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Abstract European countries have been the key destination for many Syrians since the beginning of the civil war in 2011. In this new context, refugees have faced various challenges, including negative public attitudes and pressure of assimilation that might negatively influence psychophysical adaptation. This indicates the necessity of exploring the factors associated with the adaptation of refugees in their new society. Using a multidimensional individual difference acculturation (MIDA) model as a theoretical framework, the present study investigated the psychophysical adaptation of Syrian refugees (N = 265, Mage = 33.03 years) in Germany. The MIDA model is a theoretical model on immigrants’ adaptation that takes into account the role of psychosocial resources (e.g., psychological strength), co-national connectedness (e.g., ingroup support), hassles, and acculturation orientations in predicting adaptation of immigrants. Using structural equation modelling, specific hypotheses drawn from the MIDA model were tested. It was found that Syrian refugees with high psychological strength and cultural competence reported high levels of adjustment as indicated by low levels of distress. On the other hand, refugees with high levels of perceived hassles reported low levels of adjustment as indicated by high level of distress. The results highlight the importance of psychological strength, cultural competence, and hassles in refugees’ adaption. The study’s findings have the potential to inform host country policymakers regarding the positive integration of refugees into German society, and specific recommendations have been made.

Dominant leadership is, surprisingly, on the rise globally. Previous studies have found that intergroup conflict increases followers’ support for dominant leaders, but identifying the potential benefits that such leaders can supply is crucial to explaining their rise. We took a behavioral-economics approach in Study 1 ( N = 288 adults), finding that cooperation among followers increases under leaders with a dominant reputation. This pattern held regardless of whether dominant leaders were assigned to groups, elected through a bidding process, or leading under intergroup competition. Moreover, Studies 2a to 2e ( N = 1,022 adults) show that impressions of leader dominance evoked by personality profiles, authoritarian attitudes, or physical formidability similarly increase follower cooperation. We found a weaker but nonsignificant trend when dominance was cued by facial masculinity and no evidence when dominance was cued by aggressive disposition in a decision game. These findings highlight the unexpected benefits that dominant leaders can bestow on group cooperation through threat of punishment.

RATIONALE The pathophysiology of interstitial lung disease (ILD) impacts body composition, whereby ILD severity is linked to lower lean mass. OBJECTIVES To determine i) if pectoralis muscle area (PMA) is a surrogate for whole-body lean mass in ILD, ii) whether PMA is associated with ILD severity, and iii) if the longitudinal change in PMA is associated with pulmonary function and mortality in ILD. METHODS Patients with ILD (n = 164) were analyzed retrospectively. PMA was quantified from a chest computed tomography scan. Peripheral oxygen saturation (SpO2), 6-min walk distance (6MWD), and pulmonary function were obtained as part of routine clinical care. Dyspnea and quality of life were assessed using the UCSD Shortness of Breath Questionnaire and European Quality of Life 5 Dimensions questionnaire, respectively. RESULTS PMA was associated with whole-body lean mass (p  0.05). The annual negative PMA slope was associated with annual negative slopes in FVC, FEV1, and DLCO (all p < 0.05), but not FEV1/FVC (p = 0.46). Annual slope in PMA was associated with all-cause mortality (hazard ratio = -0.80, 95% CI:0.889-0.959; p < 0.001). CONCLUSION In patients with ILD, PMA is a suitable surrogate for whole-body lean mass. A lower PMA is associated with indices of ILD severity, which supports the notion that ILD progression may involve sarcopenia.

Background: In the metastatic or recurrent cervical cancer, systemic chemotherapy constitutes the main treatment. Though there is an increasing use of high dose external radiation and brachytherapy in the metastatic setting, no consensus exists. Methods: A 17-item survey was designed with additional case-based questions to explore present management of oligo-metastatic and oligo-recurrent cervix cancer within EMBRACE research group participating sites. The questions were designed to elicit prevailing practices in the management of de-novo oligo-metastasis and oligo-recurrent setting after completing the primary treatment of cervix cancer. The survey was sent electronically with two rounds of email reminders to respond over a 2-week survey period. The online survey was designed such that it was mandatory to complete all questions. The responses were recorded and results were summarized as proportions and summary statistics were generated. Results: Twenty-two centers responded to this survey. A majority (90%) of respondents reported a low incidence of de-novo oligo-metastatic cervical cancer in their practice (<5%), with a higher proportion of patients with oligo-recurrence after completing primary treatment (5–10%). All responding sites preferred to treat pelvic disease in the de-novo oligo-metastatic setting albeit with different fractionation regimens. While 68.2% of respondents recommended chemo-radiation and brachytherapy, 31.8% considered additional systemic therapy. Overall 77.3% centers recommended the use of stereotactic ablative radiation therapy to oligo-metastasis. For out-of-field nodal recurrences, 63.7% of respondents considered treating with curative intent, while 59% preferred treating in-field recurrence with palliative intent. A vast majority of the participating centers (90%) have stereotactic radiation therapy capacity and would consider a clinical trial addressing oligo-metastatic and oligo-recurrent cervical cancer. Conclusion: Although contemporary practice is variable, a substantial proportion of EMBRACE centers consider high dose radiation in de-novo metastatic and oligo-recurrence settings. However, there is clear need for a joint clinical protocol and prospective studies to address the role of high dose radiation within oligo-recurrent and oligo-metastatic scenarios.

