M., & Gurt J. (2014). Getting followers to transcend their self-interest for the benefit of their company: Testing a core assumption of transformational leadership theory. Journal of Business Psychology, 29, 131-143. DOI: 10.1007/s10869-013-9305-xEmile, M., Chalabaev, A., Stephan, Y., Corrion, K. & d’Arripe-Longueville, F. (2013). Aging stereotypes and active lifestyle: Personal correlates of stereotype internalization and relationships with level of physical activity among older adults. Psychology of sport and exercise, 2013. DOI: 10.1016/j.psychsport.2013.11.002 Fox, K. R. & Corbin, C. B. (1989). The physical self-perception profile: Development and preliminary validation. Journal of Sport and Exercise Psychology, 11, 408-430. Doi: 10.1123/jsep.11.4.408Golden, C. R. (2011). Student athletes' perceptions of academic support, career support and personal support. Unpublished paper.Retrieved from: h7p://thekeep.eiu.edu/theses/153Hernandez, M. (2012). Toward an understanding of the psychology of stewardship. Academy of Management Review, 37(2), 172-193. http://dx.doi.org/10.5465/amr.2010.0363Hatamleh, M. R. (2013). The life transitions of high performance athletes retirement from sport. European Scientific Journal, 9,11. ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431Iglesias-Gutierrez, E., Garcia-Roves, P. M., Garcia, A., & Patterson, A. M. (2008). Food preferences do not influence adolescent highlevelathletes’ dietary intake. Appetite, 50, 536-540. DOI:10.1016/j.appet.2007.11.003Kadlcik, J. & Flemr, L. (2008). Athletic career termination model in Czech Republic: A qualitative exploration. International Review for the Sociology of Sport, 43(3), 251-269. Retrieved from: http://irs.sagepub.comKlassen, R. M., Krawchuck, L. L., Lynch, S. L. & Rajani, S. (2008). Procrastination and motivation of Undergraduates with learning disabilities: A mixed-methods inquiry. Learning Disabilities Research & Practice, 23 (3), 137–147. Retrieved from http://www.academia.edu/Koonce, G. E. J. (2013). Role transition of National Football League retired Athletes: A grounded theory approach. 23 MarquetteSports Law Review, 23 (2), 250-338. Retrieved from: http://scholarship.law.marquette.edu/sportslaw/vol23/iss2/10Li, L. (2017). Study on Chinese retired athletes job placement countermeasure based on Bayes Discriminant Analysis classification method. Revista de la Facultad de Ingeniería U.C.V., 32(5), 416-422.Li, Y. R., Niu, C. & Quian, J. X. (2016). Dissociation and Missing: Evaluation of Athletes' Disability Security System in China. 2016 2nd International Conference on Modern Education and Social Science (MESS 20160). ISBN: 978-1-60595-346-5.Maiano, C., Morin, A. J. S., Ninot, G., Monthuy-Blanc, J., Stephan, Y., Florent, J. F., & Vallee, P. (2008). A short and very short form of the physical self-inventory for adolescents: Development and factor validity. Psychology of Sport and Exercise, 9, 830–847. Doi:10.1016/j.psychsport.2007.10.00McKnight, K. M., Bernes, K. B., Gunn, T., Chorney, D., Orr, D. T., & Bardick, A. D. (2009). Life After Sport: Athletic Career Transition and Transferable Skills. Journal of Excellence, 13, 63-77. Retrieved from http://hdl.handle.net/10133/1175McMillan, W. (2016). The phenomenological analysis of psychospiritual transformation in athletic retirement and everyday narcissism in former athletes. University of Lethbridge Research Repository. Retrieved from: http://hdl.handle.net/10133/4450Maffulli, N., Longo, U. G., Spiezia, F. & Denaro V. (2010). Sports injuries in young athletes: Long-term outcome and prevention strategies. The Physician and Sports Medicine, 2 (38), 29-34. ISSN – 0091-3847Mohamed, Z. (2017). The reflection physical education and sports on configuration self- physical in adolescents. International Journalof Fitness Health, Physical Education and Iron Games, 4(2), 62-69. Retrieved from: https://www.researchgate.net/publication/325742983O'Brien, J. C. & Eller, C. (2016). Representing retired athletes. Arts, Sports & Law. Hennepin Lawyer, 12-14. Retrieved from: thl@hcba.orgPark, S. & Lavallee, D. (2015). Roles and influences of Olympic athletes’ entourages in athletes’ preparation for career transition out of sport. Sport and Exercise Psychology Review, 11 (1), 3-19. ISSN: 1745-4980.Park, S., Lavallee, D., & Tod, D. (2012). Athletes’ career transit ion out of sport. International Review of Sport and Exercise Psychology, 6, 22-53.Polit, D. F., & Beck, C. T. (2010). Generalization in quantitative and qualitative research: Myths and strategies. International Journal of Nursing Studies, 47, 1451-1458. Doi: 10.1016/j.ijnurstu.2010.06.004 Potgieter, S. (2013). Sport nutrition: A review of the latest guidelines for exercise and sport nutrition from the American College of Sport Nutrition, the International Olympic Committee and the International Society for Sports Nutrition. South African Journal of Clinical Nutrition, 26(1), 6-16.Runeson, P., & Host, M. (2009). Guidelines for conducting and reporting case study research in software engineering. Empirical Software Engineering, 14(2), 131-164. doi:10.1007/s10664-008-9102-8Saunders, M., Lewis, P., & Thornhill, A. (2010). Research Methods for Business Students (5th ed.). Philippines: Pearson Education. Thompson, W. R. (2018). Worldwide survey of fitness trends: The CREP edition. American College of Sports Medicine (ACSM's) Health and Fitness Journal.Tshube, T. & Feltz, D. L. (2015). The relationship between dual- career and post-sport career transition among elite athletes in South Africa, Botswana, Namibia and Zimbabwe. Psychology of Sport & Exercise. DOI: 10.1016/j.psychsport.2015.05.005Tulle, E. (2008). Acting your age? Sports science and the ageing body. Journal of Aging Studies, 22, 340-347. doi:10.1016/j.jaging.2008.05.005Wessa P. (2017). Cronbach alpha (v1.0.5) in Free Statistics Software (v1.2.1), Office for Research Development and Education. Retrieved from: https://www.wessa.net/rwasp_cronbach.wasp/Villanova A. & Puig, N. (2014). Personal strategies for managing a second career: The experiences of Spanish Olympians. International Review for the Sociology of Sport, 1–18. DOI: 10.1177/1012690214536168Wiles, R., Crow, G., Heath, S., & Charles, V. (2008). The management of confidentiality and anonymity in social research. International Journal of Social Research Methodology, 11(5), 417-428. Retrieved from http://eprints.ncrm.ac.uk/651/1/The_Management_of_Confidentiality_and_Anonymity_in_ Social_Research.pdf

Ixodes scapularis ticks are expanding their range in parts of northeastern North America, bringing with them pathogens of public health concern. While rodents like the white-footed mouse, Peromyscus leucopus, are considered the primary reservoir of many emerging tick-borne pathogens, the contribution of birds, as alternative hosts and reservoirs, to local transmission cycles has not yet been firmly established. From 2016 to 2018, we collected host-seeking ticks and examined rodent and bird hosts for ticks at 48 sites in a park where blacklegged ticks are established in Quebec, Canada, in order to characterize the distribution of pathogens in ticks and mammalian and avian hosts. We found nearly one third of captured birds (n = 849) and 70% of small mammals (n = 694) were infested with I. scapularis. Five bird and three mammal species transmitted Borrelia burgdorferi to feeding larvae (n larvae tested = 2257) and we estimated that about one fifth of the B. burgdorferi-infected questing nymphs in the park acquired their infection from birds, the remaining being attributable to mice. Ground-foraging bird species were more parasitized than other birds, and species that inhabited open habitat were more frequently infested and were more likely to transmit B. burgdorferi to larval ticks feeding upon them. Female birds were more likely to transmit infection than males, without age differentiation, whereas in mice, adult males were more likely to transmit infection than juveniles and females. We also detected Borrelia miyamotoi in larvae collected from birds, and Anaplasma phagocytophilum from a larva collected from a white-footed mouse. This study highlights the importance of characterising the reservoir potential of alternative reservoir hosts and to quantify their contribution to transmission dynamics in different species assemblages. This information is key to identifying the most effective host-targeted risk mitigation actions.

