Use of Policy Risk Assessment Results in Political Decision Making

The RAPID project established, during the first period, a thematic network of risk assessment experts, including relevant partners in the ten countries involved, the "Risk assessor database". The project devoted a specific activity, a single work package, to the dissemination and discussion of the methodology developed during" first two years of the project. National workshops were planned in each country to facilitate integrated knowledge translation activity, using a participatory approach to increase potential knowledge-users awareness on the RAPID project, and to engage them in using the RAPID guidance. Workshops were conceived to present case studies and the RAPID guidance to a targeted audience, to discuss and collect further insights, and integrate different perspectives in the final version of the policy evaluation methodology. However, national workshops also actively contributed to develop evidence based methodological guidance and increase its quality and relevance for potential users by bridging know-do gap between researchers and stakeholders; by involving decision makers and potential users in the knowledge creation process; by facilitating diverse stakeholder participation from governmental, academic and private sectors, carefully identified by national RAPID surveys as having direct expertise in the field of risk assessment. The cultural and administrative differences existing in the countries involved in RAPID guarantee the inclusion of a wide range of perspectives. Results of the national workshops helped to identify barriers and solutions for using the guidance, for adapting necessary changes to it and for communicating results to other potential users.

Public Health, Policy Analysis, Risk Assessment,and Impact Assessment

Public health has been defined as "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals"(Winslow 1920) or as "the art of applying science in the context of politics so as to reduce inequalities in health while ensuring the best health for the greatest number"(WHO1998). As the challenges of public health have evolved, from sanitary surveillance and infectious diseases in the past, to chronic diseases, lifestyle factors,socioeconomic conditions, occupational and environmental health determinants,health reforms and others, so have the methods of assessment advanced by research technologies development. The new health threats and epidemics, such as AIDS, SARS (Severe Acute Respiratory Syndrome), influenza H5N1, or emergencies like natural disasters or bioterrorism, effects of globalization and migration present new tasks to public health governance requiring new working methods.

Віддалені результати хірургічного лікування синдрому аорто- мезентеріальної компресії

The aim of the work: to evaluate the remote results in the surgical treatment of the nutcracker syndrome. Materials and Methods. 146 patients with suspected nutcracker syndrome (pain in the left lumbar region, hematuria, left sided varicocele in men, and pudendal varicosity in women) underwent the examination from 1999 to 2019. The patients’ age ranged from 14 to 34 years. All patients underwent color Doppler ultrasonography to define the presence of pathological refluxes in the left renal and gonadal veins with the measurement of peak systolic velocity. According to color Doppler ultrasonography, different degree of aorta mesenteric compression was confirmed in 81 (55.4 %) patients, 11 patients with critical stenosis underwent the left renal vein reimplantation. Results and Discussion. Assessment of the effectiveness of the left renal vein reimplantation in the remote postoperative period (from 6 to 20 years): 8 patients underwent ultrasound control examination of the reconstruction site, restenosis was not detected in 4 patients, hemodynamically insignificant stenosis of the left renal vein (less than 50 %) without venous outflow impairment was noted in 4 patients. All of the examined patients indicated disappearance of the pain in the left lumbar region, disappearance of hematuria, recurrence of varicocele was not observed in all patients.Цель работы: исследовать отдаленные результаты операции реимплантации левой почечной вены. Материалы и методы. С 1999 по 2019 годы обследовано 146 пациентов в возрасте от 14 до 34 лет с подозрением на “синдром щелкунчика”. В исследование включены пациенты с явлениями гематурии, протеинурии, левостороннего варикоцеле, левостороннего пудендального варикоза и болью в левой половине живота неясной этиологии. Всем больным проводили ультразвуковую цветную допплерографию почек, почечных и гонадных вен. У 81 пациента по данным УЗИ диагностирована аорто-мезентериальная компрессия разной степени (55,4 %). 11-ти пациентам с критическим стенозом левой почечной вены проведена реимплантация левой почечной вены. Результаты исследований и их обсуждение. Отдаленные результаты изучены в сроки от 6 до 20 лет после операции. На осмотр явились 8 пациентов. Все обследованные пациенты указывали на исчезновение боли в левой половине живота, гематурии (только один пациент жаловался на рецедив гематурии, которая возникла через 5 лет после оперативного лечения), у всех пациентов отсуствие рецидива варикоцеле. При проведении УЗД-контроля места реконструкции у 4-х пациентов стеноза места реконструкции не обнаружено, у 4-х пациентов обнаружен некритический стеноз места реконструкции (до 50 %).Мета роботи: дослідити віддалені наслідки реімплантації лівої ниркової вени. Матеріали і методи. З 1999 по 2019 рр. обстежено 146 пацієнтів віком від 14 до 34 років з підозрою на “синдром лускунчика”. В дослідження увійшли пацієнти з явищами гематурії, протеїнурії, лівобічного варикоцеле, лівобічного пудендального варикозу та болем в лівій половині живота нез’ясованої етіології. Всім хворим проведено ультразвукову кольорову доплерографію нирок, ниркових та гонадних вен. У 81 пацієнта за даними УЗД діагностовано різний ступінь аорто-мезентеріальної компресії (55,4 %). 11-ти пацієнтам із критичним стенозом лівої ниркової вени проведено реімплантацію лівої ниркової вени. Результати досліджень та їх обговорення. Віддалені результати вивчені в строки від від 6 до 20 років після операції. На огляд зʼявились 8 пацієнтів. Всі опитані пацієнти вказували на зникнення болю в лівій половині живота, гематурії (лише один пацієнт вказував на рецидив гематурії, що з’явилась через 5 років після оперативного лікування), у всіх пацієнтів відсутній рецидив варикоцеле. При проведенні УЗД-контролю місця реконструкції у 4-х пацієнтів стенозу місця реконструкції не виявлено, у 4-х пацієнтів виявлено некритичний стеноз місця реконструкції (до 50 %)

