Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.

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ZusammenfassungIn dieser Längsschnittstudie wurden unterschiedliche Verläufe in der Entwicklung der intrinsischen Wertüberzeugungen in den Unterrichtsfächern Mathematik und Französisch in den Schuljahren 9 bis 11 und deren Zusammenhänge mit Berufsaspirationen untersucht. Bei 850 Schüler*innen von Deutschschweizer Gymnasien (54 % weiblich, Alter T1: 15,6 Jahre) wurden in einem bivariaten Wachstumsmodell fünf Wachstumsklassen identifiziert. Zwei dieser Klassen zeigten eine klare Differenzierung in den Wertüberzeugungen zwischen den beiden Fächern und eine stabile Entwicklung im bevorzugten Fach. Die anderen drei Klassen waren durch Mittelwertunterschiede (hohe, mittlere, niedrige intrinsische Wertüberzeugungen) gekennzeichnet und zeigten moderate Abnahmen über die Zeit in beiden Fächern. Die fünf Wachstumsklassen gingen mit unterschiedlichen Berufsorientierungen am Ende des 11. Schuljahres einher, wobei Berufsorientierungen bezüglich eines Fachs besonders hoch ausgeprägt waren, wenn die Wertüberzeugung bezüglich des anderen Faches niedrig war. Geschlechterunterschiede in den Berufsorientierungen konnten vollständig über die Zugehörigkeit der Geschlechter zu den fünf Wachstumsklassen erklärt werden.

Introduction: We assessed best available data on access and delivery of acute stroke unit (SU) care, intravenous thrombolysis (IVT) and endovascular treatment (EVT) in the European region in 2019 and 2020. Patients and methods: We compared national data per number of inhabitants and per 100 annual incident first-ever ischaemic strokes (AIIS) in 46 countries. Population estimates and ischaemic stroke incidence were based on United Nations data and the Global Burden of Disease Report 2019, respectively. Results: The estimated mean number of acute SUs in 2019 was 3.68 (95% CI: 2.90–4.45) per one million inhabitants (MIH) with 7/44 countries having less than one SU per one MIH. The estimated mean annual number of IVTs was 21.03 (95% CI: 15.63–26.43) per 100,000 and 17.14% (95% CI: 12.98–21.30) of the AIIS in 2019, with highest country rates at 79.19 and 52.66%, respectively, and 15 countries delivering less than 10 IVT per 100,000. The estimated mean annual number of EVTs in 2019 was 7.87 (95% CI: 5.96–9.77) per 100,000 and 6.91% (95% CI: 5.15–8.67) of AIIS, with 11 countries delivering less than 1.5 EVT per 100,000. Rates of SUs, IVT and EVT were stable in 2020. There was an increase in mean rates of SUs, IVT and EVT compared to similar data from 2016. Conclusion: Although there was an increase in reperfusion treatment rates in many countries between 2016 and 2019, this was halted in 2020. There are persistent major inequalities in acute stroke treatment in the European region. Tailored strategies directed to the most vulnerable regions should be prioritised.

Motivational interactions during multiple language learning have been largely neglected in language motivation research. To fill this gap, we investigate longitudinal relations between Swiss German students' value beliefs in English, French, and German in upper secondary schools and whether there are differences in motivational development between multilingual and monolingual students. Multivariate latent growth modeling was used to analyze data from 850 students (M age = 15.61 years, SD = .62; 54% female) gathered yearly from Grades 9 to 11. Results suggest an interference between students' value beliefs in English and the other 2 languages. Students who reported higher value beliefs in English in Grade 9 showed steeper decreases in their value beliefs for French and German from Grades 9 to 11. However, stronger increases in English value beliefs over time were associated with stronger increases in French and German value beliefs. Moreover, while multilingual students reported higher initial value beliefs in French and English, they also showed steeper decreases in French and English value beliefs over time compared to their monolingual peers. Findings are discussed in relation to their implications for teaching practice and future research directions.