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The Hemophilia Joint Health Score (HJHS) was developed and validated to detect arthropathy in children. Additional evidence is required to show validity in adults. We studied the convergent and discriminant construct validity of the HJHS version 2.1(HJHSv2.1) in adults with hemophilia. A secondary aim was to define age‐related normative adult HJHSv2.1 reference values. We studied 192 adults with hemophilia, and 120 healthy adults in four age‐matched groups—18 to 29, 30 to 40, 41 to 50, and >50 years—at nine centers. Trained physiotherapists scored the HJHS and World Federation of Hemophilia (WFH) joint score. Health history, the Functional Independence Scale of Hemophilia (FISH), Hemophilia Activities List (HAL), and Short‐Form McGill Pain Questionnaire (SF‐MPQ) were also collected. The median age was 35.0 years. Of participants with hemophilia, 68% had severe, 14% moderate, and 18% mild disease. The HJHS correlated strongly with WFH score (Spearman’s rho [rs] = .95, P < .001). Moderate correlations were seen between the FISH (rs = .50, P < .001) and SF‐MPQ Present Pain Intensity (rs = .50, P < .001), while a modest correlation was found with the HAL (rs = −.37, P < .001). The HJHS significantly differentiated between age groups (Kruskal‐Wallis T = 35.02, P < .001) and disease severity in participants with hemophilia. The HJHS had high internal reliability (Cronbach’s α = .88). We identified duration of swelling as a redundant item in the HJHS. The HJHS shows evidence of strong convergent and discriminant construct validity to detect arthropathy in adults with hemophilia and is well suited for use in this population.

Hemophilia is a bleeding disorder characterized by recurrent bleeding into muscles and joints. Many people with hemophilia experience multiple traumatic painful bleeding episodes, meaning that pain is often a significant problem for people with hemophilia, with a potentially high prevalence of posttraumatic stress and posttraumatic stress disorder symptoms. Current pain treatments are often ineffective and do not consider pain memories, which are experienced by almost half of people with posttraumatic stress disorder and which has not been explored in people with hemophilia. To fill this gap, 14 semistructured interviews with men with hemophilia were completed between November 2022 and January 2023 to explore their lived experiences of pain relating to their hemophilia. Data were analyzed using reflexive thematic analysis. Three overarching themes were constructed from the data: \"trauma histories,\" \"pain management,\" and \"impact on the present.\" Findings show that pain experienced by people with hemophilia is complex and does include a memory element for many individuals. Pain memories are clear and vivid and include visual, somatic, and emotional elements in intricate detail. Pain can also be experienced in the present when experiencing a pain flashback, and pain in the present can be a trigger to recalling and re-experiencing pain memories from the past. Self-taught active dissociation from pain, imagery, and distraction were described as useful pain management strategies. Findings from this study have implications for clinicians and service providers because current pharmacological and physical pain management techniques may be ineffective when pain memory is involved. Future interventions should consider how pain management is advanced for people with hemophilia and how hemophilia services become trauma informed.

Background A large body of literature exists on trade liberalisation and the ways in which trade agreements can affect food systems. However, the systematic and objective monitoring of these and their impact on national food environments has been limited. Using a case study, this paper undertakes a systematic analysis of how Vanuatu’s obligations under WTO agreements has impacted its food environment. Results Data collection was guided by the INFORMAS trade monitoring framework’s minimal approach and seven selected indicators outlined in three domains: trade in goods, trade in services and FDI, and policy space. Strong associations between trade liberalisation and imported foods, especially ultra-processed foods were evident in measured indicators as follows: (i) food trade with 32 WTO countries showing high levels of import volumes; (ii) a marked increase in ‘less healthy’ focus food imports namely fatty and other selected meat products, sugar, savoury snacks, ice-cream and edible ices and energy-dense beverages; (iii) actual and bound tariff rates impacting import trends of ice-cream and edible ices, bakery products and confectionary; and in other instances, a sharp increase in import of crisps, snacks and noodles despite tariff rates remaining unchanged from 2008 to 2019; (iv) policies regulating food marketing, composition, labelling and trade in the domestic space with relatively limited safeguard measures; (v) 49 foreign-owned food-related companies involved in food manufacturing and processing and the production of coffee, bakery products, confectionary, food preservatives, fish, local food products and meat, and the manufacturing, processing and packaging of palm oil, coconut oil, cooking oil, water, cordial juice, flavoured juices, soft drinks and alcoholic beverages. These were largely produced for local consumption; (vi) 32 domestic industries engaged in food and beverage production; and (vii) an assessment of WTO provisions relating to domestic policy space and governance showing that the current legal and regulatory environment for food in Vanuatu remains fragmented. Conclusions The analysis presented in this paper suggest that Vanuatu’s commitments to WTO agreements do play an important role in shaping their food environment and the availability, nutritional quality, and accessibility of foods.