Background: To investigate relationships between five single nucleotide polymorphisms (SNP) in four maternal genes involved in one carbon metabolism and adverse pregnancy outcomes, including preterm birth (PTB), low birth weight (LBW), and small-for-gestational-age (SGA). Methods: This was a prospective mother and child cohort study in Wuqiang, China. Pregnant women (n = 939) were recruited from Jun 2016 to Oct 2018. Pregnancy outcomes (PTB, LBW, and SGA) were extracted from medical records and other information including age at childbearing, maternal education level, gravidity, parity, pre-pregnancy weight and height was collected by using a structured questionnaire. The maternal serum folate concentration was measured by using Abbott Architect i2000SR chemiluminescence analyzer in the first prenatal care visit. DNA genotyping of methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C, methionine synthase reductase (MTRR) A66G, methionine synthase (MTR) A2756G, and thymidylate synthetase (TYMS) rs3819102 was processed by Sequenom MassARRAY iPLEX Platform. Univariate and multivariate logistics regression analysis were used to test the relationships between 5 SNPs and PTB, LBW, SGA. Results: Totally, 849 dyads of women and infants were included in the analysis. The prevalence of PTD, LBW, and SGA were 3.76%, 1.58%, and 5.31% respectively. The homozygote frequencies of MTHFR C677T, MTHFR A1298C, MTRR A66G, MTR A2756G, and TYMS rs3819102 were 44.2%, 1.4%, 6.7%, 1.3%, and 3.2%, and the alt allele frequencies were 66.1%, 10.8%, 24.9%, 10.5%, and 20.5% respectively. The average serum folate concentration was 11.95 ng/mL and the folate deficiency rate was 0.47%. There were no significant associations between MTHFR C677T, MTHFR A1298C, MTRR A66G, MTR A2756G, TYMS rs3819102 alleles and PTD, LBW, SGA (p > 0.05). Conclusions: In the population with adequate folate status and low prevalence of adverse pregnancy outcomes, MTHFR C677T, MTHFR A1298C, MTRR A66G, MTR A2756G, TYMS rs3819102 alleles may not be related to PTD, LBW, and SGA.

87 Background: Combination therapies using the androgen deprivation therapy (ADT) backbone have revolutionized treatment of metastatic hormone sensitive prostate cancer (mHSPC). Combinations include ADT plus docetaxel (DOC) or the androgen receptor targeting agents (ARTAs) abiraterone (AA), enzalutamide (ENZ), apalutamide (APA), and darolutamide (DAR). This study evaluates the utilization of these therapies in de novo mHSPC in a cohort of veterans and assesses recent overall survival (OS) of these therapies. Methods: Veterans were identified from 2012-2021 in the Veterans Affairs Prostate Cancer Data Core (VAPC) and oncology tumor registries using the initial pathological diagnosis of prostate cancer with SEER stage ‘distant’. All veterans had ADT initiated within 1 month prior and 3 months after diagnosis in VAPC. Additional therapies including DOC or ARTAs were collected from VAPC if initiated from 1 month prior to 4 months after ADT initiation. Data cut point was June 2022. Results: 5,006 patients with de novo mHSPC were identified with median age of 73.1 years (yrs), and 1338 (26.7%) identified as Black race. From 2012 to 2021, ADT alone was used in 3,569 (71.3%) of veterans, DOC in 438 (8.7%) and ARTAs in 999 (20.0%), wherein use of different ARTAs was AA in 783 (78.4%), ENZ in 204 (20.4%), APA in 10 (1.0%), and DAR in 2 (0.2%). Use of combination therapy for mHSPC increased from 3.1% in 2012-2013 to 61.2% in 2020-2021. Use of DOC peaked in 2016 and was used in 16.3% of veterans that year. Veterans treated with DOC were significantly younger (median 67.3 yrs, p<0.001) compared to veterans treated with ARTAs (73.1 yrs) or ADT alone (74.3 yrs). Veterans treated with combination therapies had longer median OS compared to ADT alone (37.2 vs. 29.3 months, p<0.001), with no significant difference between DOC and ARTA combinations (p=0.84). For 2,042 veterans with de novo mHSPC treated from 2018-2021, median OS of veterans treated with ADT+DOC (n=161, 35.3 months) and ADT+ARTA (n=849, 41.2 months) was longer than ADT alone (n=1,032, 29.3 months, p<0.001). There was no significant difference in median OS between DOC and ARTA combinations in this group (p=0.69). Conclusions: In veterans presenting with de novo mHSPC, use of initial combination therapy has increased, with the majority of veterans treated with ADT and an ARTA in 2020-2021. In this cohort, combination therapy was associated with longer OS compared to ADT alone and no significant differences were found between type of combination and OS. [Table: see text]

ImportanceHeparin-induced thrombocytopenia (HIT) is a life-threatening condition that requires urgent diagnostic clarification. However, knowledge of the diagnostic utility of the recommended diagnostic tests is limited in clinical practice.ObjectiveTo evaluate the current diagnostic practice for managing the suspicion of HIT.Design, Setting, and ParticipantsThis prospective diagnostic study was conducted from January 2018 to May 2021 among consecutive patients with suspected HIT from 11 study centers in Switzerland, Germany, and the United States. Detailed clinical data and laboratory information were recorded. Platelet factor 4/heparin antibodies were quantified using an automated chemiluminescent immunoassay (CLIA). A washed-platelet heparin-induced platelet activation (HIPA) test was used as a reference standard to define HIT.ExposuresSuspicion of HIT.Main Outcomes and MeasuresThe primary outcome was the diagnostic accuracy of the 4Ts score, the CLIA, and the recommended algorithm serially combining both tests.ResultsOf 1448 patients included between 2018 and 2021, 1318 were available for the current analysis (median [IQR] age, 67 [57-75] years; 849 [64.6%] male). HIPA was positive in 111 patients (prevalence, 8.4%). The most frequent setting was intensive care unit (487 [37.0%]) or cardiovascular surgery (434 [33.0%]). The 4Ts score was low risk in 625 patients (46.8%). By 2 × 2 table, the numbers of patients with false-negative results were 10 (9.0%; 4Ts score), 5 (4.5%; CLIA), and 15 (13.5%; recommended diagnostic algorithm). The numbers of patients with false-positive results were 592 (49.0%; 4Ts score), 73 (6.0%; CLIA), and 50 (4.1%; recommended diagnostic algorithm), respectively.Conclusions and RelevanceIn this diagnostic study of patients suspected of having HIT, when the recommended diagnostic algorithm was used in clinical practice, antibody testing was required in half the patients. A substantial number of patients were, however, still misclassified, which could lead to delayed diagnosis or overtreatment. Development of improved diagnostic algorithms for HIT diagnosis should be pursued.

Background/Objectives: This study is to utilize the health services of N- citizens as a basic data for establishing the 7th Regional Health Plan (2018 ~ 2022) respectively.Methods/Statistical analysis: Tools for measuring the health care needs of the subjects were revised and supplemented by the tools of the Community Health Survey. Data was collected through a questionnaire from August 1 to August 21, 2018. Although 447 questionnaires were collected, 403 questionnaires were used for data analysis, except for 44 which were not clear or missing. The collected data were analyzed with the SPSS 18.0 program.Findings: The result showed that the overall health service level was 2.90 out of 4.0, and the kindness of staff in the sub - area was the highest with 3.32 points, followed by medical service level 2.86, modernization of facilities 2.77, and excellence in equipment 2.69 points. The total health care needs of the subjects were 3.38 out of 4.0, health care services and health promotion services were 3.41 points higher respectively. As a result of analyzing the difference between total health care need, health care service, health promotion service, elderly health service, maternal & child health service by general characteristics, only gender and total health care demand showed statistically significant differences(t=-2.095, p=.037). The result showed that there was positive correlation of the total health care need, health care service(r=.862, p<.01), health promotion service(r=.849, p<.01), elderly health service(r=.868, p<.01), maternal & child health service(r=.856, p<.01) in citizens of N city.Improvements/Applications: Development of a health promotion program is needed to improve the population’s health potential and the ability to overcome the risk factors of the disease.

