The Wellbeing of Priests in the Time of COVID‑19 Illness Pandemics

Svećenici su se također za vrijeme pandemije bolesti COVID‑19 suočili s novim načinom življenja vlastitog poslanja i poziva, tim više što je svećeničko poslanje usmjereno najčešće na živi kontakt s ljudima. Uzeli smo u obzir odnos svećenika prema drugima, prema sebi i prema Bogu. U istraživanju, koje je provedeno od kraja studenoga do polovice prosinca 2020. godine, sudjelovalo je 312 svećenika, redovnika i dijecezanskih svećenika, koji žive i rade u Hrvatskoj, Bosni i Hercegovini, Srbiji te jedan manji dio u ostalim državama. Za potrebe istraživanja korišteni su upitnici, prevedeni prema novim standardima prevođenja, kojima se ispitivalo psihološko blagostanje svećenika, suosjećanje i samo‑suosjećanje te je prigodni upitnik pripremljen za potrebe ovog istraživanja koji je u fokusu imao pastoralni život svećenika za vrijeme pandemije bolesti COVID‑19. Veći broj svećenika, to jest 77 %, izjavio je kako su u doba pandemije odvojili više vremena za molitvu nego uobičajeno, što je ujedno i povezano s većim osobnim rastom i pozitivnim odnosima s drugima. Materijalne poteškoće imali su svećenici koji žive i djeluju u župama manjim od 3000 stanovnika. Ističe se kako nema značajnijih razlika u psihološkoj dobrobiti (psychological well‑being) između dijecezanskih svećenika i redovnika kao ni između svećenika koji žive sami ili u zajednici s drugim svećenicima. Primijetili smo značajne razlike u brizi o sebi kod svećenika koji su na službi duže od dvadeset godina života, gdje upravo oni pokazuju višu razinu brige o sebi. Na koncu, značajnim se pokazalo da oni svećenici koji su više suosjećajni prema samima sebi, imaju i višu razinu psihološke dobrobiti.The priest also had to deal with a new way of living their own vocation and mission during the time of COVID‑19 illness pandemics, especially since their mission is most often realized through personal contact with people. The author takes into account the relation of priests towards others, towards themselves, and towards God. In the study that has been carried out from the end of November until the first half of December of 2020, 312 priests, religious order and diocesan priests, who live and work in Croatia, Bosnia and Herzegovina, Serbia, and a small number of those in other countries, took part. For the purposes of the study, questionnaires were used that were translated according to the new standards of translation and that measured the psychological wellbeing of priests, compassion, and compassion towards oneself. On the basis of that, an appropriate questionnaire was prepared for the purposes of this study that focused on the pastoral life of priests during the COVID‑19 illness pandemics. The majority of priests, more precisely 77%, stated that they used more time than usual for prayer, which is also related to a more significant personal growth and positive relationships with others. The priests who live in parishes that have less than 3000 inhabitants, however, faced financial difficulties. The study also marked that there were no significant differences in psychological wellbeing between diocesan priests and priests in religious orders, as well as between those priests who live alone and those who live in a community with other priests. The study did mark significant differences in the care for oneself among those priests who have been active in the office for more than twenty years and who show more awareness for the importance of caring for oneself. Finally, it has been shown that those priests who are more compassionate towards themselves, also exhibit a higher level of psychological wellbeing

Pediatric Complicated Appendicitis During the COVID-19 Pandemic: A National Perspective

This article is made available for unrestricted research re-use and secondary analysis in any form or be any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemicIntroduction: The COVID-19 pandemic has changed the public’s perception of safety in accessing healthcare across common surgical emergencies, including acute appendicitis in children. Here, we aim to determine whether the COVID-19 pandemic is associated with poorer appendicitis outcomes and predict that there are higher complicated appendicitis (CA) rates during this time. Methods: A retrospective cohort study was conducted in patients younger than 19 years with a new diagnosis of acute appendicitis. Rates of CA were compared in the pre- (3/1/2019-5/31/2019) and post-COVID (3/1/2020-5/31/2020) timeframes using the Pediatric Health Information System national database. The primary end point of interest was CA rates. Secondary end point of interest was hospital length of stay. A p value < 0.05 was significant. Results: Nationally, 6,212 patients had acute appendicitis pre-COVID compared with 5,372 post-COVID. The CA rate post-COVID was 33%, which was significantly higher than 30% CA rate pre-COVID, and the rate of uncomplicated appendicitis post-COVID was lower (p < 0.001). An overall increase in hospital length of stay nationally was observed for all patients treated post-COVID (p < 0.001), as well as in those with CA (p < 0.001). Conclusion: The COVID-19 pandemic is directly associated with higher disease burden in pediatric acute appendicitis. The healthcare system must understand its role in alleviating public fear in seeking healthcare for patients and their families to encourage timely medical care

