Organisational Policies and Practices for the Inclusion of Vulnerable Workers: A Scoping Review of the Employer's Perspective.

Purpose Current models of inclusive workplaces are primarily based on the perceptions of vulnerable workers, whereas attention for employer's perceptions is lacking. This scoping review addresses this issue by mapping the literature that covers employer's perceptions on the application and importance of organisational policies and practices aimed at the inclusion of vulnerable workers. Methods A literature search for qualitative and quantitative research articles was conducted in MEDLINE, Scopus, ProQuest, PsychInfo, Google Scholar and Web of Science. Studies were included when (a) they reported on practices aimed at the inclusion, participation, or rehabilitation of (b) workers with disabilities, a low education or migration background, or who were long-term unemployed, and (c) were based on samples of employers or their representatives. Results The search resulted in 3,134 articles. In total, 38 articles met the inclusion criteria of this study. We identified seven types of inclusive practices to stimulate the inclusion of vulnerable workers that employers applied and/or perceived as valuable: senior management commitment, recruitment and selection, performance management and development practices, job accommodations and redesign of work, supportive culture, external collaborations with other employers, and monitoring. Conclusions Our review identified seven categories of inclusive practices that pertain to all stages of the employee journey of vulnerable workers. These categories move beyond those reported in studies based on employee samples, for instance by highlighting the importance of monitoring and collaborations with other employers. Hence, our findings stress that insight into employers' perceptions about effective measures is crucial to increase labour market participation of vulnerable groups.

[S2k Guideline - Recommendations for Inpatient Therapy of Patients with COVID-19]. / S2k-Leitlinie ­ Empfehlungen zur stationären Therapie von Patienten mit COVID-19.

Since December 2019, the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome - Corona Virus-2) has been spreading rapidly in the sense of a global pandemic. This poses significant challenges for clinicians and hospitals and is placing unprecedented strain on the healthcare systems of many countries. The majority of patients with Coronavirus Disease 2019 (COVID-19) present with only mild symptoms such as cough and fever. However, about 6 % require hospitalization. Early clarification of whether inpatient and, if necessary, intensive care treatment is medically appropriate and desired by the patient is of particular importance in the pandemic. Acute hypoxemic respiratory insufficiency with dyspnea and high respiratory rate (> 30/min) usually leads to admission to the intensive care unit. Often, bilateral pulmonary infiltrates/consolidations or even pulmonary emboli are already found on imaging. As the disease progresses, some of these patients develop acute respiratory distress syndrome (ARDS). Mortality reduction of available drug therapy in severe COVID-19 disease has only been demonstrated for dexamethasone in randomized controlled trials. The main goal of supportive therapy is to ensure adequate oxygenation. In this regard, invasive ventilation and repeated prone positioning are important elements in the treatment of severely hypoxemic COVID-19 patients. Strict adherence to basic hygiene, including hand hygiene, and the correct wearing of adequate personal protective equipment are essential when handling patients. Medically necessary actions on patients that could result in aerosol formation should be performed with extreme care and preparation.

Melanosome maturation proteins Oca2, Mitfa and Vps11 are differentially required for cisplatin resistance in zebrafish melanocytes.

Melanoma is the deadliest form of skin cancer, partially due to its inherent resistance to therapy. Here, we test in live larvae the hypothesis that mature melanosomes contribute to resistance to chemotherapeutic drug, cisplatin, via drug sequestration. We also compare three melanosome biogenesis proteins-microphthalmia-associated transcription factor (Mitfa), vacuolar protein sorting 11 (Vps11) and oculocutaneous albinism 2 (Oca2) to determine their respective contributions to chemoresistance. Melanocytes in zebrafish larvae harbouring loss-of-function mutations in the mitfa, vps11 or oca2 genes are more sensitive to cisplatin damage than wild-type larvae. As a comparison, we examined sensory hair cells of the lateral line, which are sensitive to cisplatin. Hair cells in oca2 and mitfa mutants do not show increased cisplatin sensitivity when compared to wild-type larvae, suggesting the increase in cisplatin sensitivity could be melanocyte specific. However, hair cells in vps11 mutants are more sensitive to cisplatin than their wild-type counterparts, suggesting that this mutation increases cisplatin susceptibility in multiple cell types. This is the first in vivo study to show an increase in chemotherapeutic drug sensitivity when melanosome maturation mutations are present. The proteins tested, especially Oca2, represent novel drug targets for increasing the efficiency of melanoma chemotherapy treatment.

