Improving the quality of written information available at weekends in a paediatric hospital: the TRANSMIT sheet.

The clinical outcomes at weekends are worse than during the week in a hospital setting. There are many potential factors which influence this. High quality communication between the weekday teams and the on call weekend staff could help improve clinical outcomes at weekends, but there are no validated forms of communication that have been established in a paediatric hospital setting. The casenotes of all medical patients (n=119) were prospectively evaluated across all medical wards in a large paediatric hospital over three weekends, to establish the quality of information available to on call teams. Following introduction of structured documentation, known as a TRANSMIT (including Tasks, Respiratory, Anticipated problems, Nutrition, Sepsis, Medication, Intravenous access, Transfer/discharge) sheet, the audit was repeated (n=111). A qualitative survey of junior doctors using TRANSMIT was carried out after introduction. Prior to the introduction of the structured documentation (TRANSMIT sheet) an accurate problem list was present in 56% (67/119), and an adequate written management plan in 63% (75/119). Following introduction, an improvement in the notes was seen, with accurate problem lists in 82% (91/111) and an adequate plan in 76% (84/111). Improvements in the quantity and quality of information available to weekend on call medical staff were noted. The use of a structured documentation (TRANSMIT sheet) can improve the quality of written information available to on-call teams in a paediatric hospital setting. A retrospective qualitative assessment of junior doctors using TRANSMIT sheets showed an improvement in both the quantity and quality of information available to on call staff at weekends

A new subunit vaccine based on nucleoprotein nanoparticles confers partial clinical and virological protection in calves against bovine respiratory syncytial virus

Human and bovine respiratory syncytial viruses (HRSV and BRSV) are two closely related, worldwide prevalent viruses that are the leading cause of severe airway disease in children and calves, respectively. Efficacy of commercial bovine vaccines needs improvement and no human vaccine is licensed yet. We reported that nasal vaccination with the HRSV nucleoprotein produced as recombinant ringshaped nanoparticles (NSRS) protects mice against a viral challenge with HRSV. The aim of this work was to evaluate this new vaccine that uses a conserved viral antigen, in calves, natural hosts for BRSV. Calves, free of colostral or natural anti-BRSV antibodies, were vaccinated with NSRS either intramuscularly, or both intramuscularly and intranasally using MontanideTM ISA71 and IMS4132 as adjuvants and challenged with BRSV. All vaccinated calves developed anti-N antibodies in blood and nasal secretions and N-specific cellular immunity in local lymph nodes. Clinical monitoring post-challenge demonstrated moderate respiratory pathology with local lung tissue consolidations for the non vaccinated calves that were significantly reduced in the vaccinated calves. Vaccinated calves had lower viral loads than the nonvaccinated control calves. Thus NSRS vaccination in calves provided cross-protective immunity against BRSV infection without adverse inflammatory reaction

Safety Monitoring of COVID-19 Vaccines:Perspective from the European Medicines Agency

Prior to deployment of coronavirus disease 2019 (COVID-19) vaccines in the European Union in 2021, a high vaccine uptake leading to an unprecedented volume of safety data from spontaneous reports and real-world evidence, was anticipated. The European Medicines Agency (EMA) implemented specific activities to ensure enhanced monitoring of emerging vaccine safety information, including intensive monitoring of reports of adverse events of special interest and the use of observed-to-expected analyses. The EMA also commissioned several independent observational studies using a large network of electronic healthcare databases and primary data collection via mobile and web-based applications. This preparedness was key for two high-profile safety signals: thrombosis with thrombocytopenia syndrome (TTS), a new clinical entity associated with adenovirus-vectored vaccines, and myocarditis/pericarditis with messenger RNA vaccines. With no existing case definition nor background rates, the signal of TTS posed particular challenges. Nevertheless, it was rapidly identified, evaluated, contextualized and the risk minimized thanks to close surveillance and an efficient use of available evidence, clinical expertise and flexible regulatory tools. The two signals illustrated the complementarity between spontaneous and real-world data, the former enabling rapid risk identification and communication, the latter enabling further characterization. The COVID-19 pandemic has tremendously enhanced the development of tools and methods to harness the unprecedented volume of safety data generated for the vaccines. Areas for further improvement include the need for better and harmonized data collection across Member States (e.g., stratified vaccine exposure) to support signal evaluation in all population groups, risk contextualization, and safety communication.</p

Trajectoires des travailleurs recevant un programme de retour au travail : étude exploratoire des discussions d’une équipe interdisciplinaire

