bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing uncertainty - leaders’ perspectives on health system resilience during COVID-19 in Finland
Authors: Karreinen S , Paananen H , Kihlström L , Janhonen K , Huhtakangas M , Viita-aho M , Satokangas M , Tynkkynen L K
Published: October 2023

Background

The role of leadership in resilience is commonly acknowledged but empirical studies in the context of healthcare are less frequent. One key to public health preparedness is to understand how primary healthcare organisations are able to build resilience before, during, and after unexpected or sudden shocks. Finland offers an opportunity to investigate resilience in a public sector setting where the health system is decentralized and local health systems, including primary healthcare, are responsible for most public health actions. In this study we examined how leaders responsible for local health systems interpreted changes in their operational environment in Finland during the first year of COVID-19, and to how these views reflect aspects of resilience in healthcare.

Methods

We identified 14 leaders in four regions in Finland from a larger data set of 53 interviews. Leaders had responsibilities for local health and social care during the COVID-19 pandemic. Semi-structured interviews were conducted in March-June 2021. The audio recorded data were transcribed and analysed with abductive thematic analysis using Atlas.TI.

Results

From the data we identified three core issues of leadership in building primary healthcare resilience. Firstly, living with constant uncertainty was seen as an integral part of leadership not only during crises but also at normal times. Secondly, health systems’ adaptability was considered important. This was maintained through decisions on workforce, information, and collaboration. Thirdly, the leaders responsible for local health systems emphasized holistic approach to crisis governance and service needs of the public.

Conclusions

Leaders in local health systems have to consider uncertainties and various entwined aspects of resilience during public health crises. This should be emphasised in decision-making and policy recommendations. Qualitative research designs are needed to obtain a broad understanding of the entity.

Key messages

• Holistic approach and adaptability were key factors of local health system resilience in Finland.

• Resilience should be studied more in the context of local health systems and primary healthcare where complexities are processed continuously.
Accessing health and health behaviour interventions by people with severe and multiple disadvantage
Authors: Jain N , Adams E A , Joyes E C , Burrows M , Paisi M , McGowan L J , Watt R , Bambra C , Kaner E , Ramsay S E
Published: October 2023

Populations facing severe and multiple disadvantage (SMD) - co-occurring homelessness, substance misuse and offending, have high level of physical and mental ill-health. Poor oral health is one of the three common physical health problems among this population, and is closely linked with use of drugs, alcohol and smoking. However, little is known about pathways that improve access to health interventions for people living with SMD. This study examines organizational and individual factors that restrict access to health interventions and provides actionable suggestions for improving engagement of health services by people living with SMD. Between August 2021 and March 2022, interviews/focus group discussions were conducted with people experiencing SMD in Newcastle and with frontline staff, policy makers, and commissioners from London, Plymouth and Newcastle upon Tyne. Data were analysed iteratively using thematic analysis and were organized and coded using NVivo 1.6.1. 19 people with lived experience of SMD (age range: 27-65 years; 79% male) and 78 service providers (age range: 28-72 years; 37% male) were interviewed. The access to health interventions was reported to be affected by location, integration between services, use of technology, knowledge of services and inter-personal relationships. Furthermore, individual factors such as fear of seeking treatment, health behaviours and socio-economic disadvantage of the service user, and past experiences of treatment were common themes identified. People with SMD have complex health needs with co-occurring and linked conditions making usual pathway of care difficult to access. Reducing the number of appointments, sign posting services and coordinating with support workers may help alleviate the individual factors. Improving their health may require action across multiple domains to integrate care. Findings from our study could also be extrapolated to the planning and delivery of other health services for people with SMD.

Key messages

• Pathway of care for people with SMD can be improved through interventions that addresses organizational limitations and accounts for individual situations.

• Integrated services and engagement of people with lived experiences may improve the engagement of health services by people with SMD.
The elderly health profile and health services access during 2020-2021: results from Passi d’Argento
Authors: Contoli B , Casigliani V , Pettinicchio V , Minardi V , Asta F , Possenti V , Gallo R , Masocco M
Published: October 2023

Background

The COVID-19 pandemic has affected the community in multiple health, economic, social and cultural aspects and the impact was stronger among the over-65s. PASSI d'Argento (PdA) surveillance system monitors the effects on physical activity, partecipation in social life and healthcare renunciation due to fear of Covid contagion or services interruption.

Methods

Since 2016, PdA has been continuously collecting information on health, behavioural risk factors, quality of life and the care and assistance needs of eldely people. Data is collected through an anonymous and standardised questionnaire. Physical activity is assessed with the Physical Activity Scale for Elderly, an internationally validated instrument that considers all types of activities commonly performed by elderly. High PASE values correspond to high levels of physical activity.

Results

The percentage of physically active elderly decreased significantly during the pandemic, from 39% (CI95% 38.3-39.8) in 2016-2019 to 35% (CI95% 33.7-36.4) in 2020-2021. The decline is greater among people with economic difficulties (44.4% to 37.5), women (from 36.7% to 33.5%), among those with chronic deseases (from 37% to 31%) or sensory impairment (from 31.3% to 27.5%). Participation in social life declines significantly from 23.1% (95% CI 22.5.1-23.8) in the pre-covid period to 142 (95% CI 13.2-15.1) in 2020-2021. The pandemic develops in a context where inequalities in prevention and care already exist; 32% of elderly declared difficulties in accessing health services in 2016-2019. During pandemic period 28% of the over-65s gave up at least one medical or diagnostic examination with a risk of delayed in diagnosis and treatment.

