Adaptive response of neonatal sepsis-derived Group B Streptococcus to bilirubin

This work was funded by the Neonatal Unit Endowment Fund, Aberdeen Maternity Hospital. RH is funded by a career researcher fellowship from NHS Research Scotland. SG was funded by the MRC Flagship PhD programme. We are grateful for the support of Dr Phil Cash and Aberdeen Proteomics, at University of Aberdeen, in completing this project. Supplementary information accompanies this paper at https://doi.org/10.1038/s41598-018-24811-3.Peer reviewedPublisher PD

Ophthalmol Ther

There is little understanding of long-term treatment persistence in patients receiving anti-vascular endothelial growth factor (anti-VEGF) injections for diabetic macular edema (DME), particularly relating to treatment intervals. The aim of this study was to investigate the association between treatment interval and discontinuation rate after 24 months of unilateral anti-VEGF treatment in patients with DME under routine clinical care in the USA. This was a non-interventional, retrospective cohort study to review the health insurance claims of adults with DME linked with the IBM MarketScan Commercial and Medicare Supplemental databases, who were continuously enrolled in a health plan for at least 6 months prior to their first anti-VEGF treatment and for a duration of at least 24 months between July 2011 and June 2017. Patients were grouped on the basis of the injection interval they achieved at 24 months of treatment. Discontinuation rate beyond 24 months and its association with treatment intervals at 24 months was estimated using the Kaplan-Meier method and Cox proportional hazards models. The overall discontinuation rate among the 1702 eligible patients from 24 to 60 months after treatment initiation was 30%. At 60 months, patients were more likely to remain on treatment in shorter (75.3% [4-week interval group]) versus longer treatment interval groups (62.1% [> 12-week interval group], difference = 13.2%, [95% confidence interval (CI) 1.06, 2.06], p = 0.01). Patients on a > 12-week interval were twice as likely to discontinue treatment compared with those on an 8-week interval (hazard ratio = 2.01 [95% CI 1.43, 2.82], p < 0.001). Patients with DME on longer anti-VEGF treatment intervals at 24 months consistently had higher discontinuation rates in the following years than those on shorter treatment intervals

EBioMedicine

Background High HIV-1 DNA levels in peripheral blood mononuclear cells (PBMC) were associated with a higher risk of severe morbidity and a faster decline in CD4 count in ART-naive patients. We report the association between HIV-1 DNA and mortality in HIV-infected adults in a trial of early ART in West Africa. Methods In the Temprano trial, HIV-infected adults were randomly assigned to start ART immediately or defer ART. After trial termination, HIV-1 DNA was measured in whole blood samples frozen at baseline. We analyzed the association between baseline PBMC HIV-1 DNA and long-term mortality

Temporal trends of population viral suppression in the context of Universal Test and Treat: the ANRS 12249 TasP trial in rural South Africa

Introduction: The universal test-and-treat (UTT) strategy aims to maximize population viral suppression (PVS), that is, the proportion of all people living with HIV (PLHIV) on antiretroviral treatment (ART) and virally suppressed, with the goal of reducing HIV transmission at the population level. This article explores the extent to which temporal changes in PVS explain the observed lack of association between universal treatment and cumulative HIV incidence seen in the ANRS 12249 TasP trial conducted in rural South Africa. Methods: The TasP cluster-randomized trial (2012 to 2016) implemented six-monthly repeat home-based HIV counselling and testing (RHBCT) and referral of PLHIV to local HIV clinics in 2 9 11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters and regardless of CD4 count in intervention clusters. We measured residency status, HIV status, and HIV care status for each participant on a daily basis. PVS was computed per cluster among all resident PLHIV (≥16, including those not in care) at cluster opening and daily thereafter. We used a mixed linear model to explore time patterns in PVS, adjusting for sociodemographic changes at the cluster level. Results: 8563 PLHIV were followed. During the course of the trial, PVS increased significantly in both arms (23.5% to 46.2% in intervention, +22.8, p < 0.001; 26.0% to 44.6% in control, +18.6, p < 0.001). That increase was similar in both arms (p = 0.514). In the final adjusted model, PVS increase was most associated with increased RHBCT and the implementation of local trial clinics (measured by time since cluster opening). Contextual changes (measured by calendar time) also contributed slightly. The effect of universal ART (trial arm) was positive but limited. Conclusions: PVS was improved significantly but similarly in both trial arms, explaining partly the null effect observed in terms of cumulative HIV incidence between arms. The PVS gains due to changes in ART-initiation guidelines alone are relatively small compared to gains obtained by strategies to maximize testing and linkage to care. The achievement of the 90-90-90 targets will not be met if the operational and implementational challenges limiting access to care and treatment, often context-specific, are not properly addressed. Clinical trial number: NCT01509508 (clinicalTrials.gov)/DOH-27-0512-3974 (South African National Clinical Trials Register)

