Should eye protection be worn during dermatological surgery: prospective observational study

Background There is a potential risk of infection with blood-borne viruses if a doctor receives a blood splash to a mucous membrane. The quantification of facial contamination with blood has never been documented in the context of dermatological surgery. Objectives (i) To identify the number of facial blood splashes that occur during skin surgery and to identify the procedures that present higher risks for the operator and assistant. (ii) To assess the provision of eye protection and attitudes to its use in dermatological surgery in the U.K. Methods (i) Prospective, observational study in the skin surgery suite of a U.K. teaching hospital assessing 100 consecutive dermatological surgery procedures, plus 100 consecutive operations in which an assistant was present. Primary outcome: number of face-mask visors with at least one blood splash. Secondary outcomes: to identify if any of the following variables influenced the occurrence of a blood splash: grade of operator, site and type of procedure, and the use of electrocautery. (ii) A postal survey of all U.K.-based members of the British Society of Dermatological Surgery (BSDS) was conducted assessing facilities available and the attitudes of U.K.-based clinicians to the use of face masks during surgery. Results (i) In 33% of all surgical procedures there was at least one facial splash to the operator (range 1–75) and in 15% of procedures the assistant received at least one splash (range 1–11). Use of monopolar electrocautery was significantly less likely to result in splashes to the mask compared with bipolar electrocautery [odds ratio (OR) 0Æ04; 95% confidence interval (CI) 0Æ01–0Æ19]. Compared with the head/neck, operations on the body were significantly more likely to result in splashes to the mask (OR 6Æ52) (95% CI 1Æ7–25Æ07). The type of procedure and the status of the operator did not have a bearing on the likelihood of receiving a splash to the mask. (ii) From the survey, 33 of 159 (20Æ8%) of BSDS members had no face masks available and 54 of 159 (34Æ0%) did not wear any facial protection while operating. The majority (53Æ5%) thought they received a splash in £ 1% of procedures. Conclusions There is a substantial risk of a splash of blood coming into contact with the face during dermatological surgery for both the operator and assistant, regardless of the procedure. The risk of receiving a blood splash to the face may be substantially underestimated by U.K.-based dermatologists. The use of protective eyewear is advisable at all times, but particularly when using bipolar electrocautery, or when operating on high-risk individuals

A conserved metalloprotease mediates ecdysis in Caenorhabditis elegans

Molting is required for progression between larval stages in the life cycle of nematodes. We have identified four mutant alleles of a <i>Caenorhabditis elegans</i> metalloprotease gene, <i>nas-37</i>, that cause incomplete ecdysis. At each molt the cuticle fails to open sufficiently at the anterior end and the partially shed cuticle is dragged behind the animal. The gene is expressed in hypodermal cells 4 hours before ecdysis during all larval stages. The <i>NAS-37</i> protein accumulates in the anterior cuticle and is shed in the cuticle after ecdysis. This pattern of protein accumulation places NAS- 37 in the right place and at the right time to degrade the cuticle to facilitate ecdysis. The nas-37 gene has orthologs in other nematode species, including parasitic nematodes, and they undergo a similar shedding process. For example, <i>Haemonchus contortus</i> molts by digesting a ring of cuticle at the tip of the nose. Incubating <i>Haemonchus</i> larvae in extracted exsheathing fluids causes a refractile ring of digested cuticle to form at the tip of the nose. When <i>Haemonchus</i> cuticles are incubated with purified NAS-37, a similar refractile ring forms. NAS-37 degradation of the <i>Haemonchus</i> cuticle suggests that the metalloproteases and the cuticle substrates involved in exsheathment of parasitic nematodes are conserved in free-living nematodes

Comprehensive Diagnostic Assessment of Health Status of Patients with Asthma or COPD: A Delphi Panel Study among Dutch Experts

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Sublethal consequences of urban life for wild vertebrates

Urbanization is modifying previously pristine natural habitats and creating "new" ecosystems for wildlife. As a result, some animals now use habitat fragments or have colonized urban areas. Such animals are exposed to novel stimuli that they have not been exposed to in their evolutionary history. Some species have adapted to the challenges they face- A phenomenon known as synurbanization-while others have not. Here we present a review of the sublethal consequences of life in the city for wild vertebrates, and demonstrate that urban animals face an almost completely different set of physiological and behavioural challenges compared to their rural counterparts. We focus on the negative fitness-related impacts of urbanization, but also identify instances where there are benefits to wildlife. The effects of urbanization appear to be both species-and context-dependent, suggesting that although the field of urban ecology is far from nascent, we are still just beginning to understand how the intricacies of biodiversity on our planet are affected by our presence

Primary care professionals' views on population-based expanded carrier screening: an online focus group study

Background Population-based expanded carrier screening (ECS) involves screening for multiple recessive diseases offered to all couples considering a pregnancy or during pregnancy. Previous research indicates that in some countries primary care professionals are perceived as suitable providers for ECS. However, little is known about their perspectives. We therefore aimed to explore primary care professionals' views on population-based ECS. Methods Four online focus groups with 14 general practitioners (GPs) and 16 community midwives were conducted in the Netherlands. Results Our findings highlight various perspectives on the desirability of population-based ECS. Participants agreed that ECS could enhance reproductive autonomy and thereby prevent suffering of the child and/or parents. However, they also raised several ethical, societal, and psychological concerns, including a tendency towards a perfect society, stigmatization, unequal access to screening and negative psychosocial consequences. Participants believed that provision of population-based ECS would be feasible if prerequisites regarding training and reimbursement for providers would be fulfilled. most GPs considered themselves less suitable or capable of providing ECS, in contrast to midwives who did consider themselves suitable. Nevertheless, participants believed that, if implemented, ECS should be offered in primary care or by public health services rather than as hospital-based specialized care, because they believed a primary care ECS offer increases access in terms of time and location. Conclusions While participants believed that an ECS offer would be feasible, they questioned its desirability and priority. Studies on the desirability and feasibility of population-based ECS offered in primary care or public health settings are needed

Perceived sleep quality is worse than objective parameters of sleep in pregnant women with a mental disorder

Objective: Disturbed sleep during pregnancy is associated with adverse obstetric outcomes and less mental well-being. In pregnant women with a mental disorder, who frequently suffer from sleep problems, it is unknown whether predominantly objective or subjective sleep quality is more affected. To clarify this, we compared objective and subjective parameters of sleep quality between patients and healthy controls during pregnancy. Methods: This observational study was embedded in an ongoing study among pregnant women with a mental disorder at the department of Psychiatry of Erasmus University Medical Center Rotterdam, the Netherlands. We compared 21 pregnant women with a confirmed mental disorder with 33 healthy controls (gestational age, 23-29 weeks). To measure objective parameters of sleep quality, all participants continuously wore a wrist actigraph for 7 days and nights. Subjective sleep quality was retrospectively assessed using the Pittsburgh Sleep Quality Index (PSQI) and on a daily basis with the Subjective Sleep Quality-scale (SSQ). Differences in parameters of sleep between patients and controls were tested using a multivariate linear regression analysis adjusted for parity, gestational age, educational level, and employment status.Results: Objective parameters of sleep quality and subjective sleep quality as assessed by the PSQI did not differ significantly between patients and controls. Daily sleep reports showed that, relative to controls, patients had a significantly worse average SSQ-score (5.2 vs. 7.6, adjusted β = 0.12