Conclusions

PdA shows the importance of monitoring the strong impact of emergency on several aspects of elderly population to riorganize the local health system organization, implement targeted interventions and improve the health services’ offers to reduce inequalities.

Key messages

• Riorganize the local health system is crucial to improve targeted interventions and reduce inequalities in care and prevention for elderly population.

• Early diagnosis and adequate therapy are crucial in old age.
Roadmap for implementation of genomics in healthcare: towards equity in access to genomics
Authors: Lopes F , Costa A , Cardoso M L , Custers I , Merchant A , Konopko M , Scollen S , Vicente A
Published: October 2023

Issue

Implementing genomic medicine in healthcare can bring us closer to making personalised medicine a reality, with notable socioeconomic benefits.

Description of the problem

The 1+Million Genomes Initiative is promoting a reflection in European countries regarding their national strategies for genomic medicine, and how these contribute to research and improve clinical practice. Implementation of genomic medicine is complex and requires investment and adjustments in the organisation and practices of healthcare services, including technical infrastructure for genomic data generation and management, a trained healthcare workforce, and appropriate ethical and legal frameworks.

Methods

To promote the implementation of genomic medicine in healthcare systems, and improve its societal impact, the Beyond 1+MG (B1MG) project organised three country exchange visits for capacity building, developed and validated in real world settings a comprehensive Maturity Level Model (B1MG MLM) for genomic medicine, and organized workshops on health economics models for genomics.

Results

The products resulting from these activities provide policy recommendations for adoption of genomic medicine, an innovative MLM Toolkit for health systems to self-assess their current maturity status regarding genomic medicine implementation, and plan the path for improvement, as well as several brief papers highlighting main challenges and key indicators for health economic evaluation of genomic tests. Overall, this set of B1MG products provide a Playbook to support the development of national or regional roadmaps for the implementation of genomic medicine in healthcare systems.

Lessons

Country healthcare systems have specific practices, barriers and constraints, so the actions needed for progress in genomic medicine implementation towards optimization are specific to the context of each healthcare system.

Key messages

• The B1MG Roadmap will support the definition of strategies for adoption of genomics in healthcare systems, towards equity in the access to genomic medicine for all European citizens.

• Country healthcare systems actions needed for progress in genomic medicine implementation towards optimization are specific to the context of each healthcare system.
Carbapenemase-producing organisms under the covid 19 pandemic
Authors: Castilla-Heredia J P , Martín-Pérez F J , González-Martínez A , Fernández-Sierra A , Gutiérrez-Fernández J
Published: October 2023

Background

Antibiotic resistance is a widely recognised public health problem. Probably the factor most clearly associated with the emergence of carbapenemase-producing organisms (CPOs) is the use of antimicrobials. During the covid-19 pandemic, most patients with covid-19 received antibiotics. In addition, it is possible that the extra burden of work affected antimicrobial stewardship and infection prevention and control (IPC). The aim of the present study was to investigate the association between the frequency of carbapenemase-producing organisms (CPO) isolates and the excess of workload experienced during the covid-19 pandemic in a regional hospital in south-eastern Spain.

Methods

Descriptive study. Isolates producing one or more carbapenemases were collected from January 2015 to March 2022. Isolates of the same microorganism were grouped by individual, assuming that they correspond to the same episode of infection or colonisation. To estimate the workload, the rate of admissions of covid-19 cases in intensive care (ICU) and the total number of beds in covid-19 ICU each month were collected.

Results

The frequency of episodes shows an upward trend since 2018. From the 4th quarter of 2020 there is a clear acceleration until the 2nd quarter of 2021 (20 episodes per month), when a decrease to less than pre-pandemic frequencies is observed (10 episodes per month). The increase in episodes is parallel to the beginning of c ovid-19 admissions observed from the 4th quarter onwards. The decrease of episodes coincides with the increase of bed capacity, even with a maintained rate of admissions. CPO with two carbapenamases occur regularly from the 2nd quarter of 2020.

Conclusions

The occurrence of CPO may be related to the burden of work in healthcare systems. Disruption of antimicrobial stewardship and IPC could mediate this relationship. The decrease of episodes with a maintained rate of admissions may indicate that antibiotic use is not directly associated with CPO emergence.

Key messages

• Maintaining healthcare capacities related to antimicrobial stewardship and IPC may be critical in limiting the emergence of CPO.

• Antibiotic use may not be directly related to the increase of CPO.
Multidisciplinary model for administration of recombinant Zoster vaccine in fragile patients
Authors: Martinelli S , Regazzi L , Rizzo F , Pascucci D , Tamburrini E , Salvo P F , Landi F , Bosello S L , Spadea A , Laurenti P
Published: October 2023

Background

Target populations eligible for vaccinations are not comprehensively reached by out-of-hospital health services, particularly frail people with immunization deficits. The aim of this study was to evaluate the effectiveness of a model of shared management between hospital - IRCCS Fondazione Policlinico Universitario A.Gemelli (FPG) - and out-of-hospital health services -ASL Roma1- of fragile patients with an indication for herpes zoster (HZ) vaccination, based on counseling carried out by a multidisciplinary team in the hospital setting.

