653 research outputs found

    Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

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    Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

    Immunological profile of mice immunized with a polyvalent virosome-based influenza vaccine.

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    Background - Influenza A virus (IAV) causes respiratory disease in pigs and is a major concern for public health. Vaccination of pigs is the most successful measure to mitigate the impact of the disease in the herds. Influenza-based virosome is an effective immunomodulating carrier that replicates the natural antigen presentation pathway and has tolerability profile due to their purity and biocompatibility. Methods- This study aimed to develop a polyvalent virosome influenza vaccine containing the hemagglutinin and neuraminidase proteins derived from the swine IAVs (swIAVs) H1N1, H1N2 and H3N2 subtypes, and to investigate its effectiveness in mice as a potential vaccine for swine. Mice were immunized with two vaccine doses (1 and 15 days), intramuscularly and intranasally. At 21 days and eight months later after the second vaccine dose, mice were euthanized. The humoral and cellular immune responses in mice vaccinated intranasally or intramuscularly with a polyvalent influenza virosomal vaccine were investigated. Results- Only intramuscular vaccination induced high hemagglutination inhibition (HI) titers. Seroconversion and seroprotection (>?4-fold rise in HI antibody titers, reaching a titer of ??1:40) were achieved in 80% of mice (intramuscularly vaccinated group) at 21 days after booster immunization. Virus-neutralizing antibody titers against IAV were detected at 8 months after vaccination, indicating long-lasting immunity. Overall, mice immunized with the virosome displayed greater ability for B, effector-T and memory-T cells from the spleen to respond to H1N1, H1N2 and H3N2 antigens. Conclusions - All findings showed an efficient immune response against IAVs in mice vaccinated with a polyvalent virosome-based influenza vaccine

    Standardization of ELISA with senecavirus A recombinant VP2 protein and its use in swine herds in Brazil.

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    Abstract: Senecavirus A (SVA) is a nonenveloped, single-stranded RNA virusThe icosahedral viral particle is composed of four structural proteins: VP1, VP2, VP3 and VP4, among which VP2 is strongly involved in the antibody immune response. The virus causes vesicles on the snout and feet in pigs, which are clinically indistinguishable from other vesicular diseases such as foot-and-mouth disease. Outbreaks of SVA have been reported worldwide since 2014; however, its prevalence in Brazil remains unknown. In this study, the VP2 structural protein was produced and purified from E. coli, and recombinant VP2 (rVP2), based on the most recent Brazilian strain, was used to develop an indirect ELISA to identify antibodies against SVA in Brazilian swine herds. Sensitivity and specificity values of the rVP2 ELISA were determined using receiver operating characteristic analysis performed on 43 SVA positive and 219 negative serum samples. In addition, serum samples from pigs immunized with eight distinct Brazilian SVA inactivated strains were tested with the rVP2 ELISA. For the specificity of the assay, 17 serum samples from vesicular stomatitis virus (VSV) from naturally infected pigs were tested. The rVP2 ELISA was found to have 100% specificity and 74.4% sensitivity. The performance of the assay using samples collected during the SVA outbreak, had a sensitivity of 100%, and with those collected nine months after the outbreak it had a sensitivity of 73.4%. The rVP2 ELISA developed here was able to detect specific SVA antibodies in acute disease and recovered pigs, and no cross-reactivity with VSV was observed. This assay has potential as a useful tool for monitoring SVA infection and could help to improve disease diagnosis

    Towards optimal use of antithrombotic therapy of people with cancer at the end of life: a research protocol for the development and implementation of the SERENITY shared decision support tool Thrombosis Research

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    Background: Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs. Methods: The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe.Results: SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life. Conclusions: We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers

    Neural manifold analysis of brain circuit dynamics in health and disease

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    Recent developments in experimental neuroscience make it possible to simultaneously record the activity of thousands of neurons. However, the development of analysis approaches for such large-scale neural recordings have been slower than those applicable to single-cell experiments. One approach that has gained recent popularity is neural manifold learning. This approach takes advantage of the fact that often, even though neural datasets may be very high dimensional, the dynamics of neural activity tends to traverse a much lower-dimensional space. The topological structures formed by these low-dimensional neural subspaces are referred to as “neural manifolds”, and may potentially provide insight linking neural circuit dynamics with cognitive function and behavioral performance. In this paper we review a number of linear and non-linear approaches to neural manifold learning, including principal component analysis (PCA), multi-dimensional scaling (MDS), Isomap, locally linear embedding (LLE), Laplacian eigenmaps (LEM), t-SNE, and uniform manifold approximation and projection (UMAP). We outline these methods under a common mathematical nomenclature, and compare their advantages and disadvantages with respect to their use for neural data analysis. We apply them to a number of datasets from published literature, comparing the manifolds that result from their application to hippocampal place cells, motor cortical neurons during a reaching task, and prefrontal cortical neurons during a multi-behavior task. We find that in many circumstances linear algorithms produce similar results to non-linear methods, although in particular cases where the behavioral complexity is greater, non-linear methods tend to find lower-dimensional manifolds, at the possible expense of interpretability. We demonstrate that these methods are applicable to the study of neurological disorders through simulation of a mouse model of Alzheimer’s Disease, and speculate that neural manifold analysis may help us to understand the circuit-level consequences of molecular and cellular neuropathology

    Tools for a comprehensive assessment of public health risks associated with limited sanitation services provision

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    Three water, sanitation and hygiene (WASH) support tools were applied to Kampala city, Uganda, to evaluate areas with the highest health hazard due to poor wastewater and faecal sludge management and to develop interventions to improve sanitation and reduce exposure. The Pathogen Flow and Mapping Tool (PFMT) assessed how different sanitation management interventions influence pathogen emissions to surface water using rotavirus as the indicator pathogen, while the HyCRISTAL health hazard tool evaluated how flooding and drainage infrastructure influence the presence of human excreta in the environment. The SaniPath tool identified common high-risk pathways of exposure to faecal contamination in food, open drains and floodwater. An overlap in high health hazard hotspot areas was identified by the PFMT and the HyCRISTAL tools. Across the city, the most important hazard sources were the indiscriminate disposal of faecal waste into open stormwater drains from onsite sanitation technologies, open defecation and the insufficient treatment of wastewater. The SaniPath tool identified drain water, floodwater, street food and uncooked produce as the dominant faecal exposure pathways for selected parishes in the city, demonstrating the presence of excreta in the environment. Together, the tools provide collective evidence guiding household, community, and city-wide sanitation, hygiene and infrastructure management interventions from a richer assessment than when a single tool is applied. For areas with high spatial risks, those practising open defecation, and for low-lying areas, these interventions include the provision of watertight pit latrines or septic tanks that are safely managed and regularly emptied. Faecal sludge should be emptied before flood events, direct connections of latrines to open storm drains should be prevented, and the safe handling of food and water promoted. The tools enhance decision making for local authorities, and the assessments can be replicated in other cities

    Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

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    Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multi-disciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments

    Compatibilidade de estirpes locais de Bacillus sp. a fungicidas quĂ­micos aplicados no controle de oĂ­dio e mĂ­ldio da videira.

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    Este trabalho teve como objetivo determinar a compatibilidade de Bacillus haynesii LCB42, B. subtilis LCB28, B. amylolique-faciens LCB30, antagonistas selecionados contra Unicinula necator Schw. e Plasmopara vitĂ­cola Berl., a fungicidas utilizados no manejo do mĂ­ldio e oĂ­dio da videira (Vitis sp.)
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