Background: Evidence about the magnitude and determinants of medication intake adherence among patients and the general population in Southeastern Europe is scant. Aims: To assess the prevalence and sociodemographic correlates of medication intake adherence among adult primary health-care (PHC) users in Albania. Methods: A cross-sectional study was conducted in 2018–2019 in a representative sample of 1553 adult PHC users (response: 94%) selected probabilistically from 5 major regions of Albania. There were 849 (55%) women and 704 (45%) men, with a mean age 54.6 (16.4) years. A structured interviewer-administered questionnaire inquired about medication intake adherence prescribed by family physicians, and sociodemographic characteristics. Binary logistic regression was used to assess the sociodemographic correlates of medication intake adherence. Results: Three hundred (19.8%) participants did not take the prescribed medication. In multivariable-adjusted logistic model, significant correlates of nonintake of medication included rural residence, low educational level, unemployment and low economic level. Among these 300 participants, 273 (91%) considered the high cost of the drugs as a reason for not taking the medication. Conclusion: We found a high prevalence of nonintake of medication prescribed by family physicians. Decision-makers and policy-makers in Albania and elsewhere should consider the provision of essential drugs free of charge or at low cost to low socioeconomic groups and other vulnerable and marginalized population categories, because the costs of noncompliance will eventually be higher.

Abstract Background Patients with inflammatory bowel disease (IBD) have a greater risk of venous thromboembolism (VTE) events compared with the general population especially during flares, in both hospitalised and ambulatory patients. Although VTE prophylaxis (thromboprophylaxis) is recommended in hospitalised IBD patients, the implementation is not universal, especially for non-IBD-related hospitalisations. In this study, we aimed to present the rates of VTEs and thromboprophylaxis among hospitalised IBD patients. Methods We created an electronic data repository of all IBD patients who visited the emergency department (ED) of our tertiary medical centre between 2012 and 2018. Data included tabular demographic and clinical variables (reason for referral, VTEs, clinical characteristics, hospitalisation, lab results, treatment and outcome) as well as free-text physician records. For this study, we searched the data repository for VTE cases, using ICD10 coding. Results Overall, there were 7009 ED visits of 2405 patients with IBD, 1556 (64.7%) Crohn's disease and 849 (35.3%) Ulcerative colitis patients. Thromboprophylaxis was administered in 463 hospitalisations (12.4% of IBD-related and 10.9% of non-IBD-related hospitalisations). 1.5% of patients (36/2405) who visited the ED had a new VTE. Thirty patients were diagnosed with a deep vein thrombosis (DVT), two patients with a pulmonary embolism (PE) and six additional patients were diagnosed with both a DVT and PE in the same hospitalisation. Eleven patients had a VTE during a non-IBD-related hospitalisation and six patients during an IBD-related hospitalisation (0.6% vs. 0.3%, respectively, pv = 0.12). Five patients (29.4%) developed VTEs after receiving thromboprophylaxis during hospitalisation. The majority (72.7%) of VTEs diagnosed during a non-IBD-related hospitalisation did not have additional thrombosis-related risk factors. One patient died during hospitalisation and two more patients died in the upcoming 30 days (unrelated to VTEs). Conclusion The rate of thromboprophylaxis in hospitalised IBD patients is low, despite posing life-threatening implications. Thromboprophylaxis should be implemented in IBD patients hospitalised for all indications.

Abstract Objective The literature supports using tests developed in high-income countries to assess children in low and lower-middle income countries (LMICs) when carefully translated, adapted, and applied (Holding et al., 2018; Mitchell et al., 2017). Research has shown the Mullen Scales of Early Learning (MSEL) to have adequate validity and sensitivity when used in LMICs (Bangirana et al., 2014; Koura et al., 2013), as well as equivalency to the American normative sample in lower risk populations (Bornman et al., 2010). Here, we describe the pattern of MSEL results in rural Guatemala. Participants and Method Children (n = 842; M enrollment age = 15.9 months; range 0-5 years) enrolled in an observational study of postnatal Zika exposure in rural Guatemala were administered an adapted and translated version of the MSEL (Connery et al., in press). To date, 352 children completed one, 393 children completed two, and 97 children completed three MSELs, for a total of 1,429 administrations. Results MSEL composite scores were similar to the American normative sample in children &lt;12 months (M = 93.3, SD = 11.1), but lower for children ages 1-5 years (mean = 71.1, SD = 15.1, p &lt; 0.0001). Moreover, lower scores were observed in children ages 1-5 years for all MSEL subscales, with the largest differences observed in receptive language (&lt;12 years: mean = 47.8, SD = 7.1; 1-5 years: mean = 35.1, SD = 10.0, p &lt; 0.0001). Conclusions Results are consistent with research that demonstrates a widening gap in test performance over time between children from higher and lower risk communities (Fernald et al., 2011; Paxson et al., 2005; Schady et al., 2015). Although findings are not meant to diagnose individual children, they highlight population changes in neurodevelopmental skills and the need for a better understanding of developmental patterns in LMICs. Future analyses will evaluate the impact of developmental risk factors over time and the performance of the MSEL in this population. References Bangirana, P., Opoka, R. O., Boivin, M. J., Idro, R., Hodges, J. S., Romero, R. A., … John, C. C. (2014). Severe Malarial Anemia is Associated With Long-term Neurocognitive Impairment. Clinical Infectious Diseases, 59(3), 336–344. https://doi.org/10.1093/cid/ciu293. Bornman, J., Sevcik, R. A., Romski, M., & Pae, H. K. (2010). Successfully Translating Language and Culture when Adapting Assessment Measures, ppi_254 111.118. Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1741-1130.2010.00254.x. Fernald, L. C. H., Weber, A., Galasso, E., & Ratsifandrihamanana, L. (2011). Socioeconomic gradients and child development in a very low income population: Evidence from Madagascar. Developmental Science, 14(4), 832–847. https://doi.org/10.1111/j.1467-7687.2010.01032.x. Holding, P., Anum, A., van de Vijver, F. J. R., Vokhiwa, M., Bugase, N., Hossen, T., … Gomes, M. (2018). Can we measure cognitive constructs consistently within and across cultures? Evidence from a test battery in Bangladesh, Ghana, and Tanzania. Applied Neuropsychology: Child, 7(1), 1-13 https://doi.org/10.1080/21622965.2016.1206823. Koura, K. G., Boivin, M. J., Davidson, L. L., Ouédraogo, S., Zoumenou, R., Alao, M. J., … Bodeau-Livinec, F. (2013). Usefulness of child development assessments for low-resource settings in francophone Africa. Journal of Developmental and Behavioral Pediatrics : JDBP, 34(7), 486–93. https://doi.org/10.1097/DBP.0b013e31829d211c. Mitchell, J. M., Tomlinson, M., Bland, R. M., Houle, B., Stein, A., & Rochat, T. J. (2017). Confirmatory factor analysis of the Kaufman assessment battery in a sample of primary school-aged children in rural South Africa. South African Journal of Psychology, 1–19. https://doi.org/10.1177/0081246317741822. Paxson, C., Schady, N., Izquierdo, S., León, M., Lucio, R., Ponce, J., … Hall, W. (2005). Cognitive Development among Young Children in Ecuador The Roles of Wealth, Health, and Parenting. Retrieved from http://econ.worldbank.org. Schady, N., Behrman, J., Araujo, M. C., Azuero, R., Bernal, R., Bravo, D., … Vakis, R. (2015). Wealth gradients in early childhood cognitive development in five Latin American countries. The Journal of Human Resources, 50(2), 446–463. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25983344.

