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Background: Berotralstat (BCX7353) is an oral, once-daily inhibitor of plasma kallikrein in development for the prophylaxis of hereditary angioedema (HAE) attacks.
Objective: Our aim was to determine the efficacy, safety, and tolerability of berotralstat in patients with HAE over a 24-week treatment period (the phase 3 APeX-2 trial).
Methods: APeX-2 was a double-blind, parallel-group study that randomized patients at 40 sites in 11 countries 1:1:1 to receive once-daily berotralstat in a dose of 110 mg or 150 mg or placebo (Clinicaltrials.gov identifier NCT03485911). Patients aged 12 years or older with HAE due to C1 inhibitor deficiency and at least 2 investigator-confirmed HAE attacks in the first 56 days of a prospective run-in period were eligible. The primary efficacy end point was the rate of investigator-confirmed HAE attacks during the 24-week treatment period.
Results: A total of 121 patients were randomized; 120 of them received at least 1 dose of the study drug (n = 41, 40, and 39 in the 110-mg dose of berotralstat, 150-mg of dose berotralstat, and placebo groups, respectively). Berotralstat demonstrated a significant reduction in attack rate at both 110 mg (1.65 attacks per month; P = .024) and 150 mg (1.31 attacks per month; P < .001) relative to placebo (2.35 attacks per month). The most frequent treatment-emergent adverse events that occurred more with berotralstat than with placebo were abdominal pain, vomiting, diarrhea, and back pain. No drug-related serious treatment-emergent adverse events occurred.
Conclusion: Both the 110-mg and 150-mg doses of berotralstat reduced HAE attack rates compared with placebo and were safe and generally well tolerated. The most favorable benefit-to-risk profile was observed at a dose of 150 mg per day.
This article examines whether autonomy as an educational aim should be defended at the global scale. It begins by identifying the normative issues at stake in global autonomy education by distinguishing them from the problems of autonomy education in multicultural nation-states. The article then explains why a planet-wide expansion of the ideal of autonomy is conceivable on the condition that the concept of autonomy is widened in a way that renders its precise meaning flexibly adjustable to a variety of distinct social and cultural contexts. A context-transcendent, core meaning of autonomy remains in place, however, according to which a person is only autonomous if she relates to the values and goals that direct her life in a way so that she sees them as her own and is able to identify and critically assess her principal reasons for action. Finally, the article addresses two challenges to the global expansion of autonomy education: the objection that autonomy is presently not the most important educational aim and the objection that global autonomy education is a form of cultural imperialism. It finds both objections wanting.
The purpose of this study was to examine the psychometric properties (i.e., factorial validity, measurement invariance, and reliability) of the Grit-Original scale (Grit-O) within the Netherlands. The Grit-O scale was subjected to a competing measurement modeling strategy that sequentially compared both independent cluster model confirmatory factor analytical- and exploratory structural equation modeling approaches. The results showed that both a two first order, bi-factor structure as well as a less restrictive two factor ESEM factorial structure best-fitted the data. The instrument showed to be reliable at both a lower- (Cronbach’s alpha) and upper-level (composite reliability) limit. However, measurement invariance between genders could only be established for the B-ICM-CFA model. Finally, concurrent validity was established through relating the GRIT-O to task performance. The linear use of the Grit-O scale should therefore carefully be considered.
Despite the popularity of the term Positive Psychological Coaching within the literature, there is no consensus as to how it should be defined (framed) or what the components of a positive coaching “model” should include. The aim of this systematic review was to define positive psychological coaching and to construct a clear demarcated positive psychological coaching model based on the literature. A systematic literature review led to the extraction of 2,252 records. All records were screened using specific inclusion/exclusion criteria, which resulted in the exclusion of records based on duplicates (n = 1,232), titles (n = 895), abstracts (n = 78), and criteria violations (n = 23). Twenty-four academic, peer-reviewed publications on positive psychological coaching were included. Data relating to conceptual definitions and coaching models/phases/frameworks were extracted and processed through thematic content analysis. Our results indicate that positive psychological coaching can be defined as a short to medium term professional, collaborative relationship between a client and coach, aimed at the identification, utilization, optimization, and development of personal strengths and resources in order to enhance positive states, traits and behaviors. Utilizing Socratic goal setting and positive psychological evidence-based approaches to facilitate personal growth, optimal functioning, enhanced wellbeing, and the actualization of people's potential. Further, eight critical components of a positive psychological coaching model were identified and discussed. The definition and coaching process identified in this study will provide coaches with a fundamental positive psychological framework for optimizing people's potential.