Drawing on the work of Jeanne-Nicole Mellon Saint-Laurent, this essay proposes utilizing hagiographies from the The Book of the Saints of the Ethiopian Church, a fifteenth-century Ethiopian collection of saints’ lives, to explore various aspects of conversion. Other scholars employ a similar approach when analyzing hagiographical literature found in medieval Europe. While acknowledging that these texts do not provide details about the historical experience of conversion, they can assist scholars in understanding the conception of conversion in the imagination of the culture that created them. This essay specifically focuses on the role of women in conversion throughout the text and argues that, although men and women were almost equally represented as agents of conversion, a closer examination reveals that their participation remained gendered. Women more frequently converted someone with whom they had a prior relationship, especially a member of their familial network. Significantly, these observations mirror the patterns uncovered by contemporary scholars such as Dana Robert, who notes how women contributed to the spread of Christianity primarily through human relationships. By integrating these representations of conversion from late medieval Ethiopia, scholarship will gain a more robust picture of conversion in Africa more broadly and widen its understanding of world Christianity.

This research examines experiences of Latvian students pursuing undergraduate degrees at universities in England. Working with this population positions this research in the subject area of International Student Mobility (ISM). As a relatively new subject ISM is still developing suitable concepts, methodological practices and scientific terminology. This presents a challenge but also calls for more in-depth work in the area. As an exploratory study this research answers this call and proposes new directions in the development of ISM as a research field. ISM is particularly interesting in the context of contemporary Europe where student mobility is considered as a vehicle of human capital across national borders. As such student mobility contributes to further internationalization of the European labour force and facilitates development of the knowledge-based economy. Finding out what students gain from university education abroad remains a topic of scientific debate. This research focuses on the practical but complicated part of Higher Education: competence development. The review of the literature reveals that the topic of competence development in Higher Education has been in and out of researchers’ favour, but it has not been examined in the international context. This consideration is timely as more and more students seek education abroad and competences developed at foreign universities are transferred across borders. This research is based on in-depth interviews with Latvian students in England, their family members and friends both in Latvia and in England. Interviewing family and friends enriched the self-reporting accounts of the students, thus capturing a more holistic representation of the students’ experiences. In addition, accounts of the students’ network representatives from England and from Latvia positioned this research in the international social networks of the students. This research finds that international social networks are the natural and necessary environments in which mobility of students takes place and argues that it needs to be studied with consideration to these under-researched environments. This study also proposes a longitudinal focus. The main participants of this research, the students, were interviewed three times over three years, which goes beyond most research studies on student mobility. The analysis of the interview responses relies on multiple iterations between the literature and the data. The findings demonstrate that degree-seeking students develop competences that can be grouped in three main areas: gaining access to university education in England, socio-cultural acculturation and academic acculturation. In each of these areas students develop specific skills and abilities that support the three areas of competences. The development of the skills, abilities and competences is explained through a model created by Noel Burch for Gordon Training International (GTI). The model outlines four stages of development that progress from the level of unconscious incompetence, to conscious incompetence, to conscious competence and to unconscious competence.

According to a 2015 study by Princeton-based Educational Testing Service (ETS), Millennials in the U.S. fall short when it comes to the skills employers want most: literacy (including the ability to follow simple instructions), practical math, and, shockingly, a category called \"problem-solving in technology-rich environments.\"

Martin Shkreli, the former hedge fund manager under fire for buying a pharmaceutical company and ratcheting up the price of a life-saving drug, is in custody following a securities probe.

According to The Wall Street Journal, the Commerce Department will have to use estimated production costs in order to rule on whether the Korean companies are selling these products at unfairly low prices.

According to the AP, the agreement approved by Michigan's economic development board is the latest designed to help Gov. Rick Snyder and future administrations better budget for billions in tax incentives authorized when the state was \"hemorrhaging jobs.\"