Methods

From June 2022 to April 2023, patients with congenital and/or acquired immunodepression, who were treated at the IRCCS FPG in the Units of Hematology, Geriatrics, Infectious Diseases, Rheumatology were offered vaccination with the recombinant Zoster vaccine. At the time of enrollment, all patients completed the Vaccination Attitudes Examination (VAX-I) scale, for the purpose of assessing vaccine hesitancy. Patients received multidisciplinary counseling focusing on HZ and contrasting vaccine hesitancy. Multiple linear regression was used to analyze the impact of demographic and clinical characteristics on the VAX-I items.

Results

Sixty fragile patients were included. Mean vaccine hesitancy score was 2.1 ± 0.9. A significant correlation between vaccine hesitancy and the age group 45-64 years, female sex and patient with HIV was demonstrated. These patients had significantly higher score of “mistrust of vaccine benefits”, “worries about unforeseen future effects”, “concerns about commercial profiteering” and “preference for natural immunity”. After counseling, all patients adhered to the vaccination with two doses of a recombinant zoster vaccine. No serious adverse events or breakthrough HZ infections were observed during a median follow-up of 65.5 days.

Conclusions

Although vaccine hesitancy in some age groups is high, hospital-based multidisciplinary counseling achieved full HZ vaccination compliance.

Key messages

• herpes zoster vaccination coverage of frail patients is not fully achieved in the community health setting.

• The adoption of a multidisciplinary model for administration of recombinant Zoster vaccine in fragile patients based on a Hospital-Territory Vaccination Center may help overcome vaccine hesitancy.
Who touched that? Interconnection of high-touch surfaces drives pathogen spread in public spaces
Authors: Ackerley L , Cooper S , Upson S , Paskey A , Gent L , Buckley C , Spitzer M E , Sexton J D , Picton J L , Reynolds K A
Published: October 2023

Background

Surface contamination via hands plays an important role in pathogen spread in public spaces. This study aimed to identify frequently touched surfaces and evaluate the spread of a surrogate virus in a hotel lobby.

Methods

In a working hotel lobby, observation was performed (30 hours) to identify the surfaces and objects touched. An entry doorknob and first floor elevator button were seeded with a bacteriophage (Phi-X174) tracer; 4 hours later 25 surfaces were swabbed to determine tracer distribution and contamination levels.

Results

A total of 324 individuals performed 627 touches over 13 different fomites in the hotel lobby. The elevator button and front desk counter were the most frequently touched (32 and 22% of all touches respectively), with 55% of individuals touching the elevator button and 79% touching either the elevator button, the front desk counter, or both. More than half (56%) touched 2 or more surfaces; there were 314 interactions between surfaces. Touches from the elevator button to other surfaces (92 interactions) and from other surfaces to the elevator button (41) made up 42% of all interactions and connected the elevator button to 9 other fomites including doors, countertops, seating, a credit card reader and a hand sanitizer pump. From two seeded sites, the tracer spread to 13 surfaces over 4 hours. The most contaminated surfaces were tables, counter tops and door handles. Other contaminated objects were the luggage cart handle, sanitizer pump, and computer equipment.

Conclusions

Surfaces in the hotel lobby were frequently touched and highly interconnected, resulting in extensive spread of surface contamination in as little as 4 hours. This study demonstrates the importance of hands in distributing contamination between shared surfaces and highlights the need for hand and surface hygiene interventions to disrupt the journey of the germ in public settings.

Key messages

• Frequently touched surfaces in public spaces are interconnected.

• Interconnection of people via touched surfaces drives the spread of pathogens in a public setting.
Lessons from the past: how 19th-century anti-smallpox efforts enlighten current pandemic control
Authors: Vigezzi G P , Vecchio R , Mazzarello P , Odone A
Published: October 2023

Background

In the first decades of the 19th century, vaccination was a brand-new innovation in Lombardy, Northern Italy. Yet, anti-smallpox vaccination campaigns were successfully carried out despite organisational and communication obstacles. By establishing a parallel with current COVID-19 vaccinations, we aimed to study how laws were enforced for outbreak control through vaccination services and to evaluate how health authorities handled public communication on vaccination.

Methods

A systematic search of original documents was conducted at the State Archives of Pavia and Milan, that of the City of Pavia and the Museum for the History of Pavia University. The search timeframe was between 1797 and 1830.

Results

Luigi Sacco introduced anti-smallpox vaccination in Lombardy in 1801 (1769-1836). He inoculated a million and a half citizens with his team in seven years. Student of Johann Peter Frank, generally known as one of the founders of modern Hygiene, Sacco was appointed General Director of Vaccination for the Kingdom of Italy and designed vaccination campaigns. Church parishes acted as organisational units: they were assigned to a vaccinating doctor, and priests were asked to provide a register of newborns to plan infant immunisation sessions. Authorities adopted a mixed approach towards vaccination mandates: these were formally effective but not imposed with coercion. When new outbreaks exploded, extraordinary vaccinations were implemented with easier compliance than in the absence of contagion. Great attention was paid to effective communication: priests were involved in scientific divulgation and vaccination promotion. Of note is the sermon written by Sacco impersonating an imaginary bishop from the city of Goldstadt who condemned vaccine refusal.

