Need for recovery amongst emergency physicians in the UK and Ireland: A cross-sectional survey

OBJECTIVES: To determine the need for recovery (NFR) among emergency physicians and to identify demographic and occupational characteristics associated with higher NFR scores. DESIGN: Cross-sectional electronic survey. SETTING: Emergency departments (EDs) (n=112) in the UK and Ireland. PARTICIPANTS: Emergency physicians, defined as any registered physician working principally within the ED, responding between June and July 2019. MAIN OUTCOME MEASURE: NFR Scale, an 11-item self-administered questionnaire that assesses how work demands affect intershift recovery. RESULTS: The median NFR Score for all 4247 eligible, consented participants with a valid NFR Score was 70.0 (95% CI: 65.5 to 74.5), with an IQR of 45.5-90.0. A linear regression model indicated statistically significant associations between gender, health conditions, type of ED, clinical grade, access to annual and study leave, and time spent working out-of-hours. Groups including male physicians, consultants, general practitioners (GPs) within the ED, those working in paediatric EDs and those with no long-term health condition or disability had a lower NFR Score. After adjusting for these characteristics, the NFR Score increased by 3.7 (95% CI: 0.3 to 7.1) and 6.43 (95% CI: 2.0 to 10.8) for those with difficulty accessing annual and study leave, respectively. Increased percentage of out-of-hours work increased NFR Score almost linearly: 26%-50% out-of-hours work=5.7 (95% CI: 3.1 to 8.4); 51%-75% out-of-hours work=10.3 (95% CI: 7.6 to 13.0); 76%-100% out-of-hours work=14.5 (95% CI: 11.0 to 17.9). CONCLUSION: Higher NFR scores were observed among emergency physicians than reported in any other profession or population to date. While out-of-hours working is unavoidable, the linear relationship observed suggests that any reduction may result in NFR improvement. Evidence-based strategies to improve well-being such as proportional out-of-hours working and improved access to annual and study leave should be carefully considered and implemented where feasible

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Movable genetic elements and antibiotic resistance in enterococci

The enterococci possess genetic elements able to move from one strain to another via conjugation. Certain enterococcal plasmids exhibit a broad host range among gram-positive bacteria, but only when matings are performed on solid surfaces. Other plasmids are more specific to enterococci, transfer efficiently in broth, and encode a response to recipient-produced sex phermones. Transmissible non-plasmid elements, the conjugative transposons, are widespread among the enterococci and determine their own fertility properties. Drug resistance, hemolysin, and bacteriocin determinants are commonly found on the various transmissible enterococcal elements. Examples of the different systems are discussed in this review.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47900/1/10096_2005_Article_BF01963632.pd

Parasitoids associated with whiteflies (Homoptera: Aleyrodidae) in Hispaniola and descriptions of two new species of Encarsia Foerster (Hymenoptera: Aphelinidae)

Volume: 11Start Page: 197End Page: 21

EVALUACIÔN DE FUNGICIDAS ORGÄNICOS Y SELECTIVOS EN EL CONTROL DE ENFERMEDADES FOLIARES EN CUNDEAMOR (MOMORDICA CHARANTIA L.)

El objetivo de la présente investigaciôn fue evaluar productos de origen orgânico, selectivos y un inductor de resistencia en el control de las enfermedades del cundeamor. El primer experimento se realizô en La Ceibita de Rincôn, La Vega, durante el periodo septiembre 2006 a febrero 2007. En la investigaciôn se utilizô un diseno de bloques completos al azar con ocho tratamientos y cuatro repeticiones. Los tratamientos consistieron en cuatro aceites vegetales (Agrioil® 0.1%; Aceite de naranja dulce 0.1%; Biolife® 0.1%; Aceite de nim 0.1%); un fungicida micobiolôgico (Mycobac®, Trichoderma lignorum)·, un fungicida selectivo (Amistar® 0.40 g/L); un inductor de resistencia, Acibenzolar-S-metil (Bion®, 110.7 g/ha); y un testigo (agua mâs el coadyuvante AgroFilm 20L® a 1 L/ha). El experimento tenia 32 parcelas de 54 m2 cada una, que ocupaban un ârea de 1,728 m2, con un marco de plantaciôn de 1.7 m entre hileras y 4.0 m entre plantas (1,480 plantas/ha) y un ârea util de 27 m2/parcela). Las variables evaluadas fueron la incidencia y severidad de sintomas, asi como rendimiento. Mediante el uso del fungicida selectivo y el inductor de resistencia, se obtuvieron resultados significativos en la reducciôn de la severidad de sintomas de enfermedades foliares en Cundeamor causadas por Fusarium sp. y Alternaria sp.; esta reducciôn resultô en el aumento de la producciôn y calidad. Algunos aceites, âcidos orgânicos y Trichoderma lignorum superaron al testigo, pero no incrementaron significativamente los rendimientos. El segundo experimento se realizô en El Pinito, La Vega, durante el periodo de junio 2007 a noviembre 2007. En la investigaciôn se utilizô un diseno de bloques completos al azar con seis tratamientos y cuatro repeticiones. Los tratamientos consistieron en cuatro aceites vegetales (Aceite de nim al 0.2 % ο al 0.4%; Agrioil® 0.1%; Biolife® 0.1%); un inductor de resistencia (Acibenzolar-S-metil (Bion®, 110.7 g/ha); y un testigo comercial, sulfato de cobre pentahidratado (Hachero® 0.40 g/L). El experimento tenia 24 parcelas de 54 m2 cada una, que ocupaban un ârea de 1,296 m2, con un marco de plantaciôn y metodologia de evaluaciôn similar a aquella del primer ensayo. El sulfato de cobre pentahidratado (Hachero® 0.40 g/L) y el inductor de resistencia (Acibenzolar-S-metil, Bion®, 110.7 g/ha) causaron una reducciôn significativa en la severidad de los sintomas foliares, causados por Fusarium sp., lo que resultô en el aumento de la producciôn y calidad. La mezcla de aceites y los âcidos orgânicos ocuparon una posiciôn intermedia en la reducciôn de la severidad. La severidad fue mayor en los tratamientos a base de nim. En cuanto a rendimiento, se obtuvieron diferencias entre los tratamientos, siendo mayor con el sulfato de cobre pentahidratado; los demâs tratamientos no presentan diferencias significativas entre ellos