Background Understanding the characteristics of commenters on mental health–related online forums is vital for the development of effective psychological interventions in these communities. The way in which commenters interact can enhance our understanding of their characteristics. Objective Using eating disorder–related (EDR) forums as an example, this study detailed a methodology that aimed to determine subtypes of mental health–related forums and profile their commenters based on the other forums to which they contributed. Methods The researchers identified all public EDR forums (with ≥500 contributing commenters between March 2017 and February 2018) on a large Web-based discussion platform (Reddit). A mixed-methods approach comprising network analysis with community detection, text mining, and manual review identified subtypes of EDR forums. For each subtype, another network analysis with community detection was conducted using the EDR forum commenter overlap between 50 forums on which the commenters also commented. The topics of forums in each detected community were then manually reviewed to identify the shared interests of each subtype of EDR forum commenters. Results Six subtypes of EDR forums were identified, to which 14,024 commenters had contributed. The results focus on 2 subtypes—proeating disorder and thinspiration—and communities of commenters within both subtypes. Within the proeating disorder subtype, 3 communities of commenters were detected that related to the body and eating, mental health, and women, appearance, and mixed topics. With regard to the thinspiration group, 78.17% (849/1086) of commenters had also commented on pornographic forums and 16.66% (181/1086) had contributed to proeating disorder forums. Conclusions The article exemplifies a methodology that provides insight into subtypes of mental health–related forums and the characteristics of their commenters. The findings have implications for future research and Web-based psychological interventions. With the publicly available data and code provided, researchers can easily reproduce the analyses or utilize the methodology to investigate other mental health–related forums.

The first Hungarian kidney transplantation was performed by András Németh in Szeged in 1962, approximately 50 years ago. A preliminary agreement with Eurotransplant was signed in 2011, and special patient groups gained benefit from this cooperation in 2012, wnich lead to a full membership to Eurotransplant. This event inspired the authors to review the history of Hungarian kidney transplantation of the past 50 years, from the first operation to recent via the specific cornerstones of the transplant program. The donor of the first Hungarian kidney transplantation was the brother of the recipient. The operation itself was technically successful, but the lack of immunosuppression caused graft rejection, and the patient died after 79 days. His brother, the donor, is still healthy, after 50 years, and he encourages everybody to donate organs. Organized kidney transplant program started more than 10 years later, such as 1973, in Budapest. The program was supported by the Ministry of Health. New centers joined the program later, Szeged in 1979, Debrecen in 1991 and Pécs in 1993. These four transplant centers work currently in Hungary, and 6611 kidney transplantation has been performed up to the end of year 2012. Orv. Hetil., 2013, 154, 846–849.

10596 Background: Tumor CGP may identify both somatic and GL variants, though confirmatory testing is required to verify which variants originate from the GL. Studies have shown CGP can identify patients who both do and do not meet criteria for genetic counseling (GC). Ideally, improved annotation from tumor CGP could more appropriately direct GC referrals. We explore how a computational algorithm might be used to influence GC and confirmatory GL testing for variants in inherited cancer predisposition genes. Methods: 849 patients from the Aurora Oncology Precision Medicine Program who had routine hybrid-capture based CGP by Foundation Medicine from 8/2018-8/2020 were eligible. A previously published algorithm, SGZ (Sun et al PMID 29415044) which incorporates allele frequency, aneuploidy, and admixed copy number modeling was used to predict whether each single nucleotide variant (SNV) was GL or somatic. SGZ predictions for SNVs in 24 actionable inherited cancer predisposition genes were available to Aurora for review as part of standard screening to identify appropriate GC referrals. For patients who had GL testing, variants in genes on both assays were compared. Results: 76 pathogenic (P) or likely pathogenic (LP) variants predicted to be GL by SGZ were detected in 73/849 (9%) patients: ATM (7), BAP1 (2), BRCA1 (13), BRCA2 (8), BRIP1 (1), CHEK2 (18), FH (0), FLCN (2), MLH1 (1), MSH2 (0), MSH6 (3), MUTYH (12), PALB2 (3), PMS2 (1), POLE (0), RAD51C (1), RAD51D (0), RET (1), SDHA/B/C/D (0,0,0,0), TSC2 (0), and VHL (3). 27/73 (37%) patients had GL testing. 25/26 (96%) variants were confirmed to be GL in origin and 1 additional variant was detected by CGP in a region not interrogated by the GL assay: ATM (2/2), BRCA1 (6/6), BRCA2 (2/2), BRIP1 (1/1), CHEK2 (9/9), FLCN (0*/1), MSH6 (1/1), MUTYH (2/2), PALB2 (1/1), RAD51C (1/1), and VHL (0/1). Variants were confirmed in bladder, breast, CRC, glioma, NSCLC, ovary, pancreas, prostate, sarcoma, and gastric cancer. The VHL variant was discordant in a leiomyosarcoma. Conclusions: We identified the potential real-world clinical impact of computationally screening solid tumor patients undergoing routine CGP for potential P/LP GL variants. Predicting GL results with SGZ for 24 inherited cancer predisposition genes was highly concordant with confirmatory GL testing independent of tumor type. CGP annotations can facilitate GC referral and GL testing for at-risk patients, particularly in tumor types which may not typically meet guidelines for GL testing.[Table: see text]

Background: A preliminary survey of prospective researchers in the Kendari City General Hospital especially in the Emergency Installation (ER), the number of emergency room visits has decreased in the last 3 years, in 2017 the total number of patients treated in the ER was 10.869 patients, then in 2018 the number of visits decreased to 10.768 patients, and in 2019 the number of visits fell to 9.747 patients. Meanwhile, based on the data in the last few months in 2020 there was a very large spike in decline in the last month, in January 2020 the number of patient who visited, were 849 people, then in February 2020 the number of the patient were 1202 patients, March 2020 the number of visits was 1216 patients and finally in April 2020 it fell to 451 people. The purpose of this study is to analyse the effect of separation of the initial assessment documents on Length of Stay in Emergency Installation in Kendari City General Hospital. Methods: The research design was experimental with design pretest post-test one group design. The research location was in the Emergency Room of the Kendari City Regional General Hospital which was carried out during February 2021. The population of all patients who were hospitalized was> 17 years old while the sample was 18 people with the sampling technique of separated random sampling. Result: This study found separation of the initial assessment documents affected significantly to Length of Stay patients in Emergency room in Kendari City General Hospital (p- value = 0.045 < 0.05). Conclusion: Separation technique of the initial assessment documents on Length of Stay was effective to reduce the Length of Stay patients in Emergency room in Kendari City Hospital.