Reduction of organic trace compounds and fresh water consumption by recovery of advanced oxidation processes treated industrial wastewater.

Ozone (O(3)) has been used successfully in advanced wastewater treatment in paper mills, other sectors and municipalities. To solve the water problems of regions lacking fresh water, wastewater treated by advanced oxidation processes (AOPs) can substitute fresh water in highly water-consuming industries. Results of this study have shown that paper strength properties are not impaired and whiteness is slightly impaired only when reusing paper mill wastewater. Furthermore, organic trace compounds are becoming an issue in the German paper industry. The results of this study have shown that AOPs are capable of improving wastewater quality by reducing organic load, colour and organic trace compounds.

Denying the Truth Does Not Change the Facts: A Systematic Analysis of Pseudoscientific Denial of Complex Regional Pain Syndrome.

PURPOSE: Several articles have claimed that complex regional pain syndrome (CRPS) does not exist. Although a minority view, it is important to understand the arguments presented in these articles. We conducted a systematic literature search to evaluate the methodological quality of articles that claim CRPS does not exist. We then examined and refuted the arguments supporting this claim using up-to-date scientific literature on CRPS. METHODS: A systematic search was conducted in MEDLINE, EMBASE and Cochrane CENTRAL databases. Inclusion criteria for articles were (a) a claim made that CRPS does not exist or that CRPS is not a distinct diagnostic entity and (b) support of these claims with subsequent argument(s). The methodological quality of articles was assessed if possible. RESULTS: Nine articles were included for analysis: 4 narrative reviews, 2 personal views, 1 letter, 1 editorial and 1 case report. Seven points of controversy were used in these articles to argue that CRPS does not exist: 1) disagreement with the label "CRPS"; 2) the "unclear" pathophysiology; 3) the validity of the diagnostic criteria; 4) CRPS as a normal consequence of immobilization; 5) the role of psychological factors; 6) other identifiable causes for CRPS symptoms; and 7) the methodological quality of CRPS research. CONCLUSION: The level of evidence for the claim that CRPS does not exist is very weak. Published accounts concluding that CRPS does not exist, in the absence of primary evidence to underpin them, can harm patients by encouraging dismissal of patients' signs and symptoms.

[Acute respiratory distress syndrome]. / "Acute respiratory distress syndrome": Diagnostik und Therapie ­ State of the Art.

Acute respiratory distress syndrome (ARDS) is an intensive medical care syndrome, which has a persistently high prevalence as well as high mortality and morbidity. Since the initial description of the syndrome in 1968, the pathophysiology with inflammation after potential triggers, the diagnostics of underlying diseases and causes, the importance of differentiated invasive ventilation and intensive medical care procedures and prognosis are far better researched and understood. The 2012 Berlin ARDS definition takes these advances into account with the aim of bedside identification of patients with ARDS. Avoiding invasive mechanical ventilation when possible, lung protective invasive ventilation when it becomes necessary with adequate positive end-expiratory pressure (PEEP) and reducing barotrauma and atelectatic trauma, managing patient fluid load and positioning treatment remain the most important mechanistic procedures. Causal treatment, apart from treatment of underlying infections, is still not available. Survivors of ARDS very often face relevant long-term sequelae.

Safety assessment of Madin Darby canine kidney cells as vaccine substrate.