The seaweed industry is growing worldwide to meet future resource needs in terms of food and fuel. In the meantime, the impact of expanding off-bottom seaweed cultivation on its environment is unclear. For example, it remains poorly understood how off-bottom seaweeds affect the local hydrodynamic environment, especially concerning turbulence that is more important for nutrient transport and availability than the mean flow velocity. Here, we carried out well-controlled flume experiments with mimic seaweed thalli, which are available, controllable, and stable, to investigate the impact of off-bottom seaweed canopies on whole-depth flow velocities in terms of both mean flow and turbulence velocity profiles. A careful comparison of behavior in the flow between natural and mimic seaweed thalli was made before these experiments. The results show that the floating seaweed thalli generate a surface boundary layer and have a profound impact on the velocity structure in the bottom boundary layer. More importantly, the generation, growth and dissipation of turbulence in the seaweed thalli area deeply affect the downstream distribution of near-bed turbulent strength and associated bed shear stress. Ignoring this turbulent variation would cause inaccurate predictions of morphological changes of the seabed. Our findings suggest that expanding the seaweed cultivation area may cause high risks of bed degradation and low diffusion in the downstream cultivation area. These findings provide novel insights into the environmental influence of off-bottom seaweed cultivation, with important implications for optimizing management strategies to promote seaweed productivity while minimizing seabed destabilization.

BACKGROUND. Dose reduction strategies for coronary CTA (CCTA) have been underused in clinical practice given concern that the strategies may lower image quality. OBJECTIVE. The purpose of this study was to explore associations between dose reduction strategies and CCTA image quality in real-world clinical practice. METHODS. This subanalysis of the international Prospective Multicenter Registry on Radiation Dose Estimates of Cardiac CT Angiography in Daily Practice in 2017 (PROTECTION VI) study included 3725 patients (2109 men, 1616 women; median age, 59 years) who underwent CCTA for coronary artery evaluation performed at 55 sites in 32 countries. CCTA image sets were reviewed at a core laboratory. A range of patient and scan characteristics, including use of three dose reduction strategies (prospective ECG triggering, low tube potential, and iterative image reconstruction) and image dose, were recorded. A single core laboratory member reviewed all examinations for quantitative image quality measures, including signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), and reviewed 50% of examinations to assign a qualitative CCTA image quality score and a semiquantitative coronary calcification measure. Multivariable logistic regression models were used to identify predictors of image quality. A second core laboratory member repeated quantitative measures for 100 examinations and the qualitative measure for 383 (approximately 20%) examinations to assess interreader agreement. RESULTS. Independent predictors ( p < .05) of SNR were female sex (effect size, 2.70), lower body mass index (0.38 per 1-unit decrease), stable sinus rhythm (1.71), and scanner manufacturer (variable effect across manufacturers). These factors were also the only independent predictors of CNR. Independent predictors ( p < .05) of CCTA image quality were heart rate (0.17 per 10 beats/min reduction) and coronary calcification (0.15 per coronary calcification grade). None of the three dose-saving strategies or dose-length product was an independent predictor of any image quality measure. Interreader agreement analysis showed intraclass correlation coefficients of 0.874 for SNR and 0.891 for CNR and a kappa value of 0.812 for the qualitative score. CONCLUSION. This large international multicenter study shows that three dose reduction strategies were not associated with decreased CCTA image quality. CLINICAL IMPACT. The dose reduction strategies should be routinely implemented in clinical CCTA.