Conclusions

19th-century public health officials and authorities dealt with the same issues we face nowadays: effective organisation of vaccination services, vaccine hesitancy and related mandates, and communication strategies.

Key messages

• To ensure broad vaccination coverage, the most dependable structure consists of locally based and socially integrated organisational units, such as districts.

• Effective vaccination coverage was achieved through targeted communication, a gentle approach to mandatory vaccinations, and focusing efforts during epidemic periods.
Covid-19 vaccination coverage by birth country and underlying risk for severe Covid-19 disease
Authors: Delalic L , Gjefsen H M , Hussaini L , Gleditsch R N , Winje B A , Godøy A A
Published: October 2023

Backround

It is unknown whether differences in age and health profiles contribute to explain the observed variation in Covid-19 vaccination coverage between birth countries. If the unvaccinated are mostly young and healthy, the consequences for severe illness and healthcare capacity will be less than if the unvaccinated have underlying risk for severe Covid-19 disease. This study aims to investigate whether differences in Covid-19 vaccination coverage by birth country in Norway are equally prominent among individuals with underlying risk for a severe Covid-19 disease course.

Methods

With register data from the Norwegian Emergency Preparedness Register, we linked vaccination coverage to demographic and socioeconomic variables for all Norwegian residents. Using Poisson regression, we examined if demonstrated differences in vaccination coverage between countries of birth were as prominent among individuals with underlying risk factors for severe Covid-19 disease, controlled for gender, age, education level, household income, and county.

Results

The demonstrated variation in Covid-19 vaccination coverage between Norwegian-born and foreign-born is lower when we limit the study population to those with underlying risk factors. Among people without underlying risk, the incidence rate ratio for being vaccinated was lowest for people born in Poland (IRR = 0.55; 95% CI 0.55 to 0.56) and Lithuania (IRR = 0.61; 95% CI 0.6 to 0.62), but the greatest increase in IRR was found for people with underlying risk factors born in these countries.

Conclusions

The study illuminates two facets of the difference in vaccination coverage between Norwegian-born and foreign-born individuals. First, the difference in vaccination coverage was smaller within groups with underlying risk for severe Covid-19 outcomes than for groups without. Second, the differences in vaccination coverage by birth country remains, even constrained on individuals with underlying risk.

Key messages

• The observed differences in Covid-19 vaccination coverage by birth country are smaller within groups with underlying risk factors.

• Foreign-born individuals are a heterogenous group, crucial in considering all health policy formulations.
Tolerability of bictegravir/tenofovir alafenamide/emtricitabine versus dolutegravir/lamivudine as maintenance therapy in a real-life setting
Authors: Rocabert Alba , Borjabad Beatriz , Berrocal Leire , Blanch Jordi , Inciarte Alexy , Chivite Ivan , Gonzalez-Cordon Ana , Torres Berta , Ambrosioni Juan , Martinez-Rebollar Maria , Laguno Montserrat , De La Mora Lorena , Foncillas Alberto , Sempere Abiu , Rodriguez Ana , Solbes Estela , Llobet Roger , Miro Jose M , Mallolas Josep , Blanco Jose L , De Lazzari Elisa , Martinez Esteban
Published: October 2023

Background

While both the burden of therapy and the individual drugs in bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) and dolutegravir/lamivudine differ, it is unclear whether their real-life tolerability may be also different.

Methods

Single-centre, clinical cohort analysis of all virologically suppressed persons with HIV (PWH) who were first prescribed bictegravir as BIC/TAF/FTC or dolutegravir as dolutegravir/lamivudine and had taken ≥1 dose of study medication. Major outcomes were discontinuations either for any reason or due to toxicity. Incidence was calculated as number of episodes per 100 person-years adjusted through propensity score analysis.

Results

Relative to persons treated with BIC/TAF/FTC (n = 1231), persons treated with dolutegravir/lamivudine (n = 821) were older and had more AIDS-defining conditions although better HIV control. After a median follow-up of 52 weeks, adjusted incidence rates for discontinuation were 6.68 (95% CI 5.18–8.19) and 8.44 (95% CI 6.29–10.60) episodes per 100 person-years for BIC/TAF/FTC and dolutegravir/lamivudine, respectively; adjusted incidence rate ratio for dolutegravir/lamivudine was 1.26 (95% CI 0.89–1.78) relative to BIC/TAF/FTC (P = 0.1847). Adjusted incidence rates for discontinuation due to toxicity were 3.88 (95% CI 2.70–5.06) and 4.62 (95% CI 3.05–6.19) episodes per 100 person-years for BIC/TAF/FTC and dolutegravir/lamivudine, respectively; adjusted incidence rate ratio for dolutegravir/lamivudine was 1.19 (95% CI 0.75–1.90) relative to BIC/TAF/FTC (P = 0. 4620). Adverse events leading to discontinuation were neuropsychiatric (n = 42; 2%), followed by gastrointestinal (n = 23; 1%), dermatological (n = 15; 1%) and weight increase (n = 15; 1%), without differences between regimens.