This article seeks to deepen the debate on leadership, exploring specifcities of the Brazilian context on this topic, more specifically the principle of democratic management. The reflection focuses on both topics, explaining the path of the debate on democratic management since the mid-eighties of the twentieth century, passing through the Federal Constitution of 1988, the Law of Guidelines and Bases of National Education - Law number 9.394/96) and arriving on the most recent context, where the National Education Plan (PNE), of 2014, incorporates the subject to its goals. Considerations are presented on program contents of two national training programs: the Distance Training Program for School Managers (Progestão) and the National School Program for Managers of Basic Public Education (PNEGEB), also known as School of Managers. The main regulatory frameworks for democratic management are focused on relevant legislation. The study allows us to suggest the hypothesis that the principle of democratic management, associated with a political leadership, would have preponderated in the literature and initiatives of formation of school directors in the country, being the more technical dimension of the subject a little prioritized theme. In this sense, it can be said that the topic of leadership, as it is configured in other contexts, has become a repressed demand in Brazilian educational policy.ResumoEste artigo procura aprofundar o debate sobre liderança, explorando especificidades do contexto brasileiro em relação a esta temática, mais especificamente o princípio da gestão democrática. A reflexão detém-se sobre os dois temas, explicitando a trajetória do debate sobre gestão democrática desde meados dos anos oitenta do século XX, passando pela Constituição Federal de 1988, a Lei de Diretrizes e Bases da Educação Nacional – LDB (Lei nº 9.394/96) e chegando ao contexto mais recente, onde o Plano Nacional de Educação (PNE) de 2014 incorpora o assunto às suas metas. São apresentadas considerações sobre conteúdos programáticos de dois programas nacionais de formação: o Programa de Capacitação a Distância para Gestores Escolares (Progestão) e o Programa Nacional Escola de Gestores da Educação Básica Pública (PNEGEB), também conhecido como Escola de Gestores. Os principais marcos regulatórios da gestão democrática são focalizados na legislação pertinente. O estudo permite sugerir a hipótese de que o princípio da gestão democrática, associado a uma liderança de natureza política, teria preponderado na literatura e iniciativas de formação de diretores escolares no país, sendo a dimensão mais técnica do assunto um tema pouco priorizado. Nesse sentido, pode-se dizer que o tema da liderança, tal como se configura em outros contextos, tem se constituído em demanda reprimida na política educacional brasileira.ResumenEste artículo busca profundizar el debate sobre liderazgo, explorando especificidades del contexto brasileño en relación a esta temática, más específicamente el principio de la gestión democrática. La reflexión se detiene sobre los dos temas, explicitando la trayectoria del debate sobre gestión democrática desde mediados de los años ochenta del siglo XX, pasando por la Constitución Federal de 1988, la Ley de Directrices y Bases de la Educación Nacional - LDB (Ley nº 9.394/96) y llegando al contexto más reciente, donde el Plan Nacional de Educación (PNE), de 2014, incorpora el asunto a sus metas. Se presentan consideraciones sobre contenidos programáticos de dos programas nacionales de formación: el Programa de Capacitación a Distancia para Gestores Escolares (Progestão) y el Programa Nacional Escuela de Gestores de la Educación Básica Pública (PNEGEB), también conocido como Escuela de Gestores. Los principales marcos regulatorios de la gestión democrática se centran en la legislación pertinente. El estudio permite sugerir la hipótesis de que el principio de la gestión democrática, asociado a un liderazgo de naturaleza política, habría preponderado en la literatura e iniciativas de formación de directores escolares en el país, siendo la dimensión más técnica del tema un tema poco priorizado. En ese sentido, se puede decir que el tema del liderazgo, tal como se configura en otros contextos, se ha constituido en demanda reprimida en la política educativa brasileña.Keywords: Leadership and democratic management, Educational legislation, Public policies, Scholar managers training.Palavras-chave: Liderança e gestão democrática, Legislação educacional. Políticas públicas, Formação de gestores escolares.Palabras claves: Liderazgo y gestión democrática, Legislación educativa, Políticas públicas, Formación de gestores escolares.ReferencesALMEIDA, Bruno Luiz Teles de. Construindo uma gestão democrática no Estado da Bahia: contribuições do Curso de Especialização em Gestão Escolar promovido pelo Programa Escola de Gestores. Universidade Federal da Bahia. 2015. Dissertação de Mestrado, 2015. Disponível em: https://repositorio.ufba.br/ri/handle/ri/17694. Acesso em: 27 out. 2018.BENTO, António; OLIVEIRA, Maria Isabel. A liderança escolar a três dimensões: diretores, professores e alunos. Bragança: Ideias em prática, 2013. Disponível em: https://bibliotecadigital. ipb.pt/handle/10198/9560. Acesso em: 18 ago. 2018.BIANCO, Mônica de Fátima; SOUZA, Eloísio Moulin de; SOUZA-REIS, Antônio Marcos. A nova gestão pública: um estudo do Pró-gestão focado em dois projetos prioritários no estado do Espírito Santo. Revista Gestão e Planejamento, Salvador, v. 15, n. 1, p. 118-143, jan./abr. 2014.BOLIVAR, Antonio. El liderazgo pedagógico de la dirección escolar en España: limitaciones y acciones. In: LIMA, Licinio; SÁ, Virginio (orgs.). O Governo das escolas: democracia, controlo e performatividade. Ribeirão: Edições Humus, 2017, p. 151-171. Acesso em: 18 ago. 2018.BOLIVAR, Antonio; YÁÑEZ, Julián López; MURILLO, F. Javier. Liderazgo en las instituciones educativas. Una revisión de líneas de investigación. School leadership. A review of current research perspectives. Red de Investigación sobre Liderazgo y Mejora Educativa (RILME). Revista Fuentes, 14, 2013, pp. 15-60. Disponível em: http://institucional.us.es/revistas/fuente/14/Firma%20invitada.pdf> Acesso em: 18 ago. 2018.BRASIL. Constituição Federal de 1988. Disponível em http://www.planalto.gov.br/ccivil _03/constituicao/ConstituicaoCompilado.Htm. Acesso 6 dez. 2018.BRASIL. Lei nº 9.394, de 20 de dezembro de 1996. Estabelece as diretrizes e bases da educação nacional. Disponível em http://www.planalto.gov.br/ccivil_03/Leis/l9394.htm. Acesso 14 jun. 2018.BRASIL. MEC. INEP. Desempenho dos alunos na Prova Brasil: diversos caminhos para o sucesso escolar nas redes municipais de ensino. Brasília: Instituto Nacional de Estudos e Pesquisas Educacionais, 2008.BRASIL. MEC. UNICEF. UNDIME. Aprova Brasil: o direito de aprender – boas práticas em escolas públicas avaliadas pela Prova Brasil. 2. ed. Brasília: MEC.UNICEF, 2007. Disponível em: <https://www.unicef.org/brazil/pt/aprova_final.pdf> Acesso em: 07 ago. 2018.BRASIL. MEC. UNICEF. UNDIME. Redes de aprendiizagem: boas práticas de municipios que garantem o direito de aprender.BRASIL. Presidência da República. Casa Civil. Subchefia para Assuntos Jurídicos. Lei nº 13.005, de 25 de junho de 2014. Aprova o Plano Nacional de Educação – PNE e dá outras providências.BROOKE, Nigel; SOARES, José Francisco (orgs.). Pesquisa em eficácia escolar: origem e trajetórias. Belo Horizonte: Editora UFMG, 2008.BUENO, Edna Maria Gomes da Silva. A dimensão pedagógica do papel do diretor na gestão escolar: análise do Progestão - programa de capacitação a distância para gestores escolares da Secretaria de Educação do Estado de São Paulo. 2007. Dissertação (Mestrado em Educação e Formação). Universidade Católica de Santos, Santos, 2007. Disponível em: http://biblioteca.unisantos.br:8181/handle/tede/112>. Acesso em: 27 out. 2018.EVANGELISTA, Karla Karine Nascimento Fahel. Formação de gestores escolares: um estudo em escolas públicas do Ceará. 2016. Dissertação de Mestrado. Programa de Pós-Graduação em Educação. Universidade Estadual do Ceará. Fortaleza, 2016.FAORO, Raymundo. Os donos do poder: formação do patronato político brasileiro. Rio de Janeiro: Globo, 3ª ed, revista, 2001.FERNANDES, Cássia do Carmo Pires; TEIXEIRA, Beatriz de Basto. Avaliação do Programa Escola de Gestores: os desafios da pesquisa com egressos. Revista Temas em Educação, João Pessoa, v. 24, n.1, p.78-90, jan-jun. 2015.FERNANDES, Cássia do Carmo Pires. O programa escola de gestores da educação básica e seus efeitos para a formação de gestores escolares em Minas Gerais. 2014. Dissertação de Mestrado. Universidade Federal de Juiz de Fora. 2014. Disponível em: https://repositorio.ufjf.br/jspui/handle/ufjf/184> Acesso em: 27 out. 2018.FERREIRA, Maria Salonilde. A IV Conferência Brasileira de Educação: algumas considerações. Revista Educação em Questão. V. 1. N. 1. Jan./Jun. 1987. Disponível em: https://periodicos.ufrn.br/educacaoemquestao/article/view/12026> Acesso em: 26 out. 2018.HONORATO, Hercules Guimarães. O gestor escolar e suas competências: a liderança em discussão. Disponível em http://www.anpae.org.br/iberoamericano2012/Trabalhos/ HerculesGuimaraesHonorato_res_int_GT8.pdf. Acesso em: 26 out. 2018.INEP. Relatório do 2º Ciclo de Monitoramento das Metas do Plano Nacional de Educação. Brasília, 2018. Disponível em http://portal.inep.gov.br/informacao-da-publicacao/-/asset_publisher/6JYIsGMAMkW1/document/id/1476034. Acesso em 31 out. 2018.LEITHWOOD, K.; DAY, C.; SAMMONS, P; HARRIS, Alma; HOPKINS, D. Successful school leardership. What it is and how it influences pupil learning. National College for School Leadership. Research Report n° 800. University of Nottingham. 2006. Disponível em http://www.nysed.gov/common/nysed/files/principal-project-file-55-successful-school-leadership-what-it-is-and-how-it-influences-pupil-learning.pdf. Acesso em 31 out. 2018.LIMA, Licinio; SÁ, Virginio (orgs.). O Governo das escolas: democracia, controlo e performatividade. Ribeirão: Edições Humus, 2017. LÜCK, Heloísa. Dimensões da gestão escolar e suas competências. Curitiba: Editora Positivo, 2009.LÜCK, Heloísa. Liderança em gestão escolar. Petrópolis: Vozes, 2008.LÜCK, Heloísa. Mapeamento de práticas de seleção e capacitação de diretores escolares. Estudos e pesquisas. São Paulo: Fundação Victor Civita, 2011, p. 167-225. Disponível em: http://www.fvc.org.br/pdf/livro2-03-mapeamento.pdf. Acesso em: 25 set. 2016.MAGALDI, Ana Maria; GONDRA, José G. A reorganização do campo educacional no Brasil: manifestações, manifestos e manifestantes. Rio de Janeiro: 7Letras, 2003.MELO, Marisete Fernandes de. Programa nacional escola de gestores para a educação básica: um olhar sobre a proposta e execução na Paraíba (2010 - 2012). 2017. Dissertação de Mestrado. Universidade Federal da Paraíba. Mestrado Profissional em Políticas Públicas, Gestão e Avaliação da Educação, 2017. Disponível em https://repositorio.ufpb.br/ jspui/handle/tede/9320. Acesso em 31 out. 2018.NOGUEIRA, Danielle Xabregas Pamplona. Programa de Capacitação a Distância de Gestores Escolares – Progestão no Estado do Pará: um estudo sobre a implementação do curso de especialização, no período de 2001 a 2002. 2008. Dissertação(Mestrado em Educação). Universidade de Brasília, Brasília, 2008. Disponível em: http://repositorio.unb.br/handle/10482/1845. Acesso em: 27 out. 2018.OLIVEIRA, Ana Cristina Prado de. Gestão, liderança e clima escolar. Curitiba: Appris, 2018.OLIVEIRA, Ana Cristina Prado de; CARVALHO, Cynthia Paes de. Gestão escolar, liderança do diretor e resultados educacionais no Brasil. Rev. Bras. Educ. 2018, vol.23, p. 1-18. Disponível em: http://www.scielo.br/pdf/rbedu/v23/1809-449X-rbedu-23-e230015.pdf. Acesso em: 19 ago. 2018.OLIVEIRA, Ana Cristina Prado de; WALDHELM, Andrea Paula Souza. Liderança do diretor, clima escolar e desempenho dos alunos: qual a relação? Ensaio: aval. pol. públ. Educ., Rio de Janeiro, v. 24, n. 93, p. 824-844, out./dez. 2016. Disponível em http://www.scielo.br/pdf/ensaio/v24n93/1809-4465-ensaio-24-93-0824.pdf. Acesso em 12 jun. 2018. PENA, Anderson Córdova. Um conceito para liderança escolar: estudo realizado com diretores de escolas da rede pública estadual de Minas Gerais. 2013. Universidade Federal de Juiz de Fora. Tese de Doutorado. 2013. Disponível em: https://repositorio.ufjf.br/jspui/ handle/ufjf/2426. Acesso em 31 out. 2018.PINHEIRO, Camila Mendes; DAL RI, Neusa Maria. Democratização da educação na década de 1980: o Fórum da Educação na Constituinte e a IV Conferência Brasileira de Educação 1986. Disponível em: http://www.histedbr.fe.unicamp.br/acer_histedbr/jornada/ jornada11/artigos/8/artigo_simposio_8_749_mila_pinheiro_@hotmail.com.pdf Acesso em: 26 out. 2018.PINHEIRO, Camila Mendes. O Fórum Nacional em Defesa da Escola Pública e o princípio de gestão democrática na Constituição Federal de 1988. 2015. 234 f. Dissertação (mestrado). Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Filosofia e Ciências, 2015. Disponível em: http://hdl.handle.net/11449/ 124369. Acesso em: 26 out. 2018.POLON, Thelma Lucia P. Perfis de liderança e seus reflexos na gestão escolar. In: 34ª Reunião Anual da ANPED, 2011, Anais... Natal/RN: Centro de Convenções, 2011.ROMANO, Alessandro Segala; OLIVEIRA, Márcia Pacini de. A gestão participativa e o papel da liderança do diretor na educação profissional. Revista InSIET: Revista In Sustentabilidade, Inovação & Empreendedorismo Tecnológico, São Paulo, v. 2 n. 2, agosto/dezembro de 2015.RUA, Maria das Graças. Análise de políticas públicas: conceitos básicos. s. d.SCOTUZZI, Claudia Aparecida Sorgon. Gestão democrática nas escolas e progestão: que relação é esta?. 2008. Dissertação (mestrado). Universidade Estadual Paulista, Instituto de Biociências de Rio Claro, 2008. Disponível em: <http://hdl.handle.net/11449/90065> Acesso em: 27 out 2018.SILVA, Givanildo da; SILVA, Alex Vieira da; SANTOS, Inalda Maria dos Santos. Concepções de gestão escolar pós–LDB: o gerencialismo e a gestão democrática. Revista Retratos da Escola, Brasília, v. 10, n. 19, p. 533-549, jul./dez. 2016.SILVA, Luís Gustavo Alexandre da; ALVES, Miriam Fábia. Gerencialismo na escola pública: contradições e desafios concernentes à gestão, à autonomia e à organização do trabalho escolar. RBPAE - v. 28, n. 3, p. 665-681, set/dez. 2012. SOTTANI, Natália Bazoti Brito; MARIANO, Sandra Regina Holanda; MORAES, Joysi; DIAS, Bruno Francisco. Políticas públicas de formação de diretores de escolas públicas no Brasil: Uma análise do Programa Nacional Escola de Gestores da Educação Básica (PNEGEB). ARCHIVOS ANALÍTICOS DE POLÍTICAS EDUCATIVAS / EDUCATION POLICY ANALYSIS ARCHIVES, v. 26, p. 153, 2018.SOUZA, Celina. Introdução Políticas Públicas: uma revisão da literatura. Sociologias, Porto Alegre, ano 8, nº 16, jul/dez 2006, p. 20-45. TEODORO, António. Considerações breves sobre transdiciplinaridade de um campo de estudos. Revista de Humanidades e Tecnologias. s.d. p. 117-121. Disponível em: http://recil.ulusofona.pt/bitstream/handle/10437/2356/1019.pdf?sequence=1. Acesso em: 08 dez. 2018.UNESCO. El liderazgo escolar em América Latina y el Caribe: un estado del arte com base en ocho sistemas escolares de la región. Oficina Regional de Educación para América Latina y el Caribe (OREALC/UNESCO Santiago). 2014. Disponível em http://unesdoc.unesco.org/images/0023/002327/232799s.pdf. Acesso em 31 out. 2018.VAILLANT, Denise. Liderazgo escolar, evolución de políticas y prácticas y mejora de la calidad educativa. 2015. Disponivel em http://www.maestro100puntos.org.gt/ sites/default/files/liderazgo-escolar-evolucion-de-politicas-mejora-de-la-calidad-unesco.pdf. Acesso em 31 out. 2018.VIDAL, Eloisa Maia; VIEIRA, Sofia Lerche. Meta 19. In: INEP Plano Nacional de Educação PNE 2014 - 2024: Linha de Base. Brasília, DF: Inep, 2015. p. 313 – 334. Disponível em http://portal.inep.gov.br/informacao-da-publicacao/-/asset_publisher/6JYIsGMAMkW1/ document/id/493812. Acesso em 31 out. 2018.VIEIRA, Sofia Lerche. Poder local e educação no Brasil: dimensões e tensões. RBPAE. v.27, n.1, p. 123-133, jan./abr. 2011. Disponível em file:///C:/Users/elois/Downloads/ 19972-72432-1-PB.pdf. Acesso em 31 out. 2018.WEINSTEIN, José. (org.). Liderazgo educativo en las escuelas: nueve miradas. Santiago de Chile, Salesianos Impresores, 2016.

