Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Micro-political practices in higher education: a challenge to excellence as a rationalizing myth?

Excellence has become a ‘hoorah’ word which is widely used in higher education institutions to legitimate practices related to the recruitment/progression of staff. It can be seen as reflecting an institutionalised belief that such evaluative processes are unaffected by the social characteristics of those who work in them or their relationships with each other. Such views have been challenged by gender theorists and by those researching informal power in state structures. The purpose of this article is to raise the possibility that excellence is an ‘idealised cultural construct’ and a ‘rationalising myth’. Drawing on data from qualitative interviews with 67 men and women, who were candidates or evaluators in recruitment/progression processes in five higher educational institutions (in Ireland, Turkey, Bulgaria, Germany and Italy), it conceptualises and illustrates masculinist, relational and ‘local fit’ micro-political practices that are seen to affect such recruitment/progression. Variation exists by gender and by contextual positioning in the process (i.e. as evaluator/candidate). These practices illustrate the perceived importance of the enactment of informal power. The article suggests that the construct of excellence is used to obscure these practices and to maintain organisational legitimacy in the context of multiple stakeholders with conflicting expectationspeer-reviewe

Micro-political practices in Higher Education: A challenge to excellence as a rationalizing myth?

Excellence has become a ‘hoorah’ word which is widely used in higher education institutions to legitimate practices related to the recruitment/progression of staff. It can be seen as reflecting an institutionalised belief that such evaluative processes are unaffected by the social characteristics of those who work in them or their relationships with each other. Such views have been challenged by gender theorists and by those researching informal power in state structures. The purpose of this article is to raise the possibility that excellence is an ‘idealised cultural construct’ and a ‘rationalising myth’. Drawing on data from qualitative interviews with 67 men and women, who were candidates or evaluators in recruitment/progression processes in five higher educational institutions (in Ireland, Turkey, Bulgaria, Germany and Italy), it conceptualises and illustrates masculinist, relational and ‘local fit’ micro-political practices that are seen to affect such recruitment/progression. Variation exists by gender and by contextual positioning in the process (i.e. as evaluator/candidate). These practices illustrate the perceived importance of the enactment of informal power. The article suggests that the construct of excellence is used to obscure these practices and to maintain organisational legitimacy in the context of multiple stakeholders with conflicting expectations

Micro-political practices in higher education: a challenge to excellence as a rationalizing myth?

Excellence has become a ‘hoorah’ word which is widely used in higher education institutions to legitimate practices related to the recruitment/progression of staff. It can be seen as reflecting an institutionalised belief that such evaluative processes are unaffected by the social characteristics of those who work in them or their relationships with each other. Such views have been challenged by gender theorists and by those researching informal power in state structures. The purpose of this article is to raise the possibility that excellence is an ‘idealised cultural construct’ and a ‘rationalising myth’. Drawing on data from qualitative interviews with 67 men and women, who were candidates or evaluators in recruitment/progression processes in five higher educational institutions (in Ireland, Turkey, Bulgaria, Germany and Italy), it conceptualises and illustrates masculinist, relational and ‘local fit’ micro-political practices that are seen to affect such recruitment/progression. Variation exists by gender and by contextual positioning in the process (i.e. as evaluator/candidate). These practices illustrate the perceived importance of the enactment of informal power. The article suggests that the construct of excellence is used to obscure these practices and to maintain organisational legitimacy in the context of multiple stakeholders with conflicting expectation

Low TCR avidity and lack of tumor cell recognition in CD8(+) T cells primed with the CEA-analogue CAP1-6D peptide.