Angiogenesis: A Cellular Response to Traumatic Injury

The development of new vasculature plays a significant role in a number of chronic disease states, including neoplasm growth, peripheral arterial disease, and coronary artery disease, among many others. Traumatic injury and hemorrhage, however, is an immediate, often dramatic pathophysiologic insult which can also necessitate neovascularization to promote healing. Traditional understanding of angiogenesis involved resident endothelial cells branching outward from localized niches in the periphery. Additionally, there are a small number of circulating endothelial progenitor cells which participate directly in the process of neovessel formation. The bone marrow stores a relatively small number of so-called pro-angiogenic hematopoietic progenitor cells (PACs) – that is, progenitor cells of a hematopoietic potential that differentiate into key structural cells and stimulate or otherwise support local cell growth/differentiation at the site of angiogenesis. Following injury, a number of cytokines and intercellular processes are activated or modulated to promote development of new vasculature. These processes initiate and maintain a robust response to vascular insult, allowing new vessels to canalize and anastomose and provide timely oxygen delivering to healing tissue. Ultimately as we better understand the key players in the process of angiogenesis we can look to develop novel techniques to promote healing following injury

The Assessment of Fecal Volatile Organic Compounds in Healthy Infants: Electronic Nose Device Predicts Patient Demographics and Microbial Enterotype

Background: The assessment of fecal volatile organic compounds (VOCs) has emerged as a noninvasive biomarker in many different pathologies. Before assessing whether VOCs can be used to diagnose intestinal diseases, including necrotizing enterocolitis (NEC), it is necessary to measure the impact of variable infant demographic factors on VOC signals. Materials and methods: Stool samples were collected from term infants at four hospitals in a large metropolitan area. Samples were heated, and fecal VOCs assessed by the Cyranose 320 Electronic Nose. Twenty-eight sensors were combined into an overall smellprint and were also assessed individually. 16s rRNA gene sequencing was used to categorize infant microbiomes. Smellprints were correlated to feeding type (formula versus breastmilk), sex, hospital of birth, and microbial enterotype. Overall smellprints were assessed by PERMANOVA with Euclidean distances, and individual sensors from each smellprint were assessed by Mann-Whitney U-tests. P < 0.05 was significant. Results: Overall smellprints were significantly different according to diet. Individual sensors were significantly different according to sex and hospital of birth, but overall smellprints were not significantly different. Using a decision tree model, two individual sensors could reliably predict microbial enterotype. Conclusions: Assessment of fecal VOCs with an electronic nose is impacted by several demographic characteristics of infants and can be used to predict microbiome composition. Further studies are needed to design appropriate algorithms that are able to predict NEC based on fecal VOC profiles

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

Abstract 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

Correlating Thermodynamic and Kinetic Hydricities of Rhenium Hydrides

The kinetics of hydride transfer from Re(Rbpy)(CO)3H (bpy = 4,4′-R-2,2′-bipyridine; R = OMe, tBu, Me, H, Br, COOMe, CF3) to CO2 and seven different cationic N-heterocycles were determined. Additionally, the thermodynamic hydricities of complexes of the type Re(Rbpy)(CO)3H were established primarily using computational methods. Linear free-energy relationships (LFERs) derived by correlating thermodynamic and kinetic hydricities indicate that, in general, the rate of hydride transfer increases as the thermodynamic driving force for the reaction increases. Kinetic isotope effects range from inverse for hydride transfer reactions with a small driving force to normal for reactions with a large driving force. Hammett analysis indicates that hydride transfer reactions with greater thermodynamic driving force are less sensitive to changes in the electronic properties of the metal hydride, presumably because there is less buildup of charge in the increasingly early transition state. Bronsted α values were obtained for a range of hydride transfer reactions and along with DFT calculations suggest the reactions are concerted, which enables the use of Marcus theory to analyze hydride transfer reactions involving transition metal hydrides. It is notable, however, that even slight perturbations in the steric properties of the Re hydride or the hydride acceptor result in large deviations in the predicted rate of hydride transfer based on thermodynamic driving forces. This indicates that thermodynamic considerations alone cannot be used to predict the rate of hydride transfer, which has implications for catalyst design

