Plan S for Shock

Plan S for shock: the open access initiative that changed the face of global research. This is the story of open access publishing – why it matters now, and for the future. In a world where information has never been so accessible, and answers are available at the touch of a fingertip, we are hungrier for the facts than ever before – something the Covid-19 crisis has brought to light. And yet, paywalls put in place by multi-billion dollar publishing houses are still preventing millions from accessing quality, scientific knowledge – and public trust in science is under threat. On 4 September 2018, a bold new initiative known as ‘Plan S’ was unveiled, kickstarting a world-wide shift in attitudes towards open access research. For the first time, funding agencies across continents joined forces to impose new rules on the publication of research, with the aim of one day making all research free and available to all. What followed was a debate of global proportions, as stakeholders asked: Who has the right to access publicly-funded research? Will it ever be possible to enforce change on a multi-billion dollar market dominated by five major players? Here, the scheme’s founder, Robert-Jan Smits, makes a compelling case for Open Access, and reveals for the first time how he set about turning his controversial plan into reality – as well as some of the challenges faced along the way. In telling his story, Smits argues that the Covid-19 crisis has exposed the traditional academic publishing system as unsustainable

Plan S has fundamentally re-shaped academic publishing: as we emerge from the pandemic it should not return to how it was before.

Taking stock of what Plan S – a funder led initiative to deliver widespread open access to research – has achieved since its conception and launch in 2018, Rachael Pells and Robert-Jan Smits discuss their new book “Plan S for Shock”. In making the case for Plan S and open access more broadly, they argue that crises, such as the Coronavirus pandemic, demonstrate the necessity of openness to addressing global challenges

Plan S has fundamentally re-shaped academic publishing. As we emerge from the pandemic it should not return to how it was before

Taking stock of what Plan S – a funder-led initiative to deliver widespread open access to research – has achieved since its conception and launch in 2018, Rachael Pells and Robert-Jan Smits discuss their new book, Plan S for Shock, available open access from Ubiquity Press. In making the case for Plan S and open access more broadly, they argue that crises, such as the COVID-19 pandemic, demonstrate the necessity of openness in addressing global challenges

Plan S for Shock

Plan S for shock: the open access initiative that changed the face of global research. This is the story of open access publishing – why it matters now, and for the future. In a world where information has never been so accessible, and answers are available at the touch of a fingertip, we are hungrier for the facts than ever before – something the Covid-19 crisis has brought to light. And yet, paywalls put in place by multi-billion dollar publishing houses are still preventing millions from accessing quality, scientific knowledge – and public trust in science is under threat. On 4 September 2018, a bold new initiative known as ‘Plan S’ was unveiled, kickstarting a world-wide shift in attitudes towards open access research. For the first time, funding agencies across continents joined forces to impose new rules on the publication of research, with the aim of one day making all research free and available to all. What followed was a debate of global proportions, as stakeholders asked: Who has the right to access publicly-funded research? Will it ever be possible to enforce change on a multi-billion dollar market dominated by five major players? Here, the scheme’s founder, Robert-Jan Smits, makes a compelling case for Open Access, and reveals for the first time how he set about turning his controversial plan into reality – as well as some of the challenges faced along the way. In telling his story, Smits argues that the Covid-19 crisis has exposed the traditional academic publishing system as unsustainable

Release of Major Peanut Allergens from Their Matrix under Various pH and Simulated Saliva Conditions—Ara h2 and Ara h6 Are Readily Bio-Accessible

The oral mucosa is the first immune tissue that encounters allergens upon ingestion of food. We hypothesized that the bio-accessibility of allergens at this stage may be a key determinant for sensitization. Light roasted peanut flour was suspended at various pH in buffers mimicking saliva. Protein concentrations and allergens profiles were determined in the supernatants. Peanut protein solubility was poor in the pH range between 3 and 6, while at a low pH (1.5) and at moderately high pHs (\u3e8), it increased. In the pH range of saliva, between 6.5 and 8.5, the allergens Ara h2 and Ara h6 were readily released, whereas Ara h1 and Ara h3 were poorly released. Increasing the pH from 6.5 to 8.5 slightly increased the release of Ara h1 and Ara h3, but the recovery remained low (approximately 20%) compared to that of Ara h2 and Ara h6 (approximately 100% and 65%, respectively). This remarkable difference in the extraction kinetics suggests that Ara h2 and Ara h6 are the first allergens an individual is exposed to upon ingestion of peanut-containing food. We conclude that the peanut allergens Ara h2 and Ara h6 are quickly bio-accessible in the mouth, potentially explaining their extraordinary allergenicity

Current discharge management of acute coronary syndromes: Data from the Rijnmond Collective Cardiology Research (CCR) study