Conclusions

Switching to BIC/TAF/FTC or dolutegravir/lamivudine showed no difference in the risks of overall or toxicity-related discontinuations or in the profile of adverse events leading to discontinuation.
Examining Disparities in Alcohol Use Testing on Burn Patient Admissions: A Call for Association Guidance
Authors: Abrams Thereasa E , Nugent William R , Joseph-McCatty Andrea A , Moulick Aritra
Published: October 2023

Burn injuries are associated with as well as complicated by alcohol misuse. To date, there are no stated guidelines for alcohol testing upon burn patient admissions. This study investigated if there were associations between race and testing for alcohol upon burn admissions, controlling for demographics, burn severity (degree), and other circumstances associated with burn injuries. This study was a secondary analysis of 32 258 cases from the National Burn Data Repository. The dependent variable was whether a burn case was screened for alcohol use, and independent variables were age, gender, whether physical abuse was reported, mental health comorbidities, marital status, the severity of burns, whether the injury was work-related, injury circumstances, and etiology of injury. Controlling for independent variables, race was associated with an increased probability of having been screened for alcohol use on admission to a burn center. Data reflecting alcohol screening/testing results reported in the NBR were not included in the analysis. Study results were consistent with the possibility of bias and may have influenced decisions to screen/test for alcohol misuse/abuse in reported burn cases. It is argued these findings support the recommendation that guidelines for alcohol testing of burn patients are warranted and would benefit from specific guidance from the American Burn Association.
The critical role of BTRC in hepatic steatosis as an ATGL E3 ligase
Authors: Qi Weiwei , Fang Zhenzhen , Luo Chuanghua , Hong Honghai , Long Yanlan , Dai Zhiyu , Liu Junxi , Zeng Yongcheng , Zhou Ti , Xia Yong , Yang Xia , Gao Guoquan
Published: October 2023

Non-alcoholic fatty liver disease (NAFLD), characterized by hepatic steatosis, is one of the commonest causes of liver dysfunction. Adipose triglyceride lipase (ATGL) is closely related to lipid turnover and hepatic steatosis as the speed-limited triacylglycerol lipase in liver lipolysis. However, the expression and regulation of ATGL in NAFLD remain unclear. Herein, our results showed that ATGL protein levels were decreased in the liver tissues of high-fat diet (HFD)-fed mice, naturally obese mice, and cholangioma/hepatic carcinoma patients with hepatic steatosis, as well as in the oleic acid-induced hepatic steatosis cell model, while ATGL mRNA levels were not changed. ATGL protein was mainly degraded through the proteasome pathway in hepatocytes. Beta-transducin repeat containing (BTRC) was upregulated and negatively correlated with the decreased ATGL level in these hepatic steatosis models. Consequently, BTRC was identified as the E3 ligase for ATGL through predominant ubiquitination at the lysine 135 residue. Moreover, adenovirus-mediated knockdown of BTRC ameliorated steatosis in HFD-fed mouse livers and oleic acid-treated liver cells via upregulating the ATGL level. Taken together, BTRC plays a crucial role in hepatic steatosis as a new ATGL E3 ligase and may serve as a potential therapeutic target for treating NAFLD.
Delayed closed-suction drain removal following inflatable penile prosthesis placement: a multi-institutional experience
Authors: Shumaker Luke , Zulia Nicholas , Kennedy Emmett , Beilan Jonathan , Ortiz Nicolas , Baumgarten Adam
Published: October 2023

Background

There are little published data regarding longer percutaneous drain durations following inflatable penile prosthesis placement; despite this, drain proponents suggest reduced scrotal hematoma formation, while detractors cite the risk of retrograde device seeding.

Aim

Here, we quantify the outcomes of a multi-institutional cohort with drain durations of 48 hours or greater.

Methods

Data were collected retrospectively for patients undergoing primary 3-piece inflatable penile prosthesis (IPP) placement who had a postoperative drain placed. Cases were performed by 3 surgeons at 3 high-volume centers between January 1, 2020, and March 31, 2022. It was the routine practice of these surgeons to leave percutaneous drains for an interval of 48 hours or greater. R software was used to perform statistical analysis and data visualization.

Outcomes

Primary outcomes included rates of infection and hematoma formation. Secondary outcomes included device explantation.

Results

During the study period, there were 224 patients meeting initial inclusion criteria. Of these, 15 patients had their drains removed before 48 hours, leaving 209 patients for the analysis. Mean drain duration was 67 ± 24.7 hours. The mean follow-up interval was 170 days. Diabetes mellitus was present in 84 (40%) patients with a mean hemoglobin A1c of 7.2%. Penoscrotal and infrapubic approaches were employed (n = 114 [54.5%] vs n = 95 [45.5%]). Reservoir location was split between space of Retzius and high submuscular, with space of Retzius being more common (n = 164 [78.5%] vs n = 45 [21.5%]). Discrete hematomas were observed in 7 patients, with subsequent operative intervention on 2. Notably, both of these were infection cases. There were 3 (1.4%) total device infections. Revision for noninfection causes was required in 9 (4.3%) patients. Fisher’s exact testing demonstrated significant association between hematoma formation and anticoagulation and/or antiplatelet therapy (P = .017). On multivariable logistic regression, only anticoagulation and/or antiplatelet therapy remained significant (P = .035).

Clinical implications

Maintaining percutaneous closed-suction bulb drains for >48 hours following IPP placement is safe.