Conventional influenza vaccines are manufactured using embryonated chicken eggs, a substrate with little flexibility and vulnerable to extraneous agents. Solvay Pharmaceuticals developed a production technology based on the continuous cell line Madin Darby Canine Kidney (MDCK) as vaccine cell substrate. A risk-based safety assessment of MDCK, with respect to tumorigenicity of intact cells and oncogenicity of cellular components, cellular DNA and adventitious agents, shows that this substrate is as safe as other substrates and therefore without increased risk to the vaccine recipient.

[Cardiac hemodynamics during shock : Management in daily clinical routine]. / Kardiale Hämodynamik bei Schock : Management im klinischen Alltag.

In caring for critically ill patients, a sophisticated approach to treating hemodynamic instability in acute circulatory failure is a major concern of modern critical care. Depending on the form of shock-distributive, cardiogenic, hypovolemic or obstructive, with the possibility of overlapping forms of shock-preload, afterload, cardiac output, and contractility are altered in various ways. Modern critical care uses hemodynamic monitoring and bedside echocardiography in addition to clinical evaluation to treat the underlying cause and sequelae of shock. Fluid therapy taking volume responsiveness and need for volume into account, vasopressor therapy taking microcirculatory derangement into account, and therapy using inotropes, sometimes in combination with vasodilators are the cornerstones of critical care treatment in this regard. Preload, afterload, cardiac output, and contractility must thereby be evaluated and treated in a patient- and situation-specific manner.

[Delirium and delirium management in critically ill patients]. / Delir und Delirmanagement bei kritisch kranken Patienten.

Delirium in critically ill patients is a common entity in the intensive care unit (ICU) and is an expression of the cerebral organ dysfunction of the patient. The hallmark signs are disturbed consciousness and cognition in combination with inattentiveness and alterations in perception, which are manifested within a time interval of hours to days during treatment on the ICU. Delirium has been shown to have negative effects on patient short-term and long-term outcome parameters and increases morbidity and mortality. Despite its significance in many cases delirium remains inadequately diagnosed during routine treatment by ICU personnel. There are two validated and easily applicable scales for the standardized diagnosis of delirium: the confusion assessment method for the ICU (CAM-ICU) and the intensive care delirium screening checklist (ICDSC). These are simple to apply by medical as well as non-medical personnel. The therapy of delirium is mostly determined by non-pharmacological measures aiming at early identification, reorientation and mobilization of the patient, improving cerebral activity and establishing adequate wake-sleep cycles. There is only sparse evidence for pharmacological treatment of delirium; however, the choice of sedative agent has a proven effect on the incidence and duration of delirium in the ICU.

Immunoglobulins coat microorganisms of skin surface: a comparative immunohistochemical and ultrastructural study of cutaneous and oral microbial symbionts.

Only recently have human sweat glands been demonstrated to secrete immunoglobulins (Ig), paralleling Ig secretion in mucosal epithelia. It is well established that Ig protect mucosal membranes against infections by binding to surface structures of microorganisms. In view of these findings immunohistochemical studies were performed to determine if microbes on the skin surface are coated by Ig as proposed for mucosal bacteria and fungi. Smear preparations from the skin and oral cavity rich in micro-organisms were subjected to immunoperoxidase staining using anti-secretory component (SC), -IgA, -IgM, -IgG antibodies. An immunogold labeling technique of microbial suspensions of sweat and saliva was adapted to correlate the results on an ultrastructural level. Negative controls included unsuccessful staining for IgA in preparations obtained from an IgA-deficient patient as well as nonreactivity of subcultured microorganisms for all Ig classes or SC. Smear preparations from both the oral cavity and skin surface exhibited labeling of bacterial or fungal elements with anti-IgA, -IgM, -IgG, and -SC antibodies. Skin bacteria revealed a lower number of reactive microbes as compared to saliva. Staining intensity for the different Ig classes exhibited intra- and interindividual variations. Immunoelectronmicroscopically, Ig and SC could be detected either directly along the cell wall of coccal, coryneform, and fungal elements or on floccular and fimbrial material adhering to the bacterial surface. It is concluded that secretory Ig of the skin cover surface structures of microorganisms and thus modify their adhesional and/or infectious properties, resembling humoral surface immunity on mucous membranes.