Design of the Swiss Atrial Fibrillation Cohort Study (Swiss-AF): structural brain damage and cognitive decline among patients with atrial fibrillation.

Several studies found that patients with atrial fibrillation (AF) have an increased risk of cognitive decline and dementia over time. However, the magnitude of the problem, associated risk factors and underlying mechanisms remain unclear. This article describes the design and methodology of the Swiss Atrial Fibrillation (Swiss-AF) Cohort Study, a prospective multicentre national cohort study of 2400 patients across 13 sites in Switzerland. Eligible patients must have documented AF. Main exclusion criteria are the inability to provide informed consent and the presence of exclusively short episodes of reversible forms of AF. All patients undergo extensive phenotyping and genotyping, including repeated assessment of cognitive functions, quality of life, disability, electrocardiography and cerebral magnetic resonance imaging. We also collect information on health related costs, and we assemble a large biobank. Key clinical outcomes in Swiss-AF are death, stroke, systemic embolism, bleeding, hospitalisation for heart failure and myocardial infarction. Information on outcomes and updates on other characteristics are being collected during yearly follow-up visits. Up to 7 April 2017, we have enrolled 2133 patients into Swiss-AF. With the current recruitment rate of 15 to 20 patients per week, we expect that the target sample size of 2400 patients will be reached by summer 2017. Swiss-AF is a large national prospective cohort of patients with AF in Switzerland. This study will provide important new information on structural and functional brain damage in patients with AF and on other AF related complications, using a large variety of genetic, phenotypic and health economic parameters

The Role of Histone H4 Biotinylation in the Structure of Nucleosomes

Background: Post-translational modifications of histones play important roles in regulating nucleosome structure and gene transcription. It has been shown that biotinylation of histone H4 at lysine-12 in histone H4 (K12Bio-H4) is associated with repression of a number of genes. We hypothesized that biotinylation modifies the physical structure of nucleosomes, and that biotin-induced conformational changes contribute to gene silencing associated with histone biotinylation. Methodology/Principal Findings: To test this hypothesis we used atomic force microscopy to directly analyze structures of nucleosomes formed with biotin-modified and non-modified H4. The analysis of the AFM images revealed a 13% increase in the length of DNA wrapped around the histone core in nucleosomes with biotinylated H4. This statistically significant (p,0.001) difference between native and biotinylated nucleosomes corresponds to adding approximately 20 bp to the classical 147 bp length of nucleosomal DNA. Conclusions/Significance: The increase in nucleosomal DNA length is predicted to stabilize the association of DNA with histones and therefore to prevent nucleosomes from unwrapping. This provides a mechanistic explanation for the gene silencing associated with K12Bio-H4. The proposed single-molecule AFM approach will be instrumental for studying the effects of various epigenetic modifications of nucleosomes, in addition to biotinylation