Background Medical discharge management of acute coronary syndromes (ACS) remains suboptimal outside randomised trials and constitutes an essential quality benchmark for ACS. We sought to evaluate the rates of key guideline-recommended pharmacological agents after ACS and characteristics associated with optimal treatment at discharge. Methods The Rijnmond Collective Cardiology Research (CCR) registry is an ongoing prospective, observational study in the Netherlands that aims to enrol 4000 patients with ACS. We examined discharge and 1-month follow-up medication use among the first 1000 patients enrolled in the CCR registry. Logistic regression was performed to identify patient and hospital characteristics associated with collective guidelinerecommended pharmacotherapy at hospital discharge. Results At discharge, 94%of patients received aspirin, 100% thienopyridines, 80 % angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers, 87 % β-blockers, 96 % statins, and 65 % the combination of all 5 agents. STsegment elevation myocardial infarction, hypertension, hypercholesterolaemia, and enrolment in an interventional centre were positive independent predictors of 5-drug combination therapy at discharge. Negative independent predictors were unstable angina and advanced age. Conclusion Current data from the CCR registry reflect a high quality of care for ACS discharge management in the Rotterdam-Rijnmond region. However, potential still remains for further optimisation

Recommendations for the use of bioresorbable vascular scaffolds in percutaneous coronary interventions

Background To eliminate some of the potential late limitations of permanent metallic stents, the bioresorbable coronary stents or ‘bioresorbable vascular scaffolds’ (BVS) have been developed. Methods We reviewed all currently available clinical data on BVS implantation. Results Since the 2015 position statement on the appropriateness of BVS in percutaneous coronary interventions, several large randomised trials have been presented. These have demonstrated that achieving adequate 1 and 2 year outcomes with these first-generation BVS is not straightforward. These first adequately powered studies in non-complex lesions showed worse results if standard implan- tation techniques were used for these relatively thick scaffolds. Post-hoc analyses hypothesise that outcomes similar to current drug-eluting stents are still possible if aggressive lesion preparation, adequate sizing and high-pressure postdilatation are implemented rigorously. As long as this has not been confirmed in prospective studies the usage should be restricted to experienced centres with continuous outcome monitoring. For more complex lesions, results are even more disappointing and usage should be discouraged. When developed, newer generation scaffolds with thinner struts or faster resorption rates are expected to improve outcomes. In the meantime prolonged dual antiplatelet therapy (DAPT, beyond one year) is recommended in an individu-alised approach for patients treated with current generation BVS. Conclusion The new 2017 recommendations downgrade and limit the use of the current BVS to experienced centres within dedicated registries using the updated implantation protocol and advise the prolonged usage of DAPT. In line with these recommendations the manufacturer does not supply devices to the hospitals without such registries in place

Prevention of severe infectious complications after colorectal surgery using oral non-absorbable antimicrobial prophylaxis:results of a multicenter randomized placebo-controlled clinical trial

BACKGROUND: Surgical site infections (SSIs) are common complications after colorectal surgery. Oral non-absorbable antibiotic prophylaxis (OAP) can be administered preoperatively to reduce the risk of SSIs. Its efficacy without simultaneous mechanical cleaning is unknown. METHODS: The Precaution trial was a double-blind, placebo-controlled randomized clinical trial conducted in six Dutch hospitals. Adult patients who underwent elective colorectal surgery were randomized to receive either a three-day course of preoperative OAP with tobramycin and colistin or placebo. The primary composite endpoint was the incidence of deep SSI or mortality within 30 days after surgery. Secondary endpoints included both infectious and non-infectious complications at 30 days and six months after surgery. RESULTS: The study was prematurely ended due to the loss of clinical equipoise. At that time, 39 patients had been randomized to active OAP and 39 to placebo, which reflected 8.1% of the initially pursued sample size. Nine (11.5%) patients developed the primary outcome, of whom four had been randomized to OAP (4/39; 10.3%) and five to placebo (5/39; 12.8%). This corresponds to a risk ratio in the intention-to-treat analysis of 0.80 (95% confidence interval (CI) 0.23-2.78). In the per-protocol analysis, the relative risk was 0.64 (95% CI 0.12-3.46). CONCLUSIONS: Observational data emerging during the study provided new evidence for the effectiveness of OAP that changed both the clinical and medical ethical landscape for infection prevention in colorectal surgery. We therefore consider it unethical to continue randomizing patients to placebo. We recommend the implementation of OAP in clinical practice and continuing monitoring of infection rates and antibiotic susceptibilities. TRIAL REGISTRATION: The PreCaution trial is registered in the Netherlands Trial Register under NL5932 (previously: NTR6113) as well as in the EudraCT register under 2015-005736-17