lntérêt de l'ouverture d'un centre de soins non programmés sur la ville de Colmar:Thèse présentée pour le diplôme d'État de docteur en médecine. Diplôme d'État mention médecine générale

Médecine (médecine générale)Contexte : La médecine connaît actuellement une réelle crise démographique. On observe une forte demande des soins en médecine générale conséquente du : - Vieillissement de la population - Important flux migratoire - Taux élevé de personnes suivis pour une affection de longue durée - Changements sociétaux (téléconsultations, internet, réseaux sociaux). En opposition, on retrouve une diminution de la densité de médecins généralistes ainsi qu’une modification de la population des médecins et de leurs pratiques (féminisation de la médecine, gestion différente des cabinets de médecine générale). Mis en corrélation, ces éléments soulignent l’importance de trouver des solutions pour palier à l’inégalité de demandes et d’offres de soins. Pour répondre à cette problématique, des centres de soins non programmés se développent dans plusieurs villes françaises. Objectifs : L’objectif principal de notre étude est de mettre en évidence l’intérêt de l’implantation d’un centre de soins non programmés sur la ville de Colmar. Méthode : Afin de répondre au mieux à notre objectif, nous avons réalisé une étude descriptive transversale, quantitative associées à des données qualitatives, interrogeant les médecins installés et remplaçants de Colmar et les 14 km environnants. Le recueil des données a été effectué à l’aide d’un questionnaire en ligne envoyé par e-mail. Résultats : 140 médecins généralistes installés et 21 médecins généralistes remplaçants ont été inclus dans notre étude. Un total de 97 médecins généralistes a répondu à notre questionnaire, soit 70,1% de médecins installés (n=68) et 29,9% de médecins remplaçants (n=29). Au sein des répondants exerçant dans le périmètre établi, plus de la moitié d’entre eux sont des femmes, âgés de moins de 40 ans et ayant effectué leur internat dans la ville de Strasbourg. Concernant les soins non programmés, ils sont, dans leur majeure partie, gérés à l’aide de créneaux de consultations dédiés (estimés entre 6 et 10 par jour). Cependant, plusieurs cabinets arrivent à saturation de leur planning en fin de journée et ne peuvent satisfaire l’intégralité des demandes des patients (appartenant ou non à la patientèle traitante). Une alternative intéressante pour palier à cette hausse de demandes est l’ouverture de nombreux centres de soins non programmés. Connus par plus de 85% des médecins interrogés, près de 65% ont un avis positif les concernant, près de 70% y redirigeraient des patients et plus de 75% sont favorables à l’ouverture d’un tel centre dans la ville de Colmar. Il est essentiel de noter que l’argument d’une possibilité de désengorger leurContext: Medicine is currently experiencing a real demographic crisis. There is a high demand for general medical care due to : - Aging population - Significant migratory flow - High rate of people with chronic conditions - Societal changes (teleconsultations, internet, social media). In contrast, there is a decrease in the density of general practitioners and a shift in the demographics and practices of physicians (feminization of medicine, different management of general medical practices). Taken together, these elements highlight the importance of finding solutions to address the inequality between the demand for and supply of healthcare. To address this issue, unplanned care centers are being developed in several French cities. Objectives: The main objective of our study is to highlight the benefits of implementing an unplanned care center in the city of Colmar. Method: In order to best address our objective, we conducted a descriptive cross-sectional study that combined quantitative and qualitative data by surveying established and substitute physicians in Colmar and the surrounding 14 km area. Data collection was done through an online questionnaire sent via email. Results: Our study included 140 established general practitioners and 21 substitute general practitioners. A total of 97 general practitioners responded to our questionnaire, representing 70.1% of established physicians (n=68) and 29.9% of substitute physicians (n=29). Among the respondents practicing within the established perimeter, over half of them were women, under 40 years old, and completed their internship in the city of Strasbourg. Regarding unplanned care, the majority of it is managed through dedicated consultation slots (estimated between 6 and 10 per day). However, several practices reach capacity in their schedules towards the end of the day and are unable to meet all patient demands (both from their regular patients and others). An interesting alternative to cope with this increase in demand is the opening of numerous unplanned care centers. Over 85% of the surveyed physicians are aware of these centers, nearly 65% have a positive opinion about them, almost 70% would refer patients to them, and over 75% support the opening of such a center in the city of Colmar. It is essential to note that the argument of relieving congestion in their medical practice or the emergency department is the most frequently mentioned by the responding physiciansThèses et écrits académique