Strengths and limitations

This multi-institutional study fills a hole in IPP perioperative literature, as there have been no previously published data regarding drain durations >48 hours. The primary limitations are the retrospective nature and lack of a control population.

Conclusion

Maintaining closed-suction bulb drains for >48 hours following IPP implantation is safe and associated with infection rates comparable to other modern cohorts and a very low rate of hematoma formation.
Infectious complications associated with buttonhole cannulation of native arteriovenous fistulas: a 22-year follow-up
Authors: Labriola Laura , Crott Ralph , Desmet Christine , Romain Cécile , Jadoul Michel
Published: October 2023

Background

Buttonhole (BH) cannulation of native arteriovenous fistulas (AVFs) appears to be associated with an increased infectious risk. We previously reported a dramatic increase in the incidence of infectious events (IE) after shift to the BH technique in an in-center hemodialysis unit, which was largely reduced after staff (re)education regarding strict respect of the procedure. We assessed the evolution over the following 12-year period in our center.

Methods

In this prospective follow-up of a previous, pre [rope-ladder (RL)]–post (BH) comparison (2001–10), all in-center hemodialysis patients with a native AVF were included from 1 July 2010 to 31 December 2022. Primary and secondary outcomes were IE (unexplained bacteremia due to skin bacteria and/or local AVF infection) and complicated IE (metastatic infection, AVF surgery, death). Overall, the impact of several quality improvement strategies was tested according to the events rate over six periods: Period 1: RL in all; Period 2: switch to BH; Period 3: BH in all, before workshops; Period 4: BH in all, after workshops; Period 5: BH withdrawal in problematic AVFs; Period 6: additional procedural changes.

Results

This extended observation period allowed the addition of 195 180 AVF-days to our previous report. Overall, 381 661 AVF-days (366 AVFs, 345 patients) were analysed. After an increase of the IE rate in 2012, the shift to RL in problematic AVFs during Period 5 did not have a significant impact. The incidence of IE decrease significantly during Period 6 compared with Periods 3, 4 and 5 {incidence rate ratio (IRR) 0.24 [95% confidence interval (CI) 0.09–0.52], P = .0001, IRR 0.22 (95% CI 0.09–0.47), P < .0001 and IRR 0.29 (95% CI 0.11–0.66), P = .001, respectively}, and became eventually for the first time comparable to Period 1 [IRR 0.59 (95% CI 0.21–1.62), P = .27].

Conclusion

The constant observance of reinforced hygiene protocols by trained staff and central coordination succeeded in significantly mitigating the infectious risk associated with buttonhole cannulation.
Emergency in Ellipses
Authors: Bhagya C. S.
Published: October 2023

This chapter argues that U. R. Ananthamurthy’s 1976 novella Bara represents the Indian National Emergency (1975–1977) through ellipses. In the narrative, the bureaucratic machinery of the central and state governments colludes with self-regarding local leaders to exacerbate an ongoing ecological crisis—the titular “bara,” or drought—therefore worsening its impact on the depicted community in rural Karnataka. By situating its allusive form against patterns of representation in the anglophone literature of the Emergency, and alongside the National Award–winning Kannada film adaptation by M. S. Sathyu (1980), the chapter offers an intermedial, comparative analysis of Bara and its imagination of postcolonial Indian modernity. The chapter examines the novella’s linguistic idiosyncrasies and translational makeup to argue that “instability”—as feature and aesthetic—marks its form, its philosophy, and its negotiation of Emergency politics.
SET DOMAIN GROUP 711-mediated H3K27me3 methylation of cytokinin metabolism genes regulates organ size in rice
Authors: Lu Jingqin , Jiang Zuojie , Chen Junyu , Xie Minyan , Huang Wenda , Li Jing , Zhuang Chuxiong , Liu Zhenlan , Zheng Shaoyan
Published: October 2023

Organ size shapes plant architecture during rice (Oryza sativa) growth and development, affecting key factors influencing yield, such as plant height, leaf size, and seed size. Here, we report that the rice Enhancer of Zeste [E(z)] homolog SET DOMAIN GROUP 711 (OsSDG711) regulates organ size in rice. Knockout of OsSDG711 produced shorter plants with smaller leaves, thinner stems, and smaller grains. We demonstrate that OsSDG711 affects organ size by reducing cell length and width and increasing cell number in leaves, stems, and grains. The result of chromatin immunoprecipitation followed by deep sequencing (ChIP-seq) using an antitrimethylation of histone H3 lysine 27 (H3K27me3) antibody showed that the levels of H3K27me3 associated with cytokinin oxidase/dehydrogenase genes (OsCKXs) were lower in the OsSDG711 knockout line Ossdg711. ChIP-qPCR assays indicated that OsSDG711 regulates the expression of OsCKX genes through H3K27me3 histone modification. Importantly, we show that OsSDG711 directly binds to the promoters of these OsCKX genes. Furthermore, we measured significantly lower cytokinin contents in Ossdg711 plants than in wild-type plants. Overall, our results reveal an epigenetic mechanism based on OsSDG711-mediated modulation of H3K27me3 levels to regulate the expression of genes involved in the cytokinin metabolism pathway and control organ development in rice. OsSDG711 may be an untapped epigenetic resource for ideal plant type improvement.
The humoral response to COVID-19 vaccinations can predict the booster effect on health care workers—toward personalized vaccinations?
Authors: Freund Ophir , Harish Alma , Breslavsky Anna , Wand Ori , Zacks Nadav , Bilenko Natalya , Bar-Shai Amir
Published: October 2023

Background

Waning immunity after the coronavirus disease 2019 (COVID-19) vaccinations creates the constant need of boosters. Predicting individual responses to booster vaccines can help in its timely administration. We hypothesized that the humoral response to the first two doses of the BNT162b2 vaccine can predict the response to the booster vaccine.