Sujet : Cette étude exploratoire a pour objectif de décrire différents types de trajectoires de travailleurs présentant des troubles musculo-squelettiques pendant un programme de réadaptation. Les trajectoires sont tracées à partir des visions d’une équipe interdisciplinaire.Méthode : Le devis de recherche est une méthode de cas unique où l’unité d’analyse principale est une équipe interdisciplinaire. Cette équipe a discuté de la progression de 18 travailleurs, durant un programme de réadaptation. Les analyses des discussions ont été inspirées par la phénoménologie. Toutes les discussions de l’équipe ont été enregistrées et retranscrites. L’analyse de contenu a été effectuée par deux chercheurs. Résultats : Quatre types de trajectoires ont émergé : 1) trajectoires de retour au travail sans obstacle ; 2) trajectoires de retour au travail avec obstacles ; 3) trajectoires de non-retour au travail avec épisodes de progression et 4) trajectoires de non-retour au travail sans progression. Trois facteurs clefs ont émergé de ces analyses comme déterminant au processus de retour au travail : 1) la complaisance des travailleurs face au programme de réadaptation, 2) les différentes façons dont le travailleur aborde et vit la première exposition au travail et 3) la collaboration avec les différents partenaires. Les résultats de cette étude suggèrent aussi que l’absence de message unique entre les professionnels de la santé face au travailleur peut entraîner de la confusion et devenir un frein à la reprise des activités.Conclusions : Les résultats soulignent encore une fois la complexité pour les cliniciens de la prise en charge en réadaptation au travail de travailleurs en phase chronique. Cette intervention doit agir à la fois sur le travailleur et également sur les interactions entre les travailleurs et les différents partenaires concernés. Aussi, cette étude souligne le processus non linéaire de la réadaptation au travail pour des individus présentant des incapacités prolongées d’origine musculo-squelettique, tel que décrit par une équipe interdisciplinaire.Purpose : Based on the viewpoint of an interdisciplinary team, this exploratory study aimed to identify different types of trajectories followed by workers with musculoskeletal disorders and the factors contributing to them.Methods : The research design used a single-case study in which the main unit of analysis was an interdisciplinary work team. This team discussed eighteen workers’ progression during a work rehabilitation programme. Analytical methods were based on phenomenology. All team discussions were audiotaped and transcribed, and two researchers completed the content analysis.Results : Four types of trajectories emerged : (1) return-to-work trajectories without obstacles ; (2) return-to-work trajectories with obstacles ; (3) non-return-to-work trajectories with episodes of progression ; and (4) non-return-to-work trajectories without progression. Moreover, three outlines emerged from the data analysis : (1) the worker’s compliance with the programme ; (2) the way the worker coped with exposure to work ; and (3) stakeholder collaboration. The results of this study also suggested that the absence of a single consistent message among participating health professionals could create confusion for workers and pose a major impediment to the resumption of their activities.Conclusion : The results underscore, for clinicians, the complexity in managing this type of chronic work rehabilitation population, related to both the worker and the worker’s interactions with the stakeholders. Also, this study casts light on the non-linear work rehabilitation processes of individuals with prolonged disabilities of musculoskeletal origin, as described by an interdisciplinary team.Tema : Este estudio exploratorio se propone identificar diferentes tipos de trayectorias de trabajadores que presentan lesiones músculo-esqueléticas en el marco de un programa de readaptación. Las trayectorias se definen a partir de las visiones de un equipo interdisciplinar.Método : El método utilizado, llamado « devis de investigación » es un método basado en el estudio de casos y en el cual la unidad de análisis principal es un equipo interdisciplinar. En este caso, el equipo ha intercambiado opiniones acerca de la progresión de dieciocho trabajadores durante un programa de readaptación. El análisis de los intercambios ha seguido un enfoque fenomenológico. Todas las discusiones del equipo han sido grabadas y desgrabadas posteriormente. El análisis del contenido ha sido efectuado por dos investigadores.Resultados : Cuatro tipos de trayectorias han emergido : 1) trayectorias de reinsecion laboral sin obstaculos ; 2) Trayectorias de reinserción laboral con obstáculos ; 3) trayectorias sin reinserción laboral y con episodios de progresión ; y 4) trayectorias sin reinserción laboral y sin progresión. Tres factores clave han emergido de estos análisis en tanto determinates del proceso de reinserción laboral : 1) el hecho de que los trabajadores respeten el programa de readaptación, 2) las diferentes formas en las que el trabajador aborda y vive su primera exposición al trabajo, 3) la colaboracion con los diferentes compañeros de trabajo. Los resultados de este estudio sugieren tambien que la ausencia de unidad en los mensajes enviados por los profesionales de la salud al trabajador puede generar confusión y transformarse en un freno en el proceso de retorno a la actividad.Conclusiones : Los resultados obtenidos resaltan una vez más la complejidad que significa, desde un enfoque clínico, el hacerce cargo de la readaptación del trabajador en fase crónica. Esta intervención debe actuar a la vez sobre el trabajador y sobre las interacciones entre los trabajadores y las diferentes personas implicadas. Asimismo, este estudio subraya la no linealidad de la readaptación laboral para los individuos que presentan incapacidades prolongadas de origen musculoesquelético, tal como lo describe un equipo interdisciplinar

