Biosafety and biosecurity manual

ManualThe aim of this manual is to provide biosafety and biosecurity instructions for the staff and students of the Institute of Veterinary Medicine and Animal Sciences (VLI) of Estonian University of Life Sciences (EMÜ). Standard operating procedures gathered in this manual are applied only in VLI. The goals of these procedures include minimizing the risk of nosocomial infections and minimizing the exposure to zoonotic disease agents. New staff members and students will be notified about this manual by his/her immediate supervisor. After reading this manual the employee will give his/her signature as a sign of having acquainted with the manual and understanding the procedures needed in his/her special line of work and/or studies. For students, this will be done during the course ‘Introduction to veterinary studies’. On institute level the staff member who is responsible for biosafety and biosecurity is appointed by the director of the Institute

Bioohutuse ja bioturvalisuse juhend

JuhendJuhend on mõeldud Eesti Maaülikooli (EMÜ) veterinaarmeditsiini ja loomakasvatuse instituudi (VLI) töötajatele ja üliõpilastele bioohutuse ning bioturvalisuse tagamiseks. Juhendisse koondatud standardne töökord (STK) kehtib üksnes VLI-s. Standardse töökorra eesmärk on minimeerida haiglanakkuste riski ja kokkupuudet zoonootiliste mõjuritega. Uusi töötajaid ja üliõpilasi teavitab juhendist ning sellega tutvumise kohustusest nende vahetu töökorraldaja või juhendaja. Juhendiga tutvumise järel kinnitab töötaja/üliõpilane oma allkirjaga, et ta on teadlik STK-st, mis puudutab tööd/õpinguid tema valdkonnas/erialal. Üliõpilased tutvuvad STK-ga kursuse „Sissejuhatus loomaarstiõppesse“ raames. Instituudi tasandil määrab bioohutuse ja bioturvalisuse eest vastutava töötaja instituudi direktor

Prospective Risk Assessment of Medicine Shortages in Europe and Israel: Findings and Implications

Introduction: While medicine shortages are complex, their mitigation is more of a challenge. Prospective risk assessment as a means to mitigate possible shortages, has yet to be applied equally across healthcare settings. The aims of this study have been to: 1) gain insight into risk-prevention against possible medicine shortages among healthcare experts; 2) review existing strategies for minimizing patient-health risks through applied risk assessment; and 3) learn from experiences related to application in practice. Methodology: A semi-structured questionnaire focusing on medicine shortages was distributed electronically to members of the European Cooperation in Science and Technology (COST) Action 15105 (28 member countries) and to hospital pharmacists of the European Association of Hospital Pharmacists (EAHP) (including associated healthcare professionals). Their answers were subjected to both qualitative and quantitative analysis (Microsoft Office Excel 2010 and IBM SPSS Statistics®) with descriptive statistics based on the distribution of responses. Their proportional difference was tested by the chi-square test and Fisher's exact test for independence. Differences in the observed ordinal variables were tested by the Mann-Whitney or Kruskal-Wallis test. The qualitative data were tabulated and recombined with the quantitative data to observe, uncover and interpret meanings and patterns. Results: The participants (61.7%) are aware of the use of risk assessment procedures as a coping strategy for medicine shortages, and named the particular risk assessment procedure they are familiar with failure mode and effect analysis (FMEA) (26.4%), root cause analysis (RCA) (23.5%), the healthcare FMEA (HFMEA) (14.7%), and the hazard analysis and critical control point (HACCP) (14.7%). Only 29.4% report risk assessment as integrated into mitigation strategy protocols. Risk assessment is typically conducted within multidisciplinary teams (35.3%). Whereas 14.7% participants were aware of legislation stipulating risk assessment implementation in shortages, 88.2% claimed not to have reported their findings to their respective official institutions. 85.3% consider risk assessment a useful mitigation strategy. Conclusion: The study indicates a lack of systematically organized tools used to prospectively analyze clinical as well as operationalized risk stemming from medicine shortages in healthcare. There is also a lack of legal instruments and sufficient data confirming the necessity and usefulness of risk assessment in mitigating medicine shortages in Europe. © Copyright © 2020 Miljković, Godman, Kovačević, Polidori, Tzimis, Hoppe-Tichy, Saar, Antofie, Horvath, De Rijdt, Vida, Kkolou, Preece, Tubić, Peppard, Martinez, Yubero, Haddad, Rajinac, Zelić, Jenzer, Tartar, Gitler, Jeske, Davidescu, Beraud, Kuruc-Poje, Haag, Fischer, Sviestina, Ljubojević, Markestad, Vujić-Aleksić, Nežić, Crkvenčić, Linnolahti, Ašanin, Duborija-Kovačević, Bochenek, Huys and Miljković

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Quantifying the sensory and emotional perception of touch: differences between glabrous and hairy skin

