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.

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.

[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.

[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.

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.

[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.

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.

[The percutaneous bone biopsy: in vitro study for comparison of bone biopsy needles]. / Die perkutane Knochenbiopsie: Experimentelle Studie zum Vergleich von Knochenbiopsiesystemen.

PURPOSE: The aim of this study was to assess the differences in ease of use and quality of samples of several bone biopsy needles in an animal test. MATERIALS AND METHODS: An evaluation of eight bone biopsy needles of different gauges was undertaken. With each needle, 5 biopsies of an animal bone (lumbal vertebral body of calf, pig and lamb) were performed and compared to each other. The subjective assessment of force to obtain a sample, ease of needle use and ease of sample removal were graded on a 5-point scale. Each biopsy specimen was measured before and after fixation and the gross state was evaluated. For evaluation of histopathological quality, width and degree of fragmentation were also evaluated on a scale. RESULTS: The Somatex, Bone Marrow and Safe Cut 8 G and the Cardinal Health, Jamshidi 8 G needles were rated as being the easiest ones to use, while the Bloodline, Easy Trap 8 G and the RADI, Bonopty 15 G biopsy needles were rated as being the most difficult ones. Histological specimen quality was highest for the Somatex 8 G needles, the Cardinal Health, Jamshidi 8 G and the Bloodline, Easy Trap 8 G needles. The Inter.V, SnareLok 8 G and the RADI, Bonopty 15 G needles had the lowest yield. Furthermore, differences in length before and after fixation were recorded. The average decrease of core length after fixation was 18 %. CONCLUSION: The bone biopsy needles tested here vary significantly in performance and quality of the histopathological specimen. Detailed knowledge of the strengths and weaknesses of different needles could facilitate the decision for the selection of an appropriate instrument.

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.

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.

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.

Concerted action of the FasL/Fas and perforin/granzyme A and B pathways is mandatory for the development of early viral hepatitis but not for recovery from viral infection.

Cytotoxic T lymphocytes (CTL) play a major role in the recovery from primary viral infections and the accompanying tissue injuries. However, it is unclear to what extent the two main cytolytic pathways, perforin-granzyme A and B exocytosis and Fas ligand (FasL)-Fas interaction, contribute to these processes. Here we have employed mouse strains with either spontaneous mutations or targeted gene defects in one or more components of either of the two cytolytic pathways to analyze the molecular basis of viral clearance and induction of hepatitis during lymphocytic choriomeningitis virus infection. Our results reveal that viral clearance is solely dependent on perforin but that virus-induced liver damage only occurs when both the FasL/Fas and the perforin pathways, including granzymes A and B, are simultaneously activated. The finding that development of hepatitis but not viral clearance is dependent on the concomitant activation of FasL-Fas and perforin-granzymes may be helpful in designing novel strategies to prevent hepatic failures during viral infections.

[Treatment of 9 squamous epithelial carcinoma in situ lesions of the conjunctiva (CIN) with mitomycin C eyedrops in cytological and DNA image cytometric control]. / Behandlung von 9 plattenepithelialen Carcinomata in situ der Bindehaut (CIN) mit Mitomycin-C-Augentropfen unter zytologischer und DNA-bildzytometrischer Kontrolle.