Novel bleeding risk score for patients with atrial fibrillation on oral anticoagulants, including direct oral anticoagulants

Objective: Balancing bleeding risk and stroke risk in patients with atrial fibrillation (AF) is a common challenge. Though several bleeding risk scores exist, most have not included patients on direct oral anticoagulants (DOACs). We aimed at developing a novel bleeding risk score for patients with AF on oral anticoagulants (OAC) including both vitamin K antagonists (VKA) and DOACs. Methods: We included patients with AF on OACs from a prospective multicenter cohort study in Switzerland (SWISS-AF). The outcome was time to first bleeding. Bleeding events were defined as major or clinically relevant non-major bleeding. We used backward elimination to identify bleeding risk variables. We derived the score using a point score system based on the β-coefficients from the multivariable model. We used the Brier score for model calibration (<0.25 indicating good calibration), and Harrel's c-statistics for model discrimination. Results: We included 2147 patients with AF on OAC (72.5% male, mean age 73.4 ± 8.2 years), of whom 1209 (56.3%) took DOACs. After a follow-up of 4.4 years, a total of 255 (11.9%) bleeding events occurred. After backward elimination, age > 75 years, history of cancer, prior major hemorrhage, and arterial hypertension remained in the final prediction model. The Brier score was 0.23 (95% confidence interval [CI] 0.19–0.27), the c-statistic at 12 months was 0.71 (95% CI 0.63–0.80). Conclusion: In this prospective cohort study of AF patients and predominantly DOAC users, we successfully derived a bleeding risk prediction model with good calibration and discrimination

A systematic review of contamination (aerosol, splatter and droplet generation) associated with oral surgery and its relevance to COVID-19

IntroductionThe current COVID-19 pandemic caused by the SARS-CoV-2 virus has impacted the delivery of dental care globally and has led to re-evaluation of infection control standards. However, lack of clarity around what is known and unknown regarding droplet and aerosol generation in dentistry (including oral surgery and extractions), and their relative risk to patients and the dental team, necessitates a review of evidence relating to specific dental procedures. This review is part of a wider body of research exploring the evidence on bioaerosols in dentistry and involves detailed consideration of the risk of contamination in relation to oral surgery.MethodsA comprehensive search of Medline (OVID), Embase (OVID), Cochrane Central Register of Controlled Trials, Scopus, Web of Science, LILACS and ClinicalTrials.Gov was conducted using key terms and MeSH (Medical Subject Headings) words relating to the review questions. Methodological quality including sensitivity was assessed using a schema developed to measure quality aspects of studies using a traffic light system to allow inter- and intra-study overview and comparison. A narrative synthesis was conducted for assessment of the included studies and for the synthesis of results.ResultsEleven studies on oral surgery (including extractions) were included in the review. They explored microbiological (bacterial and fungal) and blood (visible and/or imperceptible) contamination at the person level (patients, operators and assistants) and/or at a wider environmental level, using settle plates, chemiluminescence reagents or air samplers; all within 1 m of the surgical site. Studies were of generally low to medium quality and highlighted an overall risk of contaminated aerosol, droplet and splatter generation during oral surgery procedures, most notably during removal of impacted teeth using rotatory handpieces. Risk of contamination and spread was increased by factors, including proximity to the operatory site, longer duration of treatment, higher procedural complexity, non-use of an extraoral evacuator and areas involving more frequent contact during treatment.ConclusionA risk of contamination (microbiological, visible and imperceptible blood) to patients, dental team members and the clinical environment is present during oral surgery procedures, including routine extractions. However, the extent of contamination has not been explored fully in relation to time and distance. Variability across studies with regards to the analysis methods used and outcome measures makes it difficult to draw robust conclusions. Further studies with improved methodologies, including higher test sensitivity and consideration of viruses, are required to validate these findings