Vitamin D Status among Pulmonary TB Patients and Non-TB Controls: A Cross-Sectional Study from Mwanza, Tanzania.

Little is known about vitamin D status in low-income populations burdened with infectious diseases. Hence, there is a need for data on correlates of serum 25-hydroxy vitamin D (S-25(OH)D) and its validity during infections. To assess the role of pulmonary TB (PTB) and HIV as correlates of S-25(OH)D. Age-sex-matched cross-sectional study among PTB patients and non-TB controls. PTB patients were categorized as sputum negative (PTB-) and positive (PTB+) by culture. Non-TB controls were randomly selected among age-sex-matched neighbours to PTB+ patients. Height, weight, arm circumference and triceps skinfold were measured, and body mass index (BMI), arm fat (AFA) and muscle area (AMA) computed. HIV status, and S-25(OH)D, C-reactive protein (S-CRP) and α1-acid glycoprotein (S-AGP) were determined. Linear regression analysis with controls and PTB patients combined was used to identify correlates of S-25(OH)D. S-25(OH)D data were available on 97.8% (1570) of 1605 participants. Mean (SD) S-25(OH)D was 84.4 (25.6) nmol/L with 39.6% <75 nmol/L among 347 non-TB controls. Time of recruitment, sex, PTB and HIV, and elevated S-AGP were correlates of S-25(OH)D. S-25(OH)D was 24.8 (95% CI 18.6;30.9) nmol/L higher in PTB compared to controls among females, but only 9.8 (95% CI:4.5;15.2) nmol/L among males (interaction p<0.0001). Females had 13.8 (95% CI:8.2;21.9) nmol/L lower S-25(OH)D than males, and HIV infected individuals had 8.5 (95% CI:4.9;12.1) higher S-25(OH)D compared to uninfected. Elevated S-AGP was a positive correlate of S-25(OH)D. Low BMI was associated with S-25(OH)D, but not with infections or S-AGP in the model. While S-25(OH)D may decline transiently during a mild acute phase response, it may increase if the acute phase response leads to loss of fat. The validity of S-25(OH)D as a marker of vitamin D status may be affected by infections

The Effect of CEOs’ Characteristics on Forward-Looking Information

Purpose - This paper aims to examine the effect of CEOs’ characteristics on the level of FLI disclosure. Design/methodology/approach - The study uses a disclosure index to measure the level of FLI and employs random-effect and panel data regressions to examine the relationship between CEOs’ characteristics and the level of FLI disclosure. The sample consists of 201 non-financial companies listed on the Amman Stock Exchange (ASE) for the period 2008-2013. Findings - The results show that the CEO age has a significant negative relationship with the level of FLI, whereas gender and overconfidence have a significant positive association with it. Practical implications - The results could be beneficial for a number of users of financial information, such as regulators, investors, auditors and lenders to make better decisions. Originality/value – The current study offers evidence of the effect of CEO characteristics on the level of FLI disclosure statements, particularly through narrative disclosures

BIM in Europe: innovation networks in the construction sectors of Sweden, France and the UK

European countries are developing or implementing policies that promote or require the use of Building Information Modelling (BIM) and give BIM a central role in strategies for national sector-level transformation. It is necessary to understand BIM as a systemic innovation that is enacted and adopted by firms, projects and users but also by national actors. The Industrial Marketing and Purchasing (IMP) approach has shown how the evolution of innovations can be understood in terms of networks in which actors mobilise and combine technical and social resources in order to perform activities &ndash; the Actors-Activities-Resources (ARA) model. A comparative study of BIM adoption in France, Sweden and the UK was undertaken using data from independent country-specific research projects and a pooled desktop study. A grid was developed based on the ARA model that provided a framework to inform data collection and analysis salient for explaining the extent, processes and type of adoption of BIM in each country. Similarities between countries included: the importance of large and international firms in the innovation network; and project types (non-residential public buildings and either complex or repetitive building types). Differences were found in, for example, the activities and national institutions of architecture and the policy positions and mechanisms of government actors. The analysis highlights both the value and some limitations of a country-level focus and provides a basis for thoroughgoing network analysis

Treatment prescribing patterns in patients with juvenile idiopathic arthritis (JIA): Analysis from the UK Childhood Arthritis Prospective Study (CAPS)

OBJECTIVE: Initial treatment of juvenile idiopathic arthritis (JIA) is largely based on the extent of joint involvement, disease severity and ILAR category. The licensing of biologic therapies for JIA has expanded treatment options. The aims of the study are (1) to describe treatment prescribing patterns in JIA over the first 3 years following first presentation to paediatric rheumatology and (2) to determine whether patterns of treatment have changed as biologics have become more widely available. METHODS: Children with at least 3 years of follow-up within the Childhood Arthritis Prospective Study (CAPS) were included. For analysis, children were placed into one of five groups according to their initial presentation to paediatric rheumatology: oligoarthritis (oJIA), polyarthritis (pJIA), systemic (sJIA), enthesitis-related arthritis (ERA) and psoriatic arthritis (PsA). Treatment patterns over 3 years were described. RESULTS: Of 1051 children, 58% received synthetic disease-modifying anti-rheumatic drugs (sDMARD) and 20% received biologics over the 3 years. Use of sDMARDs and biologics was higher in more severe disease presentations (sJIA and pJIA); however, 35% and 10% who presented with oJIA were also treated with sDMARDs and biologics, respectively. The number of children receiving sDMARD after 2006 was higher (p = 0.02); however, there was no difference in biologic prescribing before and after 2006 (p = 0.4). CONCLUSIONS: A high proportion of children presenting with JIA received sDMARDs plus/minus biologics during 3 years of follow-up. This was most common for patients with severe JIA but was also prescribed for patients with oligoarticular disease, despite the lack of evidence for effectiveness in this category