Influences of age and perceived activity difficulty on activity recall.

After they performed each of a series of activities, older and younger adults were asked to rate the difficulty of the activity. Recall of the activities was later tested. Older adults tended to remember those activities they perceived to be less difficult, whereas younger adults tended to remember those activities they perceived to be more difficult. Thus, when more cognitive effort was required to perform an activity, older adults tended to have difficulty later remembering the activity. Difficult activities are hypothesized to tax limited processing resources and induce anxiety in older adults, preventing successful encoding.

Ultrasonographic examination of the equine sacroiliac region.

REASONS FOR PERFORMING STUDY: Little information exists about the normal ultrasonographic appearance of the equine sacroiliac region, but knowledge of the ultrasonographic anatomy is necessary to understand the possible pathological changes in sacroiliac diseases. OBJECTIVES: The normal ultrasonographic appearance of soft tissues and bony structures of the sacroiliac region in horses was studied in order to establish clinically relevant reference parameters. METHODS: Thirteen cadaver specimens were examined using a transcutaneous approach above the tubera sacrale to image the dorsal sacroiliac ligament and the tendon of the longissimus dorsi muscle. A rectal approach was used to outline the sacroiliac joint and its adjacent structures. Thirteen sound horses with no history of back pain were examined following the same protocol as for the post mortem examinations. RESULTS: The tendon of the longissimus dorsi muscle can clearly be distinguished from the dorsal sacroiliac ligament, especially in longitudinal images. Transrectal examination of the sacroiliac joint consists of evaluation of the bony surfaces of the sacrum and ilium in comparison with the contralateral side. CONCLUSIONS: Ultrasonographic examination of the sacroiliac region provided clear images of the caudomedial border of the sacroiliac joint and its adjacent structures and is a useful aid in the diagnosis of sacroiliac joint diseases and adjacent lesions. The study has shown ultrasonography to be a useful method for examining and differentiating the longissimus dorsi muscle and the dorsal sacroiliac ligament at the level of the tubera sacrale. POTENTIAL RELEVANCE: Diagnostic ultrasound is available to most practitioners. These reference ultrasound parameters may help to improve the diagnosis of sacroiliac diseases.

[Postoperative complications of penetrating keratoplasty in herpes infected eyes. Differential diagnosis, therapy and prognostic significance]. / Postoperative Komplikationen nach perforierender Keratoplastik in Herpesaugen. Differentialdiagnose, Therapie und prognostische Bedeutung.

BACKGROUND: We evaluated in this retrospective study the impact of our diagnostic and therapeutic regimens--as illustrated by typical clinical pictures--on the frequency and prognostic values of postkeratoplasty complications in herpes eyes. PATIENTS AND METHODS: Between November 1986 and June 1994, 112 penetrating keratoplasties (KPS) in herpes eyes were performed, 76 as planned and 36 as emergency procedures. The results were compared with 646 KPS with normal risk. For statistical analysis we used the Kaplan-Meier estimation, and statistical significance was tested by the log rank test. RESULTS: After 6 years, 75% of the grafts in the planned herpes group, 86% of the à chaud KPS and 76% of the grafts of the normal-risk group were still clear without significant differences between these three groups. Fifty-four percent of the planned KPS in herpes eyes, 73% of the à chaud KPS in herpes eyes and 80% of the normal-risk KPS experienced no immune reaction, with both herpes groups showing significantly more reactions than the normal-risk KPS. There was, however, no significant difference in immune reactions between the two herpes groups. The percentage of grafts with recurrence of herpes simplex virus infection after 6 years was significantly higher in the à chaud group. CONCLUSIONS: With proper postoperative care and optimal management of immunologic and virologic complications--but only with this!--the prognosis of penetrating keratoplasties in herpes eyes equals that of normal risk eyes. An particular, the prognosis is not dependent on whether surgery was performed as a planned or as an emergency procedure.