Green infrastructure for source water protection in the form of forest protection and afforestation is gaining interest worldwide. It is considered more sustainable in the long-term than traditional engineering-based approaches. This paper presents a theoretical model to support investment decisions in green and grey infrastructure to deliver safe drinking water. We first develop a static optimal control model accounting for the uncertainties surrounding green infrastructure. This model is then extended to factor in key characteristics surrounding investment decisions aimed at optimizing the stock of green and grey infrastructure. We first include dynamic forest growth, followed by the risk of wildfires and finally the potential offsetting effect of carbon sequestration on long-term climate change and the reduced risk of wildfires. We provide a numerical example to analyze the performance of the different model specifications, interpret their outcomes and draw conclusions to guide future investment decisions in green and grey infrastructure.

Anticoagulation substantially reduces the risk of stroke in patients with atrial fibrillation (AF). However, recent studies have shown that up to 22%–36% of patients on anticoagulation will suffer an ischaemic stroke (IS). In this narrative review, we provide an overview of risk factors, mechanisms, management of acute IS and strategies for secondary prevention for patients with AF with stroke despite oral anticoagulation. For this paper, we reviewed available literature from important studies (randomised clinical trials, meta-analyses, reviews and case series) on patients with IS despite anticoagulation. We focused on recent studies that examined safety and efficacy of acute stroke treatments and evaluation and management strategies for secondary prevention. The literature review suggests that patients with AF with IS despite anticoagulation are a heterogeneous group with several possible mechanisms, which may include reduced or non-adherence to anticoagulation, competing non-cardioembolic stroke aetiologies or cardioembolic mechanisms separate from AF. The identification of one or more possible mechanisms of stroke despite anticoagulation may allow for a more targeted and individualised approach for secondary prevention. There are limited data to guide management in such patients, and strategies to prevent recurrent strokes include strict risk factor control and therapies targeting the most likely stroke mechanism. In cases where AF is suspected to be the culprit, clinical trials are needed to test the safety and efficacy of left atrial appendage occlusion plus anticoagulation versus continued anticoagulation alone.

Abstract Technological innovation can raise the returns to some skills while making others less valuable or even obsolete. We study the effects of such skill-altering technological change in the context of men’s professional tennis, which was unexpectedly transformed by the invention of composite racquets during the late 1970s. We explore the consequences of this innovation on player productivity, entry, and exit. We find that young players benefited at the expense of older players and that the disruptive effects of the new racquets persisted over two to four generations.

Numerous environmental pollutants have the potential to accumulate in sediments, and among them are endocrine-disrupting chemicals (EDCs). It is well documented that water-borne exposure concentrations of some potent EDCs, more specifically estrogenic- active compounds (ECs), can impair the reproduction of fish. In contrast, little is known about the bioavailability and effects of sediment-associated ECs on fish. Particularly, when sediments are disturbed, e.g., during flood events, chemicals may be released from the sediment and become bioavailable. The main objectives of this study were to evaluate a) whether ECs from the sediment become bioavailable to fish when the sediment is suspended, and b) whether such exposure leads to endocrine responses in fish. Juvenile rainbow trout (Oncorhynchus mykiss) were exposed over 21 days to constantly suspended sediments in the following treatments: i) a contaminated sediment from the Luppe River, representing a "hotspot" for EC accumulation, ii) a reference sediment (exhibiting only background contamination), iii) three dilutions, 2-, 4- and 8-fold of Luppe sediment diluted with the reference sediment, and iv) a water-only control. Measured estrogenic activity using in vitro bioassays as well as target analysis of nonylphenol and estrone via LC-MS/MS in sediment, water, fish plasma, as well as bile samples, confirmed that ECs became bioavailable from the sediment during suspension. ECs were dissolved in the water phase, as indicated by passive samplers, and were readily taken up by the exposed trout. An estrogenic response of fish to Luppe sediment was indicated by increased abundance of transcripts of typical estrogen responsive genes, i.e. vitelline envelope protein α in the liver and vitellogenin induction in the skin mucus. Altered gene expression profiles of trout in response to suspended sediment from the Luppe River suggest that in addition to ECs a number of other contaminants such as dioxins, polychlorinated biphenyls (PCBs) and heavy metals were remobilized during suspension. The results of the present study demonstrated that sediments not only function as a sink for ECs but can turn into a significant source of pollution when sediments are resuspended as during flood-events. This highlights the need for sediment quality criteria considering bioavailability sediment-bound contaminants in context of flood events.