Prevalence of Pneumococcal Serotypes in Community-Acquired Pneumonia among Older Adults in Italy: A Multicenter Cohort Study.

Pneumococcal community-acquired pneumonia (CAP) is a leading cause of mortality. Following the introduction of pneumococcal conjugate vaccines (PCVs) in children, a decrease in the burden of the disease was reported. In parallel, an increase in non-vaccine serotypes was also noted. The objective of this study was to assess the current serotype-specific epidemiology of pneumococci among Italian older adults hospitalized for CAP. A prospective study was conducted between 2017 and 2020 in four Italian regions. Subjects aged ≥65 years hospitalized with confirmed CAP were tested for pneumococci using both pneumococcal urinary antigen and serotype-specific urine antigen tests able to identify all 24 serotypes included in the available vaccines. Of the 1155 CAP cases, 13.1% were positive for pneumococci. The most prevalent serotypes were 3 (2.0%), 8 (1.7%), 22F (0.8 %) and 11A (0.7%). These serotypes are all included in the newly licensed PCV20. The serotypes included in PCV13, PCV15 and PCV20 contributed to 3.3%, 4.4% and 7.5% of the CAP cases, respectively. In the context of a low PCV13 coverage among older adults and a high PCV coverage in children, a substantial proportion of CAP is caused by PCV13 serotypes. Higher valency PCV15 and PCV20 may provide additional benefits for the prevention of CAP in vaccinated older adults

Older age does not influence CD4 cell recovery in HIV-1 infected patients receiving Highly Active Anti Retroviral Therapy

BACKGROUND: Diagnosis of HIV infection is recently occurring with increasing frequency in middle-aged and in older individuals. As HAART became available, a minimal beneficial effect on immunological outcome in older in respect of younger subjects has been reported. In fact, both the intensity and the rapidity of the immunological response appeared to be reduced in elderly subjects. On the contrary, only few reports have indicated a similar immunological outcome both in older and younger HIV-positive subjects. Interestingly, older age did not seem to significantly affect the long-term virological outcome of HAART treated subjects. METHODS: To characterise epidemiological and clinical features of older HIV+ subjects, a prospective case-control study was performed: 120 subjects ≥ 50 and 476 between 20 and 35 years were initially compared. Subsequently, to better define the impact of HAART on their viro-immunological response, 81 older were compared with 162 younger subjects. RESULTS: At baseline cases presented significantly lower TCD4+ cell number and were more frequently affected by comorbid conditions. Under HAART a statistically significant increase in TCD4+ cell number was observed in cases and controls. At multivariate analysis, there was no statistically significant difference between cases and controls regarding viro-immunological response. CONCLUSIONS: Although older subjects present a more severe HIV infection, they can achieve, under HAART, the same viro-immunological success as the younger individuals

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Transforming transdisciplinarity: An expansion of strong transdisciplinarity and its centrality in enabling effective collaboration

© Springer International Publishing AG, part of Springer Nature 2018. This chapter expands and enriches existing characterisations and premises of strong transdisciplinarity to develop the concept of “Transforming Transdisciplinarity”. Erich Jantsch’s, Basarab Nicolescu’s, and Manfred Max-Neef’s notions of strong transdisciplinarity all aim to stretch, transcend or reconstruct the Cartesian-Newtonian paradigm. Other theoretical orientations linked by Jantsch, Nicolescu, and Max-Neef to strong transdisciplinarity, such as systems theory and complexity theory, also share similar intentions. However, whereas Max-Neef critiqued only the onto-epistemological premise of the Cartesian-Newtonian paradigm in defining strong transdisciplinarity, these other theoretical orientations offer an extended, more holistic critique across six integrated meaning systems of which a societal paradigm or individual worldview could be comprised: cosmologies, ontologies, epistemologies, axiologies, anthropologies, and social visions. Each of these six meaning systems is quite distinct, but together they form an integrated, holistic framework, or mythic structure of a paradigm (Kauffman S, Humanity in a creative universe. Oxford University Press, New York, 2016). We argue that in order to be truly transformative, collaborative transdisciplinary researchers should make space to reflect on the power and influence of these six meaning systems in their research. After exploring the lineage of strong transdisciplinarity, we offer a (very) short synthesis of the dominant Cartesian-Newtonian paradigm’s intellectual roots, and then synthesise the alternative paradigms put forward by transdisciplinary theorists and the theoretical orientations linked to transdisciplinarity. What binds these thinkers together is their repeating call for shifting our efforts towards a process-focused, relational, complexivist paradigm, across all meaning systems or mythic structures. Their collective voice is the raison d’être for Transforming Transdisciplinarity. We intend for this synthesis of the premise for Transforming Transdisciplinarity to offer a stronger catalyst for collectively engaging in third order learning (Sterling S, Learn Teach Higher Educ 5:17–33, 2010) within collaborative research projects. In other words, our intent is to provide an impetus and resource for collective and individual transformative third order learning (paradigmatic stretching) within collaborative processes that could support a more holistic “strong” transdisciplinarity and thus the development of deeply restorative paradigms and worldviews. This intent stands in contrast with the status quo of the dominant Cartesian-Newtonian worldview, where we risk having our efforts inadvertently or unknowingly contribute to the root causes of the wicked complexities that we are collectively working to address