[Cyclosporin A therapy in severe anterior scleritis. 5 severe courses without verification of associated systemic disease treated with cyclosporin A]. / Ciclosporin-A-Therapie bei schweren anterioren Skleritiden. Fünf schwere Verläufe ohne nachgewiesene assoziierte Systemerkrankung unter systemischer Ciclosporin-A-Therapie.

BACKGROUND: Patients with severe scleritis who do not respond to high-dose corticosteroid therapy, or who require a daily corticosteroid maintenance dose higher than 30 mg prednisone should be treated by other immunosuppressants. PATIENTS AND METHODS: In five patients with various types of severe anterior scleritis a long-term high-dose steroid treatment failed to control scleral inflammation. They therefore received cyclosporin (CsA). Follow-up was 16-26 months. RESULTS: Scleral inflammation and ocular complications were controlled in all patients by a regimen of systemic CsA combined with a low maintenance steroid dose below the Cushing threshold. We observed no side effects under CsA serum levels of 120-150 ng/ml. In only one patient was scleral inflammation totally and lastingly eliminated. CONCLUSIONS: Systemic CsA therapy is of definite therapeutic value in the symptomatic management of steroid refractory severe anterior scleritis without associated systemic disease. Complete healing, however, is achieved only in a minority of cases.

[Stopping secondary prevention in AIDS patients with inactive CMV retinitis treated with HAART (highly active antiretroviral therapy)]. / Absetzen der Sekundärprophylaxe bei Aids-Patienten mit inaktiver CMV-Retinitis unter HAART.

BACKGROUND: Immune recovery of AIDS patients with cytomegalovirus (CMV) retinitis treated and healed by highly active antiretroviral therapy (HAART) is reflected by increased CD4 cell count and decreased virus load. Due to partial reconstitution of the immune status the risk of opportunistic infections decreases, as well as the risk of reactivating inactive CMV retinitis. It may therefore be possible to stop anti-CMV maintenance therapy may after HAART-induced immune recovery. PATIENTS AND METHODS: We present six patients (nine eyes) with a follow-up of 9.5 months (range 7-12 months) after cessation of the CMV-specific maintenance therapy (five orally, one intravenously). RESULTS: There was no reactivation of retinal CMV infection during the follow-up period. The virus load (< 50 Eq/ml; a single value of one patient was 2047 Eq/ml) and CD4 cell counts (range 207-454/microliter; mean: 313/microliter) remained stable during the follow-up period, reflecting immune recovery. CONCLUSIONS: Our findings confirm the expected low risk of retinal CMV reactivation after immune recovery in AIDS patients receiving HAART without secondary prophylaxis with an anti-CMV maintenance therapy. Regular ophthalmic and medical follow-up is mandatory in these patients. Cessation of maintenance therapy represents a major improvement in quality of live in AIDS patients.

[Intravitreal injection of cidofovir in cytomegalovirus retinitis]. / Intravitreale Injektion von Cidofovir bei CMV-Retinitis.