The use of "altered peptide ligands" (APL), epitopes designed for exerting increased immunogenicity as compared with native determinants, represents nowadays one of the most utilized strategies for overcoming immune tolerance to self-antigens and boosting anti-tumor T cell-mediated immune responses. However, the actual ability of APL-primed T cells to cross-recognize natural epitopes expressed by tumor cells remains a crucial concern. In the present study, we show that CAP1-6D, a superagonist analogue of a carcinoembriyonic antigen (CEA)-derived HLA-A*0201-restricted epitope widely used in clinical setting, reproducibly promotes the generation of low-affinity CD8(+) T cells lacking the ability to recognized CEA-expressing colorectal carcinoma (CRC) cells. Short-term T cell cultures, obtained by priming peripheral blood mononuclear cells from HLA-A*0201(+) healthy donors or CRC patients with CAP1-6D, were indeed found to heterogeneously cross-react with saturating concentrations of the native peptide CAP1, but to fail constantly lysing or recognizing through IFN- gamma release CEA(+)CRC cells. Characterization of anti-CAP1-6D T cell avidity, gained through peptide titration, CD8-dependency assay, and staining with mutated tetramers (D227K/T228A), revealed that anti-CAP1-6D T cells exerted a differential interaction with the two CEA epitopes, i.e., displaying high affinity/CD8-independency toward the APL and low affinity/CD8-dependency toward the native CAP1 peptide. Our data demonstrate that the efficient detection of self-antigen expressed by tumors could be a feature of high avidity CD8-independent T cells, and underline the need for extensive analysis of tumor cross-recognition prior to any clinical usage of APL as anti-cancer vaccines

European Multicenter Study of ET-COVID-19

Acute ischemic stroke and large vessel occlusion can be concurrent with the coronavirus disease 2019 (COVID-19) infection. Outcomes after mechanical thrombectomy (MT) for large vessel occlusion in patients with COVID-19 are substantially unknown. Our aim was to study early outcomes after MT in patients with COVID-19

European Multicenter Study of ET-COVID-19

International audienceBackground and Purpose: Acute ischemic stroke and large vessel occlusion can be concurrent with the coronavirus disease 2019 (COVID-19) infection. Outcomes after mechanical thrombectomy (MT) for large vessel occlusion in patients with COVID-19 are substantially unknown. Our aim was to study early outcomes after MT in patients with COVID-19. Methods: Multicenter, European, cohort study involving 34 stroke centers in France, Italy, Spain, and Belgium. Data were collected between March 1, 2020 and May 5, 2020. Consecutive laboratory-confirmed COVID-19 cases with large vessel occlusion, who were treated with MT, were included. Primary investigated outcome: 30-day mortality. Secondary outcomes: early neurological improvement (National Institutes of Health Stroke Scale improvement ≥8 points or 24 hours National Institutes of Health Stroke Scale 0–1), successful reperfusion (modified Thrombolysis in Cerebral Infarction grade ≥2b), and symptomatic intracranial hemorrhage. Results: We evaluated 93 patients with COVID-19 with large vessel occlusion who underwent MT (median age, 71 years [interquartile range, 59–79]; 63 men [67.7%]). Median pretreatment National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score were 17 (interquartile range, 11–21) and 8 (interquartile range, 7–9), respectively. Anterior circulation acute ischemic stroke represented 93.5% of cases. The rate modified Thrombolysis in Cerebral Infarction 2b to 3 was 79.6% (74 patients [95% CI, 71.3–87.8]). Thirty-day mortality was 29% (27 patients [95% CI, 20–39.4]). Early neurological improvement was 19.5% (17 patients [95% CI, 11.8–29.5]), and symptomatic intracranial hemorrhage was 5.4% (5 patients [95% CI, 1.7–12.1]). Patients who died at 30 days exhibited significantly lower lymphocyte count, higher levels of aspartate, and LDH (lactate dehydrogenase). After adjustment for age, initial National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and successful reperfusion, these biological markers remained associated with increased odds of 30-day mortality (adjusted odds ratio of 2.70 [95% CI, 1.21–5.98] per SD-log decrease in lymphocyte count, 2.66 [95% CI, 1.22–5.77] per SD-log increase in aspartate, and 4.30 [95% CI, 1.43–12.91] per SD-log increase in LDH). Conclusions: The 29% rate of 30-day mortality after MT among patients with COVID-19 is not negligible. Abnormalities of lymphocyte count, LDH and aspartate may depict a patient’s profiles with poorer outcomes after MT. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04406090

Make EU trade with Brazil sustainable

Brazil, home to one of the planet's last great forests, is currently in trade negotiations with its second largest trading partner, the European Union (EU). We urge the EU to seize this critical opportunity to ensure that Brazil protects human rights and the environment