The perception of touch is complex and there has been a lack of ways to describe the full tactile experience quantitatively. Guest et al. (2011) developed a Touch Perception Task (TPT) in order to capture such experiences, and here we used the TPT to examine differences in sensory and emotional aspects of touch at different skin sites. We compared touch on three skin sites: the hairy arm and cheek, and the glabrous palm. The hairy skin contains C-tactile (CT) afferents, which play a role in affective touch, whereas glabrous skin does not contain CT afferents and is involved in more discriminative touch. In healthy volunteers, three different materials (soft brush, sandpaper, fur) were stroked across these skin sites during self-touch or experimenter-applied touch. After each stimulus, participants rated the tactile experience using descriptors in the TPT. Sensory and emotional descriptors were analyzed using factor analyses. Five sensory factors were found: Texture, Pile, Moisture, Heat/Sharp and Cold/Slip, and three emotional factors: Positive Affect, Arousal, and Negative Affect. Significant differences were found in the use of descriptors in touch to hairy vs. glabrous skin: this was most evident in touch on forearm skin, which produced higher emotional content. The touch from another was also judged as more emotionally positive then self-touch, and participants readily discriminated between the materials on all factors. The TPT successfully probed sensory and emotional percepts of the touch experience, which aided in identifying skin where emotional touch was more pertinent. It also highlights the potentially important role for CTs in the affective processing of inter-personal touch, in combination with higher-order influences, such as through cultural belonging and previous experiences

Anthropometry, somatotypes, and aerobic power in ballet, contemporary dance, and dancesport

This study compared anthropometric variables, somatotypes, and aerobic capacity between three groups of dancers: classical ballet dancers (M 33, F 56), contemporary dancers (M 28, F 109), and dancesport dancers (M 30, F 30). The assumption was that different functional requirements should produce differences in the anthropometric and aerobic capacity variables among the three groups. Anthropometric data for body mass index (BMI) and somatotypes were measured. Body fat percentage was measured by dual-energy x-ray absorptiometry. Maximal oxygen consumption and aerobic power were measured during an incremental treadmill test until exhaustion. Dancesport athletes were taller compared with same gender contemporary dancers (p<0.05). Female ballet dancers had a lower body mass and BMI compared with their contemporary dance and dancesport equivalents (p<0.001). There was significant difference between dance styles in endomorphy (F2,221 = 8.773, p<0.001) and mesomorphy (F2,221 = 21.458, p<0.001) scores. Dancesport dancers had significantly greater VO2max values (p<0.01). It was concluded that female contemporary dancers are generally more muscular than their ballet counterparts, while dancesport dancers are taller and heavier, less muscular, with slightly greater adioposity compared to the classical ballet dancers. Ballet dancers had the lowest body fat percentage, weight, and BMI values. Dancesport dancers had greater aerobic capacity than the ballet dancers. Based on this study, we conclude that dancers in these three styles differ in some aspects of anthropometric variables, somatotypes, and aerobic capacity, but we cannot say is it because of the training or selection or both

Men have higher risk of kinesiophobia after anterior cruciate ligament reconstruction in long term follow up.

Background Psychological and physiological factors could negatively affect patients' recovery and increase re-injury rate after anterior cruciate ligament reconstruction (ACLR). In daily practice surgeons and physiotherapists see athletes struggling to improve muscle strength and complaining of lack of self-confidence during the progress of return to sport. The Tampa Scale for Kinesiophobia is a valid questionnaire to measure a patient's psychological status and isokinetic test is widely used to measure muscle recovery. Hypothesis Patients with kinesiophobia have inferior self reported and functional outcomes after ACLR. Methods 140 patients, 100 (71%) men and 40 (29%) women, mean age 32.5 (±8.3), were included in the study 5.5 (±1.25) years after ACLR. All patients were operated by two senior surgeons. Preoperative and postoperative assessments were performed by two sports specialized physical therapists. Patients completed the Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee score and Tampa Scale of Kinesiophobia (TSK-17). Quadriceps and hamstring muscle isokinetic strength was assessed at 60°/sec and 180°/sec using the HumacNorm dynamometer. Functional performance was tested with the single-leg-hop test for distance and the Y-balance test for anterior reach. Variables of the study were described by means and standard deviations. Shapiro-Wilk test was conducted to test for normality of the variables and unpaired t-tests were used to test for differences between subgroups. After tests were conducted, simple Bonferroni adjustment was applied to account for the number of tests made. Results 68/140 patients (48.6%) reported a Tampa kinesiophobia score equal or higher than 37 points, above which is the cut off score for kinesiophobia. Patients with kinesiophobia had statistically significant lower scores in the KOOS Symptoms (p=0.001) and Quality of Life subscores (p=0.001), Total score (p=0.001) and the Oxford Knee Score (p=0.024). Isokinetic peak torque muscle strength mean deficits at 60°/sec and 180°/sec for knee flexion and extension were between 6% and 7% for patients with kinesiophobia and between 2% to 4% for patients without kinesiophobia compared with the contralateral side, with no significant differences between groups. There was no statistically significant difference in the Single-leg-hop test for distance leg ratio (0.98 (±0.19) and 1.00 (±0.26)) and the Y-balance test for anterior reach leg ratio (0.99 (±0.08) and 1.01 (±0.07)) respectively between the groups. Conclusion At 5 years after ACLR operated leg functional performance is equal to nonoperated leg. However kinesiophobia is present in nearly half of patients. Strength and functional tests alone are not good enough instruments for assessing complete recovery, on the other hand self-reported questionnaires have high correlation to kinesiophobia after ALCR. Further studies are needed to avoid development of kinesiophobia as well how to recognize phobia at early stages of rehabilitation