Report from the HarmoSter study: inter-laboratory comparison of LC-MS/MS measurements of corticosterone, 11-deoxycortisol and cortisone.

Liquid chromatography-tandem mass spectrometry (LC-MS/MS) panels that include glucocorticoid-related steroids are increasingly used to characterize and diagnose adrenal cortical diseases. Limited information is currently available about reproducibility of these measurements among laboratories. The aim of the study was to compare LC-MS/MS measurements of corticosterone, 11-deoxycortisol and cortisone at eight European centers and assess the performance after unification of calibration. Seventy-eight patient samples and commercial calibrators were measured twice by laboratory-specific procedures. Results were obtained according to in-house and external calibration. We evaluated intra-laboratory and inter-laboratory imprecision, regression and agreement against performance specifications derived from 11-deoxycortisol biological variation. Intra-laboratory CVs ranged between 3.3 and 7.7%, 3.3 and 11.8% and 2.7 and 12.8% for corticosterone, 11-deoxycortisol and cortisone, with 1, 4 and 3 laboratories often exceeding the maximum allowable imprecision (MAI), respectively. Median inter-laboratory CVs were 10.0, 10.7 and 6.2%, with 38.5, 50.7 and 2.6% cases exceeding the MAI for corticosterone, 11-deoxycortisol and cortisone, respectively. Median laboratory bias vs. all laboratory-medians ranged from -5.6 to 12.3% for corticosterone, -14.6 to 12.4% for 11-deoxycortisol and -4.0 to 6.5% for cortisone, with few cases exceeding the total allowable error. Modest deviations were found in regression equations among most laboratories. External calibration did not improve 11-deoxycortisol and worsened corticosterone and cortisone inter-laboratory comparability. Method imprecision was variable. Inter-laboratory performance was reasonably good. However, cases with imprecision and total error above the acceptable limits were apparent for corticosterone and 11-deoxycortisol. Variability did not depend on calibration but apparently on imprecision, accuracy and specificity of individual methods. Tools for improving selectivity and accuracy are required to improve harmonization

Assessing inter-beach differences in semi-terrestrial arthropod assemblages on Maltese pocket sandy beaches (Central Mediterranean)

The distinctiveness of macrofaunal assemblages on different sandy beaches in the Maltese Islands was previously suggested by different single-season studies. A multi-seasonal sampling programme using pitfall trapping was implemented on four Maltese beaches to test the occurrence of this phenomenon. A total of 29,302 individuals belonging to 191 species were collected over a 2-year period, during which the beaches were sampled once per calendar season. A total of 77 species were recorded from single Maltese beaches only, of which nine were psammophiles. Non-metric multidimensional scaling analyses of pitfall trap species-abundance data resulted in a weak separation pattern, with samples grouping mainly in terms of beach and island rather than in terms of season or year of sampling, No physical variable could conclusively explain these patterns. It is concluded that although operating on Maltese beaches, macrofaunal assemblage distinctiveness is weaker than originally thought and can be attributed to the presence/absence or abundance of just a few psammophilic species. It is postulated that this phenomenon may be related to the ‘pocket beach’ nature of Maltese beaches, where headlands on either side of the beach to a large extent prevent the occurrence of longshore currents, resulting in semi-isolation of the populations of psammophilic species. A large number of single-beach records reported in this study highlight the high degree of beta diversity and spatial heterogeneity of Maltese beaches, and the conservation importance of the individual beach macrofaunal assemblages.peer-reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

L'assistenza ostetrica in caso di parto prematuro : studio sull'esperienza delle madri

Obiettivi: L\u2019obiettivo dello studio \ue8 quello di analizzare l\u2019assistenza ostetrica ricevuta dalle donne che hanno partorito prematuramente alla clinica Mangiagalli di Milano. Materiali e metodi: I dati sono stati raccolti nel periodo Luglio-Settembre 2013, avvalendosi come strumento di raccolta dati del questionario. In totale sono stati raccolti 14 questionari e le donne sono state individuate in parte durante il tirocinio in Patologia della gravidanza e in parte tramite il registro parti della sala parto, consegnando il questionario durante la degenza nel reparto di puerperio. Risultati: Complessivamente l\u2019ostetrica viene individuata facilmente in patologia della gravidanza e in puerperio, mentre questo avviene con pi\uf9 difficolt\ue0 in sala parto. Sempre l\u2019ostetrica risulta essere la figura professionale di maggior riferimento per i reparti di degenza, mentre in sala parto questo avviene per il medico ginecologo. Le lacune assistenziali riscontrate sono riconducibili alla necessit\ue0 di un maggiore supporto emotivo/psicologico e pi\uf9 chiarezza rispetto alla condizione clinica e, in puerperio, alla necessit\ue0 di maggior continuit\ue0 tra l\u2019unit\ue0 operativa di ostetricia e quella di neonatologia. Conclusioni: L\u2019aspetto cruciale \ue8 quello di gestire la situazione essendo comunque in grado di mantenere e offrire un valido supporto e accompagnamento emotivo/psicologico, insieme con il fornire adeguate informazioni e chiare spiegazioni in merito al piano assistenziale