The Development of Severe Neonatal Alloimmune Thrombocytopenia due to Anti-HPA-1a Antibodies Is Correlated to Maternal ABO Genotypes

Background. Maternal alloantibodies against HPA-1a can cross placenta, opsonize foetal platelets, and induce neonatal alloimmune thrombocytopenia (NAIT). In a study of 100, 448 pregnant women in Norway during 1995–2004, 10.6% of HPA-1a negative women had detectable anti-HPA-1a antibodies. Design and Methods. A possible correlation between the maternal ABO blood group phenotype, or underlying genotype, and severe thrombocytopenia in the newborn was investigated. Results. We observed that immunized women with blood group O had a lower risk of having a child with severe NAIT than women with group A; 20% with blood group O gave birth to children with severe NAIT, compared to 47% among the blood group A mothers (relative risk 0.43; 95% CI 0.25–0.75). Conclusion. The risk of severe neonatal alloimmune thrombocytopenia due to anti-HPA-1a antibodies is correlated to maternal ABO types, and this study indicates that the observation is due to genetic properties on the maternal side

Infant Ustekinumab Clearance, Risk of Infection, and Development After Exposure During Pregnancy

Background:Evidence on ustekinumab safety in pregnancy is gradually expanding, but its clearance in the postnatal period is unknown. The aim of this study was to investigate ustekinumab concentrations in umbilical cord blood and rates of clearance after birth, as well as how these correlate with maternal drug concentrations, risk of infection, and developmental milestones during the first year of life. Methods: Pregnant women with inflammatory bowel disease were prospectively recruited from 19 hospitals in Denmark and the Netherlands between 2018 and 2022. Infant infections leading to hospitalization/antibiotics and developmental milestones were assessed. Serum ustekinumab concentrations were measured at delivery and specific time points. Nonlinear regression analysis was applied to estimate clearance. Results:In 78 live-born infants from 76 pregnancies, we observed a low risk of adverse pregnancy outcomes and normal developmental milestones. At birth, the median infant-mother ustekinumab ratio was 2.18 (95% confidence interval, 1.69–2.81). Mean time to infant clearance was 6.7 months (95% confidence interval, 6.1–7.3 months). One in 4 infants at 6 months had an extremely low median concentration of 0.015 μg/mL (range 0.005–0.12 μg/mL). No variation in median ustekinumab concentration was noted between infants with (2.8 [range 0.4–6.9] μg/mL) and without (3.1 [range 0.7–11.0] μg/mL) infections during the first year of life (P = .41). Conclusions: No adverse signals after intrauterine exposure to ustekinumab were observed with respect to pregnancy outcome, infections, or developmental milestones during the first year of life. Infant ustekinumab concentration was not associated with risk of infections. With the ustekinumab clearance profile, live attenuated vaccination from 6 months of age seems of low risk.</p

Fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin with gemtuzumab ozogamicin improves event-free survival in younger patients with newly diagnosed aml and overall survival in patients with npm1 and flt3 mutations

Purpose To determine the optimal induction chemotherapy regimen for younger adults with newly diagnosed AML without known adverse risk cytogenetics. Patients and Methods One thousand thirty-three patients were randomly assigned to intensified (fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin [FLAG-Ida]) or standard (daunorubicin and Ara-C [DA]) induction chemotherapy, with one or two doses of gemtuzumab ozogamicin (GO). The primary end point was overall survival (OS). Results There was no difference in remission rate after two courses between FLAG-Ida + GO and DA + GO (complete remission [CR] + CR with incomplete hematologic recovery 93% v 91%) or in day 60 mortality (4.3% v 4.6%). There was no difference in OS (66% v 63%; P = .41); however, the risk of relapse was lower with FLAG-Ida + GO (24% v 41%; P < .001) and 3-year event-free survival was higher (57% v 45%; P < .001). In patients with an NPM1 mutation (30%), 3-year OS was significantly higher with FLAG-Ida + GO (82% v 64%; P = .005). NPM1 measurable residual disease (MRD) clearance was also greater, with 88% versus 77% becoming MRD-negative in peripheral blood after cycle 2 (P = .02). Three-year OS was also higher in patients with a FLT3 mutation (64% v 54%; P = .047). Fewer transplants were performed in patients receiving FLAG-Ida + GO (238 v 278; P = .02). There was no difference in outcome according to the number of GO doses, although NPM1 MRD clearance was higher with two doses in the DA arm. Patients with core binding factor AML treated with DA and one dose of GO had a 3-year OS of 96% with no survival benefit from FLAG-Ida + GO. Conclusion Overall, FLAG-Ida + GO significantly reduced relapse without improving OS. However, exploratory analyses show that patients with NPM1 and FLT3 mutations had substantial improvements in OS. By contrast, in patients with core binding factor AML, outcomes were excellent with DA + GO with no FLAG-Ida benefit