BACKGROUND: CMV retinitis is the most common opportunistic ocular infection and the main cause of blindness in AIDS patients with a T-helper cell count < or = 50/microliter. Cidofovir is a nucleotide analogue with a long half-life time after phosphorylation intracellularly. It is effective against CMV and can be given intravenously and intravitreally. The aim was to offer an alternative therapy for CMV retinitis to patients who could not receive standard treatment because of contraindications or refused it. The efficacy and tolerance of intravitreal injections of cidofovir should be evaluated. PATIENTS AND METHODS: We treated 16 eyes of 12 patients. The total number of injections with 15 micrograms of cidofovir each was 49, with an average of 3 injections per eye. The duration of follow-up was 75-295 days (median 170 days). Probenecid was given concomitantly. Injections were repeated after 6-10 weeks. Secondary prophylaxis of CMV organ infection was done with oral ganciclovir. RESULTS: Within a few days all areas with active retinitis turned into scars following the first injection. Under consequent treatment no reactivation was observed. Four eyes developed a mild iritis with hypotony within a mean time of 12 days after injection. All responded rapidly to topical steroids. None had a persisting loss of vision. Two eyes developed cystoid macular edema (CME). Two patients stopped anti-CMV treatment (ganciclovir orally and injections), followed by a recurrence after an average of 64-days. CONCLUSIONS: Intravitreal injection therapy with 15 micrograms cidofovir and concomitant oral probenecid is a valuable and safe alternative treatment for CMV retinitis in AIDS patients. Its main complication is iritis with hypotony, which is effectively treatable with topical steroids. No complications caused by the injection technique itself were noted. The occasional observation of CME in otherwise quiet eyes, however, is probably drug-related.

Duration of immunity induced by an adjuvanted and inactivated equine influenza, tetanus and equine herpesvirus 1 and 4 combination vaccine.

An adjuvanted vaccine containing inactivated equine influenza, herpesvirus antigens, and tetanus toxoid was administered to young seronegative foals of 8 months of age by deep intramuscular injection in the neck (Group A). The first two vaccinations were given 4 weeks apart. The third was administered 6 months later. Another group of foals (Group B) was vaccinated according to the same scheme at the same time with monovalent equine herpes virus (EHV) vaccine (EHV1.4) vaccine. Antibody responses to the equine influenza (single radial haemolysis; SRH) and tetanus (ToBi ELISA) components of the vaccines were examined from first vaccination until 1 year after the third vaccination. The influenza components of the combination vaccine induced high antibody titres at two weeks after the second vaccination whereafter titres declined until the time of the third vaccination. After the third vaccination, the titres rose rapidly again to remain high for at least 1 year. Antibody titres against tetanus peaked only after the third vaccination but remained high enough to offer protective immunity for at least 1 year. Foals vaccinated with monovalent EHV1.4 remained seronegative for influenza and tetanus throughout the study. Four and a half months after the third vaccination of groups A and B, a third group of animals was vaccinated twice with monovalent EHV1.4 vaccine 4 weeks apart (Group C). Two weeks after the administration of the second dose in the later group, all groups (A, B, C and an unvaccinated control group D) were challenged with EHV-4. Vaccinated foals (Group A, B, C) showed a clear reduction of clinical symptoms and virus excretion after EHV-4 challenge compared with the unvaccinated control foals. No difference could be demonstrated among the vaccinated groups, suggesting that the combination vaccine protects as well as the monovalent vaccine. In EHV1.4-vaccinated foals both antigenic fractions induced clear protection up to 6 months after vaccination (9). It can therefore be anticipated that the efficacy of the combination vaccine against EHV-1 challenge is similar to the efficacy against EHV-1 induced by EHV1.4 vaccination.

Arteriovenous malformation in the temporalis muscle.

An 18-year-old man presented with an arteriovenous malformation (AVM) in the temporalis muscle. It was shown by magnetic resonance imaging (MRI) and confirmed by intra-arterial angiography. The lesion was completely resected and the defect reconstructed with titanium mesh and cancellous bone.

Influences of age, performance, and item relatedness on verbatim and gist recall of verb-noun pairs.

Age differences in adults' memory for performed actions (e.g., wave hand) are sometimes smaller than age differences in memory for nonperformed phrases. In this study, we examined the conditions under which performance reduces age differences in recall. Younger and older adults performed or read verb-noun phrases that were either related (e.g., actions performed in a kitchen) or unrelated. Performance did not reduce age differences in recall of the exact verbs and nouns used to describe an action, but performance did reduce age differences in memory for the gist of related actions. Older adults especially had difficulty recalling the exact verb used to describe the action. These results suggest that older adults may have better memory for actions than is revealed by tests of verbatim recall. They may remember performing the action but not remember the exact words used to describe the action.