One form of early mathematical recognition is to introduce the concept of geometric shapes. Geometry is an important scientific discipline for present and future life by developing various ways that fit 21st century skills. This study aims to overcome the problem of early mathematical recognition of early childhood on geometry, especially how to recognize geometric forms based on computer learning. A total of 24 children aged 4-5 years in kindergarten has to carrying out 2 research cycles with a total of 5 meetings. Treatment activities in each learning cycle include mentioning, grouping and imitating geometric shapes. There were only 7 children who were able to recognize the geometric shapes in the pre-research cycle (29.2%). An increase in the number of children who are able to do activities well in each research cycle includes: 1) The activities mentioned in the first cycle and 75% in the second cycle; 2) Classifying activities in the first cycle were 37.5% and 75% in the second cycle; 3) Imitation activities in the first cycle 54.2% and 79.2% in the second cycle. The results of data acquisition show that computer learning application can improve the ability to recognize geometric shapes, this is because computer learning provides software that has activities to recognize geometric shapes with the animation and visuals displayed. Keywords: Early Childhood Computer Learning, Geometry Forms, Early Math Skills Reference Alia, T., & Irwansyah. (2018). Pendampingan Orang Tua pada Anak Usia Dini dalam Penggunaan Teknologi Digital. A Journal of Language, Literature, Culture and Education, 14(1), 65– 78. https://doi.org/10.19166/pji.v14i1.639 Ameliola, S., & Nugraha, H. D. (2013). Perkembangan Media Informasi dan Teknologi Terhadap Anak di Era Globalisasi. International Conferences in Indonesian Studies : “Etnicity and Globalization.” Anderson, L. W., Krathwohl, D. R., & Bloom, B. S. (2001). A taxonomy for learning, teaching, and assessing: a revision of Bloom’s taxonomy of educational objectives. New York: Longman. Arikunto, S. (2010). Prosedur Penelitian Suatu Pendekatan Praktik. Jakarta: Asdi Mahasatya. Arsyad, N., Rahman, A., & Ahmar, A. S. (2017). Developing a self-learning model based on open-ended questions to increase the students’ creativity in calculus. Global Journal of Engineering Education, 19(2), 143–147. https://doi.org/10.26858/gjeev19i2y2017p143147 Asiye, I., Ahmet, E., & Abdullah, A. (2018). Developing a Test for Geometry and Spatial Perceptions of 5-6 Year-Old. Kastamonu Education Journal, 26(1). Aslan, D., & Yasare, A. (2007). Three to Six Years OldChildren’s Recognition of Geometric Shapes. International Journal of Early Years Education, 15 :1, 83–104. Ben-Yehoshua, D., Yaski, O., & Eilam, D. (2011). Spatial behavior: the impact of global and local geometry. Animal Cognition Journal, 13(3), 341–350. https://doi.org/10.1007/s10071- 010-0368-z Charlesworth, R., & Lind, K. K. (2010). Math and Sciend for Young Children. Canada: Wadsworth/Cengage Learning. Chen, J.-Q., & Chang, C. (2006). using computers in early childhood classrooms teachers’ attitudes,skills and practices. Early Childhood Research. Clements, D. H., & Samara. (2003). Strip mining for gold: Research and policy in educational technology—a response to “Fool’s Gold.” Association for the Advancement of Computing in Education (AACE) Journal, 11(1), 7–69. Cohen, L., & Manion, L. (1994). Research Methods in Education (fourth edi). London: Routledge. Conorldi, C., Mammarela, I. C., & Fine, G. G. (2016). Nonverbal Learning Disability (J. P. Guilford, Ed.). New York. Corey, S. M. (1953). Action Research to Improve School Practice. New York: Teachers College, Columbia University. Couse, L. J., & Chen, D. W. (2010). A tablet computer for young children? Exploring its viability for early childhood education. Journal of Research on Technology in Education, 43(1), 75– 98. https://doi.org/10.1080/15391523.2010.10782562 Delima, R., Arianti, N. K., & Pramudyawardani, B. (2015). Identifikasi Kebutuhan Pengguna Untuk Aplikasi Permainan Edukasi Bagi Anak Usia 4 sampai 6 Tahun. Jurnal Teknik Informatika Dan Sistem Informasi, 1(1). Depdiknas. (2007). Permainan Berhitung Permulaan Di Taman Kanak-kanak. In Pedoman Pembelajaran. Jakarta: Depdiknas. Djadir, Minggi, I., Ja’faruddin., Zaki, A., & Sidjara, S. (2017). Sumber Belajar PLPG 2017: Bangun Datar. In Modul PLPG. Jakarta: Kementrian Pendidikan dan Kebudayaan Direktorat Jenderal Guru dan Tenaga Kependidikan.Dooley, T., Dunphy, E., & Shiel, G. (2014). Mathematics in Early Childhood and Primary Education (3-8 years). Duncan, G. J., Dowsett, C. J., Claessens, A., Magnuson, K., Huston, A. C., Klebanov, P., ... Japel, C. (2007). School Readiness and Later Achievement. Developmental Psychology, 43(6), 1428–1446. https://doi.org/10.1037/0012-1649.43.6.1428 Duncan, G. J., & Magnuson, K. (2011). The nature and impact of early achievement skills, attention skills, and behavior problems. Whither Opportunity?: Rising Inequality, Schools, and Children’s Life Chances, (0322356), 47–69. Edwards, S. (2009). Early Childhood Education and Care: a sociocultural Approach. New South Wales: Pademelon Press. Feliyanah, Norman, S., & Yulidesni. (2014). Meningkatkan Kemampuan Matematika dengan Menggunakan Teknik Mengurutkan dan Membandingkan. Universitas Bengkulu. Gardner, H. (2011). Frame of Mind ; The theory of Multiple Intelegences. New York: Basic Book. Gimbert, B., & Cristol, D. (2004). Teaching Curriculum with Technology: Enhancing Children’s Technological Competence During Early Childhood. Early Childhood Education Journal, 31(1). Gulay, H. (2011a). The evaluation of the relationship between the computer using habits and proso_cial and aggressive behaviours of 5–6 years old children. International Journal of Academic Research, 3(2), 252. Gulay, H. (2011b). The evaluation of the relationship between the computer using habits and proso_cial and aggressive behaviours of 5–6 years old children. International Journal of Academic Research, 3(2), 252–257. Gunawan, I., & Palupi, A. R. (2012). Taksonomi Bloom-Revisi Ranah Kognitif; Kerangka Landasan untuk Pembelajaran, Pengajaran, dan Penilaian. Jurnal Pendidikan Dasar Dan Pembelajaran, 2 No.2, 100–108. Inan, H. Z., & Dogan-Temur, O. (2010). Understanding kindergarten teachers’ perspectives of teaching basic geometric shapes: A phenomenographic research. ZDM - International Journal on Mathematics Education, 42(5), 457–468. https://doi.org/10.1007/s11858-010- 0241-1 Jackman, H. I., Beaver, N. H., & Wyatt, S. S. (2014). Early Childhood Curriculum: A child’s connection to the world. (sixth edit). Canada: Cengage Learning. Kennedy, L. M., Tipps, S., & Johnson, A. (2008). Guiding Children’s Learning of Mathematic (Eleventh E; Belmot, Ed.). CA: Thomson Wadsworth. Mackintosh, B. B., & McCoy, D. C. (2019). Exploring Social Competence as a Mediator of Head Start’s Impact on Children’s Early Math Skills: Evidence from the Head Start Impact Study. Early Education and Development, 30(5), 655–677. https://doi.org/10.1080/10409289.2019.1576156 Martin, M. O., Mullis, I. V. S., Foy, P., & Stanco, G. M. (2011). Results in Science. Mirawati. (2017). Matematika Kreatif; Pembelajaran Matematika bagi Anak Usia Dini Melalui Kegiatan yang Menyenangkan dan Bermakna. Jurnal Anak Usia Dini Dan Pendidikan Anak Usia Dini, 3. Mohammad, M., & Mohammad, H. (2012). Computer integration into the early childhood curriculum. Education, 133(1), 97–116. National Research Council. (2009). Mathematics Learning in Early Chidhood Paths Toward Excellence and Equity (C. T. Cross, T. Woods, & H. Schweingruber, Eds.). Washinton D.C: The National Academies Press. Norton, A., & Nurnberger-Haag, J. (2018). Bridging frameworks for understanding numerical cognition. Journal of Numerical Cognition, 4(1), 1–8. https://doi.org/10.5964/jnc.v4i1.160 Novitasari, D. R. (2010). Pembangunan Media Pembelajaran Bahasa Inggris Untuk Siswa Kelas 1 Pada Sekolah Dasar Negeri 15 Sragen. Sentra Penelitian Engineering Dan Edukas, Volume 2 N. Papadakis, S., Kalogiannakis, M., & Zaranis, N. (2017). Improving Mathematics Teaching in Kindergarten with Realistic Mathematical Education. Early Childhood Education Journal, 45(3), 369–378. https://doi.org/10.1007/s10643-015-0768-4 Papalia, Old, & Feldman. (2009). Human Development (Psikologi Perkembangan (Kesembilan). Jakarta: Kencana. Paquette, K. R., Fello, S. E., & Jalongo, M. R. (2007). The talking drawings strategy: Using primary children’s Illustrations and oral language to improve comprehension of expository text. Early Childhood Education Journal, 35(1), 65–73. https://doi.org/10.1007/s10643- 007-0184-5 Putra, L. D., & Ishartiwi. (2015). Pengembangan Multimedia Pembelajaram Interaktif Mengenal Angka dan Huruf untuk Anak Usia Dini. Jurnal Inovasi Teknologi Pendidikan, 2(2). Rich, B., & Thomas, C. (2009). Geometry: Includes Plane, Analytic, and Transformational Geometries. . (4th Editio). New York: McGraw-Hill. Rochanah, L. (2016). Pemanfaatan Media Berbasis Komputer Untuk Meningkatkan Kemampuan Huruf pada Anak Usia Dini (Urgensi Media Berbasis Komputer pada Peningkatan Kemampuan Mengenal Huruf ). Jurnal Program Studi PGRA, Volume 2 N, 1–8. Runtukahu, T., & Kandou, S. (2014). Pembelajaran matematika dasar bagi anak berkesulitan belajar. Yogyakarta: Ar-ruzz Media. Santrock, J. W. (2016). Children (Thirteenth). New York: McGraw-Hill Education. Sarama, J., & Clements, D. H. (2006). Mathematics, Young Students, and Computers: Software, Teaching Strategies and Professional Development. The Mathematics Educato, 9(2), 112– 134. Schoenfeld, A. H., & Stipek, D. (2011). Math Matters. Barkeley, California.Shilpa, S., & Sunita, M. (2013). A Study About Role of Multimedia in Early Childhood Education. International Journal of Humanities and Social Science Invention, 2(6). Siswono, T. Y. E. (2012). Belajar dan Mengajar Matematika Anak Usia Dini. Universitas Negeri Surabaya.Smaldino, S. E., Russel, J. D., & Lowther, D. L. (2014). Instructional Technology & Media for Learning (9th ed.). Jakarta: Kencana Prenada Media Group. Sudaryanti. (2006). Pengenalan Matematika Anak Usia Dini. Yogyakarta: FIP UNY. Sufa, F. F., & Setiawan, H. Y. (2017). Analisis Kebutuhan Anak Usia 4-6 Tahun Pada Pembelajaran Berbasis Komputer Pada Anak Usia Dini. Research Fair Unisri, 1(1). Suharjana, A. (2008). Pengenalan Bangun Ruang dan Sifat-sifatnya di SD. Yogyakarta: Pusat Pengembangan dan Pemberdayaan Pendidik dan Tenaga Kependidikan Matematika. Sujiono, Y . N. (2014). Batasan dan Dasar T eori Pengembangan Kognitif. In Hakikat Pengembangan Kognitif (p. 12). Suryana, D. (2013). Pendidikan Anak Usia Dini (teori dan praktik pembelajaran). Padang: UNP Press. Susperreguy, M. I., & Davis-Kean, P. E. (2016). Maternal Math Talk in the Home and Math Skills in Preschool Children. Early Education and Development, 27(6), 841–857. https://doi.org/10.1080/10409289.2016.1148480 Suwarna. (2010). Pengembangan Multimedia Pembelajaran untuk Pembinaan Kreativitas Melukis di Taman Kanak-kanak. Jurnal Universitas Negeri Yogyakarta. Suziedelyte, A. (2012). Can video games affect children’s cognitive and non-cognitive skills? UNSW Australian School of Business Research Paper. https://doi.org/10.2139/ssrn.2140983 Tarigan, D. (2006). Pembelajaran Matematika Realistik. Jakarta: Departeman Pendidikan Nasional, Direktorat Jendral Pendidikan Tunggi, Direktorat Pembinaan Pendidikan Tenaga Kependidikan dan Ketenaga Perguruan Tinggi. Tatang, S. (2012). Ilmu Pendidikan. Bandung: Pustaka Setia.Trawick, M. (2007). Enemy Line ; Warfare, Childhood, and Play in Batticaloa. London: University of California Press. Trifunović, A., Čičević, S., Lazarević, D., Mitrović1, S., & Dragovi, M. (2018). Comparing Tablets (Touchscreen Devices and PCs in Preschool Children Education: Testing Spatial Relationship Using Geometric Syimbols Traffic Signs. IETI Transections on Economics and Safety, 2(1), 35–41. https://doi.org/10.6722/TES.201808_2(1).0004 Vitianingsih, A. V. (2016). Game Edukasi Sebagai Media Pembelajaran Pendidikan Anak Usia Dini. Jurnal INFORM, 1 No. 1. Wang, F., & Kinzie, M. B. (2010). Applying Technology to Inquiry- Based Learning in Early Childhood Education. Early Childhood Education Journal. Weil, M., Calhoun, E., & Joyce, B. (2011). Models of Teaching. New York.: New York. Zack, N. (2014). Philosophy of Science and Race. New York: Routledge. Zare, Sarikhani, Salarii, & Mansouri. (2016). The Impact Of E-learning on University Student’s Academic Achievement and Creativity. Journal of Technical Education and Training (JTET), 8(11).