BACKGROUND: Conjunctival intraepithelial neoplasia (CIN) is a frequent conjunctival tumor. Following excision alone recurrences are frequent. An effective postsurgical recurrence prevention is therefore highly desirable. In this study we aimed to evaluate the effectivity of postsurgical chemotherapy of conjunctival squamous cell carcinoma in situ (CIN) with mitomycin C eyedrops. We introduced the otherwise established diagnostic tools of cytology and DNA-image-cytometry to the diagnosis and therapy-monitoring of CIN. PATIENTS AND METHODS: We treated 9 patients with CIN. For diagnosis the results of cytology and cytometry of presurgically obtained brush smears were compared with the histologic evaluation of the excised tissue. After surgery, we administered topical chemotherapy with mitomycin C eye drops 0.02% (MMC). Conjunctival brush smears were again evaluated by cytology and DNA-image-cytometry for postsurgical therapy monitoring. RESULTS: The clinical diagnosis of CIN was fully confirmed by cytology, DNA-image-cytometry and histology respectively in 7 patients. In one patient, the results of the applied diagnostic methods differed in results: Histologic evaluation indicated a moderate dysplasia but DNA-image-cytometry showed significant DNA-aneuploidy unequivocally indicating neoplasia like squamous cell carcinoma. In another patient the preoperatively obtained conjunctival brush smears could not properly analyzed by cytometry but clinical diagnosis was confirmed by histology. MMC-therapy was well tolerated except for a self-limited conjunctivitis. A complete remission of CIN was obtained in 8 of 9 patients (89%) who were free of CIN recurrences during a follow-up period of 27.2 months (11-48). Only one patient suffered from a recurrence 14 months after surgery and after 2 MMC-cycles. CONCLUSION: Adjuvant topical mitomycin C appears to be effective in the prevention of recurrences of conjunctival CIN after surgical removal. Our results indicate that at least 4 cycles of topical MMC are required to prevent local recurrences in the long term. Cytology and DNA-image cytometry are highly sensitive and specific methods for diagnosis and therapy monitoring of conjunctival squamous cell carcinoma in situ (CIN).

An analysis of a presumed major outbreak of pseudorabies virus in a vaccinated sow herd.

We describe a major outbreak of pseudorabies virus (PRV) in a sow herd in which the sows were vaccinated simultaneously three times a year with a vaccine containing Bartha strain. Also in the associated rearing herd in which the gilts were vaccinated twice an outbreak of PRV occurred. The outbreak was analysed with mathematical models, statistical methods and Monte-Carlo simulation. Under the assumption that the outbreak started with one introduction of virus the reproduction ratio R(ind)--as a measure of transmission of PRV between individuals--in the sow herd was estimated with a Generalized Linear Model to be 1.6. Also under the assumption of one introduction of virus R(ind) in the rearing herd was estimated with a martingale estimator to be 1.7. Both estimates were significantly larger than 1. Mathematical analysis showed that heterogeneity in the sow herd, because of the presence of not-optimally immunized replacement sows could not be the only cause of the observed outbreak in the sow herd. With Monte-Carlo simulations, the duration of an outbreak after a single introduction of virus and R(ind) = 1.6 did not mimic the data and thus the hypothesis of a single introduction with R(ind) = 1.6 could also be rejected and R(ind) is thus, not necessarily above 1. Moreover, with statistical analysis, endemicity in the combination of herds as a cause for the observed outbreak could be rejected. Endemicity in the rearing herd alone could not be excluded. Therefore, multiple introductions from outside and most probably from the rearing herd were possibly the cause of the observed outbreak(s). The implications for eradication of pseudorabies virus were discussed.

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.

[Measles as a rare cause of parotid swelling in childhood. Case presentation, differential diagnosis and discussion]. / Masern als seltene Ursache einer Parotisschwellung im Kindesalter. Fallvorstellung, Differenzialdiagnostik und Diskussion.

Unilateral parotid enlargements in children are very rare compared with their incidence in adulthood. Besides epidemic parotitis, juvenile hemangioma, a highly differentiated type of capillary hemangioma, is the most common reason for parotid enlargement in childhood. Parotid enlargement or changes in the adjacent tissue structures may also represent symptoms of systemic diseases. A very rare manifestation of a rubeola (measles) infection in its preexanthematic state in the parotid region is demonstrated in the following case presentation. The subsequent discussion will focus on a variety of differential diagnoses. In order to ensure an early therapeutic intervention, careful clinical examination, sufficient radiological diagnosis, and if necessary an additional diagnostic excision are essential to determine the exact diagnosis in uni- or bilateral parotid enlargement in childhood.

[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.