(Self-) Reflection / Reflexivity in Sensitive, Qualitative Research:A Scoping Review

This scoping review offers insight into researcher well-being when working with sensitive and traumatic topics in a qualitative research context. The study identified existing empirical research concerning researcher well-being and mental health. The databases included SSCI, ASSIA &lt; IBISS, Scopus, Social Policy and Practice, PsycInfo, Social Science Database/Social Science Premium Collection (Proquest), and Open Grey. An international search was conducted, with no time constraints on publication dates to gather as wide a selection as possible. 55 papers met the criteria. We found that the terminology used within the papers was not consistent which necessitated grouping the (self-) reflection/reflexive practices researchers used and categorizing them under the umbrella term SRR practices. The research questions were: 1. Which disciplines or fields are conducting SRR practices on sensitive topics? 2. What SRR practices do researchers employ in the context of sensitive research? 3. What were the self-reported outcomes from using SRR practices as a tool of researchers working on sensitive research? A key finding of the scoping review is that many researchers who work on sensitive topics feel unprepared and receive little or no training or support for SRR practices. This poses particular challenges for early career researchers. We also identified that qualitative researchers have developed a range of SRR practices to manage the emotional impact of their sensitive research work. Many authors of the scoped papers stress the importance of peer-support as well as formal and informal debriefing meetings. Another key SRR practice discussed by many researchers is reflexive journaling. Our scoping review suggests that if it is combined with other activities, self-reflexive journaling can be an excellent way to acknowledge and assess the emotional impact of sensitive research

(Self-) Reflection / Reflexivity in Sensitive, Qualitative Research:A Scoping Review

This scoping review offers insight into researcher well-being when working with sensitive and traumatic topics in a qualitative research context. The study identified existing empirical research concerning researcher well-being and mental health. The databases included SSCI, ASSIA &lt; IBISS, Scopus, Social Policy and Practice, PsycInfo, Social Science Database/Social Science Premium Collection (Proquest), and Open Grey. An international search was conducted, with no time constraints on publication dates to gather as wide a selection as possible. 55 papers met the criteria. We found that the terminology used within the papers was not consistent which necessitated grouping the (self-) reflection/reflexive practices researchers used and categorizing them under the umbrella term SRR practices. The research questions were: 1. Which disciplines or fields are conducting SRR practices on sensitive topics? 2. What SRR practices do researchers employ in the context of sensitive research? 3. What were the self-reported outcomes from using SRR practices as a tool of researchers working on sensitive research? A key finding of the scoping review is that many researchers who work on sensitive topics feel unprepared and receive little or no training or support for SRR practices. This poses particular challenges for early career researchers. We also identified that qualitative researchers have developed a range of SRR practices to manage the emotional impact of their sensitive research work. Many authors of the scoped papers stress the importance of peer-support as well as formal and informal debriefing meetings. Another key SRR practice discussed by many researchers is reflexive journaling. Our scoping review suggests that if it is combined with other activities, self-reflexive journaling can be an excellent way to acknowledge and assess the emotional impact of sensitive research

Arctic Climate Change, Economy and Society (ACCESS): Integrated perspectives

International audienceThis introduction to the special issue presents an overview of the wide range of results produced during the European Union project Arctic Climate Change, Economy and Society (ACCESS). This project assessed the main impacts of climate change on Arctic Ocean’s geophysical variables and how these impending changes could be expected to impact directly and indirectly on socio-economic activities like transportation, marine sea food production and resource exploitation. Related governance issues were examined. These results were used to develop several management tools that can live on beyond ACCESS. In this article, we synthesize most of the project results in the form of tentative responses to questions raised during the project. By doing so, we put the findings of the project in a broader perspective and introduce the contributions made in the different articles published in this special issue

Facets of Arctic Change

International audienc