The serine protease inhibitor serpinE2 is a novel target of ERK signaling involved in human colorectal tumorigenesis

<p>Abstract</p> <p>Background</p> <p>Among the most harmful of all genetic abnormalities that appear in colorectal cancer (CRC) development are mutations of KRAS and its downstream effector BRAF as they result in abnormal extracellular signal-related kinase (ERK) signaling. In a previous report, we had shown that expression of a constitutive active mutant of MEK1 (caMEK) in normal rat intestinal epithelial cells (IECs) induced morphological transformation associated with epithelial to mesenchymal transition, growth in soft agar, invasion and metastases in nude mice. Results from microarrays comparing control to caMEK-expressing IECs identified the gene encoding for serpinE2, a serine protease inhibitor, as a potential target of activated MEK1.</p> <p>Results</p> <p>1- RT-PCR and western blot analyses confirmed the strong up-regulation of serpinE2 expression and secretion by IECs expressing oncogenic MEK, Ras or BRAF. 2- Interestingly, serpinE2 mRNA and protein were also markedly enhanced in human CRC cells exhibiting mutation in <it>KRAS </it>and <it>BRAF</it>. 3- RNAi directed against serpinE2 in caMEK-transformed rat IECs or in human CRC cell lines HCT116 and LoVo markedly decreased foci formation, anchorage-independent growth in soft agarose, cell migration and tumor formation in nude mice. 4- Treatment of CRC cell lines with U0126 markedly reduced <it>serpinE2 </it>mRNA levels, indicating that expression of <it>serpinE2 </it>is likely dependent of ERK activity. 5- Finally, Q-PCR analyses demonstrated that mRNA levels of serpinE2 were markedly increased in human adenomas in comparison to healthy adjacent tissues and in colorectal tumors, regardless of tumor stage and grade.</p> <p>Conclusions</p> <p>Our data indicate that serpinE2 is up-regulated by oncogenic activation of Ras, BRAF and MEK1 and contributes to pro-neoplastic actions of ERK signaling in intestinal epithelial cells. Hence, serpinE2 may be a potential therapeutic target for colorectal cancer treatment.</p

Conditioned spin and charge dynamics of a single electron quantum dot

In this article we describe the incoherent and coherent spin and charge dynamics of a single electron quantum dot. We use a stochastic master equation to model the state of the system, as inferred by an observer with access to only the measurement signal. Measurements obtained during an interval of time contribute, by a past quantum state analysis, to our knowledge about the system at any time $t$ within that interval. Such analysis permits precise estimation of physical parameters, and we propose and test a modification of the classical Baum-Welch parameter re-estimation method to systems driven by both coherent and incoherent processes.Comment: 9 pages, 9 figure

Management of traumatic events: influence of emotion-centered coping strategies on the occurrence of dissociation and post-traumatic stress disorder

Our aim was to assess the influence of the coping strategies employed for the management of traumatic events on the occurrence of dissociation and traumatic disorders. We carried out a 1-year retrospective study of the cognitive management of a traumatic event in 18 subjects involved in the same road vehicle accident. The diagnosis of post-traumatic stress disorder (PTSD) was made for 33.3% of the participants. The participants with a PTSD diagnosis 1 year after the event used emotion-centered strategies during the event more often than did those with no PTSD, P < 0.02. In the year after the traumatic event, our results show a strong link between the intensity of PTSD and the severity of the post-traumatic symptoms like dissociation (P = 0.032) and the use of emotion-centered strategies (P = 0.004). Moreover, the participants who presented Peritraumatic Dissociative Experiences Questionnaire scores above 15 made greater use of emotion-centered coping strategies than did those who did not show dissociation, P < 0.04. Our results confirm that the cognitive management of traumatic events may play an essential role in the development of a state of post-traumatic stress in the aftermath of a violent event

Meropenem/colistin synergy testing for multidrug-resistant Acinetobacter baumannii strains by a two-dimensional gradient technique applicable in routine microbiology

Objectives Precise assessment of potential therapeutic synergy, antagonism or indifference between antimicrobial agents currently depends on time-consuming and hard-to-standardize in vitro chequerboard titration methods. We here present a method based on a novel two-dimensional antibiotic gradient technique named Xact™. Methods We used a test comprising a combination of perpendicular gradients of meropenem and colistin in a single quadrant. We compared test outcomes with those obtained with classical chequerboard microbroth dilution testing in a study involving 27 unique strains of multidrug-resistant Acinetobacter baumannii from diverse origins. Results We were able to demonstrate 92% concordance between the new technology and classical chequerboard titration using the A. baumannii collection. Two strains could not be analysed by Xact™ due to their out-of-range MIC of meropenem (>128 mg/L). Conclusions The new test was shown to be diagnostically useful, easy to implement and less labour intensive than the classical metho