Manik H, Yurmiaty H, Asmara IY, Handarto, Iskandar J, Partasasmita R. 2018. Wattled Brushturkey hunting system in the Sigim and Sinaitousi communities in the buffer zone of the Arfak Mountain Nature Reserve, West Papua, Indonesia. Biodiversitas 19: 849-856. Illegal hunting is still the cause of the decline of wildlife populations in nature. This is particularly the case with protected wildlife and endemic species, such as the Wattled Brushturkey in Palau West Papuan. Thus, research needs to be done on the hunting system at the site. The aim of this research was to know Wattled Brushturkey (Aepypodius arfakianus) hunting system by Sigim and Sinaitousi villagers, Arfak Mountains of West Papua. The research used descriptive method with field observation technique and semistructured interviews. The results showed that the main purpose of hunting Wattled Brushturkey conducted by the Sigim and Sinaitousi communities is to consume the meat, while a part of egg hunting is for sale. The hunting by the two villagers was generally done in groups. The frequency of hunting depends on needs and demand. Hunting is done using snares, dogs, and combinations of snares and dogs. The tools used are snares, machetes, air rifles, arrows nad bows. The modern tools such as gun have been used in both villages. The hunting of Wattled Brushturkey begins in the morning and continues until late afternoon. The location of hunting is usually primary forest, secondary forest of former garden and river basin.

