Routine donor tomography in the eye bank as a sterile screening method for improved graft selection in corneal transplantation

Purpose: To evaluate the efficiency of using anterior segment optical coherence tomography (AS-OCT) (CASIA2) as a non-invasive and sterile screening method in the eye bank to detect corneal grafts with curvature and/or thickness abnormalities, thus improving the graft selection for corneal transplantation. Methods: Two hundred donor corneal tissues mounted in sterile tissue cultivation flasks were imaged using AS-OCT (CASIA 2). The corneal tissues were preserved at least 24 hours in medium 2 (6% dextran T-500) before the measurement. All images were grabbed through the posterior surface of the corneal tissues within a 7 mm central zone to create 3D volume data. The volume data set was imported to MATLAB and, after preprocessing the data and defining the region of interest (ROI), the edge of the front and back surfaces of the corneal tissues was detected. Subsequently, the adaptation of a sphero-cylindrical surface model with raytracing was carried out. The radii of curvature for the front and back surfaces and the central corneal thickness were determined according to the method proposed by Mäurer S., Eppig T., and Langenbucher A. at the Institute of Experimental Ophthalmology, Homburg/Saar. Results: The mean steep/flat front surface radius was 7.5 ± 0.24 (6.6-7.9) / 7.7 ± 0.22 (7.1-8.8) mm, the corresponding values for the back surface being 6.6 ± 0.22 (5.9-7.1) / 6.8 ± 0.21 (6.2-7.5) mm and the mean central thickness was 582 ± 45.1 (453-693) μm. Abnormalities (beyond ± 2 SD) were found in 13 corneas (6.5%) for anterior surface curvature, 15 for corneas (7.5%) for the posterior surface, and five corneas (2.5%) for thickness. Conclusions: The AS-OCT provides an objective and sterile. In addition, it may allow, in the future, a semi-automated screening method to identify corneal morphological and refractive alterations (e.g., keratoconus, status post PRK/LASIK) to further optimize corneal donor selection in eye banks.Ziel: Bewertung der Effizienz der optischen Kohärenztomographie des vorderen Augenabschnitts (AS-OCT) (CASIA2) als nicht-invasive und sterile Screeningsmethode in der Hornhautbank zur Erkennung von Hornhauttransplantaten mit Krümmungs- und/oder Dickenanomalien, wodurch die Transplantatauswahl für die Hornhauttransplantation verbessert werden sollte. Methoden: 200 Spenderhornhautgewebe wurden im sterilen Gewebekultivierungsbehälter vermessen. Die Hornhautgewebe wurden mindestens 24 Stunden vor der Messung in Medium 2 (mit 6% Dextran T-500) konserviert. Alle Bilder wurden durch die hintere Oberfläche der Hornhautgewebe innerhalb einer zentralen Zone von 7 mm aufgenommen, um 3D-Volumendaten zu erstellen. Der Volumendatensatz wurde in MATLAB importiert, und nach der Vorverarbeitung der Daten und der Definition der “Region of interest“ (ROI) wurde die Kante der Vorder- und Rückseite der Hornhautgewebe detektiert. Anschließend erfolgte die Anpassung eines sphärozylinderförmigen Oberflächenmodells mittels Raytracing. Die Krümmungsradien für Vorder- und Rückseite sowie die Dicke der zentralen Hornhaut wurden nach der von Mäurer S, Eppig T und Langenbucher A (Institut für Experimentelle Ophthalmologie, Homburg/Saar) vorgeschlagenen Methode bestimmt. Ergebnisse: Der mittlere steile / flache Radius der Vorderfläche betrug 7,5 ± 0,24 (6,6-7,9) / 7,7 ± 0,22 (7,1-8,8) mm, die entsprechenden Werte für die Rückfläche betrugen 6,6 ± 0,22 (5,9-7,1) / 6,8 ± 0,21 (6,2-7,5) mm und die mittlere zentrale Dicke betrug 582 ± 45,1 (453-693) μm. Anomalien (außerhalb ± 2 SD) wurden bei 13 Hornhäuten (6,5%) für die Krümmung der Vorderfläche, bei 15 Hornhäuten (7,5%) für die Krümmung der hinteren Oberfläche und bei 5 Hornhäuten (2,5%) für die zentrale Dicke gefunden. Schlussfolgerungen: Das Vorderabschnittes-OCT bietet eine objektive, sterile und zukünftig halbautomatisches Screening-Methode zur Identifizierung morphologischer und refraktiver Veränderungen der Hornhaut (z. B. Keratokonus, Status nach PRK/LASIK), um die Hornhautspenderauswahl in der Hornhautbank weiter zu optimieren

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of COVID-19 on Florida family dependency drug courts

Abstract Background To promote parent-child reunification, family dependency drug courts (FDDCs) facilitate substance use disorder treatment for people whose children have been removed due to parental substance use. The COVID-19 pandemic disrupted FDDC operations, forcing FDDCs to quickly adapt to new circumstances. Although existing research has examined COVID-19 impacts on adult drug courts and civil dependency courts, studies have yet to examine the impact of COVID-19 on FDDCs specifically. Methods To explore the impact of COVID-19 on FDDCs, we conducted 20 focus groups and 5 individual interviews with court team members from five Florida FDDCs between 2020 and 2022. Data were analyzed using iterative categorization. Results Five overarching themes emerged. First, FDDCs adopted virtual technology during the pandemic and more flexible drug screening policies. Second, virtual technology was perceived as improving hearing attendance but decreasing client engagement. FDDC team members discussed a potential hybrid in-person/virtual hearing model after the pandemic. Third, COVID-19 negatively impacted parent-child visitation opportunities, limiting development of bonds between parents and children, and parent-child bonding is a key consideration during judicial reunification decisions. Fourth, COVID-19 negatively impacted the mental health of court team members and clients. Court team members adopted new informal roles, such as providing technical support and emotional counseling to clients, in addition to regular responsibilities, resulting in feeling overwhelmed and overworked. Court team members described clients as feeling more depressed and anxious, in part due to limited visitation opportunities with children, which decreased clients’ motivation for substance use recovery. Fifth, COVID-19 decreased recruitment of potential clients into FDDCs. Conclusions If FDDCs continue to rely on virtual hearings beyond the pandemic, they must develop practices for improving client engagement during virtual hearings. FDDCs should preemptively develop procedures for improving parent-child visitation during future public health crises, because limited visitation opportunities could weaken parent-child bonding and, ultimately, the likelihood of reunification

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this