Correlating Thermodynamic and Kinetic Hydricities of Rhenium Hydrides

The kinetics of hydride transfer from Re(Rbpy)(CO)3H (bpy = 4,4′-R-2,2′-bipyridine; R = OMe, tBu, Me, H, Br, COOMe, CF3) to CO2 and seven different cationic N-heterocycles were determined. Additionally, the thermodynamic hydricities of complexes of the type Re(Rbpy)(CO)3H were established primarily using computational methods. Linear free-energy relationships (LFERs) derived by correlating thermodynamic and kinetic hydricities indicate that, in general, the rate of hydride transfer increases as the thermodynamic driving force for the reaction increases. Kinetic isotope effects range from inverse for hydride transfer reactions with a small driving force to normal for reactions with a large driving force. Hammett analysis indicates that hydride transfer reactions with greater thermodynamic driving force are less sensitive to changes in the electronic properties of the metal hydride, presumably because there is less buildup of charge in the increasingly early transition state. Bronsted α values were obtained for a range of hydride transfer reactions and along with DFT calculations suggest the reactions are concerted, which enables the use of Marcus theory to analyze hydride transfer reactions involving transition metal hydrides. It is notable, however, that even slight perturbations in the steric properties of the Re hydride or the hydride acceptor result in large deviations in the predicted rate of hydride transfer based on thermodynamic driving forces. This indicates that thermodynamic considerations alone cannot be used to predict the rate of hydride transfer, which has implications for catalyst design

Effect of fenofibrate on amputation events in people with type 2 diabetes mellitus (FIELD study): a prespecified analysis of a randomised controlled trial

BACKGROUND: Amputations in people with type 2 diabetes mellitus substantially impair their quality of life and impose high costs on health-care systems. Our aim was to assess the effect of fenofibrate on amputation events in a large cohort of patients with type 2 diabetes. METHODS: In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, 9795 patients aged 50-75 years with type 2 diabetes were randomly assigned by computer-generated randomisation sequence to receive fenofibrate 200 mg per day (n=4895) or matching placebo (n=4900) for 5 years' duration. Information about non-traumatic amputation-a prespecified tertiary endpoint of the study-was routinely gathered. Clinicians who were masked to treatment allocation adjudicated amputations as minor or major (below or above the ankle, respectively). Amputations were also classified on the basis of whether or not large-vessel disease was present in the limb, to distinguish those related to large-artery atherosclerosis from those predominantly related to microvascular disease. Analysis was by intention to treat (ITT). The FIELD study is registered as an International Standard Randomised Controlled Trial, number ISRCTN64783481. FINDINGS: All 9795 patients were included in the ITT population. 115 patients had one or more non-traumatic lower-limb amputations due to diabetes. Previous cardiovascular disease, microvascular disease, previous non-traumatic amputation or skin ulcer, smoking, and longer duration of diabetes were more frequent in patients who had amputations during the trial than in those who had other cardiovascular events or in those who had neither event (all p&lt;0.001 for three-way comparison). Mean lipid concentrations differed between patients who had on-study amputations and those who had other cardiovascular events or neither event, but by no more than 0.2 mmol/L. The risks of first amputation (45 vs 70 events; hazard ratio [HR] 0.64, 95% CI 0.44-0.94; p=0.02) and minor amputation events without known large-vessel disease (18 vs 34 events; 0.53, 0.30-0.94; p=0.027) were lower for patients assigned to fenofibrate than for patients assigned to placebo, with no difference between groups in risk of major amputations (24 vs 26 events; 0.93, 0.53-1.62; p=0.79). INTERPRETATION: Classic markers of macrovascular and microvascular risk were associated with lower extremity amputations in patients with type 2 diabetes. Treatment with fenofibrate was associated with a lower risk of amputations, particularly minor amputations without known large-vessel disease, probably through non-lipid mechanisms. These findings could lead to a change in standard treatment for the prevention of diabetes-related lower-limb amputations. FUNDING: Laboratoires Fournier SA (now part of Solvay Pharmaceuticals) and National Health and Medical Research Council of Australia