In the UK, gastroenterology has been a male predominant medical speciality. Data regarding gender within workforce, academia and leadership at a national level are lacking. Data regarding scholarly presentation at the following annual conferences were collected and analysed; British Society of Gastroenterology (BSG) 2013, 2014, and Digestive Diseases Federation (DDF) in 2015. Data from the 2013–2015 BSG annual workforce reports were examined. In 2015, female higher specialty trainees (STs) made up 39% (328/848) of the trainee workforce, versus 37% and 35% in 2014 and 2013. From 2013 to 2015, less than a fifth of all consultant gastroenterologists were women. Female consultant (18%), ST (39%), associate (86%) and student attendance (47%) at DDF 2015 did not change significantly from 2013 to 2014. Female speakers (trainees and consultants) were significantly lower at DDF 2015 compared with BSG 2014; 43/331 (13%) versus 56/212 (26.4%) (p=0.0001) and BSG 2013 63/231 (27%) (p=0.0001). The number of female chairs, delivery of the named lectures and prizes awarded to women did not differ across the 3-year period. Female leadership via representation at Council and Executive at BSG was 4/30 (13%) in 2015 and did not differ in 2013/2014, with no elected council members since 2008 and one female president in 1973.The proportion of female gastroenterology trainees and consultants is increasing, but remains lower than across all medical specialties and is reflected in attendance and scholarly contributions. Action within the BSG is underway to address female under-representation in leadership roles.