Editorial: Positive organizational interventions: contemporary theories, approaches and applications
(2020)
The purpose of this study was to identify distinctive mental health profiles for industrial psychologists based on the Mental Health Continuum. Further, it aimed to determine how these profiles differ with respect to work-role fit, meaningfulness and work engagement. It also aimed to investigate whether industrial psychologists within managerial or specialist differ in respect of different types of mental health. An online cross-sectional survey design was employed to draw a census sample (n = 274) from all South African industrial psychologists. A biographical questionnaire, the Work-Role Fit Scale, the Psychological Meaningfulness Scale, the Work Engagement Scale, and the Mental Health Continuum–Short Form were administered. Descriptive statistics, correlations, latent profile analysis, MANOVAs and ANOVAs were computed. Three mental health profiles for industrial psychologists were identified: languishing, moderately mentally healthy and flourishing. Significant differences between the three mental health profiles and experiences of meaningful work-role fit and work engagement were found, but not between experiences of managerial roles. The results show that individuals with different mental health profiles, experience work and its related outcomes, differently. Therefore, in order to enhance meaningful work-role fit and work engagement of industrial psychologists, a one-size-fits-all model may not be appropriate.
This Dissertation deals with the development of FAIR-relevant X-ray diagnostics based on the interaction of lasers and particle beams with matter. The associated experimental methods are supposed to be employed in the HIHEX-experiments in the HHT-cave of the GSI Helmholtz Center for Heavy-Ion Research GmbH (GSI) in Phase-0 and in the APPA-cave at the Facility for Antiproton and Ion Research in Darmstadt, Germany.
Diagnostic of high aerial density targets that will be used in FAIR experiments demands intense and highly penetrating X-ray sources. Laser generated well-directe relativistic electron beams that interact with high Z materials is an excellent tool for generation of short-pulse high luminous sources of MeV-gammas.
In pilot experiments carried out at the PHELIX laser system, GSI Darmstadt, relativistic electrons were produced in a long scale plasma of near critical electron density (NCD) by the mechanism of the direct laser acceleration (DLA). Low density polymer foam layers preionised by a well-defined nanosecond laser pulse were used as NCD targets. The analysis of the measured electron spectra showed up to 10- fold increase of the electron "temperature" from T_Hot = 1–2 MeV, measured for the case of the interaction of 1–2 ×10^19 Wcm^(−2) ps-laser pulse with a planar foil, up to 14 MeV for the case when the relativistic laser pulse propagates through the by a ns-pulse preionised foam layer. In this case, up to 80–90 MeV electron energy was registered. An increase of the electron energy was accompanied by a strong increase of the number of relativistic electrons and well-defined directionality of the relativistic electron beam measured to be (12 ±1)° (FWHM). This directionality increases the gamma flux on target by far compared to the soft X-ray sources.
Additionally to laser based active diagnostics, passive techniques involving inherent X-ray fluorescence radiation of projectile and target emitted during heavy-ion target interaction can be used to measure the ion beam distribution on shot. This information is of great importance, since the target size is chosen to be smaller than the beam focus in order to ensure homogeneous heating of the HIHEX-target by the ion beam. High amounts of parasitic radiation and activation of experimental equipment is expected for experiments at the APPA-cave. For this reason, all electronic devices must be placed at a safe distance to the target chamber. In order to transport the signal over a large distance, the X-ray image of the target irradiated by heavy-ions has to be converted into an optical one.
For these purposes, the X-ray Conversion to Optical radiation and Transport (XCOT)-system was developed in the frame of a BMBF-project and commissioned in two beamtimes at the UNILAC, GSI during this work.