Ex-Officio Rights of the Judges in Signating the Holder of Currency: Hadhanah in Directions of Divorce at the Religious Court as an Efforts of Legal Protection and Administration of Legal Certainity for Children

Child custody (hadhanah) is a problem that often occurs in divorce. This is because divorce often still leaves problems. Divorce only breaks the legal relationship between husband and wife and changes the status of each to a former husband and ex-wife but does not reduce conflicts between them. The conflict between the parents which then leads to a struggle for custody of the child clearly greatly affects the psychological condition of the child. It is the duty of a judge to provide the best interests as a form of protection for the child. The results of this study indicate: the right of ex officio judges is used or applied in the context of certainty, justice and legal benefits for both parties and especially for the child himself, hadhanah or post-divorce care for the child places the child's position as a party that must be protected and is a joint obligation of both parents. in the best interest of the child

Ex-Officio Rights of the Judges in Signating the Holder of Currency: Hadhanah in Directions of Divorce at the Religious Court as an Efforts of Legal Protection and Administration of Legal Certainity for Children

Child custody (hadhanah) is a problem that often occurs in divorce. This is because divorce often still leaves problems. Divorce only breaks the legal relationship between husband and wife and changes the status of each to a former husband and ex-wife but does not reduce conflicts between them. The conflict between the parents which then leads to a struggle for custody of the child clearly greatly affects the psychological condition of the child. It is the duty of a judge to provide the best interests as a form of protection for the child. The results of this study indicate: the right of ex officio judges is used or applied in the context of certainty, justice and legal benefits for both parties and especially for the child himself, hadhanah or post-divorce care for the child places the child's position as a party that must be protected and is a joint obligation of both parents. in the best interest of the child

Association Between Patient Factors and Outcome of Synthetic Cartilage Implant Hemiarthroplasty vs First Metatarsophalangeal Joint Arthrodesis in Advanced Hallux Rigidus

BACKGROUND: We evaluated data from a clinical trial of first metatarsophalangeal joint (MTPJ1) implant hemiarthroplasty and arthrodesis to determine the association between patient factors and clinical outcomes. METHODS: Patients ≥18 years with hallux rigidus grade 2, 3, or 4 were treated with synthetic cartilage implant MTPJ1 hemiarthroplasty or arthrodesis. Pain visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM) sports and activities of daily living (ADL) scores, and Short Form-36 Physical Function (SF-36 PF) subscore were obtained preoperatively, and at 2, 6, 12, 24, 52, and 104 weeks postoperatively. Final outcome data, great toe active dorsiflexion motion, secondary procedures, radiographs, and safety parameters were evaluated for 129 implant hemiarthroplasties and 47 arthrodeses. The composite primary endpoint criteria for clinical success included VAS pain reduction ≥30%, maintenance/improvement in function, no radiographic complications, and no secondary surgical intervention at 24 months. Predictor variables included hallux rigidus grade; gender; age; body mass index (BMI); symptom duration; prior MTPJ1 surgery; preoperative hallux valgus angle, range of motion (ROM), and pain. Two-sided Fisher exact test was used ( P .05) when stratified by hallux rigidus grade, gender, age, BMI, symptom duration, prior MTPJ1 surgery status, and preoperative VAS pain, hallux valgus, and ROM. CONCLUSION: Synthetic cartilage implant hemiarthroplasty was appropriate for patients with grade 2, 3, or 4 hallux rigidus. Its results in those with associated mild hallux valgus (≤20 degrees) or substantial preoperative stiffness were equivalent to MTPJ1 fusion, irrespective of gender, age, BMI, hallux rigidus grade, preoperative pain or symptom duration. LEVEL OF EVIDENCE: Level II, randomized clinical trial

Workplace bullying and violence as risk factors for type 2 diabetes : a multicohort study and meta-analysis

The aim of this multicohort study was to examine whether employees exposed to social stressors at work, such as workplace bullying and violence, have an increased risk of type 2 diabetes. The study included 45,905 men and women (40-65 years of age and free of diabetes at baseline) from four studies in Sweden, Denmark and Finland. Workplace bullying and violence were self-reported at baseline. Incident diabetes was ascertained through national health and medication records and death registers. Marginal structural Cox models adjusted for age, sex, country of birth, marital status and educational level were used for the analyses. Nine per cent of the population reported being bullied at work and 12% were exposed to workplace violence or threats of violence. Bullied participants had a 1.46 (95% CI 1.23, 1.74) times higher risk of developing diabetes compared with non-bullied participants. Exposure to violence or threats of violence was also associated with a higher risk of diabetes (HR 1.26 [95% CI 1.02, 1.56]). The risk estimates attenuated slightly when taking BMI into account, especially for bullying. The results were similar for men and women, and were consistent across cohorts. We found a higher risk of incident type 2 diabetes among employees exposed to bullying or violence in the workplace. Further research is needed to determine whether policies to reduce bullying and violence at work may reduce the incidence of type 2 diabetes in working populations. Research on the mechanisms is also highly warranted.Peer reviewe