Methods

A prospective cohort of hospital health care workers (HCW) that received three doses of the BNT162b2 vaccine. Participants completed serological tests at 1 and 6 months after the second vaccine dose and 1 month after the third. We analyzed predictive factors of antibody levels after the booster using multivariate regression analyses.

Results

From 289 eligible HCW, 89 (31%) completed the follow-up. Mean age was 48 (±10) and 46 (52%) had daily interaction with patients. The mean (±standard deviation) antibody level 1 month after the second vaccine was 223 (±59) AU/ml, and 31 (35%) had a rapid antibody decline (>50%) in 6 months. Low antibody levels 1 month after the second vaccine and a rapid antibody decline were independent predictors of low antibody levels after the booster vaccine.

Conclusions

The characteristics of the humoral response to COVID-19 vaccinations show promise in predicting the humoral response to the booster vaccines.
Seasonal Periodicity of the Airborne Spores of Fungi Causing Grapevine Trunk Diseases: An Analysis of 247 Studies Published Worldwide
Authors: Ji Tao , Salotti Irene , Altieri Valeria , Li Ming , Rossi Vittorio
Published: October 2023

Grapevine trunk diseases (GTDs) are among the most devastating grapevine diseases globally. GTDs are caused by numerous fungi belonging to different taxa, which release spores into the vineyard and infect wood tissue, mainly through wounds caused by viticultural operations. The timing of operations to avoid infection is critical concerning the periodicity of GTD spores in vineyards, and many studies have been conducted in different grape-growing areas worldwide. However, these studies provide conflicting and fragmented information. To synthesize current knowledge, we conducted a systematic literature review, extracted quantitative data from published papers, and used these data to identify trends and knowledge gaps that need to be addressed in future studies. Our database included 26 papers covering 247 studies and 3,529 spore sampling records concerning a total of 29 fungal taxa responsible for Botryosphaeria dieback (BD), Esca complex (EC), and Eutypa dieback (ED). We found a clear seasonality in the presence and abundance of BD spores, with a peak from fall to spring, more in the northern hemisphere than in the southern hemisphere, but not for EC and ED. Spores of these fungi were present throughout the growing season in both hemispheres, possibly because of higher variability in spore types, sporulation conditions, and spore release mechanisms in EC and ED fungi than in BD. Our analysis has limitations because of knowledge gaps and data availability for some fungi (e.g., basidiomycetes, which cause EC). These limitations are discussed to facilitate further research.
N6‐methyladenosine methyltransferase METTL3 modulates the cell cycle of granulosa cells via CCND1 and AURKB in Haimen goats
Authors: Liu Zifei , Zhou Lei , Li Dongxu , Lu Honghui , Liu Liang , Mao Weijia , Yu Xiaoqing , Fan Yixuan , Huang Qunhao , Wang Feng , Wan Yongjie
Published: October 2023

N6‐methyladenosine (m6A) plays a crucial role in many bioprocesses across species, but its function in granulosa cells during oocyte maturation is not well understood in animals, especially domestic animals. We observed an increase in m6A methyltransferase‐like 3 (METTL3) in granulosa cells during oocyte maturation in Haimen goats. Our results showed that knockdown of METTL3 disrupted the cell cycle in goat granulosa cells, leading to aggravated cell apoptosis and inhibition of cell proliferation and hormone secretion. Mechanistically, METTL3 may regulate the cell cycle in goat granulosa cells by mediating Aurora kinase B (AURKB) mRNA degradation in an m6A‐YTH N6‐methyladenosine RNA binding protein 2 (YTHDF2) manner and participating in AURKB transcription via the Cyclin D1 (CCND1)‐Retinoblastoma protein (RB)‐E2F transcription factor 1 (E2F1) pathway. Overall, our study highlights the essential role of METTL3 in granulosa cells during oocyte maturation in Haimen goats. These findings provide a theoretical basis and technical means for understanding how RNA methylation participates in oocyte maturation through granulosa cells.
Decoding the meaning of medical guidelines and their medicolegal implications
Authors: Kranke Peter , Afshari Arash , Meybohm Patrick , Buhre Wolfgang , Wiege Stephanie , Romero Carolina S.
Published: October 2023