Encouraging reporting in the veterinary profession: Prospective study and analysis of the pharmacovigilance system in university settings

International audienc

Dramatic Impact of the Recently Introduced Asian Pigeon Pea Pod Fly, Melanagromyza Obtusa (Malloch) (Diptera: Agromyzidea), In the Dominican Republic

The pigeon pea (Cajanus cajan (L.) Millsp.) is the second most important leguminous crop for the Dominicans. Fresh or canned seeds are also exported, i.e., to Puerto Rico and the U.S.A. The crop with very low input requirements is produced in marginal areas and serves as an important source of protein for the peasant farmers. The pigeon pea pod fly (.Melanagromyza ob tus a Malloch) has been a pest in Asian countries for decades and was first reported in the western hemisphere in Puerto Rico and the Dominican Republic in the year 2000 (NPAG 2000; Kauffman 2001; Abud et al., 2002). Alerted by local farmers, between 2002 and 2003 two separate research teams, based at San Juan de la Maguana and San Francisco de Macoris, carried out a survey. The study consisted in the determination of the dispersal of the recently introduced pest, the damage levels and the presence and effectiveness of antagonists of the pest. Pods were collected from plants in more than 20 localities belonging to 5 provinces of the major pigeon pea producing regions in the southwest and south, as well as of more than 20 localities of 8 provinces in the central and north-eastern regions, being present at >95% of the surveyed sites. The infested pods showing small "windows" ranged between 30 to 80% and the damaged seeds between 10 and 80%. From the pods held in paper bags conected to glass tubes, no single parasitoid emerged. The mass release of introduced parasitoids is discussed, trying to reduce the damage by at least 50% and backing biocontrol applying 1PM measures

ALTERNATIVAS PARA EL MANEJO DE ARTRÔPODOS EN VEGETALES ORIENTALES EN LA REPÛBLICA DOMINICANA

Los vegetales orientales generan anualmente US$50-60 millones. La competitividad estâ amenazada debido a altos costos de production (plaguicidas), asi como residuos y/o plagas cuarentenarias detectados en productos exportados, lo que demanda una aplicaciôn de conceptos MIP. En un ensayo en vainitas chinas, en la finca de un productor en la provincia de La Vega, se compararon ocho tratamientos: Tl-Testigo; T2-Aceite de guanâbana (Annona muricata); T3-el hongo entomopatôgeno Entomophthora virulenta combinado con Aceite de semillas de nim (Azadirachta indica); T4-Thiametoxam (sistémico); T5-Carbosulfan (sistémico, 2x) sustituido por Diafenthiuron (4x); T6-Etofenprox; T7-Pymetrozine; y T8- Lambda-Cyhalothrin. Usando conteos directos y trampas pegantes amarillas, se determine» la influencia de los tratamientos sobre poblaciones de importantes plagas y enemigos naturales. Un fuerte desarrollo initial de colonias de âfidos antecediô la apariciôn de sintomas virôticos, dependiendo de la eficiencia manejando sus vectores. Sin embargo, ninguno de los tratamientos fue suficientemente eficaz en retrasar la infection, especialmente los T1-T2. Todos los tratamientos incrementaron rendimientos y calidad de los frutos, especialmente los T6-T8, resultando los T8, T3 y T2 los mâs rentables, debido a sus costos mâs bajos