Distribueret ledelse i offentlige serviceorganisationer

Begrebet ”distribueret ledelse”, som betegner et ledelsesfænomen, hvor medarbejderne og den formelle ledelse deles om ledelsesopgaverne med henblik på at påvirke ressourcer, beslutninger og mål i en organisation, har i stigende grad tiltrukket sig opmærksomhed indenfor forskningen i organisationspsykologi og generisk ledelsesteori. Denne artikel introducerer begrebet til den offentlige ledelseslitteratur samt undersøger dets empiriske relevans for forskellige organisatoriske performancemål. Under anvendelse af registerdata samt spørgeskemadata indsamlet på et af landets største hospitaler, viser artiklen, at hospitalsafdelinger med høj grad af distribueret ledelse også har mere tilfredse og innovative medarbejdere samt medarbejdere, der rapporterer højere individuel performance. Resultaterne tyder desuden på, at distribueret ledelse også er relateret til lavere sygefravær blandt de hospitalsansatte. Disse sammenhænge indikerer, at distribueret ledelse er et relevant fænomen for offentlige ledere og for forskningen i offentlig ledelse

Distributed leadership in public service organizations

During the past two decades there has been increased interest in collective or distributed forms of leadership within generic leadership theory and organizational psychology. “Distributed leadership” describes the sharing of leadership tasks between employees and managers with the aim to influence decision making, resource availability, and goal setting within an organization. This article introduces the concept of distributed leadership to the public administration literature and empirically examines the relevance of this leadership constellation for different public organization performance measures. Using survey and archival data collected at one of Denmark’s largest public hospitals, the analysis shows that hospital wards with high levels of distributed leadership also have employees who are more satisfied and innovative and who report higher levels of performance. Moreover, distributed leadership seems to be positively related with lower sickness absence among hospital employees. This indicates that distributed leadership is a relevant leadership constellation in public service producing organizations

Seed quality in organic carrot seed production. Does tunnel production in Denmark provide sufficient seed quality?

Seed quality in organic carrot seed production Does tunnel production in Denmark provide sufficient seed quality

Report on cross-cutting approaches for the assessment of climate change adaption on selected EU sites or hotspots and potentials for adaption and mitigation in the dairy sector

Adaption to climate change in the context of agriculture involves collaborative planning and development of practices which is deemed more sustainable than preceeding practices. It is however not given that sustainable development will be the outcome of such efforts. In some cases, even motivated participants experience that despite good intentions, high levels of knowledge, feasible models, appropriate technologies and many other factors present, they still might not succeed bringing about the desired change. The reasons for this can not easily be reduced to just one factor, but is very likely to be the outcome of highly complex interactions between social, technological, institutional, or even personal factors. The report documents attempts to understand the complexities of climate change adaption in a Danish water catchment, Lundgaards Bæk, which is dominated by dairy farming. As part of the EU projects AQUARIUS and MACSUR, a local action group was formed which was composed of local farmers, local agricultural advisors, advisors from the national agricultural advisory service, environmental planners from the local municipality, and environmental planners from the national environmental agency in Denmark. The action group was supposed to develop specific measures, which were supposed to lead to an overall reduction in nitrogen loading of the neighboring fjord, Mariager Fjord. The report addresses three related research themes: (1) how do the stakeholders in question interact during the process of climate change adaption, (2) when do the stakeholders encounter opportunities and barriers during the process, and finally (3) does the adaption process in question lead to the desired outcomes? The empirical background of the report is a detailed process study of dynamics within a group of stakeholders, including farmers and extension officers, who were supposed to develop sustainable management practices in order to reduce nitrogen leaching to the Mariager Fjord. The study is based on the assumption that in order for research and policy to contribute to sustainable practices, deeper understanding of complex dynamics within stakeholder partnerships is needed. Based on a theoretical framework derived from social learning, adaptive co-management and Andrew Pickering’s notion of ‘the mangle’, different in-depth explanations to why sustainable development did not occur, are offered. One explanation concerns social-psychological dynamics of knowledge. Another explanation concerns the mechanisms by which social and material forces affect outcomes of the adaption process. The report concludes by exploring the study’s relevance in relation to policy, research and practice, followed by suggestions for further in-depth case studies and experimentation in practice