Medical practice guidelines (MPGs) are important in medicine to ensure well tolerated and effective healthcare. They provide evidence-based recommendations for healthcare professionals in daily clinical settings. MPGs help patients and practitioners make informed decisions, ensure quality of care, allocate healthcare resources effectively and reduce legal liability. MPGs have medicolegal implications, as they influence clinical decision-making and patient outcomes, which can impact liability and malpractice cases. They define the standard of care within the healthcare industry and provide best practice recommendations. MPGs are a cornerstone of the informed consent process, as they facilitate a shared decision support system and they provide valuable evidence-based recommendations on various treatments or medical options. Finally, MPGs are also relevant in medical claims; thus, adherence to MPGs is highly encouraged in order to assure the best medical care. Nonetheless, MPGs have limitations and we advocate for wise usage of MPGs combined with the expertise of trained physicians that allows for individualisation and evidence-based recommendations. In this review, we describe the potential legal implications that MPGs may represent for healthcare providers and the role that MPGs have in daily practice at different stages in the doctor--patient relationship.
Medical abortion in the second trimester – an update
Authors: Kopp Kallner Helena
Published: October 2023

The safety and efficacy of medical abortion in the second trimester is provider independent and may therefore offer advantages over surgical second trimester abortion in certain settings. Due to bleeding risk, medical abortions in the second trimester are still mostly performed in a clinic or hospital setting. The most effective regimen for abortion includes pretreatment with oral mifepristone and following doses of misoprostol. An alternative is misoprostol only which should only be used when mifepristone is not available. The optimal dosing of prostaglandin to achieve the highest efficacy with the lowest proportion of complications remains to be established. Complications are rare and serious adverse events uncommon but may include uterine rupture especially in women with a previous cesarean delivery or uterine surgery. Women having second trimester medical abortion are a diverse group with different indications for the abortion. All women should be offered pain relief and respectful care. Staff involved in second trimester medical abortion often find their work challenging. At the same time, staff indicate pride and a conviction of contributing to the ‘greater good’ for women and society. Staff involved in second trimester abortion should be offered guidance and support through the employer. Post abortion contraception should be offered to all women having second trimester medical abortions, including those who have the abortion due to fetal malformation. All methods of contraception can be started immediately after a second trimester medical abortion except for cycle based methods and diaphragms.
Patient-reported Outcomes and Quality of Life in Anemic and Symptomatic Patients With Myelofibrosis: Results From the MOMENTUM Study
Authors: Mesa Ruben A. , Harrison Claire , Palmer Jeanne M. , Gupta Vikas , McLornan Donal P. , McMullin Mary Frances , Kiladjian Jean-Jacques , Foltz Lynda , Platzbecker Uwe , Fox Maria Laura , Mead Adam J. , Ross David M. , Oh Stephen T. , Perkins Andrew Charles , Leahy Michael F. , Kawashima Jun , Ro Sunhee , Donahue Rafe , Gorsh Boris , Deheshi Samineh , Verstovsek Srdan
Published: October 2023

Myelofibrosis (MF) is a chronic myeloproliferative neoplasm that typically manifests with debilitating symptoms that progressively worsen, negatively impacting patients’ quality of life. Fatigue is a multifactorial and burdensome MF-related symptom due to its severity, persistence, and prevalence, with anemia a contributing factor and major unmet need. Clinical trials of the Janus kinase (JAK)1/JAK2/activin A receptor type 1 inhibitor momelotinib have shown consistent anemia benefits, in addition to improvements in MF-related symptoms. The phase 3 MOMENTUM trial in symptomatic and anemic patients met its primary end point, with a greater proportion having a Myelofibrosis Symptom Assessment Form (MFSAF) Total Symptom Score (TSS) reduction ≥50% at week 24 with momelotinib versus danazol. To support the positive primary end point result, we conducted longitudinal, responder, and time-to-event analyses of patient-reported outcomes from MOMENTUM, as measured by the MFSAF, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and Patient-Reported Outcomes Measurement Information System (PROMIS) assessments. These analyses demonstrated rapid and durable response benefits with momelotinib, with achievement of first TSS response by day 29 and continued improvement over time. Improvements favored momelotinib versus danazol for each MFSAF individual item, and greater improvements were observed for disease- and cancer-related fatigue and physical functioning at week 24, with significant results for multiple items/domains across the 3 assessments. These findings are consistent in demonstrating that momelotinib provides substantial symptom benefit.
Leading the Next Generation of Clinical Nurse Specialists
Authors: Saunders Mitzi M.
Published: October 2023

Acting on the 2022 Clinical Nurse Specialist (CNS) census results, the National Association of Clinical Nurse Specialists (NACNS) launched a robust response. In this column, the President of NACNS highlights key survey findings and strategic initiatives to modernize the CNS scope of practice and lead the next generation of CNSs to strong impact on patient and nursing care outcomes.
R. A. Fisher on J. A. Cobb's
The problem of the sex-ratio
Authors: Gardner Andy
Published: October 2023

The logic of the rarer-sex effect, concerning how natural selection acts to balance the sex ratio among newborns, was long supposed to have originated with Ronald Aylmer Fisher in his 1930 book
The genetical theory of natural selection
. However, the principle is now understood to have originated with John Austin Cobb in his 1914 paper ‘The problem of the sex-ratio’. Fisher did not provide a citation of Cobb's sex-ratio paper, and it has been unclear whether he was aware of its existence. Here, I show that Fisher was indeed aware of Cobb's paper in 1930, as revealed by him citing it elsewhere that same year. Fisher's willingness to highlight Cobb's sex-ratio work lends support to the view that his failure to mention it in his book reflects the less stringent citation standards of the time rather than an attempt to deceive readers as to the provenance of the rarer-sex effect.