In experiments, we observed intense radiation of target atoms (K-shell transitions in Cu at 8–8.3 keV and L-shell transition in Ta) ionised in collisions with heavy ions as well as Doppler-shifted L-shell transitions of Au-projectiles passing through targets. This radiation can be used for monochromatic (dispersive elements like bent crystals) or polychromatic (pinhole) 2D X-ray mapping of the ion beam intensity distribution in the interaction region during the beam-target interaction. We measured the efficiency of the X-ray photon production depending on the target thickness and the number of ions passing through the target. The spatial resolution of the XCOT-system based on the multi-pinhole camera was measured to be (91±17) μm for the image magnification factor M = 2. It was considerably improved by application of a toroidally bent quartz crystal and reached 30 μm at M = 6. This resolution is optimal to image the distribution of a 1mm in diameter ion beam. As next step, the XCOT-system will be tested during the SIS18 beam-time at the HHT-experimental area.
A systematic review on the burden of illness in individuals with tuberous sclerosis complex (TSC)
(2020)
Objective: This review will summarize current knowledge on the burden of illness (BOI) in tuberous sclerosis complex (TSC), a multisystem genetic disorder manifesting with hamartomas throughout the body, including mainly the kidneys, brain, skin, eyes, heart, and lungs.
Methods: We performed a systematic analysis of the available literature on BOI in TSC according to the PRISMA guidelines. All studies irrespective of participant age that reported on individual and societal measures of disease burden (e.g. health care resource use, costs, quality of life) were included.
Results: We identified 33 studies reporting BOI in TSC patients. Most studies (21) reported health care resource use, while 14 studies reported quality of life and 10 studies mentioned costs associated with TSC. Only eight research papers reported caregiver BOI. Substantial BOI occurs from most manifestations of the disorder, particularly from pharmacoresistant epilepsy, neuropsychiatric, renal and skin manifestations. While less frequent, pulmonary complications also lead to a high individual BOI. The range for the mean annual direct costs varied widely between 424 and 98,008 International Dollar purchasing power parities (PPP-$). Brain surgery, end-stage renal disease with dialysis, and pulmonary complications all incur particularly high costs. There is a dearth of information regarding indirect costs in TSC. Mortality overall is increased compared to general population; and most TSC related deaths occur as a result of complications from seizures as well as renal complications. Long term studies report mortality between 4.8 and 8.3% for a follow-up of 8 to 17.4 years.
Conclusions: TSC patients and their caregivers have a high burden of illness, and TSC patients incur high costs in health care systems. At the same time, the provision of inadequate treatment that does not adhere to published guidelines is common and centralized TSC care is received by no more than half of individuals who need it, especially adults. Further studies focusing on the cost effectiveness and BOI outcomes of coordinated TSC care as well as of new treatment options such as mTOR inhibitors are necessary.
The National Institutes of Health Stroke Scale (NIHSS) score is the most frequently used score worldwide for assessing the clinical severity of a stroke. Prior research suggested an association between acute symptomatic seizures after stroke and poorer outcome. We determined the frequency of acute seizures after ischemic stroke in a large population-based registry in a central European region between 2004 and 2016 and identified risk factors for acute seizures in univariate and multivariate analyses. Additionally, we determined the influence of seizures on morbidity and mortality in a matched case–control design. Our analysis of 135,117 cases demonstrated a seizure frequency of 1.3%. Seizure risk was 0.6% with an NIHSS score at admission <3 points and increased up to 7.0% with >31 score points. Seizure risk was significantly higher in the presence of acute non-neurological infections (odds ratio: 3.4; 95% confidence interval: 2.8–4.1). A lower premorbid functional level also significantly increased seizure risk (OR: 1.7; 95%CI: 1.4–2.0). Mortality in patients with acute symptomatic seizures was almost doubled when compared to controls matched for age, gender, and stroke severity. Acute symptomatic seizures increase morbidity and mortality in ischemic stroke. Their odds increase with a higher NIHSS score at admission.